Analysis of the Significance of Key Points of Patient Interventional Psychological Care and Pain Care

Interventional therapy has become increasingly popular in clinical practice due to advancements in medical technology.However,patients often experience psychological and physiological pressure due to its invasive nature.The management of patient discomfort and tension is crucial to ensure effective treatment.Psychological and pain management are essential components of interventional therapy,as they significantly impact patient recovery and prognosis.This article discussed the importance of interventional psychological and pain care for patients,starting with the development and spread of interventional therapy.The significance of providing high-quality nursing services to patients and improving their quality of life was also discussed.

Application of Wax Therapy in Pain Care of Patients with Rheumatoid Arthritis

Objective: To investigate the effect of wax therapy in pain care of patients with rheumatoid arthritis. Methods: Convenience sampling method was used to select inpatients with rheumatoid arthritis admitted to the rheumatology and immunology department of a 3A hospital in Jingzhou City. 75 patients from January 2021 to June 2021 were selected as the control group, and 75 patients from January 2022 to June 2022 were selected as the observation group. The control group was given routine nursing, and the observation group was implemented wax therapy nursing on the basis of the control group. The relief of clinical symptoms (morning stiffness time, pain score) and quality of life score of the two groups were observed. Results: After intervention, there was statistical significance between the two groups (P Conclusion: Wax therapy can improve the time of morning stiffness, the degree of pain and the quality of life of patients with rheumatoid arthritis.

Medical School Students’ Knowledge of Pain and Palliative Care: An Observational Study

Background: Pain and palliative care are a reality in daily routines of medical treatment. However, the theoretical-practical curricula of traditional medical school course still unsatisfactorily contemplate pain management, as well as the palliative care approach. Objective: To assess the knowledge of medical students about pain and palliative care, as well as to identify their perception of teaching these topics during hospitalization. Methods: A cross-sectional observational study, with a descriptive and exploratory approach, data collection for which was carried out between August and November 2020. The target population was medical students, who responded to an online survey of a quantitative, anonymous and follow-up nature. The survey study variables concerned knowledge about pain management and palliative care. Results: An expressive majority of academics showed difficulty in understanding the pathophysiology of pain related to prescribing drugs for pain management purposes, and all of them believe that it is necessary to acquire more knowledge about pain treatment. In parallel, only 9.3% report having received sufficient information regarding palliative care during medical school. Conclusion: The results suggest a certain lack of knowledge and insecurity among medical school students with respect to pain management and care for patients receiving palliative care. The didactical approach to this theme is still deficient in the medical curriculum and requires immediate improvement and new proposals that address the training of these professionals in a more specific and effective way.

Kangaroo Care (Skin-to-Skin) for Clustered Pain Procedures: Case Study

Background: Pain management for term newborns undergoing clustered painful procedures has not been tested. Kangaroo Care (chest-to-chest, skin-to-skin position of infant on mother) effectively reduces pain of single procedures, but its effect on pain from clustered procedures is not known. Aim: The aim was to test Kangaroo Care’s effect on pain in one term infant who received clustered painful procedures while determining feasibility of the Kangaroo Care intervention. Design, Setting, and Participant: A case study design was used with one healthy term newborn who received two heel sticks and one injection in one session in the mother’s postpartum room. Method: Heart rate and oxygen saturation (recorded from Massimo Pulse Oximeter every 30 seconds), crying time (total seconds of crying on videotape) and behavioral state (using Anderson Behavioral State Scoring system every 30 seconds) were measured before (5 minutes), during (10.5 minutes) and after (30 minutes) the three clustered painful procedures in a newborn who was in Kangaroo Care during all observations. One staff nurse administered the clustered procedures. Results: Heart rate increased sequentially with each heelstick, oxygen saturation remained unchanged, sleep predominated, and crying was minimal throughout the procedures. Conclusion: Kangaroo Care appeared to reduce pain from clustered painful procedures and can be further tested.

Application of Palliative Care in Improving the Quality of Life of Patients with Cancer Pain

Objective: To explore the effect of palliative care on the quality of life of patients with cancer pain. Methods: For May 2015 to May 2016 hospitalized 57 patients with advanced cancer pain carry out palliative care. At the same time, the quality of life questionnaire, including physical function, role function, emotional function, cognitive function and social function, were investigated at the time of admission and 6 weeks after admission. Results: Patients with various functions have significantly improved after palliative care (P Conclusions: Palliative care can effectively improve the quality of life of patients with cancer pain. It is worth in clinical promotion.

