Increasing role of post-intensive care syndrome in quality of life of intensive care unit survivors

In this editorial we comment on the detrimental consequences that post-intensive care syndrome(PICS)has in the quality of life of intensive care unit(ICU)survivors,highlighting the importance of early onset of multidisciplinary rehabilitation from within the ICU.Although,the syndrome was identified and well described early in 2012,more awareness has been raised on the long-term PICS related health problems by the increased number of coronavirus disease 2019 ICU survivors.It is well outlined that the syndrome affects both the patient and the family and is described as the appearance or worsening of impairment in physical,cognitive,or mental health as consequence of critical illness.PICS was described in order:(1)To raise awareness among clinicians,researchers,even the society;(2)to highlight the need for a multilevel screening of these patients that starts from within the ICU and continues after discharge;(3)to present preventive strategies;and(4)to offer guidelines in terms of rehabilitation.An early multidisci-plinary approach is the key element form minimizing the incidence of PICS and its consequences in health related quality of life of both survivors and their families.

Verification of Quality Requirement Method Based on the SQuaRE System Quality Model

For a purpose of suitable system product development and acquisition successfully, it is extremely important to specify the quality requirement for target system during system design phase, and developing or selecting a most suitable product finally from among the alternative candidate products. However, the quality requirements analysis is a very difficult matter because it is non-formulaic and demands much of product customer’s technical perceptiveness. Traditionally, analysis of quality requirements of a product has been conducted through questionnaires or interviews with customers based on survey investigator’s personal experience. This kind of lack of structure and incompleteness in the traditional approach introduced missing requirements and errors in prioritizing requirements to implement in the requirement analysis of a product. On the other hand, we have been working on developing the techniques (SQuaRE) for quality requirements and evaluation for system and software product for a long time in ISO/IECJTC1/SC7WG 6. For the purpose of specify the quality requirement of system product, the method of quantitative quality requirement definitions based on ISO/IEC9126 [1] quality model that includes six characteristics is widely recognized. However, independency among each quality characteristic is not sure and the suitability of method by using these six quality characteristics for quality requirement is not certified statistically. In this paper, we propose the concept of quality requirements definition method based on the SQuaRE quality models define in ISO/IEC25030 [2,3]. Also, this paper proposes the result of verification about effectiveness of quantitative quality requirement definition approach from the view point of six quality characteristics described in ISO/IEC9126.

中医辨证治疗方案对老年社区获得性肺炎出院后患者生存质量和疗效满意度的评价研究

背景社区获得性肺炎(CAP)为常见的感染性疾病之一,尤其在老年患者中,其临床症状不典型,易出现严重并发症,缺乏有效的治疗措施,常预后不良。目的探究中医辨证治疗方案对老年CAP出院(1周内)患者的生存质量及其疗效满意度情况。方法本研究为多中心、随机双盲安慰剂临床研究。选取河南中医药大学第一附属医院、河南省胸科医院、河南省人民医院、郑州市中医院、郑州人民医院5家医院呼吸科2018年4月—2020年1月病房收治的老年CAP出院后患者为研究对象,采用中央随机入组模式将患者分为试验组和对照组。试验组患者经中医辨证后给予相应中药颗粒剂进行治疗,气虚痰湿证给予补肺健脾化痰方,气阴虚痰热证给予益气养阴清肺方。对照组则给予与中药颗粒外观、重量、颜色、气味基本一致的安慰剂。治疗疗程为2个月,随访至治疗开始后6个月。比较两组患者治疗前、治疗1个月、治疗2个月、随访3个月、随访6个月的生存质量[采用中文版生存质量评分量表(SF-36)评价]和疗效满意度[采用肺炎患者疗效满意度问卷(ESQ-CAP)评价]。结果纳入120例患者中,脱落8例,最终纳入符合方案集的病例112例,其中试验组54例、对照组58例。治疗前两组性别、年龄、出院后时间、中医辨证分型、CUBR-65评分、基础疾病比较,差异无统计学意义(P>0.05)。组别对SF-36生理机能领域评分(F组间=5.057,P组间=0.027)、一般健康状况领域评分(F组间=7.286,P组间=0.008)、情感职能领域评分(F组间=6.858,P组间=0.010)主效应显著。组间比较:治疗2个月、随访3个月、随访6个月,试验组SF-36生理机能领域评分高于对照组(P<0.05);治疗1、2个月和随访3、6个月,试验组SF-36一般健康状况领域、情感职能领域评分高于对照组(P<0.05);随访3、6个月,试验组SF-36精神健康领域评分高于对照组(P<0.05)。组别对ESQ-CAP日常生活与能力领域评分(F组间=16.218,P组间<0.001)、方便领域评分(F组间=25.013,P组间<0.001)及ESQ-CAP总分(F组间=13.843,P组间<0.001)主效应显著。治疗2个月和随访3、6个月,试验组ESQ-CAP日常生活与能力领域评分高于对照组(P<0.05)。治疗1、2个月和随访3、6个月,试验组ESQ-CAP方便领域评分及ESQ-CAP总分高于对照组(P<0.05)。随访3个月,试验组ESQ-CAP总体疗效领域评分高于对照组(P<0.05)。结论中医辨证治疗方案对于老年CAP出院后患者的生存质量和疗效满意度具有较好的改善作用。

