Defining mild,moderate, and severe pain in young people with physical disabilities

Purpose: The purpose of this study is to identify the cutoffs that are most suitable for classifying average and worst pain intensity as being mild, moderate, or severe in young people with physical disabilities.

Method: Survey study using a convenience sample of 113 young people (mean age?=?14.19; SD?=?2.9; age range: 8–20) with physical disabilities (namely, spinal cord injury, cerebral palsy, spina bifida, limb deficiency (acquired or congenital), or neuromuscular disease).

Results: The findings support a non-linear association between pain intensity and pain interference. In addition, the optimal cutoffs for classifying average and worst pain as mild, moderate, or severe differed. For average pain, the best cutoffs were the following: 0–3 for mild, 4–6 for moderate, and 7–10 for severe pain, whereas the optimal classification for worst pain was 0–4 for mild, 5–6 for moderate, and 7–10 for severe pain.

Conclusions: The findings provide important information that may be used to help make decisions regarding pain treatment in young people with disabilities and also highlight the need to use different cutoffs for classifying pain intensity in young people with disabilities than those that have been suggested for adults with chronic pain.

• Implications for rehabilitation

• Most clinical guidelines make treatment recommendations based on classifications of pain intensity as being mild, moderate, and severe that do not have a clear cut association with pain intensity ratings.

• Cutoffs that are deemed to be the most appropriate for classifying pain intensity as mild, moderate, and severe appear to depend, at least in part, on the pain population that is being studied and pain domain that is being used.

• This work helps to advance our knowledge regarding the meaning of pain intensity ratings in young people with physical disabilities.

• Clinicians can use this information to make empirically guided decisions regarding when to intervene in young people with disabilities and chronic pain.

     

兰州市城关区残疾人照顾质量及其影响因素

目的 探讨兰州市城关区残疾人照顾质量现状及其影响因素。 方法 2016年8月至11月,多阶段分层整群抽样法抽取兰州市城关区登记在册的残疾人606例,采用世界卫生组织残疾人照顾质量量表进行入户调查。 结果 城关区残疾人照顾质量总分(50.33±11.25)。照顾的获得、照顾的给予、照顾的可及性和照顾的环境评分占各维度满分的59.5%、62.0%、63.9%和72.6%。多元线性回归分析显示,残疾程度、残疾影响程度和收入水平是残疾照顾总分的独立影响因素(P < 0.05)。不同人口学特征和残疾严重程度残疾人,照顾质量各维度评分有显著性差异。 结论 兰州市城关区残疾人照顾质量有待改善。应采取有针对性的措施提升残疾人照顾质量。     

居家失能老人照顾者照护知识调查分析

目的：了解上海市天平街道居家失能老人居家照顾者呼吸道感染预防护理知识知晓情况。方法：向本街道80位居家失能老人的家庭照顾者和21位社区为老服务志愿者发放问卷调查表。结果：家庭照顾者照护知识及技能普遍较低,无法满足居家失能老人的护理需要。结论：提高照顾者照护技能,是发展养老事业的必要条件。     

深圳市中青年急诊患者就诊因素分析

通过与患者或其家属面谈，了解中青年急诊患者的就诊因素。每一种疾病的发生都与年龄、性别、文化程度、职业、生活现状有关。青年以自发性行为导致就医和意外为主，中年以生理疾患，如胸闷、脑溢血、心肌梗死等为主。通过对就诊因素分析，了解影响患者身心健康及引起疾病的社会问题，并提出建议。     