Pain Management and Factors Associated with Its Severity among Post Surgical Patients Admitted in the Intensive Care Unit at Muhimbili National Hospital, Tanzania

Background: Pain is the common experience among post operative patients admitted to the intensive care unit. Inadequate management can lead to undesired complications which can increase risk for morbidity and mortality. Objective: The aim of this study was to assess pain management and factors associated with its severity among post surgical patients admitted in intensive care unit at MNH. Method: A prospective study was conducted from October 2017 to February 2018 involving a total of 123 post operative patients aged 18 years and above admitted to the surgical and obstetric intensive care units. Structured questionnaires were used to obtain the required perioperative information. Severity of pain was assessed by using the Numerical Rating Scale (NRS). Data was analyzed using SPSS version 23.0. Frequency, percentages, tables and charts were used to summarize the study findings. Bivariate analysis and multivariate logistic regression were done. P-value of Results: The prevalence of severe post operative pain within 24 and 72 hours was 32.1% and 41.5% respectively. Pre operative use of analgesia (OR: 2.66, CI: 1.15 - 6.12, P value = 0.02), abdominal surgery (OR: 4.12 CI: 1.12 - 15.88, P value = 0.03) and thoracic surgeries (OR;7.42, CI: 1.54 - 35.88, P value = 0.01) was significantly associated with severe pain. Age, sex, ASA class, duration of surgery, and level of education did not show significant association with pain severity. Opioids prescribed postoperatively were pethidine (70.7%), morphine (11.4%) and fentanyl (11.4%). Other analgesics used were paracetamol (60.2%) and diclofenac (22%). Conclusion: The magnitude of post operative pain was high. Pre operative uses of analgesia, abdominal and thoracic surgery were the factors associated with severe pain. Pethidine and paracetamol were the most prescribed drugs, however the prescription pattern used was inadequate to control pain.

Clinical Audit Project Report —Audit of the Palliative Care Practitioners’ Adherence to WHO Guidelines in Managing Patients’ Pain at Cancer Diseases Hospital, Lusaka, Zambia

Appropriate adherence to World Health Organisation (WHO) pain management guidelines is vital in palliative care centres as it promotes the comfort of patients who are experiencing pain and it improves their quality of life. WHO (1996) highlighted the use of the WHO analgesic ladder guideline. This “analgesic ladder” proposes that after proper assessment with an appropriate pain assessment tool, patients in mild pain should be given non-opioids plus or minus adjuvants (including anticonvulsants and steroids);patients in moderate pain should be given weak opioids plus or minus non-opioids plus or minus adjuvants;and patients in severe pain should be given strong opioids plus or minus non-opioids plus or minus adjuvants as per the WHO pain ladder. The audit project was focused on assessing the palliative care practitioners’ (PCPs) adherence to WHO guidelines in managing their patients’ pain at Cancer Diseases Hospital (CDH). 15 participants were involved in the study and the data collection method used was a cross-sectional study in which the auditor observed PCPs, with an observation checklist comparing practice with WHO analgesic ladder guidelines. The result revealed that most of the PCPs were not meeting 80% of the standard set in the specific objectives for the audit. 7 (47%) PCPs were scoring the pain level before analgesia administration, whereas 8 (53%) PCPs were not scoring the pain level before analgesia administration. On the other hand, 47% (7 PCPs) were adhering to the WHO ladder of pain management, but 53% (8 PCPs) were not adhering to the WHO ladder of pain management. Therefore, effective adherence to the WHO analgesic ladder practice is still lacking in the PCPs at CDH. The percentage of PCPs who were not scoring the pain and not adhering to the WHO pain ladder guidelines was high, which is 8 (53%). Therefore, a re-audit is recommended to find out if levels of adherence have improved or not.