延伸护理在老年获得性免疫缺陷综合征患者抗病毒治疗中的应用

目的探究延伸护理对提高老年获得性免疫缺陷综合征患者抗病毒治疗依从性、疗效及生活质量的影响。方法选取2015年1月-2021年12月北京佑安医院接受初始抗病毒治疗的200例老年获得性免疫缺陷综合征患者作为研究对象,按照抽签法随机分为对照组与试验组,各100例。对照组接受常规护理以及健康教育,试验组则在对照组基础上给予延伸护理。随访1年,比较两组的服药依从性、疗效和生活质量。结果随访1年时,试验组的服药依从性高于对照组,差异有统计学意义(P<0.05);试验组CD4+T淋巴细胞计数增幅高于对照组(P<0.05);两组治疗后病毒载量均检测不到。试验组在生活质量的生理领域、心理领域、社会关系领域和环境领域评分均高于对照组,差异有统计学意义(P<0.05)。结论延伸护理有利于提高老年获得性免疫缺陷综合征患者的服药依从性和抗病毒效果,提高患者的生活质量,值得临床推广及应用。

“零转介”AIDS诊疗管理模式的临床验证

目的探讨“零转介”诊疗管理模式对人类免疫缺陷病毒(HIV)感染患者治疗疗效和满意度的效果。方法选取石家庄市第五医院2022年7月至12月新增HIV感染者100例,随机分为对照组和研究组,每组50例。对照组给予常规认知干预和健康指导、心理干预,研究组在确诊前较对照组提前7~10 d即给予认知干预、生活指导和心理干预。比较对照组和研究组患者的HIV感染患者睡眠[匹兹堡睡眠质量指数表(PSQI)]、服药依从性、焦虑抑郁量表分值。结果对照组患者的PSQⅠ评分高于研究组患者(P<0.01);研究组患者的焦虑抑郁的心理状况要优于对照组(P<0.05);对照组患者服药依从性良好者比例低于研究组患者(P<0.01);研究组患者对疾病的接受度和认知评定量表均好于对照组患者(P<0.01)。结论“零转介”模式,提前给予认知干预、生活指导和心理干预,可提高HIV感染患者满意度,对社会层面的AIDS预防具有积极意义。

