阿立哌唑与利培酮治疗精神分裂症对比分析

目的探讨阿立哌唑治疗精神分裂症的临床效果及安全性。方法将190例精神分裂症患者随机分为两组,分别给予阿立哌唑与利培酮治疗8周。采用阳性与阴性症状量表(PANSS)、不良反应量表(TESS)评定疗效及不良反应。结果阿立哌唑组治疗总有效率为80.21%,利培酮组为80.85%,两组比较差异无统计学意义(P>0.05)。但阿立哌唑组的不良反应稍低于利培酮组(P<0.05)。结论阿立哌唑与利培酮治疗首发精神分裂症的疗效相当,且阿立哌唑不良反应少。     

阿立哌唑与利培酮治疗精神分裂症的对照研究

目的:比较阿立哌唑与利培酮治疗精神分裂症的疗效和安全性。方法:将72例精神分裂症患者分为阿立哌唑组(n=36)和利培酮组(n=36)进行治疗,疗程8周。在治疗前及治疗后第1、2、4、8周末采用阳性阴性症状量表(PANSS)及不良反应量表(TESS)评定其疗效及药物不良反应。结果:阿立哌唑组有效率为63.9%,利培酮组有效率为61.1%,两组疗效差异无显著性。两药均无严重不良反应,但阿立哌唑组肌强直、静坐不能以及泌乳、月经紊乱的发生率明显低于利培酮组(P<0.05)。结论:阿立哌唑与利培酮治疗精神分裂症均有效,前者不良反应更少、更安全。     

阿立哌唑与利培酮治疗精神分裂症的对照研究

目的：比较阿立哌唑与利培酮治疗精神分裂症的疗效。方法：72例符合CCMD-3精神分裂症患者分为2组各36例，分别予阿立哌唑(A组)和利培酮(B组)治疗6周，采用阳性症状与阴性症状量表及不良反应症状量表评定疗效与副反应。结果：2组疗效及不良反应发生率比较差异无显著性意义。结论：阿立哌唑和利培酮对精神分裂症疗效相当，副反应差异亦不显著；但在锥体外系反应、内分泌改变及体重增加方面，阿立哌唑优于利培酮。     

阿立哌唑与利培酮治疗女性精神分裂症对照观察

目的 探讨阿立哌唑治疗女性精神分裂症的临床疗效及安全性.方法 将124例女性精神分裂症患者随机分为两组,每组62例.阿立哌唑组口服阿立哌唑治疗,利培酮组口服利培酮治疗.观察8周.于治疗前及治疗第2周、4周、8周末采用阳性与阴性症状量表评定临床疗效,副反应量表评定不良反应.结果 治疗8周末,阿立哌唑组显效率70.97%、有效率90.32%,利培酮组分别为64.52%、87.10%,两组比较差异均无显著性(χ2=0.59、0.32,P＞0.05);两组不良反应均轻微,但阿立哌唑组锥体外系反应、体质量增加、泌乳和闭经等不良反应发生率低于利培酮组.结论 阿立哌唑治疗女性精神分裂症患者疗效显著,与利培酮疗效相当,且安全性更高.     

阿立哌唑治疗精神分裂症的随机双盲对照试验

【目的】评价阿立哌唑治疗精神分裂症的疗效及安全性。【方法】收集精神分裂症患者38例,采用随机、双盲、双模拟、利培酮平行对照研究,阿立哌唑组18例与利培酮组20例分别口服阿立哌唑10~30 mg/d与利培酮2~6 mg/d,疗程42 d。【结果】治疗结束时,两组PANSS总分与BPRS总分较治疗前均显著降低(P<0.01);阿立哌唑组与利培酮组PANSS总分减分率分别为(72.3±21.1)%和(66.2±31.4)%,差异无显著性(P>0.05)。临床总有效率:阿立哌唑组88.9%,利培酮组65.0%,差异无显著性(P>0.05)。阿立哌唑常见的不良反应为:失眠、心动过速、口干、肌强直、便秘、震颤,发生率与利培酮相当。【结论】国产阿立哌唑治疗精神分裂症的疗效及不良反应与利培酮相似,是一种安全而有效的抗精神病药。     