以疼痛专科护士为主导的镇痛泵全程管理系统的构建及应用研究

目的构建以疼痛专科护士为主导的镇痛泵全程管理系统,并评价其应用效果。方法以疼痛专科护士为主导、病区护士为主体,构建集专科护士工作站模块和病区护士工作站模块为一体的智能化镇痛泵全程管理系统。于2021年7月—10月在某三级甲等综合性医院进行系统试运行,比较系统应用前后镇痛泵患者24 h内镇痛不全率、镇痛相关不良反应阳性探测率、患者满意度和护士工作耗时的差异。结果镇痛泵全程管理系统使用后,当日20:00镇痛不全发生率由12.9%下降至5.9%(χ^(2)=21.749,P<0.001);次日09:00镇痛不全发生率由20.1%下降至15.1%(χ^(2)=6.759,P=0.009);次日16:00镇痛不全发生率差异无统计学意义;镇痛相关不良反应阳性探测率上升,其中恶心呕吐探测率由9.2%上升到31.5%(χ^(2)=119.46,P<0.001),头晕阳性探测率由3.6%上升到8.1%(χ^(2)=13.96,P<0.001);患者满意度由(4.90±0.40)分提高到(4.96±0.25)分,疼痛专科护士随访前准备和随访后数据录入耗时由(93.85±11.14)min/d下降至<20 min/d,病区护士评估镇痛泵耗时由(29.72±8.80)s/次下降到2 s/次,差异均具有统计学意义(P<0.05)。结论疼痛专科护士主导的镇痛泵全程管理系统,能有效改善术后疼痛管理的质量和患者满意度,优化疼痛管理的工作流程和工作效率。

规范化疼痛干预联合功能锻炼对髋关节置换术患者睡眠质量效果观察

目的:探究在对髋关节置换术患者护理时开展规范化疼痛干预联合功能锻炼对患者睡眠质量、疼痛程度以及关节功能的影响。方法:选取2023年3月至2024年3月厦门大学附属第一医院收治的行髋关节置换术患者66例作为研究对象,按照随机数字表法分为对照组和观察组,每组33例。对照组开展常规护理,观察组开展规范化疼痛干预联合功能锻炼。针对患者睡眠质量、疼痛程度、关节功能进行对比。结果:匹兹堡睡眠质量指数量表(PSQI)、视觉模拟量表(VAS)组间比较,干预后观察组评分较低,差异有统计学意义(P<0.05);日平均睡眠时间、夜间最长连续睡眠时间长于对照组,差异有统计学意义(P<0.05);Harris髋关节功能评分组间比较,干预后观察组较高,差异有统计学意义(P<0.05)。结论:在对髋关节置换术患者护理时开展规范化疼痛干预联合功能锻炼,可以提升患者手术期间睡眠质量,降低疼痛程度,促进关节功能恢复。

“一病一品”模式在肝癌经皮肝动脉化疗栓塞术患者中的应用效果

目的探讨“一病一品”模式在肝癌经皮肝动脉化疗栓塞(TACE)术患者中的应用效果。方法选取2021年9月至2023年9月江西省肿瘤医院收治的100例肝癌患者,采用随机数字表法将100例患者分为两组,每组均为50例。对照组采取常规护理,观察组采用“一病一品”模式,连续干预至出院。比较两组心理状态、疼痛、自理能力、并发症率、生活质量。结果观察组护理后焦虑自评量表(SAS)、抑郁自评量表(SDS)、数字评价量表(NRS)评分、并发症总发生率均低于对照组,自理能力评估量表评分、世界卫生组织生存质量测定量表(WHOQOL)各项评分均高于对照组,差异有统计学意义(P<0.05)。结论“一病一品”模式能够减轻肝癌TACE术患者不良情绪和疼痛,促进日常生活自理能力和生活质量提升,降低并发症发生风险。

“互联网+”移动护理模式在癌痛患者全程关怀护理中的应用效果

目的探讨“互联网+”的移动护理模式对癌痛患者的相关应用效果。方法选取2021年1月—2023年12月广西中医药大学附属瑞康医院肿瘤一病区收治的癌痛患者84例作为研究对象,按入院先后顺序分对照组(42例)和干预组(42例),对照组予以3个月常规宣教护理,干预组在常规健康教育的基础上通过互联网给予全程关怀护理模式干预3个月。对比两组患者服药依从性、爆发痛发生率、癌痛治疗认知度、自我效能感等指标,评估两组临床效果。结果两组患者干预后服药依从性评分、癌痛治疗认知度、自我效能感评分均高于干预前,且干预组均高于对照组,干预组爆发痛发生率低于对照组,差异均有统计学意义(P<0.05)。结论“互联网+”的移动护理模式可有效提高患者的癌痛治疗认知度、服药依从性和自我效能感,使患者疼痛得到缓解,降低了爆发痛的发生率,提高了患者的生存质量。该模式简单便于操作,经济有效,值得在临床上推广。

