心理教育对精神分裂症自知力、服药依从性及复发影响的2年随访

目的 探讨心理教育对首发精神分裂症患者自知力、服药依从性及复发的影响。方法 将136例首发精神分裂症患者随机分为心理教育联合氯氮平治疗组（对照组）各68例。分别于入院和出院时进行简明精神病量表（BPRS）、自知力与治疗态度问卷（ITAQ）及服药依从性评定。并对两组临床疗效达显进以上出院的患者进行为期2年的随访，以了解其复发情况。结果 （1）两次BPRS评分两组间比较，差别均无显著性意义（t=0.27,1.28,P&;gt;0.05)；（2）入院时ITAQ评分两组间比较，差别无显著性意义（t=0.15,P&;gt;0.05)，但出院时研究组ITAQ评分明显高于对照组（t=8.32,P&;lt;0.01）；（3）入院时服药依从性两组间比较，差别无显著性意义（x^2=0.28,P&;gt;0.05)，但出院时研究组服药依从性改善明显优于对照组（x^2=7.75,P&;lt;0.05）；（4）2年内研究组复发率明显低于对照组（x^2=8.15,P&;lt;0.01）。结论 心理教育不仅有助于首发精神分裂症患者的治疗，而且可降低其复发率。     

健康教育对首发精神分裂症病人自知力恢复、服药依从性及复发的影响

目的: 探讨健康教育对首发精神分裂症病人自知力恢复、服药依从性及复发的影响.方法: 将112例首发精神分裂症病人随机分为健康教育联合氯丙嗪组(健康教育组)及单用氯丙嗪治疗组(对照组)各56例,分别于入院和出院时进行简明精神病量表(BPRS)、自知力与治疗态度问卷(ITAQ)及服药依从性评定,并对两组临床疗效达显进(痊愈 显著进步)以上的出院病人进行为期 2年的随访,以了解其复发情况.结果:两次BPRS评分两组间比较,差别均无显著性意义(P>0.05);入院时ITAQ评分两组间比较,差别无显著性意义(P>0.05),但出院时健康教育组ITAQ评分明显高于对照组(P<0.01);入院时服药依从性两组间比较,差别无显著性意义(P>0.05), 但出院时健康教育组服药依从性改善明显优于对照组(P<0.05);2年内,健康教育组复发率明显低于对照组(P<0.01).结论: 健康教育不仅有助于首发精神分裂症病人的治疗,而且可降低其复发率.     

自知力教育对首发及复发精神分裂症病人自知力影响的研究

[目的]探讨自知力教育对首发及复发精神分裂症病人自知力的影响。[方法]对首发(研究组)和复发(对照组)精神分裂症病人进行系统的抗精神病药物治疗和自知力教育,并分别于入院时及入院第4周、第8周、第12周进行自知力及治疗态度问卷(ITAQ)及服药依从性的评定。[结果]入院时ITAQ总分、服药依从性两组间比较,差异无统计学意义(P>0.05);入院第4周,对照组ITAQ总分高于研究组(P<0.05),但第12周研究组ITAQ总分、服药依从性均明显高于对照组(P<0.05)。[结论]自知力教育可改善首发精神分裂症病人住院中后期自知力,服药依从性提高。     

认知领悟治疗对精神分裂症患者服药依从性的影响

目的探讨认知领悟治疗对精神分裂症患者服药依从性和复发的作用.方法将100例精神分裂症患者随机分为研究组(50例)和对照组(50例),两组均进行系统的抗精神病药物治疗和一般的健康教育,研究组在此基础上进行认知领悟治疗,并于入组前,出院时,出院后1年、2年分别使用简明精神病评定量表(BPRS)、自知力与治疗态度问卷量表(ITAQ)及自编服药依从性调查表评定.结果出院时,出院后1年、2年ITAQ评分,服药完全依从率及复发率两组比较差异有显著性意义(P<0.05);BPRS评分出院时两组差异无显著性意义(P>0.05),出院后1年、2年两组比较差异有显著性意义(P<0.05).结论认知领悟治疗能有效提高精神分裂症患者服药依从性,降低复发率.     

