What are the self-management experiences of the elderly with diabetes?A systematic review of qualitative research

BACKGROUND The number of elderly individuals with diabetes is dramatically increasing.Diabetes is a long-term condition and a noncommunicable disease and requires intensive daily self-management.Understanding of self-management from the patients’perspectives is important to nurses,healthcare providers,and researchers and benefits people by improving their self-management skills.AIM To examine and synthesize qualitative studies that explore the experiences of elderly people in self-managing diabetes.METHODS Electronic databases were searched,including MEDLINE,CINAH,PsycINFO,PubMed,CNKI,and WANFADATA.Relevant research was identified by manually searching reference lists and gray literature.Only English and Chinese publications were included.The Critical Appraisal Skills Program was used to assess the quality of the research.The Confidence in the Evidence from Reviews of Qualitative research approach was used to assess the confidence of the findings.RESULTS A total of 10 qualitative studies were included,and content analysis was performed.Five themes were identified:The need for knowledge about diabetes care,support systems,functional decline,attitudes toward diabetes,and healthy lifestyle challenges.CONCLUSION This present review provides a deep and broad understanding of the experiences in the self-management of diabetes and can be valuable to nursing practice and provide recommendations for future research.

Multiple mediation effects of health locusof control and hope on the relationshipbetween stroke patients’ social supportand self-management

Objective:This study aimed to identify the mediation effects of health locus of control(HLC)and hope between stroke patients’social support and self-management.Methods:A cross-sectional study was conducted.A total of 300 Chinese stroke patients were recruited by convenient sampling from the acupuncture department of two Chinese Traditional Medical Hospitals in Tianjin Province from June to September 2018.The self-report questionnaires include Social Support Assessment Scale,Herth Hope Index,Mental Health Locus of Control Scale,Stroke Self-management Behavior Scale,and personal information questionnaires.All the survey data were entered in Excel and analyzed using the SPSS 24.0 program.Mediation was tested with Bootstrapping in AMOS 23.0 program.Results:The result showed that internal health locus of control(IHLC),chance health locus of control(CHLC)and hope were the mediators between social support and self-management.The direct,indirect,and total effects of social support on self-management behavior were 0.306 (P<0.01),0.109(P<0.01),and 0.415(P<0.01),respectively.Conclusions:Social support can directly influence self-management,and it can also indirectly influence self-management through IHLC,CHLC,and hope.

Factors related to self-management behavior among persons with mild-to-moderate chronic obstructive pulmonary disease in Wenzhou,China

Objective:To describe the self-management(SM)behavior among persons with mild-to-moderate chronic obstructive pulmonary disease(COPD),and it examines the correlation between COPD knowledge,self-efficacy,perceived social support,and SM behavior among persons with mild-to-moderate COPD in Wenzhou,China.Methods:A simple random sampling technique was used to recruit 121 persons with mild-to-moderate COPD who visited the respiratory outpatient department of the First Affiliated Hospital of Wenzhou Medical University in Wenzhou,China.Research instruments include a demographic data questionnaire,COPD SM scale,COPD knowledge questionnaire,6-item chronic disease self-efficacy scale,and perceived social suppor t scale.Descriptive statistics and Pearson's Correlation were used for data analysis.Results:The findings show that the mean score of COPD SM scale was 2.70(SD=0.45).The Pearson correlation analysis revealed that the COPD knowledge(r=0.47,P<0.001),self-efficacy(r=0.28,P=0.001),and perceived social support(r=0.48,P<0.001)were positively correlated to the COPD SM behavior among persons with mild-to-moderate COPD in Wenzhou,China.Conclusions:The findings indicate that disease knowledge,self-efficacy,and perceived social support were related to SM behavior in persons with mild-to-moderate COPD,which provides a theoretical basis for developing SM interventions for persons with mildto-moderate COPD and improving this population's SM behavior.

