脑卒中患者焦虑抑郁情绪及相关影响因素分析

目的 探讨脑卒中患者的焦虑抑郁情绪及相关影响因素,为综合干预提供依据.方法 将86例脑卒中患者设为研究组,抽取同期健康者85名设为对照组,采用自拟一般资料调查表、简明智能状况检查表、症状自评量表、焦虑自评量表、抑郁自评量表、汉密顿焦虑量表、汉密顿抑郁量表、社会支持评定量表、生活事件量表、艾森克个性问卷进行测评分析.结果 研究组症状自评量表、焦虑自评量表、抑郁自评量表、汉密顿焦虑量表评分及汉密顿抑郁量表总分和除体质量外的其他因子分,生活事件量表总分和除正性事件外的其他因子分,艾森克个性问卷除掩饰倾向维度外的其他维度分均显著高于对照组(P＜0.05或0.01);社会支持评定量表评分显著低于对照组(P＜0.05或0.01).研究组不同程度焦虑抑郁情绪检出率均显著高于对照组(P＜0.05或0.01);艾森克个性问卷内外倾维度中间型和神经质维度中间、稳定型检出率显著低于对照组(P＜0.05或0.01),内外倾维度外向型和神经质维度不稳定型检出率显著高于对照组(P＜0.05或0.01).结论 脑卒中患者存在明显的焦虑抑郁情绪.负性生活事件,缺乏亲人和社会支持,不良个性特征等因素可能是脑卒中患者发生焦虑抑郁情绪的危险因素.     

农村留守儿童情绪行为及个性特征调查

目的：了解农村留守儿童情绪行为及个性特征的相关因素。方法将100名留守儿童设为研究组,100名非留守儿童设为对照组,采用焦虑自评量表、抑郁自评量表、Achenbach儿童行为量表、艾森克个性问卷进行测评分析。结果研究组焦虑、抑郁情绪、行为问题检出率均显著高于对照组（P＜0．05）,焦虑自评量表、抑郁自评量表评分和艾森克个性问卷的 P、N分量表得分均显著高于对照组（P＜0．01）,男生、女生Achenbach儿童行为量表总分均显著高于对照组（P＜0．05）;研究组焦虑自评量表、抑郁自评量表、Achenbach儿童行为量表评分与艾森克个性问卷评分存在显著相关性（ P＜0．05或0．01）。结论农村留守儿童存在明显的情绪、行为及性格缺陷问题,有针对性的心理干预能显著提高其心理健康水平。     

急性心肌梗塞患者心理健康状况及人格特质研究

目的探讨急性心肌梗塞患者的心理健康水平及焦虑抑郁情绪和人格特质状况。方法将91例急性心肌梗塞患者设为研究组,抽取90例正常健康体检者设为对照组。采用症状自评量表、焦虑自评量表、抑郁自评量表、生活事件量表、社会支持评定量表及艾森克个性问卷对两组进行评定分析。结果研究组症状自评量表总分、阳性项目和阳性症状分、躯体化、强迫、人际敏感、抑郁、焦虑、敌对、恐怖、偏执因子分及焦虑自评量表、抑郁自评量表总分均显著高于对照组（P〈0．01）;1a内负性生活事件明显高于对照组（P＜0．01）,而社会支持度显著低于对照组（P〈0．01）;艾森克个性问卷评分研究组内外倾、神经质维度分均显著高于对照组（P＜0．01）,外倾性格和情绪不稳定构成比显著高于对照组（P〈0．01）。结论焦虑、抑郁、紧张、恐惧等负性情绪、负性生活事件、缺乏社会支持度以及不良性格等因素均是诱发急性心肌梗塞的危险因素,在控制其生物学病因的同时,还应调整患者的情绪,加强心理治疗,对不良性格加以矫正,有助于预防、减少和控制急性心肌梗塞的发生。     

艾滋病或艾滋病毒感染者家庭儿童心理健康状况调查

目的：探讨艾滋病或艾滋病毒感染者家庭儿童的心理健康状况。方法将艾滋病或艾滋病毒感染者家庭的87名儿童设为研究组,同期抽取普通家庭的87名儿童设为对照组,分别采用艾森克个性问卷、焦虑自评量表、抑郁自评量表及自尊量表进行测评分析。结果研究组艾森克个性问卷的内‐外倾维度分显著低于对照组（P＜0．01）,神经质、掩饰维度分均显著高于对照组（P＜0．01）;焦虑自评量表、抑郁自评量表评分均显著高于对照组（P＜0．01）,自尊量表评分显著低于对照组（P＜0．01）。结论艾滋病或艾滋病毒感染者家庭的儿童存在个性缺陷,自尊水平较低,焦虑抑郁情绪显著,心理健康状况较差,全社会应针对这一特殊群体积极开展健康教育及心理干预,以提高其心理健康水平。     

维和待命士兵心理健康与人格特征相关分析

目的探讨维和待命士兵心理健康状况与个性特征的相关性。方法将379名维和待命士兵设为研究组，同一部队380名士兵设为对照组，采用症状自评量表对两组士兵进行测评，采用艾森克个性问卷对研究组进行人格维度测定，并与症状自评量表评定结果进行相关分析。结果研究组症状自评量表躯体化、强迫、抑郁、焦虑、恐怖、精神病性因子分显著高于对照组（P〈0．01）；研究组艾森克个性问卷内、外向性格与人际敏感呈正相关，与抑郁、精神病性呈负相关，神经质维度与人际敏感、抑郁、焦虑、敌对、恐惧、偏执呈正相关，精神质维度与人际敏感、敌对、偏执、精神病性呈正相关，均有显著性差异（P〈0．01）。结论维和待命士兵集训期间可发生不同程度的心理问题，且心理健康状况与个性特征有一定的相关性。     

