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Advance care planning (ACP) is an important part of hospice care, a core index of high-quality palliative care, and one of the effective indicators for improving the life quality of end-of-life patients. By reviewing the progress of various theoretical models and their applications in ACP, including planned behavior theory, behavioral change wheel theory, self-determination theory, prospect theory, change theory, and cultural suitability theory, this paper delved into the advantages and limitations of each theoretical model and analyzed its research prospects in future ACP clinical practice to promote researchers’ correct understanding of the role of different theoretical models in various types of studies, with a view to providing new ideas for clinical research on ACP.
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OBJECTIVE：To compare the an ti-hepatocarcinoma effects of curcumin （CUR）and its derivative hydrazincurcumin （HZC），and to explore the mechanism. METHODS ：MTT assay was used to detect the effects of CUR or HZC （2.5，5，10，20， 40，80 μmol/L）on the proliferation of HepG 2 cells. Flow cytometry was used to detect the effects of CUR or HZC （10，20，40 μmol/L）on cell cycle distribution and apoptosis of HepG 2 cells. Western blotting assay was used to detect the effects of CUR or HZC（10，20，40 μmol/L）on the expression of apoptosis-related protein in HepG 2 cells. The male SD rats were randomly divided into normal control group （n＝10），CUR control group （n＝10），HZC control group （n＝10），model group （n＝30），CUR protection group （n＝30）and HZC protection group （n＝30）. CUR control group and HZC control group were given CUR 85917439。E-mail：zhaoji-an-88@163.com or HZC （80 mg/kg） intraperitoneally. Model group ，CUR protection group and HZC protection group were given diethylnitrosamine （50 mg/kg）intraperitoneally to establish hepatocarcinoma model ；at the same time ，2 protection groups were given CUR or HZC （80 mg/kg）intraperitoneally，twice a day，for consecutive 12 weeks. During medication ，the change of body weight and death of rats were recorded. Twenty four weeks later，liver index of rats was calculated and appearance was observed ；the number of cancer nodules was counted ；HE staining was used to observe the pathological changes of liver tissue and calculate the nuclear division index of hepatocarcinoma ；the proliferating cell nuclear antigen （PCNA）index was detected by immunohistochemistry. RESULTS ：CUR and HZC could increase the inhibitory rate of HepG 2 cells（P＜0.05），and increased the percentage at G 0/G1 phase and apoptotic rate of HepG 2 cells（P＜ 0.05）. CUR and HZC could significantly decrease the protein expression of p-JAK 2，p-STAT3，Bcl-2 and Bcl-xl ，while increased the protein expression of Bax ，Cyt-c，Caspase-9，Caspase-3 and PAPR （P＜0.05）. Above effects of HZC were significantly better than those of CUR （P＜0.05）. The results of animal experiment showed that there was no death ，no liver canceration and no pathological changes in liver appearance and tissue section of the three control groups ；there was no statistical significance in body weight and its increased weight ，liver index ，nuclear division index of carcinoma or PCNA index （P＞0.05）. Compared with model group， survival rate of rats were increased significantly in CUR protection group and HZC protection group ， while hepatocarcinoma incidence and the number of cancer nodules were decreased significantly （P＜0.05）；body weight and its increased weight were increased significantly ，while liver index ，nuclear division index of carcinoma and PCNA index were decreased significantly （P＜0.05）. There were some pathological changes in liver appearance and tissue section ；cancerous lesions with focal necrosis or cancerous lesions with patchy necrosis were observed. There was no statistical significance in the improvement of above indexes in 2 protection groups （P＞0.05）. CONCLUSIONS ：HZC could inhibit the proliferation and induce apoptosis of HepG 2 cells by inhibiting JAK 2/STAT3 signaling pathway and regulating the activation of mitochondrial endogenous pathway，which shows stronger anti-hepatocarcinoma effect in vitro than CUR. On the other hand ，there was no significant difference in the improvement of liver caner indexes in hepatic cancer model rats between HZC and CUR.
