322例内科住院患者的心理状态分析

目的了解不同疾病内科住院患者的心理状况及其影响因素.方法应用幸福感指数、焦虑自评量表、特质焦虑问卷及抑郁自评量表对322例肺心病、糖尿病、高血压及冠心病患者进行调查.结果①肺心病、糖尿病、高血压和冠心病患者幸福感指数、焦虑、特质焦虑得分明显增高,78.9%的患者有不同程度的抑郁;②3组患者之间的幸福感指数比较差异有统计学意义;③影响患者心理健康的因素主要有年龄、性别、职业、病种和医疗费支付方式.结论内科住院患者存在较多的心理问题,正确评估患者的心理状态,有针对性地开展心理护理,努力纠正患者的心理障碍具有十分重要的意义.     

慢性阻塞性肺疾病住院患者焦虑抑郁情绪调查

目的 调查我院慢性阻塞性肺疾病(COPD准院患者焦虑抑郁情绪的发生情况,分析相关因素及心理护理的重要性.方法 采用自编一般情况调查表和医院焦虑抑郁量表(HAD)对90例COPD住院患者进行调查.结果 64.4％的患者焦虑情绪为阳性,68.9％的患者抑郁情绪为阳性,51.1％的患者焦虑抑郁情绪并存;不同性别的COPD住院患者焦虑抑郁情绪差异显著,且女性患者比男性患者更容易出现焦虑抑郁情绪;独居患者焦虑抑郁情绪的发生率明显高于非独居患者;COPD患者每年入院次数越多越容易出现焦虑抑郁情绪;文化程度越高且对疾病越了解的患者更易出现焦虑抑郁情绪.结论 COPD住院患者的焦虑抑郁情绪发生率较高,其发生率受性别、文化程度、每年住院次数以及疾病了解情况的影响,心理护理在治疗疾病方面有着重要的意义.     

慢性病患者焦虑抑郁情绪与应对方式相关性研究

目的 了解慢性病患焦虑、抑郁情绪的发生情况，并探讨焦虑、抑郁情绪与应对方式之间的关系。方法 以医学应对问卷、焦虑自评量表、抑郁自评量表为主要工具分别对以糖尿病、高血压、冠心病为主要诊断的92例慢性病患进行间卷调查。结果 (1)焦虑的发生率为27．2％，抑郁的发生率为55．4％；(2)焦虑与性别、化程度、健康自我评价有关；抑郁与性别、年龄、化程度、健康自我评价有关；(3)面对与年龄、化程度有关，回避与性别有关。患的焦虑、抑郁情绪与其应对方式无关。结论 糖尿病、高血压、冠心病患均存在不同程度的焦虑、抑郁情绪，特别是抑郁的发生率较高，应根据患的具体情况给予相应的心理支持以减轻或消除患的焦虑、抑郁情绪对健康的不利影响。     

慢性乙型肝炎患者抑郁情绪调查及护理对策

目的探讨慢性乙型肝炎患者抑郁状况及其护理对策。方法46例慢性乙型肝炎患者入院时和出院时接受Beck抑郁自评量表调查,并针对患者不同的情绪和行为特征,采取相应的护理措施。结果76．09％的慢性乙型肝炎患者存在不同程度的抑郁状况,经过住院治疗和心理护理干预后,患者抑郁发生率下降,抑郁各因子降低（P〈0．05）,差异有统计学意义。结论慢性乙型肝炎患者抑郁情绪发生率较高,积极的心理护理可以增强患者应对疾病的适应能力,消除患者的抑郁症状,促进疾病康复。     

冠心病患者并发抑郁情绪心理干预效果评价

冠心病是一种严重危害人类健康的心身疾病,在其发生发展过程中,患者常出现不同程度的焦虑、抑郁等负性情绪,其中抑郁的发生率最高,对患者的影响也最突出,抑郁的存在会直接影响疾病的发展、预后及康复。因此,加强对冠心病患者的心理干预非常重要,我院通过对136例住院患者进行心理干预,取得了较好的疗效,现报告如下。     