HIV感染者/AIDS患者疾病接受度现状及相关因素研究

目的了解人类免疫缺陷病毒(HIV)感染者/艾滋病(AIDS)患者疾病接受度现状及其相关因素,以指导临床制定干预措施,并为改善其临床结局提供实证依据。方法采用便利抽样法选取在某医院AIDS定点治疗门诊接受治疗的555例HIV感染者/AIDS患者,收集研究对象的一般资料、疾病接受度、疾病自我管理效能和临床结局(即生活质量、CD4+T淋巴细胞计数、HIV病毒载量)。结果HIV感染者/AIDS患者疾病接受度平均为(26.08±5.34)分。多元线性回归分析结果显示,宗教信仰、疾病自我管理效能是影响患者疾病接受度的相关因素(均P<0.05),可解释HIV感染者/AIDS患者疾病接受度30.4%的变异,且患者的疾病接受度与其生活质量紧密相关(P<0.001)。结论HIV感染者/AIDS患者的疾病接受度处于中等水平。在临床工作中医务人员应充分考虑患者的宗教信仰情况和疾病自我管理效能水平,以制定针对性的干预措施,提高患者疾病接受度,从而进一步促进患者获得更高的生活质量。

Reliability and validity of dermatology life quality index: assessment of quality of life in human immunodeficiency virus/acquired immunodeficiency syndrome patients with pruritic papular eruption

OBJECTIVE: To test the reliability and validity of dermatology life quality index(DLQI) in simplified Chinese language by assessing the quality of life(QoL) in HIV(human immunodeficiency virus)/AIDS(Acquired immunodeficiency syndrome) patients with pruritic papular eruption(PPE). METHODS: A study of simplified-Chinese-versiond from10 questions with the principal component analysis and the contribution rate of the 3 common factors was 59.95%. CONCLUSION: The simplified-Chinese-version DIQL is an acceptable and valid scale for HIV/AIDS patients with PPE. It can be used to evaluate the QoL of HIV/AIDS patients with PPE in China.

Health related quality of life:is it another comprehensive evaluation indicator of Chinese medicine on acquired immune deficiency syndrome treatment?

Health related quality of life(HRQOL) can better reflect changes in acquired immune deficiency syndrome(AIDS) patients and inform economic evaluation of AIDS treatment services,and the assessment of HRQOL can help us to detect problems that may influence the progression of the disease,hence HRQOL has become a particularly important assessment indictor for HIV comprehensive interventions.Being a multi-angle,multi-level,and diversified complex intervention,roles of Chinese medicine(CM) in AIDS treatment have been recognized and accepted by more and more patients,and HRQOL has been widely used to evaluate the comprehensive management effects of CM on AIDS.In this article,the authors analyze the definition and measurement of HRQOL,measurement of HRQOL of HIV/AIDS patients and effects of CM on AIDS,and give some reasonable advices for the usage of the scale of HRQOL.The authors hold that some new HRQOL instruments specific for CM treatment of AIDS should be developed and further prospective studies should be carried out to demonstrate the practicality,reliability and validity of HRQOL as an evaluation indictor for CM treatment of AIDS.

基于健商理念的健康教育对老年社区获得性肺炎患者自护能力、肺功能及生存质量的影响

目的 探究基于健商理念的健康教育对老年社区获得性肺炎(CAP)患者自护能力、肺功能及生存质量的影响。方法 选取2021年6月至2022年4月郑州大学第一附属医院102例老年CAP患者,按照随机数字表法分为两组,每组51例。对照组接受常规护理,于此基础上观察组接受基于健商理念的健康教育。观察两组干预前后肺功能[第1秒用力呼气容积(FEV_(1))、第1秒用力呼气容积与用力肺活量比值(FEV_(1)/FVC)及用力肺活量(FVC)]、健商水平、自护能力[自我护理能力测定表(ESCA)]及随访1 a后CAP再发情况。结果 干预后观察组FEV_(1)/FVC、FEV_(1)、FVC均高于对照组(P<0.05);干预后观察组健商水平中精神状态、生活技能、健康知识、自我保健、生活方式均高于对照组(P<0.05);干预后观察组ESCA中自我概念、健康知识水平、自我责任感、自我护理技能均高于对照组(P<0.05);随访1 a观察组CAP再发率低于对照组(P<0.05)。结论 在老年CAP患者中应用基于健商理念的健康教育,可有效提升患者健商水平,增强自护能力,从而改善肺功能。

