醋酸曲普瑞林联合心理干预治疗特发性中枢性性早熟患儿的疗效观察

摘 要 目的：探讨醋酸曲普瑞林联合心理干预治疗特发性中枢性性早熟患儿的疗效。方法: 40例中枢性性早熟患儿随机分为观察组和对照组,每组20例。对照组给予肌注醋酸曲普瑞林,每28 d 1次;观察组在对照组治疗基础上,增加每28 d 1次的心理干预。观察比较两组患儿治疗1年前后的情绪稳定性、抑郁心理、治疗依从性,以及身高、体质量、生长速度、骨龄（BA）、预测成年身高（PAH）等各项生长指标变化。结果:治疗1年后,观察组患儿的情绪稳定性评分及抑郁心理HAMD评分均显著低于对照组(P＜0.05),用药依从性明显高于对照组(P＜0.05)。观察组患儿的生长速度、PAH均显著高于对照组(P<0.05)。结论:醋酸曲普瑞林联合心理干预治疗特发性中枢性性早熟患儿,可以缓解患儿的抑郁心理、稳定情绪、提高用药依从性,且有效地提高生长速度,显著改善患儿的PAH。     

Provider communication with adolescent and young females during sexual and reproductive health visits: findings from the 2011–2015 National Survey of Family Growth

Objective

This study assesses provider communication with adolescent and young women about birth control, emergency contraception and condoms during sexual and reproductive health visits.

Development of a patient-reported measure of the interpersonal quality of family planning care

Objective

The objective was to describe the development and assess evidence of the validity of a patient-reported scale measuring the interpersonal quality of contraceptive counseling.

The effect of counseling on willingness to use a hypothetical medication and perceptions of medication safety

Background

Poor medication adherence is an ongoing issue, and contributes to increased hospitalizations and healthcare costs. Although most adverse effects are rare, the perceived risk of adverse effects may contribute to low adherence rates.

Effective communication in the era of precision medicine: A pilot intervention with low health literacy patients to improve genetic counseling communication

Effective communication, where all parties share a common understanding, is necessary to realize the promise of Genomic Medicine. It is especially salient given the imperative to increase the participation of diverse populations in genomics research and to expand the reach of clinical genomics. We have previously shown that cancer genetic counseling is suboptimal for patients with limited health literacy. To address this finding, we implemented a pilot study to improve verbal communication between genetic counselors and their patients of limited health literacy that consisted of: i) curriculum development and delivery of a Genetic Counselors (GC) communication workshop; ii) two-month post-workshop interviews with GC participants (n = 9); iii) observations/audio recordings of counseling sessions involving 24 patients and two GC workshop participants; iv) post-counseling interviews with patients (n = 9). The 4.5-h workshop presented evidenced-based principles and strategies for effective communication with limited health literacy patients (e.g. use of plain language and teach-back), and offered specific techniques and exercises to practice adoption of such practices in the genetic counseling context. GCs expressed appreciation for the opportunity to refine their skills; however, they reported that some strategies were challenging given their professional training and communication habits. For example, GCs were concerned that use of plain language could undermine efforts to obtain informed consent and provide scientifically accurate information. Observations and patient interviews after the workshop revealed that GCs were able to employ the communication strategies with positive effects, with patients indicating sufficient understanding of the genetic test and its implications as well as satisfaction with the counselors’ communication. While derived from research on communication with those of limited health literacy, the communication approaches taught in the GC workshop could benefit most patients, given the high rates of low health literacy in many countries, and the many factors beyond health literacy that can contribute to reduced comprehension in health care environments.     

补肾活血汤治疗心理精神因素所致卵巢储备功能减退的临床观察

目的观察补肾活血汤对心理精神因素所致卵巢储备功能减退(DOR)患者的疗效。方法将60例心理精神因素所致DOR患者随机分为2组,治疗组30例予补肾活血汤口服,对照组30例予激素替代疗法,2组均治疗3个月。观察2组治疗前后临床症状改善情况,治疗前后卵泡刺激素(FSH)、黄体生成激素(LH)、雌二醇(E_2)及窦卵泡数(AFC)、卵巢直径(OVD)、卵巢基质血流阻力指数(RI)的变化;观察比较2组治疗后中医证候疗效及综合疗效,统计不良反应发生情况。结果 2组治疗后各项中医症状积分均较治疗前降低(P0.05),治疗组治疗后腰膝痠软症状积分低于对照组(P0.05)。2组治疗后FSH均降低(P0.01),E_2均升高(P0.05),治疗组治疗后LH下降(P0.01),2组治疗后FSH、LH比较差异有统计学意义(P0.05)。2组治疗后AFC均增加、RI均降低(P0.01),2组治疗后AFC、RI比较差异有统计学意义(P0.05);2组治疗前后OVD比较差异无统计学意义(P0.05)。2组治疗后中医证候疗效及综合疗效比较差异无统计学意义(P0.05)。2组治疗期间未见明显不良反应。结论补肾活血汤具有改善心理精神因素所致DOR患者临床症状及调经的作用;能降低FSH、LH水平,升高E_2水平,促进卵泡发育,改善卵巢血供,从而使卵巢功能得到改善。     

