中风导致吞咽障碍的摄食护理

吞咽障碍可分为器质性吞咽障碍和功能性吞咽障碍,脑血管病引发的摄食-吞咽障碍在急性期并发率相当高,占脑血管患者的40%左右.这一时期,如果摄食不当,很容易导致误咽性肺炎.因此,有必要及早对摄食-吞咽障碍加以注意及护理。     

武汉地区大一女生神经性厌食症的初步调查

目的 调查武汉地区大一女生的体重和体重指数以及异常进食行为,了解武汉地区大一女生摄食障碍和神经性厌食症(非肥胖恐惧型)的发生率.方法 以2009年9月份入学的大一女生8 520人为抽样研究对象,根据摄食障碍问卷(EDI)筛选出可疑摄食障碍学生589名,然后用EDE和SCID量表对这些学生进行访谈诊断,75名学生被诊断为摄食障碍.结果 (1)武汉地区大一女生的理想体重普遍比实际体重低,理想体重指数与实际体重指数之间差异有统计学意义;(2)摄食障碍的发生率为8.803‰,其中AN 0.352‰、BN 1.174‰、EDNOS(包括BED) 7.277‰,EDNOS是摄食障碍类型中最普遍的一个类别;(3)没有发现AN(非肥胖恐惧型)患者;(4)摄食障碍组与非摄食障碍组被试在EDI量表的求瘦倾向、内省、贪食、躯体不满、无效感以及成熟恐惧分量表上的得分都要高,且差异有统计学意义.结论 女大学生是摄食障碍的高危群体,需给予重视.肥胖恐惧依然是摄食障碍的核心表现.     

大一女生非典型摄食障碍的初步调查

目的 了解非典型摄食障碍(EDNOS)的特征表现.方法 采用进食情况调查表(EDI)进行自评问卷调查、摄食障碍检查问卷( EDE)和SCID —I的H部分进行访谈的方法,对8 600名大一女生筛选和确诊摄食障碍,并获取各类摄食障碍的心理行为特征.结果 EDNOS的发病率最高,为7.277‰.EDNOS的代偿行为基本少于神经性厌食症和神经性贪食症;EDNOS群体中,选择剧烈运动和采取一种代偿行为所占的比例相对较高,分别为38.7％和43.5％.三类摄食障碍的EDI与EDE所有因子分的差异均无统计学意义;EDE的条目中,EDNOS的空腹和体重重要性分值低于神经性厌食症,而秘密进食分值低于神经性贪食症.结论 EDNOS总体上具有摄食障碍的所有临床特征,在某些症状上表现较轻,需要鉴别和引起重视.     

中风导致吞咽障碍的摄食护理

吞咽障碍可分为器质性吞咽障碍和功能性吞咽障碍,脑血管病引发的摄食-吞咽障碍在急性期并发率相当高,占脑血管患者的40%左右〔1〕。这一时期,如果摄食不当,很容易导致误咽性肺炎。因此,有必要及早对摄食-吞咽障碍加以注意及护理。1临床资料我院2000～2002年住院及门诊患者,男35例,女10例,年龄40～72岁,平均62岁,病程2～6个月,平均4.2个月。中风后具有吞咽困难,饮水呛咳、构音障碍或咽反射迟钝或消失等患者均经颅CT、RMI确诊为脑梗死或脑出血。2摄食护理2.1摄食前的准备在细心观察患者的状态,并对进食状况反应做出正确评估后,即可做好进食…     

脑卒中并发吞咽障碍的康复护理

目的 总结脑卒中患者吞咽障碍的康复护理.方法 加强心理护理,保持口腔清洁,进行摄食前基础训练和摄食训练.结果 显著提高了脑卒中并发吞咽障碍患者的康复效果.结论 对脑卒中并发吞咽障碍的患者应及时进行吞咽功能的康复训练.     

