复发性生殖器疱疹患者精神健康状况的调查

目的了解复发性生殖器疱疹(RGH)患者的精神健康状况.方法采用汉密顿焦虑量表(HAMA)和汉密顿抑郁量表(HAMD)对60例复发性生殖器疱疹患者(RGH组)进行精神症状量化评分检查,并与60例健康体检者进行比较.结果 RGH组患者HAMA及HAMH评分显著高于健康体检组(均P<0.01).结论 RGH组患者普遍存在焦虑和抑郁,护理干预有利于疾病的康复.     

维、汉族心血管病住院患者抑郁焦虑状况调查分析

目的了解新疆地区维、汉族心血管病患者抑郁、焦虑状况，使临床心理护理更具有针对性。方法 采用焦虑自评量表（SAS）、抑郁自评量表（SDS）、汉密顿焦虑量表（HAMA）、汉密顿抑郁量表（HAMD）对雏、汉族心血管病住院患者各100例进行调查。结果汉族患者SAS、SDS、HAMA、HAMD评分显著高于维族患者（均P〈0．01）。结论 新疆地区汉族心血管病住院患者抑郁、焦虑状况显著高于维族患者，应根据民族差异实施针对性的心理护理。     

维、汉族心血管病住院患者抑郁焦虑状况调查分析

目的 了解新疆地区维、汉族心血管病患者抑郁、焦虑状况,使临床心理护理更具有针对性.方法 采用焦虑自评量表(SAS)、抑郁自评量表(SDS)、汉密顿焦虑量表(HAMA)、汉密顿抑郁量表(HAMD)对维、汉族心血管病住院患者各100例进行调查.结果 汉族患者SAS、SDS、HAMA、HAMD评分显著高于维族患者(均P＜0.01).结论 新疆地区汉族心血管病住院患者抑郁、焦虑状况显著高于维族患者,应根据民族差异实施针对性的心理护理.     

骨肿瘤患者情感障碍相关因素调查分析

目的 了解骨肿瘤患者抑郁、焦虑情绪的发生率，并对其相关因素进行分析。方法 对210倒骨肿瘤住院患者，应用抑郁自评量表（SDS）、焦虑自评量表（SAS）、汉密顿抑郁量表（HAMD）、汉密顿焦虑量表（HAMA）和自行设计的情感障碍影响因素调查表，进行情感状况及其相关因素的调查和分析。结果骨肿瘤患者抑鄙和焦虑的发生率分别为52．9％和21．4％；患者的SDS、SAS标准分显著高于常模（均P〈0．01）；不同病期骨肿瘤患者的情感障碍阳性率比较，差异有显著性意义（均P〈0．01）。影响骨肿瘤患者的情感因素诸多，但以对医疗费用（73．3％）、治疗效果的担心（62．9%）最为显著。结论 骨肿瘤患者情绪障碍严重，应及早给予心理干预和必要的社会支持，以提高患者的治疗效果及生存质量。     

闭合性多根肋骨骨折合并血气胸胸腔穿刺闭式引流术全程康复护理效果分析

目的 探讨闭合性多根肋骨骨折合并血气胸胸腔穿刺闭式引流术全程康复护理干预的效果。方法 选取2020-11—2022-07商丘市第一人民医院急诊科行胸腔穿刺闭式引流术的52例闭合性多根肋骨骨折合并血气胸患者，采用随机抽样法1∶1分为2组，各26例。对照组围术期间开展常规护理，观察组在常规护理的基础上加强心理、疼痛、活动等全程康复护理。比较2组患者术后置管引流时间、视觉模拟评分法(VAS)评分、镇痛药物持续应用时间、住院时间。采用汉密顿焦虑量表(HAMA)、汉密顿抑郁量表(HAMD)和匹兹堡睡眠质量(PSQI),评价干预前后2组患者的焦虑、抑郁不良情绪。统计术后并发症发生率。结果 观察组患者术后置管引流时间、镇痛药物持续应用时间、住院时间均短于对照组，术后VAS评分和并发症发生率低于对照组，干预后的HAMA、HAMD、PSQI评分均优于对照组。以上差异均有统计学意义(P<0.05)。结论 闭合性多根肋骨骨折合并血气胸胸腔穿刺闭式引流术期间，实施全程康复护理，能够优化术后临床指标，改善患者的不良情绪和睡眠质量，并可降低并发症风险，值得进一步完善和推广。     