Factors associated with nurses' willingness to handle abuse of older people

AimThe aim of this study was to explore predictors of nurses' willingness to handle abuse of older people.BackgroundAbuse of older people is a long-discussed healthcare issue worldwide. Although nurses are considered capable of identifying and reporting cases of abuse of older people, no study has been conducted in Taiwan on nurses' willingness to handle abuse of older people.DesignA cross-sectional design was used.MethodsThe study was conducted from May to June 2019. A convenience sampling was adopted to survey 555 nurses from a medical center in Taiwan. Data were collected using the Knowledge of Abuse of Older People Scale, Attitudes Towards Older People Scale, Attitudes Towards Handling Abuse of Older People Scale, Willingness to Handle Abuse of Older People Scale, and personal characteristics. Pearson correlation coefficient analysis, independent sample t-test, one-way analysis of variance, and multiple linear regression were performed.ResultsParticipants scored an average of 2.98 out of 4 on the Willingness to Handle Abuse of Older People Scale, indicating that they were inclined to do so. Attitudes towards older people, knowledge, attitudes towards handling abuse of older people, awareness of the hospital's reporting procedure and dissemination of information related to abuse of older people, sex, age, and clinical work experience explained 41.4% of the variance of willingness. Participants' attitudes toward handling abuse of older people was the most important predictor of their willingness to do so.ConclusionsTo improve nurses’ willingness to handle cases of abuse of older people, particularly that of male nurses, hospital authorities should provide in-service training and education and disseminate information on the subject matter. Nursing schools should prioritize offering gerontological nursing courses to foster nursing students’ positive attitudes toward older adults and handling abuse of older people.Tweetable abstractNurses' attitudes toward handling abuse of older people were the most important predictor of their willingness to handle abuse of older people.     

肢体残疾人自我效能感、照顾质量与生活质量的关系

目的 探讨肢体残疾人自我效能感、照顾质量和生活质量的现状及三者间关系。方法 2019年1月至2020年12月,整群分层随机抽样选取山东省357例肢体残疾人,采用一般资料调查表、世界卫生组织残疾人生活质量量表、自我效能感量表、世界卫生组织残疾人照顾质量量表进行网络问卷调查。结果 共回收调查问卷357份,其中有效问卷350份。肢体残疾人的生活质量为(115.00±20.70)分,自我效能感(23.33±5.78)分,照顾质量(50.43±10.56)分。肢体残疾人的生活质量及其各领域均与自我效能感呈正相关(r> 0.282, P <0.01),与照顾质量、照顾信息的获得、照顾的给予和照顾的环境维度呈正相关(r> 0.369,P <0.01)。就业情况、自我效能感和照顾质量总分是肢体残疾人生活质量的影响因素(t> 4.386, P <0.001);就业情况、自我效能感、照顾的给予和照顾的环境是生活质量生理领域、心理领域和环境领域的影响因素(t> 2.926, P <0.01);主要照顾者为父母、就业情况、自我效能感、照顾的给予和照顾的环境是生活...     

Pulmonary Embolism: Epidemiology,Patient Presentation,Diagnosis, and Treatment

Pulmonary embolism is a significant health concern, affecting mainly the adult and elderly population. The focus of this review article will be on the epidemiology, presentation, treatment, and outcomes of PE arising from deep venous thrombosis.     

Dementia, dignity and quality of life: nursing practice and its dilemmas

manthorpe j., iliffe s., samsi k., cole l., goodman c., drennan v. & warner j. (2010) Dementia, dignity and quality of life: nursing practice and its dilemmas. International Journal of Older People Nursing 5 , 235–244
doi: 10.1111/j.1748-3743.2010.00231.x Aims. The need for healthcare practitioners to respect the dignity of older people is widely recognised in England, where it has been given attention by politicians, professionals and health service regulators. This article aims to provide examples of how such ambitions may be used in practice development. Methods. This article reports the use of five vignettes discussed by dementia care practitioners that explored the areas of dementia diagnosis, lying, incontinence, behavioural and psychological distress, and end of life care. Findings. Each vignette promoted discussion of differences of perspectives about the ways to enhance the dignity of people with dementia in hospital, care home and community settings. The discussion confirmed that while dignity may be one quality indicator of good care potentially enhancing quality of life, it is not always straightforward. It may be more easily conceptualised when talking of physical care and treatment than other areas. Conclusion. The opportunity to debate the subject and to discuss practice examples revealed differences of opinion and moral perspectives between practitioners about the use and relevance of the term dignity. These need to be acknowledged in any debates about objective and subjective definitions of quality of life.     

