目的 评价标准化护理服务程序在"互联网+护理服务"中的应用效果.方法 构建并应用"互联网+护理服务"标准化护理服务程序,比较实施前后护理服务质量以及患者或家属满意度.结果 "互联网+护理服务"标准化护理服务程序实施后,护士的"核对评估符合率"、"知情告知符合率"、"健康教育符合率"和"总符合率"较前提升(p＜0.05),患者或家属满意度较实施前明显提升(p＜0.01).结论 标准化护理服务程序在"互联网+护理服务"应用中可有效提升服务质量,提高患者满意度.

目的 探讨基于患者报告结局的结构化随访在首发脑卒中患者延续护理中的应用效果.方法 采取便利抽样法,选取宁波大学医学院附属医院神经内科于2021年5月-2022年5月收治的107例脑卒中患者为研究对象;将其中2021年11月-2022年的5月收治的患者作为观察组,将2021年5-10月收治的患者作为对照组,分为观察组54例和对照组53例.对照组接受常规智能随访,观察组则进行基于患者报告结局的结构化随访.比较2组患者的身体功能、认知功能、担任社会角色与参加社交活动的能力、疲劳、疼痛影响、抑郁及满意度的差异.结果 出院时,2组患者身体功能、认知功能、担任社会角色与参加社交活动的能力、疲劳、疼痛、抑郁总分比较,差异无统计学意义(P＞0.05).与对照组相比,观察组在随访1个月、3个月后,身体功能、认知功能、担任社会角色与参加社交活动的能力得分均高于对照组,疼痛得分低于对照组,差异均有统计学意义(P＜0.05).与对照组相比,观察组随访1个月后,抑郁得分明显低于对照组,差异有统计学意义(P＜0.05);干预3个月后,2组患者抑郁得分比较差异无统计学意义(P＞0.05).与对照组相比,观察组患者满意度显著高于对照组,差异有统计学意义(P＜0.05).结论 基于患者报告结局的结构化随访,可促进首发脑卒中患者康复,提高其生活质量和满意度.

目的 构建"互联网+"PICC居家护理服务质量评价指标体系,为规范开展"互联网+"PICC居家护理服务质量评价提供客观依据.方法 基于"结构-过程-结果"三维质量结构模型,结合文献检索、半结构式访谈、小组讨论、德尔菲法,选取20名从事静脉治疗护理、有"互联网+护理服务"管理或实践经验的专家进行2轮咨询,确定"互联网+"PICC居家护理服务质量评价指标体系.专家积极系数用问卷的有效回收率和专家意见提出率表示;专家权威程度采用专家权威系数表示;专家意见协调程度采用肯德尔和谐系数表示;专家意见集中程度通常以指标的重要性赋值均数、变异系数、满分率(％)表示.结果 2轮咨询问卷有效回收率均为100％,专家的权威系数分别为0.793、0.848,专家意见的肯德尔和谐系数分别为0.202～0.216,0.222～0.270(P＜0.05),在第2轮专家咨询后所有指标的重要性赋值均数均＞4.0分,变异系数均＜0.2,满分率均＞20％.最终构建的"互联网+"PICC居家护理服务质量评价指标体系包括一级指标3项、二级指标12项、三级指标64项.结论 构建的"互联网+"PICC居家护理服务质量评价指标体系具有科学性、可靠性、实用性,并体现专科特色,可有效评价"互联网+"PICC居家护理服务质量.

良性前列腺增生(benign prostatic hyperplasia, BPH)多见于中老年男性,可致排尿障碍,表现为夜尿增多、尿急、尿频、排尿分叉或滴沥、尿不尽、排尿困难等,影响患者日常生活[1].经尿道前列腺切除术(transurethral resection of prostate,TURP)是治疗BPH的常用手术方法,具有创伤小、疗效确切、恢复快等优点[2].但TURP作为有创治疗,术后并发症难以避免,膀胱颈挛缩(bladder neck contracture,BNC)较为常见.BNC会引起膀胱充盈肿胀感、排尿急感等,阻滞伤口愈合,延缓术后恢复,增加患者痛苦,并会影响护理工作开展.本次研究探讨BPH患者TURP术后发生BNC的危险因素,为后期护理措施的制定提供参考.

This paper introduced the construction and application of "Internet + Nursing Service" intelligent followup system for older adults with chronic diseases. The system included accurate follow-up needs assessment based on patient-reported outcomes, intelligent decision making engine supported by evidence-based knowledge base, and flexible and comprehensive online and offline follow-up services. The application of the intelligent system has brought benefits to patients, constructed a new follow-up practice model to meet the diversified and multi-level follow-up needs of older adults with chronic diseases, increased the enthusiasm of nursing staff, and provided a useful reference and enlightenment for the comprehensive development of "Internet + Nursing Service" in the future.

