综合护理干预在老年抑郁症病人康复治疗中的效果观察

[目的]探讨综合护理干预对老年抑郁症病人的康复效果。[方法]将64例老年抑郁症病人随机分为观察组和对照组各32例,两组均常规予以氟西汀治疗,观察组同时实施6周综合护理干预,并进行为期1年的随访。[结果]治疗6周末及随访结束时两组汉密顿抑郁量表评分(HAMD)、临床疗效总评量表(CGI)评分比较有统计学意义(P均<0.01);随访结束时两组复发率、再住院率比较有统计学意义(P均<0.05)。[结论]综合护理干预有助于提高老年抑郁症病人的临床治疗效果,降低复发率及再住院率。     

抑郁症睡眠障碍病人的睡眠干预效果观察

[目的]探讨抑郁症睡眠障碍病人的睡眠干预效果。[方法]将64例抑郁症睡眠障碍病人随机分为观察组和对照组,各32例,两组病人均常规予以氟西汀治疗,观察组同时实施12周综合护理干预。两组病人均进行为期1年的随访。采用汉密尔顿抑郁量表(HAMD)、匹兹堡睡眠质量指数(PSQI)进行评定分析。[结果]HAMD和PSQI的总评分显示,与治疗前相比,观察组治疗3周差异有统计学意义(P<0.01),而对照组治疗6周差异有统计学意义(P<0.01)。两组之间在治疗第3周、第6周、第12周及随访结束时的比较差异均有统计学意义(P<0.01或P<0.05)。随访结束时观察组的复发率、再住院率均低于对照组,两组之间的差异均有统计学意义(P<0.05)。[结论]睡眠干预有助于提高抑郁症睡眠障碍病人的临床治疗效果,改善其睡眠障碍,降低复发率及再住院率。     

综合护理干预对促进抑郁症病人康复的临床研究

[目的]探讨综合护理干预对促进抑郁症病人有效康复的作用。[方法]将120例符合入组标准的住院抑郁症病人随机分为实验组和对照组。两组均给予常规抗抑郁药物治疗,对照组采用精神科常规护理,实验组在此基础上采取综合护理干预。分别于入组时和干预3个月后采用汉密尔顿抑郁量表（HAMD）、世界卫生组织生存质量测定量表（WHOQOL-BREF）和自杀态度问卷（QSA）评价工具进行评定。[结果]干预3个月后,实验组HAMD评分明显低于对照组（P〈0.01）,WHOQOL-BREF、QSA评分与对照组比较差异有统计学意义（P〈0.05或P〈0.01）。[结论]综合护理干预可明显改善抑郁症病人的认知障碍,提高其生存质量,有利于改善病人负性情绪,促进生理、心理和社会功能的全面康复。     

心理干预对抑郁症病人康复的影响

[目的]探讨心理干预对抑郁症病人康复的影响。[方法]将100例抑郁症病人按入院的先后顺序随机分成两组。对照组给予常规的治疗护理，观察组除常规治疗护理外进行8周有计划的心理干预。采用自知力与治疗态度问卷（ITAQ）和汉密顿抑郁量表（HAMD）进行评定。[结果]心理干预前，两纽病人的ITAQ、HAMD评分及服药依从性比较均无统计学意义（P〉0．05）：心理干预8周末，观察组病人的ITAO评分明显高于对照组，HAMD评分明显低于对照组，服药依从性明显高于对照组，两组比较均有统计学意义。[结论]住院期间对抑郁症病人实施心理干预可以帮助病人恢复自知力，提高病人对服药的依从性。     

辨证施音护理干预在病毒性肝炎病人治疗中的应用

[目的]提高病毒性肝炎病人干扰素治疗的成功率。[方法]选择70例行干扰素治疗出现轻中度抑郁症的病毒性肝炎病人,随机分为两组,观察组予情志护理加辨证施音护理干预,对照组予情志护理,采用汉密尔顿（HAMD）量表比较两组病人抑郁情况。[结果]干扰素治疗第30天、第60天 HAMD量表测评比较,观察组评分均低于对照组,差异有统计学意义（P〈0.01）。[结论]辩证施音护理干预能有效降低抑郁症程度,提高病毒性肝炎病人干扰素治疗的成功率。     