Experiences and Perceptions Toward Integrative,Complementary, and Alternative Medicine Among Conventional Medicine Practitioners of Mangalore,India

ObjectivesThe purpose of this study was to identify experiences and perception of conventional (Western, allopathic) medical practitioners toward integrative, complementary, and alternative medicine (ICAM).MethodsThere are approximately 1200 conventional medical doctors in Mangalore, India. In February 2017, semistructured self-administered questionnaires were distributed to 200 medical practitioners. The association between categorical variables was analyzed using a χ² test and those involving continuous variables using unpaired t test, analysis of variance, and Karl Pearson’s coefficient of correlation. A P value ≤ .05 was considered statistically significant.ResultsOf the surveys, 163 were returned and 129 were satisfactorily completed, giving a response rate of 64.5%. Mean age was 39.9 ± 11.9 years, and most 94 (72.9%) were male. A majority, 96 (74.4%), recommended ICAM to their patients. Nine had some training in ICAM modalities, and 76 (58.9%) participants reported personal usage of ICAM. Regarding perception toward effectiveness of ICAM, 33 (25.6%) felt that it was effective or somewhat effective. However, 82 (63.6%) participants felt that lack of sufficient scientific evidence was a major drawback of ICAM. However, 39 (30.2%) participants felt that ICAM should be part of Bachelor of Medicine and Bachelor of Surgery curricula. Favorable perception toward ICAM (P < .001) and personal usage of ICAM (P < .001) was associated with participants recommending any ICAM for their patients. Elderly practitioners (aged above 65 years) (P = .003) and practitioners with favorable perception regarding effectiveness of ICAM (P = .033) recommended a higher number of types of ICAM to their patients. Favorable perception toward effectiveness of ICAM was associated with favorable perception toward inclusion of ICAM in medical curriculum among participants (P = .002).ConclusionMost participants recommended ICAM to their patients and also reported personal usage of the same.     

脂质蓄积指数在中老年人群代谢综合征筛查中的价值

目的 探讨脂质蓄积指数（lipid accumulation product, LAP）在中老年人群代谢综合征（metabolic syndrome, MS）筛查中的价值。方法 依托2011年中华医学会发起的REACTION研究,选取2011年7-12月大连地区40岁以上健康体检的社区居民。男、女受试者以LAP四分位分为q1、q2、q3、q4组及Q1、Q2、Q3、Q4组,比较各组间MS现患率是否存在差异。应用受试者工作特征曲线（receiver operating curve, ROC）分析确定大连地区男性及女性MS筛查的最佳LAP切点。结果 ①男女受试者中MS分别为825及1 834例,现患率为30.02%及25.12%,LAP四分位组q1、q2、q3及q4组的MS现患率分别为5.1%,14.8%,30.3%和69.9%,Q1、Q2、Q3及Q4的MS的现患率分别为2.4%,8.6%,25.5%和64.0%,各组间差异均有统计学意义（P<0.001）。②Spearman相关分析显示在男性受试者中,LAP与舒张压（diastolic blood pressure, DBP）（rs=0.145）、收缩压（systolic blood pressure, SBP）（rs=0.102）、甘油三酯（triglycerides, TG）（rs=0.931）、空腹血糖（fasting plasma glucose, FPG）（rs=0.169）、餐后两小时血糖（rs=0.155）、体重指数（body mass index, BMI）（rs=0.395）呈正相关,与高密度脂蛋白胆固醇（high density lipoprotein cholesterol, HDL C）（rs=-0.299）负相关。在女性受试者中,LAP与DBP（rs=0.196）、SBP（rs=0.248）、TG（rs=0.908）、FPG（rs=0.269）、餐后两小时血糖（rs=0.299）、BMI（rs=0.427）呈正相关,与HDL C（rs=-0.376）负相关,P值均<0.01。③ROC曲线分析显示：男性受试者中,LAP、BMI、腰围诊断MS的曲线下面积分别为：0.830、0.769及0.701。女性受试者中,LAP、BMI、腰围诊断MS的曲线下面积分别为0.860、0.791及0.718。男性中,LAP=47.45为诊断MS的最佳切点,灵敏度0.743,特异度0.793。女性中,LAP=48.08为诊断MS的最佳切点,灵敏度0.803,特异度0.762。结论 LAP可以作为大连地区中老年人群MS筛查的可靠指标。     

