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Self-control brings important effects on the process and maintenance of health behavior change in individuals, but its mechanism is unclear.Healthy behavior change could be divided into goal-oriented behavior initiation stage, combating habit rejection stage, and habit acquisition and maintenance stage.Established theories of health behavior change mainly focus on the conflict between the goal-directed behavior initiation phase and habitual behavior.It is also indicated that disgust is the key mechanism to restrain the implementation of goal-oriented behavior, but ignore the mechanisms in the action implementation and new behavior acquisition phases.In fact, goal-directed and habitual behaviors work together to ensure that individuals adapt efficiently to their environment.However, when goal-oriented behavior becomes habitual, old habit and new goal-oriented behavior begin to compete, causing conflicts and aversion.The core phase of self-control functioning is just in the confrontation with habit rejection phase.On the one hand, self-control directly assists individual goal-directed behavior habituation through conflict sense adaptation.On the other hand, intensive management and stimulus control indirectly assist goal-directed behavior habituation through the relief of conflict sense.Further exploration of the theory and clinical practice of self-control affecting healthy behavior change is needed in the future.
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Objective:To explore the practical effect of goal-oriented hierarchical responsibility system in the teaching of emergency standardized training.Methods:A total of 43 residents who rotated in the Emergency Department of Huashan Hospital Affiliated to Fudan University from March 2019 to August 2019 were selected as the control group, and traditional teaching was implemented. Another 41 residents who rotated from September 2019 to March 2020 were selected as the research group, and the goal-oriented hierarchical responsibility system of teaching was implemented. They were all taught for 3 months, and the scores of theoretical and clinical skills, clinical comprehensive ability and teaching recognition before and after teaching were compared between the two groups. SPSS 24.0 was used for t-test and Chi-square test. Results:After teaching, the scores of theoretical knowledge questions, question and answer questions and case analysis in the two groups were higher than those before teaching ( P<0.05), and the scores of the research group were higher than those in the control group ( P<0.05). After teaching, the scores of 8 items in the study group on understanding of skill indications, anatomy and operation, preparation before operation, aseptic operation, operation ability, post-operation treatment, communication ability, humanistic care and overall performance were higher than those in the control group ( P<0.05). The recognition rates of teaching management, teaching methods, teaching content and teaching effect in the research group were higher than those in the control group ( P<0.05). Conclusion:The application of goal-oriented hierarchical responsibility system in the teaching of standardized training of emergency residents is helpful to improve their theoretical and clinical skill examination results and clinical ability, with high degree of teaching recognition.
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Objective:To explore the application effect of the goal-oriented comprehensive teaching method in the rotation of breast surgery residents.Method:A total of 40 residents who rotated in the Department of Breast Surgery of Xiangya Hospital of Central South University from January 2019 to January 2020 were selected as the control group, and another 41 residents who rotated from February 2020 to February 2021 were selected as the study group. The control group adopted the traditional teaching method, while the study group adopted the goal-oriented comprehensive teaching method. The scores of theory and skill operation examination after teaching, nurses' clinical ability before and after teaching and satisfaction with teaching were compared between the two groups. SPSS 25.0 was used for independent sample t test, paired t test and chi-square test. Results:After teaching, the scores of theory and skill operation in the study group were significantly higher than those in the control group [(86.19±4.64) vs. (79.27±5.36), (89.32±5.47) vs. (84.51±6.22)], with statistical differences ( P<0.05). After teaching, the scores of clinical abilities of the two groups were higher than those before teaching ( P<0.05), and the scores of clinical abilities of the study group were higher than those in the control group, with statistical differences ( P<0.05). The satisfaction with teaching form, content, effect and comprehensive evaluation of the study group were higher than that of the control group, with statistical differences ( P<0.05). Conclusion:The application of the goal-oriented comprehensive teaching method in the teaching of rotation training of residents in the department of breast surgery can enhance their learning and mastering of theoretical knowledge, operational skills and the cultivation of clinical ability, and improve the teaching quality, with high teaching satisfaction.
