抑郁症患者不成熟心理防御方式相关因素分析

目的：探讨抑郁症患者不成熟心理防御方式的相关因素。方法对42例抑郁症患者采用防御方式问卷、多伦多述情障碍量表、症状自评量表、汉密顿抑郁量表、汉密顿焦虑量表、蒙哥马利抑郁量表进行测评分析。结果抑郁症患者不成熟防御方式评分与述情障碍识别情绪和躯体感受的能力缺乏因子分呈显著正相关（P＜0．05）,与幻想性缺乏因子分呈显著负相关（P＜0．01）,回归分析显示其解释变异率分别为13．2％和19．3％;与症状自评量表的人际关系敏感、敌对、偏执、精神病性因子分呈显著正相关（ P＜0．05或0．01）,与汉密顿抑郁量表总分及焦虑/躯体化、迟缓、睡眠障碍因子分呈显著正相关（ P＜0．05或0．01）,与汉密顿焦虑量表总分及躯体性焦虑、精神性焦虑因子分呈显著正相关（P＜0．01）,与蒙哥马利抑郁量表总分呈显著正相关（P＜0．01）。结论抑郁症患者不成熟防御方式的使用,可能与识别情绪和躯体感受的能力缺乏、幻想性高有一定关联,与患者临床症状的产生具有较大关联性。     

消化性溃疡患者的情绪障碍和述情障碍

用汉密顿焦虑量表(HAMA)、汉密顿抑郁量表(HAMD)和多伦多述情障碍量表(TAS)对57例住院的消化性溃疡患者进行评定,并与57例正常健康自愿者为对照,结果发现消化性溃疡患者HAMA、HAMD总分和TAS总分及四个因子分均显著高于对照组,说明消化性溃疡患者中存在情绪障碍和述情障碍。     

神经症患者的述情障碍与个性相关性研究

目的探讨神经症患者的述情障碍及其与个性相关性。方法采用多伦多述情障碍量表、艾森克个性问卷及症状自评量表对43例神经症患者进行评估，并与58名健康者进行对照分析。结果神经症患者多伦多述情障碍量表总分及因子1、因子2评分均显著高于正常对照组（P〈0．01），多伦多述情障碍量表总分、因子1、因子2及因子4与症状自评量表评分均呈显著正相关（P〈0．05或0．01）；多伦多述情障碍量表因子3与症状自评量表评分除躯体化因子外均呈负相关；多伦多述情障碍量表因子2与艾森克个性问卷神经质评分呈显著正相关（P〈0．05）。结论神经症患者存在明显的述情障碍，与某些个性特质及症状有相关性。     

脑卒中患者心理状况与述情障碍研究

目的探讨脑卒中患者的心理及述情障碍状况。方法对80例脑卒中患者采用症状自评量表和多伦多述情障碍量表进行评定,并与国内常模进行对比分析。结果脑卒中患者症状自评量表躯体化、人际关系、抑郁、焦虑、偏执因子评分均显著高于全国常模（P〈0．01）;女性患者躯体化、人际关系、抑郁、焦虑、恐怖因子评分显著高于男性（P〈0．01）,强迫因子评分显著低于男性（P〈0．01）。多伦多述情障碍量表总分及Ⅰ、Ⅱ、Ⅲ、Ⅳ因子评分均显著高于常模（P〈0．01）,男性患者总分及因子Ⅰ、因子Ⅱ分均显著高于女性（P〈0．01）。结论脑卒中患者存在明显的心理障碍和述情障碍,在进行常规治疗的同时实施早期心理干预,有利于患者的全面康复。     

