目标设定：促进糖尿病患者行为改变的方法

目标设定是将患者的自我管理和行为改变意图转换为目标的过程,是一种常见的、行之有效的行为干预策略。本文介绍了目标的种类、目标设定的原则、方法及利用目标设定的方法进行糖尿病教育的效果,分析了目标设定在实际应用中存在的问题,为以后更好地利用目标设定的方法进行糖尿病教育,从而达到改变患者行为的目的提供了理论依据。     

一项住院2型糖尿病患者血糖控制、自我管理行为及心理评估的调查

目的:目前针对中国糖尿病教育管理现状的高质量调查仍然不是很多,因此我们对一家糖尿病专科医院的住院2型糖尿患者进行了问卷调查,收集其自我管理行为、血糖控制及抑郁与心理状况,以探讨糖尿病教育管理工作的重点。方法:对2014年9月至12月间在太原糖尿病专科医院住院治疗的2型糖尿病患者,进行面对面的问卷调查。调查问卷包括一般资料问卷、Toobert行为量表简化版及WHO-5幸福感指数量表(WHO-5Well-Being Index)和中文版简化糖尿病问题量表(short-form Chinese-version PAID[SFPAID-C]scale)。结果:共调查患者330例,经双份录入和数据澄清之后剩余有效问卷315份(95.5%),男性150(47.6%)例,女性165(52.4%)例。患者年龄(60.5±9.2)岁,病程(10.0±7.1)年,BMI(25.3±3.5)kg/m~2、腰围(91.4±9.9)厘米,糖化血红蛋白(Hb A1c)(8.5±2.0)%,超重与肥胖的患者分别为71.8%和88.5%,男性和女性腹型肥胖的患病率分别为75.0%和72.7%,8.6%的患者存在亚临床或临床抑郁问题(SF-PAID-C评分≥15)。73.3%的患者接受过糖尿病教育,86.0%的患者定期监测血糖,过去一年检测过Hb A1c和血脂的患者分别为66.7%、62.9%,87.3%的患者在诊断糖尿病后改变了饮食习惯,61.9%的患者定时定量进餐,74.6%的患者规律运动,66.7%的患者每周运动时间≥150分钟。Toobert行为量表显示,患者在执行每天吃五份以上的水果和蔬菜(2.5±2.5)、把碳水化合物均匀分布到一整天(3.5±2.8)、血糖监测(3.4±2.5)以及检查脚和鞋子(3.7±2.5)方面的天数较少,执行天数为0天的患者比例分别为36.0%、25.8%、13.3%和16.5%。将患者分为接受过(231例,75.2%)和未接受过糖尿病教育(76例,24.8%)两组,接受过糖尿病教育者,年龄更大,病程更长,合并糖尿病视网膜病变、神经病变的百分比及胰岛素治疗的百分比更高,自我管理行为更好,Hb A1c水平更低,但SF-PAID-C评分和WHO-5评分没有显著性差异。将患者根据病程分为5年、6-10年、11-15年、≥16年四组,随着病程增加,接受过糖尿病教育的患者比例增加,糖尿病并发症的患病率及胰岛素治疗的百分比显著增加,WHO-5评分下降,SF-PAID-C评分上升,自我管理行为和Hb A1c差异不显著。回归分析显示,影响Hb A1c的因素包括治疗方案和自我管理行为,影响SF-PAID-C评分的因素包括运动状况及是否合并糖尿病神经病变,影响WHO-5评分的因素包括病程和自我管理行为。结论:饮食、血糖监测、足部护理、社会支持及用药依从性方面的糖尿病教育指导需要更为细致。糖尿病人在病程较长、合并有并发症及使用胰岛素治疗时,才有更大机会获得糖尿病教育,但将错过教育的最佳时机,糖尿病教育的开始时间需更早。在提升幸福指数、改善抑郁和焦虑方面,糖尿病教育没有直接作用,改善疾病控制、坚持自我管理行为、推迟并发症的发生发展,有直接作用。     