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Objective:To evaluate the effect of goal-oriented online and offline mixed teaching method on the trainees of burn operating room.Methods:From June 2019 to June 2020, 42 trainees of burn operating room in our hospital were selected for the randomized parallel trial, and they were randomly divided into two groups, routine group and research group. The routine group adopted the conventional online and offline mixed teaching method, while the research group adopted the goal-oriented online and offline mixed teaching method. The internship time of both group lasted for 1 month. Results and excellent rates, self-confidence and burn surgery skills evaluation before and after the internship, and satisfaction with the internship mode were compared between the two groups. SPSS 19.0 was used for t test and chi-square test. Results:The results and excellent and good rates of theoretical examination and practical examination in the research group were higher than those of the routine group. The scores of self-confidence, choice of operation mode, innovation and optimization of operation, control of operation complications and treatment of intraoperative emergencies in the two groups after internship were higher than those before internship, and the above scores of research group were higher than those of the routine group after internship. The satisfaction scores of the students on enhancing self-confidence, and improving operational ability, learning initiative and learning efficiency in the research group were significantly higher than those in the routine group ( P < 0.05). Conclusion:Goal-oriented online and offline mixed teaching method on trainees in burn operating room can not only improve the examination results, enhance their confidence and burn surgery skills, but also achieve their satisfaction.
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Objective@#To investigate the value of pulse indicator continuous cardiac output (PiCCO) monitoring in the treatment management of patients with severe heart failure.@*Methods@#Sixty patients of severe heart failure admitted to intensive care unit (ICU) of Fujian Provincial Hospital from August 2017 to February 2019 were enrolled, and they were divided into control group and treatment group according to random number table method, with 30 in each group. The treatment group used bedside PiCCO to carry out minimally invasive hemodynamics monitoring, according to the monitoring data target guidance for vasoactive drugs and liquid management. The control group was based only on traditional electrocardiogram (ECG) monitoring and lung sound, urine volume of vasoactive drugs and liquid management. The changes of cardiac index (CI), global end diastolic volume index (GEDVI), extravascular lung water index (EVLWI), systemic vascular resistance index (SVRI), invasive mean arterial pressure (MAP) and central venous pressure (CVP) were observed before and 72 hours after treatment in the treatment group. The 7-day total effective rate, the length of ICU stay and 28-day mortality were compared between the two groups.@*Results@#Compared with before treatment, CI and MAP in the treatment group were significantly increased after treatment [CI (mL·s-1·m-2): 53.34±16.67 vs. 35.01±13.34, MAP (mmHg, 1 mmHg = 0.133 kPa): 72.6±10.6 vs. 62.5±10.3, both P < 0.05], GEDVI, EVLWI, SVRI, CVP were significantly decreased [GEDVI (mL/m2): 760.3±90.2 vs. 960.2±110.3, EVLWI (mL/kg): 6.5±1.3 vs. 12.5±6.2, SVRI (kPa·s·L-1·m-2): 297.3±35.1 vs. 434.1±58.8, CVP (mmHg): 10.1±2.6 vs. 12.2±3.4, all P < 0.05]. Compared with the control group, the 7-day total effective rate of the treatment group was significantly higher (90.0% vs. 80.0%), the length of ICU stay was significantly shorter (days: 8.2±4.5 vs. 10.3±2.5), and the 28-day mortality was significantly lower, with statistically significant difference (all P < 0.05).@*Conclusion@#PiCCO monitoring is a goal-oriented treatment management for patients with severe heart failure, which is helpful to individualized accurate treatment, shorten the length of ICU stay and improve short-term prognosis.
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Objective To investigate the value of pulse indicator continuous cardiac output (PiCCO) monitoring in the treatment management of patients with severe heart failure. Methods Sixty patients of severe heart failure admitted to intensive care unit (ICU) of Fujian Provincial Hospital from August 2017 to February 2019 were enrolled, and they were divided into control group and treatment group according to random number table method, with 30 in each group. The treatment group used bedside PiCCO to carry out minimally invasive hemodynamics monitoring, according to the monitoring data target guidance for vasoactive drugs and liquid management. The control group was based only on traditional electrocardiogram (ECG) monitoring and lung sound, urine volume of vasoactive drugs and liquid management. The changes of cardiac index (CI), global end diastolic volume index (GEDVI), extravascular lung water index (EVLWI), systemic vascular resistance index (SVRI), invasive mean arterial pressure (MAP) and central venous pressure (CVP) were observed before and 72 hours after treatment in the treatment group. The 7-day total effective rate, the length of ICU stay and 28-day mortality were compared between the two groups. Results Compared with before treatment, CI and MAP in the treatment group were significantly increased after treatment [CI (mL·s-1·m-2): 53.34±16.67 vs. 35.01±13.34, MAP (mmHg, 1 mmHg = 0.133 kPa): 72.6±10.6 vs. 62.5±10.3, both P < 0.05], GEDVI, EVLWI, SVRI, CVP were significantly decreased [GEDVI (mL/m2): 760.3±90.2 vs. 960.2±110.3, EVLWI (mL/kg): 6.5±1.3 vs. 12.5±6.2, SVRI (kPa·s·L-1·m-2): 297.3±35.1 vs. 434.1±58.8, CVP (mmHg): 10.1±2.6 vs. 12.2±3.4, all P < 0.05]. Compared with the control group, the 7-day total effective rate of the treatment group was significantly higher (90.0％ vs. 80.0％), the length of ICU stay was significantly shorter (days: 8.2±4.5 vs. 10.3±2.5), and the 28-day mortality was significantly lower, with statistically significant difference (all P < 0.05). Conclusion PiCCO monitoring is a goal-oriented treatment management for patients with severe heart failure, which is helpful to individualized accurate treatment, shorten the length of ICU stay and improve short-term prognosis.
