康复训练与心理干预对女性精神病患者临床康复的影响

目的：探讨康复训练与心理干预对女性精神病患者临床康复的影响。方法将128例女性精神病患者随机分为两组,每组64例。两组均给予常规抗精神病药物治疗及护理,观察组在此基础上联合康复训练与心理干预,观察3个月。采用住院精神病人康复疗效评定量表、护士用住院病人观察量表评定干预效果。结果干预3个月末,两组住院精神病人康复疗效评定量表总分较干预前显著降低（P＜0．01）,护士用住院病人观察量表总分较干预前显著升高（P＜0．01）,观察组显著优于对照组（P＜0．01）。结论在药物治疗的基础上,对女性精神病患者予以康复训练及心理干预能显著改善患者的临床症状,优于单用药物治疗。     

康复训练对精神分裂症患者临床疗效和社会功能的影响

目的：探讨康复训练对精神分裂症患者临床疗效和社会功能的影响。方法将80例住院精神分裂症患者,随机分为两组,每组40例。两组均予以抗精神病药物常规治疗及护理,研究组予以综合性康复训练,观察8周。于康复训练前后采用简明精神病评定量表、护士用住院病人观察量表评定临床疗效。结果康复训练8周末,两组简明精神病评定量表评分较训练前显著降低（P＜0．01）,组间比较差异无显著性（P＞0．05）;护士用住院病人观察量表评分较训练前显著升高（P＜0．01）,研究组显著高于对照组（P＜0．01）。结论药物治疗联合康复训练能显著改善精神分裂症患者的社会功能,提高其生活质量。     

行为训练对精神病患者社会功能的影响

目的：探讨行为训练对精神病患者社会功能的影响。方法将120例精神病患者随机分为两组,均予以精神科常规治疗及护理,研究组在此基础上联合行为训练。观察1个月。于训练前后采用阴性症状评定量表、护士用住院病人观察量表及住院精神病患者社会功能评定量表评定训练效果。结果训练后两组阴性症状评定量表和住院精神病患者社会功能评定量表评分均较训练前显著降低（P＜0．01）,护士用住院病人观察量表评分较治疗前显著改善（P＜0．01）;训练后两组比较差异有显著性（P＜0．01）。结论行为训练能显著改善精神病患者的阴性症状及社会功能,提高社会生活能力。     

康复训练对慢性精神分裂症患者临床康复的影响

目的：探讨康复训练对慢性分裂症患者临床康复的影响。方法将60例慢性分裂症患者随机分为两组,每组30例,两组均接受常规药物维持治疗和护理干预,研究组在此基础进行有计划的康复训练。观察6个月。训练前后采用阴性症状量表、护士用住院病人观察量表评定临床效果。结果康复训练6个月末,研究组阴性症状量表评分及护士用住院病人观察量表激惹、迟缓、总消极因子分均较训练前显著下降,且显著低于对照组（ P＜0．05或0．01）;护士用住院病人观察量表社会能力、个人整洁、总积极因子、病情总估计因子分均较训练前显著升高,且显著高于对照组（P＜0．01）;对照组则均无显著变化（P＞0．05）。结论康复训练能显著改善慢性精神分裂症患者的阴性症状,提高社会功能和生活质量。     

药物联合音乐治疗慢性精神病患者精神衰退效果评价

目的：探讨药物联合音乐治疗慢性精神病患者精神衰退的临床疗效。方法将90例慢性精神病伴精神衰退患者随机分为两组,每组45例,两组均予以常规抗精神病药物治疗及常规护理,研究组在此基础上联合音乐治疗,观察15周。治疗前后采用护士用住院病人观察量表评定患者的精神衰退状况。结果治疗后两组护士用住院病人观察量表积极因素评分均较治疗前显著升高,消极因素评分显著下降,研究组病情总估计评分显著升高（P＜0．01）;治疗前两组护士用住院病人观察量表评分比较差异无显著性（P＞0．05）,治疗后研究组积极因素及病情总估计评分显著高于对照组（P＜0．01）,消极因素评分显著低于对照组（P＜0．01）。结论药物联合音乐治疗能有效延缓慢性精神病患者的精神衰退进程,显著优于单纯应用药物治疗。     