青少年产生正畸治疗需求动机的影响因素

目的：研究各种主、客观因素对青少年产生正畸治疗需求动机的影响。方法：随机抽取１１岁～１３岁青少年３００名（男女各半），做问卷调查，测量研究模型，获得被测试的治疗优先指数（ｔｒｅａｔｍｅｎｔｐｒｉｏｒｉｔｙｉｎｄｅｘ，ＴＰＩ）等级。结果：１．青少年的认知水平和对外界反馈的认知均与治疗需求显著相关；２．性别因素、家长因素及客观畸形程度都对治疗需求产生影响。结论：青少年正畸治疗需求动机的产生受社会心理因素及客观畸形程度的影响     

全麻联合腹横肌平面阻滞对肥胖患者胃减容术后疼痛及认知功能的影响

【摘要】目的 探讨优化的全麻联合腹横肌平面阻滞（TAPB）对行胃减容手术的肥胖患者术后疼痛管理和认知功能的影响。方法 选取2018年11月~2019年12月安徽医科大学第二附属医院行全麻择期袖状胃切除术的肥胖患者80例,按照随机数字表法分为全麻组（GA组）和全麻联合TAPB组（GA+TAPB组）,每组各40例。外周静脉输注负荷量右美托咪定（2 μg〖DK〗·kg-1〖DK〗·h-1）,持续15 min,麻醉采用静脉诱导、七氟醚吸入维持,术后镇痛采用自控静脉镇痛泵。TAPB采用超声引导双侧肋缘下的腹横肌平面阻滞（0375%罗哌卡因加1 μg〖DK〗·kg-1右美托咪定）。记录患者入手术室时（T0)、气腹建立后（T1）、袖状胃切除后（T2）、气管导管拔出时（T3）的心率（HR）、平均动脉压（MAP）、SpO2。术前一日、术后三个月对患者进行汉密尔顿焦虑量表 （HAMA）、汉密尔顿抑郁量表（HAMD）、MoCA量表和听觉词汇学习量表（AVLT）评分。记录患者麻醉时间、手术时间、入PACU时（T4）、入PACU1h（T5）、出PACU（T6)及术后1~3 d进行VAS评分以评价镇痛效果,并观察术后恢复情况。结果 两组患者的一般资料和术前的HAMA、HAMD、MoCA及AVLT评分比较差异无统计学意义（P＞005）。与GA组比较,GA+TAPB组患者术中丙泊酚和瑞芬太尼用量显著减少（P＜005）,术中平均动脉压（MAP）及心率（HR）明显降低（P＜005）,VAS评分在T4、T5及术后第一天、术后第二天明显降低（P＜005）,术后三天需要补救镇痛的患者显著减少（P＜005）。GA+TAPB组患者术后三个月MoCA、AVLT延迟评分与术前比较差异有统计学意义（P＜005）。结论 全麻联合腹横肌平面阻滞能为胃减容患者提供良好的麻醉效果及术后镇痛,可改善患者认知功能和延迟记忆。     

人文关怀干预对住院精神分裂症患者病情的影响

目的探讨人文关怀干预对住院精神分裂症患者病情的影响。方法将2016年5月至2019年1月期间本院收治的70例精神分裂症患者纳入本次研究中。按照随机数字表法,将70例受试者分为研究组和对照组,每组35例。所有受试者按照原有治疗方案服用药物进行治疗。研究组患者接受人文关怀干预,改善病房环境,加强心理管理,关注患者的内心精神文化需求,规范生活和饮食方面的管理,定期开展机体交流活动。所有患者在入组时(治疗前)及治疗2周时、治疗4周时分别进行精神分裂症患者生活质量量表(SQLS)、自尊量表(SES)、家庭亲密度与适应性量表的评分。结果两组患者的SOLS量表、SES量表、家庭亲密度与适应性量表评分伴随治疗的时间进展出现显著变化。研究组治疗2周、4周时的SQLS评分均显著低于对照组(P0.05)。研究组治疗2周、4周时的自尊量表评分、家庭亲密度与适应性量表的评分均显著高于对照组(P0.05)。结论积极的人文关怀干预有助于精神分裂症患者个人与社会功能的恢复。