類別:

鼻咽癌患者於放射線治療期間皮膚反應之臨床與生理病理探討

2021-06-13T00:01:35Z

標題: 鼻咽癌患者於放射線治療期間皮膚反應之臨床與生理病理探討; Clinical and Pathophysiological Assessment of the Skin Reactions in Nasopharyngeal Carcinoma Patients Receiving Radiotherapy 作者: Wen-Tzu Chiu; 邱文姿摘要: 本研究以重覆性生理測量研究方法，來探討鼻咽癌病患於放射治療期間，放射治療導致皮膚反應之功能學和形態學變化之趨勢與相關因素。從96年1月16日至6月8日，為期4個月。以立意取樣，收案數共計19名，平均年齡46歲，男女比為3:1。以放射治療劑量為主軸，每累積大於10Gy時，為測量時間點，由放射治療開始前治治療結束共八次測量。利用RTOG 放射治療皮膚毒性評估準則、皮膚角質水份分析、皮膚色素分析，以及微循環血流分析與自擬自覺症狀量表為本研究工具，以SPSS 15.0版軟體中，GEE統計模式 ( generalized estimating equations method )作計算分析。研究結果放射性皮膚的生理反應軌跡，皮膚角質層水分含量與放射治療劑量累積呈現顯著負相關(p=.009)，自覺皮膚症狀感受、皮膚黑紅色素分析、微循環血流變化呈現正相關。自覺症狀困擾項目上以『發紅』、『皮膚變黑』、『搔癢感』為前三位，自覺症狀困擾以及皮膚生理變化的發生時間，開始於T2，嚴重程度以T6為高峰期。對於皮膚損傷因子以放射治療劑量、相關化學治療、皮膚角質層水份改變、血流變化與病患因應照護方式皆有顯著相關(p<.005)。另外，微循環血流與放射劑量累積時間呈正相關(p=.000，β= .292)，但皮膚損傷與血流是呈現負相關(p=.034 β=-.844)。因此，放射治療皮膚反應於微循環血流變化與皮膚嚴重程度應存在重要相關因素，是未來皮膚放射醫療照護研究發展之方向。; The purpose of this repeated measurement study is measure skin function and morphology weekly during radiotherapy. The 19 patients enrolled this study from Jan 16 to June 8, 2007. Measurement of tools were use Corneometer, Mexameter, and Laser Doppler Image for analysis skin function, RTOG skin reaction scores and the self-reports of patients. Statistics analysis was use software of SPSS 15.0, generalized estimating equations method. This study found water loss of cutonaus with the accumulated dose had negative relative. However, skin color analysis, microcirculation change and self-report of symptom with radiation accumulated dose had positive relative doses. The symptom of 'erythema”, “discoloration”, and “skin itching” have significance relative of self-report of symptom. The symptom distress and physical assessment had changed from 20 Gy, the peak stage at over 60Gy. Radiation induced skin damage influence factor had age, radiation doses, received induction chemotherapy, microcirculation change, and skin intervention. Another, this study found microculatin change with increased radiation doses had positive relative(p=.000，β= .292), but if had skin damage, microculatin changed to negative relative (p=.034β= -.844). In conclusion, blood perfusion with radiation therapy induced skin damage had very important machism. Therefore, early detection of these reactions for better care is further in research of radiation- dermatology and radiation nursing.

