Evaluation of an educational telephone intervention strategy to improve non-screening colonoscopy attendance:A randomized controlled trial

BACKGROUND Colonoscopy attendance is a key quality parameter in colorectal cancer population screening programmes.Within these programmes,educative interventions with bidirectional contact carried out by trained personnel have been proved to be an important tool for colonoscopy attendance improvement,and because of its huge clinical and economic impact,they have been widely implemented.However,outside of this population programmes,educative measures to improve colonoscopy attendance have been poorly studied and no navigation interventions are usually performed.AIM To investigate the clinical and economic impacts of an educational telephone intervention on colonoscopy attendance outside colorectal cancer screening programmes.METHODS This randomized controlled trial included consecutive patients referred to colonoscopy from primary care centres from November 2017 to May 2018.The intervention group(IG)received a telephone intervention,while the control group(CG)did not.Patients assigned to the IG received an educational telephone call 7 d before the colonoscopy appointment.The intervention was carried out by two nurses with deep endoscopic knowledge who were previously trained for a telephone educational intervention for colonoscopy.The impact on patient compliance with preparedness protocols related to bowel cleansing,antithrombotic management,and sedation scheduling was also evaluated.A second call was conducted to assess patient satisfaction.Intention-to-treat(ITT)and perprotocol(PP)analyses were performed.RESULTS A total of 738 and 746 patients were finally included in the IG and CG respectively.Six hundred thirteen(83%)patients were contacted in the IG.The non-attendance rate was lower in the IG,both in the ITT analysis(IG 8.4%vs CG 14.3%,P<0.001)and in the PP analysis(4.4%vs 14.3%,P<0.001).In a multivariable analysis,belonging to the control group increased the risk of nonattendance in both,the ITT analysis(OR 1.81,95%CI:1.27 to 2.58,P=0.001)and the PP analysis(OR 3.56,95%CI:2.25 to 5.64,P<0.001).There was also a significant difference in compliance with preparedness protocols[bowel cleansing:IG 61.7%vs CG 52.6%(P=0.001),antithrombotic management:IG 92.5%vs CG 62.8%(P=0.001),and sedation scheduling:IG 78.8%vs CG 0%(P≤0.001)].We observed a net benefit of €55600/year after the intervention.The information given before the procedure was rated as excellent by 26%(CG)and 51%(IG)of patients,P≤0.001.CONCLUSION Educational telephone nurse intervention improves attendance,protocol compliance and patient satisfaction in the non-screening colonoscopy setting and has a large economic impact,which supports its imple-mentation and maintenance over time.

Effects of an Omaha System-based follow-up regimen on self-care and quality of life in gastrointestinal surgery patients

BACKGROUND Currently,a variety of new nursing methods and routine nursing have been widely used in the nursing of gastrointestinal surgery patients.AIM To investigate the effect of follow-up protocol based on the Omaha System on self-care ability and quality of life of gastrointestinal surgery patients.METHODS A total of 128 patients with inflammatory bowel disease in gastrointestinal surgery in gastrointestinal surgery from March 2019 to August 2021 were divided into A(n=64)and B(n=64)groups according to different nursing methods.The group A received a follow-up program Omaha System-based intervention of the group B,whereas the group B received the routine nursing intervention.Medical Coping Modes Questionnaire,Crohn’s and Colitis Knowledge Score(CCKNOW),inflammatory bowel disease questionnaire(IBDQ),Exercise of Self-nursing Agency Scale(ESCA),The Modified Mayo Endoscopic Score,and Beliefs about Medicine Questionnaire(BMQ)were compared between the two groups.RESULTS Following the intervention,the group A were facing score significantly increased than group B,while the avoidance and yield scores dropped below of group B(all P<0.05);in group A,the level of health knowledge,personal care abilities,self-perception,self-awareness score and ESCA total score were more outstanding than group B(all P<0.05);in group A the frequency of defecation,hematochezia,endoscopic performance,the total evaluation score by physicians and the disease activity were lower than group B(all P<0.05);in the group A,the total scores of knowledge in general,diet,drug,and complication and CCKNOW were higher than group B(all P<0.05);in group A,the necessity of taking medicine,score of medicine concern and over-all score of BMQ were more significant than group B(all P<0.05);at last in the group A,the scores of systemic and intestinal symptoms,social and emotional function,and IBDQ in the group A were higher than group B(all P<0.05).CONCLUSION For gastrointestinal surgery patients,the Omaha System-based sequel protocol can improve disease awareness and intervention compliance,help them to face the disease positively,reduce disease activity,and improve patients’self-nursing ability and quality of life.