HIV检测质量管理和临床用血安全的若干研究

艾滋病(Acquired Immunodeficiency Syndrome,AIDS)是一种严重的传染性疾病,做好AIDS检测的质量管理工作非常重要。本文将重点分析加强人类免疫缺陷病毒(Human Immunodeficiency Virus,HIV)检测质量管理的相关措施,以提升检测结果的准确性与可靠性。同时探讨HIV检测质量管理与临床用血安全之间的关系,提出提高临床用血安全的措施,旨在为改善AIDS防控工作提供科学依据和实践建议,以促进公共卫生和医疗服务的质量和安全水平的提升。

Leveraging real-time data to drive quality improvement in a pediatric health system

We are inundated by data;healthcare is no different.The electronic medical record,the numerous patient care monitors,and the thousands of medications to be reconciled with specific dosing parameters are a few examples of the omnipresent and intimidating nature of data in healthcare.Across the world,healthcare without data does not exist.The data represent many forms but are quickly moving towards electronic formats.As ubiquitous as data are the near universal finding that such data are lagging.There is an urgent need for real-time data in improving processes and ultimately outcomes in healthcare.If data lag by four to eight weeks,if not longer,then true change cannot occur and harm continues in that interval.This review article discusses the urgent need for real-time data and demonstrates examples of how Children's National Medical Center in Washington,DC uses real-time data to drive outcomes.

Impact of HIV on the health-related quality of life in youth with perinatally acquired HIV

Background Studies investigating health-related quality of life(HRQoL)in youth with perinatally acquired HIV(PHIV+)are scarce.This study aimed to compare HRQoL of PHIV+to sociodemographic-matched youth not living with HIV(HIV-),Spanish general youth population,and to explore associations between sociodemographic variables,drug consumption,and HRQoL.Methods PHIV+youth were randomly selected from CoRISpe database(Cohort of the Spanish Pediatric HIV Network).HRQoL was evaluated by SF-12v2.Results Thirty-nine PHIV+youth(mean age:23.36 years,SD=3.83)and thirty-nine HIV-youth(mean age:22.97 years,SD=3.80)participated in this study.PHIV+obtained lower scores in SF-12 physical health subscale(PCS)than HIV-(P=0.001)and Spanish general youth population(P=0.006).PHIV+had lower scores on the mental health subscale(MCS)than the Spanish general youth population(P<0.001).PHIV+who were at school obtained better scores than those were not at school.PHIV+youth who had used cocaine and cannabis had lower scores in MCS(P=0.002).Conclusions There is a need for HRQoL management in the associated medical follow-up.

重症医学科感控认知心路

重症医学科是医院感染较为集中的科室,而医院感染与重症患者的预后紧密相关。以医院感染为轴线,重症患者的救治可分为3个阶段:(1)原发疾病的处理和器官功能支持;(2)重症导致的各种并发症的治疗;(3)控制进一步损害及新发并发症。后2个阶段循环往复,可使患者进入持续炎症反应和高代谢状态,最终导致预后不良。通过各阶段感控措施的充分落实以降低医院感染风险是重症救治过程中不可忽视的组成部分。因此,如何理解、预防、治疗重症医学科的医院感染是重症医学发展的当务之急。本文从改变对医院感染的认知、规范具体防控措施、夯实理论基础、认识防控即治疗、整合治疗和质控5个方面综合阐述重症医学科医院感染的防治策略,最终形成以重症患者医院感染防控为基石的重症救治理念,实现降低重症患者医院感染风险,提高重症医学科医疗质量的目标。