高齡髖部骨折病人術後譫妄症危險因子之探討

2021-06-17T06:17:00Z

標題: 高齡髖部骨折病人術後譫妄症危險因子之探討; Risk Factors of Postoperative Delirium in Elderly Patients with Hip Fracture 作者: Yu-Shang Chen; 陳右尚摘要: 【背景】老年人髖部骨折手術後譫妄症發生率高，危害了身體日常生活功能引發併發症，延長住院天數，增加照顧者的負擔。引發譫妄症的原因為多重因素，在髖部骨折族群手術期間的影響因子，各研究所呈現的結果不同。【目的】探討引發高齡髖部骨折病人術後譫妄症發生情形，及其風險因子之關聯性。【研究方法】本研究為前瞻性、描述性、相關性之觀察研究，自2017年4月1日至12月31日依方便取樣方式選取高齡髖部骨折病人，以混亂評估法(confusion assessment method, CAM)為工具，調查高齡髖部骨折術後譫妄症發生率，並收集引發術後譫妄症之風險因子-人口學特性、病人原有因子、手術相關因子，以分析驗證每個風險因子之勝算比Odds Ratio(OR)。【研究結果】篩選102位病人，排除術前發生譫妄症9位，共93位研究對象納入分析；術後譫妄症發生率為54.8%，平均年齡84.5歲，譫妄症持續時間24~72小時佔84.4%，發生譫妄症組術後有延後下床活動，及每日離床活動時間較短的情形。有發生術後譫妄症男性佔較多，平均年齡較大；風險因子單變項分析顯示，年齡越大者越傾向發生術後譫妄症，有宗教信仰者、Mini-Mental State Examination (MMSE)分數越高者、入院時血紅素與血比容檢驗值越高者較不傾向發生術後譫妄症。多變項邏輯式迴歸模式分析發現，MMSE分數越高者越不傾向發生術後譫妄症，MMSE每增加1分減少38 %發生譫妄症的風險 (OR=0.62) 【結論】高齡髖部骨折病人術後譫妄症發生率高，認知功能缺損為顯著的風險因子。醫療團隊應在病人術前執行風險因子評估，術後常規評估混亂評估法CAM，並及早給予介入性措施，以降低術後譫妄症及其合併症之發生。; Background: Orthopedic surgery is the best treatment recommended for hip fractures, however, the procedure often induce postoperative delirium. Any age group is susceptible to postoperative delirium, but high prevalence rates of post-operative delirium have been found in geriatric patients with hip fracture. Purpose: There is a lack of research focused on the geriatric population with hip fracture. The purpose of this study was to establish the incidence rate of post-operative delirium among elderly patients and to identify risk factors. Methods: A prospective observational design with repeated measures was used. Subjects older than 65 years who had suffer from hip fracture due to fall will be recruited when admitted in orthopedic ward. The Confusion Assessment Method will be the study tool to assess twice a day to identify subjects experiencing delirium by research team. The demographic data, history of illness, operation process, and laboratory data of the patients were recorded. The demographic data of participants were analyzed to obtain the logistic regression to identify factors associated with the odds ratio. Result: There were One hundred-and-two participants had been screened, and nine of whom was excluded due to the pre-existing delirium. Ninety-three participants with hip fracture were included. The incidence rate of delirium was 54.8%. The average age was 84.5. When postoperative delirium occurred, time to ambulation after surgery was delayed and the average ambulation time per day was decreased. The risk factors were analyzed by logistic regression. Univariate regression suggested age, religion, MMSE (Mini-Mental State Examination), hemoglobin, and hematocrit may be associated to postoperative delirium. Multivariate regression suggested MMSE was a significant risk factor of postoperative delirium in hip fracture. Conclusion: Postoperative delirium has significant impacts on the recovery and long term well-being of elderly patients. Significant predictive risk factors can be parsed out to help practitioners identify patients who are more susceptible to postoperative delirium before they receiving surgery. Recognizing patients who are more likely to develop delirium can also help practitioners develop individualized management to extend postoperative monitoring as needed and mitigate surgical risk factors.

