抑郁障碍伴慢性功能性疼痛患者认知特征分析

目的：探讨抑郁障碍伴慢性功能性疼痛患者的认知特征。方法将32名抑郁障碍伴慢性功能性疼痛患者设为研究组,49名非抑郁障碍慢性功能性疼痛患者设为对照组,采用自动思维问卷、功能失调性态度问卷和疼痛应对方式问卷对两组患者的自动思维、功能失调性态度、疼痛应对方式进行测评分析。结果研究组自动思维问卷总均分、功能失调性态度问卷的7个因子分均显著高于对照组（P＜0．01）,认知哲学因子分显著低于对照组（P＜0．01）;疼痛应对方式问卷的灾难化、祈祷因子分均显著高于对照组（P＜0．01）,转移注意力因子分显著低于对照组（P＜0．05）。结论抑郁障碍伴慢性功能性疼痛患者存在显著的负性自动思维和功能失调性态度,对躯体疼痛症状更多地采用消极应对方式。     

肠易激综合征患者的人格情绪和应对方式研究

目的分析肠易激综合征患者人格、情绪、应对方式的特点,探讨精神心理因素与肠易激综合征的关系。方法采用艾森克人格简式问卷、简式简明心境问卷对120例肠易激综合征患者（研究组）与120例健康志愿者（对照组）的人格、情绪状况进行测评分析,采用医学应对问卷对120例肠易激综合征患者的医用应对方式进行测评,并与肝病及消化性溃疡患者国内常模进行对比分析。结果艾森克人格简式问卷测评,研究组神经质维度分显著高于对照组（t=4.63,P〈0.01）。简明心境问卷测评,研究组紧张-焦虑、抑郁-沮丧、愤怒-敌意、疲乏、迷惑-混乱因子分及总分均显著高于对照组（P〈0.01）,精力因子分显著低于对照组（P〈0.01）。医学应对问卷测评,研究组回避因子分均显著低于肝病及消化性溃疡患者（P〈0.01）,屈服因子分显著高于消化性溃疡患者（P〈0.05）。结论神经质人格、紧张、焦虑等负性情绪及消极应对方式与肠易激综合征密切相关。     

研究生自杀意念与人格特质及应对方式相关性研究

目的探讨在校研究生自杀意念与人格特质及应对方式的相关性,为制定有效干预措施提供理论依据。方法对武汉市某高校600名在校硕士研究生采用Beck自杀意念量表、简易应对方式问卷和艾森克人格问卷进行调查。结果回收有效问卷568份。1w内自杀意念发生率11．8％,最消沉时自杀意念发生率45．1％。艾森克人格问卷-外倾性维度分与自杀意念呈显著负相关（P〈0．01）,精神质和神经质维度分与自杀意念呈显著正相关（P〈0．01）,应对方式与自杀意念存在相关,与外倾性维度呈显著正相关（R=0．258）。多元回归分析显示,人格维度中的精神质、神经质、外倾性维度与最近1w自杀意念及最消沉最抑郁时自杀意念均显著相关。结论在校研究生自杀意念的产生与多种因素有关,其中应对方式及人格特质与自杀意念存在显著相关,对在校研究生积极开展有效的心理健康教育及心理干预,不断提高积极应对方式,可有效降低自杀意念的发生。     

地震灾区医务人员创伤事件应对方式与心理健康相关性研究

目的：探讨汶川地震2a后灾区医务人员心理健康状况及其与心理创伤、应对方式的相关性。方法对180名灾区医务工作者（研究组）和144名非灾区医务工作者（对照组）采用症状自评量表、埃森创伤问卷以及简易应对方式问卷进行测评分析。结果研究组症状自评量表评分和埃森创伤问卷总分及闯入、回避和分离症状评分均显著高于对照组（ P＜0．05或0．01）;两组积极应对和消极应对维度分比较差异无显著性（P＞0．05）;相关分析显示,研究组消极应对维度分与症状自评量表评分和埃森创伤问卷评分呈显著正相关（ P＜0．05或0．01）,积极应对维度分与症状自评量表总分及4个因子分呈显著正相关（ P＜0．05或0．01）,对照组无显著相关性（P＞0．05）。结论经历过地震的灾区医务人员的心理健康水平低于非灾区医务人员,不同应对方式对创伤后应激反应症状的发生有重要影响,可能会进一步影响应激者的心理健康水平。     

银行职员工作倦怠状况调查及其影响因素分析

目的 探讨银行职员工作倦怠状况及其影响因素,为制定有效的心理干预措施提供依据.方法 对492名银行职员采用中式工作倦怠量表、艾森克人格问卷、简易应对方式问卷、生活事件量表进行测评分析.结果 492名银行职员中349名(70.90%)存在工作倦怠,其中轻度倦怠180名(36.60%),中度倦怠151名(30.70%),重度倦怠18名(3.60%);中式工作倦怠量表情感耗竭维度评分与艾森克人格问卷内外倾维度评分呈显著负相关(P＜0.01),与神经质维度和简易应对方式问卷消极应对维度评分呈显著正相关(P＜0.01);人格解体维度评分与艾森克人格问卷精神质维度和简易应对方式问卷消极应对维度评分呈显著正相关(P＜0.01),与积极应对维度评分呈显著负相关(P＜0.01);成就感降低维度评分与艾森克人格问卷精神质维度评分呈显著正相关(P＜0.05),与内外倾维度和简易应对方式问卷积极应对维度评分呈显著负相关(P＜0.05或0.01);积极应对方式直接影响人格解体、成就感降低,消极应对方式直接影响情感耗竭、人格解体;个性特征既直接影响工作倦怠还可以通过影响应对方式对工作倦怠产生间接效应.结论 银行职员普遍存在工作倦怠,人格特征、应对方式对其工作倦怠状况有显著影响.     

