社区原发性高血压综合干预——随访

目的 :探讨原发性高血压综合干预模式及其疗效。方法 :对 1992年参加社区原发性高血压综合干预跟踪研究的 177名患者进行随访 ,被试者年龄范围 5 1-77岁 ,75 7%为退休人员。采用自编调查表、SCL -90和简短智力状态检查 (MMSE)量表对患者进行随访及现状调查 ,完成各种测查者共 15 2人。结果 :较好执行原治疗方案者占 44 1% (坚持度 >70 % ) ;目前治疗模式有三种 :(1)药物治疗 ,占 19 7% ,(2 )综合治疗 (除服药外包括低盐低脂饮食、戒烟酒、控制体重、增加活动和保持心理平衡 ) ,占 5 7 2 % ;(3 )药物 运动 (运动量较大的体育活动 ) ,占 2 2 4% ;SCL -90测查结果显示 ,综合治疗和药物 运动治疗的患者SCL -90总分、抑郁及焦虑因子分均低于单纯服药者 (P <0 0 5～ 0 0 1) ;认知功能明显受损者 (MMSE)占 0 7%。结论 :对原发性高血压患者采用综合干预措施可取得较好的远期效果 ,在药物治疗的基础上调整生活方式、增加运动可促进患者的心身健康     

HIV/AIDS人员心理卫生状况与心理社会影响因素

目的 :研究HIV/AIDS (艾滋病毒感染者 /艾滋病患者 )人群的心理卫生状态与心理社会因素的影响。方法 :采用病例对照研究方法。病例组与对照组两组对象均接受一般情况问卷、症状自评量表(Symptomchecklist 90 ,SCL -90 )、生活事件量表 (LifeEventScale ,LES)、生活质量综合评定问卷 (GenericQualityofLifeInventory -74,GQOLI -74)、自我接纳问卷 (Self -AcceptanceQuestionnaire ,SAQ )五个量表的测查。结果 :(1)病例组的SCL -90各个因子分高于对照组 (P <0 0 0 1) ;(2 )病例组总生活事件和负性生活事件得分高于对照组 (P =0 0 0 1) ;(3 )病例组自我接纳得分低于对照组 (P =0 0 0 1) ;(4 )病例组生活质量综合评定得分低于对照组 (P <0 0 0 1) ;(5 )多因素逐步回归分析 ,SCL -90总因子分相关因素主要为躯体症状严重程度 (负向评分 )、负性生活事件和自我接纳因子 ,躯体症状严重程度与SCL -90总因子分呈负相关 ,负性生活事件得分与SCL -90总因子分呈正相关 ,自我接纳得分与SCL -90总因子分呈负相关。结论 :HIV/AIDS组较对照组心理健康状态有明显差异 ,有较多的负性生活事件 ;自我接纳得分低于对照组 ;生活质量低于对照组。     

综合性心理治疗冠心病的临床研究

目的　观察综合性心理治疗冠心病的疗效。方法　将 1 0 0例冠心病患者按心理检查时单双序号分为研究组和对照组。研究组在常规药物治疗的基础上 ,采用行为干预治疗、生物反馈、放松训练、音乐疗法、支持性心理治疗等综合疗法。对照组仅常规药物治疗。每位患者均于治疗前、治疗后 3个月和 6个月检测临床指标 :血压 ( SBP、DBP)、血脂 ( TC、TG、HDL-C)进行治疗前及同期组间比较 ;治疗后 6个月观察心电图 ST-T和临床疗效 ;并行治疗前和治疗后 6个月给两组患者测查生活质量评定问卷 ( GQOL-74 ) ,进行治疗前后及同期组间比较。结果　研究组治疗后 3个月和 6个月临床指标改善明显优于对照组 ( P<0 .0 5 ) ,治疗 6个月后研究组的心电图 ST-T改善和临床疗效及生活质量得分明显高于对照组。结论　综合性心理疗法能有效提高冠心病患者的临床治疗效果和生活质量。     