GVHD after transfusion of stored RBC concentrates in a solution of mannitol, adenine, phosphate, citrate, glucose, and NaCl following trauma

BACKGROUND: It has not previously been reported that WBC-reduced RBC preparations can cause transfusion-associated GVHD, even in an immunocompetent individual. CASE REPORT: A 74-year-old man suffered a hemorrhage from the mesentery of the transverse colon after a traffic accident. During surgery, he received 10 units of RBCs from 10 donors in a solution containing mannitol, adenine, phosphate, citrate, glucose and NaCl (MAP). MAP RBCs had been stored for 7 to 8 days before use. On the 27th day after surgery, an erythematous, pruritic rash appeared over the face, neck, and trunk, which was associated with low-grade fever and pancytopenia. Transfusion-associated GVHD was strongly suspected and was confirmed by skin biopsy. To determine the origin of lymphocytes causing GVHD, several microsatellite loci were amplified from DNA of the patient's nails and blood and from blood samples of all 10 RBC donors by using PCR. Amplified alleles derived from the patient's blood were identical to those from one of the 10 samples. CONCLUSION: These findings indicate that transfusions of MAP-RBCs can cause transfusion-associated GVHD in an elderly but immunocompetent host.     

桂西地区中老年人骨密度调查分析

目的：探讨桂西地区中老年人骨密度（BMD及骨质疏松（OP）的变化规律。方法：采用单光子吸收仪（SPA）测定桂西地区415例中老年人的骨密度，同时用化学发光仪测定女性血雌二醇（E2）和男性血睾酮（T）浓度。结果：随着年龄增加BMD、T、E2逐渐下降。同龄男性BMD大于女性。OP随着年龄增加而逐渐上升，女性更为明显。女性50岁以后OP的发病率为51．78％，男性发病率为36．13％。结论：桂西地区50岁左右女性和男性应预防骨质疏松的发生。     

剪切波弹性成像在健康人群眼外肌中的初步研究

探讨剪切波弹性成像(shear wave elasticgraphy,SWE)在健康人群眼外肌中的应用价值,并初步建立健康人群眼外肌弹性值的参考范围。     

青年急性脑梗死的MRA特点及其临床价值

目的分析青年急性脑梗死的磁共振血管成像(magnetic resonance angiography,MRA)表现特点,探讨其临床价值。材料与方法回顾性对比分析149例青年急性脑梗死及187例中老年急性脑梗死的MRA表现。结果青年脑梗死MRA表现正常率高于中老年组,局限性靶血管异常高于中老年组,动脉硬化性靶血管异常低于中老年组,靶血管阳性患者预后好于中老年组(P0.05)。结论青年脑梗死与中老年脑梗死的MRA表现差异性很大,应及时分析病因及危险因素,采取不同的措施做好治疗及防范。     

Involvement of older people in care, service and policy planning

In line with other helping professions nursing has moved from traditional views of technical expertise as the prime shaper of health care, to a more equal relationship with service users and patients which respects their expertise, knowledge, goals and choices. This philosophy has underpinned the movement to involve older people in care, policy and planning activities. The literature review presented in this paper highlights the growing literature on this subject with respect to older people and maps the key issues and debates for nursing.