Objective:To systematically evaluate the qualitative studies on the decision dilemma of blood glucose management during pregnancy in patients with gestational diabetes mellitus, so as to provide reference for the subsequent formulation of intervention strategies.Methods:The qualitative studies on the decision dilemma of blood glucose management during pregnancy in patients with gestational diabetes mellitus in the Cochrane Library, CINAHL, EMbase, PubMed, PsycINFO, ProQuest, Web of Science, China National Knowledge Internet, Wanfang, VIP and Chinese Biomedical Database were searched from inception to May 2022. The JBI Critical Appraisal Tool for qualitative studies in Australia (2016) was used to evaluate the literature quality, and research results were summarized and integrated by integrating methods.Results:A total of 13 studies were included, 56 themes were extracted, and they were summarized into 9 categories, forming 3 integrated results as following, lack of personalized and professional information on blood glucose management, worring about the influence of blood glucose management on the health of mothers and children, conflict between daily life and blood glucose management plan.Conclusions:Health care workers should provide gestational diabetes mellitus patients with adequate personalized professional information support on blood glucose management to facilitate scientific decision-making during pregnancy, and also analyze the benefits and risks of different decisions for patients to help them make the best decision and strengthen their external support system to help them implement blood glucose management decisions.

目的:探讨宫颈癌患者灵性健康的现状,了解宫颈癌症患者灵性健康和生命质量相关性.方法:采用一般资料问卷,慢性病治疗功能评估-灵性量表-12(FACIT-Sp-12),宫颈癌生活质量评价量表(FACT-Cx);于2019年3～12月对湖南省某两所三级甲等医院及一所专科性医院住院治疗的宫颈癌患者148例经病理诊断为宫颈癌的患者进行问卷调查;采用Pearson相关分析宫颈癌患者灵性健康与生命质量的相关关系结果:生命质量总分(96.18±15.51);灵性健康总分(31.06±8.15);相关分析表明生命质量与灵性健康呈显著正相关.结论:宫颈癌患者灵性健康处于中低水平,年龄、文化水平、家庭收入,婚姻状态是灵性健康的主要影响因素;灵性健康与生活质量呈正相关;临床护理人员应关注低家庭收入,文化水平不高的患者,与患者建立互相信任有效的沟通,有效的评估患者的灵性健康水平,以积极的心态应对疾病,促进灵性健康,从而改善患者的生活质量.

目的 了解乳腺癌化疗患者的赋权水平现状,分析其与自我效能感、感知护理服务质量的相关性.方法 采用便利抽样法,选取2020年6-12月在湖南省人民医院、湖南省肿瘤医院及中国人民解放军联勤保障部队第九二一医院肿瘤科住院的乳腺癌化疗患者303例为研究对象,采用一般资料调查问卷、乳腺癌赋权量表、中文版乳腺癌幸存者自我效能感量表、住院患者感知护理服务质量评价量表对其进行调查.结果 乳腺癌化疗患者的乳腺癌赋权量表得分为(90.38±20.09)分,中文版乳腺癌幸存者自我效能感量表得分为(40.46±9.40)分,住院患者感知护理服务质量评价量表得分为(127.25±15.89)分.单因素分析显示,不同文化程度、有无照护者、家庭成员人均月收入、手术方式的乳腺癌化疗患者赋权水平得分比较,差异有统计学意义(P<0.05).Pearson相关分析显示,乳腺癌化疗患者赋权水平与自我效能感呈正相关(r=0.733,P<0.05),与感知护理服务质量呈正相关(r=0.526,P<0.05).结论 乳腺癌化疗患者赋权水平处于中等水平,且与自我效能感、感知护理服务质量存在相关性,医护人员应采取有针对性的干预措施以提高患者的赋权水平,从而达到控制疾病、管理生活和促进自身健康的目的.

