非小细胞肺癌患者靶向治疗服药依从性及影响因素分析

目的：调查非小细胞肺癌患者口服靶向药的服药依从性，并分析其影响因素，为提高患者靶向治疗依从性提供参考。方法：采用便利抽样法，选取2021年2月至7月208例接受口服靶向药治疗的非小细胞肺癌患者作为调查对象，采用一般资料调查表、服药依从性量表、出院患者药物素养调查问卷和社会支持评定量表进行调查。结果：肺癌患者靶向治疗依从性得分为（4.52±1.58）分，高依从性占2.9%，中依从性占18.3%，低依从性占78.8%。多因素回归分析显示，影响肺癌患者靶向治疗依从性的主要因素为药物素养、社会支持、年龄、居住地及居住方式。结论：非小细胞肺癌患者口服靶向药治疗依从性较低。医护人员应鼓励家属给予患者更多的关注和支持，同时积极为肺癌患者搭建沟通交流的平台，增进患者间的支持，并进一步发展延续性护理，发挥自身专业优势，为院外患者提供用药指导和咨询，帮助患者提高药物素养，从而提高患者服药依从性。     

基于信息、管理、关系的三维度延续护理在老年COPD患者中的应用研究

目的 探讨基于信息、管理、关系的三维度延续护理干预在老年COPD患者中的应用价值.方法 选择我院2015年2月至2016年1月收治的老年COPD患者共124例为对象.按照患者出院顺序号随机分为观察组与对照组各62例.对照组采用常规随访护理,观察组采用基于信息、管理、关系的三维度延续护理模式.于患者出院时、出院1月后、2月后与3月后采用COPD评估测试量表(CAT量表)和自制的治疗依从性评价量表进行生活质量评价与治疗依从性评价.结果 观察组在出院2月后、3月后的CAT评分分别为(16.27±1.75)分、(11.04±1.42)分,均显著低于对照组同时期评分(t=4.136、4.271,P＜0.05).观察组出院1月后、2月后与3月后的治疗依从性评分分别为(8.65±0.34)分、(8.60±0.42)分、(8.55±0.51)分,均显著高于对照组同时期评分(t=3.924、4.167、4.583,P＜0.05).结论 基于信息、管理、关系三维度为老年COPD患者提供延续护理,能够改善患者出院后生活质量,提高治疗的依从性,是一种较为理想的护理随访方案.     

老年肿瘤疼痛患者口服止痛治疗依从性的调查分析

目的了解老年肿瘤疼痛患者口服止痛治疗的依从情况,为有效止痛给药护理提供依据。方法采用问卷对口服止痛治疗的老年肿瘤疼痛患者依从性及相关情况进行调查。结果 52例(50.5%)老年肿瘤疼痛患者口服止痛治疗依从性差,影响其依从的原因90.4%为"担心药物的不良反应";不同年龄、医药报销、个人月收入和疼痛程度的患者依从性差异有统计学意义(P<0.05)。结论老年肿瘤疼痛患者口服止痛治疗依从性差,特别是小于75岁老年人、自费及部分报销的患者、低收入者、疼痛程度轻的患者依从性差,应该给予更多的关注与干预,提高其口服止痛治疗依从性。     

基于IMB理论为指导的护理干预对非小细胞肺癌患者口服靶向药物的影响

目的探讨基于信息-动机-行为技巧模型(IMB)理论为指导的护理干预对非小细胞肺癌患者口服靶向药物的影响。方法选取2020年10月至2021年12月南通市肿瘤医院肿瘤内科收治的80例非小细胞肺癌口服靶向药物患者,采用随机数字表法将其分为对照组和试验组,各40例。对照组采用常规护理,试验组采用基于IMB理论为指导的护理干预措施,分别于患者出院后1个月、2个月、3个月采用欧洲癌症研究与组织生存质量量表(EORTC QLQ-C30)对两组患者进行问卷调查,并统计、比较两组患者服药依从性、护理满意度。结果试验组患者EOPTC QLQ-C30评分、服药依从性、护理满意度均优于对照组,差异具有统计学意义(P<0.05)。结论以IMB理论为指导的护理干预有助于提高非小细胞肺癌患者口服靶向药物的依从性,改善患者的生活质量,提升护理满意度。     

温馨提示卡在出院老年心血管疾病患者延续护理模式中应用效果的观察

目的探讨温馨提示卡在延续护理模式中对老年心血管疾病患者出院后服药依从性及护理满意度的影响。方法选取2015年6月—2016年1月老年心血管疾病患者81例作为研究组,出院温馨提示卡作为延续护理模式中对患者服药和心脏康复护理指导。对照组选取2014年11月—2015年5月出院老年心血管疾病患者85例,采取常规出院健康宣教,观察2组护理效果。结果研究组出院患者服药依从性显著优于对照组(P0.05),护理服务满意度调查高于对照组(P0.05)。结论出院温馨提示卡能提高出院老年心血管患者服药依从性,形成健康的生活方式,提高护理服务满意度。     

基于信息化的延续护理模式对老年冠心病患者服药依从性的影响

目的 探讨基于信息化的延续护理模式对老年冠心病患者服药依从性的影响.方法 选取2019年6-12月出院老年冠心病患者144例,将其随机分为对照组和干预组,对照组给予常规出院随访,干预组给予基于信息化的延续护理模式干预.比较2组服药依从性和生化指标.结果 干预组服药依从性高于对照组(Z=-0.499,P=0.618),三...     

