英国临终关怀机构基本服务理念的启示

以英国小型独立临终关怀院——圣米歇尔临终关怀院(Saint Michael's Hospice)为例,介绍英国临终关怀院的高质量死亡、护理优先、支持生者、全民参与等服务理念,提出了应培育医务人员与民众科学理性死亡观、将临终关怀纳入基本公共卫生服务项目、建立以护理为核心的临终关怀服务模式、探索建立小型独立临终关怀机构等适合中国国情的临终关怀发展道路。     

老龄化背景下社区老年人群对临终关怀的需求及对策研究

随着社会发展及人口老龄化,我国临终关怀服务的发展正在由传统的综合性医院内附设临终关怀病房向社区居家照料的临终关怀服务过渡,并呈多元化发展.文章分析社区临终关怀服务的发展现状,并提出我国临终关怀服务发展中存在的问题及相关对策研究,以推进我国临终关怀事业的发展.     

中国临终关怀现存问题及对策

目的:中国的临终关怀的发展和别的国家相比仍存在巨大的差距,本研究旨在调查中国临终关怀现存问题并提出对策。方法:本研究采用文献查找的方法,比较分析了解国内临终关怀服务的发展现状。结果:中国临终关怀现存问题主要有三个,死亡教育和临终关怀教育发展落后、缺少政府的支持以及缺乏临终关怀专家。     

临终关怀在我国存在的问题和对策

我国已经进入了人口老龄化的阶段,临终关怀护理不仅有利于解决老年人在临终阶段的生活照料问题还能缓解老年人面临疾病、死亡的心理痛苦问题,因此,我国应该加大力度发展临终关怀护理服务。本文针对临终关怀在我国存在问题的基础上,提出了相应对策。     

看美国如何临终关怀

<正>美国临终关怀事业发展了40多年,2011年,美国接受临终关怀的患者占总死亡人数的42.1%。美国很大比例的危重症患者都选择了接受临终关怀服务。接受临终关怀服务的患者人数也在持续增加。从1974年首个项目开放起,临终关怀项目的数量在美国大幅增加,2013年已有大约5800个项目运行。这些项目遍布美国的各个区域。无论是从患者中的推广程度还是提供服务者的数量来说,美国临终关怀产业已     

临终关怀纳入社会保障制度安排的多维思考——以湖北省为例

把临终关怀事业纳入社会保障制度安排进行讨论,是基于人类生命终结的普适与不可回避性考虑,基于湖北省人口老龄化发展规模与速度所带来的赡养压力和临终老人对于社会医疗、养老保障需求的变化.加入政府的制度安排与政策导引、完善临终关怀服务体系、构建临终关怀服务供给模式和发展临终关怀专业化教育等,是发展临终关怀事业的基本策略.     

长沙市三级医院急诊科护士对待死亡的态度与临终关怀态度的相关性研究

目的调查长沙市急诊科护士对临终关怀的态度以及死亡态度现状,探索死亡态度与临终关怀态度的相关性。方法 2018年6—8月,采用数字表法随机抽取长沙市三级医院急诊科护士365名进行问卷调查,并对结果进行统计分析。结果急诊科护士临终关怀态度量表平均分为95.13±7.99,死亡态度量表平均分为93.52±12.93,死亡态度与临终关怀态度量表的Pearson相关系数(r值)为-0.19(P0.01),死亡态度各维度中,逃离接受维度、死亡恐惧维度及死亡逃避维度与临终关怀态度得分呈负相关(P0.01),自然接受维度与临终关怀态度呈正相关(P0.01),死亡态度因素可解释护士照顾临终患者态度变异度的25.90%(P0.01)。结论护士的死亡态度与临终关怀态度存在相关关系,护士的死亡态度是影响护士照顾临终患者态度的因素,护士树立正确死亡观念可改善其对临终关怀工作的态度。     

