基层卒中单元治疗脑出血疗效观察

目的探讨基层卒中单元治疗脑出血的临床疗效。方法选择2007-06-2011-12我院神经内科脑出血患者46例纳入卒中单元进行观察和治疗;与2005-06-2007-06采用普通病房方法46例患者(传统治疗组)比较,治疗前后对2组患者进行神经功能缺损评分及日常生活活动能力评定,并对其平均住院费用及平均住院时间进行比较。结果卒中单元组神经功能缺损程度评分及日常生活能力评分与传统治疗组比较,差异有统计学意义(P<0.01);而平均住院时间和住院费用比较,差异无统计学意义(P>0.01)。结论基层卒中单元在不增加患者经济负担的基础上有效提高脑出血患者的临床疗效,减轻病残程度,降低病死率。     

应用卒中单元治疗卒中的临床观察

目的探讨卒中单元治疗脑卒中的临床应用价值。方法将2006年3月～5月份住院的脑卒中患者共194例,做为治疗组采用卒中单元的治疗模式进行治疗;与2005年同期按照传统治疗模式治疗的156例住院脑卒中患者做对比。观察两组治疗前后临床疗效、患者满意度、住院时间、住院费用。结果治疗组的显效率为41.7%,总有效率为87.6%,明显高于对照组的26.2%和66.6%(P<0.01);治疗组患者及家属满意度平均95.9%,而对照组为80.5%(P<0.01);治疗组的平均住院时间为27.2d,与对照组的26.6d(P>0.05)无明显差别;治疗组平均住院费用为8351.0元与对照组的8233.7元(P>0.05)无明显差别。结论在患者住院天数及住院费用基本相同的情况下,采用卒中单元治疗的患者治疗效果明显好于传统治疗方法,患者及家属满意度提高,取得广泛推广。     

在二级医院建立延伸卒中单元模式病房的疗效分析

目的 通过在二级医院建立延伸卒中单元模式病房,探讨脑血管病新的管理模式及疗效评定.方法 将398例住院卒中患者,随机分入卒中单元病房和普通病房,通过对急性期病死率、并发症发生率、Barthel指数(BI)、NIHSS、出院时医疗满意度评分观察,评估近期疗效.通过观察卒中后两年内的复发率、病死率、NIHSS、BI、Hamiltom量表及评估远期疗效.结果 卒中单元组急性期病死率、并发症发生率低,患者满意度高,NIHSS、BI相比较,两组间有显著性差异(P＜0.05).卒中后两年内的复发率、病死率卒中单元组低于对照组.结论 延伸卒中单元的建立提高了脑血管病患者的近期及远期疗效.     

卒中单元的引进和使用

目的探讨卒中单元救治急性脑血管病的意义。方法引进急性卒中康复联合单元、卒中监护单元,增加院前急救系统。结果共收治48例病人,平均住院天数较普通病房缩短,住院费用未见明显增加,卒中单元住院病人的预后较好。结论引进和使用卒中单元,是治疗急性脑血管病的有效途径,从中可以获得良好的社会效益和可观的经济效益。     

卒中单元院前抢救模式对提高脑卒中抢救效果的作用分析

目的 探讨卒中单元院前抢救模式对提高卒中抢救效果的作用.方法 回顾性分析我院收治的64例脑卒中患者的临床资料,根据院前抢救模式分为卒中单元组和对照组,院前抢救分别采用卒中单元模式和常规模式,比较2组患者的临床疗效和抢救后的NIHSS评分、ADL评分及平均住院时间和费用.结果 治疗组总有效率93.75%,显著高于对照组患者的75.00%（P＜0.05）;治疗后卒中单元组NIHSS评分显著低于对照组,ADL评分高于对照组（P＜0.05）;卒中单元组患者平均住院时间（18.47±7.48）d,平均住院费用（12.45±4.37）千元,均少于对照组（P＜0.05）.结论 卒中单元院前抢救模式能显著提高临床疗效,改善患者生活质量,是脑卒中的有效抢救模式.     

