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By exposing on the institutional level the sufferings of his present, the adolescent talks to us about his history, the damaged, destroyed or uninhabited links which mark out his life trajectory and arise in this “meantime” of his existence in so many painful shards in the internal world of his psyche and in the body. During their journey through the care institution, we work with these adolescents and their families, in this space-time, on what could help to reduce the internal breaking lines so that they can again start moving their subjective capacities to think and act in the world. Our work ethic is based on the specific capacity of each institutional actor to deploy his/her containing psychic envelopes around young patients; symbolized deployment of the containing function by the time to think about the care for the caregiver, the time to consent to it in a safe way for the adolescent, then for the latter the time once again acceptable to explore the field of possibilities.  相似文献   
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目的 分析住院超高龄患者急性肾损伤(AKI)发病后死亡相关因素。方法 回顾性分析2016年1月— 2018年1月三亚市人民医院收治的住院超高龄患者513例。其中200例患者住院期间发生AKI,出院12个月内死亡67例(死亡组),存活133例(存活组)。分析患者死亡原因,单因素和Logistic多因素分析住院超高龄患者AKI发病后死亡的相关因素。结果 脓毒症、休克、心功能不全、肾毒性药物为患者死亡的主要原因。经单因素分析,死亡组和存活组患者的年龄、体重指数(BMI)、基础疾病、AKI病因、肾小球滤过率(GFR)、平均动脉压、机械通气、尿量<0.05?ml/(kg·h)、AKI发生时各指标、AKI类型和AKI分期的差异有统计学意义(P?<0.05)。死亡组患者较存活组年龄高、BMI低、高血压发生率低、低血压和高尿酸血症发生率高,感染所致AKI发生率高,肾毒性药物所致AKI发生率低,GFR水平高,AKI发生时平均动脉压低,机械通气和尿量<0.05?ml/(kg·h)发生率高,尿酸、Scr峰值、Scr、尿素氮、血钙、血磷水平较高,血清前白蛋白、血红蛋白、血镁水平较低,AKI多为持续型,多为Ⅲ期患者,住院时间较长。Logistic多因素分析结果显示,高龄、低血压、伴发感染、平均动脉压降低、尿量<0.05?ml/(kg·h)、尿素氮升高、血清前白蛋白降低、高AKI分期、住院时间长为住院超高龄患者AKI发病后死亡的危险因素(P?<0.05)。结论 高龄、低血压、伴发感染、平均动脉压降低、尿量<0.05?ml/(kg·h)、尿素氮升高、血清前白蛋白降低、高AKI分期、住院时间长为住院超高龄患者AKI发病后死亡的危险因素,临床中应加强对此类患者的监控,以提高患者生存率。  相似文献   
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This study was designed to assess whether cocaine abuse was associated with a different set of antecedents and course for hospitalized schizophrenic patients. Forty‐three cocaine‐using and 27 non‐cocaine‐using patients with schizophrenia admitted to a dual diagnosis unit were compared with regard to antecedents to hospitalization such as prior treatment episodes, reliance on drugs for pleasure and tension reduction, and criminal history as well as course of hospital treatment. Cocaine‐using patients were more likely to have had a history of prior inpatient drug treatment and to rely on drugs to a greater extent for tension reduction and pleasure. There was a trend for cocaine users to have a history of arrests for violent crimes. Although cocaine‐using patients exhibited lower levels of global distress during the first week of hospitalization, they were no different from their counterparts who abused nonpsychostimulant drugs with regard to outcome of hospital treatment. These findings suggest that the lifetime course of illness among schizophrenic patients presenting for hospitalization who abuse cocaine may be characterized by episodes of repeated inpatient drug treatment and impaired impulse control. More rigorous discharge planning and aftercare program monitoring in the community as well as stress management interventions directed to tension reduction are therefore warranted.  相似文献   
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Abstract

The Hospital Stress Rating Scale was used to measure stress due to the experience of hospitalization for 535 medical and surgical patients in a community hospital. Patients were also asked to rate the pain they experienced on a pain thermometer, and a recovery inventory was used to score patient self-reports of their physical status, both during hospitalization and subsequent to discharge. With statistical control for patient characteristics correlated with self-reports of pain and physical status, associations between hospital stress and these variables were observed. Patients scoring high in hospital stress tended to report more pain, lower physical status during hospitalization, and less improvement after discharge than patients scoring low in hospital stress.  相似文献   
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