The moderating effect of social cognitive factors on self-management activities and HbA1c in Thai adults with type-2 diabetes

Background: Diabetes mellitus (DM) has become a serious chronic disease.Self-management strategies help persons with DM make choices which will develop skills needed to reach their goal of blood glucose control and allow them to be successful in reaching goals.Objective: To examine the impact of self-management activities on HbA1c for persons with DM and to examine the impact of social support,self-efficacy and Buddhist values as moderators on the relationship between the self-management activities and HbA1c.Method: This study is a cross-sectional design.The sample included 401 Thai adults diagnosed with type 2 diabetes,aged 20-65 years old who had at least one HbA1c test in the last three months were recruited.Participants completed four questionnaires to measure self-management activities,as well as self-efficacy,Buddhist values and social support as moderating factors on self-management activities and HbA1 c,Results: The self-management activities were negatively associated (β =-2.05,p ≤ 0.001) with HbA1c.The Social support,self-efficacy and Buddhist values had a significant interaction effect between selfmanagement activities and HbA1c (β =-0.97,p ≤ 0.05,β =-0.18,p ≤ 0.05 and β =-2.76,p ≤ 0.001).Conclusion: The diabetes self-management activities were more strongly associated with HbA1c under conditions of high social support,self-efficacy and health beliefs with Buddhist values.Future interventions for T2DM self-management programs should incorporate mechanisms to measure and support these factors.

Social Prescribing through Primary Care: A Systematic Review of the Evidence

Background: In primary care, social prescribing (SP) is where a patient is referred to a “link worker”, who considers their needs and then “prescribes” or connects them to appropriate community-based resources and services. Recent policy and guidance in the UK has significantly expanded the provision of SP to improve patient health and wellbeing. Methods: This study conducted a systematic review of evidence for SP effectiveness and to report needs addressed, interventions provided, and behaviour change techniques employed. Inclusion criterion was patient referral from primary care to a SP link worker. Online databases were searched for studies published from February 2016 to July 2021. Searches were restricted to English language only. Risk of bias assessment and a narrative analysis were undertaken. Results: Eight studies were included. All studies reported some positive outcomes. There were weaknesses and limitations in study design and in reporting of results: a lack of comparative controls, short duration and single point follow-up, a lack of standardised assessments, missing data, and a failure to consider potential confounding factors. All studies had features which indicated a high risk of bias. Conclusion: Evidence for the value and positive impact of SP is accumulating, but evaluation design remains relatively weak. There is a need to improve evaluation through robust methodological design and the adoption of universal outcome measures and evaluation/analytical framework. SP should seek to assess patient wellbeing, self-management, and quality of lifeoutcomes systematically, and adopt behaviour change techniques to enable healthier lifestyles in the short and long term.

个体化系统营养支持联合阶段式认知行为干预在食管癌放化疗患者中的应用

目的:探讨个体化系统营养支持联合阶段式认知行为干预在食管癌放化疗患者中的应用效果。方法:选取2019年1月1日~2023年1月1日收治的150例食管癌放化疗患者作为研究对象,按照随机数字表法分为研究组和对照组各75例,对照组实施常规护理,研究组实施个体化系统营养支持联合阶段式认知行为干预;比较两组干预前后营养状况[包括血清血红蛋白(Hb)、前白蛋白(PA)、白蛋白(ALB)、总蛋白(TP)]、生活质量[采用欧洲癌症治疗研究组织生命质量测定量表(EORTC-QOL-C30)]、不良事件、自我护理能力[采用自我护理能力测定量表(ESCA)]、负性情绪[采用贝克抑郁自评量表(BDI)、焦虑敏感指数量表(ASI)、恐惧视觉模拟评分法(FAVS)],不良事件发生情况、满意度。结果:干预后,两组Hb、PA、ALB、TP、EORTC-QOL-C30、ESCA评分均优于干预前(P<0.05),且研究组优于对照组(P<0.01);干预后,两组BDI、ASI、FAVS评分均低于干预前(P<0.05),且研究组低于对照组(P<0.01);研究组不良事件发生率及满意度均优于对照组(P<0.05)。结论:个体化系统营养支持联合阶段式认知行为干预,能改善食管癌放化疗患者的营养状况和负性情绪,提高其自我护理能力和满意度,减少不良事件发生,从而提高患者生活质量。

临床决策支持系统管理高血压患者血压和心血管风险效果的系统评价

目的系统评价临床决策支持系统(CDSS)应用于高血压患者血压与心血管风险管理的效果。方法检索中国知网、万方、维普、PubMed、EMbase等数据库,检索时限由建库至2023年5月。由2名研究人员独立进行文献筛选、数据提取、证据质量评价。结果最终纳入11项研究,临床决策支持系统功能包括辅助诊疗、诊疗质量反馈、用药推荐、随访监测、信息提醒、心血管风险评估等。结果显示,CDSS对高血压患者血压及心血管风险管理具有一定的改善作用。文献质量评价结果显示,1篇等级为“强”,4篇为“中”,6篇为“弱”。结论CDSS可以辅助改善高血压患者血压及心血管风险管理效果,未来应用前景广阔。今后的研究可以考虑加强高血压领域CDSS全程化功能设计,建设更多的本土化高血压CDSS。