Clear cell sarcoma metastasizing to the pancreas

In this editorial based on a case report,we delve into a seldom-seen occurrence of clear cell sarcoma featuring pancreatic metastasis in a 47-year-old male patient.Recognized for its typical tendency to metastasize to the lungs,bones,and brain,clear cell sarcoma rarely extends its reach to the pancreas.Despite the initial absence of discernible abnormalities during the patient's physical examination,the manifestation of abdominal pain prompted further investigation.Subsequent abdominal computed tomography brought to light the presence of a pancreatic tumor,culminating in the definitive diagnosis of clear cell sarcoma with pancreatic metastasis.The successful management of this atypical presentation involved a series of surgical interventions,including distal pancreatectomy and splenectomy.This report not only sheds light on the infrequent manifestation of clear cell sarcoma within the pancreas but also underscores the pivotal role of vigilant postoperative follow-up in addressing this rare sarcoma.The emphasis on postoperative care serves as a crucial aspect of the broader narrative,acknowledging the need for ongoing monitoring and management to ensure a comprehensive and successful treatment trajectory for patients with this unique presentation of clear cell sarcoma.

Follow-up of combined intervention for patients with both renal and cerebral artery stenosis

Renal artery stenosis （RAS） is a frequently overlooked clinical entity that can cause uncontrolled hypertension and lead to a progressive deterioration of renal function.1 We observed 20 patients with RAS complicated with cerebral artery stenosis （CAS）, who underwent cerebral and renal artery angiography and combined intervening treatment. Clinical follow-up was performed for more than 3 years.

Long-Term Follow-Up of Chinese Herbal Medicines Combined with Conventional Treatment in Patients with Acute Coronary Syndrome after Percutaneous Coronary Intervention: A Multicenter Randomized Controlled Trial

Objective： To evaluate the prognosis effect of Chinese herbal medicines（CHMs） for benefiting qi and activating blood circulation adjunctive to conventional treatment in patients with acute coronary syndrome（ACS） after percutaneous coronary intervention（PCI）. Methods： A total of 702 patients with ACS who underwent PCI were enrolled and randomly assigned to receive conventional treatment plus CHMs for benefiting qi and activating blood circulation（treatment group, 351 cases） or conventional treatment alone（control group, 351 cases） for 6 months. Six months later, all patients received conventional treatment alone. Follow-ups were scheduled at 6th, 12 th, 18 th, 24 th month after enrollment in April 2008, and the final follow-up visit was during September 2011 and November 2011. The primary endpoint was the composite of cardiac death, nonfatal myocardial infarction or revascularization（PCI or coronary artery bypass grafting）; and the secondary endpoint was the composite of re-admission for ACS, congestive heart failure, nonfatal stroke or other thrombus events. Results： A total of 621（88.59%） patients completed 35.4±3.8 months follow-up, while 80（11.41%） patients withdrew from the trial（41 in the treatment group and 39 in the control group）. The incidence of primary endpoint was 5.7%（20 patients） in the treatment group versus 10.86%（38 patients） in the control group [relative risk（RR）： 0.53; 95% confidence interval（CI）： 0.30, 0.88; P=0.013; absolute risk reduction（ARR）： –0.052, 95% CI： –0.06, 0.01]. The incidence of secondary endpoint was 5.98%（21 patients） in the treatment group versus 10.28%（36 patients） in control group（RR： 0.58, 95% CI： 0.33, 0.97, P=0.037; ARR： –0.043, 95% CI： 0.06, 0.01）. Most of the primary and secondary endpoints were occurred in 18 months（84.50% in the treatment group versus 78.10% in the control group）. Conclusion： CHMs for benefiting qi and activating blood circulation adjunctive to conventional treatment improved clinical outcomes for patients with ACS after PCI in long-term follow-up.

