目的探讨尊严疗法对癌症晚期患者尊严状况和负性情绪的影响。方法检索PubMed、The Cochrane Library、Embase、Web of Science、中国知网、万方数据库、维普资讯中文期刊服务平台和中国生物医学文献数据库从建库至2020年2月关于尊严疗...目的探讨尊严疗法对癌症晚期患者尊严状况和负性情绪的影响。方法检索PubMed、The Cochrane Library、Embase、Web of Science、中国知网、万方数据库、维普资讯中文期刊服务平台和中国生物医学文献数据库从建库至2020年2月关于尊严疗法对癌症晚期患者尊严状况和负性情绪干预效果的随机对照试验。使用RevMan5.3软件进行Meta分析。结果共纳入7篇文献,包括724例患者。Meta分析结果显示,尊严疗法在改善癌症晚期患者的尊严(MD=-8.65,95%CI为-11.24~-6.06,P<0.00001)、抑郁(SMD=-1.10,95%CI为-1.74~-0.46,P=0.0007)、焦虑(SMD=-0.92,95%CI为-1.59~-0.25,P=0.007)方面优于对照组。结论尊严疗法可以改善癌症晚期患者的尊严状况,缓解负性情绪。展开更多
Objectives:A framework for the advanced practice nurse(APN)role was developed in our Canadian Tertiary Care Centre,delineating five domains of advanced nursing practice:clinical practice,consultation,research,educatio...Objectives:A framework for the advanced practice nurse(APN)role was developed in our Canadian Tertiary Care Centre,delineating five domains of advanced nursing practice:clinical practice,consultation,research,education and leadership.The goal of this study was to evaluate perceptions of the effectiveness of the implementation of an innovative APN role on an in-patient Neurosurgery unit.Methods:A pre-and-post implementation design,incorporating both qualitative and quantitative data,was utilized.An innovative APN role was implemented within the Neurosurgery program focusing on the clinical domain and required the successful candidates to be NP prepared.This APN role was designed to improve patient flow,documentation,communication and patient and staff satisfaction.Three primary outcomes were measured:pre-implementation questionnaire(nurses),post-implementation questionnaire(nurses and residents)and number of pages to the on-call resident.Results:Survey scores by nurses and residents indicated improvement across all aspects studied.Average scores increased from 1.1 to 2.6,reflecting an overall statistically significant increase.The number of pages to the on-call resident also showed a decrease.Conclusion:Perceptions of patient care delivery and professional collaboration improved following implementation of the APN role.Responses indicated that APNs significantly impacted patient care and improved nurses and residents'job satisfaction.展开更多
Many advanced age patients who are diagnosed with colorectal cancer are often not offered surgical treatment due to presumed high risks of the procedure.While there is data to support surgical treatment of colorectal ...Many advanced age patients who are diagnosed with colorectal cancer are often not offered surgical treatment due to presumed high risks of the procedure.While there is data to support surgical treatment of colorectal cancer in advanced age patients,screening colonoscopy is not currently recommended for patients older than 85 years.Moreover,recent studies concluded that the incidence of colorectal cancer in patients 80 years and older is increasing.This raises the concern that the current guidelines are withholding screening colonoscopy for healthy elderly patients.Another concern contrary to this would be the new trend of growing incidence of advanced colorectal cancer in the younger patient population.Together they raise the ethical dilemma of how to best utilize colonoscopies as well as surgical intervention,as they are limited resources.展开更多
Aim:Portal vein thrombosis(PVT)in the liver transplant recipient poses many challenges.Unfortunately,the risk factors and effects on outcomes of PVT are not well-defined.Methods:This study analyzed the experience with...Aim:Portal vein thrombosis(PVT)in the liver transplant recipient poses many challenges.Unfortunately,the risk factors and effects on outcomes of PVT are not well-defined.Methods:This study analyzed the experience with PVT in liver transplant program from 2007 to 2013.This included the effectiveness of PVT diagnostics and its risk factors using logistical regression.The primary endpoints were Kaplan-Meir patient and graft survival.The secondary endpoints were the length of stay(LOS),transfusion rate,and overall morbidity.Independent predictors of survival were identified using a Cox’s proportional hazards model.Results:Two hundred and sixteen consecutive liver transplant recipients were examined,and 30(13.8%)had either a total or partial PVT.Two hundred and five patients had imaging within 1 year of liver transplantation with only 7(23.3%)of the 30 PVTs identified pre-operatively.Calculated sensitivity(4.8-50%)and negative predictive values(10.5-22.2%)were poor.Only,age significantly predicted PVT[P=0.037/hazard ratio(HR)=0.95].Ninety-day-patient and graft survival for PVT was similar at 6 months,although 1-year survival was significantly lower.“Occult”PVT was not associated with inferior survival.Model for end-stage liver disease score>25(P=0.001,HR=0.49/P=0.004,HR=0.52)and age>60 years(P=0.017,HR=0.64/P=0.013,HR=0.67)were significant predictors of patient and graft survival.Although the transfusion rate was significantly greater with PVT,LOS,and morbidity were not.Conclusion:Older recipients had a greater likelihood of PVT.Diagnostic studies were not effective at excluding PVT,and occult diagnosis did not affect the outcome.PVT was not an independent predictor of mortality or graft loss,but was associated with greater blood loss but not increased LOS or morbidity.展开更多
