护理干预对膀胱癌患者焦虑抑郁状态的影响

目的:探讨护理干预对膀胱癌(BC)患者焦虑、抑郁状态的影响。方法:采用Zung焦虑自评量表(SAS)、抑郁自评量表(SDS)对46例BC患者护理干预前后的焦虑和抑郁状态进行调查分析并比较。结果:46例BC患者护理干预前SAS评分和SDS评分与国内常模比较差异有统计学意义(P<0.01);护理干预后患者焦虑、抑郁发生率及SAS评分、SDS评分均低于护理干预前(P<0.05,P<0.01)。结论:BC患者存在明显的焦虑、抑郁状态,在临床治疗过程中给予积极护理干预可有效缓解其焦虑、抑郁情绪。     

糖尿病患者200例焦虑抑郁状况调查

目的分析糖尿病患者的心理特点,为临床治疗和心理护理提供依据。方法用Zung焦虑自评量表(SAS)、Zung抑郁自评量表(SDS),对收住入院的200例糖尿病患者进行心理问卷调查,将测试结果与国内常模进行比较,并从不同性别、年龄、经济状况、文化程度及病程方面进行心理状况的分析。结果糖尿病患者SAS评分(45.18±9.64)、SDS评分(51.81±12.18)与国内常模比较,差异有统计学意义(P<0.01),且男女之间、不同年龄段、文化程度、经济状况之间的SAS、SDS评分比较,差异具有统计学意义。结论糖尿病患者常存在焦虑、抑郁心理,且受性别、年龄、文化程度和经济状况的影响。     

心理干预对缓解膀胱癌Bricker术后患者焦虑抑郁状态的影响

目的:探讨心理干预对缓解膀胱癌患者膀胱全切加回肠膀胱术(Bricker)术后患者焦虑抑郁状态的影响,为临床治疗提供客观依据.方法:对27例膀胱癌患者行Bricker手术,并在常规护理基础上给予系统的心理干预,于心理干预前后应用Zung焦虑自评量表(SAS)和抑郁自评量表(SDS)进行评分.结果:心理干预前患者平均SAS、SDS评分与国内常模比较,差异有统计学意义(P<0.01,P<0.05);心理干预后患者焦虑抑郁发生率及评分均低于干预前(P<0.01,P<0.05).结论:对膀胱癌Bricker手术患者实行心理干预能减轻其焦虑抑郁情绪,提高患者生活质量.     

人文关怀护理对维持性血透患者焦虑抑郁情绪的影响

目的 探讨人文关怀护理对维持性血透患者焦虑抑郁情绪的影响.方法 将196例维持性血透患者随机分为对照组和观察组,对照组按血透护理常规护理,观察组在对照组的基础上实施人文关怀护理,分别于干预前、干预后采用Zung焦虑自评量表(SAS)、抑郁自评量表(SDS)测量患者焦虑抑郁程度.结果 干预前两组患者的SAS、SDS评分无统计学意义,干预后观察组的SAS、SDS评分明显降低,而对照组下降不明显.结论 人文关怀护理能缓解维持性血透患者的焦虑抑郁情绪.     

综合护理干预对颈椎间盘突出症患者焦虑抑郁情绪的影响

目的 探讨综合护理干预对颈椎间盘突出症患者焦虑、抑郁情绪的影响.方法 将符合颈椎间盘突出症诊断标准的80例患者随机分为观察组和对照组各40例,观察组在常规治疗和护理的基础上给予综合护理干预,包括支持性干预、行为干预、教育性干预、集体干预、家庭干预、放松疗法、娱乐疗法等,对照组给予常规治疗护理及健康教育.应用Zung氏焦虑自评量表(SAS)和抑郁自评量表(SDS)评定颈椎间盘突出症患者焦虑抑郁情绪.结果 观察组经上述干预后,焦虑抑郁情绪明显减轻,SAS、SDS评分明显低于对照组,差异有统计学意义(P＜0.01);对照组SAS、SDS评分降低不明显,无统计学意义(P＞0.05);干预后观察组评分明显低于对照组(P＜0.01).结论 对颈椎间盘突出症患者实施综合护理干预后其焦虑抑郁情绪得到有效改善,值得推广.     

