心理护理干预对骨折患者抑郁焦虑及生活质量的影响

目的：探讨心理护理干预对骨折患者抑郁焦虑及生活质量的影响。方法选择骨折患者60例作为研究对象,随机分为护理干预组和对照组,对照组给予常规护理,干预组在常规护理基础上给予心理护理干预,比较两组焦虑抑郁情况以及生活质量。结果两组护理后焦虑和抑郁评分均显著下降（P ＜0.01）,护理后,干预组焦虑抑郁评分显著低于对照组（P ＜0.01）。出院后1个月随访,干预组生活质量各维度得分显著高于对照组（P ＜0.01）。结论心理干预能够显著缓解骨折后患者的焦虑和抑郁情绪,从而提高患者的生活质量。     

系统护理干预对恶性肿瘤患者负性心理及生活质量的影响

目的减轻恶性肿瘤患者的负性心理。提高其生活质量。方法将226例恶性肿瘤患者随机分为两组各113例。对照组患者采用传统护理模式,观察组患者实施系统化护理干预,包括尊重患者的自主权,提供专业化心理干预,按制定的路径实施健康教育,举办患者沙龙等。比较实施前后患者焦虑、抑郁及生活质量评分。结果干预后观察组焦虑、抑郁评分显著低于对照纽（均P〈0．05）,生活质量总分及身体功能、角色功能、情绪及社会功能维度显著优于对照组（均P〈0．01）。结论系统护理干预能够更有效地降低恶性肿瘤患者焦虑及抑郁等负性心理,有利于提高患者的生活质量。     

针对性心理护理对腋臭患者情绪的影响

目的:了解针对性心理护理对腋臭患者焦虑抑郁情绪的缓解作用.方法:选择诊断明确的60例腋臭患者,随机分为干预组和对照组,按照相应的腋臭诊疗常规对所有入组患者进行系统治疗和护理,干预组在治疗基础上进行为期4周的针对性心理护理,4周后随访,整个干预进间为12周.在入组时和入组后第12周末,采用Zung焦虑自评量表(SAS)和抑郁自评量表(SDS)进行评分,比较干预前后患者情绪的变化.结果:入组后第12周末,干预组和对照组SAS和SDS评分较入组时均有显著降低(P均＜0.05);但干预组下降更明显P＜0.05).结论:针对心理学护理能有效缓解腋臭患者焦虑抑郁情绪,改善患者心理健康状况,有利于患者康复.     

综合护理干预对术后下肢深静脉血栓形成患者焦虑抑郁情绪、遵医行为及生活质量的影响

目的探讨综合护理干预对术后下肢深静脉血栓形成(DVT)患者焦虑抑郁情绪、遵医行为及生活质量的影响。方法选取2015-01—2019-01间郑州大学第一附属医院(郑东院区)大血管外科收治的84例术后下肢DVT患者,随机分为2组,各42例。对照组实施常规护理,观察组在常规护理基础上采取心理护理和健康教育等综合护理干预。比较2组患者的焦虑、抑郁(HAD)评分,遵医行为及生活质量。结果综合护理干预后,观察组患者的HAD评分、遵医行为及生活质量均优于对照组,差异有统计学意义(P0.05)。结论在常规护理的基础上,给予心理护理和健康教育等综合护理干预,可显著改善下肢DVT患者的焦虑、抑郁情绪,提升其遵医行为和生活质量。     

以家庭为中心的护理干预对酒依赖患者家属心理状况的影响

目的 探讨酒依赖患者家属的心理状况及护理干预方法。方法 将97例酒依赖住院患者随机分为观察组（49例）和对照组（48例）。均配对选择患者1名与其生活关系密切的家属。两组患者均接受常规治疗与护理。观察组在此基础上进行以家庭为中心的护理干预，1次／周。共6周。于入院第1周及第6周末．分别采用焦虑自评量表（SAS）、抑郁自评量表（SDS）及自行设计的感受描述问卷进行评定。结果 干预后观察组患者家属SAS、SDS评分显著低于对照组（均P〈0．01），主观感受描述显著优于对照组（P〈0．01）。结论 以家庭为中心的护理干预．对酒依赖患者家属的焦虑、抑郁情绪有显著的缓解作用，对增强家属对患者摆脱酒依赖的信心、减轻恐惧心理、增加与患者的感情有显著的促进作用。     

