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Objective:To observe and analyze the macular microvascular system changes in unilateral pediatric uveitis (PU) and healthy contralateral eyes.Methods:A cross-sectional case-control study. From January 2019 to July 2021, 21 eyes of 21 patients with PU diagnosed in one eye (PU group), 21 unaffected contralateral eyes (contralateral eye group), and 21 age-matched volunteers with 21 eyes (NC group) during the same period were examined in Peking Union Medical College Hospital. Optical coherence tomography angiography was used to scan the 6 mm × 6 mm fundus macular area in the three groups of selected eyes to measure the vessel density of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) of the retina, the area of the avascular zone (FAZ) in the fovea of the macula, the choroidal thickness under the fovea (SFCT), and the retinal thickness in the fovea of the macula (CRT). The device comes with a software choriocapillary flow measurement tool, which can obtain the macula's choriocapillary density (CCD) with the fovea as the center and the diameter of the annular area of 1.0 mm, 1.5 mm, and 3.0 mm, respectively. They were recorded as CCD-1.0, CCD-1.5, and CCD-3.0. The measurement data of multiple groups were compared by analysis of variance; if the variance of the three groups of data was not uniform, the Kruskal-Wallis test was used. Multiple linear regression analysis was used to evaluate the potentially related factors of CCD.Results:Compared with the contralateral eye group and the NC group, the vessel density of SCP ( H=-13.857,-25.500; P=0.043, P<0.001), DCP ( H=-15.333, -31.595; P=0.007, P<0.001) and CCD-1.0 ( H=-14.000,-16.214; P=0.040, 0.012) of the clinically quiescent PU group were significantly decreased. CRT and FAZ were not statistically different between PU and NC groups ( F=0.955; P=1.000, 0.661). Compared with the NC group, the mean vessel density of SCP and DCP in the contralateral eye group decreased, and the difference in DCP vessel density was statistically significant ( H=-16.262, P=0.004). There was no statistically significant difference between the CCD of two groups ( P=1.000). The SFCT of the PU group was significantly thicker than that of the NC group ( F=5.552, P=0.004), however, difference was not statistically significant from the fellow eye group ( F=5.552, P=0.270). The results of multiple linear regression analysis revealed that the CCD-1.0, CCD-1.5, and CCD-3.0 showed a linear correlation with the area of FAZ ( β=-0.494, -0.527, -0.566; P=0.015, 0.009, 0.010) and CRT ( β=-0.322, -0.466, -0.342; P=0.026, 0.002, 0.028). CCD-1.0 and CCD-1.5 showed a linear correlation with the vessel density of DCP ( β=0.277, 0.275; P=0.047, 0.045). Conclusion:Both retinal and choroidal microvasculature are abnormal in resting eyes with PU, and macular circulation disorders may be present in the unaffected fellow eye.
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With the accelerating process of aging, the burden of elderly care in China is increasing dramatically. However, the current care models were difficult to meet the multi-level and diversified needs of the elderly. Time banking mutual care model is proposed as an important auxiliary model. Since the elderly in urban communities are the major participants of time banking mutual care model, understanding their willingness to participate is very important for the effective implementation and sustainable development of time banking mutual care model. This paper summarizes the research progress and the major influencing factors of the willingness of the elderly to participate in time banking mutual care model, in order to provide theoretical support for alleviating the increasingly severe burden of elderly care in China and realizing active aging.