卒中单元的引进和使用

目的 探讨卒中单元救治急性脑血管病的意义。方法 引进急性卒中康复联合单元、卒中监护单元，增加院前急救系统。结果 共收治48例病人，平均住院天数较普通病房缩短，住院费用未见明显增加，卒中单元住院病人的预后较好。结论引进和使用卒中单元，是治疗急性脑血管病的有效途径，从中可以获得良好的社会效益和可观的经济效益。     

卒中单元对急性脑卒中患者近期预后的影响

目的 探讨卒中单元对急性脑卒中患者近期预后的影响.方法 196例急性脑卒中患者(脑出血59例,脑梗死137例)随机分为卒中单元组(101例)和普通病房组(95例),并进行相应的治疗.比较两组治疗后与治疗前美国国立卫生研究院卒中量表(NIHSS)评分、Barthel指数(BI)的差值及疗效,以及并发症的发生率.结果 与治疗前比较,卒中单元组治疗后NIHSS评分降低(12.6± 5.5)分,普通病房组降低(8.9 ±4.1)分;卒中单元组BI升高24.3±14.8,普通病房组升高15.1±10.6;两组间差异有统计学意义(均P<0.05).卒中单元组基本痊愈率、总有效率、并发症发生率及病死率(27.7%、97.0%、10.9%及2.0%)与普通病房组(15.8%、88.4%、23.2%及8.4%)比较差异均有统计学意义(均P<0.05).结论 卒中单元能明显改善急性脑卒中患者的近期预后.     

森田疗法在轻-中度急性缺血性卒中治疗中的应用研究

目的 探讨森田疗法对轻-中度急性缺血性卒中患者康复、住院时间、住院费用的影响.方法 将NIHSS评分为＜15分的70例中度脑卒中患者随机分为两组,分别给予森田疗法与常规疗法联合治疗(心理干预组20例)和单用常规疗法治疗(未心理干预组50例).比较两组患者入院时和出院前的NIHSS、mRS、BI、住院天数、住院费用上的差别.结果 与常规治疗相比,对轻-中度急性缺血性卒中用森田疗法进行心理治疗可以使患者平均住院天数明显缩短[心理干预组:(10.5士2.7)d,未心理干预组:(15.4±2.1)d,(P＜0.05)],平均住院费用降低[心理干预组:(14 885.5士3 687.5)元,未心理干预组:(22 773.4±4 221.7)元,(P＜0.05)],而对△NIHSS、△mRS、△BI评分无明显影响.结论 对脑卒中患者进行心理干预,可以缩短其住院时间、减少住院费用、促进康复.     

高压氧联合卒中单元治疗重症小脑出血48例疗效观察

目的观察高压氧联合卒中单元治疗严重小脑出血的疗效。方法将研究对象分为卒中单元组(SU组)和普通病房组(非SU组),均常规采用微创钻颅及药物治疗,普通病房组采用常规内科及康复治疗,卒中单元组按标准化操作程序,给予综合康复及高压氧治疗。治疗前后对比分析2组患者的感染率、多脏器功能衰竭(MOF)发生率、病死率及神经功能(NIHSS)、生活能力(Barthel)评价。结果治疗后,与非SU组比较,SU组的感染发生率显著降低;MOF发生率及病死率皆低于非SU组,但无显著性差异;NIHSS和Barthel评定显著改善。结论联合高压氧的卒中单元模式综合管理治疗重症小脑出血患者的疗效显著优于普通住院治疗模式。     

中国脑血管病防治指南(节选)

第三章 卒中单元 一、概念 卒中单元（stroke unit）是指改善住院卒中患者的医疗管理模式，专为卒中患者提供药物治疗、肢体康复、语言训练、心理康复和健康教育、提高疗效的组织系统。卒中单元的核心工作人员包括临床医师、专业护士、物理治疗师、职业治疗师、语言训练师和社会工作者。基于以上概念，可以将卒中单元概括为以下特点：（1）针对住院的卒中患者，因此它不是急诊的绿色通道，也不是卒中的全程管理，只是患者住院期间的管理。（2）卒中单元不是一种疗法，而是一种病房管理系统。（3）这种新的病房管理体系应该是一种多元医疗模式（muhidisciplinary care system），也就是多学科的密切合作。（4）患者除了接受药物治疗，还应该接受康复治疗和健康教育。但是，卒中单元并不等于药物治疗加康复治疗，它是一种整合医疗（integrated care）或组织化医疗（organized care）的特殊类型。（5）卒中单元体现对患者的人文关怀，体现了以人为本。它将患者的功能预后以及患者和家属的满意度作为重要的临床目标，而不像传统的理念仅强调神经功能的恢复和影像学的改善。     

Physical and Sexual Abuse and Neglect and Eating Disorder Symptoms

Abstract

For eating-disordered patients with a history of post-traumatic stress, childhood abuse and neglect, and dissociative disorder, eating behavior symptoms may function as a rational response to unmetabolized traumatic experiences. This paper will review trauma-based theory, dissociation, abreactive, and ego-states therapy as they apply to eating disorder patients.     