不稳定性心绞痛焦虑抑郁患者的综合性心理干预

目的探讨综合性心理干预对不稳定性心绞痛焦虑抑郁患者的影响。方法将100例不稳定性心绞痛焦虑抑郁患者随机分为观察组和对照组各50例，对照组采用常规的护理和健康教育措施。观察组在此基础上采用综合性心理干预，包括行为干预、生物反馈、放松训练、支持性心理治疗等。连续干预6个月后评价效果。结果干预后观察组焦虑自评量表（SAS）、抑郁自评量表（SDS）和心绞痛调查量表（SAQ）评分显著优于对照组（均P〈0．05）；生活质量评定问卷（GQOL-74）的社会功能和心理功能维度评分显著提高（均P〈0．05），临床疗效及ECG表现显著改善（均P〈0．01）。结论综合性心理干预能有效改善不稳定性心绞痛焦虑抑郁患者的负性情绪，改善疾病症状，提高其生活质量。     

对面部烧伤整形患者伴有情绪障碍人本主义心理干预的疗效评估

目的：探讨应用人本主义疗法对伴有情绪障碍的面部烧伤整形患者实施心理干预的效果。方法：将63例伴有情绪障碍的面部烧伤整形住院患者随机分为干预组31例,对照组32例。对照组给予常规心理护理,干预组在常规心理护理的基础上,给予人本主义疗法。两组患者在干预前后的心理状况分别用焦虑自评量表（SAS）、抑郁自评量表（SDS）和症状自评量表（SCL-90）进行评价。结果：干预组在干预后焦虑和抑郁情绪、思维、情感、行为、人际关系等方面较对照组有统计学意义,P〈0.01。结论：应用人本主义疗法对伴有情绪障碍的面部烧伤整形患者实施心理干预能显著地降低焦虑和抑郁情绪,改善患者的症状,在临床烧伤整形患者心理护理中效果明显,措施可行。     

临终关怀降低老年临终患者家属心理应激及负性情绪的效果

目的 提高老年临终患者的生活质量，降低其家属心理应激及焦虑、抑郁情绪。方法 将76例老年临终患者及其家属（76名）随机分为研究组和对照组，每组38例患者和38名家属。对照组按常规进行护理，研究组在常规护理的基础上接受临终关怀护理干预。在干预前及干预1个月后采用家属应激量表（RSS）、焦虑自评量表（SAS）、抑郁自评量表（SDS）对两组患者家属进行评定。结果 干预后研究组患者家属RSS总分及心理痛苦和生活被扰乱2个维度评分显著低于对照组（均P〈0．01），SAS、SDS评分显著低于对照组（P〈0．05，P〈0．01）。结论 临终关怀护理在降低老年临终患者家属应激水平的同时，也降低了其焦虑、抑郁程度。     

接纳与承诺疗法对脑瘫患儿行为问题及其父母养育心理灵活性的影响

目的 探讨接纳与承诺疗法对脑瘫患儿行为问题及其父母焦虑、抑郁、养育心理灵活性的影响。 方法 将60例有焦虑或抑郁情绪的脑瘫患儿及父母随机分为对照组与干预组各30例。对照组实施常规护理,干预组在此基础上进行接纳与承诺疗法干预。干预前及干预8周后运用焦虑、抑郁自评量表,父母养育心理灵活性问卷和儿童行为问卷进行评价。 结果 干预8周后,干预组脑瘫患儿行为问题、脑瘫患儿父母焦虑和抑郁评分显著低于对照组,父母养育心理灵活性得分显著高于对照组（P＜0.05,P＜0.01）。 结论 采用接纳与承诺疗法干预可缓解脑瘫患儿父母焦虑和抑郁情绪,提高其养育心理灵活性,降低患儿行为问题。     

护理干预对情感障碍患者认知行为的影响

目的 探讨护理干预对情感障碍患者认知行为的影响。方法 将62例情感障碍患者随机分为观察组（30例）和对照组（32例）。两组均给予常规药物治疗及情感支持；观察组在此基础上予以认知行为护理干预。6周后运用症状自评量表（SCL-90）、抑郁自评量表（SDS）评定疗效。结果 观察组干预后SCL-90评分中。强迫、人际关系、抑郁、焦虑、恐怖、躯体化、精神病性各因子分显著低于对照组（P〈0．05。P〈0．01）；SDS评分显著低于对照组（P〈0．01）。结论 护理干预可降低情感障碍患者抑郁、焦虑情绪及躯体症状。促进疾病康复。     

