脑卒中后认知障碍与抑郁的相关因素分析

目的 探讨脑卒中后认知功能障碍患者的抑郁情绪与各种因素之间的关系.方法 对1997～2004年间住院脑卒中患者入院时进行老年认知功能量表（SECF）、自评抑郁量表（SDS）、自评焦虑量表（SAS）和日常生活能力量表（ADL）检测.SECF≤90分236例中SDS≥50分为抑郁组（72例）;SDS〈50分为非抑郁组（164例）.2个月后复查4种量表.记录患者入院时SECF、ADL、SAS,以及SECF、ADL、SAS和SDS前后差值共7个变量,分别以其中1个变量为因变量,其他6个变量为自变量进行多元逐步回归.结果 抑郁组患者抑郁情绪的改善及ADL能力的提高有助于降低焦虑、提高认知功能（P〈0.05）.改善焦虑情绪、提高认知功能有助于减轻抑郁、提高ADL（P〈0.05）.SDS与ADL差值、SAS与SECF差值呈负相关（P〈0.05）.结论 住院康复治疗中减轻抑郁、焦虑情绪,提高日常生活能力和认知功能应同时进行,能起到互相促进作用,更好地治疗脑卒中后认知功能障碍.     

治疗性沟通系统对急性脑卒中患者焦虑抑郁情绪和治疗依从性的护理干预

目的：探讨治疗性沟通系统对急性脑卒中患者焦虑抑郁情绪和治疗依从性的干预效果。方法将62例急性脑卒中患者随机分为对照组30例和干预组32例。对照组采用常规护理方法,干预组在常规护理方法的基础上实施治疗性沟通系统。2组干预前采用焦虑自评量表（SAS）、抑郁自评量表（SDS）进行调查;2组干预后采用SAS、SDS、治疗依从性调查表进行调查。结果干预后2组患者SAS、SDS评分与本组干预前比较均显著下降,差异有统计学意义（P＜0．05）;组间比较,干预组下降程度显著高于对照组（P＜0．05）。干预组患者治疗完全依从性显著高于对照组（P＜0．05）,治疗不依从性显著低于对照组（P＜0．05）。结论治疗性沟通系统能有效改善急性脑卒中患者的焦虑抑郁情绪,提高患者治疗依从性。     

心理干预对脑卒中长期卧床患者照顾者负性情绪的影响

目的：探讨心理干预对脑卒中长期卧床患者照顾者负性情绪的影响。方法：选择脑卒中长期卧床患者照顾者52例,随机分为干预组和对照组各26例,2组均给予药物维持治疗,应用照顾者压力指标（CSI）及焦虑自评量表（SAS）、抑郁自评量表（SDS）评估患者照顾者的负性情绪及压力源,并针对性给予干预组心理护理干预。结果：52例照顾者的负性情绪的压力源主要来自于患者家属（82．7％）、照顾者自身经济状况（75．0％）及身体素质（71．2％）等。干预1个月后,干预组焦虑及抑郁例数均较干预前及对照组明显下降（ P＜0．05）。对照组干预前后比较差异无统计学意义。结论：心理干预能够改善脑卒中长期卧床患者照顾者的负性情绪。     

心理干预对康复期脑卒中伴焦虑抑郁障碍患者情绪及幸福感的影响

目的：探讨心理干预对康复期脑卒中伴焦虑抑郁障碍患者情绪及幸福感的影响。方法将120例康复期脑卒中伴抑郁焦虑障碍患者随机分为两组,每组60例。两组均予以神经内科常规治疗及训练,研究组联合心理干预,观察12个月。于干预前后采用焦虑自评量表、抑郁自评量表评定焦虑抑郁情绪,症状自评量表评定心理健康状况,总体幸福感指数量表评定幸福感, Barthel指数量表评定日常生活活动能力;干预12个月评估两组患者的治疗依从性。结果干预前两组各量表评分比较差异无显著性（ P＞0．05）;干预12个月两组焦虑自评量表、抑郁自评量表及症状自评量表评分较干预前显著降低（P＜0．01）,研究组显著低于对照组（P＜0．01）;干预后各时间点两组Barthel指数量表评分和研究组总体幸福感指数量表评分较干预前显著升高（P＜0．01）,研究组显著高于对照组（P＜0．01）。干预后研究组依从率为96．7％,对照组为81．7％,研究组显著高于对照组（ P＜0．01）。结论心理干预能有效缓解或消除脑卒中患者的焦虑抑郁情绪,提高其心理健康水平、总体幸福感及日常生活活动能力,有利于疾病的预后。     