80例老年糖尿病病人健康教育效果评价

老年糖尿病（DM）是指年龄在60岁以上的DM病人。DM是常见内分泌代谢疾病,随着人民生活水平提高,自身行为改变,老年糖尿病的发病率随年龄上升,患病人数在全球范围内逐年增加。因此,对老年DM病人开展健康教育,是整体医疗护理中重要组成部分。通过对2000-2004年在我院住院的80例老年2型DM病人进行有目的、有计划地进行健康教育,使病人及家属了解糖尿病知识,掌握自我保健技能,增强战胜疾病的信心。现将对80例2型DM病人实施健康教育的方法与效果报告如下。     

对门诊离休老干部糖尿病患者的健康教育体会

糖尿病是一种常见病、多发病,其发病率随着人民生活水平的提高、生活方式的改变和人口老龄化而迅速增加。糖尿病的治疗是一项长期的、不断调整的管理过程,除了及时调整治疗方案外,还包括对患者的健康教育,以帮助患者正确面对疾病,掌握自我管理技巧、病情监测技能和预防糖尿病并发症发生等。有文献报道,每年有1／3的糖尿病患者因缺乏糖尿病相关知识而发生各种急慢性并发症。我科2002年6月-2010年12月,接诊离休老干部糖尿病患者18例,在门诊治疗过程中进行糖尿病知识健康教育,取得较好效果,现报告如下。     

微信平台健康教育在肺心病患者延续护理中的应用

目的：探讨微信平台健康教育在慢性肺源性心脏病（肺心病）患者延续护理中的效果，为临床护理工作提供依据。方法：将90 名肺心病患者按出院顺序分成观察组和对照组，各45 例，对照组进行定期随访，观察组利用微信平台进行健康教育，6 个月后评 价两组患者的遵医行为，并采用慢性肺源性心脏病患者生命质量测定量表（QLICD-CPHD）于患者出院时及6 个月后进行生活质 量评价。结果：观察组患者具有很好的遵医行为，对照组遵医行为较差，两组比较有显著差异（P<0.01）。两组患者干预前生活质量 比较无显著差异（P＞0.05）；观察组在干预前后，生活质量各模块无明显改变（P＞0.05），对照组生活质量各模块明显降低，与观察 组比较，差异有统计学意义（P<0.05）。结论：微信教育在一定程度上能够地提高患者的遵医行为,弥补传统健康教育的不足，提升 了健康教育的效果，值得临床借鉴。     

健康教育应用于糖尿病护理中的效果分析

目的:分析健康教育在糖尿病患者护理中的作用效果。方法:将进行糖尿病治疗的患者随机分为两个组,进行不同的护理模式,并通过多种调查方式对护理效果进行整理。结果:进行健康教育的研究组患者,对护理工作更为支持且对糖尿病相关知识有了更为深入的了解。结论:在糖尿病传统护理工作中开展健康教育在建立良好护患关系方面所起的作用是明显的,对保证患者的治疗和康复具有重要意义。     

授权在糖尿病自我管理教育中的应用进展

阐述了授权的定义及理论框架,比较了授权模式与传统教育模式的区别,介绍了以授权为基础的糖尿病自我管理教育项目的实施要点、教育方式、策略、评价指标、评价工具、效果以及医护人员和患者对授权的态度,为更好地应用授权的方法进行糖尿病自我管理教育提供理论支持.     

大鼠糖尿病溃疡动物模型的初步研究

目的构建大鼠糖尿病溃疡动物模型,观察评价该模型的临床及病理特点。方法利用磁片循环压迫的方法,构建大鼠糖尿病溃疡动物模型,并从整体,组织和生化三个层次对糖尿病溃疡进行了研究。结果构建出了一个可以复制的糖尿病溃疡动物模型,该模型具有组织坏死、白细胞聚集以及高浓度晚期糖化终末产物等特征。结论利用缺血再灌注法构建了大鼠糖尿病溃疡动物模型。其病理改变与人极为相似,是一种很好的用于糖尿病溃疡发病机制和治疗研究的动物模型。     