北京东城区朝阳门医院临终关怀病人分析

本文对北京东城区朝阳门医院临终关怀病区的30名现住病人(文中简称住院组)和调查之日前在该病区死亡的30名病人(文中简称死亡组)的一般状况、接受临终关怀的原因、经费及满意度进行了分析。60名病人中女性占63.3％,70岁及以上占68.3％,50.0％的病人丧偶,文盲占21.1％,95.0％为退休或无职业者。75.0％的病人享受公费医疗或劳保医疗。接受临终关怀的原因以其他医院拒绝接收为最高,占40.0％,其中死亡组占66.7％。而住院组以家庭成员工作忙无法照顾和信任临终关怀医院为两个主要原因,各占43.0％。病人的病种死亡组经癌症和脑血管病后遗症为主,各占40.0％。住院组以脑血管病后遗症为主,占63.3％。死亡组平均住院17.6天,平均日住院费用117.74元,住院组平均住院254.7天,平均日住院费用53.42元。病人对临终关怀服务比较满意(4.50分)。更难能可贵的是死亡组家属对临终关怀给予高度评价(4.86分)。通过分析,我们对发展临终关怀事业,提高生命垂危人群的保健服务质量和满足不同人群的服务需要进行了粗浅的探讨。     

临终关怀在我国发展现状

临终关怀自二十世纪六七十年代自英美兴起,我国于1988年出现第一家专门临终关怀研究机构-天津医学院临终关怀研究中心.经过近30年的发展,临终关怀在我国呈现出了具有中国特色的发展模式.本文针对临终关怀这一"新生事物"在中国的独特的发展模式进行了表述,并对未来发展进行了展望.     

广西医学生临终关怀态度现状及其影响因素分析

目的了解广西医学生临终关怀态度现状及其影响因素,为开展临终关怀教育提供参考依据。方法采用分层整群随机抽样方法对广西1062名医学生进行问卷调查,根据问卷结果进行临终关怀态度及其影响因素分析。结果调查对象中临终关怀态度得分护理专业得分为(133.79±11.06)分,高于临床;年级中大一得分最高,为(132.53±10.31)分;不同家中讨论死亡情形中,"气氛很坦然公开"得分为(132.53±10.79)分,高于"从未讨论过死亡";自己未患过重病者得分为(130.89±10.22)分,高于患过重病者,以上差异均有统计学意义(P0.05);相关分析发现,死亡态度各维度[死亡恐惧(r=-0.331)、死亡逃避(r=-0.258)、自然接受(r=0.319)、趋近接受(r=-0.198)、逃离接受(r=-0.216)]、生命意义(r=0.450)、青少年生活事件(r=-0.174)与临终关怀态度均有显著相关(P0.05);层次回归分析发现,在控制了人口社会学变量后,心理因素对临终关怀态度作出了新的贡献,解释的变异量增加了26.30%。结论不同特征医学生临终关怀态度差异显著,提示我国在临终关怀亡教育上的不足,未能通过教育使不同背景的医学生树立科学、理性并具有人文关怀色彩的态度。     

长春新碱过量引起严重毒副反应1例的护理体会

报道1例霍奇金淋巴瘤患者因误用长春新碱（VCR）10mg一次性静脉推注后治疗护理情况。其出现间断性神志恍惚、眼睑闭合不全、言语不清、口腔黏膜糜烂、全身疼痛、麻痹性肠梗阻、尿潴留、手足麻木等症状,经积极解救,禁食,持续胃肠减压、胃管内注入麻油、开塞露、生理盐水灌肠,合理应用肠外营养,注重疼痛、心理护理,做好口腔、肛周护理,预防感染加重,患者病情得到控制好转出院。     

Correlates of stages of change of smoking among inhabitants of deprived neighbourhoods