出院后精神分裂症患者服药依从性电话和短信干预的1年随访

目的:探讨以问题解决为基础的电话和短信干预改善出院后精神分裂症患者服药依从性的效果。方法:将178例出院精神分裂症患者随机分为电话干预组(63例)、短信干预组(n=61)和对照组(n=54),电话和短信干预组患者接受"立足于解决问题干预"的服药依从性干预,三组患者均接受常规治疗并于基线和第1、3、6、9和12个月时进行服药依从性、阳性和阴性症状量表(PANSS)评估。结果:整体上,电话组的服药依从性评分显著高于短信组(P<0.001),短信组服药依从性评分高于对照组(P<0.001);电话组和短信组的PANSS评分差异无统计学意义(P=0.115),但均低于对照组(P<0.001);随访期间,对照组的再住院率高于电话组和短信组(9.3%vs.0%、1.6%,P=0.014)。结论:以问题解决为基础的电话和短信干预均可有效提高出院后精神分裂症患者的服药依从性,从而有利于减少患者的精神症状和降低再住院率。相对而言,电话干预能更好的改善患者的服药依从性。

高血压电话访问式健康管理模式成本效果分析

目的评估高血压电话访问式健康管理模式在社区人群的成本效果。方法研究设计为社区随机对照试验,2011年10月—2012年12月从天津市友谊社区卫生服务中心高血压管理数据库中按居住区域分层,应用整群抽样的方法抽取240例高血压患者组成研究队列。按随机数字表分配到规范管理组80例、电话访问组80例和对照组80例,比较各组研究前、6个月、1年血压控制率,分析规范化管理和电话访问式健康管理模式的成本效果。结果 3组完成随访的患者的血压控制率比较,差异无统计学意义(P>0.05);不同随访时间血压控制率比较,差异亦无统计学意义(P>0.05)。规范管理组随访满1年的患者血压平均下降7.2 mm Hg,电话访问组血压平均下降5.8 mm Hg。血压每降低1 mm Hg意愿投入4元/人年及以上,电话访问组较规范管理组有效的概率不超过40%。结论电话访问式健康管理模式可以保证较好的血压控制效果,但其成本效果与规范化管理模式差别甚微,未显示出明显优势。

结肠造口患者出院早期电话干预延续护理模式之构建

目的:阐述结肠造口患者出院早期电话干预延续护理模式的构建。方法:对7家三级甲等医院的59名出院早期的结肠造口患者进行出院后1个月内的2～3次电话干预。由造口护士记录电话干预的具体时间、每次电话干预持续时间,59名患者出院后1个月和3个月分别自评电话干预的效果。结果:3次电话的通话时间分别为(9.23±4.94)min、(8.15±4.93)min和(6.87±4.40)min,平均时间为(8.50±4.92)min;通3次电话的时间距离患者出院的天数分别为(8.71±4.72)天、(19.85±6.07)天和(29.65±4.45)天。59名患者出院后1个月和3个月对延续护理服务表示非常满意和满意的分别占98.11%和96.30%;认为造口护士的支持很大和大的分别占96.23%和94.44%。结论:电话干预是一种有效的出院后延续护理的方法。在具体的实施过程中必须满足一定的条件,同时应采取相应的措施以保证电话干预的剂量和效果,对进行电话干预的护士应进行必要的培训,从而使电话干预的效益最大化。