全膝关节置换患者术后初期康复效果影响因素

目的探讨全膝关节置换(TKA)患者术后初期康复效果的影响因素。方法将南方医科大学第三附属医院2018年1月至2019年10月收治的102例初次行TKA治疗的膝骨关节炎患者纳入研究,记录术后3个月Lysholm评分,将Lysholm评分≥70分者纳入康复良好组(n=53),Lysholm评分70分者纳入康复不佳组(n=49)。比较两组患者视觉模拟量表(VAS)评分、术后并发症发生率、康复自我效能感量表(SER)评分、依从性评分、汉密顿焦虑量表(HAMA)评分及汉密顿抑郁量表(HAMD)评分的差异,对TKA术后初期膝关节功能康复效果的影响因素进行Logistic回归分析。结果康复良好组的VAS评分、术后并发症发生率、HAMA评分及HAMD评分低于康复不佳组,SER评分和依从性评分高于康复不佳组,差异具有统计学意义(P 0.05)。Logistic回归分析结果显示,疼痛、并发症发生、焦虑及抑郁状态是TKA术后初期膝关节功能康复效果的危险因素,康复自我效能和训练依从性则是保护因素(P 0.05)。结论给予患者积极的止痛治疗,采取措施减轻心理压力、减少并发症发生,增强自我效能和锻炼依从性,可促进TKA患者术后初期膝关节功能的康复,提高临床疗效。     

加拿大麦吉尔大学护理硕士教学及其启示

目的探讨妊娠期肝内胆汁淤积症（ICP）患者焦虑水平及影响因素,为实施针对性护理干预提供依据。方法应用汉密顿焦虑量表（HAMA）调查86例ICP患者焦虑水平,并对其影响因素进行分析。结果86例患者中,67例患者（77.9%）发生焦虑。精神性焦虑中焦虑和抑郁心境评分较高,躯体性焦虑主要表现为肌肉系统和胃肠道症状。患者的焦虑水平与年龄、学历、职业及有无ICP的家族史或既往妊娠史有关（均P〈0.01）,焦虑的影响因素依次是担心胎儿安危、担心身体状况、知识缺乏、经济费用、社会支持不足及医源因素。结论ICP患者存在一定程度的焦虑,应根据患者焦虑的相关因素进行个体化护理干预,从而降低其焦虑程度,维持其身心健康。     

心理干预对维持性血液透析患者精神状况和生活质量的影响

目的探讨维持性血液透析（MHD）患者精神状况与生活质量的相关性,并进行针对性的心理干预,旨在改善其患者的精神状况及生活质量。方法将具有完整生活质量评定资料的180例男性MHD患者随机分为精神症状组（A组）104例和非精神症状组（B组）76例。采用健康相关生活质量量表（SF-36）评估180例MHD患者生活质量;分别用Beck抑郁问卷（BDI）并制成量表、汉密尔顿焦虑量表（HAMA）评估患者抑郁、焦虑症状,比较2组间生活质量的差异。结果MHD患者抑郁、焦虑症状的发生率分别为18．89％（34／180）和38．89％（70／180）。精神症状评分与生活质量8项指标中7项呈负相关,A组的生活质量明显低于B组患者（P〈0．05）。心理干预治疗后,心理干预组（A1组）的生活质量明显高于非心理干预组（A2组）（P〈0．05）。结论血液透析患者精神症状发生率较高,与患者生活质量密切相关。针对性的心理干预治疗可明显改善MHD患者的精神症状,提高其患者的生活质量。     

抗抑郁剂治疗手术后胃瘫综合征31例临床分析

目的：探讨精神、心理因素与手术后胃瘫综合征的关系及抗抑郁剂对其的疗效。方法：对31例正常人和31例手术后胃瘫综合征患者进行汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）和症状自评量表（SCL-90）评分;31例手术后胃瘫综合征患者用5-羟色胺再摄取抑制剂（SSRI）西酞普兰治疗,疗程均为8周,治疗后再行量表评分。结果：3种量表（HAMD、HAMA、SCL-90）评分结果,均显示手术后胃瘫综合征患者的精神、躯体症状与正常人之间差异有非常显著性（P〈0.01）;手术后胃瘫综合征患者接受抗抑郁剂治疗8周后,精神和躯体症状均有明显改善。结论：手术后胃瘫综合征与精神心理因素相关,患者普遍存在抑郁和焦虑情绪,用抗抑郁剂治疗能显著改善精神和躯体两方面症状。     

