高血压病病人主观幸福感与情绪状态的调查

[目的]探讨高血压病病人主观幸福感与情绪状态的关系.[方法]采用幸福感指数量表、Zung焦虑自评量表(SAS)和抑郁自评量表(SDS)对69例高血压住院病人进行测量.[结果]高血压病病人幸福感体验低下,负性情绪较严重,其负性情绪状态与幸福感体验呈负相关.[结论]高血压病病人幸福感与焦虑、抑郁负性情绪密切相关,对高血压病痛人予心理干预,改善其情绪状态,可提高病人生活质量,增强主观幸福感,促进身心健康.     

高血压病病人主观幸福感与情绪状态的调查

[目的]探讨高血压病病人主观幸福感与情绪状态的关系。[方法]采用幸福感指数量表、Zung焦虑自评量表（SAS）和抑郁自评量表（SDS）对69例高血压住院病人进行测量。[结果]高血压病病人幸福感体验低下，负性情绪较严重，其负性情绪状态与幸福感体验呈负相关。[结论]高血压病病人幸福感与焦虑、抑郁负性情绪密切相关，对高血压病病人予心理干预，改善其情绪状态，可提高病人生活质量，增强主观幸福感，促进身心健康。     

系统性红斑狼疮患者的心理问题分析及心理干预

目的 对系统性红斑狼疮患者进行心理状态的分析,针对其存在的心理问题给予心理干预.方法 采用随机、双盲的对照实验方法,将系统性红斑狼疮患者60例分为两组,对照组30例,干预组30例,采用症状自评量表(SCL-90)于心理干预前后进行心理状态的评定,采用焦虑自评量表(Self-Rating Anxiety Scale,SAS)、抑郁自评量表(Self-Rating Depression Scale,SDS)于心理干预前后进行量表评定.结果 心理干预后SCL-90各因子分值与中国常模比较差异有统计学意义(P＜0.05);心理干预前后SAS 、SDS值差异有统计学意义(P＜0.01).结论 系统性红斑狼疮患者存在不同程度的焦虑、抑郁症状,对他们进行心理干预可以改善其抑郁、焦虑状态,缓解其不良情绪.     

手语操音乐疗法对服刑康复期精神分裂症患者负性情绪的影响

目的 探讨手语操音乐疗法对服刑康复期精神分裂症患者负性情绪的影响.方法 将60例男性服刑康复期精神分裂症患者随机分为观察组和对照组各30例.对照组给予一般支持性的心理护理,观察组在此基础上进行为期6周的手语操音乐治疗干预.采用焦虑自评量表(Self-Rating Anxiety Scale,SAS)、抑郁自评量表(Self-Rating Depression Scale,SDS)、护士用住院病人观察量表(Nurses Obseration Scale for Inpatient Evaluation,NOSIE-30),分别在患者手语操治疗前和治疗后6周进行评定.结果 观察组经过6周的手语操音乐治疗干预后,SAS、SDS分值与对照组比较差异有统计意义(P＜0.05),NOSIE-30中社会能力、社会兴趣、激惹、迟缓、抑郁5项因子分与对照组比较差异有统计意义(P＜0.01).结论 手语操音乐疗法能改善男性服刑康复期精神分裂症患者的负性情绪,提高患者主动性、社会兴趣和社会能力,对心理康复有一定的帮助.     

肝硬化患者主观幸福感及其影响因素的调查研究

目的探讨肝硬化患者主观幸福感的水平及其影响因素。方法采用便利抽样方法抽取100例肝硬化患者,运用纽芬兰纪念大学主观幸福度量表、社会支持量表、医学应对问卷、焦虑自评量表、抑郁自评量表进行调查。结果肝硬化患者主观幸福感为中等水平[(21.58±4.72)分],不同经济收入、医疗费用支付方式和疾病严重程度患者的主观幸福感得分差异均有统计学意义(P0.01);高社会支持组的幸福感高于低社会支持组,差异有统计学意义(P0.01);肝硬化患者幸福感总分与回避、屈服呈负相关,差异有统计学意义(P0.05);肝硬化患者的焦虑、抑郁情绪状态与幸福感总分、正性情感和正性体验呈负相关,与负性情感和负性体验呈正相关,差异有统计学意义(P0.05)。结论肝硬化患者主观幸福感水平不高,医护人员应通过各种措施,增加患者的社会支持,加强心理干预,改善负性情绪,指导患者采用积极地面对,尽量避免屈服和回避的心理,以提高主观幸福感,促进身心健康。     