佳木斯快乐舞步健身操干预对抑郁症病人康复效果的影响

[目的]探讨佳木斯快乐舞步健身操干预对抑郁症病人康复效果的影响。[方法]将202例抑郁症病人随机分为两组,观察组在药物治疗和常规护理的基础上进行佳木斯快乐舞步健身操干预6个月,对照组仅用药物治疗和常规护理;采用抑郁自评量表（SDS）分别在干预前、干预结束时进行评价。[结果]干预结束时观察组 SDS评分低于对照组,差异有统计学意义（P〈0.01）。[结论]应用佳木斯快乐舞步健身操干预可增加人的愉快感、幸福感,缓解抑郁情绪。     

早期综合干预对首发精神分裂症病人预后影响的研究

[目的]探讨早期综合干预对首发精神分裂症病人预后的影响。[方法]将152例精神分裂症病人随机分为研究组和对照组，两组常规给予抗精神病药物系统治疗，研究组给予为期1年的综台护理干预，内容包括集体健康教育和个别心理干预、社会生活职业技能训练、家庭干预等。采用阳性和阴性症状评定量表（PANSkS）、住院病人护士观察量表（NOSIE-30）进行评估。[结果]随访结束时研究组PANSS总分、阳性症状及阴性症状评分低于对照组（P〈0．01）；NOSIE-30总分及总积极因素评分高于对照组（P〈0．01），总消极因素评分低于对照组（P〈0．01）。[结论]综合护理干预不仅可改善精神分裂症病人的精神症状，而且可降低病人的复发率，提高病人的社会功能。     

全程综合干预对复发性抑郁症病人生活质量的影响

[目的]探讨全程综合干预对复发性抑郁症病人生活质量的影响。[方法]将92例复发性抑郁症病人随机分为研究组和对照组，各46例，对照组给予常规治疗护理，研究组在此基础上给予全程综合干预1年。采用生活质量评定量表（QOL-100）进行评定。[结果]干预前两组病人的QOL-100总评分及各因子分比较均无统计学意义（P〉0．05）；干预1年后，研究组病人生活质量总评分及生活领域、心理领域、独立性领域、社会关系领域评分均优于对照组（P〈0，01）。[结论]全程综合干预能明显提高复发性抑郁症病人的生活质量，有助于病人重返社会。     

家庭干预对精神分裂症病人社会功能康复的影响

[目的]探讨家庭干预对精神分裂症病人社会功能康复的影响。[方法]将痊愈出院的精神分裂症病人72例随机分为家庭干预组和一般随访组，家庭干预组由医驴人员对病人家属定期进行康复指导，一般随访组不进行特殊指导，比较两组出院后0．5年、1．0年、1.5年的复发率及社会功能缺陷量表（SDSS）得分。[结果]两组0．5年、1．0年、1．5年时复发率经χ^2检验均有统计学意义（P〈0．05或P〈0.01），且家庭干预组SDSS评分显著低于一般随访组（P〈0．01）。[结论]家庭干预对降低精神分裂症病人复发率、促进病人社会功能康复具有重要意义。     

综合护理在女性抑郁症康复中的应用

[目的]探讨综合性护理对规范药物治疗的女性抑郁症病人转归的影响。[方法]2010年5月—2014年2月我院收治住院的女性重型抑郁症病人90例,随机分为干预组和对照组。均使用帕罗西汀进行基础药物治疗,对照组采用常规护理,干预组采用综合性护理干预。采用抑郁自评量表(SDS)、汉密尔顿抑郁量表(HAMD)评定抑郁症状,观察两组病人治疗依从性情况。[结果]护理干预后干预组SDS评分(36.4分±2.6分)低于对照组(46.2分±2.8分);干预组HAMD评分(9.4分±1.8分)低于对照组(19.2分±2.3分);干预组治疗总依从率(95.83%)高于对照组(85.71%),两组比较差异均有统计学意义(P0.05)。[结论]综合性护理干预用于女性重型抑郁症病人的治疗能提高疗效、增加病人治疗依从性。     

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.