吸烟与老年人慢性支气管炎的相关性研究

我们对在膳食习惯和生活条件都基本相同的２６个部队干休所的全部离退休老干部进行了吸烟与老年人慢性支气管炎的相关性流行病学调查。结果显示:两组老年人的慢性支气管炎的患病率分别为６１．８９％（１０８３／１７５０），１５．２８％（１２５／８１８），Ｐ＜０．００５，ＲＲ＝４．１０。同时发现随着吸烟等级的增加其患病率也逐渐上升。     

慢性疾病患者家属的心理健康水平及其应对方式的研究

目的探讨慢性疾病患者家属的焦虑、抑郁发生情况及与应对方式的相关性。方法采用自评焦虑量表（SAS）、自评抑郁量表（SDS）、应对方式量表（SCSQ）对232例慢性疾病患者家属进行了测试。结果232例慢性疾病患者家属焦虑发生率25．9％,抑郁发生率43．,1％,同时发生焦虑、抑郁者占25．9％;家属的心理健康问题与家属性别、患者的年龄、患者的病程、家属的积极应对方式、医疗费用、家庭经济状况等因素有关。结论慢性疾病患者的家属均不同程度地存在负性情绪,由此影响慢性病患者。重视对慢性疾病患者家属心理干预,有利于患者疾病的转归,提高慢性疾病患者家属的生活质量。     

血小板活化、高敏C反应蛋白与慢性肺心病患者肺动脉压的关系

目的探讨慢性肺心病患者血小板活化指标PAC-1、CD62p和高敏C反应蛋白（hs—CRP）与肺动脉收缩压之间的关系。方法用三色全血流式细胞术测定50例慢性肺心病急性加重期患者及50例缓解期患者外周血中血小板PAC-1、CD62p的表达水平,采用免疫比浊法测定hs-CRP,并与40例健康对照者比较。用超声心动图检测慢性肺心病患者肺动脉收缩压。结果慢性肺心病急性加重期组PAC-1、CD62p的表达分别为（81．84±8．68）％、（47．12±6．30）％,明显高于缓解期组[（52．70±7．87）％、（33．66±5．83）％]及正常对照组[（48．73±5．55）％、（30．63±4．09）％]（均P〈0．01）,并与hs-CRP、肺动脉收缩压呈正相关。慢性肺心病急性加重期组hs—CRP为（10．28±6．23）mg／L,明显高于缓解期组[（5．48±3．34）mg／L]（P〈0．01）,并与肺动脉收缩压呈正相关。慢性肺心病急性加重期组肺动脉收缩压为（44．22±6．70）mmHg,明显高于缓解期组[（39．88±6．18）mmHg]（P〈0．01）。结论慢性肺心病急性加重期患者血小板明显活化,hs-CRP参与了慢性肺心病急性加重期炎症反应,血小板活化、炎症反应与肺动脉高压之间关系密切。     

综合心理干预对慢性心力衰竭患者焦虑与抑郁状态的影响

目的：探讨以团体认知行为干预为主的综合性心理干预措施对慢性心力衰竭患者的焦虑及抑郁状态的效果。方法选取2012年1月—2013年12月收治的100例慢性心力衰竭患者为研究对象,采用随机数字表法将患者分为干预组和对照组各50例。对照组患者在住院期间实施常规护理,干预组在此基础上进行团体认知行为干预为主的综合心理干预。采用焦虑自评量表（ SAS）和抑郁自评量表（ SDS）比较两组患者的焦虑和抑郁情况。结果基线时,总体焦虑发生率为25％,其中轻度11例,中度10例,重度4例;总体抑郁发生率为39％,其中轻度19例,中度14例,重度6例。对照组和干预组干预后SAS及SDS得分均优于干预前,干预组分别为（36．90±8．465）,（27．53±7．162）分,较对照组的（40．91±8．019）,（36．78±10．562）分改善更明显,且差异有统计学意义（t分别为9．244,10．335;P＜0．01）。结论团体认知行为干预为主的综合心理干预策略能有效地缓解和改善慢性心力衰竭患者的焦虑、抑郁情绪。     

心理干预对慢性乙型肝炎患者家属抑郁及焦虑情绪的影响

目的：探讨心理干预对慢性乙型肝炎患者家属抑郁焦虑情绪的影响。方法选择慢性乙型肝炎患者家属68例,采用随机数字表法随机分为观察组（34例）和对照组（34例）。对照组给予常规护理健康教育,观察组在此基础上给予心理干预,家属均应用抑郁自评量表（ SDS ）及焦虑自评量表（SAS）评估干预前后的心理健康状况。结果干预前,患者家属 SDS 及 SAS评分分别为（39．81±5.34）,（34．67±4．61）分,均高于国内常模,差异有统计学意义（t值分别为9．71,8．92;P＜0．05）;干预前,两组患者家属SDS及SAS评分差异无统计学意义（ P＞0．05）;干预后,观察组患者家属SDS及SAS评分低于对照组,差异均有统计学意义（ t值分别为3．61,2．85;P＜0．05）。结论慢性乙型肝炎患者家属存在一定程度的抑郁焦虑状况,心理干预能改善患者家属的抑郁焦虑状况。     

