L’importance du discours intérieur dans la sémiologie psychiatrique

ObjectivesEntangled in a semiology that aspires to imitate medical semiology, psychiatry does not take seriously enough the question of internal discourse, while many psychiatric phenomena relate to the articulation between internal discourse and external discourse.The intention of this article is to draw the attention of psychiatry to the issue of internal discourse, which is insufficiently addressed within the discipline. Psychiatric semiology should be more interested in and should approach this issue of internal discourse differently. For this, it could integrate the contribution of modern linguistics and rediscover Jacques Lacan's theory of language.MethodThe article first recalls the basic principles of psychiatric semiology based on the work of Lanteri-Laura, Henri Ey, and, more recently, that of Steeves Demazeux. He shows how psychiatry has moved from a classical semiology based on the body to that of mental faculties, more or less attached to bodies. The question of internal discourse does not find its place in these approaches.DiscussionHallucinations, delusions, obsessive and melancholy ruminations… All these phenomena are related to the question of inner speech. This does not mean that they are similar or should be approached in a comparable way.ConclusionHuman beings seem to be both speaking through their outwardly directed speech and partly spoken, through their internal speech. This must be taken into account not only from a semiological point of view but also when it comes to organizing care.     

手术室心理护理对手术患者精神状态的影响

目的探讨手术室心理护理对手术患者焦虑、抑郁状态及护理满意度的影响。方法以医院2017年1月—2019年4月在医院接受手术治疗的1200例患者展开研究,随机将其划分为研究组(n=600)与对照组(n=600),分别接受常规基础上的心理护理以及单纯常规护理,对比分析患者抑郁、焦虑评分、护理满意度。结果治疗后,与对照组比,观察组抑郁、焦虑评分均更低;且研究组(97.0%)患者护理满意度高于对照组(83.7%),差异有统计学意义(P<0.05)。结论心理护理干预对于手术患者精神干预结果比较好,不仅可以改善患者的抑郁、焦虑情况,也能提升其护理满意度。     

Survival Disparities in Black Patients With EGFR-mutated Non–small-cell Lung Cancer

BackgroundLittle is known about the difference between black and non-black patients with epidermal growth factor receptor (EGFR)-mutated non–small-cell lung cancer (NSCLC), particularly regarding survival. We thus characterized the EGFR expression profile, clinical characteristics, and survival outcome in these patients.Patient and MethodsWe reviewed the cancer registry and patient charts at a New York-Bronx network (n = 2773) treating a large population of minority patients, for non-squamous NSCLC (n = 1986) diagnosed between 2009 and 2015. Survival was adjusted for smoking, gender, age, weight, and stage.ResultsThe EGFR mutation rate was 15% (98/652) in tested patients (black, 14%; non-black, 16%). There was no significant difference between the 2 cohorts with respect to age at diagnosis, gender, presenting stages, and socioeconomic status. On the other hand, weight was noted to be heavier in black patients with EGFR-mutated NSCLC than their non-black counterparts (P = .012). After adjusting for gender, age, smoking status, weight, and stage, the multivariate analysis revealed no racial disparity in survival among patients with wild-type EGFR (P = .774); However, among patients with EGFR-mutated NSCLC, black patients had shorter survival in comparison with non-black patients (P = .001), with 2-year survival rates being 33% versus 61%, respectively. Such shorter survival was also observed among EGFR-inhibitor treated patients with common EGFR mutations (P = .040).ConclusionsTo our knowledge, this is the first report of inferior survival among black patients with NSCLC with EGFR mutations, relative to non-black patients. The survival disparities suggest the need of more tailored management for this patient population.     

血清学检测联合前列腺超声造影对老年患者前列腺癌的诊断价值分析

目的分析血清前列腺特异性抗原(PSA)检查联合超声造影诊断老年前列腺癌的价值。方法选取2016年4月至2018年12月湖北钟祥市中医院诊治的50例前列腺癌患者作为研究对象。将这50例患者设为前列腺癌组,另将50例非前列腺癌患者设为非前列腺癌组。所有患者均行超声造影检查和血清PSA检查。对比前列腺癌组与非前列腺癌组年龄、前列腺体积、超声造影参数(强度减半时间、绝对增强强度、峰值强度、基础强度、加速时间、达峰时间、显影时间);对比两组血清游离PSA(f-PSA)、血清总PSA(T-PSA)、游离前列腺特异抗原/前列腺特异抗原比值(f/T-PSA)、PSA密度(PSAD);分析不同病理类型患者血清PSA水平分布情况;经ROC曲线评估血清PSA、超声造影在该病中的诊断价值。结果①与非前列腺癌组相比,前列腺癌组强度减半时间、加速时间、达峰时间、显影时间均更短,且差异具有统计学意义(P<0.05)。②前列腺癌组患者T-PSA、PSAD组水平均较非前列腺癌组高,差异具有统计学意义(P<0.05)。③结节型和隐匿性血清PSA<4ng/mL率最高,弥散浸润伴结节型>100ng/mL最高,不同病理分型的前列腺癌患者血清PSA水平分布差异具有统计学意义(P<0.05)。④超声造影参数中仅达峰值时间、显影时间的ROC曲线下面积超过0.5。血清PSAD、T-PSA联合达峰值时间、显影时间诊断该病的ROC曲线下面积为0.924。结论血清PSAD、T-PSA联合超声造影能提高老年前列腺癌诊断价值,其中血清PSA能辅助疾病类型鉴别。     

伊布利特联合胺碘酮转复持续性房颤的有效性及安全性研究

目的 探讨运用循证护理模式对脑卒中恢复期患者在社区家庭康复中的干预效果。 方法 选取80例首发脑卒中患者作为研究对象，采用随机数字表法分为常规组和观察组各40例。常规组采用常规社区家庭康复护理方法，而观察组实施循证护理模式，即采用循证护理路径制定出适合患者的最佳社区家庭康复护理方案。评估2组患者干预前后的心理状态、神经功能缺损程度、日常生活能力和运动功能，比较2组患者干预后的总有效率、生活质量、疾病复发率和护理满意度。 结果 观察组干预后的总有效率高于常规组（P＜0.05）；观察组干预后的DSI评分、CSS评分、Barthel指数和MAS评分均优于常规组（P＜0.05）；观察组患者干预后的复发率低于常规组，护理满意度高于常规组（P＜0.05）。 结论 在脑卒中恢复期患者的社区家庭康复中，实施循证护理模式能够改善患者的心理状况及运动功 和日常生活能力，降低复发率，提高患者生活质量；能够增进护患间信任及和谐关系。