The topic of physical activity interventions for the treatment of Alzheimer’s disease (AD) has been discussed for decades, but there are still inconsistent views on the effect of its intervention in different studies. With the increase in randomized controlled trials (RCTs), it is necessary to update newly published studies and systematically evaluate the effects of physical activity interventions. Scientific citation databases (e.g., PubMed, EMBASE, etc.) and registration databases (e.g., ISRCTN, CHICTR, etc.) were checked to screen RCTs and systematic reviews of physical activity interventions in AD. Then extract and review the intervention methods and their evaluation results in the included studies. Spearman correlation method was used to test the association between the mean difference (MD) of intervention results and activity time. The Hedges’g method was used to combine continuous data to analyze the standard MD (SMD) of different intervention types or time subgroups. The overall results show that physical activity intervention can improve the cognition, neuropsychiatric symptoms and quality of life (Qol) of AD patients, but the duration of the intervention significantly affected the outcome of the assessment. Subgroup analysis results showed that an intervention duration of 2–5 months had a significant advantage: cognitive function (Minimum Mental State Examination: SMD = 0.47, 95% CI = 0.33 ∼ 0.61, P < 0.01), neuropsychiatric symptoms (Neuropsychiatric Inventory: SMD = −0.48, 95% CI = −0.85 ∼−0.11, P < 0.01), and quality of life (Qol-AD: SMD = 0.47, 95% CI = 0.23 ∼ 0.71, P < 0.01). The systematic review and analysis results of updated RCTs suggested that short-term (2–5 months) physical activity interventions were more beneficial in improving cognitive function, neuropsychiatric symptoms and Qol in patients with AD. And there was no evidence of differences in the effectiveness of different physical activity interventions.

BackgroundCurrently, few studies have explored the heterogeneity of symptoms and functions in patients with breast cancer. This study aimed to identify the subgroups of symptoms and functions in women receiving chemotherapy for breast cancer and determine whether the subgroups differed in demographic and clinical characteristics.MethodsA cross-sectional multicenter survey involving five hospitals in Zhejiang, Shanghai, Shandong, and Guangxi provinces of Mainland China was implemented between August 2020 to December 2021. Participants completed questionnaires that included the PROMIS-57, PROMIS cognitive function short form, and demographic and clinical characteristics. Latent class analysis was performed, followed by chi-square test and analysis of variance. Subsequently, significant variables were included in multinomial logistic regression.ResultsA total of 1,180 patients were investigated, with an average age of 48.9 years. Three classes were identified: low symptom burdens and functions group (26.2%, Class 1), moderate symptom burdens and functions group (16.9%, Class 2), and low symptom burdens and high functions group (56.9%, Class 3). Compared with patients in Class 1 and 3, those in Class 2 consistently showed a higher tendency of having urban employee health insurance (odds ratio = 2.506, P < 0.05) and rural health insurance (odds ratio = 2.207, P < 0.05). Additionally, patients in Class 2 tended to be in their fourth cycle of chemotherapy. However, receiving chemotherapy and surgery increased the likelihood of belonging to Class 1.ConclusionsA high proportion of patients experienced varying degrees of symptom and function issues, suggesting that attention is warranted for women with breast cancer undergoing chemotherapy. Patients with the urban employee basic medical system, the new rural cooperative medical system and in the early stage of chemotherapy cycles were more likely to have symptom burdens. Middle-aged postmenopausal women reported varying degrees of cognitive issues. Additionally, surgery increased the presence of potential long-term effects in functional levels.

This article reviews the application of patient-reported outcome measures in symptom measurement, quality of life measurement, adverse event reporting and clinical decision-making in breast cancer patients, so as to provide a reference for the application and development of related measures.

Retrograde ejaculation (RE), known as one of the late complications of diabetes mellitus, is rarely a presenting symptom in the diagnosis of diabetes. A 30-year-old male presented with a progressive decline in ejaculate over 2-month. Lab results revealed a high random blood glucose level (425 mg/dL). A substantial number of sperm were found in the post-ejaculate urine specimens, confirming a diagnosis of RE. Further lab tests revealed an hemoglobin-A1c (HbA1c) of 12.7%, with negative results for antibodies to glutamic acid decarboxylase, insulin antigen-2, insulin receptor and islet cell, consistent with a diagnosis of type 2 diabetes mellitus (T2DM). Insulin glargine and oral anti-hyperglycemic agents were initiated. Also, imipramine and pseudoephedrine were prescribed for 4-week and then discontinued, as no positive effect on ejaculation was seen. At the 36-month follow-up, the patient had a normal glucose level with HbA1c <6.5%. However, RE persisted. RE is commonly seen as a late-stage complication among T2DM. We presented a rare case where RE was the first referred symptom of T2DM and RE persisted even after adequate control of glycemia.