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Objective: To evaluate the clinical efficacy and safety of intermittent injection of methylprednisolone sodium succinate in the treatment of cervical spinal cord injury complicated with incomplete paraplegia
Methods: Seventy-eight patients with cervical spinal cord injury complicated with incomplete paraplegia who were admitted between August 2016 and December 2017 were enrolled and grouped into an observation group and a control group using random number table, 39 in each group. Patients in the control group were given vertebral body decompression and bone grafting and internal fixation according to the severity of spinal cord compression, while patients in the observation group were treated by methylprednisolone sodium succinate in addition to the same treatment as the control group. The clinical efficacy and medicine associated adverse reactions were compared between the two groups
Results: The cure rate of the observation group was significantly higher than that of the control group [46.2% [18/39] vs. 20.5% [8/39]]. After the treatment, the Japanese Orthopaedic Association [JOA] score and American Spinal Cord Injury Association [ASIA] score of the two groups after treatment were significantly higher compared to before treatment, and the scores of the observation group were much higher than those of the control group [P<0.05]. The incidence of adverse reactions of the observation and control groups was 15.4% and 17.9% respectively, and the difference was not statistically significant [P>0.05]
Conclusion: Intermittent injection of methylprednisolone sodium succinate has definite efficacy in treating cervical spinal cord injury complicated with incomplete paraplegia, with a low incidence of adverse reactions; hence it is worth promotion
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Objective To observe the effect of evidence-based nursing combined with targeted nursing on rehabilitation of children with hand, foot and mouth disease complicated with encephalitis. Methods One hundred and eight children with hand, foot and mouth disease and encephalitis who were treated in Xiaoyi People's Hospital from February 2015 to August 2017 were selected. The time node was May 2016, 58 children who were treated from February 2015 to April 2016 were selected as a single nursing group, and 50 children who were treated from May 2016 to August 2017 as a combined nursing group. The single nursing group adopted targeted nursing; while the combined nursing group adopted evidence-based nursing on the basis of the single nursing group. Flow cytometry was used to detect the level of white blood cell count (WBC) in cerebrospinal fluid (CSF); enzyme-linked immunosorbent assay (ELISA) was used to determine the content of CSF protein; high performance liquid chromatography (HPLC) was used to detect the content of CSF glucose (Glu); and the rehabilitation effect, complication rate, family satisfaction and hospitalization time of the two groups were observed. Results The levels of WBC, protein and Glu in CSF of the two groups were lower than those before treatment, and the above indexes in the combined nursing group were significantly lower than those in the single nursing group [WBC (×106/L): 16.98±5.76 vs. 32.53±10.74, protein content (g/L): 0.29±0.06 vs. 1.02±0.14, Glu (mmol/L): 3.26±0.28 vs. 4.69±0.51, all P < 0.05]. Compared with the single nursing group, the hospitalization time of the children in the combined nursing group was significantly shortened (days: 8.2±2.2 vs. 14.6±3.1), the total effective rate of rehabilitation and family satisfaction were significantly increased [total effective rate of rehabilitation:94.00% (47/50) vs. 75.86% (44/58), family satisfaction: 98.00% (49/50) vs. 91.38% (53/58), P < 0.05], and the incidence of complications was significantly reduced [6.00% (3/50) vs. 27.59% (10/58), P < 0.05]. Conclusion Evidence-based nursing combined with targeted nursing can improve the treatment efficiency of children with severe hand, foot and mouth combined with encephalitis, reduce the incidence of complications, speed up recovery and enhance the confidence of patients' families.
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Objective: To explore the effectiveness of controlled blood pressure elevation and limited fluid resuscitation in treating patients with multiple injuries in combination with shock in Intensive Care Unit [ICU]
Methods: One hundred and sixty-four patients with multiple injuries in combination with shock who were admitted into the ICU of the hospital between June 2014 and November 2017 were selected and divided into an observation group and a control group using random number table, 82 each group. Controlled blood pressure elevation was given to both groups. Moreover, the control group was given conventional fluid resuscitation, while the observation group was given limited fluid resuscitation. The treatment effectiveness and complications were compared between the two groups
Results: The resuscitation time, post-resuscitation PT and post-resuscitation C-reactive protein level of the observation group were significantly lower than those of the control group [P<0.05]. The post-resuscitation hemoglobin level of the observation group was significantly higher than that of the control group [P<0.05]. The lactate clearance rate [LCR] of the observation group was [0.22+/-0.01] and [0.37+/-0.06] respectively three and six hours after fluid resuscitation, which was remarkably different with that of the control group [[0.27+/-0.03] and [0.51+/-0.08]] [P<0.05], but the difference became insignificant 24 h after fluid resuscitation [P>0.05]. The observation group had significantly lower incidences of complications such as disseminated intravascular coagulation, respiratory distress syndrome and multiple organ dysfunction syndromes of the observation group and death rate than the control group, and the differences had statistical significance [P<0.05]
Conclusion: Controlled blood pressure elevation in combination with limited fluid resuscitation is more effective than conventional fluid resuscitation in the treatment of patients with multiple injuries and shock in ICU as it can shorten recovery time, improve microcirculation perfusion and prognosis, and reduce related complications and fatality rate
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Objective To test the reliability and validity of the home care demand forecasting scale for fracture patients when they were before discharge. Methods This study was descriptive study. Convenience sampling was used and 412 patients with fracture from 5 comprehensive hospitals in Yanbian Korean Autonomous Prefecture were selected. Finally, the number of valid questionnaires is 398 which were used for testing. Results Five factors and 32 items were eventually determined. The split-half reliability coefficient was 0.910, and split-half coefficient in each dimension was over 0.75; the content validity showed scale level content validity index(S-CVI) was 0.948, and the index in each item′s item level content validity index (I-CVI) was between 0.76 to 1.00. The result of factor analysis included 5 factors and the cumulative contribution of variance was 59.181%. The result of construct validity χ2/df=1.554, root mean square error approximation (RMSEA)=0.037, goodness-of-fit index (GFI)=0.920. The total of scale′s Cronbach coefficient was 0.948, Each dimension′s Cronbach coefficient was between 0.797-0.875. Conclusions The home care demand forecasting scale was proved to be reliable and valid. It can be used to assess the home-care needs of fracture patients before they were discharge.
