OBJECTIVE:To systematically review and analyze the effects of Internet-based cognitive behavioral therapy (ICBT) on physical, psychological, and daily life outcomes in patients with breast cancer. METHODS:Relevant studies were retrieved from Wanfang, CBM, CNKI, CINAHL, PsycINFO, Web of Science, The Cochrane Central Register of Controlled Trials, Embase and PubMed from inception to December 2023. Two independent authors conducted the literature search and data extraction. The Cochrane bias risk assessment tool was used to evaluate the included studies for methodological quality, and the data analysis was performed using Stata (Version 15.0). RESULTS:Among 700 records, 11 randomized controlled trials were identified in this study. The meta-analysis showed statistically significant effects of ICBT on depression (standardized mean difference (SMD) = -0.38, 95% confidence interval (CI): -0.70 to -0.06, P = .019) and insomnia severity (SMD = -0.71, 95% CI: -1.24 to -0.19, P = .008). However, there were no statistically significant effects on anxiety, fatigue, sleep quality and quality of life. CONCLUSIONS:ICBT appears to be effective for improving depression and reducing insomnia severity in patients with breast cancer, but the effects on anxiety, fatigue, sleep quality and quality of life are non-significant. This low-cost treatment needs to be further investigated. More randomized controlled trials with a larger sample size, strict study design and multiple follow-ups are required to determine the effects of ICBT on patients with breast cancer.

目的 探讨家属赋能模式对老年下肢淋巴水肿患者居家维持期治疗效果的影响.方法 便利选取在南京医科大学附属苏州医院门诊接受综合消肿治疗的盆腔肿瘤术后淋巴水肿的老年患者作为研究对象.以2020年1-12月接受治疗的32例患者为对照组,以2021年1-12月接受治疗的42例患者为观察组.对照组接受常规护理,观察组在常规护理的基础上对家属进行赋能干预,比较两组患者居家维持期治疗3个月及12个月时的自我照护能力、自我照护依从性及淋巴水肿程度.结果 居家维持期的第3、12个月,观察组患者掌握淋巴水肿知识、手法淋巴引流、功能锻炼的正确率均高于对照组,观察组患者自我照护依从性优于对照组,差异均有统计学意义(P<0.05);但两组患者随访12个月时的自我照护依从性均低于3个月时,差异有统计学意义(P<0.05).最初完成门诊治疗时,两组患者淋巴水肿程度均得到有效缓解,差异无统计学意义(P>0.05);在居家维持期,观察组患者水肿程度明显轻于对照组,差异有统计学意义(P<0.05).结论 家属赋能模式有效提高了老年下肢淋巴水肿患者的居家自我照护能力,减轻了其淋巴水肿程度,有助于改善患者临床结局.

总结1例宫颈癌术后双下肢Ⅲ期合并下腹部及外阴部Ⅱ期淋巴水肿患者进行改良式综合消肿治疗的护理经验.治疗期护理要点包括进行皮肤护理,预防和减少感染;改良手法淋巴引流联合空气波压力治疗仪,促进淋巴液定向流动;采用多种方法进行压力包扎,维持消肿效果;制订个体化的饮食及运动管理方案,科学减重.维持期护理要点包括结合凯格尔训练编制自我淋巴引流操,提高锻炼依从性;多学科协作进行随访管理,激发患者自我照护潜能.经过9个月的精心治疗及护理,患者双下肢各部位周径缩小了2.0～14.2 cm,下腹部及会阴部肿胀感消失,BMI降至正常水平.

