A cross‐sectional survey of patients with open surgical wounds in Slovenia

Most surgical wounds heal by primary intention, that is, the wound is closed with sutures, clips, or glue. However, some surgical wounds are either left open to heal from the bottom up (“healing by secondary intention”) or break open partially or fully after primary closure. There is little basic knowledge about the occurrence and natural history of surgical wounds healing by secondary intention (SWHSI); therefore, the aim of this survey was to estimate the number of people with SWHSI in Slovenia, the nature of these wounds, and to investigate how they are managed. A multiservice, cross‐sectional survey was carried out over a 2‐week period in the city of Ljubljana, Slovenia (population 288,919). Healthcare professionals across health and social care settings completed one anonymised form for each patient with a SWHSI. Forms were completed for 110 patients. The point prevalence of SWHSI was 0.38 per 1,000 of the population (95% CI: 0.33–0.44). Patients’ mean age was 50.5 years. The majority of SWHSI were planned to heal by secondary intention before surgery (76/110, 69%). Of SWHSI, 83% (92/110) were treated with wound dressings, and 6% were treated with negative pressure wound therapy. Data were missing for 11 cases. This survey is the first to provide essential information about the extent, nature, and treatment of SWHSI in Slovenia. Furthermore, it is one of the latest of a very small number of studies to have contributed to knowledge about SWHSI globally. The results from the survey can be used for planning future research, health resources management, and policy development.     

肿瘤化疗患者癌性厌食现状及影响因素研究

目的 调查肿瘤化疗患者癌性厌食现状并分析其影响因素,为实施针对性干预提供参考。方法 采用便利抽样法,选取286例肿瘤化疗患者为调查对象,采用一般资料调查表、癌性厌食量表、化疗相关性味觉改变量表、医院焦虑抑郁量表、家庭功能问卷进行调查。结果 患者癌性厌食得分为(18.50±5.88)分,癌性厌食与化疗相关性味觉改变、负性情绪呈负相关,与家庭功能呈正相关(均P<0.05)。多元回归分析显示,性别、化疗相关性味觉改变、焦虑、家庭功能是化疗患者癌性厌食的影响因素(均P<0.05),可解释总变异的31.2%。结论 肿瘤患者在化疗期间普遍存在癌性厌食,医护人员应关注并识别发生厌食的患者,制定个体化干预措施,缓解患者癌性厌食症状。     

不悦症状理论及其应用现状

从不悦症状理论背景与发展、核心概念、影响因素、内部评价、外部评价、理论应用等方面对不悦症状理论进行了介绍。     

Characteristics of oxygenated hemoglobin concentration change during pleasant and unpleasant image‐recall tasks in patients with depression: Comparison with healthy subjects

Aim

Patients with major depressive disorder (MDD) have been reported to show cognitive impairment in attention, cognition control, and motivation. The prefrontal cortex plays an important role in the pathophysiology of depression. Neurophysiological abnormalities have been examined in MDD patients by several neuroimaging studies. However, the underlying neural mechanism is still unclear. We evaluated brain function during pleasant and unpleasant image‐recall tasks using multichannel near‐infrared spectroscopy (NIRS) in MDD patients.

Methods

The subjects were 25 MDD patients and 25 age‐ and sex‐matched healthy controls. Patients were classified according to DSM‐IV‐TR criteria. We measured the oxygenated hemoglobin concentration change (δoxyHb) in the forehead and temporal lobe during image‐recall task with pleasant (e.g., puppy) and unpleasant (e.g., snake) images using NIRS. To check whether all subjects understood the task, they were asked to draw pictures of both image tasks after NIRS measurement.

Results

The δoxyHb in the healthy group was significantly higher than that in the MDD group in the bilateral frontal region during the unpleasant condition. A significant negative correlation between the Hamilton Rating Scale for Depression score and δoxyHb was observed in the left frontal region during the unpleasant condition.

Conclusion

We suggest that image‐recall tasks related to emotion measured by NIRS might be a visually useful psychophysiological marker to understand the decrease in the frontal lobe function in MDD patients. In particular, we suggest that the decrease in δoxyHb in the left frontal lobe is related to the severity of depression.     

The Leonardo EURACT Course for Trainers in Family Medicine.