妊娠剧吐患者心理因素分析及心理护理

目的探讨妊娠剧吐患者的心理因素及心理护理疗效。方法61例妊娠剧吐患者,分为观察组34例,对照组33例。入院时分别采用焦虑自评量表（SAS）、抑郁自评量表（SDS）进行评分,所有患者常规药物治疗,同时观察组予心理护理。10d后两组患者再次进行SAS及SDS评分。结果入院时SAS评分发现所有患者均存在焦虑症状,SDS评分发现观察组34例患者中28例存在抑郁症状,对照组33例患者中29例存在抑郁症状。经心理护理后观察组患者焦虑及抑郁症状的缓解率分别为82．35％和82．14％,显著高于对照组60．61％和55．17％,同时观察组护理后SAS及SDS评分分别为（42．82±4．73）分和（42．11±5．65）分,显著低于对照组的（48．25±4．61）分和（48．52±5．00）分。结论妊娠剧吐患者普遍存在焦虑和抑郁症状,心理护理对于改善症状有积极的作用。     

老年人超重和肥胖与慢性病的相关性调查及健康教育

目的 对驻京部队离退休老年人超重和肥胖状况及其与慢性病的相关性进行调查，旨在为以后的健康教育对策提供依据。方法 对134个驻京部队干休所或部队大院的1513例老年人进行全面查体，测量体重指数，调查常见慢性疾病。结果 该群体超重和肥胖率分别为48．9％和12．8％，仅有36．5％的人体重正常。慢性病顺位统计前10位疾病是：前列腺肥大、高脂血症、白内障、高血压病、脂肪肝、冠心病、糖尿病、慢性支气管炎、高尿酸血症和脑血管病。超重和肥胖者高血压病、冠心病、糖尿病、高脂血症、高尿酸血症和脂肪肝的发病率明显高于正常体重者（P〈0．05）。结论 驻京部队离退休老年人超重和肥胖情况严重，并且与多种慢性病的发病有明显关系，防治肥胖应是老年健康教育的工作重点。     

吸烟与呼吸系统疾病关系的流行病学调查

我们为了解部队离退休干部吸烟与疾病的关系，特选择了在膳食习惯、生活条件和所处环境都相同的26个部队干休所的离退休老干部长达8个月的同群队列流行病学调查，发现本地区离退休老干部的吸烟率为68.15%（1750/2568），结果表明吸烟组的慢支炎、肺气肿、肺心病、肺癌的患病率明显高于不吸烟组，P＜0.005 RR2。同时显示随着吸烟等级的增加，这些疾病的患病率显著上升，P＜0.005，RR2。     

北京市长青园社区站门诊患者103例焦虑抑郁状态筛查

目的：筛查北京市长青园地区社区门诊就诊患者焦虑抑郁状态发生情况。方法：调查样本来源于整群抽取的2004-10．在北京市长青园地区社区门诊就诊患者103例。采用医院焦虑抑郁量表（由14条目组成，其中7个条目评定焦虑，7个条目评定抑郁；0～7分属无症状。8～10分属症状可疑。11-21分属存在症状）进行调查。由患者本人如实填写上个月情绪变化，调查者根据量表筛查结果对不同性别、年龄、文化程度、工作状况以及疾病情况下焦虑、抑郁障碍发生情况进行分析评估。结果：103例受试对象的测试结果均纳入结果分析。①不同性别、年龄、文化程度、工作状况焦虑、抑郁障碍发生情况：抑郁障碍发生率高于焦虑障碍发生率（32.0％和21.4%）。男性抑郁障碍发生情况略多于女性（33％和31％）；≥60岁离退休老年人中49．4％存在不同程度的情绪障碍；小学及小学以下文化程度的人群的焦虑、抑郁障碍发生率高于初中及以上文化水平的人群（焦虑：25％和20％；抑郁：28％和24％）。②不同疾病情况下焦虑、抑郁障碍发生情况：焦虑、抑郁患者和可疑症状人群患有两种以上慢性病占25．2％，3种以上慢性病占6．8％。结论：北京市长青园地区社区门诊就诊的患者中抑郁状态人数多于焦虑状态人数，焦虑和抑郁障碍的发生率男性略多于女性，文化程度低的发生率低于文化程度高者，患两种以上慢性病的离退休老年人有近半数人存在不同程度的焦虑和抑郁障碍。     

认知干预护理对原发性高血压患者焦虑抑郁的影响

目的：探讨认知干预护理对原发性高血压患者的焦虑、抑郁情况的影响。方法选择伴有焦虑和／或抑郁症状的54例原发性高血压患者作为研究对象,采用随机数字表法分成干预组和对照组。对照组患者进行医院常规治疗和护理,干预组患者在此基础上进行认知干预护理,分别在干预前后对两组患者进行焦虑自评量表（ SAS）和抑郁自评量表（ SDS）进行评价,比较两组患者干预前后的评分情况以及血压水平。结果干预后干预组患者SAS、SDS评分分别为（36．67±8．61）,（37．88±8．56）分,收缩压和舒张压分别为（143．66±10．25）,（84．12±8．81）mmHg;对照组患者SAS评分、SDS评分分别为（41．99±7．83）,（42．92±9．75）分,收缩压和舒张压分别为（156．79±14．69）,（89．99±8．72）mmHg,两组比较差异均有统计学意义（t值分别为2．3753,2．0185,3．8088,2．4606;P＜0．05）。干预后干预组SAS评分、SDS评分、收缩压和舒张压均低于干预前,差异有统计学意义（ t值分别为3．1410,2．3081,3．4094,2．9423;P＜0．05）。干预后对照组患者各项指标与干预前比较,差异无统计学意义（P＞0．05）。结论认知干预护理可降低原发性高血压患者的焦虑、抑郁评分,有效控制患者的血压,提高临床治疗效果。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.