认知行为干预对固定矫正器正畸患者心理负担和自护能力的影响

目的:探讨认知行为干预对固定矫正器正畸患者心理负担和自护能力的影响。方法:选取2020年1月-2021年1月某院收治的90例固定矫正器正畸患者为研究对象,按照入院先后分为对照组和观察组,每组各45例;对照组采取常规干预,观察组采取认知行为干预;对比两组治疗依从性,干预前后心理负担[汉密尔顿焦虑自评量表(HAMA)、汉密尔顿抑郁自评量表(HAMD)]、舒适度和疼痛情况[Kolcaba简化舒适状况量表、视觉模拟评分法(VAS)]、自护能力[自我护理能力量表(ESCA)]及自我效能[口腔保健自我效能量表(SESS)]。结果:两组治疗依从性比较,观察组高于对照组(χ^(2)=5.404,P<0.05)。干预后,两组HAMA、HAMD评分均下降(P<0.05),且观察组均低于对照组(t=-8.993,-7.187;P<0.05);干预后,两组Kolcaba量表评分均升高(P<0.05),且观察组均高于对照组(t=10.804,P<0.05);两组VAS评分均降低(P<0.05),且观察组均低于对照组(t=-15.429,P<0.05);干预后,两组自我概念、健康知识水平、自我护理技能、自我护理责任感及ESCA量表总分均高于干预前(P<0.05),且观察组均高于对照组(t=6.692,3.663,5.640,5.183;P<0.05);干预后,两组口腔就诊、正确刷牙、平衡饮食得分均高于干预前(P<0.05),且观察组均高于对照组(t=4.295,7.013,7.427;P<0.05)。结论:对固定矫正器正畸患者采用认知行为干预效果显著,可提高治疗依从性,减轻心理负担,缓解疼痛,提高舒适度、自护能力和口腔保健自我效能。

住院患者急性疼痛智能管理平台的构建与应用

目的:基于临床照护分类系统构建住院患者急性疼痛智能管理平台,并评价应用效果,为提高住院患者疼痛管理质量提供借鉴。方法:以临床照护分类系统2.5中文版知识库和编码库为基础,开发包括评估工具智能推荐、评分高值预警、护理任务排程、疼痛程度自动触发个体化护理诊断及护理措施等功能的住院患者急性疼痛智能管理平台,于2022年4月试运行,比较平台使用前后住院患者疼痛管理质量指标及满意度。结果:使用平台后,住院患者的首次疼痛评估覆盖率、疼痛动态评估率、疼痛处置及时率均高于使用平台前(P<0.05),护士对信息系统使用满意度、患者对疼痛护理满意度均高于平台运行前(P<0.05)。结论:基于临床照护分类系统的住院患者急性疼痛智能管理平台的使用提升了住院患者急性疼痛管理效果,提高了患者满意度,同时提高了护士工作效率,具有临床推广使用价值。