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This study was aimed to investigate the effect of Compound Danshen injection in treatment of dysphagia by electromyography (EMG) guided on new Renying point caused by bulbar paralysis after stroke.A total of 60 patients with dydphagia caused by cerebral palsy after stroke were randomly divided into the experimental group and the control group (30 patients in each group).Patients in the control group were conducted with routine treatment,local low frequency electrical stimulation and rehabilitation training.Patients in the experimental group were treated with acupoint injection therapy guided by EMG on the basis of treatment of the control group.Four weeks were one treatment course.Observations were made on changes of indexes,such as water swallow test,swallowing ability evaluation,and etc.between two groups.The results showed that the cure rate of the experimental group was 76.67％,which was higher than that of the control group (50.00％).The treatment efficiency of the experimental group (93.33％) was higher than that of the control group (80.00％),with statistical significance (P ＜ 0.05).It was concluded that clinical effects of EMG guided injection on new Renying point in the treatment of dysphagia caused by bulbar paralysis in the experimental group was better than that of the control group.It is worthy widely applied and distributed in clinical practices.
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Objective: To observe the influence of psychological intervention on pain, immune system and adrenocortical functions of patients receiving lung cancer surgery
Methods: We selected 124 patients who received surgery for treating stage I or II lung cancer and divided into experimental group and control group. The experimental group received comprehensive psychological intervention while the control group was given conventional nursing intervention. Pain of patients in two groups was evaluated by visual analog scale [VAS]. Before and after intervention, CD3[+], CD4[+], CD8+, CD4[+]/ CD8+ and free cortisol level in serum were measured. Moreover, QLQ-C30, a life quality measurement scale developed by European Organization for Research and Treatment of Cancer [EORTC] was used
Results: Compared to control group, VAS of patients in experimental group remarkably decreased before anesthesia, 6 hour, 12 hour 24 hour and 48 hour after surgery [P<0.05], and moreover, OLQ-C30 score and various factor scores [except physical symptoms] in experimental group were much higher [P<0.05]. No statistical significant difference was found in immune index between two groups before intervention [P>0.05]. Differences of CD3[+] and CD4[+] before and after intervention were both statistically significant [P<0.05], so did free cortisol level [P<0.05]
Conclusion: Comprehensive psychological intervention can effectively relieve pain, improve immune functions and enhance quality of life for patients suffering from lung cancer surgery
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Objective To understand the phenotype distribution of negative RhD blood donors in local region ,and to establish negative RhD phenotype database .Methods A total of 554 specimens screened firstly as negative RhD were confirmed by indirect antiglobulin test .Repeat donors were excluded ,the remaining specimens were 366 cases ,which were analyzed the phenotype of Rh blood .Results Distribution characteristics of negative RhD phenotype was ccdee (56 .28% ) > Ccdee (29 .51% ) > ccdEe (7 .38% )> CcdEe (3 .55% )> CCdee (3 .01% )> ccdEE (0 .27% ) ,there were no CcdEE ,CCdEe ,CCdEE detected .Conclusion The establishment of Negative RhD phenotype database is help for providing matching blood for persons with negative RhD blood or same antibody blood ,and meeting the emergency blood usage ,it′s important for scientific management and reasonable application of negative RhD blood ,and accumulate data for then negative RhD blood of the local area ,especially for Mongolian .
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Objective To screen nursing workload items in the perioperative period of lumbar disc herniation by using Delphi method for providing scientific basis in order to undertake nursing care cost calculation of single disease. Methods The measuring content of nursing workload was firstly designed on the basis of consulting literature and experts discussion,then two rounds of consultations were made with experts by using the Delphi method. Results Valid questionnaires collected back were 35 and 37,respectively, accounting for 89% and 94% in the two rounds of consultations with the experts,by which fully reflected the support of experts to the study. The average number of authoritative coefficients in the two rounds of consultations with the experts was respectively 0.79, 0.88,which indicated high reliability of the consulting. The overall coordination index for nursing care items in the preoperative/intraoperative/postoperative period of consulting experts respectively was 0.265/0.305/0.359 and 0.435/0.316/0.425, which had statistical significance and indicated the good coordination among the experts advice in determining the nursing care items and the desirability of the results. Conclusions Measurement items of nursing workload in perioperative period of lumbar disc herniation had been screened scientifically and reliably,which could accurately measure the nursing workload of the disease and lay the foundation for further accounting of nursing care cost.