目的 了解乳腺癌术后化疗患者赋权水平现状,并分析其影响因素,为医护人员开展赋权教育提供理论依据.方法 应用横断面研究方法,通过便利抽样法,抽取长沙市某2所三级甲等综合医院和1所专科肿瘤医院住院的350例女性乳腺癌术后化疗患者作为研究对象,采用一般资料问卷、乳腺癌赋权量表(breast cancer empowerment scale,BCES)、乳腺癌幸存者自我效能感量表(breast cancer survivors self-efficacy scale,BCSES)、中文版领悟社会支持量表(Chinese version of perceived social support scale,CV-PSSS)和住院患者感知护理服务质量评价量表对患者进行问卷调查.使用多重线性回归分析法探讨术后化疗患者赋权水平的影响因素.结果 乳腺癌术后化疗患者赋权水平总分为(90.22±20.19)分,处于中等偏高水平,3个维度得分由低至高依次为内在资源的应用、健康管理行为和社会支持的利用.多重线性回归结果表明,合并慢性病(B=-3.804)、自我效能感(B=1.147)、领悟社会支持(B=0.367)和感知护理服务质量(B=0.216)是赋权行为水平的独立影响因素(均P<0.05),共能解释因变量61.1％的变异.结论 乳腺癌术后化疗患者赋权行为尚可,但在外貌以及人生目标、健康管理方面表现为信心不足;合并其他慢性病、自我效能低的患者其赋权行为较差;社会支持、感知护理服务质量越好者其赋权行为越好.医护人员可从患者疾病因素、心理状态、家庭支持等多方面考虑,提供更多专业支持和情感支持,以提高其赋权水平.

目的 系统评价服用益生菌对抑郁症患者抑郁及焦虑情绪的影响.方法 计算机检索PubMed,Cochrane Library,Web of Science,Sinomed,中文知网(CNKI),WanFang,VIP数据库中相关的随机对照试验(RCT),2名研究者独立评价文献质量,采用RevMan5.3软件进行meta分析.结果 共纳入9篇RCT,843例病人.Meta分析结果显示,长期服用益生菌对抑郁症患者的抑郁情绪有改善作用[SMD=-0.88,95％CI(-1.63,-0.13),P=0.02],对抑郁症患者的焦虑情绪有改善作用[MD=-0.79,95％CI(-1.54,-0.04),P=0.04].结论 益生菌可以降低抑郁症患者的抑郁及焦虑情绪.

目的 分析近十年灵性研究的热点,为我国开展灵性研究提供参考.方法 计算机检索2010年1月～2020年7月发表在Web of Science核心合集数据库的灵性研究相关文献,采用可视化分析软件CiteSpaceⅤ对国际护理领域灵性研究类文献进行计量、国家分析、机构分析、被引文献以及关键词分析.结果 共纳入护理学领域灵性研究论文727篇;2010年1月～2020年7月论文数量总体呈增长趋势;以美国为首的西方国家是灵性研究的主要阵地;护士和肿瘤患者是灵性研究的焦点,灵性健康、灵性教育、灵性需求相关领域是近十年研究热点.结论 灵性在国外护理领域研究虽然比较多,但不同机构、不同国家之间缺乏深层次、大规模的学术合作.此外,我国目前仅有台湾一家机构对灵性有较深入的研究,需要研究者在今后探索出适合我国国情的灵性研究,加强不同机构和不同国家间的合作,提高护理质量.

目的 了解医院临床护士组织氛围和知识共享行为现状,并分析二者之间的关系,探讨临床护士组织氛围感知对知识共享行为的影响.方法 采用护理组织氛围感知量表和知识共享行为量表对420名临床护士进行问卷调查.结果 临床护士组织氛围感知总分为(3.01±0.52)分,知识共享行为总分为(2.54±0.78)分;组织氛围感知总分及6个维度得分均与护士知识共享行为总分及各维度得分成正相关,分层回归分析显示组织氛围可独立预测知识共享行为39.4％的变异.结论 医院管理者可从组织层面采取适当的措施,改善临床护士的组织氛围感知,以提高其知识共享行为水平,进而提高护理质量.

目的 探讨健康素养与围生期孕妇的身体健康及心理健康状况的关系,为提高围生期孕妇身体健康及心理健康状况提供参考依据.方法 于2017年6-8月随机抽取长沙市3所综合性三甲医院符合标准的298例门诊围生期孕妇作为研究对象进行调查,发放一般资料问卷、“母婴健康素养测评”问卷、健康状况调查问卷.结果 围生期孕妇健康素养总分为(42.06±12.71)分,其3个维度的得分分别为:健康基本知识与理念(29.22±10.03)分,健康生活方式与行为(7.50±3.06)分,健康基本技能(5.35±2.43)分,均处于低等水平.围生期孕妇身体健康状况的影响因素有职业、怀孕是否担心影响工作、自评健康状况、健康基本知识与理念,差异有统计学意义(P＜0.05);心理健康状况影响因素有文化程度、睡眠质量、夫妻感情、怀孕是否担心影响工作、健康基本知识与理念,差异有统计学意义(P＜0.05).结论 健康素养是影响围生期孕妇身体健康及心理健康状况的重要因素,提高其健康素养水平,有利于促进其身心健康.

