As the rate of population aging accelerates, the prevalence of stroke among the older population continues to rise. Elderly stroke patients have a high prevalence of neurological impairment, severe clinical manifestations, many associated comorbidities, unfavorable prognosis, prolonged rehabilitation duration, and need extended caregiver support. Elderly stroke patients have challenges in accessing necessary long-term care services due to several circumstances, resulting in notable issues in long-term care. This paper examines the clinical features of elderly stroke patients and presents an overview of long-term care both domestically and internationally. It discusses the current issues surrounding long-term care in our country, focusing on three different forms of care. The paper proposes countermeasures to address these problems, considering the roles of the government, society, medical professionals, institutions, families, and individuals. The aim is to offer guidance for enhancing the quality of long-term care.

This paper analyzed the current research situation of liver transplantation patients at home and abroad，the influencing factors of return to work were analyzed from general demographic factors，physical function，psychological factors，medical factors，social economic and social welfare factors，and the intervention measures were put forward according to the controllable factors.

Background . Stroke is associated with a high number of disability-adjusted life years globally, so long-term care is necessary and important for those survivors, so self-management is becoming a more significant concept in stroke rehabilitation. Methods . Ischemic stroke patients ( n  = 354) were enrolled from the outpatient department of Neurology in West China Hospital from September 2018 to December 2019. The general demographic and disease-related data of stroke patients were collected. The stroke self-efficacy questionnaire (SSEQ), the brief cognition questionnaire (BIPQ), and the stroke self-management scale (SSMS) were used to collect data on self-efficacy, disease cognition, and self-management behavior separately. The chi-square test, Fisher exact test, independent sample t -test, and Mann–Whitney U test were used for comparison among groups. The logistic regression analysis was used to explore the independent risk factors of the different levels of self-management behavior in stroke patients. Results . The score of self-management among Chinese stroke patients was 151.07 ± 18.53. Multivariate analysis showed that the way of paying medical expenses (OR = 3.215, 95% CI (1.130, 7.769)), self-management efficacy (OR = 2.467, 95% CI (1.534, 3.968)), health education before discharge (OR = 2.354, 95% CI (1.457, 3.802)), age (elder) (OR = 2.060, 95% CI (1.265, 3.355)), educational level (OR = 1.869, 95% CI (1.169, 2.988)), and mRS score (OR = 1.850, 95% CI (1.129, 3.031)) were statistically significant ( P   <  0.05). Conclusions . The self-management behavior of Chinese stroke patients was at the middle level. Patients with medical insurance, high self-efficiency of management, and better limb function may have better self-management behavior. Besides, patients with a high educational level who accept health education before discharge may also have better self-management behavior. For patients, it is important to know this disease in the right way and set up the faith to take care of themselves independently gradually. For medical staff, it is necessary and important to give all patients health education about self-management before discharge. It is urgent to call for attention to this disease, and the government and all of society should give more support to stroke patients.

全球护士处于极度短缺的状况,其中重症监护病房(intensive care unit,ICU)护士因工作强度高、患者病情危重等原因常遭受更多压力、职业倦怠等问题,离职率也更高.现有文献证实,心理韧性可以作为保护性因素能使ICU护士在压力、创伤中更好的适应及应对.针对ICU护士心理韧性,本文从定义、现状及干预措施等方面进行综述,总结国内外ICU护士心理韧性的研究现状及发展趋势,探讨现有研究的不足及展望,希望能对我国ICU护士心理韧性的干预方案提供参考,在未来的研究中更多关注ICU护士的心理韧性,多方面进行干预,从而减少ICU护士压力、倦怠的发生,稳定护士队伍.

Objective:To explore the status quo of self-learning readiness of in-service nurses in self-taught examination and its correlation with general self-efficacy.Methods:Convenience sampling method was conducted with nurses who studied in the self-taught nursing examination of a university from a university in Sichuan Province from March to May 2020. General information questionnaire, Chinese version of Self-regulated Learning Readiness Scale for Nursing Education (SLDRS) and General Self-Efficacy Scale (GSES) were used to investigate the research. SPSS 24.0 was used to analyze the scores, multiple linear stepwise regression analysis was used to analyze the influencing factors, and Pearson correlation analysis was used to analyze the correlation between self-learning readiness and general self-efficacy. A total of 468 questionnaires were collected and 455 were valid.Results:The total scores of 455 nurses were (147.93±18.07) points, and the overall average scores were (3.70±0.45) points. Multiple linear stepwise regression analysis showed that the desire to continue to study for postgraduate students, the times of face-to-face classes in each subject, the preference for nursing major, aimlessness and satisfaction with the forms of assistance were the important influencing factors of autonomous learning readiness ( P<0.05). There is a positive correlation between self-learning readiness and general self-efficacy ( r=0.551, P<0.05). Conclusion:The self-learning readiness of nurses for self-taught examination is at a medium level. Their self-learning ability may be improved by encouraging them to carry out career planning, improving their professional identity and self-efficacy, and choosing teaching methods that are more suitable for in-service staff.