重型胸部损伤患者ICU获得性衰弱现状及危险因素分析

目的:对重型胸部损伤患者ICU获得性衰弱(Intensive Care Unit AcquiredWeakness,ICU-AW)风险因素进行量化,为早期识别、预防ICUAW提供理论依据。方法:采用便利抽样法,选取某三级甲等医院胸腔外科ICU重型胸部损伤患者180例作为研究对象,采用一般资料调查表和ICU-AW危险因素采集表收集患者相关资料,通过二元Logistic回归分析筛选出ICU-AW的危险因素。结果:73例(40.56%)患者并发ICU-AW;二元Logistic回归分析结果显示,年龄大、APACHEⅡ评分高、存在多器官功能衰竭、机械通气时间长、活动受限、使用糖皮质激素、乳酸水平高为重型胸部损伤患者ICU-AW的危险因素(P<0.05)。结论:重型胸部损伤患者ICU-AW发生率较高且影响因素复杂,临床医务人员应加强对老年患者的关注,及时对入住ICU患者进行APACHEⅡ评分,注意对多器官功能衰竭患者的识别,根据患者胸部创伤严重程度制定个体化机械通气方案,密切关注长期大量使用糖皮质激素患者全身症状及肌力变化情况,关注患者血乳酸水平,预防重型胸部损伤患者ICUAW的发生,从而提高重型胸部损伤患者的护理管理质量。

妇科手术患者术中获得性压力性损伤预防护理质量评价指标体系构建及应用

目的:构建并验证妇科手术患者术中获得性压力性损伤(IAPIs)预防护理质量评价指标体系,为妇科手术提供有效的IAPIs预防护理,提高护理质量。方法:采用Delphi专家函询法形成妇科手术患者IAPIs预防护理质量评价指标体系。采用历史对照研究验证该指标体系的效果。结果:共进行2轮函询,专家回复率均100.0%,权威系数(Cr)均0.919,2轮函询的Kendall系数分别为0.291和0.364。最终制定妇科手术患者IAPIs预防护理质量评价指标体系含3个一级指标,35个二级指标。应用该指标体系能显著降低妇科手术患者IAPIs的发生率(0.7%比3.1%),提高患者护理满意度(46.52±1.72分比41.57±3.87分)(均P<0.05)。结论:本研究制定的妇科手术患者IAPIs预防护理质量评价指标体系科学性较强,能降低妇科手术患者IAPIs发生率,提高患者护理满意度,今后需在应用中不断完善提高。

艾考恩丙替片对初治艾滋病患者的疗效及安全性评价

目的评价艾考恩丙替片对初治艾滋病患者的疗效及安全性。方法选取80例初治艾滋病患者作为研究对象,随机分为对照组和观察组,每组40例。对照组采用免费抗病毒药物(替诺福韦+拉米夫定+依非韦伦)治疗,观察组采用艾考恩丙替片治疗。比较2组患者治疗前和治疗3、6、9、12个月后的CD4^(+)、人类免疫缺陷病毒(HIV)载量、生化指标水平,并比较2组患者依从性、不良反应和生活质量。结果治疗时,观察组有6例患者不依从,对照组有9例患者不依从;随着治疗时间的延长,2组患者CD4^(+)水平逐渐升高,HIV载量逐渐降低,差异有统计学意义(P<0.05);治疗3、6、9、12个月后,观察组CD4^(+)水平均高于对照组,HIV载量均低于对照组,差异有统计学意义(P<0.05);随着治疗时间的延长,对照组谷丙转氨酶、谷草转氨酶、尿素、肌酐、尿酸水平逐渐升高,且对照组治疗3、6、9、12个月后的随机血糖水平均高于治疗前,差异有统计学意义(P<0.05);治疗3、6、9、12个月后,观察组谷丙转氨酶、谷草转氨酶、尿素、肌酐、尿酸、随机血糖水平均低于对照组,差异有统计学意义(P<0.05);观察组不良反应发生率为2.94%(1/34),低于对照组的90.00%(36/40),差异有统计学意义(校正χ^(2)=55.718,P<0.001);随着治疗时间的延长,2组患者生活质量各维度评分逐渐升高,且观察组治疗后的生活质量各维度评分均高于对照组,差异有统计学意义(P<0.05)。结论与免费抗病毒药物方案相比,艾考恩丙替片对初治艾滋病患者的疗效更佳,可显著升高CD4^(+)水平,降低HIV载量,且安全性高,可显著提高患者的生活质量。