认知行为治疗对住院精神分裂症患者康复效果的影响

目的：探讨认知行为治疗对住院精神分裂症患者康复效果的影响。方法将80例住院精神分裂症患者随机分为两组,均予以精神科常规治疗及护理,研究组在此基础上联合认知行为治疗,观察6周。采用自知力评定量表、护士用住院病人观察量表评定康复效果。结果治疗6周末研究组自知力评定量表各因子分和护士用住院病人观察量表的社会能力、精神病表现、退缩、抑郁因子分均较治疗前显著降低（ P＜0．05或0．01）,兴趣爱好、个人卫生因子分较治疗前显著升高（ P＜0．05或0．01）,对照组仅部分因子分有显著改善（ P＜0．05或0．01）;研究组各量表评分显著优于对照组（ P＜0．05或0．01）。结论认知行为治疗能显著改善精神分裂症患者的认知功能和行为障碍,有利于促进患者的康复。     

阿立哌唑联合社交技能训练治疗慢性精神分裂症对照研究

目的：探讨阿立哌唑联合社交技能训练对慢性精神分裂症临床疗效的影响。方法将100例慢性精神分裂症患者随机分为两组,每组50例。两组均予以阿立哌唑治疗,研究组在此基础上联合社交技能训练。观察8周。于治疗前后采用阳性与阴性症状量表、护士用住院病人观察量表、住院精神病人康复疗效评定量表评定临床疗效。结果治疗后两组阳性与阴性症状量表、精神疾病康复疗效评定量表总分均较治疗前显著降低（P＜0．01）,研究组较对照组下降更显著（P＜0．01）;护士用住院病人观察量表总分较治疗前显著升高（P＜0．01）,研究组较对照组升高更显著（P＜0．01）。结论阿立哌唑合并社交技能训练能显著改善慢性精神分裂症患者的精神症状和社交能力,提高其生活质量,最大程度地减轻精神残疾,促进患者顺利回归社会。     

人性化护理干预对住院青少年精神分裂症患者康复的影响

目的 探讨人性化护理干预对住院青少年精神分裂症患者康复的影响.方法 将114例住院青少年精神分裂症患者随机分为两组,均予以精神科常规药物治疗,观察组予以人性化护理干预,对照组予以常规护理干预,观察8周.于干预前后采用阳性与阴性症状量表、个人和社会功能量表、护士用住院病人观察量表评定临床效果.结果 干预后两组阳性与阴性症状量表评分均较干预前显著下降（P＜0.01）,观察组较对照组下降更显著（P＜0.01）;个人和社会功能量表、护士用住院病人观察量表评分均较干预前显著升高（P＜0.01）,观察组较对照组升高更显著（P＜0.01）.结论 人性化护理干预对改善青少年精神分裂症患者的临床症状,提高社会功能和生活质量具有重要作用.     

心理干预对疑病性神经症患者临床康复的影响

目的：探讨心理干预对疑病性神经症临床康复的影响。方法将80例疑病性神经症患者分为两组,每组40例。两组均予以帕罗西汀治疗,研究组在此基础上联合心理干预。观察8周。于治疗前后采用汉密顿抑郁量表及症状自评量表评定干预效果。结果治疗后两组汉密顿抑郁量表评分均较治疗前显著降低（P＜0．01）,研究组显著低于对照组（P＜0．01）;两组症状自评量表各因子分均较治疗前显著降低（ P＜0．05或0．01）,研究组躯体化、强迫、抑郁、焦虑、敌对、精神病性因子分显著低于对照组（ P＜0．05或0．01）。结论对疑病性神经症患者在药物治疗的基础上予以心理干预,能显著提高临床康复效果。     

人文关怀对康复期精神病患者心理健康状况及治疗依从性的影响

目的探讨人文关怀对康复期精神病患者的心理健康状况及治疗依从性的影响。方法将200例康复期精神分裂症患者随机分为两组,每组lOO例,两组患者均予以常规治疗及护理管理,在此基础上研究组接受人文关怀护理管理,观察8周。于人文关怀护理8周末采用症状自评量表评定两组的心理健康状况,同时评定两组的住院满意度及治疗依从性。结果人文关怀护理干预8周末研究组症状自评量表各因子评分均显著低于对照组（P〈0．01）;住院满意度及治疗依从性均显著高于对照组（P〈0．01）。结论人文关怀护理能显著提高康复期精神病患者的心理健康水平、住院满意度及治疗依从性,有利于促进患者的全面康复。     

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.