强化心理干预对老年白血病患者治疗依从性的影响

目的探讨强化心理干预对老年白血病患者治疗依从性的影响。方法选取85例白血病患者,按照随机数字表法将其分为对照组与研究组,对照组42例接受临床常规护理,研究组43例在对照组的护理基础上强化心理干预,对比两组患者干预前后治疗依从性、应对方式以及心理状态评分,并调查两组患者对其所接受的护理满意度评价。结果干预前两组患者治疗依从性对比差异无统计学意义(P 0.05);干预后研究组治疗依从性明显高于对照组,差异有统计学意义(P 0.05);干预前两组患者应对方式评分比较,差异无统计学意义(P 0.05),干预后研究组患者面对维度评分明显高于对照组,回避与屈服维度评分明显低于对照组,差异有统计学意义(P 0.05);干预前两组患者SCL-90评分中所选指标对比差异无统计学意义(P 0.05);干预后研究组躯体化、人际关系敏感、抑郁、焦虑、敌对、恐怖等项目评分均明显低于对照组,差异有统计学意义(P 0.05);研究组患者护理满意度明显高于对照组,差异有统计学意义(P 0.05)。结论强化心理干预的实施可有效提高老年白血病患者治疗依从性,促使患者选择积极的应对方式,进而改善心理状态,提高护理满意度。     

日间手术患者术前心理状况与应对方式的相关性研究

目的探讨泌尿外科日间手术患者术前心理状况与应对方式的相关性。方法分别采用Zung的焦虑自评量表(SAS)和医学应对问卷(MCMQ)对100例泌尿外科日间手术患者术前心理健康状况和应对方式进行调查分析。结果泌尿外科日间手术患者术前的SAS评分明显高于国内常模,两者比较差异有显著意义(P<0.05);在"回避"和"屈服"医学应对方式评分中明显高于国内常模,差异有显著意义(P=0.00);患者SAS评分与"面对"(γ=0.200,P<0.05)和"屈服"(γ=0.351,P<0.01)呈显著正相关,与"回避"(γ=0.056,P>0.05)无相关性。结论泌尿外科日间手术患者术前心理状况与应对方式密切相关,更倾向于采取面对和屈服的应对方式,医护人员应采取有效措施引导患者采用积极的应对方式。     

术前语言安抚配合心理护理干预对白内障手术患者的影响

目的:探讨语言安抚配合心理护理干预对白内障手术患者的影响。方法:将2018年7月1日～12月31日行白内障手术的67患者作为对照组,采用常规术前护理干预;将2019年1月1日～7月31日行白内障手术的71例患者作为观察组,在常规护理基础上实施语言安抚配合心理护理干预。比较两组患者护理干预前后心率、血压,焦虑、抑郁状态及应对方式情况。结果:干预后观察组心率、血压水平高于对照组(P0.05);干预后两组阿姆斯特丹术前焦虑量表(APAIS)、汉顿抑郁量表(HDRS)评分均降低(P0.05),且观察组焦虑评分、信息需求评分及HDRS评分均低于对照组(P0.05);干预后观察组积极应对评分提升,消极应对评分下降(均P0.05),对照组应对方式评分无明显变化(P0.05),两组间比较,观察组积极应对评分高于对照组,消极应对评分低于对照组,差异有统计学意义(P0.05)。结论:语言安抚配合心理护理干预能有效稳定白内障手术患者术前生命体征,改善其术前心理状态,缓解焦虑、抑郁等不良情绪,使患者以更积极的态度接受治疗。     

危机干预对宫颈癌患者手术后应对方式及希望水平的影响

目的探讨危机干预对宫颈癌患者手术后应对方式及希望水平的影响。方法选取2013年1月至2015年11月收治的106例宫颈癌患者,按照随机数字表法分为对照组与观察组,每组53例。对照组实施常规护理干预,观察组在对照组基础上实施心理危机干预,分别在干预前后采用汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、Jalowies应对方式量表及Herth希望量表对两组患者焦虑、抑郁、应对方式及希望水平进行评价。结果观察组患者干预后HAMA、HAMD评分低于对照组,差异有统计学意义(P0.05);干预后观察组患者面对、逃避、寻求支持、情感宣泄、自我依靠、宿命、乐观、姑息8个项目评分均优于对照组,差异有统计学意义(P0.05);干预后观察组希望水平评分均高于对照组,差异有统计学意义(P0.05)。结论对宫颈癌患者实施危机干预能够显著改善其焦虑、抑郁情绪。     