基于照顾、照顾者、照顾者需求相关定义,介绍国内外对脑卒中居家主要照顾者照顾需求的评估工具,为有效评估照顾者照顾需求提供参考依据.

心理韧性是护士促进职业发展,应对逆境的能力.肿瘤科护士压力水平较大,易产生职业倦怠、同情心疲乏和二次创伤等不利结局,心理韧性有助于肿瘤科护士职业生涯的发展,减少压力水平.我们通过对国内外肿瘤科护士心理韧性现状及干预措施的研究进展进行综述,为今后对肿瘤科护士心理韧性发展及干预提供参考依据.

This paper introduced the definition of medication compliance and epidemiology of stroke patients with hypertension，analyzed status quo and influencing factors of compliance of antihypertensive drugs in stroke patients at home and abroad.It explored significance and intervention measures for improving medication compliance of stroke patients，in order to improve their medication compliance.

帕金森病( PD)是仅次于阿尔茨海默病的第二大最常见的神经退行性疾病,典型症状包括运动症状与非运动症状,其中运动症状主要以静止型震颤、肌强直、运动迟缓等为特征.而非运动症状主要以嗅觉减退、睡眠障碍、自主神经功能障碍等为主,并且可能与运动症状同时发生,也可能在运动症状发作之前[1,2].流涎作为其常见的非运动症状之一,给患者生活社交等方面带来诸多不便,降低其生活质量,但目前临床上对神经精神症状、睡眠障碍等方面关注较多,针对流涎研究较少[3].对PD患者非运动症状频率及其严重程度的准确评估对指导临床医疗计划的制定、患者结局预测重要意义,而有效评估患者流涎症状是深入研究、实施干预的有效前提[4].为此本文基于流涎相关定义及流行病学、介绍评估PD患者流涎的有关工具及以期为有效评估PD患者流涎症状提供参考.

脑卒中是我国首位致死致残性疾病,终生发病风险高,危险因素众多,疾病负担沉重.引导公众及患者正确识别卒中,指导其全面了解发病危险因素,做到早防早治,帮助居民建立健康生活方式十分重要.我们对国内外社区居民对脑卒中预警症状及危险因素知晓现状进行了综述,主要从个人、家庭、社会3个方面分析影响因素,以期为临床工作提供指导,从而提高脑卒中防治知识水平.

目的 对中国帕金森病患者(Parkinson's Disease,PD)抑郁情绪发生率进行Meta分析.方法 通过系统检索CNKI、VIP、万方、PubMed、Web of Science、Embase等中英文数据库,纳入建库至2019年有关中国PD患者抑郁情绪的调查研究,由2位研究者背对背按照纳入排除标准独立筛选文献、提取资料并应用美国卫生保健质量和研究机构横断面研究文献质量评价标准评价文献质量,根据异质性检验结果,采用Stata 12.0软件随机效应模型对数据进行合并分析.结果 最终纳入37篇文献,共计7482例PD患者,男性4394例,女性3088例,抑郁情绪检出率的合并值为43.0％[95％ CI(0.370,0.490)].亚组分析显示样本量＜150例的研究抑郁发生率为47.7％[95％CI(0.413,0.542)],样本量≥150者抑郁发生率为34.3％[95％CI(0.254,0.432)];不同的评估工具抑郁发生率分别为汉密尔顿抑郁量表43.0％ [95％CI(0.359,0.501)]、流调中心抑郁量表38.1％ [95％CI (0.301,0.461)]、Zung抑郁自评量表41.0％ [95％ CI(0.163,0.657)]、贝克抑郁问卷46.0％ [95％ CI(0.353,0.567)];男性PD患者抑郁发生率为40.0％[95％CI(0.312,0.489)],女性抑郁发生率为43.0％ [95％ CI(0.340,0.519)];病程≤5 y的PD患者抑郁发生率为43.2％[95％ CI(0.330,0.533)],病程＞5y者抑郁发生率为44.4％ [95％ CI(0.362,0.527)];平均起病年龄≥60岁的PD患者抑郁发生率为40.2％ [95％ CI(0.266,0.538)],平均起病年龄＜60岁者抑郁发生率为45.3％[95％CI(0.335,0.570)];UPDRSⅢ得分＞25分者抑郁发生率为45.4％ [95％ CI(0.441,0.497)],得分≤25分者抑郁发生率为39.1％[95％ CI(0.261,0.521)];PD患者轻度抑郁发生率为42.1％[95％CI(0.303,0.538)],中度抑郁发生率为22.7％[95％CI(0.160,0.293)],重度抑郁发生率为7.4％[95％CI(0.049,0.100)].结论 PD患者抑郁情绪发生率较高,急需医护人员对各时期PD患者的情绪状态早评估、早诊断、早干预.

