"五习惯"医患沟通评价量表的构建及信效度研究

背景 医患沟通障碍是导致医疗纠纷发生的主要原因之一。目前，我国对医务人员医患沟通能力的评价研究较少，缺乏信效度良好的评估工具。 目的 构建"五习惯"医患沟通评价量表（5HCS），检验其信度和效度。 方法 2014年3月，采用Brislin翻译法在"四习惯"医患沟通评价体系（4HCS）的基础上，形成5HCS初稿；2014年4—6月，采用德尔菲法，使用问卷分两轮征求专家意见，根据专家意见修订条目后形成5HCS定稿；2018年3月，使用新构建的5HCS对127名住院医师的医患沟通能力进行评估，通过分析其评价数据，检验量表的内部一致性、评价者间信度、内容效度和标准关联效度。 结果 正式版5HCS包含5个维度（"尊重示善，融洽关系""采集信息，引导观点""表达共情，建立信任""风险告知，知情同意""提供诊断，协商决策"），21个条目。量表的Cronbach's α系数为0.716，各维度与量表总分的r值为0.524~0.692，各条目的内容效度指数（I-CVI）≥0.81，量表总分的评价者间信度r值为0.912，组内相关系数（ICC）=0.912，标准关联效度以中文版医患沟通技能评价量表（SEGUE）为标准，两个量表总分之间的r值为0.377（P<0.01）。 结论 5HCS具有良好的信度和效度，可将其作为我国住院医师医患沟通能力测评工具加以推广应用。     

戴天章《广瘟疫论》温病辨治特色

戴天章是清代著名的温病学家,精通医理,尤擅瘟疫的诊治,推动了瘟病辨治理论的发展。现基于戴天章《广瘟疫论》,从首创瘟疫五辨、力辨寒瘟异同,创瘟疫五种治法,完善外感病腹诊法3个方面进行深入探讨,系统总结其瘟疫辨治经验及学术思想,这些内容不仅丰富了温病学理论,亦对现代温病的临床辨治具有重要指导价值。     

Prospective feasibility study of a mindfulness-based program for breast cancer patients in the southeastern US

BackgroundMindfulness interventions can improve psychological distress and quality of life (QoL) in cancer survivors. Few mindfulness programs for cancer recovery exist in Southeastern U.S. The primary objective of this study was to assess the feasibility of a modified mindfulness-based stress reduction (MBSR) program for breast cancer patients in Birmingham, Alabama. The secondary objective was to explore potential program effects on mindfulness skills and QoL.MethodsThis study was a prospective, quasi-experimental feasibility study conducted over 10 months at a university hospital. Feasibility was achieved if 80% of eligible patients screened enrolled in the study and 70% of enrolled patients attended all 8 program sessions. Effectiveness was estimated by changes in mindfulness and QoL indicators measured with validated scales administered at 3 time points and assessed with a non-parametric Friedman test. Sessions included meditation, yoga, and an attention practice called body scan. There were 3 groups of 2–5 patients.ResultsThe sample totaled 12 patients. Forty-four percent (12/27) of eligible patients enrolled in the study, and two out of 12 enrolled patients completed 8 program sessions, resulting in 16.7% (2/12) retention. However, more than half (66.7%) of participants completed at least 7 sessions. Between baseline and 8-week follow-up, patients demonstrated statistically significant improvements in distress, general wellbeing, and fatigue-related QoL.ConclusionsFeasibility objectives were not achieved. However, a majority of participants (66.7%) completed 7 of 8 program sessions. Program effects were promising for distress, fatigue, and wellbeing. Results warrant further research on MBSR-like programs for breast cancer patients in Alabama.     

从五脏辨证施针论治颈椎病

颈椎病是常见病、多发病,临床治疗多从心肾施针,然笔者通过查阅文献,结合多年临床经验,认为其与五脏皆有关,故从心、肝、脾、肺、肾五脏进行辨证施针论治,取得了较好的治疗效果。现将其总结归纳如下,供广大学者参考。     

Is repeat head CT necessary in patients with mild traumatic intracranial hemorrhage

BackgroundPatients with traumatic intracranial hemorrhage (TIH) frequently receive repeat head CT scans (RHCT) to assess for progression of TIH. The utility of this practice has been brought into question, with some studies suggesting that in the absence of progressive neurologic symptoms, the RHCT does not lead to clinical interventions.MethodsThis was a retrospective review of consecutive patients with CT-documented TIH and GCS ≥ 13 presenting to an academic emergency department from 2009 to 2013. Demographic, historical, and physical exam variables, number of CT scans during admission were collected with primary outcomes of: neurological decline, worsening findings on repeat CT scan, and the need for neurosurgical intervention.ResultsOf these 1126 patients with mild traumatic intracranial hemorrhage, 975 had RHCT. Of these, 54 (5.5% (4.2–7.2 95 CI) had neurological decline, 73 (7.5% 5.9–9.3 95 CI) had hemorrhage progression on repeat CT scan, and 58 (5.9% 4.5–7.6 95 CI) required neurosurgical intervention. Only 3 patients (0.3% 0.1–0.9% 95 CI) underwent neurosurgical intervention due to hemorrhage progression on repeat CT scan without neurological decline. In this scenario, the number of RHCT scans needed to be performed to identify this one patient is 305.ConclusionsRHCT after initial findings of TIH and GCS ≥ 13 leading to a change to operative management in the absence of neurologic progression is a rare event. A protocol that includes selective RHCT including larger subdural hematomas or patients with coagulopathy (vitamin K inhibitors and anti-platelet agents) may be a topic for further study.     