510例脑卒中患者的抑郁、焦虑及其相关因素分析

目的探讨脑卒中后抑郁、焦虑与各种因素之间的关系.方法对1997～2004年住院治疗的510例脑卒中患者在入院后7 d内进行老年认知功能量表（SECF）、自评抑郁量表（SDS）、自评焦虑量表（SAS）和日常生活能力量表（ADL）检测,两个月后复查.结果抑郁组患者病程长、左侧偏瘫比例高,入院时ADL评分低、SAS评分高,与非抑郁组有显著性差异,抑郁情绪与认知功能之间无明显关联;焦虑组患者入院时ADL评分低、SDS评分高,ADL评分提高幅度大,与非焦虑组有显著性差异;病程长者抑郁评分降低的幅度小;治疗后,抑郁组和焦虑组患者的抑郁及焦虑评分降低的幅度明显大于非抑郁组和非焦虑组.结论早期住院康复治疗有助于减轻抑郁;轻微焦虑情绪可以提高ADL能力;抑郁和焦虑密切相关.     

颌面肿瘤患者术后情绪障碍的评估及心理行为干预对情绪的影响

目的：对颌面肿瘤患者手术前后的心理状况进行评估，保持心理行为干预前后患者情绪（SDS积分）的变化。方法：将62例颌面肿瘤患者按术后颜面及功能改变情况分为轻度（n=36)和中度（n=26)两组。应用焦虑自评量表（SAS），抑郁自评量表（SDS）、症状自评量表（SCL－90）量表随机对其进行术后心理状况调查以及对SDS＞40分的患者进行干预后再进行SDS评定。结果：（1）轻度和中度以上两组比较，SAS、SDS和SCL－90的躯体化、人际关系、抑郁、敌意、其他因子差异均有显著性（P＜0．01）。（2）术后SDS＞40分的患者心理行为干预前、后比较SDS差异有显著性（P＜0．001）。结论：颌面肿瘤患者术后颜面及功能改变严重的患者，其抑郁、焦虑情绪反应较轻度改变者明显，且术后患者抑郁情绪在进行心理行为干预后得到了明显的改善。     

脑卒中后认知障碍及相关因素分析

目的 探讨脑卒中后认知功能障碍与各种因素之间的关系。方法 对1997～2004年住院的脑卒中患者进行老年认知功能量表（SECF）、自评抑郁量表（SDS）、自评焦虑量表（SAS）和日常生活活动能力量表（ADL）检测，SECF≤90分为脑卒中后认知障碍，2个月后复查以上量表，分别以性别、年龄、受教育年限、病程、病因、偏瘫侧、SECF1、SECF3、ADL1、ADL3、SAS1、SAS3、SDS1和SDS314个变量中的1个变量为因变量，其他13个变量为自变量进行多元逐步回归分析。结果 脑卒中后认知障碍患者住院2个月后SECF、ADI。明显提高，SAS、SDS明显降低（P=0．000）；年老患者中女性、脑梗死比例增高，ADL能力降低（P〈0．05）；人院前病程长者，抑郁分高，ADL可提高的幅度小（P〈0．05）；ADL高者焦虑情绪少（P=0．028）。结论 早期人院康复治疗有助于提高脑卒中患者的日常生活能力，降低抑郁情绪。     