高齡整合性照護、健康識能和生命意義與目的之偏鄉社區研究-以桃園復興區為例

2025-09-30T16:08:31Z

標題: 高齡整合性照護、健康識能和生命意義與目的之偏鄉社區研究-以桃園復興區為例; Integrated Care for Older People, Health Literacy, and Meaning and Purpose of Life among the Elderly: A Community-based study in Rural Fuxing District, Taoyuan 作者: 蔣壽元; Shou-Yuan Chiang 摘要: 研究目的:在世界衛生組織大力推動高齡整合性照護（Integrated Care for Older People, ICOPE）的背景下，功能衰退與心理失能的交互影響成為活躍老化領域的重要議題。本研究桃園市復興區65歲以上偏鄉高齡長者，為了解偏鄉長者的高齡整合性照護（ICOPE）、健康識能和生命意義與目的之現況，探討ICOPE和其生命意義與目的之相關性，探討健康識能在ICOPE和生命意義與目的之交互作用，同時控制人口學特徵（性別、年齡、教育程度、婚姻、工作、居住型態與慢性病），期待能為偏鄉高齡長者身心整合照護提供實證基礎。研究方法:本研究採橫斷式研究設計，於2025年1月至5月問卷收集，具護理背景調查員在復興區進行一對一紙本問卷調查，共取得 119 份有效樣本，回收率 100%。研究工具包含ICOPE十項功能評估、健康識能量表及生命意義與目的量表。統計以 SPSS(29.0)統計套裝軟體進行描述統計、獨立樣本 t 檢定、單因子變異數分析、皮爾森相關與階層式多元迴歸，迴歸分析以檢定調節效果。研究結果:受訪長者平均74.3 ± 6.3歲，其中61.3%至少在一個ICOPE面向出現異常，平均異常項數為1.12 ± 1.26；認知（44.5%）、視力（21.8%）與憂鬱（12.6%）為前三大問題。整體健康識能平均4.032 ± 0.498（滿分5分），以「理解健康資訊」得分最高（4.229 ± 0.522），「獲取健康資訊」最低（3.647 ± 0.838），顯示資訊可近性不足。皮爾森分析顯示ICOPE與健康識能呈中度負相關（r = –0.494，p < 0.001），健康識能與生命意義與目的呈高度正相關（r = 0.626，p < 0.001）。階層式迴歸加入生命意義與目的後，模型係數由16.1%提升至48.5%；健康識能為正向預測因子（β = 0.470，p < 0.001），ICOPE仍具負向效果（β = –0.277，p < 0.001），而ICOPE×健康識能交互項不顯著。結論: 偏鄉長者功能退化愈高，其生命意義與目的愈低；相較之下，健康識能對提升生命意義與目的的相關性更高，ICOPE與健康識能共同影響偏鄉長者的生命意義與目的，健康識能具顯著中介效果。建議未來高齡整合照護納入常規評估，結合多媒體之健康識能課程，以強化獲取能力與跨專業轉介追蹤機制，以提升偏鄉長者生命意義與目的。; Research Purpose: Against the World Health Organization’s promotion of Integrated Care for Older People (ICOPE), the interplay between functional decline and psychosocial impairment has become a key concern in active aging. Focusing on rural adults aged ≥65 years in Fuxing District, Taoyuan, this study (1) describes the status of ICOPE-assessed functional/intrinsic capacity, health literacy, and meaning and purpose in life; (2) examines the association between ICOPE status and meaning and purpose in life; and (3) tests whether health literacy interacts with (i.e., moderates) the relationship between ICOPE and meaning and purpose in life, while controlling for sociodemographic characteristics (sex, age, educational attainment, marital status, employment, living arrangement, and chronic conditions). The goal is to provide an empirical foundation for integrated biopsychosocial care for rural older adults Methods: We employed a cross-sectional design and conducted paper-and-pencil, one-on-one interviews administered by nurse-trained surveyors in Fuxing District from January to May 2025. A total of 119 valid responses were collected (response rate: 100%). Instruments included the ICOPE functional assessment, a health literacy scale, and a meaning-and-purpose-of-life scale. Analyses used SPSS 29.0 for descriptive statistics, independent-samples t tests, one-way ANOVA, Pearson correlations, and hierarchical multiple regression to test moderation via interaction terms. Results: Participants’ mean age was 74.3 ± 6.3 years; 61.3% had abnormalities in at least one ICOPE domain, with a mean of 1.12 ± 1.26 abnormal items. The most prevalent issues were cognition (44.5%), vision (21.8%), and depression (12.6%). Overall health literacy averaged 4.032 ± 0.498 (out of 5), with the highest score in “understanding health information” (4.229 ± 0.522) and the lowest in “accessing health information” (3.647 ± 0.838), indicating limited information accessibility. Pearson analyses showed a moderate negative correlation between ICOPE abnormalities and health literacy (r = –0.494, p < .001) and a strong positive correlation between health literacy and meaning and purpose in life (r = 0.626, p < .001). In hierarchical regression, the explained variance across models increased from 16.1% to 48.5%; health literacy was a positive predictor (β = 0.470, p < .001), ICOPE abnormalities remained negatively associated (β = –0.277, p < .001), and the ICOPE × health literacy interaction was not significant. Conclusion: Among rural older adults, greater functional decline is associated with lower meaning and purpose in life; by contrast, health literacy exerts a stronger positive effect on meaning and purpose. ICOPE-assessed functional status and health literacy independently and jointly shape older adults’ sense of purpose, with health literacy mediating the association between functional decline and meaning/purpose. We recommend institutionalizing ICOPE as routine screening and pairing it with locally tailored, multimedia health-literacy programs to strengthen information access, along with interprofessional referral-and-follow-up mechanisms to prevent further decline.