教育管理在糖尿病患者健康教育中的应用

目的:对糖尿病病患的健康教育中教育管理所起到作用及其具体效果进行分析探讨。方法:选取同期于我院进行治疗的糖尿病患者96例,将其作为研究对象。对患者教育前后的一系列控制目标如舒张压、收缩压、餐后血糖、空腹血糖、体重指数、糖尿病疾病知识了解情况以及患者的满意度等统计分析。结果:患者在糖尿病健康教育之后,餐后血糖、空腹血糖、体重指数以及收缩压较教育之前均有显著进步(P0.05),而教育前后的舒张压指标不存在显著差异(P0.05),患者的满意度及糖尿病疾病知识了解情况较教育前存在显著提升(P0.05)。结论:对糖尿病患者采取教育管理方式进行健康教育可以使病患积极配合治疗,对糖尿病疾病知识有一个基础全面的了解。在控制餐后血糖、空腹血糖、体重指数及收缩压等指标方面有着积极作用,可以有效提升患者的满意度。     

“蛋白质与酶工程”教学的课程思政探索与实践

蛋白质与酶工程是生物技术专业的核心、必修课程,在专业人才培养体系中具有重要地位。文中以教育部颁布的《高等学校课程思政建设指导纲要》为依据、结合专业及课程特色,科学设定教学目标,深入挖掘课程思政教育元素,从融入内容、方法路径及评价等方面进行了课程思政教学改革的探索和实践。通过精心开展教学设计,利用对分课堂、以学生为中心,从讲故事、谈生活、说案例、议热点、读文献、做训练入手,激发并培养学生的科学精神、公民品格、全球视野、生态文明、法治意识、家国情怀和文化自信素养,促进课程思政教育有机融入教学全过程,实现课程育人目标的同时推动教学卓越。     

Medical ethics and education for social responsibility.

The physician, said Henry Sigerist in 1940, has been acquiring an increasingly social role. For centuries, however, codes of medical ethics have concentrated on proper behavior toward individual patients and almost ignored the doctor''s responsibilities to society. Major health service reforms have come principally from motivated lay leadership and citizen groups. Private physicians have been largely hostile toward movements to equalize the economic access for people to medical care and improve the supply and distribution of doctors. Medical practice in America and throughout the world has become seriously commercialized. In response, governments have applied various strategies to constrain physicians and induce more socially responsible behavior. But such external pressures should not be necessary if a broad socially oriented code of medical ethics were followed. Health care system changes would be most effective, but medical education could be thoroughly recast to clarify community health problems and policies required to meet them. Sigerist proposed such a new medical curriculum in 1941; if it had been introduced, a social code of medical ethics would not now seem utopian. An international conference might well be convened to consider how physicians should be educated to reach the inspiring goals of the World Health Organization.     

Children's Reactions to and Memory for a Stressful Event: Influences of Age,Anatomical Dolls,Knowledge, and Parental Attachment

This article investigated how age and cancer are associated with goal commitment in recently diagnosed cancer patients and healthy controls. One hundred and thirty-two cancer patients and 132 healthy control group members generated a list of present goals and assessed perceived difficulty of goals, effort for goal attainment, influence of health on goal attainment, and anticipated time of goal attainment. In regression analyses, main effects of cancer status on life goals were found, indicating among cancer patients a lower total number of goals; a focus on social, transcendental, and health-related rather than achievement-related goals; higher perceived difficulty of goals; lower effort to attain one's goals; stronger perceived negative health effects on goal attainment; and a stronger focus on short-term rather than long-term goals. In addition, main effects of age indicated an age-associated reduction in the number of goals and a shift away from achievement-related goals toward easier and short-term goals and higher effort for goal attainment. Further, age differences in goal variables were stronger in healthy controls than in cancer patients.     

Efficacies of the new Paclitaxel-eluting Coroflex Please™ Stent in percutaneous coronary intervention; comparison of efficacy between Coroflex Please™ and Taxus™ (ECO-PLEASANT) trial: study rationale and design

Background

Almost 50% of Americans have elevated low-density lipoprotein cholesterol (LDL-C). The behaviors required to lower LDL-C levels may be difficult to adhere to if they are inconsistent with spouses' health practices, and, alternatively, may be enhanced by enlisting support from the spouse. This trial extends previous trials by requiring spouse enrollment, teaching spouses how to provide emotional and instrumental support, allowing patients to decide which component of the intervention they would like to receive, and having patients determine their own goals and action plans.