复方苦参注射液联合西黄丸对晚期结直肠癌姑息治疗患者癌性疼痛和疲乏中位生存期及并发症发生率影响

目的:探讨复方苦参注射液联合西黄丸对晚期结直肠癌姑息治疗患者癌性疼痛和疲乏、中位生存期及并发症发生率影响。方法:将2020年1月至2021年5月成都医学院第一附属医院收治的153例晚期结直肠癌患者随机分为对照组(常规姑息治疗)、单药组(常规姑息治疗+西黄丸)、联合组(常规姑息治疗+西黄丸+复方苦参注射液),各51例。比较三组治疗前、治疗1个周期及治疗3个周期后癌性疼痛[疼痛数字分级法(NRS)]、癌因性疲乏[Piper疲乏修订量表(PFS-R)]、生存情况[功能状态评分(KPS)]评分、炎症因子[白细胞介素-6(IL-6)、C反应蛋白(CRP)、IL-8、IL-1β]、免疫功能(总T淋巴细胞、总B淋巴细胞、NK细胞),并比较三组肿瘤控制效果、并发症、毒副反应及中位生存期。结果:联合组肿瘤稳定占比高于对照组、单药组,且单药组高于对照组,进展患者占比低于单药组、对照组,且单药组低于对照组(P<0.05);联合组治疗1个、3个周期后NRS评分、PFS-R评分低于单药组、对照组,且单药组低于对照组,KPS评分高于单药组、对照组,且单药组高于对照组(P<0.05);联合组治疗1个、3个周期后总T淋巴细胞、总B淋巴细胞、NK细胞高于单药组、对照组,且单药组高于对照组(P<0.05);联合组治疗1个、3个周期后IL-6、CRP、IL-8、IL-1β低于单药组、对照组,且单药组低于对照组(P<0.05);联合组便秘、失眠、肠梗阻、肠出血、低热、感染发生率低于单药组、对照组,单药组便秘、失眠、肠梗阻、低热、感染发生率低于对照组(P<0.05);联合组恶心呕吐、骨髓抑制发生率低于单药组、对照组,且单药组低于对照组(P<0.05);随访2年,均失访2例,联合组死亡7例,单药组死亡20例,对照组死亡34例。联合组、单药组、对照组中位生存期分别为18、14、13个月,联合组中位生存期长于单药组、对照组(P<0.05)。结论:复方苦参注射液联合西黄丸可有效减轻晚期结直肠癌姑息治疗患者癌性疼痛和疲乏,改善患者生存质量,提高免疫功能,降低炎症反应及并发症发生率。

联合应用多种中医适宜技术干预阿片类药物相关性便秘的多中心临床研究

目的通过多中心临床研究,评价多项中医适宜技术联合干预对阿片类药物相关性便秘的临床疗效。方法2021年7月至2022年10月,在上海中医药大学附属岳阳中西医结合医院肿瘤科病房、利群医院安宁疗护病房、长征社区卫生服务中心安宁疗护病房选取符合阿片类药物相关性便秘诊断标准及便秘津亏肠燥证辨证标准的住院患者为研究对象,采用随机数字法分为对照组(n=164)与观察组(n=164)。两组患者均参照《阿片类药物相关性便秘中西医结合护理方案》开展常规护理工作。对照组在常规护理的基础上,给予乳果糖口服液(每日3次,每次10 mL空腹服用)及相应的用药指导;观察组在常规护理的基础上,采用中药贴敷、中药离子导入、耳穴压豆3项中医适宜技术联合干预。两组患者干预时间均为14 d,比较两组患者干预后的日均排便次数、平均排便间隔时间,干预前后的便秘症状、便秘相关生活质量及疼痛评分。结果观察组患者治疗便秘的显效率(31.71%)高于对照组(8.54%),且两组便秘症状疗效比较,差异有统计学意义(Z=-5.41,P<0.01);治疗后两组患者的日均排便次数及平均排便间隔时间差异均无统计学意义(P>0.05);两组患者治疗后便秘症状及相关生活质量较治疗前均有明显改善和提高,且观察组便秘症状及便秘相关生活质量评分的变化均比对照组更为明显,差异均有统计学意义(P<0.01);两组患者干预后疼痛评分均明显低于干预前,差异有统计学意义(P<0.01),但组间差异无统计学意义(P>0.05)。结论多种中医适宜技术联合干预可改善阿片类药物相关性便秘患者的便秘情况,同时可有效缓解患者的便秘不适症状、提高患者的生活质量,符合晚期肿瘤患者安宁疗护的理念,具有一定临床推广意义。

急性胸痛患者早期风险评估研究进展

急性胸痛是急诊常见的症状之一,早期精准识别高风险性和低风险性胸痛有益于高危患者得到及时诊疗以及低危患者减少过度医疗,同时改善预后和缓解院前急救及急诊科医疗资源的严峻。近年来急性胸痛患者早期危险分层工具不断开发,其敏感度和特异度各有不同。本文对目前急性胸痛患者早期风险评估的研究进展进行综述。