慢性乙型肝炎患者病毒复制与肝纤维化五项联合检测的临床应用

目的探讨慢性乙型肝炎患者乙型肝炎病毒(HBV)DNA复制与肝纤维化五项指标:透明质酸(HA)、Ⅲ型前胶原N端肽(PⅢPN)、Ⅳ型胶原(CⅣ)、层粘连蛋白(LN)、甘胆酸(CG)联合检测的临床意义。方法选取2018年7月至2019年9月在汉川市人民医院确诊的慢性乙型肝炎患者109例为研究对象,选取40例健康体检者为对照组,按HBV DNA的载量,将研究对象分为低载量组(104copy/mL)39例,中载量组[(104～106)copy/mL]33例,高载量组(106copy/mL)37例,对照组(500 copy/mL)40例。分别检测HBV DNA和肝纤维化五项,采用SPSS 19.0统计学软件对数据进行统计分析。结果低载量组和中载量组肝纤五项检测结果与对照组比较,差异无统计学意义(P0.05);高载量组肝纤五项检测结果与对照组比较,差异有统计学意义(P0.05)。随着HBV DNA载量的增加,肝纤五项各检测指标的数值也在增加。肝纤五项(HA、PⅢPN、CⅣ、LN、CG)的ROC曲线下面积(AUC)分别为0.556、0.763、0.742、0.420、0.695,其中PⅢPN的AUC最大,表明PⅢPN比其他指标对肝脏疾病的诊断准确率最高;LN的AUC最小,0.5,表明其单独诊断的准确率低。结论 HBV DNA载量与血清肝纤维化五项指标联合检测是慢性乙型肝炎患者病情监测的一个良好指标,临床应及时关注慢性乙型肝炎患者病毒复制与肝纤维化水平,延缓肝硬化的发生。     

胸腺五肽联合化疗治疗糖尿病合并结核性胸膜炎临床疗效观察

目的 探讨胸腺五肽联合化疗治疗糖尿病合并结核性胸膜炎的临床疗效.方法 将临床确诊的糖尿病合并结核性胸膜炎70例患者随机分为治疗组(n=35)和对照组(n=35);对照组给予常规抗结核药物、调整血糖和胸腔穿刺抽液治疗.治疗组在上述常规治疗的基础上加用胸腺五肽注射液治疗.疗程均为30 d.比较两组间治疗后空腹血糖、体温恢复正常时间、胸水吸收时间、胸痛缓解时间.结果 治疗组治疗后空腹血糖、胸水吸收时间均优于对照组,两组比较,差异有统计学意义(P<0.01);两组间在体温恢复时间、胸痛缓解时间比较,差异无统计学意义(P>0.05).结论 胸腺五肽联合化疗治疗糖尿病合并结核性胸膜炎可促进空腹血糖控制、促进胸水吸收,疗效显著,且无不良反应.     

“五位一体”的健康教育模式在PICC置管患者中的应用

目的 探讨“五位一体”的健康教育模式在PICC置管患者中的应用效果.方法 将772例需进行PICC置管的化疗患者随机分为实验组和对照组,各386例.对照组实施常规PICC护理,实验组在此基础上实施“五位一体”的健康教育模式.比较两组患者的并发症发生率、非计划拔管率、导管留置时间及患者的满意度.结果 实验组患者的并发症发生率及非计划拔管率依次为6.99％、1.30％,低于对照组的35.5％、11.92％(P＜0.05)；实验组的导管留置时间为(139.74±20.56)d,对照组为(116.95±30.21)d,两组比较有统计学意义(P＜0.01)；实验组患者的满意度高于对照组(P＜0.05).结论 系统完善的健康教育模式能减少PICC带管期间的并发症发生率,提高患者满意度.     

黄芪桂枝五物汤联合祛腐生肌膏对肛肠病术后创面的影响

目的:观察黄芪桂枝五物汤联合祛腐生肌膏对肛肠病术后创面的影响。方法:选取本院180例肛肠病术后患者为研究对象,随机分为对照组和观察组各90例,对照组患者术后应用祛腐生肌膏外敷治疗,观察组在对照组治疗的基础上联合黄芪桂枝五物汤治疗。比较两组患者临床疗效。结果:观察组患者的创面愈合情况优于对照组,观察组患者并发症发生情况少于对照组,差异具有统计学意义(P0.05)。观察组患者炎症指标优于对照组,差异具统计学意义(P0.05)。结论:应用祛腐生肌膏联合黄芪桂枝五物汤可明显促进肛肠术后患者创面愈合,降低并发症发生率,效果显著。     

2005年湖区五省急性血吸虫病疫情分析

目的描述和分析2005年湖区五省急性血吸虫病和突发疫情的分布、特点和流行趋势。方法根据急性血吸虫病周报告、零报告,用描述流行病学方法对急感周报、网络直报数据和突发疫情报表数据资料进行分析。结果2005年湖区五省共报告急性血吸虫病人515例,其中确诊病例411例,临床诊断病例104例;湖区五省共报告急性血吸虫病突发疫情5起,病例42例。2005年湖区5省急感病例以散发为主,突发疫情分布较为集中,急感病人多为农民和中小学生,主要感染方式为生产生活和嬉戏接触疫水。结论长江流域的江洲湖滩地区是感染急性血吸虫病、特别是突发疫情的重点地区;应重点加强血吸虫病的监测工作。