基于IMB模型的电话短信教育应用于社区老年高血压病人自我效能的干预研究

[目的]探讨IMB理论模式结合电话短信健康教育对社区老年高血压病病人自我效能水平影响。[方法]采用便利抽样的方式,选取社区90例符合条件的老年高血压病病人,随机分为干预组(45例)与对照组(45例)。干预组实施基于IMB模型的电话短信教育干预方案,对照组实施普通电话短信教育干预方案,干预时间均为5个月,在干预前及干预第1个月、第3个月、第5个月应用高血压自我效能问卷进行评价。[结果]干预后干预组与对照组自我效能水平差异均有统计学意义(P<0.05),且干预组效果优于对照组。[结论]基于IMB模型的电话短信教育可提高社区老年高血压病病人的自我效能水平,且明显优于单纯的电话短信教育。

目标设定电话提醒对缺血性脑卒中患者服药依从性的影响

目的探讨目标设定电话提醒对缺血性脑卒中患者服药依从性的影响。方法采用同期单盲随机对照研究,将缺血性脑卒中患者分为对照组和干预组。对照组采用常规健康教育法,干预组在接受常规健康教育的同时,在干预护士指导下设定服药目标及制定行动计划,并接受其3次电话提醒(出院后第1周及出院后第1个月、3个月)。在干预前、出院3个月、6个月时采用Morisky 4条服药依从性量表(MAS)分别测量两组患者的服药依从性。结果出院6个月干预组服药依从性高于对照组(P<0.05);但干预前及出院3个月两组的服药依从性比较P>0.05;两组患者出院3个月的服药依从性与干预前比较均得以提高,但出院3个月后至出院6个月的变化比较平稳,其中干预组的效果可延续到出院后6个月,且有上升趋势,但对照组呈下降趋势。结论目标设定电话提醒可提高缺血性脑卒中患者的服药依从性,是脑卒中患者出院延续护理的重要措施之一。

75岁以上经皮冠状动脉介入治疗术患者电话随访现况调查及对策分析

目的探讨75岁以上行经皮冠状动脉介入治疗术治疗的患者电话随访过程中存在的问题,寻求提高随访成功率、改进随访质量的有效策略。方法 2016年1月至2017年12月,便利抽样法选取入住某三级甲等医院75岁以上行经皮冠状动脉介入治疗的患者为研究对象,进行电话随访,并统计分析随访情况。结果总随访628例,其中未失访464例、失访164例,总失访率为26.1%。其中成功随访用药情况281例,占60.56%;成功随访生活方式情况244例,占52.59%;成功随访到心血管不良事件52例,占11.21%。在电话随访失败的原因中,拒访占45.1%(74/164)、无人接听占20.7%(34/164)、空号占15.9%(26/164)、电话错误占9.1%(15/164)、停机占3.7%(6/164)、关机占3.7%(6/164),未留电话1.8%(3/164)。结论高龄冠状动脉硬化性心脏病患者介入治疗后电话随访失访率高,出院后的延续性治疗难以保证,需采取对应的措施进行改进。

电话回访式饮食干预在预防食管癌术后吻合口狭窄中的作用分析

目的 探讨电话回访式饮食干预在预防食管癌术后吻合口狭窄中的作用.方法 选取2012年4月～2013年1月行食管癌手术的127例患者,按出院日期分为两组,单日出院者为对照组（n=54）,双日出院者为试验组（n=73）,对照组出院后提供常规饮食指导方案;试验组在常规饮食指导的基础上,于出院后2～20 d,隔日由专人以电话方式进行饮食干预,询问并记录饮食情况.比较两组患者术后1、3个月的营养状况及吻合口狭窄情况.结果 两组患者术后复查时,体重、营养状况较术前有明显改善,组间或不同时期组内比较差异有统计学意义（P＜0.05）;术后1个月进普通食物时,对照组51.9％的患者、试验组53.4％的患者存在哽噎感,但组间比较差异无统计学意义（P＞0.05）.对照组中只有20.4％的患者遵守饮食教育,低于试验组78.1％的遵医率;对照组吻合口狭窄率为33.3％,吻合口直径平均（7.3±1.4）mm,而试验组吻合口狭窄率仅为12.3％,吻合口直径平均（11.2±1.3）mm;3项指标组间比较差异均有统计学意义（P＜0.05）.结论 电话回访式饮食干预对食管癌患者术后的营养状况及预防术后吻合口狭窄起到积极作用.