阿尔茨海默病会导致记忆认知下降,但早期精准诊断不容易.随着神经影像数据的不断丰富,遗传学、生物化学等学科的进步为多维度研究阿尔兹海默(Alzheimer disease,AD)成为可能.不断演变进步的机器学习和深度学习算法,克服了神经影像维度高,样本量少的缺点,为临床智能无创诊断提供了先进的模型.本文回顾基于磁共振影像的深度学习方法与策略在轻度认知功能障碍和AD早期智能诊断的应用研究,文献表明改进磁共振深度学习策略有助于提高预测AD亚型的准确率,未来的研究需要同质性地比较智能诊断与基于传统生化检测诊断或病理诊断的敏感性与特异性,为临床早筛早干预提供参考.

目的 探讨网约护士对"互联网+"PICC居家护理服务质量评价的认知,为构建"互联网+"PICC居家护理服务质量评价指标体系提供参考.方法 采用质性研究中的现象学研究方法,基于"结构-过程-结果"三维质量模式理论,对10例护士进行深度访谈.结果 共提炼出与"互联网+"PICC居家护理服务中结构质量评价相关的主题有,网约护士服务能力与资质认证、互联网平台系统管理和居家护理用品配备;与过程质量评价相关的主题有,护理服务前有效沟通、护理服务操作规范、感染预防控制和健康教育指导;与结果质量评价相关的主题有,PICC并发症早期识别、患者/家属满意度和网约护士满意度.结论 通过质性研究初步形成了"互联网+"PICC居家护理服务质量评价的相关主题,可作为下一步构建"互联网+"PICC居家护理服务质量评价指标体系的参考依据.

Aim: There is currently no consensus on the best risk assessment technique for predicting complications after hip surgery in the elderly, which is hindering the accuracy of surgical risk assessment. The goal of this study was to build a risk assessment model and evaluate its predictive value using the modified frailty index (5-mFI) and the prognostic nutritional index (PNI). Methods: A retrospective investigation was undertaken on 150 patients (aged >= 60 years) who had hip fracture surgery. Using univariate and multivariate logistic regression models, the relationship between combined 5-mFI and PNI and the evaluation of postoperative unfavorable outcomes such as infection and unscheduled intensive care unit (ICU) admission was investigated. Finally, utilizing receiver operating characteristic (ROC) curve analysis, the model's predictive value for adverse outcomes following hip fracture surgery in elderly patients was assessed. Results: Univariate and multivariate logistic analyses revealed that preoperative PNI, 5-mFI, ASA, and gender acted as independent predictors of adverse outcomes after hip fracture surgery in the elderly. According to the ROC curve analysis, the predictive model demonstrated a high predictive value for total postoperative complications (AUC: 0.788; 95%CI: 0.715-0.860; p<0.01), infectious complications (AUC: 0.798; 95% CI: 0.727-0.868; P<0.001), and unplanned ICU admission (AUC: 0.783; 95% CI: 0.705-0.861; P<0.001). Conclusions: The multivariable evaluation model, which included 5-mFI and PNI, showed a high predictive value and can hence be applied to predict the adverse outcomes in elderly patients undergoing hip fracture surgery.

目的:提出一种面向医学宣教长文本的多分类方法,提高管理人员的数据管理效率.方法:采用ALBERT预训练模型对宣教内容进行编码,然后利用多尺度金字塔卷积神经网络提取和学习长文本宣教内容的深层语义特征,最后输出多分类结果.结果:ALBERT预训练模型具有较高的分类精确率,达到93.56％,召回率与F1值分别为91.29％和92.22％,构建了带科室标注的宣教内容数据集,利用诊断名称对数据集进行样本增强,增加了模型的鲁棒性.结论:结合深度学习的宣教内容分类系统提供了准确的科室分类结果,具有实际的应用价值.

Participants Competent resident doctor were expected to help the patients, advance medical knowledge, and promote public health. The time and effort necessary for residents to devote to standarized training is extensive. Anxiety and depression can negatively affect professional development and work efficacy. The study aimed to assess the psychosocial effects of the hospital reappraisal during the post-pandemic era of COVID-19 and analyze potential risk factors leading to their symptoms of anxiety and depression. Method In March 2021, the “Questionnaire Star” electronic questionnaire system was used to collect data. A total of 96 resident doctors from the affiliated hospital of the medical school of Ningbo University were invited to complete the questionnaires. Results According to our study, the prevalence of symptoms of anxiety and depression in the resident doctors in the institution was 61.5 and 59.4%, respectively. The residents who were worried about clinical skills tend to have anxiety symptoms under online education (OR = 3.436, 95%CI: 1.122–10.526). Compared with participants who were assigned by other hospitals, social trainees (OR: 7.579, 95%CI: 1.747–32.885), and full-time masters (OR: 5.448, 95% CI: 1.586–18.722) were more likely to have anxiety symptoms. Participants without a labor contract (OR = 3.257, 95% CI: 1.052–10.101) had a high risk of depression symptoms. Participants who spent more time learning the details prepared for the tertiary hospital reappraisal were significantly more likely to develop anxiety and depressive symptoms. Conclusion This study suggested that the tertiary hospital reappraisal program has an impact on the high incidence of anxiety and depression of the young resident doctors during the post-pandemic era of the COVID-19 in Ningbo.