财政视角下国家创新体系的有效转型

我国正处于由“科技大国”向“科技强国”转型的关键时期。财政为国家创新体系的运行提供了必要的资源供给和政策支持,是国家创新体系转型与演化的重要物质基础。基于演化范式构建创新市场选择的演化分析框架,刻画国家创新体系内发生创新“突变”时所面临的不同市场选择,以及政府借助不同的财政科技投入方式影响科技创新的“遗传与扩散”过程。国家创新体系转型需遵循创新市场演化的基本规律,顺应科技创新演化规律的财政科技支持手段方能促进国家创新体系成功转型。创新体系有效转型需从物质基础、市场选择、关键动力、融资机制四方面着力,为面向重大应用的基础研究提供稳定、持续增长的投入保障,以财政手段引导多元主体融合参与知识、技术和制度的共生演化过程,遵循不同科技创新活动的市场选择规律,最终提升我国国家创新体系的内循环动力。

“五化”并进:推进“大思政课”高质量发展的实践理路

新时代推进“大思政课”高质量发展,要以习近平总书记关于“大思政课”的系列重要论述为思想指引,以教育部等十部门联合印发的《全面推进“大思政课”建设的工作方案》为实践遵循,以“大课堂”“大平台”“大师资”等为重要抓手,秉承系统化思维、夯实体系化支撑、展现生活化样态、坚持集约化发展、构筑协同化机制,以“五化”并进推进“大思政课”从思想理念层面进入精耕细作层面,推动“大思政课”落地见效。

营养支持病人发生再喂养综合征预测模型的系统评价

目的:系统评价营养支持病人发生再喂养综合征风险预测模型。方法:计算机检索PubMed、EMbase、CINAHL、Web of Science、中国生物医学文献数据库、中国知网和万方数据库中有关再喂养综合征风险预测模型的研究,检索时限为建库至2023年5月11日。2名研究者独立进行文献检索、筛选与资料提取,采用诊断或预后多因素预测模型研究偏倚风险的评估工具对纳入研究进行偏倚风险和适用性评价。结果:最终纳入10篇文献,包含14个营养支持病人再喂养综合征风险预测模型,模型中已报道的受试者工作特征曲线下面积(AUC)值为0.626~0.950。纳入预测模型中常见预测因子包括年龄、SOFA评分、利尿剂的使用、基线血钾、急性生理与慢性健康状况(APACHEⅡ)评分和蛋白质摄入情况。所有研究的适用性较好,但存在一定的偏倚风险。结论:现有证据表明,目前建立的再喂养综合征预测模型主要针对重症监护室病人,对于风险因素的分析和建模还处于初级阶段。有必要明确再喂养综合征的诊断标准,开展多中心、大样本的研究,并进行内外部的验证。

情感支持联合系统健康教育对老年脑梗死合并认知功能障碍患者不良情绪及生活质量的影响

目的探讨情感支持联合系统健康教育对老年脑梗死合并认知功能障碍患者不良情绪及生活质量的影响。方法纳入2023年1月—2023年10月复旦大学附属华山医院神经内科收治的恢复期老年脑梗死合并认知功能障碍患者160例,采用随机数字表法分为2组:观察组(n=80例)和对照组(n=80例)。对照组住院期间进行常规护理及康复训练,观察组在与对照组相同处理的基础上加用情感支持联合系统健康教育。比较2组干预前、干预后3个月认知功能简易智力状态检查表(MMSE)、蒙特利尔认知评估量表(MoCA)、不良情绪焦虑(SAS)、抑郁(SDS)自评量表、生活能力(改良Barthel指数)及脑卒中专用生活质量量表(SS-QOL)评分。结果干预后3个月,观察组MMSE评分、MoCA评分均高于对照组(P<0.05);观察组SAS评分、SDS评分均低于对照组(P<0.05);观察组改良Barthel指数评分、SS-QOL评分均高于对照组(均P<0.05)。结论情感支持联合系统健康教育用于老年脑梗死合并认知功能障碍患者治疗中,可能提高患者的认知功能,减轻不良情绪,改善生活质量。

Development and evaluation of the Directive and Nondirective Support Scale for Patients with Type 2 Diabetes

