神经危重症患者床旁肌电图检查的应用价值

目的探讨神经危重症患者床旁肌电图检查对患者诊断及预后判断的意义。 方法对2016年11月至2017年4月在南方医科大学南方医院神经危重症病房（NCU）住院、且住NCU时间超过3 d的58例神经危重症患者进行床旁肌电图检查。检查项目包括运动神经传导、感觉神经传导、直接肌肉刺激。对超过两个肢体共计3条及以上运动和/或感觉神经传导出现异常定义为多发神经传导异常,并进行分组后病因分析、临床特点和电生理特点的比较。 结果48.3%（28/58）患者呈多发神经传导异常,为多发神经传导异常组,其余30例患者为对照组。与对照组比较,多发神经传导异常组的急性病生理学和长期健康评价（APACHE）Ⅱ评分[（12 ± 5）分vs.（16 ± 6）分]、在院最高脓毒症相关器官衰竭评分（SOFA）分值[4（3,6）分vs. 7（4,11）分]、脓毒症[11/30 vs. 21/28]及多器官功能障碍综合征（MODS）发生率[2/30 vs. 10/28]均更高,预后情况中机械通气时间[0（0,4）d vs. 6（0,16）d]、ICU住院时间[8（5,13）d vs. 14（7,20）d]均更长,出院后30 d [4（3,4）分vs. 5（5,6）分]及90 d [3.0（2.0,4.0）分vs. 6.0（4.2,6.0）分]的改良Rankin评分（mRS）分值、30 d（2/30 vs. 12/28）及90 d（4/30 vs. 15/28）病死情况均更高（P均< 0.05）。多因素Logistic回归分析发现,多发神经传导异常是出院后30 d及90 d病死情况的独立危险因素（P均< 0.05）。多发神经传导异常患者电生理特点显示与其他病因组（14例）比较,危重病性神经肌病（CIPNM）组（14例）运动神经传导未引出复合肌肉动作电位（CMAP）波形的比例更高（6/90 vs. 15/87）,而感觉神经传导异常占比均更低（58/83 vs. 28/81、29/37 vs. 14/37、29/44 vs. 14/44;P均< 0.05）。 结论神经危重症患者常存在周围神经肌肉病变,且病因复杂多样,床旁肌电图检查对神经危重症患者的病因鉴别具有重要意义,且对神经危重症患者预后判断具有重要价值。     

A descriptive study of meaning of illness in chronic renal disease

AIM: To explore the subjective meaning of illness in a sample of renal patients. BACKGROUND: Patients' illness representations, such as the meaning they attach to illness, may affect their coping and adaptation. Improved understanding in this area may therefore benefit patient care. Meaning of illness has not previously been explored in renal disease. DESIGN AND METHODS: Cross-sectional survey (n=405) in a single regional renal unit in the North of England. Ethical approval was obtained and patients gave written consent. The instrument used was an eight-item schema, based on the work of Lipowski (1970, Psychiatry in Medicine 1, 91-102). Field notes regarding rationale for choice were recorded concurrently, then content analysed to enable identification of themes. The chi-square test (significance level P < 0.05) was used to analyse differences in selected meaning in older and younger patients; males and females; and patient groups (predialysis, haemodialysis and transplant). FINDINGS: 'Challenge' was selected by most patients (n=253, 62.5%), with similar results in all three patient groups. Slightly more older than younger patients selected 'challenge', although the difference was not statistically significant and older patients more commonly had a fatalistic interpretation of the option. More men selected 'challenge' than women. Those selecting 'challenge' and 'value' appeared to have a more positive outlook than other patients. CONCLUSIONS: Patients had identifiable meanings for their illness, and these may be associated with their response to renal disease. The schema appeared to be comprehensive, but is in need of further refinement. Consideration of the possible influence of social desirability is necessary.     