造口护士电话干预记录单的设计和使用效果分析

目的探讨造口护士电话干预记录单设计和应用效果。方法自行设计应用于造口患者出院后电话干预记录单,由造口护士采用自行设计的造口患者出院后电话干预记录单对59例出院结肠造口患者进行电话干预。结果造口护士记录的电话干预单共156份,进行了第1、2、3次电话干预的患者分别为59例、57例和40例。3次电话干预患者的情绪状况、自我效能水平以及患者对造口管理的依从性各条目差异均具有统计学意义(P<0.01或P<0.05)。结论电话干预记录单能够对干预流程起到引导作用,可以为出院后患者延续护理工作提供参考。

电话随访提高老年冠心病患者PCI术后药物治疗依从性的效果观察

目的探讨电话随访对老年冠心病患者经皮冠状动脉支架植入术(percutaneous coronary intervention,PCI)术后药物治疗依从性效果。方法将160例老年冠心病行PCI术后患者随机分为对照组(79例)和实验组(81例)。对照组患者出院后常规药物治疗,6个月电话随访1次;实验组患者在对照组基础上,出院后12个月内,根据患者服药依从性不佳原因,实施电话随访,共8次(如在随访过程中发现服药依从性欠佳则随时予增加随访次数)。比较出院后12个月两组患者药物治疗依从性及心血管不良事件发生率、冠状动脉再狭窄率、再住院率情况。结果实验组患者药物治疗依从性明显优于对照组,不良心血管事件发生率、冠状动脉再狭窄率、再住院率明显低于对照组,两组比较,均P<0.05,差异具有统计学意义。结论电话随访能提高老年冠心病PCI术后患者药物治疗依从性,从而提高治疗效果。

单纯心理干预与心理加电话干预对男性吸烟者的戒烟效果比较

目的评价单纯心理干预与心理加电话干预两种戒烟干预方法,在自愿戒烟的男性吸烟者中的有效性。方法 2008年10月-2012年12月,来解放军总医院戒烟门诊自愿戒烟,资料完整的504例男性,分为心理干预和心理加电话干预两组。单纯心理干预组在初次诊疗时进行面对面心理咨询干预,只安排1个月、3个月和6个月3次简单电话随访,每次5 min不进行干预。心理加电话干预组初次诊疗与单纯心理干预组相同,安排1周、1个月、3个月和6个月4次每次持续20 min的电话随访,继续强化戒烟干预。主要评价指标为1个月、3个月和6个月随访的7 d时点戒烟率,3个月和6个月随访的1个月持续戒烟率。结果 383例男性吸烟者完成6个月随访,心理加电话干预组和单纯心理干预组的1个月持续戒烟率分别为32.2%和18.0%。结论心理加电话干预戒烟比单纯心理干预戒烟更为有效。

电话干预对癌症患者支持性需求和心理健康影响的系统评价

目的系统评价电话干预对癌症患者支持性需求和心理健康的效果。方法计算机检索中国生物医学文献数据库、中国知网、万方数据库、维普网、Pub Med、Springer Link、Elsevier以及Wiley Online Library获取相关文献,时间限定为建库至2015-01-01。由2名研究者按照纳入与排除标准独立筛选文献并交叉核对提取的资料,整个筛选过程采用盲法。提取的内容包括第一作者、发表时间、样本量、结局指标、干预措施、测量工具、结局指标评定时间、主要结果、干预人员及患者肿瘤类型。由2名研究者独立根据Cochrane工作手册质量评价标准的偏倚风险评估工具进行文献质量评价。根据文献异质性进行描述性分析或Meta分析。结果共纳入12篇文献,干预组干预的次数为3-6次,干预措施的持续时间为6-12个月。有关电话干预对癌症患者支持性需求影响的文献异质性较大,放弃Meta分析进行描述性分析。基线或0.05）。≥6个月时,干预组心理健康状况优于对照组,差异有统计学意义〔SMD=-2.64,95%CI（-3.11,-2.18）,P〈0.05〕。结论电话干预对癌症患者支持性需求短、长期效应尚无定论;对心理健康短期效应不明显,而对心理健康长期效应明显。