[Objective]To investigate the application of Double Column Universal Volar Locking Compression Plates in the treatment of traumatic type C fractures of the distal radius.[Methods]From June 2012 to April 2016,96 patients with traumatic type C (AO type) and closed fractures of the distal radius were studied.The total selected study subjects included 38 cases of sub-type C1,39 cases of sub-type C2 and 19 cases of subtype C3.All type C fractures of the distal radius were treated with Double Column Universal Volar Locking Compression Plates.The parameters were measured with imaging,and the Gartland-Werley Wrist Score was used to assess the operative effect.[Results]All of the patients healed during the follow-up period of 9～36 months (mean 21.36 months).Compared to the status of pre-operation,the parameters of volar tilt angle,ulnar inclination angle and radial shortening-all improved significantly.The postoperative functional excellence rate was 87.5 ％ (84/96).Postoperative complications included 10 cases of wrist pain tenderness,5 cases of finger flexion and extension restriction,4 cases of osteoarthritis and 2 cases of flexor tendon adhesion.There were no internal fixation failures,tendon raptures or nerve injuries.[Conclusion]Using the Double Column Universal Volar Locking Compression Plates in treatment of type C distal radius fractures has bettered the height of radius,reinforced fixative effects,decreased instances of complications,and allows for successful postoperative functional recovery.

Objective To evaluate the clinical efficacy and safty of the olecranon osteotomy approach and the bilateral triceps brachii surgical approach for the treatment of type C humeral condylar fractures. Methods Pubmed, CochraneLibrary, SpringerLink, VIP, Wanfang, CNKI database were searched from inception to May 1, 2017 for published trails of C type humeral condylar fracture patients , who were operated with olecranon osteomy incision or bilateral triceps brachii incision ,on the basis of strict inclusion and exclusion criteria.The relevant data were extracted , and analyzed with Review Manager 5.3. Results 12 studies were incorporated.Meta-analysis results showed that there was no statistically significant difference on the total elbow scores in the two kinds of surgical approaches [RR =0.90,95%CI(0.75, 1.08), I 2 =72%,P =0.26]. There was a statistically significant differnce on surgical time [MD =-18.59,95%CI( -35.42, -1.76) I 2 =97%,P =0.03].There was no statistically significant difference on postoperative complications [RR =1.13, 95%CI(0.61,2.10), I 2 =60%,P =0.69].There was statistically significant difference on the amount of bleeding[MD =-22.08,95%CI( -41.92, -2.24), I 2 =86%,P =0.03]. Conclusions There are obvi-ous advantages of the oclecranon osteotomy approach in the treatment of C type humeral condylar fractures .

从应用进展和形式、开展模式、应用特点、应用影响等方面综述微信在健康教育中的应用进展，指出微信可全面实现健康教育个体化和点对点传播，将改变目前的健康教育形态，给健康教育带来新的生机与活力，今后可以通过建立和完善健康管理数据库，针对不同疾病提出相应健康监测和评价标准，提供个性化的健康服务，充分利用微信订阅号功能，向群众普及疾病预防常识。

[目的]探讨实习护生的主观幸福感、自我效能感及应对方式的特点及三者之间的关系。[方法]采用幸福感指数量表、一般自我效能量表、特质应对方式量表对135名实习护生进行问卷调查，并运用 SPSS 18.0软件进行统计数据分析。[结果]实习护生主观幸福感总分为9.94分±2.45分，处于中低水平；主观幸福感与一般自我效能感、积极应对方式呈正相关(P<0.05)，与消极应对呈负相关(P<0.05)。[结论]一般自我效能感和积极应对方式是实习护生主观幸福感的主要影响因素。

Objective To explore the influence of gratitude intervention on the level of gratitude and well-being on breast cancer patients receiving chemotherapy. Methods Sixty patients were randomly divided into intervention group (n=30) and control group (n=30). Routine nursing was conducted in control group. In addition to routine nursing, a 4-week gratitude intervention was performed in intervention group. GQ-6 (Gratitude Questionnaire-6) and MUNSH (Memorial University of Newfoundland Scale of Happiness) were applied for the assessment. Results There was statistical significance in the comparison of the level of gratitude and well-being in both groups (P<0.05). Conclusion Gratitude intervention is effective for improving the level of gratitude and well-being of breast cancer patients receiving chemotherapy.