Restless legs syndrome (RLS) has been thought to be a basically neurological disorder, often observed among patients with sleep disturbance. Although the disease identity was proposed more than half a century ago, the pathogenesis of RLS has not been elucidated, and high prevalence of the disease has been demonstrated in many reports. I hypothesize that the crucial event for the occurrence of unpleasant sensations in the legs at night should be the change of blood flow dynamics. Acceleration of blood flow in the legs when lying down should stimulate nerve fibres which are closely located to the blood vessels. This hypothesis can explain many aspects of RLS, including symptoms as well as epidemiological findings. Treatment utilizing vitamin E might be extremely easy, safe, and inexpensive compared with the dopaminergic agents or opioids usually recommended for treatment.     

症状困扰在食管癌术后患者家庭功能与支持性照护需求间的中介作用

目的 探讨症状困扰在食管癌术后患者的家庭功能和支持性照护需求间的中介效应.方法 便利选取食管癌术后患者218例,采用一般资料调查表、家庭关怀度指数问卷、安德森症状评估量表胃肠道肿瘤特异性模块、支持性照护需求简明问卷进行调查,通过结构方程模型分析三者的关系.结果 食管癌术后患者家庭功能得分为(6.60±1.59)分,症状...     

基于不愉快症状理论乳腺癌患者化疗相关认知障碍的研究进展

本文介绍了乳腺癌患者化疗相关认知障碍的概念、不愉快症状理论模型、化疗相关认知障碍的影响因素及现状,影响因素基于不愉快症状理论从症状产生的生理、心理和情境层面进行总结,以期为医务人员早期识别乳腺癌患者化疗相关认知障碍,针对性提高其认知功能提供理论依据。     

重症加强治疗病房清醒患者不良住院经历调查分析

目的 调查重症加强治疗病房(ICU)清醒危重患者住院期间心理及生理不良经历的发生情况,并分析相关诱发因素.方法 选择全国31家三级甲等医院ICU进行为期2个月的连续性调查,所有转出ICU的清醒患者均入选本次调查,于转出后2 d内由上海诺德健康咨询有限公司委派、经课题组系统培训合格的访问员按问卷要求独立对患者进行访问.结果 共计234例患者接受调查,其中163例(69.6%)发生了心理不良经历;有生理不良经历患者的比例高达97.0%,其中74.8%的患者发生了严重生理不良经历.有86.5%存在心理不良经历的患者发生了严重生理不良经历,显著高于无心理不良经历的患者(46.5%),差异有统计学意义(P<0.01).分别有65.8%和74.8%的患者抱怨对噪音及医护操作难以忍受,且此类患者心理及生理不良经历的比例均较能耐受者显著增高(P<0.05或P<0.01).多因素分析发现,急性生理学与慢性健康状况评分系统Ⅱ(APACHE Ⅱ)评分为诱发心理不良经历的独立高危因素[优势比(OR)=1.070,95%可信区间(CI)为1.020～1.130,P<0.05];年龄因素为发生生理不良经历的高危因素(OR=0.936,95%CI为0.879～0.998,P<0.05).此外,恰当的镇静能有效降低ICU清醒危重患者心理及生理不良经历的发生率.结论 ICU清醒危重患者不良住院经历发生率高,存在心理不良经历的患者更容易出现生理不良经历.疾病严重程度是诱发不良心理经历的独立危险因素,ICU环境因素(如噪音)以及医护操作与心理及生理不良经历关系密切,而恰当的ICU镇静策略是减少心理及生理不良经历的有效措施之一.     

The impact of fatigue on the development of postpartum depression

BACKGROUND: Previous research suggests early postpartum fatigue (PPF) plays a significant role in the development of postpartum depression (PPD). Predicting risk for PPD via early identification of PPF may provide opportunity for intervention. OBJECTIVE: To replicate and extend previous studies concerning the impact of PPF on symptoms of PPD and to describe the relationships among PPF, PPD, and other variables using the theory of unpleasant symptoms. DESIGN: Correlational, longitudinal study. SETTING: Participants' homes. PARTICIPANTS: Convenience sample of 42 community-dwelling women recruited before 36 weeks of pregnancy. MAIN OUTCOME MEASURES: PPF, depressive symptoms, and stress measured during prenatal weeks 36 to 38, and on Days 7, 14, and 28 after childbirth. Salivary cortisol was measured as a physiological marker of stress. RESULTS: Significant correlations were obtained between PPF and symptoms of PPD on Days 7, 14, and 28, with Day 14 PPF levels predicting future development of PPD symptoms in 10 of 11 women. Perceived stress, but not cortisol, was also correlated with symptoms of PPD on Days 7, 14, and 28. Women with a history of depression had elevated depression scores compared to women without, but no variable was as effective at predicting PPD as PPF. CONCLUSIONS: Fatigue by Day 14 postpartum was the most predictive variable for symptoms of PPD on Day 28 in this population.