糖尿病患者焦虑抑郁分析及其干预

目的 探讨糖尿病患者焦虑、抑郁的发病率,并观察综合干预的效果.方法 采用Zung焦虑自评量表(SAS)及抑郁自评量表(SDS)对69例糖尿病患者进行问卷调查,然后进行为期8周的药物和心理综合干预,再进行复查.结果 糖尿病患者存在不同程度的抑郁及焦虑,经8周综合干预后,SAS及SDS评分分别由(47.35±8.72)分和...     

心理行为干预对维持性血液透析病人生活质量的影响

[目的]探讨心理行为干预对血液透析病人生活质量的影响.[方法]将60例血液透析病人随机分为两组,对照组28例,干预组32例,对干预组进行心理行为干预.应用生活质量综合评定问卷(GQOLI)、Zung焦虑自评量表 (SAS)及Zung抑郁自评量表 (SDS)对两组病人干预前后进行评定.[结果]两组GQOLI、SAS、SDS评分比较差异有统计学意义(P<0.05或P<0.01);干预组干预前后GQOLI、SAS、SDS评分比较差异有统计学意义(P<0.05或P<0.01).[结论]心理行为干预能有效改善血液透析病人的生活质量.     

抑郁症患者焦虑程度的调查及社区健康教育

目的了解抑郁症患者的焦虑程度及社区健康教育对患者的影响。方法2001年10月～2002年10月,在顺德新桂社区对122例抑郁症患者,应用抑郁自评、Zung氏焦虑量表(SAS、SDS)进行焦虑程度调查,并进行了社区健康教育,教育前后测定患者焦虑及抑郁程度,并进行比较。结果抑郁症患者在干预前的SAS、SDS评分均高于我国常模,健康教育干预前后的SAS、SDS评分结果比较,均P<0.01,差异有统计学意义。结论社区健康教育有利于减轻抑郁症患者的焦虑、抑郁情绪,从而也提高了治疗的效果。     

中医情志护理路径干预对中风患者负性情绪的影响

目的:探讨中医情志护理路径干预对中风患者负性情绪的影响。方法:将符合纳入标准的120例中风患者随机分为干预组和对照组各60例,干预组采取中风患者情志护理路径进行护理干预;对照组给予中风患者常规心理护理。分别评价各组入院第1、7、14天Zung氏抑郁自评量表(SDS)、Zung氏焦虑自评量表(SAS)评分、神经功能缺损(CSS)评分,比较两组护理疗效。结果:干预第7、14天,干预组在改善抑郁程度、焦虑程度及SAS评分、SDS评分明显优于对照组(P0.01);干预第14天,干预组CSS评分明显优于对照组(P0.05)。结论:中医情志护理方案能有效改善中风后患者抑郁、焦虑为主的负性情绪,促进神经功能康复。     

CCU急性冠状动脉综合征病人焦虑与抑郁现状调查

[目的]了解冠心病监护病房(CCU)急性冠状动脉综合征(ACS)病人焦虑与抑郁状况.[方法]采用Zung焦虑自评量表(SAS)和抑郁自评量表(SDS)对CCU 48例ACS病人进行问卷调查.[结果]SDS总分高于国内常模,19例病人出现抑郁,占39.6%;SAS总分与国内常模相近,3例病人出现焦虑,占6.3%.不同年龄ACS痛人抑郁评分比较差异有统计学意义.[结论]应关注ACS病人焦虑与抑郁状况,提高CCU病人护理质量.     