《人间词话》“内美”与“修能”之辨析

王国维的《人间词话》以“境界说”为核心,是“天才说”“古雅说”的升华。“内美”作为“天才说”的一种阐释,“修能”作为“古雅说”的外化,都与天才理论有关并共同构成一对概念。而“内美”与“修能”孰轻孰重却引发了不少讨论,观点主要集中在三点:即“内美”重于“修能”;“内美”与“修能”并重但偏向于“内美”;“内美”与“修能”兼顾但偏向于“修能”。这三种观点在王国维处汇集并且集中于探讨“内美”,“修能”往往被捎带提及。从“内美”和“修能”之间的关系展开,分析建立在“天才说”基础之上的“内美”的含义,从而明确“内美”与“修能”的不同指向,并通过王国维在“内美”与“修能”之间的犹疑矛盾探讨王国维更重视“内美”的原因。

衰弱对社区获得性肺炎患者的临床疗效及生活质量的影响研究

目的:探究衰弱对社区获得性肺炎患者的临床疗效及生活质量的影响。方法:选取2022年1月至2023年8月期间我院收治的60例获得性肺炎患者作为研究对象。按照患者的衰弱表型评估方法(Fried衰弱评估)评分是否小于3分将患者分为非衰弱组(n=23)和衰弱组(n=37)。根据《中国成人社区获得性肺炎诊断和治疗指南》的建议,对患者采取相应的治疗措施。比较两组患者临床疗效、临床症状消退时间、肺功能[第1秒用力呼气量(First second forced expiratory volume,FEV1)、用力肺活量(Forced vital capacity,FVC)及FEV1与FVC的比值(Ratio of FEV1 to FVC,FEV1/FVC)]、生活质量[生活质量量表(SF-36)]的差异。结果:治疗后4 w,衰弱组的总有效率明显低于非衰弱组(P<0.05);衰弱组患者的临床症状消失时间明显长于非衰弱组(P<0.05);两组患者FEV1、FVC、FEV1/FVC肺功能明显高于治疗前,但衰弱组明显低于非衰弱组(P<0.05);衰弱组患者的生活质量指标评分明显低于非衰弱组(P<0.05)。结论:针对社区获得性肺炎患者,衰弱对临床疗效有负面影响,会延长患者的临床症状消退时间,影响患者肺功能恢复,降低患者的生活质量。

疾控中心微生物检验对医院感染防控的效果评价

分析疾控中心微生物检验对医院感染防控的应用效果。选取青岛市即墨区中心医院于2022年3月-2023年3月收治的140例住院患者为研究对象,以随机数字表法将其分为对照组(n=70例)和观察组(n=70例),对照组采取常规感染控制,观察组采用联合疾控中心行微生物检验,比较两组患者相关指标的变化情况。结果显示,观察组的样本检验质量和检验操作评分均明显高于对照组,差异有统计学意义(P<0.05)。两组患者中度感染发生率相比较,无统计学差异(P>0.05),观察组轻度感染发生率低于对照组,差异有统计学意义(P<0.05)。研究发现,在医院感染防控中引入疾控中心微生物检验,能够显著提升防控质量,预防医院感染的发生,降低感染程度,可推广。

手术室建立全面质量管理体系在术中获得性压力性损伤质量管理中的应用

目的探讨建立手术室护理工作全面质量管理(TQM)体系在术中获得性压力性损伤质量管理中的应用效果。方法成立手术室TQM小组,建立手术室护理工作TQM体系,TQM体系在术中获得性压力性损伤质量管理中应用:培养良好的质量文化、建立合格员工上岗机制、规范标准化工作、制订指标体系并进行效果评价、研发数据管理信息化系统。结果构建的TQM体系在术中获得性压力性损伤中应用后,术中获得性压力性损伤发生率由1.36%降至0.72%;2期及以上术中获得性压力性损伤发生率由0.23%降至0.12%。结论TQM体系的建立在术中获得性压力性损伤中应用,能有效降低术中获得性压力性损伤发生率,提升手术室护理工作质量,保障患者安全。