肿瘤外科围手术期患者负性情感的调查分析

目的　探讨肿瘤外科围手术期患者负性情感状况及影响因素。方法　应用抑郁和焦虑自评量表 (SDS、SAS)与汉密顿抑郁和焦虑量表 (HAMD、HAMA)及影响因素调查表 ,同时对 180名肿瘤外科手术治疗患者进行测评分析。结果　SDS和SAS均分为 (4 8.73± 10 .5 9)和 (4 1.14± 7.97) ,阳性率为 4 2 .2 2 %和 13.33% ;HAMD和HAMA均分为 (19.17± 9.5 8)和 (12 .2 6± 7.2 8) ,阳性率 35 .0 %和 31.1% ;自评与他评显示抑郁焦虑并存者分别为 11.1%与 2 8.3% ;影响因素前五位依次为 :治疗费用、疾病相关知识缺乏、自理能力下降、治疗效果、疼痛。结论　肿瘤外科围手术期患者存在较普遍的负性情感反应 ,而影响因素来自躯体、心理和社会等诸多方面 ,应引起临床医护人员重视。     

肿瘤外科围手术期患者负性情感的调查分析

目的探讨肿瘤外科围手术期患者负性情感状况及影响因素.方法应用抑郁和焦虑自评量表(SDS、SAS)与汉密顿抑郁和焦虑量表(HAMD、HAMA)及影响因素调查表,同时对180名肿瘤外科手术治疗患者进行测评分析.结果SDS和SAS均分为(48.73±10.59)和(41.14±7.97),阳性率为42.22%和13.33%;HAMD和HAMA均分为(19.17±9.58)和(12.26±7.28),阳性率35.0%和31.1%;自评与他评显示抑郁焦虑并存者分别为11.1%与28.3%;影响因素前五位依次为:治疗费用、疾病相关知识缺乏、自理能力下降、治疗效果、疼痛.结论肿瘤外科围手术期患者存在较普遍的负性情感反应,而影响因素来自躯体、心理和社会等诸多方面,应引起临床医护人员重视.     

不同疗程鼻咽癌病人的心理状况与生存质量的相关性研究

[目的]探讨不同疗程鼻咽癌病人心理健康及生存质量状况。[方法]采用Zung编制的抑郁自评量表(SDS)、焦虑自评量表(SAS)、陈和年等制定的鼻咽癌生存质量量表(SQOL-NPC)对100例鼻咽癌病人放疗前、放疗中、放疗后进行调查。[结果]鼻咽癌病人放疗前、放疗中、放疗后SDS评分分别为(43.93±9.70)分、(53.29±9.67)分、(45.63±9.40)分,SAS评分分别为(38.43±9.47)分、(48.74±9.08)分、(39.69±8.93)分。放疗中鼻咽癌病人抑郁、焦虑得分最高,治疗中症状与治疗副反应指标(YD)、精神心理指标(YP)在放疗中得分最低。抑郁、焦虑与生存质量呈负相关。[结论]不同疗程的鼻咽癌病人心理健康状况不同,心理健康状况影响其生存质量,临床上应进行相应的、有针对性的心理治疗及护理干预。     

慢性乙型肝炎病人焦虑与抑郁的调查及其心理干预

[目的 ]了解慢性乙型肝炎病人的焦虑、抑郁状况 ,并进行心理干预效果评估。 [方法 ]采用焦虑自评量表 (SAS)及抑郁自评量表 (SDS)对 10 0例慢性乙型肝炎病人 (观察组 )及 10 0例健康人 (对照组 )进行问卷调查。根据调查存在的心理问题 ,对观察组实施为期 8周的心理干预 ,然后再测评SAS及SDS1次 ,并与心理干预前比较。[结果 ]观察组SAS及SDS评分均明显高于对照组 (P <0 .0 1) ,经心理干预后 ,其SAS及SDS评分分别由 3 6.82分± 6.2 4分和 41.16分± 10 .73分降为 3 2 .19分± 5 .72分和 3 5 .74分±9.16分 (P <0 .0 1) ;其焦虑及抑郁的发生率分别由 3 6.0 %和 43 .0 %降为 12 .0 %和 2 1.0 %(P <0 .0 1)。 [结论 ]慢性乙型肝炎病人存在一定程度的焦虑及抑郁 ,心理干预可缓解慢性乙型肝炎病人的焦虑及抑郁症状。     

