护理双语演讲比赛word.docx

1、护理双语演讲比赛word开头讲一下2010年和刘老师一起申报课题的情况，作为开场白。I would like to introduce a paper which published in the journal “pharmacy world & science”,thats “Patients dont lie: a view on adherence in asthma.(“患者不会说谎”：关于哮喘用药依从性的一个观点)作者：Claus Mldrup Jonathan Stein Birthe SndergaardReceived: 6 October 2009 / Accepted:

2、13 September 2010(收稿日期：2009/10月接收日期：9月13日)Abstract Objective The primary objective of this article is to examine the extent of self-reported non-adherence among patients participating in a controlled trial of an asthma compliance optimization intervention. (这篇文章的主要目的是检查参与哮喘遵从优化干预对照试验的病人自我报告的非依从性的程度)

3、The secondary objective is to introduce a two-question questionnaire that is, in wording and design, a neutral tool for disclosure of non-adherence behaviour. (第二个目标是引进两个问题的调查问卷，在措辞和设计，中立的工具披露的非依从行为)Method Data in this study was obtained as part of a controlled trial on an SMS monitoring and complia

4、nce intervention developed for Danish asthma patients. （本研究中获得的资料来源于为丹麦哮喘患者开发的短信监控及依从性干预的对照试验）The trial was conducted from November 2007 to May 2008. A total of 244 patients participated in the study. Two new designed nonadherence questions were asked in immediate succession.（两个全新设计的不依从性问题紧接着被提出）Thi

5、s practice, along with the wording of the questions and use of the Web as medium, constitute a new approach to self-reported adherence assessment. （这种做法包括问题的措辞和使用网络作为媒介，构成了一个新的自我报告依从性评估的方法）Results A total of 43.9% of the participants in the trial reported non-adherence to the medical dosage regime f

6、or which they had, only one question earlier, documented their awareness. （总共有43.9的参与者在试验报告不遵守他们的医疗剂量制度，之前只有一个问题记录了他们的意识）Conclusion This illustrates that at least 43.9% of the participants in the trial dared to report non-adherence to asthma medication. （这表明，至少有43.9参与试验的人敢于报告不依从服用治疗哮喘的药物）Keywords As

7、thma Compliance Denmark Non-adherence QuestionnaireImpact of findings on practice（实践的结果的影响） This article introduces a two-question questionnaire that is, in wording and design, a neutral tool for disclosure of non-adherence behaviour that might be a useful instrument in research. Self-reported adher

8、ence data can be regarded as a valuable and reliable supplement to other data sources on adherence.自我报告依从性数据对其他依从性发面的数据源可以被视为一个有价值的和可靠的补充。 In Denmark, 44% of a representative asthma population reports being non-adherent to their pharmacotherapy.在丹麦，44有代表性的哮喘人口的报告在药物治疗中有不依从性。IntroductionThe transitio

9、n in terminology from compliance to adherence, and more recently to concordance, （从compliance到adherence这两个术语的演变，再到近来concordance一致性）is primarily a documentation of the transition in how healthcare systems and healthcare professionals perceived the nature of being a patient. 主要是一个文件的过渡，关于医疗系统和医疗保健专业人士

10、如何感知病人的本质。Starting with the concept of compliance, with the patient as a passive, powerless recipient of care. 从遵从性的概念开始，作为一个被动的、无法自理的病人。Developing into adherence, as the extent to which the patients behaviour matches agreed recommendations. 发展为依从性，即病人行为符合商定的建议的程度。Now concordance, which suggests equ

11、ality, sharing of power, and ongoing negotiation and interaction respecting the beliefs of the patient . 现在是concordance，即建议平等，共享能源和进行谈判和互动，尊重患者的信仰。A nice concept analysis of compliance, adherence and concordance can be found in a review by Cohen in the context of cardiovascular risk reduction .在科恩对心

12、血管病风险减少的研究中发现一个很好的概念分析。Even though it looks like a somewhat evolutionary transition, the real life situation even today is a mix of all three concepts, and the concepts are even used interchangeably . 虽然它看起来像一个有点进化的过渡，但即使在今天，现实生活中的情况是三个概念的混合，甚至可以互换使用。Another way to illustrate the shift in focus is t

13、o take a look at the scientific articles published on the topics. 另一种来说明重点转移的方式是来看看发表的关于这个主题的科学论文。Simple searches on the terms medical adherence +year and medical compliance +year with no language limit on Pubmed illustrate this change in research focus. 简单搜索术语“医疗依从性+年”和“医疗遵从+年”，并没有医学语言限制来说明这种变化的研究热

14、点。The number of articles discussing adherence and compliance today is almost overwhelming, with more than 8,000 articles discussing this compared with only 1,500 articles yearly until 2003.现今研究adherence和compliance的文章铺天盖地，超过8000篇文章，而2003年只有1500篇。 A boom in articles is seen in 2004, possibly reflectin

15、g the publication of the WHO adherence reference report in 2003.在2004年的文章呈爆炸式发展，可能反映世卫组织于2003年出版的依从性参考报告。The long-standing belief in the healthcare system has been Patients do what they are told. 在医疗保健系统长期的信念一直是“患者按照他们被叮嘱的事去做”。Just a few years ago, the majority of health professionals did not acknow

16、ledge non-adherence issues. 就在一些年前，大部分的卫生专业人员，不承认非依从性的问题存在。Now non-adherence has been reported in almost all the treatment areas, in both acute and chronic situations and for both medical and nonmedical interventions. 现在非依从性在几乎所有的治疗领域被报导，包括急性和慢性两种情况，医疗和非医疗干预措施。Overviews of the number of nonadherent