伴侣参与认知访谈联合希望干预对复发性流产患者心理状态、应对方式的影响

目的探讨分析伴侣参与访谈联合希望干预对复发性流产患者心理状态、应对方式的影响。方法选取2019年4月至2021年4月期间复旦大学附属妇产科医院收治的复发性流产患者123例,采用数字表法随机为观察组62例、对照组61例,对照组予以常规护理联合希望干预,观察组在对照组基础上采用伴侣参与认知访谈干预。2 w后,采用汉密顿焦虑量表(HAMA)与汉密顿抑郁量表(HAMD)评估两组干预前后的心理状态、采用医学应对问卷(MCMQ)评估两组心理应对方式、采用Herth希望量表(HHI)评估患者希望水平、采用生活质量调查表(SF-36)评估两组生活质量。结果干预前两组HAMA评分和HAMD评分比较差异无统计学意义(P>0.05),干预后两组上述两个量表评分均降低、且观察组两个量表评分均低于对照组(P<0.05);干预前两组应对方式各维度评分比较差异无统计学意义(P>0.05),干预后两组面对维度评分均升高、回避和屈服维度评分均降低(P<0.05),且观察组面对维度评分高于对照组、回避和屈服维度评分低于对照组(P<0.05);两组干预前HHI量表各维度得分比较差异无统计学意义(P>0.05),干预后两组HHI量表各维度得分均升高、且观察组HHI量表各维度得分均高于对照组(P<0.05);两组干预前生活质量量表各维度评分比较差异无统计学意义(均P>0.05),干预后两组量表各维度评分均升高、且观察组各维度评分均高于对照组(P<0.05)。结论伴侣参与认知访谈联合希望干预可减轻RSA患者焦虑、抑郁情绪,优化心理应对方式,希望水平和生活质量。     

妇科恶性肿瘤患者心理弹性与应对方式相关性调查

目的:调查妇科恶性肿瘤患者心理弹性与应对方式的相关性,为制定针对性护理干预措施提供科学的理论依据.方法:采用自编一般资料调查表、心理弹性量表(CD-RIS)、医学应对量表(MCMQ)对临床确诊的100例妇科恶性肿瘤患者进行问卷调查.结果:不同治疗方式患者间心理弹性得分差异有统计学意义(P＜0.01),不同住院次数患者间心理弹性差异有统计学意义(P＜0.05),住院次数与心理弹性呈正相关(r=0.193,P＜0.05);患者应对方式中的回避应对与心理弹性呈正相关(r=0.363,P＜0.01),屈服应对与心理弹性呈显著负相关关系(r=-0.364,P＜0.01).结论:妇科恶性肿瘤患者的心理弹性因不同治疗方式及住院次数而存在显著性差异;应对方式对患者的心理弹性有显著影响,其中回避应对与心理弹性呈显著正相关,屈服应对与心理弹性呈显著负相关.     

治疗性沟通系统对胃癌患者术前焦虑及特质应对方式的影响

目的探讨治疗性沟通系统对胃癌患者术前焦虑及特质应对方式的影响。方法以胃癌术前伴焦虑的59例患者为研究对象,随机分为对照组28例,干预组31例。对照组予常规术前护理及临床一般沟通,干预组在此基础上予以系统的治疗性沟通。干预前后(入院当天、术前1 d)采用焦虑自评量表与特质应对方式问卷进行测量。结果干预前,一般资料、焦虑、特质应对方式组间差异无显著意义(P0.05);干预后与干预前比较,干预组焦虑有所缓解,特质应对方式中的积极应对有所提高,消极应对有所降低(P0.05),对照组均无显著变化(P0.05);干预后,干预组焦虑、积极应对、消极应对的改善均优于对照组(P0.01),且焦虑的好转组间差异有显著意义(P0.001)。结论治疗性沟通系统能比较有效地缓解胃癌患者术前焦虑,提高其应对能力。     