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Purpose@#The goal of this study was to describe the current status of oncology nurses' behaviors toward end of life (EOL) care in China and to explore the factors associated with oncology nurses’ behaviors toward EOL care. @*Methods@#A cross-sectional design was applied and a convenience sample of 1038 oncology nurses from 22 grade A hospitals were recruited into this study. A general social demographic data questionnaire was administered, and the Chinese version of Nurses’ Behaviors of Caring for Dying Patients Scale was used to assess nurse behavior toward EOL care. The total score ranges from 40 to 200 points. Data were analyzed with SPSS 26.0 software. @*Results@#Chinese oncology nurses' average score of holistic EOL care behaviors was 2.97 ± 0.59. Oncology nurses provide physical care most (3.81 ± 0.76), followed by family care (3.02 ± 0.86), and spiritual care (2.37 ± 0.67). Multiple regression analysis showed that a higher frequency of sharing EOL care experience with colleagues, in-service palliative care education, higher level of head nurse support for EOL patient care, more cases of EOL care, higher working position, and nurse's perceived high level of support were positively associated with behavior toward EOL care. These six factors explained 16.2% of the total variance. @*Conclusions@#The results may help provide a basis for converting behavior for EOL care among oncology nurses and design interventions to better improve quality of life for EOL patients with cancer in China.
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The increasing use of target therapy and immunocheckpoint inhibitors in cancers has brought new hope of survival to patients with advanced tumors. However, more and more adverse side-effects and toxicities of these medications had been reported, affect almost all human organs including the eye. These adverse effects may affect the entire ocular tissues, like eyelid, eye lashes, conjunctiva, cornea, uvea, retina, optic nerve and so on, which are always been ignored by patients and doctors. In this paper we will summarize the characteristics of the related ocular diseases and give our advice on how to diagnose and manage these diseases.
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Objective@#To analyze the changes of peripheral blood leukocyte in patients with Behçet uveitis (BU) at different stages.@*Methods@#Case control study was performed.Twenty active stage BU patients and 21 quiet stage BU patients were enrolled from July to November 2015 in Peking Union Medical College Hospital.Ten active stage BU patients treated with glucocorticoid and/or immunosuppressive agents were served as improvement stage BU patients.Meanwhile, 82 healthy controls were collected from the physical examination center.Peripheral blood was obtained and then analyzed by using Hematoflow method.The percentages of leukocytes in peripheral blood of different stage BU patients were compared.This study was approved by the Ethics Committee of Peking Union Medical College Hospital (ZS-1341) and all participants signed informed consent.@*Results@#The percentage of mature neutrophils, eosinophils, basophils, B lymphocytes, non-cytotoxic T and NK lymphocytes, granular T and NK lymphocytes, T blasts, B blasts and immature granulocytes were all significantly different among active stage BU group, quiet stage BU group and healthy control group (F=42.324, 10.220, 8.660, 11.254, 29.795, 31.305, 23.742, 27.738 and 34.638, all at P<0.001). The percentage of mature neutrophils in active stage BU group and quiet stage BU group were (73.10±10.21)% and (62.40±12.09)%, which were significantly higher than (54.95±6.07)% in healthy control group.The percentage of mature neutrophils in active stage BU group was significantly higher than that in quiet stage BU group (P<0.05). The percentages of non-cytotoxic T, NK lymphocytes, granular T and NK lymphocytes in active stage BU group and quiet stage BU group were significantly lower than that in healthy control group, the percentage of non-cytotoxic T, NK lymphocytes and granular T, NK lymphocytes in active stage BU group were significantly lower than those in quiet stage BU group (all at P<0.05). The percentage of immature granulocytes after treatment was significantly higher than that before treatment in improvement stage BU group (t=-2.469, P=0.036).@*Conclusions@#Increase of peripheral blood mature neutrophil was observed in BU patients, which may help to monitor the inflammatory activity of BU.
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Glaucoma is a potentially blinding complication of uveitis.Management of uveitic glaucoma remains challenging.Vision can be partly recovered if correct diagnosis and timely treatment are given.The mechanisms of intraocular pressure (IOP) elevation include peripheral anterior synechia, pupillary block, trabecular meshwork inflammation, cyclitis and prolonged corticosteroid use.Treatment is targeted at identifying the cause of raised IOP first, followed by etiological treatment and IOP lowering medications.The indications for surgery include uncontrolled IOP despite maximum-tolerated medical management or definite optic nerve damage.Recently, selective laser trabeculopasty for steroid-induced intraocular hypertension/open angle glaucoma, CO2 laser-assisted sclerectomy surgery or micro-invasive glaucoma surgery for uveitic glaucoma have been gradually applied in clinical practice.