目的 分析国内外慢性便秘患者结肠镜检查肠道准备领域研究现状、热点及发展趋势.方法 系统检索中国生物医学文献数据库(CBM)、中国知网(CNKI)、万方数据库(WanFang)、维普生物医学期刊数据库(VIP)、PubMed、Web of Science和Cochrane Library数据库建库至2020年8月收录的有关慢性便秘患者结肠镜检查肠道准备的相关文献,分析收集文献的发表年份、文献期刊、作者单位、地区分布、基金资助、关键词分析、文献类型、研究内容、评估工具和指标等,利用Note express、Excel进行文献计量分析.结果 共纳入143篇文献;2011年起慢性便秘患者结肠镜检查肠道准备相关文献量呈显著增长;143篇文献发表于100种期刊上,作者单位主要为医院,广东、陕西、江苏等地区发文较多;共有18篇(12.59％)研究受科研基金支持;该领域关键词集中分布在便秘、结肠镜检查、肠道准备、复方聚乙二醇电解质散、老年人等方面;研究内容主要包括口服导泻药物联合不同肠道清洁手段的效果分析、不同清洁灌肠剂的选择、肠道清洁剂给药方式及给药时机的选择、结肠镜检查前饮食准备等方面;评估工具主要是波士顿肠道准备量表.结论 便秘患者结肠镜检查前肠道准备研究已受国内外学者关注,但存在研究水平较低、地域分布不均、投入资金少等问题,部分研究结果尚未达成共识,仍需进一步深入探讨.

目的:探讨培养护理骨干人才的有效方法和途径。方法:制定护理骨干人才库的选拔条件、培养模式、考评机制等，选拔护理骨干人才，均以承担护理单元总带教工作并完成相应任务的形式进行培养。在为期3年的培养期间，针对培养要求完成了理论、实践的定向培训，期满后进行考核验收，并根据考核结果修订后续培养方案。结果:2015年2月选拔了48名护理骨干人才，考核结果显示，除1人因个人原因退出外，其他均以综合考评得分≥925分的优异成绩期满出库，并在临床、教学、科研、管理、专科等方面表现突出，提高了骨干护士工作满意度，差异有统计学意义( P<0.05)。 结论:护理总带教任职制骨干培养模式，为骨干人才提供了进步阶梯，明确了努力方向，激发了进取动力，为培养新时期具有综合素养的护理人才提供了新的模式。

新型冠状病毒肺炎疫情的突然爆发给综合医院的护理管理工作带来了严峻挑战.苏州市某三级甲等医院综合护理部充分发挥其职能作用,通过科学化规范落实、可持续调配支援、苏城码精准防控、楼长制督查工作、信息化及时培训、人性化全面保障等,保证了护理工作的正常有序进行,对医院系统的正常循环起到了有力地促进作用.

目的 探讨疼痛专科质量指标在中度疼痛患者管理中的应用效果.方法 选取南京医科大学附属苏州医院2017年3月至6月份尚未实施疼痛专科质量指标前,中度以上疼痛住院患者208例为对照组;2017年7月至10月份实施疼痛专科质量指标后,中度以上疼痛住院患者234例作为观察组.比较疼痛专科质量指标实施前后2组患者疼痛评分正确率、疼痛描述正确率、复评时间正确率、止痛药物不良反应反馈率.结果 疼痛专科质量指标实施后,观察组患者疼痛评分正确率(93.59％)、疼痛描述正确率(91.03％)、复评时间正确率(94.02％)、止痛药物不良反应反馈率(90.17％)均高于对照组患者(85.58％、80.77％、87.02％、80.29％),差异均有统计学意义(均P<0.05).结论 疼痛专科质量指标的建立与实施,能规范护理人员疼痛护理措施,提高疼痛护理质量和疼痛护理的管理水平.

目的 探讨恶性肿瘤患者生活质量与心理痛苦的相关性.方法 采用一般资料调查表、心理痛苦筛查工具和EORTC生命质量测定量表QLQ-C30(V3.0)对苏州市4所三级医院的681例恶性肿瘤患者进行研究.结果 恶性肿瘤患者心理痛苦得分为(3.11±2.41)分,其中无痛苦118(17.33％)例,轻度痛苦307(45.08％)例,中度痛苦195(28.63％)例,重度痛苦56(8.22％)例,极重度痛苦9(1.32％)例.躯体功能、情绪功能、角色功能、认知功能、社会功能和总体健康状况与心理痛苦分级呈负相关(P<0.01),症状领域、气促、失眠、食欲丧失、便秘、腹泻、经济困难方面与心理痛苦分级呈正相关(P<0.01).Logistic回归分析显示情绪功能、总体健康状况和失眠是心理痛苦的独立影响因素.结论 恶性肿瘤患者的生活质量与心理痛苦程度相关,可以通过对其生活质量各方面进行干预以减轻患者的心理痛苦.