创伤高血糖与感染和MODS早期诊断和干预

本文详细介绍了创伤后血糖应激适度理论,以及高血糖与感染和多器官功能不全综合征的关系;提出涉及胰岛B细胞功能不全的MODS实验诊断新方案和极化液个体化干预新措施,可早期发现创伤MODS、降低感染率及MODS发生率和病死率。     

腹膜后纤维化与肾积水发生关系的临床研究

目的：探讨腹膜后纤维化（RPF）导致肾积水的原因及诊治经验。方法：回顾分析2004年1月—2010年12月24例腹膜后纤维化致肾积水患者的诊治资料。结果：（1）RPF患者常见首发症状为腰背痛或腹痛（69.2%）;（2）红细胞沉降率（ESR）增快和血清IgG4升高最常见。超声检查仅提示上尿路积水。RPF的静脉肾盂造影（IVP）和CT尿路成像（CTU）表现具有特征性。IVP肾盂输尿管显影不良时,CTU能较清晰的显示上尿路影像。CT扫描发现腹膜后软组织肿块9例（37.5%）,优于超声检查;（3）输尿管松解和腹腔化手术治疗22例;行肾切除术1例;行输尿管置双J管术1例。最终确诊为继发性RPF8例,其中4例为术前诊断,3例为术中腹膜后软组织肿块冷冻活检证实,1例为术后病理证实;（4）特发性RPF手术后肾积水均获长期缓解,而继发性RPF的预后取决于原发疾病及其治疗方案。结论：影像学检查是诊断RPF的重要手段,CTU优于超声检查和IVP。输尿管松解和腹腔化手术可以使特发性RPF输尿管梗阻得到长期的缓解,术中对肿块进行冷冻活检有助于鉴别特发性和继发性RPF,及时调整治疗方案。     

Fibrinogen and fibrin structure and functions

Fibrinogen molecules are comprised of two sets of disulfide-bridged Aalpha-, Bbeta-, and gamma-chains. Each molecule contains two outer D domains connected to a central E domain by a coiled-coil segment. Fibrin is formed after thrombin cleavage of fibrinopeptide A (FPA) from fibrinogen Aalpha-chains, thus initiating fibrin polymerization. Double-stranded fibrils form through end-to-middle domain (D:E) associations, and concomitant lateral fibril associations and branching create a clot network. Fibrin assembly facilitates intermolecular antiparallel C-terminal alignment of gamma-chain pairs, which are then covalently 'cross-linked' by factor XIII ('plasma protransglutaminase') or XIIIa to form 'gamma-dimers'. In addition to its primary role of providing scaffolding for the intravascular thrombus and also accounting for important clot viscoelastic properties, fibrin(ogen) participates in other biologic functions involving unique binding sites, some of which become exposed as a consequence of fibrin formation. This review provides details about fibrinogen and fibrin structure, and correlates this information with biological functions that include: (i) suppression of plasma factor XIII-mediated cross-linking activity in blood by binding the factor XIII A2B2 complex. (ii) Non-substrate thrombin binding to fibrin, termed antithrombin I (AT-I), which down-regulates thrombin generation in clotting blood. (iii) Tissue-type plasminogen activator (tPA)-stimulated plasminogen activation by fibrin that results from formation of a ternary tPA-plasminogen-fibrin complex. Binding of inhibitors such as alpha2-antiplasmin, plasminogen activator inhibitor-2, lipoprotein(a), or histidine-rich glycoprotein, impairs plasminogen activation. (iv) Enhanced interactions with the extracellular matrix by binding of fibronectin to fibrin(ogen). (v) Molecular and cellular interactions of fibrin beta15-42. This sequence binds to heparin and mediates platelet and endothelial cell spreading, fibroblast proliferation, and capillary tube formation. Interactions between beta15-42 and vascular endothelial (VE)-cadherin, an endothelial cell receptor, also promote capillary tube formation and angiogenesis. These activities are enhanced by binding of growth factors like fibroblast growth factor-2 (FGF-2) and vascular endothelial growth factor (VEGF), and cytokines like interleukin (IL)-1. (vi) Fibrinogen binding to the platelet alpha(IIb)beta3 receptor, which is important for incorporating platelets into a developing thrombus. (vii) Leukocyte binding to fibrin(ogen) via integrin alpha(M)beta2 (Mac-1), which is a high affinity receptor on stimulated monocytes and neutrophils.     