On the basis of reviewing the connotation and development of process indicators of stroke nursing,the nursing sensitivity indicators constructed and applied in different countries were compared,and their characteristics were summarized. It was pointed out that China has not formed a unified and recognized sensitive index of stroke care.So it was necessary to learn from the successful experience of the world and explore the establishment of relevant indicators in line with the process of stroke care in China,so as to ensure the consistency and effectiveness of data collection.

It reviewed the main types and assessment tools of eating difficulties after acute stroke，and tried to put forward countermeasures from the perspective of causes of eating difficulties.It aimed to provide references for related research and clinical work.

目的 运用Meta分析探索老年高血压患者跌倒的影响因素.方法 检索中、英文数据库,包括中国学术期刊网络出版总库、维普中文生物医学期刊数据库、万方数据库、Pubmed、Embase及Web of Science.按照文献纳入排除标准进行筛查,评估纳入文献质量,使用Stata12.0软件进行meta分析.结果 共纳入文献8篇,研究对象111493例,研究人群来源于加拿大、澳大利亚、美国及中国,其中男性29407例,女性82086例,纳入的研究对象年龄均≥60岁.过去1年曾经发生过跌倒(OR=2.015,95％CI 1.675～2.424)、服用降血压药物(OR=1.424,95％CI 1.143～1.774)、高血压药物限定日剂量>3.00(OR=1.378,95％CI 1.084～1.751)及服用钙通道阻滞剂(OR=1.289,95％CI 1.050～1.583)是老年高血压患者跌倒的危险因素(均P<0.05).结论 应该加强过去1年曾经发生过跌倒、服用降压药物、高血压药物限定日剂量>3.00及服用钙通道阻滞剂的老年高血压患者跌倒的健康宣教,重点防治该类人群跌倒的发生.

青年卒中大多指发生在18～44岁的卒中,国内外情况各异,我国青年卒中形势严峻.近年来,青年卒中发病率明显升高,卒中后导致患者部分或全部劳动能力和生活自理能力的丧失,给其家庭、社会带来沉重负担.与老年人群相比,青年卒中的危险因素更复杂多变,传统血管性危险因素如高血压、糖尿病等十分突出.此外药物滥用、不健康饮食、缺乏运动锻炼等亦可能引起青年卒中的发生,因而针对其危险因素选择有效的预防治疗措施十分重要.本文从青年卒中特点及其流行现状出发,对影响青年卒中可控制的物质滥用行为、不健康饮食行为、缺乏身体活动行为3类行为展开综述,并根据不同行为特点,针对性给出建议,为临床防治提供参考.

目的 了解脑卒中居家主要照顾者需求现状,并分析其影响因素.方法 纳入2018年9月—2019年1月在四川大学华西医院神经内科门诊就诊的脑卒中患者及其主要照顾者298对,并收集患者及其主要照顾者一般资料,运用脑卒中居家主要照顾者需求量表评估照顾者需求.应用多因素Logistic回归分析分别探索患者、照顾者资料与照顾者需求的关系.结果 多因素分析显示患者性别(OR=0.558,95％CI:0.329～0.945)、辅助照顾者人数(OR=7.212,95％CI:1.439～36.137)、照顾者学历(OR=0.273,95％CI:0.103～0.726)是脑卒中居家主要照顾者信息需求的独立影响因素;辅助照顾者人数(OR=2.467,95％CI:1.162～5.240)、患者家庭人均月收入(OR=2.470,95％CI:1.216～5.019)、照顾者与患者的关系(OR=3.322,95％CI:1.245～8.868)是脑卒中居家主要照顾者照顾技能需求的独立影响因素;辅助照顾者人数(OR=4.497,95％CI:1.130～22.110)是脑卒中居家主要照顾者社会支持需求的独立影响因素;照顾者年龄(OR=3.348,95％CI:1.021～10.983)及辅助照顾者人数(OR=14.200,95％CI:2.521～79.988)是脑卒中居家主要照顾者整体需求的独立影响因素.结论 脑卒中居家主要照顾者需求程度由高到低排序依次为信息需求、社会支持需求、照顾者个人需求、照顾技能需求.女性患者、家庭人均月收入较高的患者、学历较高的照顾者、辅助照顾者者较多以及照顾者的子女是患者主要照顾者需求的独立影响因素.提示医护人员应重点关注此类人群,及时提供相应的服务,以期减少照顾者负担.