自知力教育对门诊精神分裂症患者自知力及服药依从性的影响

目的探讨自知力教育对门诊精神分裂症患者自知力恢复及服药依从性的影响.方法将60例首次门诊治疗精神分裂症患者随机分为对照组及观察组各30例,对照组常规药物治疗,观察组在常规药物治疗基础上进行自知力教育.分别于首次就诊时、2周、4周、8周复诊时进行简明精神病评定量表(BPRS),自知力与治疗态度问卷表(ITAQ)测定以及服药依从性评定.结果首次就诊和2周、4周复诊时2组BPRS量表,ITAQ及服药依从性差异无显著性(P>0.05),门诊治疗8周后观察组ITAQ评分显著高于对照组,BPRS评分显著低于对照组,服药依从性明显提高,差异有显著性意义(P<0.05);ITAQ与服药依从性,BPRS评分呈显著负相关.结论对门诊精神分裂症患者进行自知力教育可以有效恢复患者自知力,提高服药依从性,促进疾病恢复.     

自知力教育对首发及复发精神分裂症病人自知力影响的研究

[目的]探讨自知力教育对首发及复发精神分裂症病人自知力的影响。[方法]对首发（研究组）和复发（对照组）精神分裂症病人进行系统的抗精神病药物治疗和自知力教育，并分别于入院时及入院第4周、第8周、第12周进行自知力及治疗态度问卷（ITAQ）及服药依从性的评定。[结果]入院时ITAQ总分、服药依从性两组间比较，差异无统计学意义（P〉0．05）；入院第4周，对照组ITAQ总分高于研究组（P〈0.05），但第12周研究组ITAQ总分、服药依从性均明显高于对照组（P〈0．05）。[结论]自知力教育可改善首发精神分裂症病人住院中后期自知力，服药依从性提高。     

自知力教育对精神分裂症患者自知力及服药依从性的影响

目的探讨自知力教育对精神分裂症患者自知力恢复及服药依从性的影响。方法将淄博市第五医院精神分裂症患者60例随机分为研究组和对照组,每组30例。研究组在常规抗精神病药物治疗的基础上进行自知力教育,对照组单纯采用抗精神病药物治疗,均治疗6周。以自知力与治疗态度问卷(ITAQ)和简明精神病量表(BPRS)进行评定,观察两组患者自知力恢复情况及服药依从性变化。结果研究组ITAQ评分显著高于对照组,服药依从性从性明显提高,两组比较差异有显著性意义(P<0.05)。研究组BPRS评分显著低于对照组,差异有显著性意义(P<0.01)。结论自知力教育可有效恢复精神分裂症患者自知力。     

适应心理治疗在精神分裂症患者服药依从性中的应用

目的探讨适应心理治疗对精神分裂症患者服药依从性的作用.方法将110例精神分裂症患者随机分成2组,干预组55例和对照组55例.2组均接受系统的抗精神病药物治疗,干预组在此基础上进行适应心理治疗,对照组仅限于一般健康教育,出院后随访1年.采用简明精神病量表(BPRS)、自知力与治疗态度问卷量表(ITAQ)、自拟服药依从性调查表,于治疗前、出院时、出院后6个月、1年分别进行评定对比.结果干预组和对照组比较,BPRS、ITAQ、服药依从性和再次住院次数有显著性差异(P＜0.05).结论适应心理治疗能有效提高精神分裂症患者服药依从性,降低复发率.     

自我管理训练对精神分裂症康复期患者的影响

目的:探讨自我管理训练对精神分裂症康复期患者的影响。方法:将100例精神分裂症康复期患者随机分为观察组和对照组各50例,对照组进行常规护理,观察组在此基础上进行自我管理训练,随访1年,比较两组患者入院时、出院时及出院1年时的简明精神病评定量表(BPRS)、自知力与治疗态度问卷量表(ITAQ)评分,及出院1年患者的服药依从性、复发率。结果:观察组出院1年BPRS评分、ITAQ评分、服药依从性、复发率均优于对照组(P<0.05)。结论:自我管理训练能提高患者服药依从性,对预防复发和改善预后有明显的促进作用。     

整体护理对住院精神分裂症病人康复的影响

目的探讨整体护理对精神分裂症病人康复效果的影响。方法将180例精神分裂症病人随机分为研究组(整体护理组)和对照组,2组病人均接受系统的抗精神病药物治疗,研究组实施整体护理,对照组给予卫生宣教和常规护理,分别于入院时和治疗3个月后进行简明精神病量表(BPRS),自知力与治疗态度问卷(ITAQ)及服药依从性评定并比较其结果。结果治疗3个月后ITAQ总分,BPRS总均分及缺乏活力、敌对性因子分与对照组比较差异均存在显著意义(P<0.05),服药依从性,研究组的改善也明显优于对照组。结论整体护理能有效提高精神分裂症病人的康复效果及服药依从性,减少社会功能残疾。     