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Objective To search the Web of Science for the papers related to case management to understand the present situation and direction of case management. Methods Papers on case management were retrieved in the Web of Science from 1999 to 2017.The Web of Science and excel were used to analyze the publication years, research themes, journals, countries and institutes. Results Totally,970 articles were included,with a sum of cited times,12,075.The number of publications on the case management was going up. Most of the authors were from the USA and China was ranked at 7 in authorship. Most of the papers concerned the research in chronic diseases such as chronic heart failure,mental disease and HIV. Conclusions Case management has been widely researched in the developed countries.China still has a lot of room for improvement in the study.The future research should be focused on the establishment of case manager training,multidisciplinary combination,case management mode suitable for chronic disease and aging population and exploration of the mode's effectiveness.
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Non-infectious uveitis is one of the leading causes of preventable blindness worldwide. Long-term immunosuppressive treatment is generally required to achieve durable control of inflammation in posterior and panuveitis. Although systemic corticosteroids have been the gold standard of immunosup- pressive treatment for uveitis since first introduced in 1950s, its side effects of long-term use often warrant an adjuvant treatment to reduce the dosage/duration of corticosteroids needed to maintain disease control. Conventional immunosuppressive drugs, classified into alkylating agent, antimetabolites and T cell inhibitors, have been widely used as corticosteroid-sparing agents, each with characteristic safety/tolerance profiles on different uveitis entities. Recently, biologic agents, which target specific molecules in immunopathogenesis of uveitis, have gained great interest as alternative treatments for refractory uveitis based on their favorable safety and effectiveness in a variety of uveitis entities. However, lack of large randomized controlled clinical trials, concerns about efficacy and safety of long-term usage, and economic burden are limiting the use of biologics in non-infectious uveitis. Local administration of immunosuppressive drugs (from corticosteroids to biologics) through intraocular drug delivery systems represent another direction for drug development and is now under intense investigation, but more evidences are needed to support their use as regular alternative treatments for uveitis. With the numerous choices belonging to different treatment modalities (conventional immunosuppressive agents, biologics and local drug delivery systems) on hand, the practice patterns have been reported to vary greatly from center to center. Factors influence uveitis specialists' choices of immunosuppressive agents may be complex and may include personal familiarity, treatment availability, safety/tolerability, effectiveness, patient compliance, cost concerns and suggestions from related specialists such as rheumatologists and pediatricians. The focus of this review is to provide an overview of each treatment modality on safety/tolerability and effectiveness, which are believed to be the two most important factors affecting treatment decision making.
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Humans , Immunosuppression Therapy , Methods , Immunosuppressive Agents , Therapeutic Uses , Uveitis , Allergy and Immunology , Pathology , TherapeuticsABSTRACT
Objective To explore the self-management behaviors of the patients with lumbar disc herniation. Methods Chronic disease self-management behavior measuring scale was used to investigate the self-management behaviors of 96 lumbar disc herniation patients. Results The score on self-management behaviors of the LDH patients was 20.42±7.52. 65.63%~84.38%of the patients took the wrong position at sitting, moving articles, and fetching articles from a low and high spot. 59.38%of them did not wear the waist supporter. 73.96%~95.83%of them did not follow the doctors' advice to sleep on hard bed, carry weights and keep the back warm. Conclusions The self-management behavior among LDH patients is dissatisfying. The nurses should provide patients with education on self-management behaviors, instructing them to take effective functional exercises, focusing on importance of cognitive symptom management in relieving pain and reducing negative emotion. Meanwhile, the nurses should advice patients to take right self-management behavior in daily life in order to promote the recovery of the function by patients' healthy behavior and life style.