糖尿病足溃疡是糖尿病患者晚期并发症之一［1］，是因糖尿病血管病变和（或）神经病变和感染等因素，导致糖尿病患者足或下肢组织破坏的一种病变。糖尿病足患者往往足部皮肤干燥弹性差，有刺痛麻木感，血运差，感染久治不愈等特点，是现代医学发展的一大难题。负压封闭引流（vacuum sealing drainage，VSD）技术［2］是由裘华德教授于1994年从德国引进、发展并改良，并于2005年6月由我国维斯第公司自主研发成功，是近年发展起来的利用负压治疗创面的有效技术［3］。VSD 技术是用负压封闭引流术材料＋半透膜＋三通接管＋负压吸引器进行负压吸引的技术［4］，其作用原理是以聚乙烯酒精水化泡沫填塞机体皮肤或软组织缺损、感染坏死后形成的创面，充当创面与引流管之间的中介，将传统的点线状引流变为全方位引流；以生物半透膜为全密封性材料，覆盖、封闭整个创面和空隙，同时将引流管与负压源连接是整个与 VSD 材料相接触的创面处于一个全表面封闭负压引流状态，以促进创面、腔隙内的渗液、液化坏死组织及时排出体外；隔绝创面与外坏境之间的感染机会；对与 VSD材料接触面下的毛细血管起拔苗助长的作用，加快创面的肉芽组织均匀整齐的生长；敛合创面及腔隙。我科于2015年5月13日收治一名难治性糖尿病足溃疡患者经 VSD 术治疗后取得良好效果，现报告如下。

目的：对我国治疗性沟通临床护理应用研究文献进行文献计量学分析，以供临床参考。方法应用文献分析法，分析1994-2013年中国期刊全文数据库、万方数据库的所有医药卫生期刊中，有关治疗性沟通临床护理应用的文章，分析类别包括：文献发表年限、收入期刊情况、实施者资质要求、实施对象、实施时间、实施内容、存在的局限。结果共纳入76篇论文，实施领域主要集中在肿瘤、门诊、系统性红斑狼疮、心血管疾病方面；干预次数为3~6次；实施者要求护师以上职称并有一定的工作经验；实施内容大多包括一般性沟通、评估性沟通和治疗性沟通等。存在的问题主要有：干预时间短，样本量不够大，护士沟通能力及技巧有待提高等。结论我国治疗性沟通开始受到重视，但临床护理应用仍不多，应用过程中存在一些局限，有待改进和进一步实践。

[Objective] To explore the efficacy and feasibility of minimally invasive spinal endoscopy through interlaminar approach combined with radiofrequency ablation for the treatment of L 5/S1 protrusion of intervertebral disc .[Methods] Totally 86 patient with L5/S1 protrusion of intervertebral disc treated with minimally invasive spinal endoscopy combined with flexible dipolar-electrode radiofrequency through interlami-nar approach in our hospital from May 2009 to Sept .2012 were analyzed retrospectively .Among them ,51 pa-tients were male and 35 patients were female .Their average age was 51 .2 years(32~69 years) .According to Yeung typing ,11 patients were central type ,and 32 patients were paracentral type ,and 43 patients were lat-eral type .Among these patients ,there were 12 patients with calcification and 33 patients with free nucleus pulposus .According to the MRI results ,all of free nucleus pulposuses were on one side of vertebral canal ,and 23 nucleus pulposuses moved towards caudal vertebral canal ,and 10 nucleus pulposuses moved towards the head of vertebral canal .Among 33 patients ,free nucleus pulposuses of 6 patients with huge prolapse reached to posterior border of vertebral canal with an average sacroiliac spacing of 39 .2mm .The clinical symptoms and signs accorded with imaging findings .All patients were followed up for 4~26 months after operation with an average of 15 months .According to Macnab standard ,the efficacy was evaluated .[Results] Three patients changed to open operation ,and 83 patients completed the operation successfully .The excellent rate was 89 .5% .[Conclusion]Suitable patients with L5/S1 protrusion of irtervertebral disc and especially patients with huge protrusion or high iliac crest should be chosen .Minimally invasive spinal endoscopy through interlaminar approach combined with flexible dipolar-electrode radiofrequency ablation is a feasible and better method .