骨肉瘤行半骨盆截断术后幻肢痛患者的药学监护

目的探讨临床药师在幻肢痛治疗中的药学监护作用。方法临床药师通过参与1例骨肉瘤患者行半骨盆截断术后幻肢痛的治疗,结合相关指南及文献,对治疗过程中可能引起尿潴留的可疑药物进行评估,并提出相应的治疗方案优化建议。结果临床药师判断文拉法辛引起尿潴留的可能性大,并提供调整用药方案。调整后,患者的尿潴留症状逐渐缓解消失,幻肢痛得到有效控制。结论临床药师参与幻肢痛的治疗,能发挥药学专业优势,保障患者用药安全、有效,加速患者康复。

优质综合护理干预在重症监护室肺癌术后患者中的护理效果观察

目的:观察优质综合护理干预在重症监护室(ICU)肺癌术后患者中的护理效果。方法:选取2023年1—6月中山大学附属肿瘤防治中心ICU收治的肺癌术后患者100例为研究对象,采用随机数字表法分为观察组与对照组,各50例。观察组接受优质综合护理干预,对照组接受基础护理干预。比较两组视觉模拟疼痛评分法(VAS)评分、生存质量评分、并发症发生率、护理满意度。结果:术后12 h、24 h、48 h,观察组VAS评分均低于对照组(P<0.001);护理后,两组生理、心理、环境评分升高,观察组高于对照组(P<0.05);观察组并发症发生率低于对照组(P=0.045);观察组护理总满意度高于对照组(P=0.026)。结论:ICU肺癌术后患者行优质综合护理干预的效果显著,可缓解疼痛,改善生存质量,降低并发症发生率,提高护理满意度。

基于时机理论的护理干预结合循证式癌痛护理对肺癌患者NRS评分及睡眠质量的影响

目的:分析肺癌患者应用基于时机理论的护理干预结合循证式癌痛护理对其疼痛及睡眠质量的影响。方法:选取2022年2月至2023年2月福建中医药大学附属宁德市中医院肿瘤科收治的肺癌患者78例作为研究对象,随机分组为对照组和观察组,每组39例。对照组实施常规性护理干预,观察组实施基于时机理论的护理干预结合循证式癌痛护理,观察2组的疼痛评分及生命质量、睡眠质量。结果:护理后,观察组的疼痛评分低于对照组,观察组的生命质量评分均高于对照组,观察组的睡眠质量评分均优于对照组(P<0.05)。结论:肺癌患者应用基于时机理论的护理干预结合循证式癌痛护理对其疼痛及睡眠质量有积极的影响,极大地缓解了疼痛程度,改善了睡眠质量,进而提高了生命质量。

胸痛发作时床边即时检测心肌钙蛋白T诊断急性心肌梗死的价值

目的确定胸痛症状发作后不同时间间隔内,床边心肌肌钙蛋白T(point of care troponin-T testing,POCT-cTnT)对急性心肌梗死(acute myocardial infarction,AMI)的诊断性能,了解其在快速排除AMI方面的意义。方法这项回顾性研究包括了2019年1月至2022年12月期间出现胸痛症状的6024例患者。在入院时测量了POCT-cTnT和中心实验室cTnI水平。通过按时间窗口划分的受试者工作特征(receiver operating characteristics,ROC)分析,评估POCT-cTnT在诊断AMI时的准确性。结果总体而言,POCT-cTnT诊断AMI的AUC为0.826(95%CI:0.816~0.836),灵敏度和特异度分别为72.81%和86.26%。根据胸痛发作的时间进行区间分组(<3 h、3~6 h、6~12 h、12~24 h、24~72 h和≥72 h),6~12 h以后的分组AUC值分别为0.918、0.928、0.920和0.908,差异无统计学意义(P>0.05),均要高于6 h时以内的组(P<0.001);根据胸痛发作时间点进行分组,≥8 h组的AUC为0.921,阴性预测值(negative predictive value,NPV)98.1%和阴性似然比(negative likelihood ratio,-LR)0.11,其AUC高于≥3 h、≥2 h、≥1 h和overall组(P<0.05),而与≥4 h以后的各时间组相比,差异无统计学意义(P>0.05)。结论胸痛发作时间对单次检测POCT-cTnT诊断AMI的性能存在一定的影响,结合胸痛发作至就诊时间,可能提高其诊断或排除AMI的可靠性。在胸痛发作4 h后,单次POCT-cTnT检测能可靠地诊断或排除AMI;当胸痛发作8 h后,其诊断或排除AMI方面具有更高的可靠性。