BACKGROUND: This study examines the prevalence and correlates of stages of change of smoking, in terms of psychosocial, structural and sociodemographic factors, among inhabitants of deprived neighbourhoods. METHODS: Cross-sectional data were obtained from a survey on health related behaviour. Subjects were 2009 current and former smokers, aged 20-46, living in deprived neighbourhoods in Rotterdam, the second largest city in the Netherlands. Three groups of smokers were formed according to the stages of change-definitions of the Transtheoretical Model: smokers not planning to quit (precontemplators), smokers planning to quit (contemplators/preparators) and former smokers (actors/maintainers). Smokers planning to quit and smokers not planning to quit were compared regarding psychosocial factors (attitude, social norm, self-efficacy), structural factors (neighbourhood problems, material deprivation, financial problems, employment status) and sociodemographic factors (age, gender, marital status, cultural background, educational level). Former smokers were compared with smokers planning to quit regarding structural and sociodemographic factors. Logistic regression was used to assess correlates of stages of change. RESULTS: Smokers planning to quit (prevalence = 19%) reported a more positive attitude, stronger social norms and higher self-efficacy expectations in quitting smoking than smokers not planning to quit (prevalence = 57%). Smokers planning to quit less often were Dutch-born, more often had attended higher vocational schooling or university and more often reported experiencing two or more neighbourhood problems compared to smokers not planning to quit. Former smokers (prevalence = 24%) were older, more often Dutch-born, married, employed and higher educated, compared to smokers planning to quit. Furthermore, former smokers less often reported material deprivation and financial problems than smokers planning to quit. CONCLUSION: Among people living in deprived neighbourhoods, different factors correlate with different stages of change of smoking. Implications for health promotion are discussed.     

Choice of measures of vaccination and estimates of risk of pediatric pertussis

BackgroundVaccination uptake at the individual level can be assessed in a variety of ways, including traditional measures of being up-to-date (UTD), measures of UTD that consider dose timing, like age-appropriate vaccination, and risk reduction from individual doses. This analysis compared methods of operationalizing vaccination uptake and corresponding risk of pertussis infection.MethodsCity-wide case-control study of children in Philadelphia aged 3 months through 6 years, between 2001 and 2013. Multiple logistic regression was used to isolate the independent effects of each measure of vaccination uptake and the corresponding relative odds of pertussis.ResultsBeing UTD on vaccinations was associated with a 52% reduction in risk of pertussis (OR 0.48, 95% CI: 0.34, 0.69). Evaluation of delayed receipt of vaccine versus on-time UTD yielded similar results. There was a decrease in risk of pertussis for each additional dose received with the greatest reduction in pertussis infection observed from the first (OR 0.48, 95% CI: 0.28, 0.83) and second dose (OR 0.17, 95% CI: 0.08, 0.34). Additional doses conferred minimal additional protection in this age group.ConclusionExamining vaccination status by individual doses may offer improved predictive capacity for identifying children at risk for pertussis infection compared to the traditional UTD measure.     

两种不同肌瘤剔除术治疗子宫肌瘤的临床疗效比较

目的:比较腹腔镜子宫肌瘤剔除术与腹式子宫肌瘤剔除术的临床疗效。方法:回顾分析63例腹腔镜子宫肌瘤剔除术与61例腹式子宫肌瘤剔除术的临床资料,比较2种手术方式的手术时间、术中出血量、肛门排气时间、使用抗生素时间、术后感染率、体温恢复正常时间、住院时间等情况。结果:两组患者接受子宫肌瘤剔除术顺利完成,腹腔镜组手术时间长于开腹组(P0.05),腹腔镜组术中出血量及剔除肌瘤个数均少于开腹组(P0.05),术后腹腔镜组体温恢复正常时间、肛门排气时间、抗生素使用及住院时间均短于开腹组,两组患者最多随访6个月,腹腔镜组平均康复时间较开腹组短(P0.05),两组随访B超均未发现明显肌瘤结节。结论:腹腔镜子宫肌瘤剔除术损伤小,恢复快,住院时间短,是值得推广的微创手术。     

上海市某医院骨科平均住院日影响因素分析

对上海市某医院2003年-2007年骨科出院病人的住院日描述性分析．2003年-2007年骨科的床位利用指数与平均住院日相关性分析．2003年-2007年骨科床位与医护比例分析．2007年骨科前10大病种平均住院目影响因素分别进行单因素相关性分析和多因素逐步回归分析（STATA软件）。通过对骨科10大病种住院日影响因素分析,术前等待天数、手术类型、是否输血分别对10个、9个和8个病种的住院目有影响。输血因素和手术类型是医院不可控、由病人的病情决定的,术前等待天数是管理因素,是最值得医院重视的影响因素。     