抑郁症病人抑郁症状与心理弹性、自我缺陷感及述情障碍的关系

[目的]探讨抑郁症病人抑郁症状与心理弹性、自我缺陷感及述情障碍的关系。[方法]2018年1月—2018年12月应用贝克抑郁量表、心理弹性量表、自我缺陷感量表、多伦多述情障碍量表对52例抑郁症病人及50例健康对照组进行调查及评估,比较两组抑郁评分、心理弹性评分、自我缺陷感评分、多伦多述情障碍评分,应用Pearson单因素分析抑郁症病人抑郁症状与心理弹性、自我缺陷感及述情障碍的关系。[结果]抑郁症组病人抑郁评分、自我缺陷感总评分、多伦多述情障碍总评分均高于对照组(P0.05)。经Pearson单因素分析可知,抑郁症病人抑郁评分与述情障碍总评分、自我缺陷感评分呈正相关(P0.05),而与心理韧性总评分及情绪控制、积极认知、家庭支持呈负相关(P0.05)。[结论]抑郁症病人存在明显的述情障碍且自我缺陷感严重,心理韧性差。心理韧性作为中介变量在调节抑郁症病人自我缺陷感与述情障碍方面起到一定的作用。     

阅读疗法对抑郁症患者社会功能的影响

目的：了解阅读疗法对抑郁症患者社会功能的影响。方法将60例抑郁症患者随机分为两组,每组30例。两组均予以常规抗抑郁药物治疗及常规护理,研究组在此基础上联合阅读疗法治疗。观察住院全程。于治疗前后采用个体和社会功能量表、多伦多述情障碍量表及汉密顿抑郁量表评定社会功能、述情障碍及抑郁状况。结果重复测量方差分析显示,时间因素对抑郁症患者个体和社会功能量表总分及各因子分均存在主效应（P＜0．01）,阅读疗法对患者社会中有益的活动、个人关系和社会关系因子分存在主效应（P＜0．05）,且与时间因素存在交互作用（P＜0．05）。逐步回归分析显示,抑郁症患者的社会功能受干预前社会功能、阅读疗法、汉密顿抑郁量表总分减少值的影响;另外多伦多述情障碍量表描述情感的能力因子分改变值对个人关系和社会关系增加值有影响作用,扰乱及攻击行为增加值仅受干预前扰乱及攻击行为因子分的影响。结论阅读疗法能够显著改善抑郁症患者的人际关系状况和社会功能,提高患者的治疗依从性。     

精神分裂症患者述情障碍与自动思维相关性研究

目的 探讨精神分裂症患者述情障碍与负性自动思维的相关性,为临床治疗提供依据.方法 将72例精神分裂症患者设为研究组,抽取同期健康志愿者66名设为对照组,采用自拟一般资料调查表、多伦多述情障碍量表和自动思维问卷对两组进行测评,同时采用阳性与阴性症状量表对研究组进行评定,对上述评定结果进行对比分析及相关分析.结果 研究组多伦多述情障碍量表总分及各因子分和自动思维问卷总分均显著高于对照组(P＜0.05或0.01),阳性与阴性症状量表总分和阳性症状、阴性症状因子分及抑郁症状项目分与多伦多述情障碍量表、自动思维问卷评分均无显著相关(P＞0.05),自动思维问卷评分与多伦多述情障碍量表总分及描述自身情感的能力、认识和辨别情感和躯体感受的能力因子分呈显著正相关(P＜0.05或0.01).结论 精神分裂症患者存在较高水平的述情障碍和负性自动思维,述情障碍与自动思维存在相关,提示在认知治疗的过程中,开展述情能力的情绪加工能力训练治疗,对患者的功能康复具有积极意义.     