高擬真模擬教學對護理學生於健康評估課程學習成效探討-以心血管系統評估為例

2022-11-24T03:10:00Z

標題: 高擬真模擬教學對護理學生於健康評估課程學習成效探討-以心血管系統評估為例; Evaluation of High-Fidelity Simulation Pedagogy on Nursing Students’ Learning Effectiveness in Health Assessment Course -An Example Of Cardiovascular System Assessment 作者: Yi-Fei Chen; 陳怡妃摘要: 研究背景：健康評估技巧是護理實務必備的核心能力之一，它仰賴生物、醫學課程和護理專業教育為基石，也是建構往後內外科護理學、臨床實習及臨床照護的重要基礎。熟練的健康評估技巧對於臨床推理、提供高質量的護理相當重要，進而影響日後病人安全及照護品質。國外文獻研究發現高擬真模擬教案運用於護理教育將可有助於提高學生於知識、情意及技能層面的分數，但目前尚不清楚此法運用於台灣護理系學生於健康評估課程之成效，故藉此研究了解台灣學生在此科目學習狀態及高擬真模擬教案介入後之學習成效分析。研究目的：健康評估課程是綜合護理學生在完成基本護理學、解剖生理學、病理學等先備知識後集大成所必修的重要科目，也是往後內外科護理學、臨床實習以及踏入臨床工作的重要基礎。本研究係探討護理學系學生在學習「健康評估」課程與實習時的現況，依該課程教學目標及學生需求設計高擬真模擬教案，探討高擬真模擬教案教學法介入後對學生於知識、情意及技能之間的相關性。研究方法：本研究採二階段進行，第一階段以行動研究法確認教案內容；其後以類實驗研究法，採雙組前後測，招募北部國立某大學之護理學系學生為研究對象，共收案59位受訪者，有效回收率為74.7%。研究工具包含自擬式問卷及人口學特性、先備知識的信心程度、健康評估課程與實習的學習現況、高擬真模擬教具及心衰竭教案，由研究者（專科護理師）負責研擬和各組教學。研究資料以IBM SPSS Statistics 22.0版統計軟體進行資料建檔與分析，進行描述性統計及推論性統計。研究結果：心血管系統是受訪學生於健康評估課程中最喜歡但自覺學習最困難的單元，本研究因此設計心衰竭個案高擬真模擬教案，教案經專家效度檢定CVI值為0.93～0.95。經過逐步多元迴歸分析建立學習成效迴歸模型，研究結果顯示：年齡、入學方式、對內外科護理學的信心程度及自學時數…等皆為影響學習成效之單變項顯著因子，以逐步複迴歸法分析結果：知識及學習態度等變項是健康評估技術考成績之正向預測因子，此迴歸模型預測力R2值為 0.513；高擬真模擬教案組的技術考成績高於對照組1.45分；且在控制了組別因素下，學習態度和紙筆測驗亦為技能成效之正向預測因子（p < .001），期末考成績愈高、其後的技能測驗也能顯著增加0.59分（p < .001），總解釋變異量為51.3%。結論：行動研究法能了解學生在健康評估課程的學習需求，設計合適的高擬真情境模擬教案。以高擬真教具教學之護理學生於健康評估技術考和學習態度均有正向學習效果，此結果能提供未來教育研究、教學設計、臨床照護訓練參考。