恶性肿瘤伴焦虑、抑郁病人的心理护理研究

[目的]探讨心理护理对恶性肿瘤病人伴焦虑、抑郁情绪的作用。[方法]将66例恶性肿瘤伴焦虑、抑郁病人随机分为干预组(33例)和对照组(33例),对照组予常规护理,干预组在常规护理的基础上给予心理护理,观察两组治疗前后焦虑自评量表(SAS)、抑郁自评量表(SDS)、汉密尔顿焦虑量表(HAMA)及汉密尔顿抑郁量表(HAMD)得分的变化。[结果]干预后干预组SAS、SDS、HAMA和HAMD评分明显低于对照组(P<0.05)。[结论]实行心理护理后恶性肿瘤病人的焦虑、抑郁程度得到了明显改善。     

乳腺癌与鼻咽癌患者情感特征对比研究

目的了解乳腺癌与鼻咽癌患者情感特征及相关影响因素,探讨有效的干预对策.方法应用抑郁、焦虑测评量表等(SDS、SAS、HAMD、HAMA)和影响因素调查表,对56例乳腺癌和65例鼻咽癌患者进行评定,并进行比较分析.结果乳腺癌与鼻咽癌患者SDS、SAS、HAMD、HAMA均值和阳性率均高于正常人群,但2组癌症患者比较无显著差异(P＞0.05);影响因素调查显示,2组患者在治疗费用、治疗效果、家庭责任方面均占较高比例,乳腺癌组在家庭责任、自理能力、自尊丧失、不知病情、死亡威胁及夫妻感情方面的影响明显高于鼻咽癌组(P＜0.05).结论乳腺癌与鼻咽癌患者由于性别、病种、治疗手段及社会文化背景不同,导致情感特征存在明显差异.建议在常规抗肿瘤治疗的同时,应根据不同病种、不同个体给予针对性的情感和社会支持,以促进癌症患者病体和心理的同期康复.     

护理人员心身健康状况的研究

[目的 ]了解肿瘤专科护士心身健康状况及影响因素。 [方法 ]采用抑郁自评量表 (SDS)、焦虑自评量表 (SAS)及护士职业压力源调查表 ,对 12 8名护士进行调查。 [结果 ]护士SDS得分为 44 .2 6分±9.2 2分 ,高于我国常模SDS标准分 41.88分± 10 .5 7分 (P <0 .0 1) ;SAS得分为 3 9.2 8分± 8.88分 ,高于我国正常人 3 7.2 3分± 0 .46分(P <0 .0 1) ;SDS、SAS得分与工作压力源呈正相关 ,高风险职业的压力、晋升和深造机会太少、经常倒班、工作量太大、担心出现护理纠纷和差错事故、社会地位低、工作职位竞争等为主要压力源。 [结论 ]护士心身健康状况与职业压力密切相关 ,而影响因素是多方面的 ,应引起各级管理者高度重视     

联合心理行为干预对鼻咽癌病人负性心理的影响

[目的]探讨联合心理行为干预对鼻咽癌病人负性心理的影响。[方法]以入院时间为顺序收集在我院接受放射治疗或化学治疗的400例鼻咽癌住院病人,应用随机数字表分为干预组和对照组,对照组实施常规护理,干预组在此基础上实施联合心理行为干预,设定放化疗前和放化疗时心理行为干预常规,采用个体结合团体干预法。两组病人分别于接受放射治疗或化学治疗前后采用焦虑自评量表(SAS)、抑郁自评量表(SDS)及症状自评量表(SCL-90)进行施测。[结果]干预后两组SCL-90总分、SAS标准分、SDS标准分比较,差异均有统计学意义(P0.01);干预组干预前后SCL-90总分、SAS标准分、SDS标准分比较,差异均有统计学意义(P0.01);对照组干预前后SAS标准分比较,差异有统计学意义(P0.01)。[结论]联合多种形式的心理行为干预,引导鼻咽癌放化疗病人正确认知疾病,缓解不良情绪,可有效提高病人心理健康水平。     