中枢神经系统甘丙肽调节摄食行为及相关机制研究进展(英文)

甘丙肽广泛分布于各个脑区,具有广泛的生理活性,能够调节能量消耗、促进摄食、增加体重。研究表明,甘丙肽主要通过甘丙肽受体1、5-HT1A受体以及α-2肾上腺素能受体调节摄食行为。本文主要对中枢神经系统甘丙肽的调节摄食行为及其相关机制进行综述,为甘丙肽功能的进一步研究提供依据。     

康复护理对脑卒中患者摄食-吞咽功能恢复的应用效果观察

目的探讨康复护理对脑卒中患者摄食-吞咽功能恢复的应用效果。方法选取我院收治的158例脑卒中患者作为研究对象,随机分为观察组和对照组各79例,对照组给予常规护理,观察组在对照组的基础上给予康复护理干预。比较2组经摄食-吞咽功能训练后吞咽障碍程度和不良反应发生情况。结果 2组治疗后在摄食-吞咽障碍程度方面并无明显差异(P0.05),而观察组治疗过程中出现误咽、误吸、食管反流以及肺部感染的人数明显少于对照组,差异有统计学意义(P0.05)。结论对脑卒中患者摄食-吞咽功能训练过程中采取相应的康复护理干预,可有效减少患者出现误咽、误吸、食管反流以及肺部感染的发生率,值得临床推广使用。     

头部针刺联合口肌训练对儿童孤独症摄食行为及语言交流障碍的影响

目的分析头部针刺联合口肌训练对儿童孤独症摄食行为及语言交流障碍的影响。方法选择郑州儿童医院2015-01—2018-06收治的82例孤独症儿童,参照随机数字表法分为对照组37例和观察组45例。对照组采用口肌训练,观察组采用头部针刺联合口肌训练。比较2组临床疗效以及治疗前后摄食行为变化情况、自闭症行为评定量表(ABC)、口部运动功能。结果治疗后,观察组总有效率高于对照组86.67%vs 67.56%(P0.05)。治疗前,2组摄食行为、ABC量表评分及口部运动功能比较差异无统计学意义(P0.05);治疗后,2组摄食行为评分、ABC量表评分均下降,观察组低于对照组,2组口部运动功能均上升,观察组高于对照组(P0.05)。结论头部针刺联合口肌训练能够有效改善孤独症儿童的摄食行为,纠正语言交流障碍,提高患儿语言表达能力。     

脑卒中患者摄食-吞咽功能训练的风险管理

目的分析脑卒中患者摄食-吞咽功能训练的风险管理对患者的影响。方法以我院2009—2013年收治的158例脑卒中患者为研究对象,其中2009—2011年采用常规训练模式的79例患者为对照组,2012—2013年在常规训练模式基础上给予风险管理措施的79例患者为观察组,比较2组患者经摄食-吞咽功能训练后吞咽障碍程度和不良反应发生情况。结果2组患者治疗后摄食-吞咽障碍程度方面无明显差异(P0.05),观察组患者治疗过程中误咽、误吸、食管反流以及肺部感染明显少于对照组(P0.05)。结论对脑卒中患者摄食-吞咽功能训练过程中采取相应的风险管理措施,可有效减少患者出现误咽、误吸、食管反流以及肺部感染的发生率,值得临床推广使用。     

摄食障碍:情感障碍的变异形式吗?

摄食障碍与情感障碍关系的研究,可以追溯到1939年,当时Carrier提出摄食障碍是情感障碍的一种变异(Variant)形式。然而,直到1977年,Cantwell等发表题为“神经性厌食是一种情感障碍吗”?的论文之后,两者的关系问题才成为摄食障碍     

Kinematic study of whole body center of mass position during gait in Parkinson's disease patients with and without festination

Gait festination (FE) can cause serious disability in Parkinson's disease (PD) patients. It is argued that the center of pressure position (COP) and body center of mass (COM) are possibly implicated in FE pathogenesis. The relationship between them remains unclear. The goal of this study was to determine spatiotemporal relationships between COM and COP in PD and to explore whether FE arises as a consequence of lack of physiological link between COP and COM during step stride. Twenty patients with idiopathic PD, in OFF state and 17‐age‐matched control subjects completed a 10‐m walking protocol. PD patients were divided in two groups: those with FE and those without (NF). COM position, excursion, and its relationship with COP, as well as other kinematic parameters were analyzed. COM displacement along the horizontal and vertical plane was significantly lower in FE patients as was the maximum position on the movement direction axis compared with controls or NF patients. Significant difference in minimal COM position in FE patients was also observed. The percentage of stride time during which COM was situated ahead of COP along the movement axis in FE patients was significantly greater than for controls or NF patients. This would seem to indicate that FE patients are constantly attempting to align COP to COM, causing FE. The explanation might be that FE arises as a postural strategy to align COP within the area of COM displacement. Findings illustrate a putative role for postural strategies in the treatment of FE. © 2010 Movement Disorder Society     