综合性心理干预对甲状腺功能亢进症治疗的临床研究

目的 :观察综合性心理干预对甲状腺功能亢进症 (简称甲亢 )的疗效。方法 :将 10 3例甲亢患者按心理检查时单双序号随机分为研究组和对照组。研究组在常规药物治疗的基础上 ,采用行为干预治疗、生物反馈、放松训练、音乐疗法、支持性心理治疗等综合性心理干预 ,对照组仅常规药物治疗。观察两组治疗前、治疗后 3个月和 6个月的甲状腺功能———三碘甲腺原氨酸 (T3)、总甲状腺素 (T4 )、促甲状腺激素(TSH)、游离T3(FT3)、游离T4 (FT4 )、 2 4小时1 31 I摄取率 ,进行同期组间比较 ;同时进行治疗前和治疗后 6个月给两组患者测查生活质量评定问卷 (GQOL -74) ,进行同期组间比较。结果 :研究组治疗后 3个月和 6个月临床指标改善明显优于对照组 (P <0 0 5 ) ,治疗后 6个月研究组病人生活质量得分明显高于对照组。结论 :综合性心理干预能有效提高甲亢患者的临床治疗效果和生活质量。     

西酞普兰对女性慢性精神分裂症患者临床症状和生活质量的影响

目的:探讨西酞普兰对女性慢性精神分裂症患者的疗效。方法:将52例女性慢性精神分裂症患者分为研究组和对照组,在原药物治疗基础上分别加用小剂量西酞普兰和安慰剂治疗12周,并用阳性和阴性症状量表(PANSS)、生活质量综合评定问卷(GQOLI-74)、临床疗效总评量表(CGI-SI)进行评定。结果:治疗前两组各量表评分差异均无显著性(P>0.05),治疗后研究组PANSS阴性因子分、一般精神病理量表分、总分及反应缺乏因子、抑郁因子分较治疗前明显下降(20.0±4.2/27.6±4.6,30.1±2.6/37.1±6.3,62.7±7.3/76.6±10.7,9.4±1.9/12.2±1.7,7.7±1.0/10.2±1.3,t=4.21～7.72,P<0.01),研究组的生活质量综合评定问卷总分及各维度评分均高于对照组(如总分40.7±7.0/33.1±3.6,t=4.64,P<0.01)。结论:西酞普兰可能改善女性慢性精神分裂症患者的临床症状和生活质量。     

阈上安全感启动对有留守经历大学生自杀意念的影响

目的:探讨阈上安全感启动对有留守经历大学生自杀意念的影响。方法:在浙江某高校选取有留守经历大学生62人,随机分入阈上安全感启动组和中性启动组,每组各31人,通过阈上安全感启动技术实现对安全感的操控。在启动前施测中文人生意义问卷(C-MLQ)、自杀态度问卷(QSA)和自杀意念测查问卷,来检验启动的有效性;在启动后施测安全感启动有效性测查问卷(SPVQ)、书写有效性测查问卷(WVQ)、C-MLQ、QSA和自杀意念测查问卷,来探究不同启动方式对自杀意念的影响。结果:阈上安全感启动组的SPVQ总分高于中性启动组[(4. 3±0. 6) vs.(3. 2±1. 0),P 0. 001]。C-MLQ总分及寻求意义感维度得分、QSA总分及"对自杀行为的认识"维度得分、自杀意念得分的组别与时间交互作用均有统计学意义(均P 0. 05)。进一步简单效应分析表明,启动前两组的各变量得分差异均无统计学意义(均P 0. 05);启动后阈上安全感启动组的C-MLQ总分及寻求意义感维度得分,QSA总分及"对自杀行为的认识"维度得分均高于中性启动组(均P 0. 05),而自杀意念得分低于中性启动组(P 0. 05)。结论:本研究提示,阈上安全感启动可以降低有留守经历大学生的自杀意念。     