泌尿系统恶性肿瘤患者的述情障碍与心理健康状况

目的:调查泌尿系统恶性肿瘤患者述情障碍和心理状况,并对两者的关系进行分析。方法:肿瘤组为2003-12/2004-12肇庆市第一医院泌尿外科收治的60例泌尿系统恶性肿瘤患者,对照组为同期本医院进行健康体检的正常人(n=60)。采用多伦多述情障碍量表(因子Ⅰ描述情感能力;因子Ⅱ认识和区别情绪和躯体感受能力;因子Ⅲ幻想;因子Ⅳ外向型思维。采用5级评分:1代表完全不同意;2代表基本不同意;3代表不同意也不反对;4代表基本同意;5代表完全同意。)进行述情障碍评定。总分越高,表示患者的述情障碍越重。选择症状自评量表(包含躯体化、强迫、人际关系、恐怖、抑郁、焦虑、敌对、偏执、精神病性等9大症状因子。参照全国成人常模标准:因子分<1.8分为正常;1.8～2.0分为轻度异常;2.1～3.0分为中度异常;>3.0分为重度异常)作为心理症状调查问卷,评定心理健康状况。得分越高,心理问题越重。测试均在医生办公室进行,时间为60～80min。测试者自行完成。如无法自己填写,由作者按照其回答完成调查,采用无记名形式,量表当场收回。比较两组多伦多述情障碍量表及症状自评量表评分情况。用t检验行组间显著性测试。结果:120份问卷均完整合格。①述情障碍量表评定情况:肿瘤组的述情障碍量表总分、因子Ⅰ描述情感能力;因子Ⅱ认识和区别情绪和躯体感受能力;因子Ⅲ幻想;因子Ⅳ外向型思维的评分均明显高于对照组(t=2.182～6.467,P<0.05)。②症状自评量表评定情况:肿瘤组的躯体化、强迫、恐怖、抑郁、焦虑、偏执和精神病性因子评分明显高于对照组(t=2.130～3.426,P<0.05)。③泌尿系统恶性肿瘤患者的述情障碍总分平均为(73.46±4.18)分,设定≥73.46分为高述情障碍分组(n=21),<73.46分为低述情障碍分组(n=39)。高述情障碍分组的躯体化、强迫、人际关系、恐怖、抑郁、焦虑、敌对、偏执和精神病性因子评分均明显高于低述情障碍分组(t=2.009～2.443,P均<0.05)。结论:泌尿系统恶性肿瘤患者存在较明显的述情障碍和心理问题,并且述情障碍评分较高者心理状况中不良情绪较为严重。     

惊恐障碍病人的述情障碍与焦虑及抑郁的相关性研究

[目的]探讨惊恐障碍病人的述情障碍以及与焦虑、抑郁的关系。[方法]采用多伦多述情障碍量表(TAS)、Hamilton焦虑量表(HAMA)及Hamilton抑郁量表(HAMD)对56例惊恐障碍病人和56例健康自愿者进行测评,并对述情障碍与焦虑、抑郁作相关分析。[结果]惊恐障碍组TAS总分及因子Ⅱ评分均显著高于对照组(P<0.01),其他因子评分与对照组比较,差异均无统计学意义(P>0.05)。惊恐障碍病人的TAS总分及因子分与HAMA及HAMD评分均无显著性相关性。[结论]惊恐障碍病人存在着明显的述情障碍,尤以识别情绪和躯体感受能力缺乏突出,与焦虑、抑郁症状的严重程度关系不密切。     

抑郁症与抑郁焦虑障碍共病临床特征对照研究

目的探讨抑郁症与抑郁焦虑障碍共病患者的临床特征。方法对34例抑郁焦虑障碍共病患者（研究组）和44例抑郁症患者（对照组）采用自拟一般人口学资料问卷统计一般资料,采用汉密顿抑郁量表及汉密顿焦虑量表评定两组患者的抑郁和焦虑状况,对评定结果进行对比分析。结果两组患者一般人口学资料均无显著性差异;研究组汉密顿抑郁量表总分、焦虑／躯体化、认知障碍、阻滞因子分以及自杀条目分均显著高于对照组（P〈0．01～0．05）;汉密顿焦虑量表总分、躯体性焦虑、精神性焦虑因子分,以及焦虑心境、紧张、抑郁心境、肌肉系统症状、感觉系统症状、心血管系统症状、胃肠道症状、植物神经症状及会诊时行为表现单项条目分均显著高于对照组（P均〈0．01）;其他因子或条目分均无显著性差异（P〉0．05）。结论抑郁焦虑障碍共病患者较单纯抑郁症患者的抑郁和焦虑症状更严重、自杀风险大。     

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.     

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.     

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.     

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.     

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.