Attitudes towards mental illness in Sweden: adaptation and development of the Community Attitudes towards Mental Illness questionnaire

The main purpose for the expansion of supported community care for persons with serious mental illness in Sweden was to ensure the right for these persons to live as citizens in the community. However, earlier research shows that negative attitudes towards mental illness present an obstacle for social integration of persons with serious mental illness. The aim of this study, conducted in Sweden, was to evaluate an existing instrument's (Community Attitudes towards Mental Illness, CAMI), validity and reliability. An additional aim was to adapt and develop the questionnaire to Swedish circumstances. After translation and modification of the original CAMI, the Swedish version of the questionnaire (CAMI-S) was distributed to all student nurses at three different universities in Sweden. The overall Cronbach's alpha coefficient was 0.90 of the original CAMI-S. A corrected inter-item total correlation excluded 20 items because they showed loading <0.43. The overall Cronbach's alpha coefficient on the 20 items (new CAMI-S) that showed loading, >0.43, was 0.903. A factor analysis of these items revealed that the data could be extracted in three factors labelled as: open-minded and pro-integration, fear and avoidance and community mental health ideology. Finally, in order to reach reliable results in attitude research, it is important to measure the respondent's attitude towards the object in common as well as the respondent's attitude to interact with the object. Accordingly, it is important to add behavioural intention items to the 'new CAMI-S'. Statements exemplifying how something 'ought to be' in an impersonal way have a good degree of stability over time and place.     

The Relationship of Illness Uncertainty, Illness Intrusiveness, and Asthma Severity to Depression in Young Adults with Long-Standing Asthma

This study examined the potential mediating/moderating influence of both illness intrusiveness and asthma severity on the association between illness uncertainty and depression in a college sample of older adolescents and young adults (N = 40) with histories of childhood asthma. There was a significant association between increased illness uncertainty and increased levels of depression. However, analyses indicated that neither illness intrusiveness nor asthma severity served as mediators in the uncertainty–depression relationship. Examination of moderator effects of intrusiveness and severity on the uncertainty–depression relationship revealed an interaction for severity only; thus, the significant effect of uncertainty on depression was at its maximim under conditions of increased illness severity. Results suggest that cognitive appraisal mechanisms involving decreasing ambiguity about illness may be worthwhile targets for intervention.     

低磷血症在危重病患者中的发生及临床意义

目的 观察危重病患者的低磷血症的发生情况，探讨其临床意义。方法 对入住EICU186例危重病人的血磷进行检测，并进行急性生理学及慢性健康状况评分（APACHEⅡ），根据血磷值、APACHEⅡ评分值、年龄及死亡分组。结果 死亡组低磷血症发生率、APACHEⅡ评分值均明显高于存活组；老年组低磷发生率明显高于中青年组（P〈0．05）。结论 危重病时常常伴有低血磷的发生，低磷血症在一定程度上提示疾病的危重性，及时诊断并治疗低磷血症有利于危重病人的抢救，改善预后。     

Maternal severity of illness across levels of care: A prospective, cross-sectional study

Background

The severity of illness of women experiencing severe maternal morbidity has not been quantified outside of the intensive care setting yet is likely to have a bearing on clinical needs.

Aim

To examine severity of illness in women with severe maternal morbidity.

Methods

A prospective observational study of critically ill pregnant and postpartum women was undertaken in intensive care units (ICU), high dependency units (HDU) and delivery suites (DS) of seven tertiary-level hospitals in Melbourne, during 2002–2004. Severity of illness was scored using the Acute Physiology and Chronic Health Evaluation version II (APACHE II) and Therapeutic Intervention Scoring System 28 items (TISS 28).

Results

137 women participated in the study: ICU (n = 33), HDU (n = 46) and DS (n = 58). The mean APACHE II score was 8.6 (95% CI 7.7–9.5) and mean TISS 28 score was 22.5 (95% CI 21.2–23.9). Women in ICU were sicker according to both APACHE II (mean 12.6, 95% CI 8.3–16.9) and TISS 28 (mean 31.5, 95% CI 28.2–35.5) compared to women not admitted to ICU (p < .005). There was no difference in the mean APACHE II scores of women in HDU (7.7, 95% CI 5.5–9.9) and DS (7.0, 95% CI 5.2–8.8; p = .20). Women born outside of Australia were more likely to be admitted to ICU (OR 3.27, 95% CI 1.19–8.97). Known risk factors like multiple pregnancy, age ≥35 years and nulliparity were not associated with ICU admission.

Conclusions

There was no difference in the severity of illness in women cared for in HDU and DS. It was not possible to predict which women would require ICU admission. Measurement of severity of illness adds a valuable dimension to the study of severe maternal morbidity.     