Fibrinogen and fibrin structure and functions

Fibrinogen molecules are comprised of two sets of disulfide-bridged Aalpha-, Bbeta-, and gamma-chains. Each molecule contains two outer D domains connected to a central E domain by a coiled-coil segment. Fibrin is formed after thrombin cleavage of fibrinopeptide A (FPA) from fibrinogen Aalpha-chains, thus initiating fibrin polymerization. Double-stranded fibrils form through end-to-middle domain (D:E) associations, and concomitant lateral fibril associations and branching create a clot network. Fibrin assembly facilitates intermolecular antiparallel C-terminal alignment of gamma-chain pairs, which are then covalently 'cross-linked' by factor XIII ('plasma protransglutaminase') or XIIIa to form 'gamma-dimers'. In addition to its primary role of providing scaffolding for the intravascular thrombus and also accounting for important clot viscoelastic properties, fibrin(ogen) participates in other biologic functions involving unique binding sites, some of which become exposed as a consequence of fibrin formation. This review provides details about fibrinogen and fibrin structure, and correlates this information with biological functions that include: (i) suppression of plasma factor XIII-mediated cross-linking activity in blood by binding the factor XIII A2B2 complex. (ii) Non-substrate thrombin binding to fibrin, termed antithrombin I (AT-I), which down-regulates thrombin generation in clotting blood. (iii) Tissue-type plasminogen activator (tPA)-stimulated plasminogen activation by fibrin that results from formation of a ternary tPA-plasminogen-fibrin complex. Binding of inhibitors such as alpha2-antiplasmin, plasminogen activator inhibitor-2, lipoprotein(a), or histidine-rich glycoprotein, impairs plasminogen activation. (iv) Enhanced interactions with the extracellular matrix by binding of fibronectin to fibrin(ogen). (v) Molecular and cellular interactions of fibrin beta15-42. This sequence binds to heparin and mediates platelet and endothelial cell spreading, fibroblast proliferation, and capillary tube formation. Interactions between beta15-42 and vascular endothelial (VE)-cadherin, an endothelial cell receptor, also promote capillary tube formation and angiogenesis. These activities are enhanced by binding of growth factors like fibroblast growth factor-2 (FGF-2) and vascular endothelial growth factor (VEGF), and cytokines like interleukin (IL)-1. (vi) Fibrinogen binding to the platelet alpha(IIb)beta3 receptor, which is important for incorporating platelets into a developing thrombus. (vii) Leukocyte binding to fibrin(ogen) via integrin alpha(M)beta2 (Mac-1), which is a high affinity receptor on stimulated monocytes and neutrophils.     

Migraine and genetic and acquired vasculopathies

It is remarkable that migraine is a prominent part of the phenotype of several genetic vasculopathies, including cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL), retinal vasculopathy with cerebral leukodystrophy (RVCL) and hereditary infantile hemiparessis, retinal arteriolar tortuosity and leukoencephalopahty (HIHRATL). The mechanisms by which these genetic vasculopathies give rise to migraine are still unclear. Common genetic susceptibility, increased susceptibility to cortical spreading depression (CSD) and vascular endothelial dysfunction are among the possible explanations. The relation between migraine and acquired vasculopathies such as ischaemic stroke and coronary heart disease has long been established, further supporting a role of the (cerebral) blood vessels in migraine. This review focuses on genetic and acquired vasculopathies associated with migraine. We speculate how genetic and acquired vascular mechanisms might be involved in migraine.     

创伤高血糖与感染和MODS早期诊断和干预

本文详细介绍了创伤后血糖应激适度理论,以及高血糖与感染和多器官功能不全综合征的关系;提出涉及胰岛B细胞功能不全的MODS实验诊断新方案和极化液个体化干预新措施,可早期发现创伤MODS、降低感染率及MODS发生率和病死率。     