目的 评价多学科团队协作模式对乳腺癌内分泌治疗服药依从性的影响.方法 将106例符合内分泌治疗的乳腺癌患者,随机分成干预组54例和对照组52例,对照组失访2例.2组患者在首次服药时均给予常规护理教育,干预组患者同时引入多学科团队(MDT),评价比较在内分泌治疗期间两组患者的服药依从性.结果 乳腺癌内分泌治疗服药依从性逐年下降(P＜0.05);干预组依从性及服药信念均高于对照组(P＜0.05).结论 乳腺癌内分泌治疗加入多学科团队,可提高患者的依从性,改善疗效.

Objective To investigate the prevalence and specific manifestations of enduring psychological distress in patients with breast cancer after operation. Methods Totally 263 patients of the newly diagnosed breast cancer treated with the operation from August 2014 to August 2015 were collected by convenience sampling. Distress Thermometer (DT) and Problem List recommended by national Comprehensive Cancer Network was used to assess the persistent psychological distresses in the 6th, 15th, 20th, 25th, 30th months after the disease diagnosis,while a self-designed questionnaire was for the demographic data. Results The results of the DT screening showed that 16％(42/263) patients had persistent psychological problems;the incidences of five stages of significant psychological distress (DT≥4) was 43％(113/263), 34％(89/263), 31％(81/263), 28％ (73/263) and 25％ (65/263), respectively. The main manifestations of persistent psychological distress were:fatigue 59 cases (22.4％) , sleep disorders 51 cases (19.4％), nervous 48 cases (18.2％), anxiety 24 cases (9.1％), fear of appearance 23 cases (8.7％) and the difference in persistent psychological distress scores between different demographic characteristics (age, educational level, marital status, economic situation, operation method, disease stage) were statistically significant (t=-2.295-2.966, P<0.05). Conclusion The incidences of persistent psychological distress in patients with breast cancer is higher and the manifestation is different,which should be paid attention to by medical workers.

目的 研究临床护理路径(CNP)在规范外周中心静脉导管(PICC)肿瘤患者护理中的效用.方法 选择2016年1～12月本科进行化疗,并且接受PICC置管护理的肿瘤患者90例.按照单双数排列将90例分为CNP组和对照组,每组45例.对照组采用常规的PICC置管护理方法进行护理,在护理过程中根据医嘱进行穿刺并遵循穿刺以后的护理要点进行操作;CNP组患者在入院置管后,使用临床护理路径,根据预先定制好的临床护理路径单进行护理.结果 CNP组的并发症明显低于对照组(P＜0.05);留置成功率和留置时间都要优于对照组(P＜0.05);CNP组的患者满意度较高(P＜0.05).结论 实施CNP能显著提高PICC留置成功率、留置稳定性,减少并发症发生,提高患者和家属的满意度.

目的：探讨延续性护理对出院后乳腺癌患者的临床价值。方法选择2014年5月至2015年5月收治的乳腺癌患者50例，随机分为实验组和对照组。对照组患者给予常规护理，实验组患者实施延续性护理。结果实验组患者护理后SAS评分与SDA评分显著低于对照组(均P<0.05)。实验组患者护理后生命质量的5个维度得分及总分均高于对照组(均 P<0.05)；实验组患者对护理的总体满意度显著高于对照组患者( P<0.05)。结论延续性护理可显著缓解乳腺癌出院患者的负面情绪，提高生活质量，是一种值得推广的护理方法。