On the Self-Regulation of a Health Threat:Cognitions, Coping, and Emotions Among Women Undergoing Treatment for Infertility

The Self-regulation Model (SRM) proposed by Leventhal and colleagues (H. Leventhal, Meyer, & Nerenz, 1980) argues that cognitive representations of a health threat guide coping with the threat, which in turn affects physical and emotional outcomes. The current study tested these hypothesized relationships between cognitive perceptions of infertility, ways of coping with infertility and its treatment, and emotional outcomes, in a sample of 310 women undergoing treatment for infertility. The data provided evidence for direct and indirect relationships between cognitions and emotions and underscored the importance of examining illness cognitions and attending to both positive and negative emotions in research and therapy.     

Critical illness polyneuropathy and myopathy: a review of evidence and the implications for weaning from mechanical ventilation and rehabilitation

Critical illness polyneuropathy is the most commonly occurring neuromuscular dysfunction on the intensive care unit, and is often described in conjunction with critical illness myopathy. Both conditions are significant causes of weakness, increased length of stay, delayed weaning and prolonged rehabilitation. Sepsis, systemic inflammatory response syndrome and multi-organ dysfunction syndrome are the most reliable independent risk factors. The current evidence regarding critical illness polyneuropathy and critical illness myopathy is reviewed; in particular, the implications for weaning and rehabilitation.     

Medically unexplained illness in short- and long-term disability applicants: Prevalence and cost of salary reimbursement

Purpose. Compared to patients with explained illness, patients with medically unexplained illness (MUI) may be at elevated risk of applying for disability. Accordingly, patients with MUI may account for a disproportionate number of disability claims and for a disproportionate percentage of salary reimbursement costs. The study was conducted to determine: (a) The prevalence of MUI among disability insurance claimants; (b) the cost of salary reimbursement; and (c) the impact of psychiatric comorbidity on length and cost of disability.

Method. An insurance database of 26,451 short-term disability (STD) recipients with long-term disability (LTD) coverage was analyzed to determine the prevalence and salary reimbursement costs of MUI. Applicants with medically explained and psychiatric illness were included for comparison.

Results. The prevalence of MUI among STD recipients was lower than clinical and community rates. Rates of application and receipt of LTD benefits for MUI were similar to explained illness. When LTD payments were projected to retirement age, costs associated with unexplained back pain and fibromyalgia were comparable to those of explained illness. The length of disability and salary reimbursement costs were greater when comorbid psychiatric illness was present.

Conclusions. Patients with MUI did not account for a disproportionate number of disability claims or amount of the money spent on salary reimbursement. Comorbid psychiatric illness increased the length and cost of disability.     

Conceptualizing and measuring illness self-concept: a comparison with self-esteem and optimism in predicting fibromyalgia adjustment

Illness self-concept (ISC), or the extent to which individuals are consumed by their illness, was theoretically described and evaluated with the Illness Self-Concept Scale (ISCS), a new 23-item scale, to predict adjustment in fibromyalgia. To establish convergent and discriminant validity, illness self-concept was compared to self-esteem and optimism in predicting health status, illness intrusiveness, depression, and life satisfaction. The ISCS demonstrated good reliability (alpha = .94; test-retest r = .80) and was a strong predictor of outcomes, even after controlling for optimism or self-esteem. The ISCS predicted unique variance in health-related outcomes; optimism and self-esteem did not, providing construct validation. Illness self-concept may play a significant role in coping with fibromyalgia and may prove useful in the evaluation of other chronic illnesses.     

危重病患者血清胃泌素测定的临床意义

报告８个病种３２５例危重病患者血清胃泌素的测定结果并与５８例正常人对比。结果表明：危重病患者不管是否伴有消化道出血，其血清胃泌素均有意义地升高（Ｐ＜０．００１）。说明危重病患者有高胃泌素血症存在。并与消化道出血和ｐＨ值降低可能有一定关系。提示在危重病治疗时，不管是否有消化道出血，及早应用抑制胃泌素分泌的药物对保护胃粘膜，预防消化道出血可能有一定益处。     

