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.     

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.     

脑卒中后抑郁治疗的初步探索

目的探索脑卒中后抑郁治疗的最佳方案。方法对 1996— 2 0 0 1年间住院脑卒中患者在入院时进行自评抑郁量表(SDS)、自评焦虑量表 (SAS)、老年认知功能量表 (SECF)和日常生活能力量表 (ADL)的检测并进行心理治疗。自评抑郁量表SDS≥5 0分为脑卒中后抑郁 ,符合入组条件的有 115例 ,随机分为两组 :心理治疗加上百忧解药物联合治疗组 (甲组 ) 5 4人 ,单用心理治疗组 (乙组 ) 6 1人。 2个月后复查 1次。结果两组在年龄、性别、受教育年限、病程和偏瘫左右侧方面无显著性差异。住院 2个月后复查 ,两组抑郁、焦虑情绪明显降低 (P <0 0 0 1) ,日常生活能力明显提高 (P <0 0 0 1) ,认知功能改变不明显 (P >0 5 )。两组SDS、SAS、SECF、ADL两次测验降低或提高的分数无显著差异 (P >0 5 )。结论脑卒中后抑郁单用心理治疗与心理加上百忧解药物联合治疗疗效相似     

脑卒中抑郁及相关因素分析

目的 了解脑卒中抑郁与焦虑情绪、认知功能的关系及预后情况。方法 对144例脑卒中患者进行抑郁自评量表（SDS）、焦虑自评量表（SAS）和老年认知功能量表（SECF）评定。SDS≥50分者为抑郁组,SDS＜50分者为非抑郁组。结果 抑郁发生率是40．27％,有自杀意念者占总数的17．36％。抑郁组认知功能低于非抑郁组,焦虑情绪高于非抑郁组,有非常高度性差异（P＜0．001）。2个月后复查,抑郁组抑郁、焦虑情绪显著降低（P＜0．001）,非抑郁组焦虑情绪亦明显降低（P＜0．01）。两组认知功能改善不明显。结论 脑卒中后抑郁与患者焦虑情绪、认知功能密切相关。住院2个月后抑郁组患者抑郁、焦虑情绪均改善,非抑郁组患者焦虑情绪亦降低,但认知功能改善较慢,2个月内变化不大。     

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。     

癫痫患者的生活质量以及与焦虑、抑郁情绪的相关性研究

目的探讨癫痫患者的生活质量以及与焦虑、抑郁情绪的关系。方法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60例癫痫患者（癫痫组）及60名健康自愿者（对照组）进行评定，并对生活质量与焦虑、抑郁作相关分析。结果癫痫患者的生活质量总分及躯体功能、心理功能、社会功能、物质生活4个维度分均明显低于对照组（P〈0．01），而SAS及SDS评分则均明显高于对照组（P〈0．01）；生活质量总分及躯体功能、心理功能、社会功能、物质生活4个维度分均与SAS及SDS评分呈显著性负相关。结论癫痫患者的生活质量较差，焦虑、抑郁情绪明显，其生活质量与焦虑、抑郁情绪密切相关。     

强直性脊柱炎96例心理健康状况调查与心理干预

目的：探讨强直性脊柱炎患者的心理健康状况及心理干预的效果。方法：采用焦虑自评量表（SAS）和抑郁自评量表（SDS）对96例强直性脊柱炎患者进行心理问卷调查，根据患者存在的焦虑、抑郁心理问题实施心理干预2周，再次进行SAS和SDS自评量表评分。结果：本组心理干预前SAS、SDS评分较国内常模高，两组比较有极显著性差异（P〈0．01）；干预后患者SAS、SDS评分较干预前低，两组比较有极显著性差异（P〈0．01）。结论：强直性脊柱炎患者存在明显的焦虑、抑郁心理，实施心理干预后患者焦虑、抑郁心理有明显改善。     

强直性脊柱炎96例心理健康状况调查与心理干预

目的：探讨强直性脊柱炎患者的心理健康状况及心理干预的效果。方法：采用焦虑自评量表（SAS）和抑郁自评量表（SDS）对96例强直性脊柱炎患者进行心理问卷调查，根据患者存在的焦虑、抑郁心理问题实施心理干预2周，再次进行SAS和SDS自评量表评分。结果：本组心理干预前SAS、SDS评分较国内常模高，两组比较有极显著性差异（P〈0．01）；干预后患者SAS、SDS评分较干预前低，两组比较有极显著性差异（P〈0．01）。结论：强直性脊柱炎患者存在明显的焦虑、抑郁心理，实施心理干预后患者焦虑、抑郁心理有明显改善。     

肠造口患者焦虑抑郁的认知治疗及护理

目的评估肠造口患者焦虑及抑郁状态并观察认知疗法的疗效。方法通过对14例肠造口患者进行抑郁自评量表（SDS）和焦虑自评量表（SAS）测评，计算评分并与国家常模比较，应用认知疗法进行干预后重新测评，治疗前后评分比较。结果肠造口患者SDS和SAS评分明显高于国家常模（P〈0．001），应用认知疗法干预后SAS、SDS评分较治疗前明显下降（P〈0．001）。结论肠造口患者具有明显的焦虑、抑郁情绪，认知疗法可有效消除上述不良情绪。     

脑卒中患者家属心理健康水平及其影响因素

目的 探讨脑卒中患者家属的心理健康水平及其影响因素。方法 对34名脑卒中患者家属应用症状自评量表测量其心理健康水平，并与国内常模比较．对高于常模的因子分进行相关因素分析。结果 脑卒中患者家属症状自评量表中躯体化、抑郁、焦虑、恐怖4个因子分均高于常模（P〈0．05～0．01）；躯体化因子分与学历相关，抑郁因子分与家庭经济收入相关，焦虑因子分与患者的认知障碍相关。与患者日常生活活动能力（ADL）的相关分析显示，家属的躯体化因子分与患者目前的ADL总分、卫生、进食、排便、移动、入浴动作分数呈负相关；抑郁因子分与进食、排便动作呈负相关；恐怖因子分与个人卫生、进食、排便、交流、移动、人浴及总分呈负相关（P〈0．05～0．01）。结论 脑卒中患者家属的心理健康水平较低，且受家庭经济收入减少、患者认知障碍．特别是患者ADL的影响。     

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.