Pontomedullary Efferent Projections of the Ventral Respiratory Neuronal Subsets of the Rat

The pontomedullary trajectories of projections efferent from the ventral respiratory cell group were anterogradely labelled after discrete injections of Fluoro Ruby into three morphophysiologically identified subdivisions (Bötzinger complex, rostral inspiratory, and caudal expiratory cell groups). The anterogradely labelled varicosities were located in a variety of areas involved in cardiorespiratory function: other subdivisions of the ventral respiratory cell group, the parabrachial (medial, central, and external lateral), Kölliker-Fuse, and lateral paragigantocellular nuclei, A5, and perifacial areas. Although the target areas were similar for the three studied subdivisions, some differences of the location and densities of labelled varicosities were found. Anterogradely labelled fibre bundles were found bilaterally after all of the tracer injections. Three caudally efferent bundles passed through the ventral respiratory cell group, dorsal medullary, and paramedian reticular nuclei. A labelled fibre bundle also took an ascending route through the ventral respiratory cell group: it surrounded the facial nucleus, and then followed two different pathways, one coursing towards forebrain areas and the other to the parabrachial and Kölliker-Fuse complex. Bundles of efferent axons decussated mainly at medullary levels and to a lesser extent in the pons. In the contralateral medulla and pons these labelled fibre bundles followed pathways similar to those observed ipsilaterally. The three ventral respiratory neuronal subsets sent axonal projections through similar tracts, but within them they were topographically organized. The present data are discussed with respect to the circuitry involved in the mechanisms of cardiorespiratory and other visceral functions.     

Development of an Epilepsy Comprehensive Care Center: A Japanese Model

Summary:  Purpose: To review the requirements of a comprehensive care center for people with epilepsy.
Methods: Twenty-seven years have passed since the foundation of the Japanese Epilepsy Center in Shizuoka. The development of this center is presented as a model of an epilepsy comprehensive care center.
Results: Between 1926 and 1947, the Shizuoka Higashi Hospital (the former name of SMIND) served as a tuberculosis hospital. In 1975, a proposal for a special center for the care of people with epilepsy was submitted to the Japanese government. An epilepsy center (the Center) was soon built, and the tuberculosis sanatorium ended its 50-year history. The facilities of the Center include an outpatient clinic, four inpatient wards with 200 beds, a day-care center for medical rehabilitation, and classrooms for elementary and junior high school children. The Center has modern diagnostic tools such as electroencephalography (EEG), closed-circuit TV-EEG (CCTVEEG), computed tomography (CT) scan, magnetic resonance imaging (MRI), single-photon emission CT (SPECT), and magnetoencephalography (MEG). Neurosurgery for intractable seizures has been conducted at the Center since 1983. Approximately 25,000 patients with epilepsy from all over Japan have been registered since 1975. Annually, ∼5,000 outpatients and 600 inpatients attend the Center. As of March 2002, 500 patients had received resective surgery for epilepsy. Other activities in the Center include research and specialized training of professionals, including foreign nationals, in the treatment of epilepsy.
Conclusions: The experience in Shizuoka suggests that management of epilepsy should be oriented toward psychological well-being, social rehabilitation, and seizure control.     

CNS connections with the median raphe nucleus: retrograde tracing with WGA-apoHRP-Gold complex in the rat

In this work we examined the neuronal input to one of the serotoninergic centers in the brain, median raphe nucleus (MR). Special consideration is given to projections of the hypothalamus. To describe the afferents to MR, a retrograde transport technique was used after microinjection of WGA-apoHRP-Gold complex under pressure and subsequent gold-silver intensification on formaldehyde-fixed rat brain sections. Optimal conditions were obtained when the coordinates of the injection site were A +/- 1.5, L +/- 0.15, and H +/- 2.7 according to Paxinos and Watson (The Rat Brain in Stereotaxic Coordinates. New York: Academic Press, '82). Results obtained under these conditions show a heterogeneous distribution of labeled neurons throughout the brain, including a large proportion (+/- 65%) of hypothalamic neurons. Extra-hypothalamic neurons projecting to MR were from the prefrontal cortex, lateral and medial habenular nuclei, the pontine area of the central grey, interpeduncular nucleus, dorsal raphe nucleus, oculomotor and trochlear nuclei, dorsal and laterodorsal tegmental nuclei, parabrachial nuclei, and lateral and interpositus cerebellar nuclei. Hypothalamic neurons connected to MR were found to be from medial and lateral preoptic areas, lateral hypothalamus, dorsomedian nucleus, the perifornical area, and the complex of mammillary bodies. Many other discrete regions contained different densities of labeled perikarya: the medial preoptic nucleus, paraventricular nucleus, retrochiasmatic area, arcuate nucleus, lateral magnocellular nucleus, and the posterior area. The MR appears as an integrative center receiving many neuroanatomically and functionally heterogeneous inputs from the whole brain.     