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Objective To determine the safety criteria for early goal-oriented rehabilition exercise in patients undergoing mechanical ventilation in intensive care unit (ICU) by systematic review.Methods Randomized controlled trails (RCTs) and cohort studies about early goal-oriented rehabilition exercise in patients undergoing mechanical ventilation in ICU were retrieved in CBM,CNKI,Wanfang Data,PubMed,Cochrane Library and Web of Science from their foundation to March 2018,and other sources as supplement was also retrieved.The intervention program of RCT study was ICU routine nursing in control group,early activity in observation group,and early activity in cohort study without control group.Early activities included active and passive activities on the bed,sitting upright,bed-chair transfer,standing and walking.Literature screening and data extraction were performed independently by two researchers.Variables or parameters.related to cardiovascular,respiratory,nervous,orthopedic and other systems were collected for safety criteria.Variables or parameters used in at least three literatures were collected for each system.Cochrane 5.1.0 was used to evaluate the quality of RCT study,and Newcastle-Ottawa scale (NOS) was used to evaluate the quality of cohort study.Results A total of 24 articles about early activity of patients undergoing mechanical ventilation in ICU were enrolled,involving 4647 patients,including 11 RCT studies involving 1 031 patients,509 in control group and 522 in observation group;13 cohort studies including 3616 patients.It was shown by systematic review that safety criteria for early activity in patients undergoing mechanical ventilation in ICU involved five systems,20 variables or parameters.The cardiovascular system included 8 variables or parameters,such as 40 bpm ＜ heart rate (HR) ＜ 130 bpm (n =4),hemodynamic stability (n =5),no myocardial infarction (n =3),no arrhythmia (n =4),no vascular active drugs (n =4),90 mmHg ＜ systolic blood pressure (SBP) ＜ 200 mmHg (1 mmHg =0.133 kPa,n =4),65 mmHg ≤ mean arterial pressure (MAP) ≤ 110 mmHg (n =3),no history of cardiopulmonary resuscitation (CPR,n =5).The respiratory system included 4 variables or parameters,involving 5 times/min ＜ respiratory rate (RR) ＜ 40 times/min (n =5),fraction of inspired oxygen (FiO2) ≤ 0.60 and positive end-expiratory pressure (PEEP) ≤ 10 cmH2O (1 cmH2O =0.098 kPa,n =4),FiO2 ＜ 0.60 or PEEP ＜ 10 cmH2O (n =3),pulse blood oxygenation (SpO2) ＞ 0.88 (n =5).The nervous system included 4 variables,including no neuromuscular disease (n =7),no increase in intracranial pressure (n =7),no coma (n =4),understand and do the right thing (n =4).The orthopedic system included 2 variables,including no fracture (n =3),no unstable fracture (n =8).Other factors included 2 variables,including no open abdomen wound (n =4),and no palliative care (n =3).Conclusions This study identified safety criteria for early goal-directed rehabilition exercise in patients undergoing mechanical ventilation in ICU included five systems of cardiovascular,respiratory,neurological,orthopedic,and other systems,in which cardiovascular and respiratory systems were the most frequently cited variables or parameters.The consistency of each system security criteria or variables reported by different literatures was high,but the parameters need to be further verified by high-quality study.
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Objective To explore the effect of goal-oriented repetitive training on motor function of upper limb in patients with stroke. Methods From March, 2014 to February, 2016, a total of 60 stroke patients were randomly divided into experiment group (n=30) and con-trol group (n=30). Both groups received routine rehabilitation, while the experiment group received goal-oriented repetitive training in addi-tion, 30 minutes once a day, 5 days a week for 4 weeks. They were assessed with simple Fugl-Meyer Assessment-Upper Extremity (FMA-UE) and modified Barthel index (MBI) before and after training. Results There was no difference in the scores of FMA-UE and MBI between two groups before training (Z0.05). The scores of FMA-UE and MBI significantly improved in both groups after treat-ment (Z>5.645, P2.275, P5.770, P<0.001). Conclusion Goal-oriented repetitive training could promote the recovery of upper limb motor function in patients with stroke.