文摘目的探讨尊严疗法对癌症晚期患者尊严状况和负性情绪的影响。方法检索PubMed、The Cochrane Library、Embase、Web of Science、中国知网、万方数据库、维普资讯中文期刊服务平台和中国生物医学文献数据库从建库至2020年2月关于尊严疗法对癌症晚期患者尊严状况和负性情绪干预效果的随机对照试验。使用RevMan5.3软件进行Meta分析。结果共纳入7篇文献,包括724例患者。Meta分析结果显示,尊严疗法在改善癌症晚期患者的尊严(MD=-8.65,95%CI为-11.24~-6.06,P<0.00001)、抑郁(SMD=-1.10,95%CI为-1.74~-0.46,P=0.0007)、焦虑(SMD=-0.92,95%CI为-1.59~-0.25,P=0.007)方面优于对照组。结论尊严疗法可以改善癌症晚期患者的尊严状况,缓解负性情绪。
文摘Objectives:A framework for the advanced practice nurse(APN)role was developed in our Canadian Tertiary Care Centre,delineating five domains of advanced nursing practice:clinical practice,consultation,research,education and leadership.The goal of this study was to evaluate perceptions of the effectiveness of the implementation of an innovative APN role on an in-patient Neurosurgery unit.Methods:A pre-and-post implementation design,incorporating both qualitative and quantitative data,was utilized.An innovative APN role was implemented within the Neurosurgery program focusing on the clinical domain and required the successful candidates to be NP prepared.This APN role was designed to improve patient flow,documentation,communication and patient and staff satisfaction.Three primary outcomes were measured:pre-implementation questionnaire(nurses),post-implementation questionnaire(nurses and residents)and number of pages to the on-call resident.Results:Survey scores by nurses and residents indicated improvement across all aspects studied.Average scores increased from 1.1 to 2.6,reflecting an overall statistically significant increase.The number of pages to the on-call resident also showed a decrease.Conclusion:Perceptions of patient care delivery and professional collaboration improved following implementation of the APN role.Responses indicated that APNs significantly impacted patient care and improved nurses and residents'job satisfaction.
文摘Many advanced age patients who are diagnosed with colorectal cancer are often not offered surgical treatment due to presumed high risks of the procedure.While there is data to support surgical treatment of colorectal cancer in advanced age patients,screening colonoscopy is not currently recommended for patients older than 85 years.Moreover,recent studies concluded that the incidence of colorectal cancer in patients 80 years and older is increasing.This raises the concern that the current guidelines are withholding screening colonoscopy for healthy elderly patients.Another concern contrary to this would be the new trend of growing incidence of advanced colorectal cancer in the younger patient population.Together they raise the ethical dilemma of how to best utilize colonoscopies as well as surgical intervention,as they are limited resources.
文摘Aim:Portal vein thrombosis(PVT)in the liver transplant recipient poses many challenges.Unfortunately,the risk factors and effects on outcomes of PVT are not well-defined.Methods:This study analyzed the experience with PVT in liver transplant program from 2007 to 2013.This included the effectiveness of PVT diagnostics and its risk factors using logistical regression.The primary endpoints were Kaplan-Meir patient and graft survival.The secondary endpoints were the length of stay(LOS),transfusion rate,and overall morbidity.Independent predictors of survival were identified using a Cox’s proportional hazards model.Results:Two hundred and sixteen consecutive liver transplant recipients were examined,and 30(13.8%)had either a total or partial PVT.Two hundred and five patients had imaging within 1 year of liver transplantation with only 7(23.3%)of the 30 PVTs identified pre-operatively.Calculated sensitivity(4.8-50%)and negative predictive values(10.5-22.2%)were poor.Only,age significantly predicted PVT[P=0.037/hazard ratio(HR)=0.95].Ninety-day-patient and graft survival for PVT was similar at 6 months,although 1-year survival was significantly lower.“Occult”PVT was not associated with inferior survival.Model for end-stage liver disease score>25(P=0.001,HR=0.49/P=0.004,HR=0.52)and age>60 years(P=0.017,HR=0.64/P=0.013,HR=0.67)were significant predictors of patient and graft survival.Although the transfusion rate was significantly greater with PVT,LOS,and morbidity were not.Conclusion:Older recipients had a greater likelihood of PVT.Diagnostic studies were not effective at excluding PVT,and occult diagnosis did not affect the outcome.PVT was not an independent predictor of mortality or graft loss,but was associated with greater blood loss but not increased LOS or morbidity.