Annual Number of Spinal Cord Stimulation Procedures Performed in the State of Florida During 2018: Implications for Establishing Neuromodulation Centers of Excellence

ObjectiveTo assess the volume of spinal cord stimulation procedures performed by physicians in the state of Florida in 2018.Materials and MethodsWe obtained information from publicly available state databases for all patients undergoing procedures in 2018 at Florida hospitals, hospital-owned facilities, and independent ambulatory surgery centers. Cases in which a spinal cord stimulation procedure was performed were identified. We estimated for each physician office-based spinal cord stimulation trials (not subject to state reporting) based on the published Florida conversion factor of 25.6% of the total number of such procedures. The medical specialty of the listed performing physician was determined based on the national provider identifier. Counts of neurostimulation procedures performed by physician and within specialties were determined. The numbers of physicians and specialties performing various thresholds between 1 and ≥100 per year were determined, and the percentages of patients whose care was delivered by physicians below each threshold were determined.ResultsThe data analyzed included 10,762 spinal cord stimulation cases. Among the 606 physicians who performed at least one spinal cord stimulation procedure, only nine performed at least 100 cases in 2018. During 2018, 78.4% of physicians performed, on average, <2 spinal cord stimulation procedures per month; there were 29.4% of spinal cord stimulation patients cared for by such physicians. Physicians performing less than four cases per month provided care for 56.9% of all cases.ConclusionsFew physicians performing spinal cord stimulation procedures in the state of Florida in 2018 would have been considered as "high volume.” Although volume is only one among many criteria used to designate centers of excellence for other procedures, the potential impact on physician practice and patient access to care should be considered if a specific minimum number of annual cases by physician is to be established.     

Épidémiologie et facteurs associés au syndrome dépressif chez les patients suivis au centre hospitalo-universitaire de Rennes pour une épilepsie

ObjectivesThe occurrence of depression in people with epilepsy is almost twice as common as in the general population. Furthermore, depression is the first cause of lower quality of life among those patients. Which is why the main goal of this study was to assess the epidemiology of depression and its associated factors among the patients from the tertiary department of epileptology in Rennes.Methods/resultsThe subjects were included prospectively and consecutively at the moment of their consultation or hospitalisation in the department. Personal data about the socio-economic status and the type of epilepsy was collected. The subjects filled validated self-assessment of depression (NDDIE), anxiety (GAD-7) and quality of life (QOLIE-10). Thanks to the NDDIE, the patients were divided into: “depressed” and “not depressed”; and the two groups were compared with univariate and multivariate models. Of the 322 patients followed-up in the department between the 17th of June and the 9th of September 2016 223 of them were included in the study. According to the NDDIE, 22.6% suffered from depression; according to the GAD-7, 46.4% suffered from anxiety. In the “depressed” group, 82% were not under anti-depressant medication. In the univariate model, depression was associated with: anxiety, suicidal ideations, lower quality of life, vague nervus stimulation treatment, anticonvulsant benzodiazepine medication or psychiatric medication, and last of all bitherapy or polytherapy antiepileptic medication compared to monotherapy. In the multivariate model, depression was significantly related to anxiety (OR: 8.86 [3.00; 26.19] p = 0.0001), suicidal ideas (OR: 7.43 [2.93; 18.81] p < 0.0001), anticonvulsant benzodiazepine medication (OR: 3.31 [1.16; 9.49] p = 0.0255), and lower quality of life (OR: 1.09 [1.02; 1.17] p = 0.0087). Generalised epilepsy was a protective factor with uni and multivariate models (OR: 0.34 [0.11; 1.00] p = 0.0492).ConclusionsIn the tertiary epileptic department of Rennes, more than 20% of patients with epilepsy suffered from depression during the inclusion period according to the NDDIE. Among those “depressed” subjects, fewer than one out of five seemed to receive proper psychiatric care. Which is why this study highlights the importance of interdisciplinary cooperation between neurologists and psychiatrists in order to aim at better management of epileptic patients as a whole.     