精神分裂症患者家庭干预后生活质量对照分析

目的 :研究精神分裂症患者家属干预后与对照组的生活质量差异及其相关影响因素。方法 :对社区 10 4例干预组家庭进行综合式干预 2年后与 10 9例对照组家庭之照料者采用社区用修订版生活质量(QOL)问卷 ( 4 1项 )评定 ,同时进行患者社会功能 (DAS)、症状学 (PANSS) ,及家属焦虑自评量表 (SAS)评定。结果 :干预组的家属QOL明显高于对照组 (P <0 0 5 ) ,信心与家庭关系两项因子分优于对照组 (P <0 0 1)。干预组的复发率显著低于对照组 (u =2 0 6P <0 0 5 )。QOL总分、主客观因子分的高低与PANSS ,DAS ,SAS等总分均有不同程度的相关。结论 :综合式干预有利于提高精神分裂症家属的生活质量 ,降低复发率 ,提高患者的社会功能。     

慢性乙型肝炎患者心身症状和应对方式对生活质量的影响

目的 :研究慢性乙型肝炎患者的心身症状水平和应对方式对生活质量的影响。方法 :对 15 2名住院慢性乙肝病人用慢性肝病问卷 (CLDQ)、症状自评量表 (SCL - 90 )、医学应对问卷 (MCMQ)进行调查。结果 :慢性乙肝患者SCL - 90得分与常模和对照组有显著差异 ,各因子与CLDQ各维度呈负相关 ,以SCL - 90总均分 0 .4 4为划界分将病人分成阳性组和阴性组 ,阳性组CLDQ各维度得分均低于阴性组。患者面对应对低于常模 ,回避和屈服应对高于常模 ,阳性组比阴性组患者更倾向于采用回避和屈服应对 ,这两种消极的应对方式与生活质量呈负相关。结论 :慢性乙肝患者的心身症状及不良的应对方式对患者的生活质量有较大影响 ,要想通过心理干预减轻患者心身症状 ,提高患者的生活质量 ,重点应该放在改变不良应对方式上     

社区随访干预对精神分裂症患者生活质量的影响

目的探讨社区随访干预对精神分裂症患者生活质量和社会功能康复的影响。方法将出院的精神分裂症患者152例随机分成干预组和对照组,对干预组患者及其家属、社区居民实施群体随访干预和个别指导,对照组针对患者个体给予一般健康指导,共干预1年。采用家庭关怀度指数问卷(APGAR)、社会功能缺陷量表(SDSS)和生活质量综合评定问卷(GQOL I-74)对干预效果进行评定。结果实施社区随访干预后,干预组患者的社会功能缺陷程度明显降低,与干预前及两组间比较,均有显著统计学意义(P<0.01)。患者得到较多的家庭、社会支持,家庭社会关怀度显著提高(P<0.05)。患者生活质量与家庭社会支持度的相关性分析,除物质生活维度,其余3个维度即躯体功能(r=0.37,P<0.01)、心理功能(r=0.35,P<0.01)、社会功能(r=0.27,P<0.05)均与家庭社会关怀度呈正相关。患者生活质量明显提高。结论社区随访干预可有效提高精神分裂症患者的生活质量和社会功能。     

社区干预对精神分裂症患者生活质量的影响

目的探讨社区干预对精神分裂症患者生活质量的影响。方法将120例男性精神分裂症患者随机分为实验组与对照组各60例。出院后对实验组家属和患者进行定期康复指导，实施社区干预．对照组不进行特殊指导。对两组患者随访2年，采用日常生活能力量表（ADL）、社会功能缺陷量表（SDSS）和生活质量综合评定问卷（GQOLI-74）对其生活质量进行评估。结果干预后实验组患者GQOLI-74中躯体功能、心理功能、社会功能显著高于干预前，差异有统计学意义（P均〈0．01）；干预后实验组GQOLI-74中各维度得分均高于对照组，差异有统计学意义（P〈0．05或P〈0．01）；ADL的躯体生活自理能力和日常生活能力也高于对照组（P〈0．05），SDSS的社会功能改善程度高于对照组（P〈0．05）。结论社区干预有助于增进患者自我照顾能力，提高服药依从性，减少复发，延缓精神分裂症患者的功能衰退，提高生活质量。     