阿立哌唑治疗首发精神分裂症对照研究

目的：对比阿立哌唑与利培酮治疗首发精神分裂症的疗效和安全性。方法：分别用阿立哌唑与利培酮治疗首发精神分裂症各32例，采用阳性症状与阴性症状量表(PANSS)，副反应量表(TESS)，在治疗前及治疗后第1、2、6、8周末分别评定疗效及不良反应。结果：阿立哌唑有效率93．75％，显效率68.75％，利培酮有效率96.88％，显效率71．88％。两组治疗后与治疗前的PANSS评分比较差异有显著性。阿立哌唑与利培酮疗效相仿，而阿立哌唑不良反应少而轻。结论：阿立哌唑治疗精神分裂症疗效好，且安全性较高。     

阿立哌唑与哌罗匹隆治疗精神分裂症对比分析

目的探讨阿立哌唑治疗精神分裂症的临床效果及安全性。方法将278例精神分裂症患者随机分为两组,分别给予阿立哌唑与哌罗匹隆治疗8周。采用阳性与阴性症状量表(PANSS)、副反应量表(TESS)评定疗效及不良反应。结果阿立哌唑组治疗总有效率为82.6%,哌罗匹隆组为82.1%,两组比较差异无统计学意义(P>0.05)。但阿立哌唑组的不良反应低于哌罗匹隆组(P<0.05)。结论阿立哌唑与哌罗匹隆治疗首发精神分裂症的疗效相当,且阿立哌唑不良反应少。     

阿立哌唑与利培酮治疗老年期精神分裂症对照研究

目的：比较阿立哌唑与利培酮治疗老年期精神分裂症患者的临床疗效和安全性。方法：对60例老年期精神分裂症的住院患者随机分为两组，分别用阿立哌唑和利培酮治疗8周。采用阳性与阴性症状量表（PANSS）评定疗效，用副反应量表（TESS）评定不良反应。结果：阿立哌唑与利培酮治疗老年期精神分裂痖患者的临床疗效差异无显著性。阿立哌唑不良反应均少而轻。结论：阿立哌唑治疗老年期精神分裂症疗效好，起效快，不良反应少。     

阿立哌唑与利培酮治疗精神分裂症对照研究

目的探讨阿立哌唑治疗精神分裂症的疗效及安全性。方法将100例精神分裂症患者随机分为两组各50例,分别给予阿立哌唑与利培酮治疗,疗程6w。于治疗前及治疗2w、4w、6w末采用阳性与阴性症状量表、副反应量表评定临床疗效及不良反应。结果治疗6w末阿立哌唑组显效率80%,有效率90%;利培酮组分别为84%和96%,两组差异均无显著性(χ2=0.271,1.382,P均>0.05)。阳性与阴性症状量表评分于治疗第2w末起两组总分及各因子分均较治疗前有显著下降,并随着治疗时间的延长,疗效进一步增加,同期组间比较差异无显著性。均未发生严重不良反应,但阿立哌唑组锥体外系症状、体重增加发生率显著低于利培酮组,心动过速发生率显著高于利培酮组(P<0.01)。结论阿立哌唑治疗精神分裂症疗效与利培酮相当,安全性高,依从性好。     

阿立哌唑及利培酮治疗男性精神分裂症的疗效及对性功能的影响

[目的]探讨阿立哌唑治疗精神分裂症的疗效及对男性性功能的影响.[方法]将84例已婚男性精神分裂症患者随机分为两组各42例,分别给予阿立哌唑与利培酮治疗,疗程12周.于治疗前及治疗4周、6周、12周末采用阳性与阴性症状量表(PANSS)、副反应量表(TESS)及性功能评定评价临床疗效及不良反应.[结果]治疗12周末阿立哌唑组显效率81%,有效率92.9%;利培酮组显效率78.6%,有效率90.5%,两组显效率与有效率比较差异均无显著性(P均>0.05).治疗12周后阿立哌唑组性唤起因子分、性功能总分显著高于利培酮组(P<0.01).在入组后4周,8周及12周,利培酮组的性欲、性唤起、性高潮及性功能总分均显著低于基线值(P<0.01).[结论]阿立哌唑治疗精神分裂症疗效与利培酮相当,安全性高,对男性性功能影响小,依从性好     

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.     