性发育异常发病机制的研究进展

正常的性腺分化可分为3个过程：原始性腺形成、性别决定和卵巢/睾丸发育。在任一环节中,基因表达或调控发生异常均有可能导致性发育异常疾病的发生。性发育异常是指染色体、性腺和解剖性别不典型。随着分子生物学技术的发展,不断地发现新的基因或信号通路参与性腺分化和发育,如SRY、SF1、WT1、Sox9等基因与睾丸发育密切相关,Wnt/Rspo1/B连环蛋白通路、Dax1、Foxl2等基因在卵巢分化中发挥着重要作用,一些非编码RNA和转化生长因子也有重要的调节功能,且睾丸和卵巢发育均为主动过程,即使在出生后因某些基因的改变两者间也可出现横向分化。这些为揭示性分化异常的发病机制提供了可能。     

尘肺病患者145例死因调查

目的分析汉中市尘肺病的发生、发展和死亡原因，以提高尘肺病患者的生存质量。方法对145例尘肺病患者的死因进行回顾性分析，计算其平均发病年龄、死亡年龄及患尘肺病后的存活年限。结果矽肺的平均发病年龄和死亡年龄均早于煤工尘肺和石棉肺，尘肺病的主要死因为患肺部疾患，患尘肺病后的平均存活年限为12a。结论加强职业健康体检工作，对尘肺病人做到早发现早治疗和预防并发症的发生。     

One-year stability of the Measure of Processes of Care

BACKGROUND: The Measure of Processes of Care (MPOC) is a 56-item self-administered measure designed to examine what parents of a child with a chronic health problem think of the services they and their child receive, and to measure the extent to which these services are family-centred. Reliability and validity of the MPOC were established in prior studies. The aim of the present study was to assess the 1-year stability of the MPOC to justify its use as an evaluative tool. METHODS: Nine paediatric rehabilitation centres in the Netherlands participated in this short longitudinal survey study. Subjects were 205 parents (response rate 74.8%) of children aged 1-18 years who received care in one of the participating paediatric rehabilitation centres. All subjects filled out two MPOCs with a 1-year interval. RESULTS: All correlations between the scale scores of the MPOC at the first and second administration were relatively high and significant (range: 0.443-0.609, all P < 0.001), demonstrating high inter-individual stability. However, all mean scale scores, except for Providing General Information, significantly reduced after 1 year. CONCLUSIONS: The MPOC has a moderate 1-year stability. However, because of its tendency to score lower when repeated after 1 year, its use as an evaluative follow-up instrument to assess the effectiveness of a programme intervention is restricted.     

儿童皮质发育畸形的MRI诊断

目的探讨儿童皮质发育畸形(MCD)的MRI表现特点,为MCD的早期诊断提供依据。 方法选择2010年1月至2012年12月在四川省医学科学院·四川省人民医院放射科经MRI检查确诊为MCD的44例患儿为研究对象。回顾性分析及总结其MRI影像学特征。本研究遵循的程序符合四川省医学科学院·四川省人民医院人体试验委员会制定的伦理学标准,得到该委员会批准,征得受试对象及其监护人知情同意,并与监护人签署临床研究知情同意书。 结果本组44例经MRI确诊为MCD患儿中,巨脑回-无脑回为17例,多小脑回为14例,灰质异位为9例,脑裂畸形为4例。MCD的MRI特点中,巨脑回表现为脑回增宽、皮质增厚及白质变薄;无脑回表现为正常脑沟、脑回消失,皮质增厚及白质变薄;多小脑回表现为脑回增多、细小;灰质异位表现为皮质下及侧脑室周围深部白质区结节状、团块状或带状病灶,信号与灰质信号相同;脑裂畸形表现为从侧脑室到脑表面贯穿大脑半球的裂隙,表面覆盖灰质。 结论MRI是诊断儿童MCD的可靠影像学方法。     

244株真菌鉴定结果分析

目的 了解某院2000～2001年各类真菌的检出率。方法 用酵母样真菌同化试验编码鉴定板TH-15进行编码鉴定。结果 真菌分离率为8．85％；244株真菌分为10种，其中以白色念珠菌和热带念珠菌较高，分别占真菌总数的75．41％和11．47％；检出真菌的主要标本是痰和阴道分泌物。结论 及时进行真菌培养，有利于合理使用抗菌药物和控制真菌感染。