氯氮平与利培酮对精神分裂症病人生活质量影响的双盲对照研究

目的 :观察氯氮平与利培酮治疗对精神分裂症病人生活质量的影响。方法 :双盲对照研究。用阳性症状与阴性症状评定量表 (PANSS)观察病人的精神症状 ,用生活质量综合评定问卷 (GQOLI)分析病人生活质量。结果 :利培酮组的躯体健康维度、心理健康维度及社会功能维度得分明显高于氯氮平组 ,均有显著性差异 (P <0 0 1)。结论 :利培酮组精神分裂症病人生活质量优于氯氮平组。     

精神分裂症患者生活质量量表信效度检验与应用

目的：引进和进行《精神分裂症患者生活质量量表》（SQLS）的信度和效度检验，并初步进行临床应用。方法：将SQLS译成中文，并回译。以174例精神分裂症住院患者和51例门诊患者为样本进行信度，效度评定。结果：SQLS中文版重度测度0．87，内部一致性α系数0．70－0．92，与SF－36，SCL－90显著相关，因素分析证实了三个因子。在临床应用中，我们发现住院患者在精力／动机上反而好于门诊患者，而患病时间对主观生活质量的影响最为显著，随着患病时间的延长，主观生活质量呈下降趋势。此外，参加工娱治疗，使用副反应小的新型抗精神药物的患者主观生活质量高。上述结论提示量表反映的情况与临床实际基本相符。结论：《精神分裂症患者生活质量量表》（SQLS）中文版经初步测试，信度，效度符合要求，具有临床应用价值。     

Improvement in medication adherence and self-management of diabetes with a clinical pharmacy program: a randomized controlled trial in patients with type 2 diabetes undergoing insulin therapy at a teaching hospital

OBJECTIVE:

To evaluate the impact of a clinical pharmacy program on health outcomes in patients with type 2 diabetes undergoing insulin therapy at a teaching hospital in Brazil.

METHOD:

A randomized controlled trial with a 6-month follow-up period was performed in 70 adults, aged 45 years or older, with type 2 diabetes who were taking insulin and who had an HbA1c level ≥8%. Patients in the control group (CG) (n = 36) received standard care, patients in the intervention group (IG) (n = 34) received an individualized pharmacotherapeutic care plan and diabetes education. The primary outcome measure was change in HbA1c. Secondary outcomes included diabetes and medication knowledge, adherence to medication, insulin injection and home blood glucose monitoring techniques and diabetes-related quality of life. Outcomes were evaluated at baseline and 6 months using questionnaires.

RESULTS:

Diabetes knowledge, medication knowledge, adherence to medication and correct insulin injection and home blood glucose monitoring techniques significantly improved in the intervention group but remained unchanged in the control group. At the end of the study, mean HbA1c values in the control group remained unchanged but were significantly reduced in the intervention group. Diabetes-related quality of life significantly improved in the intervention group but worsened significantly in the control group.

CONCLUSION:

The program improved health outcomes and resulted in better glycemic control in patients with type 2 diabetes undergoing insulin therapy.     

肺动脉高压患者生活质量及其影响因素

目的：了解肺动脉高压患者的生活质量状况并探讨其影响因素。方法：采用整群抽样的方法选择2014年6月至2015年6月期间在中南大学湘雅医院住院治疗的68例肺动脉高压患者作为研究对象。采用一般资料问卷、中文版简明健康调查量表(Short Form 36 Health Survey Questionnaire,SF-36)对其进行调查,运用单因素分析及多元线性回归法分析其影响因素。结果：肺动脉高压患者SF-36量表各维度评分均低于常模,差异均有统计学意义(P<0.05)。影响生活质量生理健康的因素为性别、6分钟步行试验距离(6-minute walking distance,6MWD)、是否合并右心衰竭、是否坚持氧疗;影响生活质量心理健康的因素为性别、文化程度、有无医疗保险。结论：肺动脉高压患者生活质量不高。医护人员应对女性、文化程度低、无医疗保险、6MWD短、合并右心衰竭、未坚持氧疗的患者给予更多的关注。     