Migraine and genetic and acquired vasculopathies

It is remarkable that migraine is a prominent part of the phenotype of several genetic vasculopathies, including cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL), retinal vasculopathy with cerebral leukodystrophy (RVCL) and hereditary infantile hemiparessis, retinal arteriolar tortuosity and leukoencephalopahty (HIHRATL). The mechanisms by which these genetic vasculopathies give rise to migraine are still unclear. Common genetic susceptibility, increased susceptibility to cortical spreading depression (CSD) and vascular endothelial dysfunction are among the possible explanations. The relation between migraine and acquired vasculopathies such as ischaemic stroke and coronary heart disease has long been established, further supporting a role of the (cerebral) blood vessels in migraine. This review focuses on genetic and acquired vasculopathies associated with migraine. We speculate how genetic and acquired vascular mechanisms might be involved in migraine.     

Telemedicine and teleradiology technologies and applications

Summary. Telemedicine and teleradiology hold the key for improving future health care delivery. In this paper we first review current communication and computer technologies used in telemedicine and teleradiology. Five examples in teleradiology applications are given including hospital-integrated picture archiving and communication systems, tele-neuro-imaging, telemammography, university consortium teleradiology service, and teleradiology for second opinion. Parameters important to teleradiology applications like costs, image quality, system reliability, and turn around time are considered. Data security is discussed, including patient confidentiality and image authenticity-which will be a major issue in future teleradiology applications.     

Physician and Nurse Practitioner Teamwork and Job Satisfaction: Gender and Profession

Designing interprofessional primary care teams composed of physicians and nurse practitioners (NPs) is a national priority. We assessed how profession and gender affect teamwork and job satisfaction among primary care physicians and NPs by using survey data from 186 physicians and 398 NPs practicing in New York State. Our regression models show profession (NP vs physician) moderates the associations of gender with teamwork and job satisfaction. Among NPs, men had higher job satisfaction than women. Among physicians, women had higher job satisfaction than men. Our results can benefit interprofessional primary care teams to optimize their professional and gender mix.     

Acetaminophen and acetylcysteine dose and duration: Past,present and future

Abstract

Acetylcysteine has been utilized successfully in the treatment of acetaminophen overdose since the 1970s. Although prospective trials as to efficacy and safety of acetylcysteine were conducted, there were no randomized controlled trials. This commentary addresses the reasons for this, and the background to choice of dose of acetylcysteine utilized in the oral and IV dosing regimens. Nomograms to predict possible hepatotoxicity based upon time of ingestion of acetaminophen were developed from a relatively arbitrary definition of toxicity as an aspartate aminotransferase/alanine aminotransferase (ALT/AST) greater than 1000 IU/L. While these have proved generally useful, patients still continue to develop hepatic damage after acetaminophen overdose, particularly if they present late after ingestion. The optimum management of these patients remains unclear, and one area of uncertainty is the dose and duration of acetylcysteine in various circumstances. This article discusses the issues that need to be elucidated to better target changes in acetylcysteine dose. The potential for measurements of other markers to improve treatment selection is the subject of further research.     

Trust and distrust between patient and doctor

To trust someone is to have expectations of their behaviour; distrust often involves disappointed expectations. But healthy trust and distrust require a good understanding of which expectations are reasonable, and which are not. In this paper, I discuss the limits of trustworthiness by drawing on recent studies of trust in the context of defensive medicine, biobanking and cardiopulmonary resuscitation decisions.