日常想法记录表对肺癌患者医学应对方式及生活质量的影响

目的探讨日常想法记录表对肺癌患者医学应对方式和生活质量的影响。方法 2017年2-8月,采用方便抽样法选择在解放军总医院呼吸内科住院的60例肺癌患者为调查对象。按照住院日期单双号随机分为观察组和对照组,每组30例。两组患者均接受常规治疗护理。观察组患者在对照组的基础上,由获得国家二级心理咨询师的护理人员依据认知情绪疗法,鼓励患者建立关于疾病的个人日常想法记录表(daily thought record),主要内容包括日期、情境、情绪、自动想法、合理回答等。干预期为3个月。干预前后,分别采用医学应对方式问卷(medical coping modes questionnaire,MCMQ)和癌症患者生活功能指标(the functional living index cancer,FLIC)对其进行调查。结果干预前,两组患者MCMQ中面对、回避、屈服各分量表得分的差异均无统计学意义(均P0.05)。干预后,两组患者上述量表的评分差异均有统计学意义(均P0.05)。干预前后,对照组患者在面对、回避、屈服各分量表得分上的差异均无统计学意义(均P0.05),但观察组患者面对量表得分显著高于干预前,差异有统计学意义(P0.05),回避、屈服量表得分低于干预前,差异均有统计学意义(均P0.05)。在FLIC评分上,干预前后两组患者在社会、家庭状况、与医生的关系、情感状况、功能状况等四个维度上的评分差值的差异均有统计学意义(P0.05);在生理状况及附加的关注维度上的评分差值的差异无统计学意义(P0.05)。结论日常想法记录表可促进患者选择更为积极的应对方式面对癌症,是改善肺癌患者医学应对方式的有效途径。     

理性情绪调节结合希望理论对癫痫病人心理状况及应对方式的影响

[目的]探讨理性情绪调节结合希望理论在癫痫病人护理中的应用价值。[方法]选取收治的癫痫病人102例为研究对象,经随机数字表法分为对照组51例,观察组51例,对照组给予常规护理,观察组在对照组基础上应用理性情绪调节结合希望理论,观察两组病人心理状态、应对方式变化及治疗依从性。[结果]护理干预前两组病人心理状况比较差异无统计学意义(P0.05),经干预后均有改善,观察组焦虑自评量表(SAS)与抑郁自评量表(SDS)评分低于对照组,差异有统计学意义(P0.05);护理干预前两组病人应对方式比较差异无统计学意义(P0.05),经干预后均有好转,观察组合理化、解决问题、求助评分高于对照组,自责、退避、幻想评分低于对照组,差异有统计学意义(P0.05);观察组病人治疗依从率为96.08%高于对照组(84.31%),差异有统计学意义(P0.05)。[结论]理性情绪调节结合希望理论可有效减少癫痫病人负性情绪,改善其心理状况及应对方式,提高治疗依从性。     

阶梯式护理模式用于颅内动脉瘤介入治疗患者围术期的效果观察

目的:探讨阶梯式护理模式用于颅内动脉瘤介入治疗患者围术期的效果。方法:将2019年5月1日～2020年12月31日82例脑动脉瘤介入栓塞患者随机分为观察组和对照组各41例;对照组给予常规护理干预,观察组在对照组基础上给予阶梯式护理模式干预;比较两组心理应激状态、并发症发生率、术后恢复情况、心理困扰[采用心理困扰管理量表(DM)]、负性情绪[采用焦虑自评量表(SAS)和抑郁自评量表(SDS)]、应对方式(采用Jalowies应对方式量表)。结果:入院时,两组血压、心率比较差异无统计学意义(P0.05);术前30 min,两组血压、心率水平均高于入院时(P0.05),但观察组低于对照组(P0.05);观察组术后并发症发生率低于对照组(P0.05);两组预后情况比较差异无统计学意义(P0.05);干预后,观察组DM、SAS、SDS评分均低于干预前(P0.05),且观察组低于对照组(P0.05);干预后,观察组应对方式评分优于干预前(P0.05),且观察组优于对照组(P0.05)。结论:阶梯式护理模式能减轻颅内动脉瘤患者心理应激反应,降低术后并发症发生率,缓解患者心理困扰和负性情绪,促进患者积极应对疾病。     

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。