目的 了解脑卒中患者主要照顾者照顾能力现状并分析其影响因素,为制定提升照顾者照顾能力的干预措施提供依据.方法 纳入2017年8月-2018年2月在四川大学华西医院神经内科住院部就诊的脑卒中患者及其主要照顾者395对,并收集患者及其主要照顾者一般资料,运用家庭照顾者照顾能力问卷评估主要照顾者的照顾能力;运用心理弹性量表简化版及中文版疾病不确定感家属量表评估照顾者的心理弹性及疾病不确定感.采用单因素分析和多重线性回归分析对风险因素进行探讨.结果 脑卒中患者主要照顾者照顾能力基本处于较高的水平.多重线性回归分析显示患者的年龄[非标准化偏回归系数(b)=-0.051,95％置信区间(confidence interval,CI)(-0.079,-0.024),P＜0.001]、家庭平均月收入[b=-0.455,95％CI(-0.770,-0.141),P=0.005]、入院时生活自理能力[b=-0.017,95％CI(-0.029,-0.006),P=0.003]以及照顾者的自觉睡眠情况[b=0.636,95％CI (0.340,0.932),P＜0.001]、心理弹性[b=-0.143,95％CI(-0.202,-0.083),P＜0.001]及疾病不确定感[b=-0.127,95％CI(-0.153,-0.100),P＜0.001]是照顾者照顾照顾能力的影响因素.结论 脑卒中患者主要照顾者照顾能力较好,患者年龄越大、家庭平均月收入越高、入院时生活自理能力越好主要照顾者照顾能力越好;照顾者睡眠越好,心理弹性及疾病不确定感越强照顾者的照顾能力越好.提示医护人员应重点关注照顾者身心状况,提高照顾者对于脑卒中的认识,教授相应的知识和照顾技能,以期减轻照顾者身心负担,改善患者预后,提升患者及其照顾者生活质量.

According to the definition of readmission within 30 days,to introduce the status quo and main reasons of readmission within 30 days of stroke patients in China and abroad.And to explore the influencing factors from three aspects:patients,hospitals and social economy.So as to provide guidance for clinical work and to reduce the incidence of unplanned readmission of stroke patients within 30 days,effectively.

Objective:To explore the clinical applicability of fall risk level warning system. Methods:The 1000 cases of hospitalized patients from January to December in 2014 were selected and randomly divided into experimental group and the control group. The control group is used with conventional fall pre-vention measures,and the experimental group with uses the patients fall risk level warning system. The objective evaluation index is applied to evaluate in different both of them at different time points. Results:The implementation of fall risk early warning system helped patients with fall preventionawareness, whose difference had statistically significant incidence(P ﹤ 0. 05). Conclusion:The early warning system for the risk of fall had an obvious effect on preven-ting the patient fall.

目的:探讨以预算配置为基础的护理岗位管理模式的建立与临床实施效果.方法:2012年1月～2013年2月以我院340名护理人员为研究对象,建立并实施以预算配置为基础的护理岗位管理,对比实施前(2012年1～7月)和实施后(2012年8月～2013年2月)护士工作业绩、业务水平、职业发展、护士工作满意度,同时选取实施前后患者各500例,对比实施前后患者对护理工作满意度.结果:以预算配置制为基础的护理岗位管理模式的实施,护理人员流失情况低于实施前(P＜0.05),患者对护理人员工作的满意度及分级护理正确执行情况较实施前均明显提高(P＜0.01),护理不良事件发生情况低于实施前(P＜0.01).结论:建立以预算配置制为基础的护理岗位管理模式,对合理分配护理人力资源,减少护理成本,提高护理工作质量、患者满意度及护士满意度等均具有重要意义.