ICU患者安宁疗护筛查工具的研制与信效度检验

目的 研制ICU患者安宁疗护筛查工具并检验信效度,为ICU医护人员提供便捷、有效的安宁疗护对象筛查工具。 方法 通过文献分析、专家函询构建ICU患者安宁疗护筛查工具;回顾性分析206例ICU患者的相关资料,检验该筛查工具信效度,并确定安宁疗护触发值。 结果 ICU患者安宁疗护筛查工具包含3个一级条目、17个二级条目。内容效度指数为0.919,评定者间信度为0.979。2种结局（转出或死亡）患者筛查得分比较,差异有统计学意义（P＜0.05）;触发值为8.5分,ROC曲线下面积为0.992［95%CI（0.983,1.000）,P＜0.05］,灵敏度为0.936,特异度为0.969,阳性预测值为0.917,阴性预测值为0.981。 结论 ICU患者安宁疗护筛查工具的信效度良好,可作为ICU安宁疗护对象的筛查工具。     

Importance of recognizing and managing delirium in intensive care unit

Delirium is an acute and fluctuating change in mental status, with inattention and altered levels of consciousness. It is a common comorbidity in intensive care units (ICU), resulting in delayed withdrawal of mechanical ventilation, prolonged length of stay in ICU, increased ICU mortality and impaired long-term cognitive function of the survivors.     

基于养老服务管理者及老年人视角的社区嵌入式养老服务的SWOT分析

目的 分析社区嵌入式养老服务优劣势、机遇及威胁,为社区嵌入式养老服务持续健康发展提供参考。 方法 采用目的抽样法及滚雪球抽样法抽取天津市6名社区嵌入式养老服务管理者及6名接受服务的老年人,对其进行半结构式深入访谈,使用内容分析法分析资料,基于SWOT模型从优势、劣势、机会、威胁4个维度对社区嵌入式养老服务进行分析评价。 结果 社区嵌入式养老优势包括提供服务多元、满足情感需求、统筹整合优质资源、开放式养老;劣势为场地资源受限、盈利困难;机遇有服务需求量大、政府有力支持、信息技术发展日益成熟;威胁包括功能定位模糊、护理员短缺、老年人缺乏自主消费观念。 结论 在积极推进“互联网+社区养老”的背景下,天津市社区嵌入式养老因其服务多元,形式灵活,兼具地缘优势,具有良好的社会反响。未来,需在运营中进一步加强政府引导及监督,细化功能定位、稳定护理员队伍,以切实满足社区老年人多元化养老服务需求。     

基于CLHLS的老年人社区养老服务需求及影响因素研究

目的分析社区现有养老服务内容以及老年人对社区养老服务的护理需求,为政府合理分配社区养老服务资源,提高老年人生活质量提供参考。方法基于2017~2018年中国老年人健康长寿影响因素追踪调查数据(CLHLS),采集有关老年人期望社区提供的养老服务需求与社区供给情况,以及老年人人口学、社会经济状况、健康状况相关数据,运用Logistic回归分析方法,探究老年人社区养老服务需求的影响因素。结果共采集到11981名老年人数据资料。75.7%的老年人希望得到保健知识教育服务,42.2%的老年人报告其社区会提供该类服务;64.3%的老年人希望得到居家护理服务,但仅10.2%的老年人报告其社区会提供此类服务;81.0%的老年人希望得到家访照顾,35.0%的老年人报告其社区会提供此类服务;67.3%老年人希望提供心理咨询服务,但仅12.1%的老年人报告其社区会提供此类服务。老年人的年龄、居住地、居住现状、经济情况及健康状况等是影响其社区养老服务需求的主要因素(P<0.05,P<0.01)。结论老年人对社区养老服务需求较大,但我国社区养老仍存在供需不平衡、城乡差距明显以及老年人生活水平差异等。社区养老应以老年人需求为导向,建立多层次、全方位、多元化的养老服务体系,提高社区养老服务质量,满足老年人社区养老服务需求。     

Family presence and environmental factors at the time of a patient's death in an ICU