音乐治疗加放松内心意象法对癌症化疗病人生活质量的影响

目的：通过临床实验验证自行编制的“音乐治疗加放松内心意象法”这种心理干预方法的效果。探讨心理干预能否提高癌症化疗病人的生活质量。方法：运用随机对照的方法,对260例化疗病人（实验组124例,对照组136例）进行了心理干预临床实验研究。采用中国癌症化疗患者生活质量量表（QLQ－CCC）及卡氏功能状态量表作为癌症化疗病人生活质量状况和心理干预效果的测查指标,在实验设计和病人筛选时对医学变量进行了控制,同时对心理变量也进行了控制。结果：癌症化疗病人的生活质量状况以化疗前最好,化疗后次之,化疗中最差。经过心理干预的癌症化疗病人,化疗后其生活质量各功能指标均明显提高,化疗中仅以心理情绪状况明显提高。结论：“音乐治疗加放松内心意象法”这种心理干预方法简便实用,可明显提高癌症化疗病人生活质量。     

透析治疗对肾衰患者生活质量影响的对照随访研究

目的：评价终末期肾衰患者生活质量改变及治疗方法对其生活质量的影响。方法：对腹膜透析、血液透析与保守内科治疗的终末期肾衰患者分别在治疗前后评价其生活质量。结果：透析患者躯体功能与非透析患者相比无显著性差异，但心理功能、社会功能与物质生活条件均显著地优于后者；透析治疗对肾衰患者生活质量各维度有着不同的影响，但对总分无显著性改善；血透与腹透病人的生活质量不同维度亦存在差异，但总分无明显判别，结论：在费用昂贵的血透与相对低廉的腹透之间，我们认为应选择腹膜透析作为肾脏替代疗法的首选疗法。     

Concordance therapy: an intervention to help older people take antidepressants

BACKGROUND: Older people often do not adhere fully to antidepressant medication. Compliance Therapy improves adherence with antipsychotic medication. OBJECTIVE: To adapt Compliance Therapy for use in older depressed patients, to pilot this 'Concordance Therapy' for feasibility and acceptability and to gain preliminary indications of its efficacy. METHODS: Randomised controlled trial (RCT). SETTING: Psychiatric services for older people in North London and Essex. PARTICIPANTS: A total of 19 older depressed patients. Intervention: 10 patients received Concordance Therapy over 3-4 sessions. CONTROL: 9 patients received treatment as usual. MAIN OUTCOME MEASURE: medication adherence at 1 month. Secondary outcome measures: medication adherence at 3 months; depression severity, beliefs about medication, quality of life at 1 and 3 months; patient feedback about the therapy. RESULTS: The therapy was acceptable to patients. Intervention patients were more likely to take antidepressants, had a higher quality of life, had less depressive symptomatology and were less likely to be cases of depression at 1 month. Beliefs around antidepressants at 1 month were more positive in the intervention group but this was not the case for medication in general. LIMITATIONS: As a pilot, patient numbers were small and the findings did not reach statistical significance. Three patients (1 intervention, 2 control) were in hospital and therefore offered medication at follow-up. CONCLUSION: Concordance Therapy for older people prescribed antidepressants is acceptable and feasible and shows sufficient promise of efficacy to justify an adequately powered RCT.     

综合医院护士WHOQOL—100调查

目的：研究不同护士群体生活质量的特点。方法：抽取武汉市某综合医院的护士574人，采用世界卫生组织生活质量评定量表（World Health Organization Quality of Life with 100 quesitons ,WHOQOL-100)进行评估。结果：与常模相比：除生理部分和社会关系部分，医疗服务与社会保障，休闲娱乐2个方面在统计学上无显著性差异外，其它4个部分和22个方面均有显著性差异，其中疼痛不适，睡眠休息，对药物及医疗手段依赖，性生活，环境条件5个方面低于常模,萁 余高于常模（P＜0．05），不同科室护士之间的疼痛不适，消极感觉，行动能力，医疗服务及经济来源与社会保障5个方面有显著性差异（均P＜0．05），不同年龄段护士在心理方面，积极感受，身材与相貌，行为能力，工作能力社会关系方面，社会帮助，住房环境，休闲娱乐有显著性差异，结论：护士的生活质量高于普通人群，五官，神经精神科护士的生活质量较高，不同科别及不同年龄段护士生活质量存在差异。     