Objectives:This study aims to develop the Directive and Nondirective Support Scale for Patients with Type 2 Diabetes(DNSS-T2DM)to measure diabetes-specific support and patients’preference as well as evaluate the construct validity and reliability of the DNSS-T2DM.Methods:A cross-sectional study was conducted in Tongzhou District,Beijing,China from July to September 2015.A total of 474 participants who had been diagnosed as type 2 diabetes by physicians and completed the DNSS-T2DM were included.The original 11-item DNSS-T2DM contains five items on nondirective support(Items 1-5)and six items on directive support(Items 6-11).There were two parallel questions for each item with one to measure the preference for support(Preference part)and the other to measure the perception of support in reality(Reality part).The final DNSS-T2DM was determined based on the results of the exploratory factor analysis(EFA).The construct validity of the final DNSS-T2DM was evaluated by the confirmatory factor analysis(CFA).The reliability was evaluated by internal consistency with Cronbach’sαcoefficients.Results:A final 7-item DNSS-T2DM loaded on 2 factors with four items representing nondirective support and three items representing directive support was determined based on the EFA.The CFA indicated a satisfactory construct validity.The internal consistency of the 7-item DNSS-T2DM as well as the nondirective support items was satisfactory with Cronbach’sα≥7.00.70.Conclusions:Our study supported the validity and reliability of the 7-item DNSS-T2DM.Further studies on the application of the DNSS-T2DM in different settings and population are needed.

Study and Proposal to Build the Maintenance Systematization for Preservation of Buildings Aiming at Long-Lived Buildings

Systematization for the maintenance of buildings enables their supporting system to be more practical than before. This study aims to make the maintenance and the long-term repairs for the buildings to be easier. In Japan, 30-40-year-old buildings seem to have been planned and built with little thought about their future maintenances, which have made them very difficult to be repaired on a large scale. This is why effective management systems about dealing with the data should be strongly suggested. Since the Building Standard Law was amended on April 1, 2008, in Japan, the regular investigation and report for particular buildings are legally obligated every three years, thus a variety of useful data can be obtained through Kitakyushu City cases as well as former data personally obtained. With those data used usefully, systematization for the maintenance of the buildings will produce satisfactory results by building up a connection between those data and the long-term repair planning.

智慧社会体系化建设总体构想与发展建议

智慧社会是数字中国建设的重要组成部分,而相关建设面临着现实挑战;研究智慧社会体系化建设方法,将支持构建国家竞争新优势、推进中国式现代化、实现数字中国战略。本文围绕如何构建新型智慧社会、实现社会资源效益最大化的主旨,分析了智慧社会建设现状并概括了发展趋势,凝练了当前存在的分散建设投资大、运营效率低、发展不平衡等突出问题;基于系统工程方法,提出了智慧社会体系化建设的总体架构,即采用“1+N+X”智慧社会业务应用体系化建设新模式,以统筹全社会信息基础设施资源、共建智慧社会体系能力支撑平台为重点,据此扩展各类业务应用。研究建议,加强顶层设计,共建“网、云、数、控、智”一体的体系能力支撑平台,形成智慧社会体系化建设基础数字底座;采取体系化建设新模式,以高效运营推动智慧社会建设持续发展;配套改革举措,构建完善的智慧社会标准和法律法规体系;以国家级智慧社会数字化系统工程实验室的形式,为智慧社会体系化建设提供坚实的理论、技术、人才支撑。

风险感知视角下个体信息处理模式对政策支持态度的影响研究

公众对政策的态度是决定政策能否有效实施的重要因素,但公众是否对政策持积极态度以及哪些因素会影响公众接受政策尚不明确。在风险环境下,个体如何选择信息处理模式、如何通过信息处理进行决策及政策支持,对风险沟通效果具有关键影响。基于启发式-系统式模型及风险信息寻求与加工模型,研究不同风险感知水平下个体信息处理模式如何影响个体对风险防范控制政策的支持。对2022年3月10日至2022年5月10日期间收集的2541份有效样本进行实证分析,结果显示:信息不足和负面影响影响信息处理模式,信息处理模式影响公众政策的支持态度;风险感知对信息处理模式与公众行为意向之间的关系起调节作用。