目前,全球约有350万患者接受维持性血液透析(MHD)治疗,因并发高血压、糖尿病、高脂血症及心血管疾病等多种并发症而易引起认知功能障碍[1].研究显示,认知功能障碍发生率在MHD患者中高达87.3％,其中有37.3％为重度认知损害[2].我国研究报道,MHD患者认知功能障碍的发病率为33.6％[3].

目的 探讨动态对比增强磁共振(DCE-MRI)无创评估剖腹阑尾切除小鼠的血脑屏障(BBB)通透性改变.方法 采用D-gal药物催老小鼠的模型,将小鼠随机分为老年手术组、老年对照组、青年手术组和青年对照组行剖腹阑尾切除术.采用反转式Morris水迷宫和新物体实验观察小鼠围术期认知的改变,采集动态对比增强磁共振成像(DCE-MRI),测量Ktrans值变化,并和小鼠海马的荧光素钠渗透率进行相关性分析,最后用电镜观察验证血脑屏障破坏情况.结果 与青年小鼠和对照组小鼠相比,老年小鼠仅术后第2天出现水迷宫潜伏期显著延长,各组小鼠术后第7天新物体分辨指数差异无统计学意义(P=0.68);磁共振提示Ktrans值术后短期增加,术后第2天与第7天Ktrans与荧光素钠渗出相关系数分别为0.984和0.825.结论 老年小鼠阑尾手术后认知功能的改变与血脑屏障的恢复相关,MRI能早期无创评估围术期血脑屏障的改变.

目的 为国内癌症患者提供简便有效的身体活动能力自评量表.方法 对患者报告结局测量信息系统(PROMIS)身体功能简表6b进行翻译和文化调适,形成中文版PROMIS身体功能简表6b;对240例癌症患者进行调查,检验简表的测量学属性.结果 中文版PROMIS身体功能简表6b为6个条目的 单维度结构,验证性因子分析,x2/df=2.260,CFI=0.983,TLI=0.971,SRMR =0.029,RMSEA =0.072;效标效度为rs=0.668,P＜0.01;条目间最大标准化残差矩阵-0.349～0.184,Rasch分析模型单维度解释量为80.8％,各条目与总分相关系数为0.71～0.89,受试者信度为0.86,条目难度分布不存在重合;内部一致性Cronbach's α系数=0.892;被试者填表时间1.0～1.5 min.结论 中文版PROMIS身体功能简表6b具有良好结构效度、内容效度、受试者信度及效标效度,条目难度分布合理,内部一致性信度良好,答题便捷;可用于国内癌症患者身体活动能力自评.

维持性血液透析(MHD)是终末期肾病(ESRD)患者主要的肾脏替代治疗方式[1],但由于并发症较多,患者的生活质量和心理弹性明显低于普通人群的平均水平,尤其是女性患者[2].本研究旨在通过质性研究,探究女性MHD患者适应轨迹,深入了解其身心变化过程,构建其理论模型.报道如下.

Background: The Patient-Reported Outcomes Measurement Information System (PROMIS) has been proven to be an effective and efficient measurement tool and has entered its global promotion phase. Our research team was authorized by the PROMIS Health Organization to translate five adult Patient-Reported Outcomes Measurement Information System (PROMIS) physical function short forms (4a, 6b, 8b, 8c, and 8c 7-Day) to ensure the conceptual and semantical equivalence to the source and pretest them in a Chinese population for cultural adaptation. Methods: The translation was conducted following the Functional Assessment of Chronic Illness Therapy (FACIT) methodology, which mainly includes forward translation, reconciliation, back-translation, expert reviews, cognitive testing, and linguistic validation, etc. And cognitive interview was used to pretest the translated items in Chinese patients with cancer and a healthy population. Results: The translation process was relatively smooth, except for some translated versions that slightly altered some word choices or sentence structures. Subsequent pre-testing of the Simplified Chinese short forms showed that clarifying or laying emphasis on the time frame in the instructions was needful, and two sets of response categories and one item stem needed some slight revisions due to cultural or language discrepancies. Conclusion: The translation and linguistic validation of five adult PROMIS physical function short forms into Simplified Chinese have been completed, and field testing, calibration, and psychometric testing are pending.