Physical and Sexual Abuse and Neglect and Eating Disorder Symptoms

For eating-disordered patients with a history of post-traumatic stress, childhood abuse and neglect, and dissociative disorder, eating behavior symptoms may function as a rational response to unmetabolized traumatic experiences. This paper will review trauma-based theory, dissociation, abreactive, and ego-states therapy as they apply to eating disorder patients.     

Efficacy and Effectiveness of Child and Adolescent Psychotherapy and Pharmacotherapy

Decades of intervention research have produced a rich body of evidence on the effects of psychotherapies and pharmacotherapies with children and adolescents. Here we summarize and critique that evidence. We review findings bearing on the efficacy of psychosocial treatments and medications under controlled experimental conditions. We also report evidence, where available, on the effectiveness of both classes of treatment with clinically referred youth treated in real-world clinical contexts. In general, the large body of evidence on efficacy contrasts sharply with the small base of evidence on effectiveness. Addressing this gap through an enriched research agenda could contribute importantly to linking scientific inquiry and clinical practice—to the benefit of both ventures. This is one element of a multifaceted agenda for future research and for synthesis of research, which will require the interplay of multiple disciplines related to child and adolescent mental health.     

Presence and severity of anorexia and bulimia among male and female Omani and non-Omani adolescents

OBJECTIVE: The population of Oman is a heterogeneous mix of nationalities providing a natural setting for studying the cross-cultural differences in the presence and severity of eating disorders as well as an opportunity for evaluating the performance of measurement instruments for these disorders. METHOD: Disordered eating screening instruments (the Eating Attitude Test and the Bulimic Investigatory Test) were administered to Omani teenagers, non-Omani teenagers, and Omani adults. RESULTS: On the Eating Attitude Test, 33% of Omani teenagers (29.4% females and 36.4% males) and 9% of non-Omani teenagers (7.5% of males and 10.6% females) showed a propensity for anorexic-like behavior. On the Bulimic Investigatory Test, 12.3% of Omani teenagers showed a propensity for binge eating or bulimia (13.7% females and 10.9% males). Among the non-Omani teenagers, 18.4% showed a tendency toward bulimia, with females showing a slightly greater tendency than males. In contrast, barely 2% of Omani adults showed either a presence of or a severity of disorderly behavior with food. CONCLUSION: Omani teenagers scored significantly higher than other ethnic groups and Omani adults. This finding is discussed in the light of emerging evidence from many parts of the world suggesting that cultural transition, compounded by demographic constraints, plays a significant role in abnormal eating attitudes.     

Spatial attention and conscious perception: interactions and dissociations between and within endogenous and exogenous processes

A current controversy exists about the relationship between spatial attention and conscious perception. While some authors propose that these phenomena are intimately related (Bartolomeo, 2008, Chun and Marois, 2002, O’Regan and Noë, 2001, Posner, 1994), others report dissociations between them (Kentridge et al., 1999, Koch and Tsuchiya, 2007, Wyart and Tallon-Baudry, 2008). However, spatial attention is not a unitary mechanism, and it is possible that not all forms of attention dissociate from conscious perception. In the present study we used a paradigm in which endogenous and exogenous forms of attention are orthogonally manipulated in order to investigate their relation with conscious perception within the same design. By analyzing two different cue-related components, our results demonstrated that while endogenous attention was electrophysiologically dissociated from conscious perception, exogenous attention was not, consistent with the hypothesis that exogenous attention is an important antecedent of our conscious experience. Our results support previous claims of dissociations between some forms of spatial attention and conscious perception, but also highlight the importance of exogenous orienting on the selection of information for conscious access.     

Serious emotional and behavioral problems and mental health contacts in American and British children and adolescents

OBJECTIVE: To compare prevalence of serious emotional and behavioral problems and mental health contacts for these problems among American and British children and adolescents. METHOD: Data on children and adolescents ages 5 to 16 years were drawn from the 2004 U.S. National Health Interview Survey (response rate = 79.4%) and the 2004 survey of Mental Health of Children and Young People in Great Britain (response rate = 76.0%). Emotional problems, hyperactivity/inattention, and conduct problems were assessed using the parent version of the Strengths and Difficulties Questionnaire (SDQ). Psychometric properties of SDQ scales were compared across countries. RESULTS: The SDQ has similar psychometric properties across countries. More British than American children met the criteria for emotional and conduct problems, but not hyperactivity/inattention. Prevalence was higher for all problems in 5- to 8-year-old British boys and for emotional problems in 13- to 16-year-old British girls. American children with serious emotional and behavioral problems had a higher prevalence of mental health contacts overall and with mental health providers but not with general medical providers. CONCLUSIONS: British children have a higher prevalence of parent-reported serious emotional and behavioral problems than American children. However, British children with these problems are less likely than American children to receive mental health care.