简化新生儿危重病例评分法的临床应用评价

目的 通过与2001年发表的新生儿危重病例评分法(NCIS)进行比较,探讨简化新生儿危重病例评分法在临床应用的可行性.方法 这是一项前瞻、对照的临床研究.选取705例2007年1月1日至2009年12月31日首都儿科研究所重症监护病房(NICU)收治的外院转运新生儿,于入院当日、第3,7天及出院或死亡时进行新生儿危重病例评分.首次评分时,在10项评分指标中减去动脉血氧分压(PaO2)和pH,余8项指标;在其后3次评分时,再减去血钠、钾和肌酐或尿素氮,余5项指标,彤成新的简化评分法.分析简化新生儿危重病例评分与原评分方法对病情评估的符合率(>80%)及二者的相关性.结果 人院首次评分使用8项指标,与原病情评估一致的符合率为86.7%,第3,7天和末次评分使用5项指标,与原病情评估一致的符合率为86.6%-95.7%,简化前后有良好的相关性(P<0.01).简化后的首、末次评分,非危重、危重和极危重三组患儿的病死率差异有统计学意义(P<0.01),与NCIS的结果一致;简化前后相同病情程度患儿的病死率差异无统计学意义(P>0.05).结论 与NCIS相比,简化NCIS法对患儿病情的评估基本一致,可以较准确客观评价危重新生儿,是一种简便易行的临床评分方法.

Abstract：

Objective To discuss the clinical application of simplified neonatal critical illness score (sNCTS)in comparison with original neonatal critical illness score(oNCIS)published in 2001.Method A total of 705 neonates referred to neonate ICU(NICU)from 1 st January 2007 to 31th December 2009 were prospectively studied with control.The patients were scored by oNCIS on admission day,3rd,7th days after admission and on the day of discharge or dead.At the first scoring on admission,2 items of the PaO2 and pH were excluded from oNCIS's 10 items,and the remaining 8 items were used.Three items of plasma sodium,potassium and creatinine or BUN were scored out from 8 items and the still remained 5 items were used for the subsequent 3 scorings.The remaining 8 and 5 items were used as a simplified neonatal critical illness score.The simplified NCIS was evaluated by comparing the patients'condition that was assessed by the originat NCIS.The consistency rate between oNCIS and sNCIS should be over 80%.Results There were 8 items were used to evaluate the severity of disease on admission, and the consistence rate was 86.7%with the original NCIS.The 5 items selected from the original NCIS were used on the 3rd,the 7th days and the day of discharge or death.the consistence rate with original NCIS were 86.6%to 95.7%.A close correlation existed between the original NCIS and simplified NCIS(P<0.01).There were significant differences in mortality rates of the non-serious,serious and extremely serious groups between original NCIS and simplifled NCIS used for the first and the last seorings(P<0.01).Within a cohort of neonates with the same general condition,the assessments of mortality rates were not significantly different between these two methods (P>0.05).Conclusions Compared with the original NCIS.the simplified NCIS is consistent to a large extent in disease assessment,which is a concise way to evaluate the critical ill neonates objectively and can be easily applied to clinical practice.     

危重病人血浆甲状腺激素含量变化及其临床意义

目的　探讨危重病人血浆甲状腺激素（ Ｔ Ｈ） 的变化及其临床意义。方法　应用放射免疫分析法测定７３ 例危重病人和６０ 例健康人（ 对照组） 的血浆 Ｔ Ｈ 含量。结果　危重病人血浆 Ｔ３／ Ｆ Ｔ３ 含量〔（１０５ ±０４６）ｎ ｍｏｌ／ Ｌ〕／〔（２８５ ±１４１）ｐｍｏｌ／ Ｌ〕明显低于对照组〔（１９８ ±０５１）ｎｍｏｌ／ Ｌ， Ｐ＜ ００１〕／〔（６３７ ±１３１）ｐｍｏｌ／ Ｌ， Ｐ＜０００１〕；死亡组 Ｔ３／ Ｆ Ｔ３ 水平与非死亡组 Ｔ３／ Ｆ Ｔ３ 水平相比较有显著差异（ Ｐ＜ ００５／ Ｐ＜ ００１） 。结论　 Ｔ Ｈ 参与了危重病人的病理生理过程，监测危重病人血浆 Ｔ Ｈ 水平可作为反映病情程度和评估预后的一项参考指标。     

Patient Perceptions of Life-limiting Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is a life-limiting, progressive disease that eventually leads to death. Despite medical models supporting the use of quantitative measurements of airflow limitation to guide treatment, research on the patient perspective remains limited. This study explores a group of 6 patients living with stage IV COPD. Using qualitative methodology, this study describes the experience of disease burden from the individuals experiencing it. The findings of this study align with current qualitative literature on the phenomenon of living with COPD. The findings will help to guide individual care for these patients and prompt ongoing research in this area.