腹膜后纤维化与肾积水发生关系的临床研究

目的：探讨腹膜后纤维化（RPF）导致肾积水的原因及诊治经验。方法：回顾分析2004年1月—2010年12月24例腹膜后纤维化致肾积水患者的诊治资料。结果：（1）RPF患者常见首发症状为腰背痛或腹痛（69.2%）;（2）红细胞沉降率（ESR）增快和血清IgG4升高最常见。超声检查仅提示上尿路积水。RPF的静脉肾盂造影（IVP）和CT尿路成像（CTU）表现具有特征性。IVP肾盂输尿管显影不良时,CTU能较清晰的显示上尿路影像。CT扫描发现腹膜后软组织肿块9例（37.5%）,优于超声检查;（3）输尿管松解和腹腔化手术治疗22例;行肾切除术1例;行输尿管置双J管术1例。最终确诊为继发性RPF8例,其中4例为术前诊断,3例为术中腹膜后软组织肿块冷冻活检证实,1例为术后病理证实;（4）特发性RPF手术后肾积水均获长期缓解,而继发性RPF的预后取决于原发疾病及其治疗方案。结论：影像学检查是诊断RPF的重要手段,CTU优于超声检查和IVP。输尿管松解和腹腔化手术可以使特发性RPF输尿管梗阻得到长期的缓解,术中对肿块进行冷冻活检有助于鉴别特发性和继发性RPF,及时调整治疗方案。     

Telemedicine and teleradiology technologies and applications

Summary. Telemedicine and teleradiology hold the key for improving future health care delivery. In this paper we first review current communication and computer technologies used in telemedicine and teleradiology. Five examples in teleradiology applications are given including hospital-integrated picture archiving and communication systems, tele-neuro-imaging, telemammography, university consortium teleradiology service, and teleradiology for second opinion. Parameters important to teleradiology applications like costs, image quality, system reliability, and turn around time are considered. Data security is discussed, including patient confidentiality and image authenticity-which will be a major issue in future teleradiology applications.     

Physician and Nurse Practitioner Teamwork and Job Satisfaction: Gender and Profession

Designing interprofessional primary care teams composed of physicians and nurse practitioners (NPs) is a national priority. We assessed how profession and gender affect teamwork and job satisfaction among primary care physicians and NPs by using survey data from 186 physicians and 398 NPs practicing in New York State. Our regression models show profession (NP vs physician) moderates the associations of gender with teamwork and job satisfaction. Among NPs, men had higher job satisfaction than women. Among physicians, women had higher job satisfaction than men. Our results can benefit interprofessional primary care teams to optimize their professional and gender mix.     

探讨儿童慢性顽固性咳嗽与支原体感染的关系及临床治疗观察

目的探讨儿童慢性顽固性咳嗽与肺炎支原体（MP）感染的关系及临床疗效观察。方法采用回顾性研究方法对于现将2005年3月至2008年3月在我院的55例确诊慢性顽固性咳嗽患儿,主要表现为肺炎支原体感染为临床特点进行分析,并进一步临床治疗研究。结果①临床特点：在55例确诊慢性咳嗽的患儿中,以慢性顽固性咳嗽为主要症状。58％（32／55）的病例无肺部体征;②外周血：85％（47／55）的病例外周血变化不大,WBC（4—10）×10 9／L之间,嗜酸性粒细胞增多;③特别检查：47．27％（26／55）肺炎支原体IgM（MP—IgM）抗体阳性,83．64％（46／55）PeR技术检测肺炎支原体特异性DNA;④X光报告为多种形式。结论肺炎支原体（MP）感染是引起儿童慢性顽固性咳嗽的病因之一,对儿童慢性咳嗽,特别是顽固性咳嗽的诊治中应更加重视。     

Acetaminophen and acetylcysteine dose and duration: Past,present and future

Abstract

Acetylcysteine has been utilized successfully in the treatment of acetaminophen overdose since the 1970s. Although prospective trials as to efficacy and safety of acetylcysteine were conducted, there were no randomized controlled trials. This commentary addresses the reasons for this, and the background to choice of dose of acetylcysteine utilized in the oral and IV dosing regimens. Nomograms to predict possible hepatotoxicity based upon time of ingestion of acetaminophen were developed from a relatively arbitrary definition of toxicity as an aspartate aminotransferase/alanine aminotransferase (ALT/AST) greater than 1000 IU/L. While these have proved generally useful, patients still continue to develop hepatic damage after acetaminophen overdose, particularly if they present late after ingestion. The optimum management of these patients remains unclear, and one area of uncertainty is the dose and duration of acetylcysteine in various circumstances. This article discusses the issues that need to be elucidated to better target changes in acetylcysteine dose. The potential for measurements of other markers to improve treatment selection is the subject of further research.