吸毒者在强制戒毒期间的SCL-90测试及心理治疗

目的对吸毒者在戒毒期间进行戒毒前后心理状态分析及心理治疗。方法对246例吸毒者在强制戒毒期间，采用SCL-90症状自评量表进行测试。结果吸毒者戒毒前SCL-90测试结果示其抑郁、焦虑、敌对3项因子分与国内常模相比差异有非常显著性（P〈0．001）；躯体化、强迫、人际关系敏感及偏执等因子分差异有非常显著性（P〈0．01）；精神病因子分高于常模（P〉0．05），恐怖因子分无明显差异。吸毒者戒毒后SCL-90测试结果显示在躯体化、强迫、人际关系敏感、抑郁、焦虑、敌对等6项因子分显著高于常模（P〈0．01），偏执因子分高于常模（P〈0．05），恐怖及精神因子分无明显差异。吸毒者戒毒前后SCL-90测试结果显示躯体化、强迫、抑郁、焦虑、敌对等5项因子分戒毒前后差异有非常显著性（P〈0．01），强迫症状明显好转，人际关系敏感、恐怖、偏执、精神病性因子分无明显差异（P〉0．05）。结论心理问题以躯体化、强迫、抑郁、焦虑、敌对最为突出，因此对于戒毒者不能仅限于解除躯体依赖，更重要的是心理治疗，以促进他们早日康复，回归社会。     

海洛因依赖者脱毒后心理状态分析

目的：研究海洛因依赖者脱毒后的心理状态。方法：对58例海洛因依赖者在脱毒后作SCL-90测评。结果：海洛因依赖者脱毒后在躯体化、忧郁、焦虑、恐怖、精神病性等因子分上均高于国内常模,男生依赖者在强迫、敌对性、偏执等因子分上高于女性。结论：海洛因依赖者脱毒后存在躯体稽延症状及焦虑、抑郁情绪,需使用有关药物并进行心理社会干预以防复吸。     

大学生乙肝患者心理状况调查

目的了解大学生乙肝患者心理健康状况,为做好心理疏导及健康教育提供依据。方法采用症状自评量表（SCL-90）对102例大学生乙肝患者进行调查与统计。结果澳抗阳性学生SCL-90的各项因子得分均高于全国常模,其中躯体化得分[（1．62±0．50）分比（1．37±0．48）分]、强迫得分[（1．90±0．43）分比（1．62±0．58）分]比较差异均有统计学意义（t分别为9．92,5．53;P〈0．05）;其他因子包括人际关系敏感、抑郁、焦虑、恐怖、精神病性差异均有统计学意义（P〈0．05）;不同性别大学生乙肝患者在躯体化、抑郁和恐怖3个因子分上差异有统计学意义（P〈0．05）,其他因子差异无统计学意义（P〉0．05）;不同区域大学生乙肝患者在人际关系、强迫、焦虑、抑郁、恐怖、精神病性因子得分上差异有统计学意义（P〈0．05）,其他因子差异无统计学意义（P〉0．05）。结论大学生乙肝患者心理健康状况较差,需要有区别地开展各种形式的心理健康教育,切实提高他们的心理应对能力和自控能力。     

跳伞运动员心理健康状况调查分析

目的：探讨军队跳伞运动员心理健康状况的特点。方法：采用症状自评量表（SCL-90）对57例跳伞运动员进行测评。结果：跳伞运动员存在中度心理问题（因子分≥3）者不少于7．0％，其中SCL-90的躯体化、人际关系敏感和焦虑均显著低于中国军人常模（P〈0．05或〈0．01）；而阳性项目、强迫症状、偏执和精神病性却显著高于中国正常人常模（P〈0．05或0．01）；SCL-90的总分、阳性项目和各因子分均显著高于勤务分队（P〈0．01）。不同年龄跳伞运动员SCL-90的躯体化和恐怖情绪差异有显著性意义（P〈0．05）；跳伞不同次数、男女运动员SCL-90的恐怖情绪差异有显著性意义（P〈0．05）。结论；加强跳伞运动员的心理卫生宣教，有助于运动员对训练和比赛的适应，提高跳伞成绩。     

肿瘤科护士心理状况及应对方式调查

[目的]探讨肿瘤科护士心理状况及其应对方式。[方法]采用症状自评量表（SCL-90）及简易应对方式量表（SCSQ）对49名肿瘤科护士进行问卷调查。[结果]肿瘤科护士SCL-90量表总分与国内常模比较，差异无统计学意义（P〉0．05），躯体化、焦虑、强迫症状、抑郁、恐怖因子分高于国内常模（P〈0．05或P〈0．01）；肿瘤科护士积极应对方式得分明显低于国内常模（P〈0．01）；躯体化、强迫症状及恐怖因子与年龄呈正相关，抑郁因子与年龄呈正相关，与学历呈负相关，焦虑与婚姻状况正相关。[结论]肿瘤科护士躯体化、焦虑、强迫、抑郁、恐怖症状较重，应采取积极的应对方式。     