17、patients can be found in various reviews.可以在多种评论中找到关于非依从患者的数量的概述。Perspectives on adherence and compliance have certainly changed in the scientific community and in the practice of healthcare, but what about the patient perspective? 依从和遵守的观念在科学界和医疗的实践中确实改变，但是病人的观念呢？For years, it has been the general

18、belief that if a researcher or doctor asked a patient, Do you take your medication as prescribed?, the result would be unreliable because the patient would not dare to answer no in case this would offend the doctor. 多年来，一直普遍认为，如果研究人员或医生询问病人“你按时服药了吗？”，回答往往不可信赖，因为病人不敢回答说“没”以防得罪医生。For this reason, self

19、-reported adherence data have been regarded as less reliable than other data sources, such as direct or indirect data collection on this matter. 由于这个原因，自我对依从性的报告没有在这个问题上的直接或间接的数据收集来得可靠。Direct and indirect measuring methods both have advantages and disadvantages and, thus far, a combination of method

20、s seems to provide the most reliable results. 直接和间接的测量方法都有优点和缺点，相结合的方法，迄今为止，似乎提供了最可靠的结果。Horne et al. argue that a judgment-neutral non-adherence disclosure procedure is needed to deal with this issue. 霍恩等认为需要用一个公正披露非依从的程序来处理这个问题。One might suggest that the openness to, and new insights into, complian

21、ce, adherence, and concordance concepts in the healthcare system would carry over to patient attitudes towards these concepts as well, our changes in attitudes change the patients attitude as well.有人可能会认为从卫生系统用新的角度去注解compliance, adherence和concordance会让病人对依从性的态度发生改变，同样，我们自身态度的改变也会影响病人对依从性的看法。It is po

22、ssible that patients now dare to answer no to the question and, if this is the case, self-reported nonadherence data can be considered a more reliable tool for researching adherence issues than earlier believed. 这是可能的，患者现在敢回答“没有”的问题，如果是这样的话，自我报告的不依从性的数据可以被认为是比早先认为的更可靠的研究依从性问题的工具。Some newly conducted

23、 studies of adherence and compliance indicate that this seems to be the case in some areas, 一些正在进行的有关依从性的研究表明这似乎是在某些领域的情况下such as antiretroviral therapy, 抗逆转录病毒疗法or at least it is possible to establish a calibrated measure that more closely approximates objectively measured adherence and thus is mor

24、e sensitive for detecting non-adherence. 或者至少建立一个校准的措施来更客观测量依从性是可能的，从而对检测非依从性更为灵敏。In other areas such as heart failure, self-reported non-adherence data has not shown to be a more reliable tool. 在其他领域，如心脏衰竭，自我报告的非依从性数据则不那么可靠。In general, novel studies on the true-value of self-reported healthcare dat

25、a is very limited, and need more attention, as the patient/health care professional relation is under transition. 在一般情况下，新的“真值”自报的医疗数据的研究是非常有限的，需要更多的关注，因为病人/保健体系是随着转变的。MethodThe trialData in this study was obtained as part of a controlled trial on an SMS monitoring and compliance intervention develo

26、ped for Danish asthma patients. 本研究中获得的资料来源于为丹麦哮喘患者开发的短信监控及合规干预的对照试验The trial was conducted from November 2007 to May 2008. 该试验是从2007年11月至2008年5月。 Patients were recruited through the use of a large NetDoktor.dk database of approximately 4,000 asthma patients, 通过使用一个巨大的包含约4000名哮喘患者的NetDoktor.dk数据库招募病

27、人and were continuously stratified based on age, gender, and self-reported asthma control (asthma control questionnaire) 并根据年龄，性别，和自我报告的哮喘控制（哮喘控制问卷）连续分层and randomized into intervention or control groups to secure homogeneous groups. 并随机分为干预组和对照组，以确保均匀的群体。A total of 244 patients participated in the st

28、udy. The questionnaireAs a part of this trial, both the control and intervention groups were asked to answer an Internet questionnaire of approximately 30 questions, 作为这项试验的一部分，对照组和干预组都被要求回答一个约30个问题的网上问卷including questions on demographics, use of medicine, use of the health care system, and self-ass

29、essed asthma control based on the Asthma control questionnaire. 包括人口统计数据的问题，使用药物，使用的医疗保健系统，和自我评估哮喘控制The questionnaire was posed on days 1, 45, and 90 of the study. 在研究的第1、45和90天进行了问卷调查。The total questionnaire was piloted and validated based on qualitative interviews with ten patients. 整个问卷与10名患者在定性访

30、谈的基础上进行试点和验证。 The specific questions used to assess non-adherence were asked in immediate succession. 用于评估非依从的具体问题被接替提出 This practice, along with the wording of the questions and use of the Web as medium, constitute a new approach to self-reported adherence assessment. 这种做法，包括问题的措辞和使用网络作为媒介，构成一个新的自我

31、报告的依从性评估的方法。The wording of the questions was:What is the dose indicated on the label of your preventive (asthma) medication that you should take? 预防（哮喘）药物的标签上标明的剂量，你应该服用多少？Please select2 inhalations吸入 2 time(s) a dayWhat dose of your preventive (asthma) medication do you actually take?你实际上服用的预防哮喘的剂量

32、是多少？Please select2 inhalations 2 time(s) a dayCompliant behaviour is obtained if the answer to the two questions at day 1, 45 and 90, respectively, are the same. 如果第1、45和90天分别得到的两个问题的答案是一样的，就会得到依从行为。Non-compliant behaviour is obtained if the answers to the two questions at day 1, 45 and 90, respectively, are different from each other. 如果第1、45和90天分别得到的两个问题的答案是不同的，就会得到不依从行为。Statistical analysisSummary statistics include number, mean, median, standard deviation, and range for continuous variables and frequencies for categorical variables. 汇总统计，包括数，平均数，中位数，标准差，为连续变量和分