颞下颌关节紊乱病患者疾病不确定感与应对方式、负性情绪的相关性

目的分析颞下颌关节紊乱病患者疾病不确定感与应对方式、负性情绪的相关性。方法采用Mishel疾病不确定感量表(Mishel's Uncertainty in Illness Scale,MUIS)、医学应对问卷(Medical Coping Modes Questionnaire,MCMQ)以及焦虑自评量表(Self-rating anxiety scale,SAS)、抑郁自评量表(Self-Rating Depression Scale,SDS)对患者进行调查,并分析患者疾病不确定感与应对方式、负性情绪的相关性。结果颞下颌关节紊乱病患者MUIS平均得分为(95.97±19.46)分;Pearson相关分析结果显示,MUIS总分与屈服、SAS、SDS评分均呈显著正相关性(r0,P0.05);与面对、回避评分均呈显著负相关性(r0,P0.05)。结论颞下颌关节紊乱病患者疾病不确定感整体处于中等水平,且与应对方式、负性情绪密切相关。     

焦虑自评量表简介

焦虑自评量表（Self-Rating Anxiety Scale,SAS）,由Zung1971年编制。从量表构造的形式到具体评定方法,都与抑郁自评量表（SDS）十分相似,用于评定焦虑病人的主观感受。     

临床综合干预改善网络成瘾患者症状的对照研究

目的 探讨临床综合干预对网络成瘾患者症状的改善效果.方法 将就诊于我院的126例网络成瘾患者随机分为研究组(61例)与对照组(65例).研究组进行包括个体心理治疗、家庭心理治疗、团体心理治疗在内的综合性心理干预治疗及药物治疗.对照组只进行个体心理治疗,共用时6个月.两组分别于干预前及干预后利用焦虑自评量表(Self-Rating Anxiety Scale,SAS)、抑郁自评量表(Self-Rating Depression Scale,SDS)及精神卫生症状自评量表(SCL-90)评定效果.结果 研究组干预后SAS及SDS评分均低于干预前,SAS评分(41.72士3.42)分vs(62.17土6.42)分(P＜0.01),SDS评分(38.68±2.54)分vs (65.37±5.38)分(P＜0.01).干预后研究组SAS及SDS评分均显著低于对照组(P ＜0.01).结论 临床综合干预治疗比单纯个体心理治疗更有助于戒除网瘾.     

悟言点击术对慢性心力衰竭患者焦虑抑郁情绪的干预研究

目的评价悟言点击术对慢性心力衰竭患者焦虑、抑郁情绪的干预效果。方法将200例研究对象按住院治疗的单、双号分为试验组和对照组。试验组采用悟言点击术进行心理干预,对照组采用传统的心理疏导和认知疗法进行心理干预,干预时间均为3个月。干预前后,两组患者均采用焦虑自评量表(Self-Rating Anxiety Scale,SAS)和抑郁自评量表(Self-Rating Depression Scale,SDS)进行测试,比较两组患者干预前后焦虑、抑郁情绪的改善情况。结果干预后两组SAS和SDS得分均有所下降,试验组患者处于轻度的焦虑和抑郁状态,但对照组患者仍存在中度焦虑和抑郁状态,差异具有统计学意义(P0.01)。结论实施悟言点击术可有效改善慢性心力衰竭患者的焦虑、抑郁情绪。     

肺心病患者心理状况分析及护理对策

目的了解肺心病患者的心理状况,探讨护理对策。方法采用幸福感指数量表及Zung的焦虑自评量表(SAS)和抑郁自评量表(SDS)对湘雅三医院呼吸内科住院及门诊肺心病患者96例进行心理状况调查。结果96例肺心病患者的幸福感指数低于普通人群(P<0.01);焦虑、抑郁均分高于普通人群(P<0.01),抑郁的发生率高于焦虑。结论肺心病患者的幸福感降低.有明显的焦虑、抑郁情绪,尤以抑郁情绪更为明显;结果提示护士对肺市心病患者应采取积极的心理护理对策。     

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.