鼻咽癌住院患者心理状况影响因素分析

目的探讨鼻咽癌住院患者心理状况影响因素。方法采用方便抽样法选取我院2017年1月至2018年1月耳鼻喉科收治的68例鼻咽癌患者作为研究对象,分别应用焦虑自评量表(SAS)、抑郁自评量表(SDS)、压力知觉量表、应对方式量表对患者进行评价,采用Pearson相关系数分析鼻咽癌住院患者心理状况与压力知觉评分及应对方式的关系,采用多元回归分析影响鼻咽癌住院患者心理状况的相关因素,并制定有效的干预措施。结果鼻咽癌住院患者SAS评分为(61. 22±4. 58)分,SDS评分(61. 78±4. 12)分,压力知觉评分(22. 96±3. 58)分,积极应对方式评分(18. 96±3. 12)分,消极应对方式评分(23. 89±4. 05)分。经Pearson相关分析可知,鼻咽癌住院患者SAS,SDS评分与心理知觉评分、消极应对方式评分呈正相关(P 0. 05),与积极应对方式评分呈负相关(P 0. 05)。经多元回归分析可知,鼻咽癌患者学历、临床分期、压力知觉是焦虑的独立危险因素(P 0. 05),学历、压力知觉是抑郁的独立危险因素(P 0. 05),而积极的应对方式是焦虑、抑郁的保护因素(P 0. 05)。结论鼻咽癌住院患者心理状况受多种因素影响,采取有效的措施增强患者治疗信心,使其以积极的方式面对疾病将有助于减轻心理压力,促进身心健康。     

急性冠状动脉综合征病人焦虑、抑郁状况及心理危险因素分析

[目的]了解急性冠状动脉综合征(ACS)与急性胰腺炎(AP)住院病人焦虑、抑郁状况及相关心理危险因素。[方法]应用抑郁自评量表(SDS)、焦虑自评量表(SAS)、汉密顿抑郁量表(HAMD)、汉密顿焦虑量表(HAMA)和自行设计相关心理危险因素调查表,对120例ACS及116例AP住院病人进行问卷调查。[结果]ACS病人焦虑、抑郁发生率明显高于AP病人,家庭因素、经济因素、对病情认知情况、认知干预因素等对心理状态影响更大。[结论]应加强对ACS病人心理干预,给予更多的关爱、照顾和支持,控制焦虑、抑郁症状,改善病人生活质量。     

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.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Molecular characterization of virulence and antimicrobial resistance profile of Shigella species isolated from children with moderate to severe diarrhea in northeastern Brazil

Molecular characterization of virulence and antimicrobial resistance profiles were determined for Shigella species isolated from children with diarrhea in Fortaleza, Brazil. Fecal specimens were collected along with socioeconomic and clinical data from children with moderate to severe diarrhea requiring emergency care. Shigella spp. were isolated by standard microbiological techniques, and we developed 4 multiplex polymerase chain reaction assays to detect 16 virulence-related genes (VRGs). Antimicrobial susceptibility tests were performed using disk diffusion assays. S. flexneri and S. sonnei were the predominant serogroups. S. flexneri was associated with low monthly incomes; more severe disease; higher number of VRGs; and presence of pic, set, and sepA genes. The SepA gene was associated with more intense abdominal pain. S. flexneri was correlated with resistance to ampicillin and chloramphenicol, whereas S. sonnei was associated with resistance to azithromycin. Strains harboring higher numbers of VRGs were associated with resistance to more antimicrobials. We highlight the correlation between presence of S. flexneri and sepA, and increased virulence and suggest a link to socioeconomic change in northeastern Brazil. Additionally, antimicrobial resistance was associated with serogroup specificity in Shigella spp. and increased bacterial VRGs.     

护理干预对面部中重度寻常型痤疮的临床疗效影响分析

目的研究护理干预对面部中重度寻常型痤疮的临床疗效影响。方法选取本院在2014年4月~2016年7月诊治的136例面部中重度寻常型痤疮患者,随机分为研究组与对照组,每组68例;所有患者均依据其情况给予对应的治疗,其中对照组在治疗期间给予常规护理,研究组在对照组的基础上再给予综合性护理干预,比较两组的治疗效果及护理满意度情况等。结果患者在接受治疗和护理后,研究组中度与重度患者的治疗效果较对照组均明显提高(P0.05),研究组护理满意度较对照组明显增高(P0.05)。结论对面部中重度寻常型痤疮患者在其治疗期间给予综合性护理干预,具有良好的效果。