Objective To explore the strategies in health management of clinical nursing staff and to observe the implementation effect.Methods We established a health management mode for nursing staff.The human resource department built physical health profile for each nurse,then health promoting plans for staff were formulated in many sectors and carried out stage-by-stage.Health management measures covered staff′s lifestyle modification,individual behavioral control,group behaviors and environment ma-nagement,physical and lab testing,treatment,and psychological adaptation,etc.Results In the past year,nurses working for the hospital participated averagely 43.3 times per capita in unit-organized exercises,3.2 times per capita in hospital-organized exercises,10.5 times per capita in unit-organized thought communication activities and 3.4 times per capita in hospital-organized thought communication activities.The morbidity rate of nursing staff descended from 22.3% in 2010 to 12.4% in 2011.Staff sickness absence descended from 2 570 working days in 2010 to 1 920 working days in 2011.The turnover rate of nurses also descended from 3.6% of 2010 to 2.2% of 2011.A total of 583 nurses gave higher appraisal to job security,environment support,job change,and self development than before the implementation of health management(all P<0.01).Conclusion Implementation of health ma-nagement could effectively reduce nurses′ health risks,arouse their strong sense of belonging for their affiliation,improve their individual values,strengthen sense of self-realization,and improve work-and-life quality.

目的探讨全方位护理在行脐血源间充质干细胞移植患者中的有效性。方法对81例患者在经蛛网膜下腔注入脐血源间充质干细胞后,根据手术要求制定了一系列的护理计划,包括术前宣教及常规术前准备,术后体位、术后知识宣教、术后密切观察和预防并发症及康复指导等,确保了脐血源间充质干细胞移植的治疗效果。结果对脐血源间充质干细胞移植患者行全方位护理后,干预前后结果有统计学意义(P<0.05)。结论全方位护理可有效提高行脐血源间充质干细胞移植患者的治愈率。

[Objective] To understand the status and influential factors of job satisfaction of army civilian nurses .[Methods]Rousg/Miller special scale for measuring job satisfaction of clinical nurses and questionnaire survey were used for the convenience sampling questionnaire survey of 422 army civilian nurses of 3 first-class ternary hospitals in Guangzhou military command .Job satisfaction and its influential factors were analyzed . MMSS scale was used for the assessment .[Results] The overall scores of job satisfaction of army civilian nur-ses were 72 .63 ± 11 .50 .There were significant differences in job satisfaction such as scheduling ,working con-ditions ,technology development ,policy implementation ,welfare benefits ,participation in decision -making , relationship ,opportunities for interaction with colleagues ,career opportunities ,the praise and recognition , control ,responsibility and so on between army civilian nurses and civilian cadres ( P < 0 .05 or P < 0 .01) .[Conclusion]The overall job satisfaction of civilian nurses is lower than that of civilian cadres ,which suggests that nursing managers should strengthen the attention .

[目的]探讨心理干预对消化道肿瘤患者负性情绪及免疫功能的影响.[方法]将60例消化道肿瘤患者随机分为干预组、对照组各30例,对照组给予常规对症治疗及护理,干预组在常规治疗及护理的基础上给予心理干预.两组患者在治疗前后用焦虑自评量表(SAS)和抑郁自评量表(SDS)进行情绪测试,并于治疗前后测T细胞亚群CD3+、CD4+、CD8+、CD4+/CD8+细胞,分析心理干预对消化道肿瘤患者情绪及免疫功能的影响.[结果]两组患者心理干预前SAS及SDS评分差异无统计学意义(P>0.05),心理干预后,干预组患者SAS、SDS评分较治疗前及对照组同期明显下降(P＜0.01);干预前后两组免疫指标差值比较,差异均无统计学意义(P>0.05).[结论]心理干预,能有效减轻消化道肿瘤患者的心理压力,改善负性情绪.