BACKGROUND: In an intensive care unit (ICU), privacy and proximity are reported to be important needs of dying patients and their family members. It is assumed that good communication between the ICU team and families about end-of-life decisions improves the possibilities of meeting families' needs, thus guaranteeing a dignified and peaceful death in accordance with end-of-life care guidelines. The aim of this study was to explore the circumstances under which patients die in Swedish ICUs by reporting on the presence of family and whether patients die in private or shared rooms. An additional aim was to investigate the frequency of end-of-life decisions and whether nurses and family members were informed about such decisions. METHODS: A questionnaire based on the research questions was completed when a patient died in the 10 ICUs included in the study. Data were collected on 192 deaths. RESULTS: Forty per cent of the patients died without a next of kin at the bedside and 46% of deaths occurred in a shared room. This number decreased to 37% if a family member was present. Patients without a family member at their bedside received less analgesics and sedatives. There was a significant relationship between family presence, expected death and end-of-life decisions. CONCLUSIONS: The results indicate the necessity of improving the ICU environment to promote the need for proximity and privacy for dying patients and their families. The study also highlights the risk of underestimating the needs of patients without a next of kin at their bedside at the time of death.     

Current state and future perspectives of trauma care system in mainland China

Objective

To investigate the current state of trauma care in mainland China, and to propose possible future suggestions for the development of the trauma care system in mainland China.

Method

An extensive Medline/PubMed search on the topic of trauma care or trauma care system was conducted. Publications in Chinese that could best describe the state of trauma care in China were also included. In addition, two meetings were held by Group for Trauma Emergency Care and Multiple Injuries, Trauma Society of Chinese Medical Association to discuss the development and perspectives of trauma care system in mainland China. Important conclusions from the two meetings were included in this publication.

Results

Trauma has become an increasing public health problem in mainland China in association with the rapid growth of the economy over the past 30 years. Although great progress has been made in regards to the care of the injured, there is still no government agency dedicated to deal with trauma-related issues, or a national trauma care system operating on the Chinese mainland. Various trauma prevention measures have been taken, but with little effect. Funds contributed to trauma-related research has increased in recent years and promoted rapid development in this field, but further improvement in research is needed. However, many groups such as the Trauma Society of the Chinese Medical Association have continued to explore mechanisms for the treatment of trauma patients and have developed various types of regional trauma care systems, resulting in improved trauma care and a better outcome for the injured.

Conclusions

Although great progress has been made in trauma care in mainland China, there are many failings. To improve trauma care in China, the establishment of a sophisticated trauma system and various enhancements on trauma prevention are urgently required.     

30 years of polytrauma care: An analysis of the change in strategies and results of 4849 cases treated at a single institution

The quality and progress of treatment of 4849 multiple trauma patients treated at one institution was reviewed retrospectively. Three periods, 1975-1984 (decade I; n = 1469) and 1985-1994 (decade II; n = 1937) and 1995-2004 (decade III; n = 1443) were compared.65% of multiple trauma patients had cerebral injuries, 58% thoracic trauma and 81% extremity fractures (37% open injuries). Injury combinations decreased during all decades with head/extremity injuries being the most common combination. Throughout the three decades pre-hospital care became more aggressive with an increase of intravenous fluid resuscitation (I: 80%, II: 97%, III: 98%). Chest tube insertion decreased after an initial increase (I: 41%, II: 83%, III: 27%) as well as intubation (I: 82%, II: 94%, III: 59%). Rescue times were progressively shortened. For initial clinical diagnosis of massive abdominal haemorrhage ultrasound (I: 17%, II: 92%, III: 97%) replaced peritoneal lavage (I: 44%, II: 28%, III: 0%). CT-scans were used more frequently for the initial diagnosis of head injuries and other injuries to the trunk throughout the observation time. With regard to complications, acute renal failure decreased by half (I: 8.4%; II: 3.7%; III: 3.9%), ARDS initially decreased but increased again in the last decade (I: 18.1%, II: 13.4%, III: 15.3%), whereas the rate of multiple organ dysfunction syndrome (MODS) increased continuously (I: 14.2%, II: 18.9%, III: 19.8%) probably due to a decline of the mortality rate from 37% in the first to 22% in the second and 18% in the third decade and parallel increase of the time of death.These treatment results summarise the enormous clinical effort as well as medical progress in polytrauma management over the past 30 years. Further reduction of mortality is desirable, but probably only possible when immediate causal therapy of later posttraumatic organ failure can be established.