电话干预对经皮经肝胆道外引流术患者康复及生活质量的影响

目的探讨电话干预对经皮经肝胆道外引流术治疗恶性梗阻性黄疸患者康复及生活质量的影响。方法将某三级甲等医院经皮经肝胆道外引流术治疗恶性梗阻性黄疸患者分为对照组48例和干预组51例。干预组在接受常规健康教育的基础上,出院后3个月内接受电话干预提供的个性化健康教育;出院后3个月对两组患者带管相关知识、带管相关并发症及生活质量进行调查比较。结果患者出院后3个月除引流袋更换外,电话干预组带管相关知识均优于对照组,生活质量优于对照组,带管相关并发症低于对照组(P<0.01或P<0.05)。结论电话干预可以提高经皮经肝胆道外引流术治疗梗阻性黄疸患者的自我护理能力及生活质量。

心理教育支持干预对乳腺癌术后出院患者疾病不确定感的影响

目的探讨心理教育支持干预对乳腺癌术后出院患者疾病不确定感的影响。方法采用便利抽样法抽取乳腺癌术后出院患者80例为研究对象,将患者按随机数字表法分为干预组和对照组各40例,对照组患者出院后接受常规随访,干预组在常规随访的同时给予乳腺癌心理教育支持干预。于干预2、4、6个月后对患者进行疾病不确定感水平的评价。结果两组疾病不确定感总分比较,干预主效应、时间效应、交互效应均P<0.01。结论对乳腺癌术后出院患者采取面对面的心理教育支持和电话随访心理教育支持干预,可显著降低其疾病不确定感水平,且干预时间越长效果越好。

电话随访综合心理干预对门诊抑郁症患者睡眠质量的影响

目的探讨电话随访综合心理干预对门诊抑郁症患者睡眠质量的影响。方法对64例门诊抑郁症伴睡眠障碍的患者在药物治疗基础上实施定期电话随访综合心理干预,在干预前和干预后2周采用匹兹堡睡眠质量指数问卷(pittsburgh sleep quality index,PSQI)调查患者的睡眠情况。比较患者干预前后睡眠状况。结果干预后抑郁症患者PSQI总分较干预前明显降低,前后比较,差异具有统计学意义(P<0.001),其中睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍、日间功能因子得分比较,差异具有统计学意义(均P<0.001),但催眠药物因子得分前后比较,差异无统计学意义(P>0.05)。结论定期电话随访综合心理干预能明显改善抑郁症患者睡眠障碍状况。

电话随访对急性脑梗死患者出院后服药依从性的影响

目的:本研究旨在评价对首次发病的急性脑梗死患者出院后实施电话随访干预对改善服药依从性的效果。方法:将连续收住院的264例初发急性脑梗死患者随机分为两组,对照组131例在出院时给予常规健康指导,而研究组133例除常规健康指导外,出院后还进行每月2～3次电话随访。出院3个月时调查两组患者抗血小板药物、抗高血压药物、调脂药物和糖尿病药物的服用率。结果:完成电话随访且资料完整者共212例,其中对照组104例,研究组108例。研究组患者在抗血小板药物、他汀类药物和胰岛素类药物的服用率高于对照组(P<0.05),两组患者抗高血压药物服用率无统计学差异(P>0.05)。结论:电话随访可以在急性脑梗死患者二级预防中发挥一定的作用,通过健康教育和电话随访,可以改善患者对药物的依从性。