Methods

Veteran outpatients with above-goal LDL-C (N = 250) and their spouses are randomized, as a couple, to receive printed education materials only or the materials plus an 11-month, nurse-delivered, telephone-based intervention. The intervention contains four modules: medication adherence, diet, exercise, and patient-physician communication. Patients decide which modules they complete and in which order; modules may be repeated or omitted. Telephone calls are to patients and spouses separately and occur monthly. During each patient telephone call, patients' progress is reviewed, and patients create goals and action plans for the upcoming month. During spouse telephone calls, which occur within one week of patient calls, spouses are informed of patients' goals and action plans and devise strategies to increase emotional and instrumental support. The primary outcome is patients' LDL-C, measured at baseline, 6 months, and 11 months. Linear mixed models will be used to test the primary hypothesis that an 11-month, telephone-based patient-spouse intervention will result in a greater reduction in LDL-C as compared to printed education materials. Various process measures, including social support, self-efficacy, medication adherence, dietary behavior, and exercise, are also assessed to explain any change, or lack thereof, in LDL-C.

Discussion

Given the social context in which self-management occurs, interventions that teach spouses to provide instrumental and emotional support may help patients initiate and adhere to behaviors that lower their LDL-C levels. Moreover, allowing patients to retain autonomy by deciding which behaviors they would like to change and how may improve adherence and clinical outcomes.

Trial Registration

The ClinicalTrials.gov registration number is NCT00321789.     

Physicians as Patient Teachers

Physicians have a central role in educating patients and the public in the elements of personal health maintenance. To be an effective teacher, one must recognize the learning needs of each patient and use methods of information transfer that will result in comprehension and compliance. To bring about a change in life-style, one must also have an understanding of a patient''s health beliefs and the determinants of human behavior. Using this information together with behavior modification strategies, physicians can forge an effective partnership with patients working toward the goal of optimum health.     

Integrating mental health into primary health care in Iraq

The Ministry of Health in Iraq is undertaking a systematic programme to integrate mental health into primary care in order to increase population access to mental health care. This paper reports the evaluation of the delivery of a ten day interactive training programme to 20% of primary care centres across Iraq. The multistage evaluation included a pre- and post-test questionnaire to assess knowledge, attitudes and practice in health workers drawn from 143 health centres, a course evaluation questionnaire and, in a random sample of 41 clinics, direct observation of health workers skills and exit interviews of patients, comparing health workers who had received the training programme with those from the same clinics who had not received the training. Three hundred andseventeen health workersparticipated in the training, which achieved an improvement in test scores from 42.3% to 59%. Trained health workers were observed by research psychiatrists to have a higher level of excellent skills than the untrained health workers, and patient exit interviews also reported better skills in the trained rather than untrained health workers. The two week course has thus been able to achieve significant change, not only in knowledge, but also in subsequent demonstration of trained practitioners practical skills in the workplace. Furthermore, it has been possible to implement the course and the evaluation despite a complex conflict situation.     

Metal Craft Problems

Although goals change and reflect the issues of the time, two primary goals of education in a democracy have remained constant over time. The first goal is to educate for vocational competence and the second is to produce caring, intelligent, and wise citizens. Articulating the connection of design education concepts to the economy and social responsibility is beneficial in educating K–12 students. This article illustrates the ways in which design education fosters the skills needed in the global twenty-first century to help students make a better life for themselves and their community and improve the world. I articulate ways to incorporate design as an essential component into a comprehensive visual arts program.     

How Physicians Can Improve Patients' Participation and Maintenance in Self-Care

A protocol for the stepped education and support of patients is derived from the cumulative experience of more than 200 clinical trials of patient education and behavioral change interventions. The recommended procedure entails assessing a patient''s educational needs by asking a sequence of “diagnostic” questions to assure patient motivation, skill and resources and to reinforce adherence to the prescribed medical regimen or life-style modifications. The sequence of questions and interventions is also designed to minimize a physician''s time commitment and to maximize the medical benefit to the patient.