住院慢性肾脏疾病患者抑郁情绪分析与对策

目的:探讨慢性肾脏疾病患者抑郁发生的相关因素,为临床护理提供依据。方法:通过抑郁自评量表,自拟情绪影响相关因素调查表及患者一般资料表,在患者知情同意原则下,对80例住院慢性肾脏疾病患者进行调查研究。结果:慢性肾脏疾病患者的抑郁发生率为60.0%,患者的住院天数、性格、经济状况、自理程度、支持系统是影响抑郁症状发生的主要因素。结论:慢性肾脏疾病患者抑郁的发生与多种因素有关,心理干预应及早进行。     

肺心病患者焦虑、抑郁状态的分析及护理

目的：了解肺心病患者的焦虑、抑郁状态，为做好护理工作，提高患者生活质量提供依据。方法：采用Zung的焦虑自评量表（SAS）和抑郁自评量表（SDS）对我院呼吸内科住院及门诊肺心病患者96例进行心理状况的调查，并对其原因进行了分析。结果：96例肺心病患者的焦虑和抑郁的均分均高于普通人群（P〈0．01）。焦虑的发生率为27．08％，抑郁的发生率为60．4％。结论：肺心病患者有明显的焦虑、抑郁情绪，护理上应注重患者心理状况的改善。     

综合医院住院患者抑郁情绪和自杀行为的系统化心理干预与效果

目的探索系统化心理干预对降低住院患者抑郁情绪与自杀行为发生率的效果。方法应用抑郁自评量表、心理测量对300例住院患者进行较系统的早期识别抑郁情绪和心理危机,早期报告、及时心理疏导。结果 119例(39.67%)住院患者有不同程度的抑郁情绪。通过开展心理疏导,患者在医院自杀率由2006年20.7/10万降至2009年零发生。结论系统化的心理干预可有效降低住院患者抑郁情绪和自杀意向。     

冠心病合并焦虑抑郁调查及影响因素分析

目的:调查冠心病(Coronary Heart Disease,CHD)合并焦虑抑郁的情况。方法:对确诊的245例冠心病患者给予汉密顿焦虑量表(Hamilton Anxiety Scale,HAMA)和汉密顿抑郁量表(Hamilton Depression Scales,HAMD)进行量表评分并进行统计分析。分析245例患者的性别、文化程度、婚姻状况、高血压史、糖尿病史、冠心病类型等因素对冠心病合并焦虑抑郁的影响。结果:在接受调查的245例冠心病患者中,焦虑障碍64例,发生率为26.1%;抑郁障碍71例,发生率为28.98%,焦虑抑郁障碍并存的25例,发生率为10.2%。对245例CHD合并焦虑抑郁患者进行HAMA和HAMD量表评分,结果表明:无论焦虑评分还是抑郁评分结果,女性积分均较男性积分高,单身者积分较已婚者积分高,有高血压病史者积分较无高血压病史者积分高,有糖尿病史者积分较无糖尿病史者积分高,差异有统计学意义(P<0.01或P<0.05)。年龄及吸烟史对冠心病合并焦虑和抑郁积分均无影响(P>0.05)。结论:CHD患者容易伴发焦虑和抑郁情绪障碍,焦虑和抑郁情绪障碍往往能诱发和加重CHD的发作并影响其治疗效果。本调查发现性别、文化程度、婚姻状况、高血压史、糖尿病史、冠心病类型等均成为其有统计学意义的影响因素,其中女性、文化程度低、单身、有高血压史、有糖尿病史、冠脉病变程度重的患者更容易伴发焦虑抑郁障碍。     

住院冠心病患者抑郁情绪及相关因素的调查分析

目的：探讨冠心病患者抑郁发生的相关因素，为临床心理护理提供方向和依据。方法：通过抑郁自评量表（SDS）。自拟情绪影响相关因素调查表及患者一般资料，在患者知情同意原则下，对120例住院冠心病患者进行了调查研究。结果：冠心病患者的抑郁发生率为41．5％，高于国内常模；患者的住院天数、性格、经济状况、自理程度、支持系统是影响抑郁症状发生的主要因索。结论：冠心病患者抑郁的发生与多种因素有关，心理干预应及早进行。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.     

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.     

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.     

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.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.