Endoscopic ligation compared with combined treatment with nadolol and isosorbide mononitrate to prevent recurrent variceal bleeding

BACKGROUND: After an episode of acute bleeding from esophageal varices, patients are at high risk for recurrent bleeding and death. We compared two treatments to prevent recurrent bleeding--endoscopic ligation and combined medical therapy with nadolol and isosorbide mononitrate. METHODS: We randomly assigned 144 patients with cirrhosis who were hospitalized with esophageal variceal bleeding to receive treatment with endoscopic ligation (72 patients) or the combined medical therapy (72 patients). Sessions of ligation were repeated every two to three weeks until the varices were eradicated. The initial dose of nadolol was 80 mg orally once daily, with adjustment according to the resting heart rate; isosorbide mononitrate was given in increasing doses, beginning at 20 mg once a day at bed time and rising over the course of one week to 40 mg orally twice a day, unless side effects occurred. The primary end points were recurrent bleeding, complications, and death. RESULTS: The median follow-up period was 21 months. A total of 35 patients in the ligation group and 24 in the medication group had recurrent bleeding. The probability of recurrence was lower in the medication group, both for all episodes related to portal hypertension (P=0.04) and for recurrent variceal bleeding (P=0.04). There were major complications in nine patients treated with ligation (seven had bleeding esophageal ulcers and two had aspiration pneumonia) and two treated with medication (both had bradycardia and dyspnea) (P=0.05). Thirty patients in the ligation group died, as did 23 patients in the medication group (P=0.52). The probability of recurrent bleeding was lower for patients with a hemodynamic response to therapy, defined as a decrease in the hepatic venous pressure gradient of more than 20 percent from the base-line value or to less than 12 mm Hg (18 percent, vs. 54 percent in patients with no hemodynamic response at one year; P<0.001), and the probability of survival was higher (94 percent vs. 78 percent at one year, P=0.02). CONCLUSIONS: Combined therapy with nadolol and isosorbide mononitrate is more effective than endoscopic ligation for the prevention of recurrent bleeding and is associated with a lower rate of major complications. A hemodynamic response to treatment is associated with a better long-term prognosis.     

Gut-directed hypnotherapy for irritable bowel syndrome: piloting a primary care-based randomised controlled trial

BACKGROUND: In western populations irritable bowel syndrome (IBS) affects between 10% and 30% of the population and has a significant effect on quality of life. It generates a substantial workload in both primary and secondary care and has significant cost implications. Gut-directed hypnotherapy has been demonstrated to alleviate symptoms and improve quality of life but has not been assessed outside of secondary and tertiary referral centres. AIM: To assess the effectiveness of gut-directed hypnotherapy as a complementary therapy in the management of IBS. DESIGN OF STUDY: Randomised controlled trial. SETTING: Primary care patients aged 18-65 years inclusive, with a diagnosis of IBS of greater than 6 weeks' duration and having failed conventional management, located in South Staffordshire and North Birmingham, UK. METHOD: Intervention patients received five sessions of hypnotherapy in addition to their usual management. Control patients received usual management alone. Data regarding symptoms and quality of life were collected at baseline and again 3, 6, and 12 months post-randomisation. RESULTS: Both groups demonstrated a significant improvement in all symptom dimensions and quality of life over 12 months. At 3 months the intervention group had significantly greater improvements in pain, diarrhoea and overall symptom scores (P<0.05). No significant differences between groups in quality of life were identified. No differences were maintained over time. Intervention patients, however, were significantly less likely to require medication, and the majority described an improvement in their condition. CONCLUSIONS: Gut-directed hypnotherapy benefits patients via symptom reduction and reduced medication usage, although the lack of significant difference between groups beyond 3 months prohibits its general introduction without additional evidence. A large trial incorporating robust economic analysis is, therefore, urgently recommended.