美沙酮维持治疗对海洛因依赖患者心理健康状况的影响

目的探讨美沙酮维持治疗对海洛因依赖患者心理健康状况的影响。方法将41例海洛因依赖患者设为研究组,给予美沙酮维持治疗1a,抽取社区35名一般资料与研究组相匹配的居民设为对照组。研究组入组时及治疗1a末采用症状自评量表评定心理健康状况,对照组于入组时进行评定。结果研究组经美沙酮维持治疗1a末,症状自评量表各因子分及阳性项目数均较入组时有显著下降,其中强迫症状、人际关系、焦虑、敌对、恐怖、精神病性因子分和阳性项目数均有显著或极显著性差异（P〈0．05或0．01）;入组时及治疗1a末症状自评量表各因子分及阳性项目数均显著高于对照组（P〈0．05或0．01）。结论海洛因依赖者存在诸多方面的心理健康问题,美沙酮维持治疗能使部分心理问题得以改善。     

宁夏地区327例强制戒毒人员症状自评量表分析

目的 了解强戒人员心理卫生状况方法采用精神症状自评量表（SCL-90）对宁夏银川市、石嘴山市327例药物依赖强戒人员进行SCL-90测定。结果 海洛固依赖者在精神症状自评量表中各因子及总分、总均分显著高于常模（P〈0．01），且这些差异与脱毒者复吸原固有着直接的联系。在327例药物依赖强戒人员中男女SCL-90测定中，除躯体化、阳性项目平均分因子外，其他备因子及总分、总均分均有显著差异．尤以强迫症状、抑郁、总分、总均分、阴性项目常数、阳性项目因子及总分、总均分差异非常显著。提示女性海洛固依赖者的心理缺陷较男性海洛因依赖者为重。结论 海洛因依赖者的个性心理特征为明显的社会适应障碍，对自己健康过分关注，缺乏对社会环境的归属感，容易将自己的问题合理化而归因于别人，并由这种心理特征增加了复吸率。     

地震救援人员早期心理状况分析

目的：调查和分析汶川地震救援某部队官兵早期心理健康状况,为部队心理健康服务提供科学依据。方法：采用症状自评量表（SCL-90）对336例参加抗震救灾的某部队官兵进行测评和心理晤谈,并依据救援种类、独生子女等分组进行统计分析。结果：SCL-90结果显示救援部队躯体化因子分显著高于地方常模（P〈0．05）,强迫、人际关系、抑郁、焦虑及偏执等因子分均显著低于地方常模（P〈0．01或0．05）;参加搬运尸体组的躯体化因子分、强迫、焦虑及敌对性因子分均显著高于未搬运尸体组（P〈0．01或0．05）;独生子女SCL-90躯体、抑郁和焦虑因子分高于非独生子女。结论：抗震救灾早期救援部队官兵总体心理状态良好;搬运尸体组和独生子女组救援人员的应激反应水平较高。     

待产妇女产前1周的心理状况分析

目的了解待产妇女的心理健康状况。方法随机选择距预产期不超过7d的待产妇女90名,采用SCL-90进行问卷调查,将调查结果与全国常模进行比较,并将预备自然产和预备剖宫产两组进行比较。结果待产妇女躯体化、抑郁、焦虑、恐怖4个因子均分高于全国常模（P〈0．01或P〈0．05）;预备剖官产组的躯体化、人际关系敏感、抑郁、焦虑、恐怖5个因子分均高于预备自然产组（P〈0．01或P〈0．05）。结论待产妇女产前1周存在躯体化、抑郁、焦虑、恐怖4方面的问题,预备剖宫产妇女在以上4个方面症状表现更加严重。     

医学实习生心理健康的调查研究

目的探讨当前医学实习生的心理健康情况,为提高临床实习质量提供依据。方法采用症状自评量表（SCL-90）对232名来本院临床实习的医学生（观察组）进行调查,分析总体及不同性别（男性、女性）的各因子得分和心理问题检出率,选取未进行过临床实习的250例医学生作对比（对照组）。结果对照组和观察组的 SCL-90总分分别为（147．46±12．35）分和（142．52±17．09）分,且在 SCL-90各因子得分及总分上差异均无统计学意义（P＞0．05）;观察组的“抑郁”“焦虑”和“偏执”心理问题检出率和 SCL-90总分异常率均高于对照组（P＜0．05）;临床实习医学生中,女性的“人际敏感”“抑郁”和“焦虑”得分和心理问题检出率均高于男性（P＜0．05）,其余因子及总分差异均无统计学意义（P＞0．05）。结论临床实习对医学生总体心理健康情况的影响较少,但对女性实习生有一定的影响,导致其人际敏感、抑郁和焦虑,应针对性的进行心理疏导。     

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.