关于海洋测绘技术体系化归类与专业教育思考

为加深对海洋测绘知识、技术体系的系统化认识,在分析海洋测绘概念形成与发展、学科专业体系构成与分类现状以及海洋测绘理论和技术特征的基础上,将海洋测量各分支技术按面向要素或目标的客体认知技术、面向应用方向的服务技术,以及通用型关键支撑技术进行体系化归类论证,依此建构了立足学科交叉理论、凝聚关键技术,适应多样化服务需求的专业教育模式。将海洋测绘技术进行体系化归类,厘清了相关科学与海洋测绘各分支的关系,突出了学科的认知与描述目标,彰显了技术驱动与需求牵引的海洋测量技术与应用发展状态,也适应人才能力指标设定和灵活的专业教育课程体系构建。

新时期中小河流系统治理思路和对策

以流域为单元推进中小河流系统治理是推动新阶段水利高质量发展、支撑国家水网建设、助力乡村振兴的重要举措。探讨现阶段我国中小河流治理现状、存在问题和主要挑战,研究提出了新时期中小河流系统治理的思路,从做好中小河流治理顶层设计、夯实中小河流治理理论和技术支撑、创新中小河流治理管理体制机制、强化中小河流智慧化建设等方面提出了对策建议,为中小河流治理管理提供参考。

从41种知识综合方法中推荐系统评价类型:一项基于网络的决策支持工具——“Right Review”的介绍

知识综合方法的激增为研究者正确选择系统评价方法带来了挑战。为应对这一挑战,加拿大多伦多大学、女王大学,英国谢菲尔德大学等多家研究机构组建的研究团队研发了一项基于网络的决策支持工具“Right Review”。该工具能为用户从41种知识综合方法中推荐系统评价方法,其中定量研究系统评价26种、定性研究系统评价15种。“Right Review”工具免费开放,简单易用,能有效辅助科研工作者选择合适的系统评价方法和获取相关信息和资源。本文对该工具的核心功能进行介绍,以期为国内研究者开展系统评价提供工作辅助的提示和参考。

结直肠癌诊疗中患者决策辅助工具应用效果的系统评价

背景患者决策辅助工具(PDA)是在实施医患共同决策过程中,辅助患者决策的重要工具,然而在结直肠癌的诊疗过程中,其应用效果并不一致。目的系统评价结直肠癌PDA研发的核心要素及临床应用效果。方法于2022年2月,计算机检索PubMed、Web of Science、CINAHL、Cochrane Library、EmBase、PsycINFO、乔安娜布里格斯研究所(JBI)循证卫生保健数据库、Scopus、中国知网、万方数据知识服务平台、维普中文科技期刊全文数据库、中国生物医学文献数据库,获取有关结直肠癌PDA的随机对照试验,检索时限均为建库至2022年1月。由2名研究者独立根据纳入标准逐层筛选文献并提取资料后,采用Cochrane偏倚风险评估工具(5.1.0版)进行文献质量评价。采用描述性分析法分析PDA研发的核心要素,总结其临床应用效果。结果最终纳入11篇文献,文献总体质量中等,其中A级文献1篇,B级文献10篇。11篇文献涉及结直肠癌筛查、晚期结直肠癌患者的系统治疗与支持性照护、转移性结直肠癌化疗、遗传性非息肉病性结直肠癌风险基因检测等临床决策主题。通过分析得知:现阶段结直肠癌PDA的研发主要参照国际患者决策辅助工具标准协作组发布的质量评价标准,工具核心要素包括信息支持、方案利弊分析、患者价值澄清;11篇文献中,4篇文献发现结直肠癌PDA的应用有助于提高患者知识水平,8篇文献发现结直肠癌PDA的运用降低了患者决策冲突水平,2篇文献结果表明结直肠癌PDA的使用促进了知情选择。结论结直肠癌PDA的应用有助于促进决策行为及结果的改善尚缺乏足够的证据支持,但其应用前景十分广阔。未来可以借鉴国外决策辅助相关理论成果,结合我国人群特点,开发出适用于不同疾病阶段的结直肠癌PDA,并进一步评估其在辅助决策中的运用效果。

大型活动医疗保障管理综述

目的系统性综述大型活动医疗保障的管理。方法检索中国知网、万方数据库、PubMed和Web of Science数据库以获取2011年1月至2021年11月发表且符合要求的相关文献。结果系统综述显示,大型活动医疗保障的管理涉及组织框架,方案制定,人员、物资和现场医疗服务管理,信息化技术的支撑以及文档管理,但我国缺乏相关的规范性文件或指南。结论鉴于大型活动医疗保障是一个系统性的项目,我国应制定大型活动医疗保障指南或规范性文件,改善大型体育赛事的医疗保障管理,加强相关研究。