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Objective To explore the effect of competency based education (CBE) in the nursing training of GNS (gerontological nurse specialist).Method The CBE was used in the nursing training of GNS and the differences in knowledge and nursing skills,ability in nursing training,and aiblity in organization and scienticific research.Result After the training,the GSN was above 80 in knowledge and skills,ability in nursing training,ability in organization and scientific research and self-assessment better than that before training (P＜0.05).Conclusion The CBE for the nursing training can upgrade the abilities in the GSN in the aspects of knowledge and skills,nursing training,organization and scientific research so that they become more competent in the gerontological nursing.
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Objective To explore trajectories of joint function recovery and its influencing factors of patients un-derwent hip arthroplasty. Methods A self-designed questionnaire and Harris Hip Score(HHS) were used to collect data from 80 patients underwent hip arthroplasty for three months. Results Scores of patients' hip joint function were poor,poor,moderate and excellent at baseline,one week,one month and three months after surgery,respectively. The influencing factors included time to start exercise,frequency of rehabilitation exercise and supports from family mem-bers. Conclusion Nurses should take targeted measures according to the characteristics of hip joint function in dif-ferent periods,and provide professional health education to improve patient's hip function and capacity of daily living.
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Objective To explore the correlation of oral chemotherapy adherence and illness perception among colorectal cancer patients at different stages of chemotherapy in order to provide evidence for improving oral chemotherapy adherence among colorectal cancer patients in clinical practice.Methods A prospective longitudinal study was employed.Convenience sampling was used to recruit 132 cases of colorectal cancer patients.Data of general information,oral chemotherapy adherence and illness perception were collected by questionnaire.Results At different stages of chemotherapy,patient's score of oral chemotherapy adherence were 7.24±1.15,6.97±1.43,6.95± 1.17;patients' illness perception scores were 40.12±9.47,39.91±8.65,37.01±6.83.Oral chemotherapy adherence was negatively correlated with illness perception (r=-0.225,P＜0.05;r=-0.279,P＜0.01;r=-0.277,P＜0.01).Conclusion Higher level of patient's illness perception was related to worse oral chemotherapy adherence.Nurses should instruct patients to understand the disease and the treatment correctly,to reduce the adverse impact on patients' life and emotion,and to improve patients' compliance with oral chemotherapy.
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Objective To analyze the results of diagnostic pars plana vitrectomy (PPV) in patients with uveitis of unknown cause.Methods This is a retrospective case series study.Sixty-five patients (67 eyes) with uveitis of unknown cause were enrolled in this study.There were 31 males (32 eyes) and 34 females (35 eyes).The ages were from 6 to 84 years,with the mean age of (55.00± 18.56) years.All eyes were received PPV.Examination of vitreous samples consisted of microbial stains and culture,microbial DNA and antibody detection,cytokine measurement,cytology,flow cytometry and gene rearrangement detection.Results Vitreous analysis was positive in 40 of 67 eyes (59.7％).Positive results indicated bacterial endophthalmitis in 20 of 40 eyes (50.0％),lymphoma in 11 eyes (27.5％),viral IgM and IgG increased significantly in 3 eyes (7.5％),fungal endophthalmitis in 3 eyes (7.5％),IgG of toxocara increased significantly in 2 eyes (5.0％),IgG of toxoplasma Gondii increased significantly in 1 eye (2.5％).Conclusion The diagnostic yield of vitreous samples in uveitis eyes of unknown cause is 59.7％.