失眠症患者心理健康状况及相关因素分析

目的 了解失眠症患的心理健康状况及相关因素。方法 采用症状自评量表（SCL－90）及艾森克个性问卷（EPQ）,对67例失眠症及78例健康对照进行测试。结果 失眠组躯体化、人际关系敏感、抑郁、焦虑因子分,EPQ的稳定性（N）、掩饰（L）量表分及情绪不稳定较对照组显增多。N量表分与SCL－90各因子间有显相关性,E量表分与人际关系敏感抑郁因子及L量表分与强迫症、焦虑、人际关系敏感因子间有相关性（P＜0．01或P＜0．05）。结论 失眠症患存在一定的心理健康问题,应引起足够的重视。     

急性心肌梗塞患者心理健康状况和相关危险因素研究

目的 探讨急性心肌梗塞患者心理健康状况和相关危险因素,为急性心肌梗塞的综合防治提供依据.方法 将91例急性心肌梗塞患者设为研究组,90名正常志愿者设为对照组.自拟生活方式调查表统计生活方式,采用生活事件量表评定生活事件,社会支持评定量表评定社会支持利用度,艾森克个性问卷评定个性特征,症状自评量表、焦虑自评量表、抑郁自评量表评定心理健康状况及焦虑、抑郁状况.结果 研究组急性心肌梗塞发作前有明显心理刺激因素者占80.22%;生活事件量表评分精神紧张总值、负性事件、家庭事件、工作事件、社交事件紧张维度评分均显著高于对照组(P＜0.01);社会支持评定量表总分及客观支持、主观支持、支持利用度维度分均显著低于对照组(P＜0.05或0.01);艾森克个性问卷的内外倾、神经质维度分均显著高于对照组(P＜0.01);症状自评量表除精神病性因子分与对照组差异无显著性外,总分、其他因子分以及焦虑自评量表、抑郁自评量表总分均显著高于对照组(P＜0.01).结论负性事件较多,缺乏亲人和社会支持,有缺陷的个性特征、心理健康状况差和不良的生活方式可能是急性心肌梗塞发生发展的危险因素.     

失眠症患者53例社会心理状况分析及护理对策

目的：探讨社会心理因素对失眠的影响及护理对策。方法：采用艾森克个性问卷（成人版）、Zung抑郁自评量表（SDS）、焦虑自评量表（SAS）、生活事件量表（LES）和社会支持评定量表对53例失眠症患者（失眠组）及45例无失眠者（对照组）进行评分比较。结果：失眠组患者内外向分值、对支持的利用度低于对照组（P〈0．01）,而神经质、抑郁、焦虑、负性生活事件、主观支持的分值明显高于对照组（P〈0．01）。结论：失眠症患者具有明显的内向和神经质、抑郁、焦虑个性,且与负性生活事件有关,在药物治疗失眠症的同时,应注重心理社会因素干预,有利于患者的全面康复。     

产前综合性心理干预对围产期抑郁患者情绪及生活质量的影响

目的：探讨产前综合性心理干预对围产期抑郁患者情绪及生活质量的影响。方法将497例围产期抑郁患者按产检号随机分为两组,研究组251例,对照组246例。两组均接受常规孕期保健宣教,研究组在此基础上联合综合性心理干预,于孕28周、36周及产后1个月采用焦虑自评量表、爱丁堡产后抑郁量表、生活质量量表进行测评分析。结果孕28周两组各量表评分比较差异无显著性（ P＞0．05）。孕36周及产后1个月两组焦虑自评量表、爱丁堡产后抑郁量表总分均较孕28周显著降低（ P＜0．05或0．01）,研究组显著低于对照组（ P＜0．05或0．01）;研究组生活质量量表的精神成分及躯体成分维度分较孕28周显著升高（ P＜0．05或0．01）,对照组仅躯体成分维度分较孕28周显著升高（ P＜0．01）,研究组显著高于对照组（ P＜0．05或0．01）。结论综合性心理干预能显著改善围产期抑郁患者的焦虑抑郁情绪,提高患者的生活质量。     

药物治疗联合道家认知疗法治疗中老年失眠症对照研究

目的：探讨药物治疗联合道家认知疗法治疗中老年失眠症的临床疗效。方法将101例中老年失眠症患者随机分为两组。两组均口服佐匹克隆治疗,研究组予以道家认知治疗,对照组予以常规健康教育。观察12周。于治疗前后采用匹兹堡睡眠质量指数评定睡眠状况,症状自评量表、社会支持量表、特质应对方式问卷评定临床症状、社会支持状况及应对方式。结果治疗6周末起两组匹兹堡睡眠质量指数总分较治疗前显著降低（P＜0．01）,研究组显著低于对照组（P＜0．01）;治疗12周末研究组症状自评量表评分较治疗前显著降低（P＜0．01）,社会支持量表主观支持、支持利用度维度分较治疗前显著升高（P＜0．01）,特质应对方式问卷积极应对维度分较治疗前显著升高（P＜0．01）,消极应对维度分较治疗前显著降低（P＜0．01）,与对照组比较差异均有显著性（P＜0．05或0．01）。结论药物联合道家认知疗法能显著改善中老年失眠症患者的睡眠状况和躯体症状,对提高社会支持利用度,改善积极应对方式具有重要作用,显著优于单用药物治疗。     

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.