个性化心理护理对老年脑梗死患者的应用效果分析

目的探讨个性化心理护理对老年脑梗死患者的应用效果,分析对SDS评分影响。方法采用前瞻性随机试验方法,将2018年6月～2020年2月本院收治的实施常规心理护理的32例老年脑梗死稳定期患者纳入对照组,将同期本院收治的实施个性化心理护理的32例老年脑梗死稳定期患者纳入观察组。两组均干预至出院,比较干预前及出院时患者抑郁自评量表(SDS)评分以及干预期间护理依从性。结果与干预前相比,两组出院时的SDS评分均明显降低,且观察组SDS评分低于照组,差异有统计学意义(P0.05);观察组干预期间护理依从性明显高于对照组,差异有统计学意义(P0.05)。结论将个性化心理护理用于老年脑梗死患者中,能有效减弱患者的抑郁情绪,提升其护理依从性。     

品管圈在提高老年高血压患者服药依从性中的应用

目的探讨品管圈活动在提高老年高血压患者口服降压药依从性中的应用效果。方法以提高老年高血压患者口服降压药依从性为品管圈活动主题,对老年高血压患者口服降压药依从性情况进行调查,经过头脑风暴、原因分析、拟定对策,制订专科用药指引,加强护士药理知识和高血压相关专科知识培训,制订老年高血压患者健康教育路径,制订健康教育手册,应用多种方法进行健康教育。比较对策实施前后老年高血压患者口服降压药依从性。结果对策实施后老年高血压患者口服降压药依从性由39.42%提高至79.59%(χ~2=33.63,P0.001)。结论品管圈活动制订的对策有效提高了老年高血压患者口服降压药依从性。     

口服希罗达不良反应的观察及护理

希罗达是一种对肿瘤细胞具有选择性活性的口服抗肿瘤药物,作为单药治疗转移性结肠癌、直肠癌疗效显著,可模拟5-氟尿嘧啶的持续滴注,临床给药方便,毒副反应轻,易被患者接受,服药期间可以保证较高的生活质量.我科自2003年5月开始希罗达一线治疗转移性结直肠癌的三期开放临床研究.现结合有关文献,将该药不良反应的观察及护理体会报告如下.     

延伸护理对老年慢性心力衰竭患者生活质量的影响

目的 探讨延伸护理对老年慢性心力衰竭(CHF)患者出院后遵医行为依从性及生活质量的影响.方法 选择老年心血管科病区符合研究条件的108例CHF出院患者作为研究对象,随机分为实验组和对照组各54例,实验组出院后实施延伸护理1年,包括定期电话和上门随访,提供药疗护理、饮食护理、康复锻炼和督导自我护理等.对照组进行常规的出院健康教育.比较2组患者在出院后第3,6个月及1年的遵医行为依从性及自我管理能力,并比较2组患者出院时、1年后各项生活质量评分.结果 2组患者在服药、饮食、定期复诊等方面依从性比较无显著差异,但在白测尿量、体质量、记录自我症状、体征及按要求运动等依从性方面实验组显著优于对照组.延伸护理后实验组患者在功能性生活指数、幸福度、老年人生活质量的评分均显著高于对照组.结论 延伸护理可改善患者的遵医行为,并提高老年CHF患者生活质量.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Molecular characterization of virulence and antimicrobial resistance profile of Shigella species isolated from children with moderate to severe diarrhea in northeastern Brazil

Molecular characterization of virulence and antimicrobial resistance profiles were determined for Shigella species isolated from children with diarrhea in Fortaleza, Brazil. Fecal specimens were collected along with socioeconomic and clinical data from children with moderate to severe diarrhea requiring emergency care. Shigella spp. were isolated by standard microbiological techniques, and we developed 4 multiplex polymerase chain reaction assays to detect 16 virulence-related genes (VRGs). Antimicrobial susceptibility tests were performed using disk diffusion assays. S. flexneri and S. sonnei were the predominant serogroups. S. flexneri was associated with low monthly incomes; more severe disease; higher number of VRGs; and presence of pic, set, and sepA genes. The SepA gene was associated with more intense abdominal pain. S. flexneri was correlated with resistance to ampicillin and chloramphenicol, whereas S. sonnei was associated with resistance to azithromycin. Strains harboring higher numbers of VRGs were associated with resistance to more antimicrobials. We highlight the correlation between presence of S. flexneri and sepA, and increased virulence and suggest a link to socioeconomic change in northeastern Brazil. Additionally, antimicrobial resistance was associated with serogroup specificity in Shigella spp. and increased bacterial VRGs.     

护理干预对面部中重度寻常型痤疮的临床疗效影响分析

目的研究护理干预对面部中重度寻常型痤疮的临床疗效影响。方法选取本院在2014年4月~2016年7月诊治的136例面部中重度寻常型痤疮患者,随机分为研究组与对照组,每组68例;所有患者均依据其情况给予对应的治疗,其中对照组在治疗期间给予常规护理,研究组在对照组的基础上再给予综合性护理干预,比较两组的治疗效果及护理满意度情况等。结果患者在接受治疗和护理后,研究组中度与重度患者的治疗效果较对照组均明显提高(P0.05),研究组护理满意度较对照组明显增高(P0.05)。结论对面部中重度寻常型痤疮患者在其治疗期间给予综合性护理干预,具有良好的效果。