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Objective To explore the possible factors of early postoperative fluid balance and the influence of early postoperative fluid balance on the prognosis of patients undergoing cardiopulmonary bypass. Methods A retrospective study was conducted on the clinical data of 180 adult patients undergoing cardiopulmonary bypass from January 2012 to December 2015.All the patients were from Sun Yat-sen Memorial Hospital, Sun Yat-Sen University. The data were input and analyzed by SPSS 17.0 software. Results The early postoperative fluid balance of cardiovascular surgery with cardiopulmonary bypass was (540.94 ± 135.86) ml. The value of the early postoperative fluid balance (the difference of the total input amount and the total output amount/body quality) in predicting the major clinical outcome was analyzed by ROC curve. The area under the ROC curve from fluid balance was 0.850 (95%CI 0.736-0.965, P<0.01) and it had the sensitivity of 80.0%, and the specificity was 84.6%. The result showed that the cut off values had a good prediction ability for outcome. The cut off values determined by the biggest Youden index were 28.63 ml/kg, indicated that patients may had better outcome when they had the fluid balance of 28.63 ml/kg. The level of early postoperative fluid balance of patients undergoing cardiopulmonary bypass was correlated with mechanical ventilation time, ICU length of stay, higher risk of acute kidney injury, mixed venous oxygen saturation and clinical outcome (P<0.05). Multivariate analysis indicated that European System for Cardiac Operative Risk Evaluation Ⅱ(EuroSCORE Ⅱ), other types of surgery, body mass index, early postoperative urine output and early postoperative drainage flow were independently associated with postoperative fluid balance of patients undergoing cardiopulmonary bypass. Conclusions Early postoperative fluid balance has a good prediction ability for prognosis of patients undergoing cardiopulmonary bypass. Compared with patients having lower level of fluid balance, the patients with a higher level would be more likely to have longer mechanical ventilation time, longer ICU length of stay, higher risk of acute kidney injury and lower level of mixed venous oxygen saturation. By analysis of ROC curves, the cut-off value for early postoperative fluid balance is 28.63 ml/kg, worse prognosis may be predicted if fluid balance is above 28.63 ml/kg. EuroSCORE Ⅱ, other types of surgery, body mass index, early postoperative urine output and early postoperative drainage flow are independently associated with the postoperative fluid balance of patients undergoing cardiopulmonary bypass.
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Objective To explore the self-management behaviors of the patients with lumbar disc herniation. Methods Chronic disease self-management behavior measuring scale was used to investigate the self-management behaviors of 96 lumbar disc herniation patients. Results The score on self-management behaviors of the LDH patients was 20.42±7.52. 65.63%~84.38%of the patients took the wrong position at sitting, moving articles, and fetching articles from a low and high spot. 59.38%of them did not wear the waist supporter. 73.96%~95.83%of them did not follow the doctors' advice to sleep on hard bed, carry weights and keep the back warm. Conclusions The self-management behavior among LDH patients is dissatisfying. The nurses should provide patients with education on self-management behaviors, instructing them to take effective functional exercises, focusing on importance of cognitive symptom management in relieving pain and reducing negative emotion. Meanwhile, the nurses should advice patients to take right self-management behavior in daily life in order to promote the recovery of the function by patients' healthy behavior and life style.
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Objective To describe the self-management behaviors and self-efficacy in patients with chronic low back pain (CLBP) and to explore the relationship between them. Methods The Chronic Disease Self-Management Study Measures and the Chronic Disease Self-Efficacy Scale were used to investigate a total of 113 patients with chronic low back pain. Results The average score of self-management behavior of CLBP patients was 21.42 ± 8.11. The average time for exercise was (168.72 ± 148.97) min/week;the average level of cognitive symptoms management practice and communication with physicians were 1.70 ± 0.74 and 2.10 ± 1.05 respectively. The self-efficacy was achieved the average level of 7.10 ± 1.88. There was a positive and significant correlation between the self-management behaviors and self-efficacy (P<0.05 or 0.01). Conclusions The self-management behaviors among patients with chronic low back pain was poor and was related with self-efficacy. Individualized health education was needed for improving self-efficacy, which would be benefit for self-management behaviors.