目的：探讨集束化干预对肿瘤患者耐高压双腔PICC导管堵管的预防作用。方法选择2013年1月~2014年7月集束化策略干预前置双腔耐高压PICC导管的肿瘤患者32例,2014年8月~2015年5月开展集束干预策略后置双腔耐高压PICC导管肿瘤患者36例,比较集束干预前后双腔耐高压PICC堵管发生率差异。结果集束策略干预前堵管率为40.63%,集束策略干预后堵管率降至16.67%,两组比较差异有统计学意义( P<0.05)。结论实施集束干预策略能有效减少耐高压双腔PICC堵管的发生。

Objective To analysis the causes and preventive measures of acquired pressure ulcers in hospitalized patients, and to provide evidences and references for strengthening hospital management of pressure ulcers.Methods We took a retrospective study to collect relevant information of 201 patients with hospital-acquired pressure ulcers from January 2012 to December 2014, and conducted a descriptive statistical analysis on the cause of the developed, high-risk departments and high-risk areas, then came up with preventive suggestions.Results The high incidence of 201 hospital-acquired pressure ulcers was oncology department, which accounted for 33.83%;the most common part was the sacrococcygeal region, which accounted for 59.2%;stage II was the most common stage of pressure ulcer, which accounted for 76. 12%; 64. 67% of the pressure ulcers happens within the first two weeks in hospital. Braden scoring less than 12 points that accounted for 58. 21%;anemia accounted for 72. 14%; hypoalbuminemia accounted for 75. 62%; forced postures caused by pain or hydrothorax and ascite accounted for 26.87%; medical equipment pressure accounted for 10.95%. The use of vacuum pad accounted for 87.56%;turning over once every 2 hours accounted for 41.79%. Skin nursing according to the guide accounted for 62. 19%; nutritional support through the mouth or vein accounted for 38.81%. Reporting to the nursing department timely after the occurrence accounted for 95.52%; found in ward rounds accounted for 1.99%; reported by patients or their families accounted for 1.49%; failure to report and found in the medical records accounted for 1.00%,the patient or family members to report accounted for 1.49%. Conclusions Cancer patients are high-risk groups of nosocomial pressure ulcers. The sacrococcygeal region is the high-risk area;stage II is the most common stage, and most of them happens within the first 2 weeks in hospital. Main reasons are hypoalbuminemia, anemia, forced postures, unable to turn over periodically, and the preventive care implementation is not enough. For cancer patients, preventive care is recommended, especially those patients with cancer pain, malnutrition and forced postures.

Objective:To probe into the influence of “life boat club”health education on the quality of life of pa-tients with breast cancer and their spouses.Methods:A total of 100 breast cancer patients who underwent modi-fied radical mastectomy and their spouse were randomly divided into intervention group and control group with 50 cases each.Patients in intervention group were involved in the “life boat club”.Cases in control group re-ceived routine nursing care.At 1st month,3rd month,6th month after surgery and before admission of chemo-therapy,their quality of life was measured.Results:After the intervention,quality of life score,physiological sta-tus,functional status scores of breast cancer patients in intervention group were higher than that in control group from the beginning 1 months after operation (P<0.05).The scores of social/family status,emotional sta-tus,additional status were higher than that in control group from 3 months after the operation(P<0.05).The qual-ity of life score and all dimensions scores changed with the score of intervention time.And there was interaction between the way of intervention and intervention time.The physiological health score of spouse was higher than that in control group from the third months after operation(P<0.05).Mental health score was higher than that in control group from the first month after operation(P<0.05).The physiological function of quality of life and mental health score were higher than the control group from the first month after operation(P<0.05).The vitality,so-cial function and emotional function were higher than that in control group from third month after surgery(P<0.05).The physiological function and general health were higher than that in control group from 6 months after operation(P<0.05 ).Two areas and dimensions (except social function)scores with the intervention time change,(in addition to physical pain)showed the interaction between intervention and intervention time.Conclu-sion:“Life boat club”model of health education for breast cancer patients and their families can arouse the psy-chological potential,improve their quality of life,build friendship type of doctor patient interaction.