Prospects for the control of neglected tropical diseases by mass drug administration

The prospects for the control of neglected tropical diseases, including soil-transmitted helminthiasis, shistosomiasis, lymphatic filariasis, onchocerciasis and trachoma, through mass drug administration, are exemplified by the elimination of the trachoma as a public-health problem in Morocco. In spite of this and other striking successes, mass drug administration programs are faced with major challenges resulting from suboptimal coverage and lack of efficacy. At current suboptimal coverage rates, programs may need prolongation for an extended period, increasing costs and undermining sustainability. Community participation through health education and information appears to be crucial to improve coverage and to achieve sustainability. Implementation of complementary measures, such as vector control, improved hygiene and environmental sanitation, are important to further control transmission and to prevent re-emergence of the infection and, again, may only be achieved effectively through community-based initiatives. To reduce costs and to relieve pressure on the health system, combining neglected tropical disease programs in areas where diseases coexist and integration with existing control programs for malaria, tuberculosis and HIV/AIDS is advocated. The risk of developing drug resistance is of particular concern in view of the lack of alternative drugs, and reduced treatment efficacy due to emerging resistance is evident for the soil-transmitted helminths and onchocerciasis. Given the risk for the development of drug resistance and the need for a high degree of participation, close attention should be paid to the monitoring of the coverage and efficacy of the different program components.     

Bacterial meningitis: an update of new treatment options

The outcome of bacterial meningitis critically depends on the rapid initiation of bactericidal antibiotic therapy and adequate management of septic shock. In community-acquired meningitis, the choice of an optimum initial empirical antibiotic regimen depends on the regional resistance patterns. Pathogens resistant to antibacterials prevail in nosocomial bacterial meningitis. Dexamethasone is recommended as adjunctive therapy for community-acquired meningitis in developed countries. In comatose patients, aggressive measures to lower intracranial pressure <20 mmHg (in particular, external ventriculostomy, osmotherapy and temporary hyperventilation) were effective in a case–control study. Although many experimental approaches were protective in animal models, none of them has been proven effective in patients. Antibiotics, which are bactericidal but do not lyse bacteria, and inhibitors of matrix metalloproteinases or complement factor C5 appear the most promising therapeutic options. At present, vaccination is the most efficient method to reduce disease burden. Palmitoylethanolamide appears promising to enhance the resistance of the brain to infections.     

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.     

Imaging choices in occult hip fracture

Background: Hip fracture is a common injury, with an incidence rate of > 250,000 per year in the United States. Diagnosis is particularly important due to the high dependence on the integrity of the hip in the daily life of most people. Objectives: In this article we review the literature focused on hip fracture detection and discuss advantages and limitations of each major imaging modality. Discussion: Plain radiographs are usually sufficient for diagnosis as they are at least 90% sensitive for hip fracture. However, in the 3–4% of Emergency Department (ED) patients having hip X-ray studies who harbor an occult hip fracture, the Emergency Physician must choose among several methods, each with intrinsic limitations, for further evaluation. These methods include computed tomography, scintigraphy, and magnetic resonance imaging. Conclusion: We present an evidence-based algorithm for the evaluation of a patient suspected to have an occult hip fracture in the ED. Also outlined are future directions for research to distinguish more effective techniques for identifying occult hip fractures.     

Systematic Reviews Published in the April 2012 Issue of the Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD but monthly online. The April 2012 issue (second DVD for 2012) contains 5045 complete reviews, 2182 protocols for reviews in production, and 17,084 short summaries of systematic reviews published in the general medical literature. In addition, there are citations of 674,000 randomized controlled trials, and 15,400 cited papers in the Cochrane methodology register. The health technology assessment database contains just over 11,000 citations. One hundred and seventeen new reviews have been published in the last 3 months of which 12 have potential relevance for practitioners in pain and palliative medicine. The impact factor of the Cochrane Library stands at 6.186. Readers are encouraged to access the full report for any articles of interest as only a brief commentary is provided.     

Platelets,thrombosis, coagulation,and atherosclerosis

When I first got the invitation to join a medical delegation going to Moldova, I thought for a moment that our destination was the fictional country in the old Marx Brothers movie Duck Soup. On further checking, it turns out that entertaining place was called Freedonia. I now know that Moldova is indeed a real country, bordered on the west by Romania and on the other three sides by the Ukraine. It is a proud country, rich with traditions, and its people are warm, giving, eager to learn ways to improve their healthcare system, and deeply appreciative of our attempts to help them in the task.