癫痫患者配偶婚姻质量及其相关影响因素研究

目的探讨癫痫患者配偶婚姻质量及其相关影响因素,为制定心理干预措施提供依据。方法将93名癫痫患者配偶设为研究组,91名健康志愿者设为对照组,采用一般情况调查表、中国人婚姻质量问卷、艾森克人格问卷简式量表中国版、简易应对方式问卷对两组进行测评分析。结果研究组中国人婚姻质量问卷总分及各因子分均显著低于对照组（P〈0．01）;研究组中国人婚姻质量问卷总分与性别、病程、疾病严重程度、积极应对、消极应对因子分呈显著负相关（P〈0．05或0．01）,与癫痫发作类型、掩饰性因子分呈显著正相关（P〈0．05）;疾病严重程度、积极应对、年龄、病程、消极应对、学历、精神质、职业类型是预测研究组婚姻质量的主要因素。结论癫痫患者配偶婚姻质量水平较低,影响因素较多;在对患者进行治疗的同时应对其配偶进行综合干预,以提高患者及配偶的生活质量。     

服刑人员心理健康状况与应对方式的相关性

目的：探讨服刑人员心理健康状况与应对方式的相关性。方法对197名男性服刑人员（研究组）和193名当地男性居民（对照组）采用症状自评量表和应对方式问卷进行测评分析。结果研究组症状自评量表除敌对、恐怖因子外其他各因子分均显著高于对照组（ P＜0．05或0．01）;应对方式问卷解决问题及求助因子分显著低于对照组（P＜0．01）,自责、幻想、退避因子分显著高于对照组（P＜0．01）。研究组症状自评量表躯体化、人际关系敏感、偏执因子分与应对方式问卷解决问题因子分呈显著负相关（P＜0．05）,抑郁、焦虑因子分与自责因子分呈显著正相关（P＜0．01）,人际关系敏感因子分与求助因子分呈显著负相关（P＜0．05）,强迫症状、人际关系敏感、恐怖因子分与退避因子分呈显著正相关（ P＜0．05或0．01）。结论服刑人员存在不同程度的心理健康问题,心理健康水平与其采取不成熟的应对方式显著相关。     

大学生个性特征状况调查

目的探讨大学生的个性特征状况,为引导大学生的健康成长提供依据。方法采用艾森克人格问卷中国版对900名在校大学生进行调查分析。结果艾森克人格问卷中国版评分,女大学生精神质、神经质、掩饰性维度分均显著高于全国常模（P〈0．01）,男大学生神经质、掩饰性维度分均显著高于全国常模（P〈0．01）,女大学生掩饰性维度分显著高于男生（P〈0．05）,一、二年级大学生掩饰性维度分显著高于三、四年级大学生（P〈0．01）;不同专业大学生艾森克人格问卷各维度评分均有显著或极显著性差异（P〈0．05或0．01）。结论大学生人格特征与正常人群有显著差异性,不同专业大学生也存在显著性差异,高校教师应针对大学生的个性特征和心理健康状况,引导大学生健康成长。     

社交焦虑障碍患者人格特征及社会支持研究

目的探讨社交焦虑障碍患者的人格特征及社会支持特征。方法对38例社交焦虑障碍患者（研究组）及30名正常人（对照组）采用艾森克个性问卷和社会支持评定量表进行评定,并进行对比分析。结果研究组艾森克个性问卷的N、L维度分均显著高于对照组,E维度分显著低于对照组（P〈0．01）,社会支持评定量表总分及主观支持和对支持利用度因子分均显著低于对照组（P〈0．05或0．01）。结论社交焦虑障碍患者具有神经质、内向和过度掩饰的个性特征;且主观支持和对支持的利用度较低,需社会给予关注。     

失眠症患者心理健康状况调查

目的：了解失眠症患者的心理健康状况,为临床开展有针对性的心理干预提供依据。方法对58例失眠症患者（研究组）和54名健康志愿者（对照组）采用艾森克个性问卷、抑郁自评量表、焦虑自评量表、生活事件量表及社会支持评定量表进行测评分析。结果研究组艾森克个性问卷的内外向维度分显著低于对照组（P＜0．01）,神经质维度分显著高于对照组（P＜0．01）;抑郁自评量表、焦虑自评量表评分和生活事件量表的负性生活事件评分显著高于对照组（P＜0．01）;社会支持评定量表3个维度分均显著低于对照组（P＜0．01）。结论失眠症患者性格内向,存在抑郁、焦虑情绪,且负性生活事件较多,社会支持度较低,应对其予以有针对性的心理干预。     

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.     

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.     

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.     

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.     

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.