目的：探讨不同时机预测量无瓣膜PICC置管长度对提高导管尖端一次到位率的影响。方法选择2014年1－12月在我院肿瘤内科行无瓣膜双腔耐高压PICC置管患者114例，随机分为对照组和观察组，对照组采用穿刺前测量置管长度，观察组采用穿刺成功顺利放入导丝后测量置管长度。比较两组患者PICC导管尖端一次到位率。结果观察组PICC导管尖端一次到位率为91．23％，高于对照组的77．19％，P＜0．05，差异有统计学意义。结论采用穿刺成功后预测量无瓣膜PICC置管长度的测量方法，可以提高导管尖端一次到位率，延长了导管留置时间，提高了置管的安全性，值得临床推广应用。

目的 探讨综合护理对维持性血液透析患者焦虑、抑郁水平及治疗依从性的影响.方法 选取104例维持性血液透析患者随机分为干预组和对照组,分别给予综合护理干预和常规护理,比较两组患者护理干预前后焦虑、抑郁水平,治疗依从性.结果 干预组患者SAS、SDS评分较对照组患者显著降低,干预组患者干预后治疗依从率为98.08％,对照组患者为86.54％.干预组治疗依从性较对照组好,分别为71.15％、34.62％.差异均具有统计学意义(P＜0.05).结论 综合护理干预可有效改善维持性血液透析患者焦虑、抑郁状况,提高患者治疗的依从性,值得进一步在临床上推广.

Objective to investigate patients with head and neck cancer radiotherapy the comfortable degree in the process of the status quo and analyze its influencing factors .Methods the medical coping questionnaire ,social support rat‐ing scale and degree of patients with head and neck cancer radiotherapy comfortable scale ,Our department of 363 routine ra‐diotherapy of head and neck cancer patients .Results patients during radiotherapy for head and neck cancer overall comfort level score (61 .65-9 .43) .Age ,cultural level ,family income ,chemotherapy ,families with disease ,hypertension ,diabetes and so on are the factors affect patients with neck tumor radiotherapy comfort ,compare the difference was statistically sig‐nificant (P < 0 .05) .Social support and overall comfort levels were positively correlated (P < 0 .05) ,coping styles of yield ,to escape and negatively correlated with the overall comfort level (P < 0 .05) ,all have statistical significance .Accom‐panied by diabetes and ,yield response to chemotherapy ,radiation therapy ,the number is negative factors .Conclusion nursing work should be strengthened to the low degree of culture ,no family member accompany the middle ,with high blood pressure ,diabetes ,radiotherapy and chemotherapy of patients with head and neck cancer at the same time the comfortable nursing during radiation therapy ,to encourage patients to take active coping styles ,effective utilization of social support .

目的：探讨知信行模式干预加强护士对重症监护病房IC U综合征管理的影响。方法（1）对我院重症监护病房40名护士进行相关知识教育、信念培养和行为指导的干预，比较干预前后护士对IC U综合征知识的掌握和认知情况。（2）将2014年6月－2015年3月入住我院IC U的218例患者按入住IC U时间先后分为干预前和干预后，比较干预前后患者IC U综合征的发生率。结果干预后护士对IC U 综合征知识的掌握程度和认知程度均有提高（P＜0．05）。干预后患者ICU综合征的发生率显著低于干预前（P＜0．05）。结论知信行模式干预能够提高IC U护士对相关知识的认知、改善其对IC U综合征的信念、态度和行为水平，降低患者IC U综合征的发生率。

[目的]探讨长期使用抗凝药物及血小板极低的恶性肿瘤病人在使用超声引导下结合改良Seldinger技术行经外周静脉穿刺中心静脉置管(PICC)的应用,总结有效的预防护理措施.[方法]3例长期使用抗凝药物及血小板极低病人在使用药物前进行详细评估,选择在超声引导下结合改良塞丁格技术行PICC,并给予有效的预防并发症的护理措施.[结果]1例病人在插管时异位与腋静脉,在DSA室一次复位成功;2例一次置管成功,置管后进行有效护理,均未发生并发症.[结论]对于长期使用抗凝药物及血小板极低的恶性肿瘤病人使用超声引导下结合改良塞丁格技术行PICC置管最适宜,为病人开通了安全的静脉通路,并发症相比盲穿PICC置管明显少.