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Objective To describe uncertainty in illness of patients with hepatocellular carcinoma intending to undergo transcatheter artery chemoembolization (TACE) and to identify the related factors. Methods A descriptive and correlative design was used. By convenience sampling, 95 patients with hepatocellular carcinoma were recruited from Sun Yat-Sen University Cancer Center in this study. Mishel Uncertainty in Illness Scale was used to assess uncertainty in illness and information needs of patients with hepatocellular carcinoma intending to undergo TACE and the demographic questionnaire and Information Needs Assessment Scale were used to measure demographic data, disease and treatment characteristics and information needs of patients. Results The level of uncertainty in illness in most patients with hepatocellular carcinoma intending to undergo TACE was middle (77.61±9.15) points. The mean score of indeterminacy subscale was (50.16 ± 6.16) points. Uncertainty in illness of patients with hepatocellular carcinoma intending to undergo TACE was affected by the degree of education background, domicile, family economic status, way to pay for the medical expenses, course of diseases, how many times he (she) used to undergo assisted treatments and the level of information needs. Conclusions The level of uncertainty in illness in most patients with hepatocellular carcinoma intending to undergo TACE was middle and it is important to assess patients′uncertainty in illness at clinical work and to take effective interventions to content patients′information needs to decrease the level of uncertainty.
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Objective To build the access standard and role function of cancer case manager which is suitable for China.Methods The draft indicators of access standard and role function of cancer case manager were formulated based on literature review,group discussion and Delphi method.All the indicators were appraised by using two-round Delphi method.Results Round 1 consulting experts 43,and round 2 consulting experts 41.The experts showed high degree on the access standard and role function of cancer case manager during the two rounds of expert advice (two advisory Kendall coordination coefficients were 0.300,0.358 and 0.375,0.358,P ＜ 0.01).The access standard of cancer case manager included 4 first-level indicators and 34 secondary indicators,and the system of role functions included 7 first-level indicators,35 secondary indicators.Conclusions It indicates that the outcome is high reliability.The finding provide scientific basis for the selection of cancer case manager as well as clear identify of role functions which are significant for improving their work efficiency.
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Adherence refers to the extent to which a patient′s behavior coincides with medical advice without missing a dose or overdosing and taking drugs at the right time. Good adherence could assure the effect of the therapy and reduce neoplasm metastasis and recurrence as well. In this article, status of oral chemotherapy adherence in cancer patients, impact factors and measurement tools had been reviewed. Adherence of oral chemotherapy in cancer patients and measurement tools of oral chemotherapy adherence needed further study. Besides, nursing should also focus on impact factors of the adherence of cancer patients during the oral chemotherapy, and take effective interventions to improve the adherence, so as to ensure the effect of chemotherapy, and improve the survival rate of cancer patients.
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Context: We report a 59 year old Chinese woman in pheochromocytoma multisystem crisis and was initially stabilised with ECMO; subsequently she manifested rapid cyclical fluctuation of blood pressure precipitated by explantation of ECMO. Case Description: Madam L presented with chest pain and giddiness. She developed cardiogenic shock refractory to double inotropes and intra-aortic balloon pump (IABP); but responded to Extra-Corporal Membrane Oxygenation (ECMO). Subsequently rapid cyclical blood pressure fluctuations from 230 mmHg to 50mmHg systolic occurred after explantation of ECMO. Biochemically urine metanephrines and normetanephrines were more than seven times above upper limit of normal. Imaging confirmed the presence of right adrenal mass likely pheochromocytoma. She was started on alpha blockade and underwent an uneventful laparotomy with removal of a 10 cm adrenal mass. Histology confirmed a large cystic pheochromocytoma with haemorrhagic components. Conclusions: Pheochromocytoma crisis should be suspected in cases of unexplained shock or Takutsubo cardiomyopathy; early recognition and ECMO support can be life-saving. In addition, ECMO explantation can trigger rapid cyclical blood pressure fluctuations and should be closely monitored for.