认知干预对老年脑血管疾病患者情绪及治疗依从性的影响

目的：探讨认知干预对老年脑血管疾病患者情绪及治疗依从性的影响。方法将122例老年脑血管疾病患者根据抽签结果随机分为两组,每组61例。两组均予以常规治疗护理及康复训练,观察组在此基础上联合认知干预,观察1个月。于干预前后采用焦虑自评量表和抑郁自评量表评定焦虑抑郁情绪,干预后根据患者的遵医行为评定治疗依从性。结果干预前两组焦虑自评量表和抑郁自评量表评分比较差异无显著性（P＞0．05）;干预后两组均较干预前显著降低（P＜0．01）,观察组显著低于对照组（P＜0．01）。干预后观察组治疗依从率为86．9％,对照组为65．6％,观察组显著高于对照组（ P＜0．01）。结论认知干预能显著改善老年脑血管疾病患者的焦虑抑郁情绪及治疗依从性。     

综合干预对脑卒中患者焦虑抑郁情绪的影响

目的探讨综合干预对脑卒中患者焦虑抑郁情绪的影响。方法将56例脑卒中患者随机分为两组,观察组27例,对照组29例。两组均给予神经内科常规治疗和肢体康复训练。观察组在此基础上联合综合干预,观察3个月。于综合干预前及干预1个月、3个月末采用焦虑自评量表、抑郁自评量表评定两组患者的焦虑抑郁状况。结果综合干预前两组患者焦虑自评量表、抑郁自评量表评分均无显著性差异（P〉0．05）,干预后观察组评分均显著低于对照组（P〈0．05）。结论综合干预能显著改善脑卒中患者康复治疗过程中的焦虑抑郁情绪,进一步促进患者的全面康复。     

立体健康教育对阿尔茨海默病患者临床康复及生活质量的影响

目的：探讨立体健康教育对阿尔茨海默病患者的临床效果。方法将68例阿尔茨海默病患者随机分为两组,均接受常规治疗及护理,研究组在此基础上联合立体健康教育,观察6个月。采用简易精神状态量表评定认知功能,日常生活能力量表评定日常生活能力,汉密顿焦虑量表、汉密顿抑郁量表评定焦虑抑郁情绪。结果干预6个月末研究组简易精神状态量表评分显著高于对照组（P＜0．05）,日常生活能力量表、汉密顿焦虑量表、汉密顿抑郁量表评分均显著低于对照组（P＜0．05）。结论立体健康教育能显著改善阿尔茨海默病患者的认知能力,提高日常生活能力,缓解焦虑、抑郁情绪。     

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.     

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.     

Clinical Trial Updates and Hotline Sessions presented at the European Society of Cardiology Congress 2007

This article provides information and commentaries on trials which were presented at the Hotline and Clinical Trial Update Sessions at the European Society of Cardiology Congress 2007 in Vienna. The key presentations were performed by leading experts in the field with relevant positions in the trials or registries. It is important to note that unpublished reports should be considered as preliminary data, as the analysis may change in the final publications. The comprehensive summaries have been generated from the oral presentation and the webcasts of the European Society of Cardiology and should provide the readers with the most comprehensive information of relevant publications.     

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.     

Balance and Boundaries in Grief Counseling: An Intervention Framework for Volunteer Training

Volunteers or paraprofessional counselors are commonly used to provide supportive care to the bereaved. These counselors generally are trained in basic listening skills, providing a generic, nonspecific approach to intervention that remains to be proven effective. The present paper outlines a framework that provides paraprofessionals with a broader model for intervention with the bereaved. Attention to boundaries as a helper and balance in the grief recovery are central to the model. Interventions are described that provide the paraprofessional counselor with more options for tailoring their counseling strategy to the individual. These include techniques that are presumed to be more specific to the enhancement of grief recovery.     

A new method for the simultaneous analysis of unmodified and modified urinary nucleosides and nucleobases by high performance liquid chromatography

Details are given of a new, rapid and simple pre-fractionation method and an isocratic high performance liquid chromatography system suitable for parallel analysis of nucleosides and nucleobases from urine and other biological fluids. The quantitative recovery and excellent reproducibility of the method is demonstrated by analysis of representative standard RNA catabolites. The advantage of this new method for application to biological samples is discussed.     

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.