Clinical Equivalence of Generic Clozapine

Objective: To determine if mental health service utilization increases when patients are converted to generic clozapine.Method: About 125 patients taking clozapine in a community mental health clinic were switched from Novartis Clozaril to generic clozapine (Mylan Pharmaceuticals). Serum clozapine levels were obtained 2 weeks before, and 2 weeks after, the switch to generic clozapine. The number of outpatient visits, emergency room visits, and hospitalizations in the year prior to the switch were compared to those in the year following the switch, to determine service utilization.Results: Psychiatric emergency room visits decreased, but clozapine serum levels, inpatient hospital days, partial hospital admissions, and outpatient psychiatrist visits did not change after the switch to generic clozapine.Conclusions: There were no significant increases in mental health service utilization after the conversion to Mylan generic clozapine. The switch to Mylan generic clozapine was cost effective, as the reduction in pharmacy costs was not offset by increased utilization costs.     

延髓呼吸中枢损伤后神经营养因子基因表达特点的免疫组化研究

目的为临床应用神经营养因子（ｎｅｕｒｏｔｒｏｐｈｉｃｆａｃｔｏｒｓ,ＮＴＦｓ）疗法治疗脑干呼吸中枢损伤提供理论和实验研究基础。方法实验动物采用ＳＤ大鼠,以直流电解损毁法建立一侧延髓呼吸中枢损伤动物模型,采用免疫组化染色法对损伤后不同时间点ＮＴＦｓ基因的表达特点进行了研究。结果神经营养素－３（ｎｅｕｒｏｔｒｏｐｈｉｎ－３,ＮＴ－３）和神经生长因子（ｎｅｒｖｅｇｒｏｗｔｈｆａｃｔｏｒ,ＮＧＦ）的表达最为活跃,脑源性神经营养因子（ｂｒａｉｎ－ｄｅｒｉｖｅｄｎｅｕｒｏｔｒｏｐｈｉｃｆａｃｔｏｒ,ＢＤＮＦ）和成纤维细胞生长因子（ｆｉｂｒｏｂｌａｓｔｇｒｏｗｔｈｆａｃｔｏｒ,ＦＧＦ）也有一定表达。结论在延髓呼吸中枢的局灶性损伤后,ＮＴ－３、ＮＧＦ、ＢＤＮＦ和ＦＧＦ可能在延髓呼吸神经元受损后的自我保护及修复中发挥了活跃的作用     

Service Priority and Standard Performance of Community Mental Health Centers in South Korea: A Delphi Approach

Objective

The role of community mental health centers (CMHCs) in Korea is quite different than that of these centers in Western countries due to nation-specific health care system characteristics. For example, CMHCs of Korea are expected to provide services for serious mental illness in addition to other services in response to community needs, such as internet addiction of adolescents. Consequently, it is important to determine service priorities of CMHCs and to define standard service performances in order to maximize their effectiveness with limited resources. The present study aimed to generate expert consensus on service priorities and to identify standard service performances of CMHCs in South Korea.

Methods

Forty-five mental health professionals participated as experts in a Delphi survey. We made a survey questionnaire based on Korean and international data and guidelines of some countries such as the UK and Australia. Experts answered the first and second round questionnaires and their answers were analyzed using frequency analysis.

Results

For the question about future directions of CMHCs, twenty-two experts (49%) answered that the growth of services for serious mental illness should be preferred to other areas. The service for chronic mental illness was thought to be the most important service area (27.1%) and, early psychosis (10.5%) is included, the services for serious mental illness should be regarded as the most important service area of Korean CMHCs. It is followed by child and adolescent services (13.2%) and mental health promotion services (10.8%). The relative importance of service performances on each service domain were given by answers of experts.

Conclusion

CMHCs in Korea should focus their priority on the management of serious mental illness. Service standardization by the relative importance of service performances on each service domain is needed.