择期开颅手术患者围术期抑郁焦虑评价分析

目的探讨择期开颅手术患者围术期抑郁焦虑状况。方法于入院时、术前1d和术后3d对109例择期开颅手术患者采用SAS和SDS量表评价其自身抑郁焦虑状况，同期由5名经过培训的护士采用HAMA和HAMD量表评价患者抑郁焦虑状况。结果患者SAS和SDS自评分与HAMA和HAMD他评分时间主效应比较，均P〈0．05，且SAS和HAMA、SDS和HAMD评分呈正相关（均P〈0．05）。结论开颅手术患者围术期存在抑郁焦虑情绪，应根据不同时期的心理需求采取相应的护理措施。经过培训的护士可以对患者进行心理状况评价。     

Presenteeism and Absenteeism Before and After Total Hip and Knee Arthroplasty

BackgroundAbsenteeism is costly, yet evidence suggests that presenteeism—illness-related reduced productivity at work—is costlier. We quantified employed patients’ presenteeism and absenteeism before and after total joint arthroplasty (TJA).MethodsWe measured presenteeism (0-100 scale, 100 full performance) and absenteeism using the World Health Organization’s Health and Work Performance Questionnaire before and after TJA among a convenience sample of employed patients. We captured detailed information about employment and job characteristics and evaluated how and among whom presenteeism and absenteeism improved.ResultsIn total, 636 primary, unilateral TJA patients responded to an enrollment email, confirmed employment, and completed a preoperative survey (mean age: 62.1 years, 55.3% women). Full at-work performance was reported by 19.7%. Among 520 (81.8%) who responded to a 1-year follow-up, 473 (91.0%) were still employed, and 461 (88.7%) had resumed working. Among patients reporting at baseline and 1 year, average at-work performance improved from 80.7 to 89.4. A Wilcoxon signed-rank test indicated that postoperative performance was significantly higher than preoperative performance (P < .0001). The percentage of patients who reported full at-work performance increased from 20.9% to 36.8% (delta = 15.9%, 95% confidence interval = [10.0%, 21.9%], P < .0001). Presenteeism gains were concentrated among patients who reported declining work performance leading up to surgery. Average changes in absences were relatively small. Combined, the average monthly value lost by employers to presenteeism declined from 15.3% to 8.3% and to absenteeism from 16.9% to 15.5% (ie, mitigated loss of 8.4% of monthly value).ConclusionAmong employed patients before TJA, presenteeism and absenteeism were similarly costly. After, employed patients reported increased performance, concentrated among those with declining performance leading up to surgery.     

The German emergency and disaster medicine and management systemdhistory and present

As well for optimized emergency management in individual cases as for optimized mass medicine in disaster management, the principle of the medical doctors approaching the patient directly and timely, even close to the site of the incident, is a long-standing marker for quality of care and patient survival in Germany. Professional rescue and emergency forces, including medical services, are the “Golden Standard” of emergency management systems. Regulative laws, proper organization of resources, equipment, training and adequate delivery of medical measures are key factors in systematic approaches to manage emergencies and disasters alike and thus save lives. During disasters command, communication, coordination and cooperation are essential to cope with extreme situations, even more so in a globalized world. In this article, we describe the major historical milestones, the current state of the German system in emergency and disaster management and its integration into the broader European approach.     

Differences in Osteocyte Density and Bone Histomorphometry Between Men and Women and Between Healthy and Osteoporotic Subjects

Bone defects related to osteoporosis develop with increasing age and differ between males and females. It is currently thought that the bone remodeling process is supervised by osteocytes in a strain-dependent manner. We have shown an altered response of osteocytes from osteoporotic patients to mechanical loading, and osteocyte density is reduced in osteoporotic patients, which might relate to imperfect bone remodeling, leading to lack of bone mass and strength. Hence, information on osteocyte density will contribute to a better understanding of bone biology in males and females and to the assessment of osteoporosis. Osteocyte density as well as conventional histomorphometric parameters of trabecular bone were determined in cancellous iliac crest bone of healthy postmenopausal women and men and of osteoporotic women and men. Osteocyte density was higher in healthy females than in healthy males and lower in osteoporotic females than in healthy females. Bone mass was reduced in osteoporotic patients, both male and female. In females, trabecular number was reduced, whereas in males, trabecular thickness was reduced and eroded surface was increased. There were no correlations between the parameter groups bone architecture, bone formation, bone resorption, and osteocyte density. These results are consistent with impaired osteoblast function in osteoporotic patients and with a different mechanism of bone loss between men and women, in which osteocyte density might play a role. The reduced osteocyte numbers in female osteoporotic patients might relate to imperfect bone remodeling leading to lack of bone mass and strength. M. G. Mullender and S. D. Tan contributed equally to this work.     

肝内胆管囊腺瘤和囊腺癌的CT、MRI及病理表现

目的探讨肝内胆管囊腺瘤和囊腺癌的CT、MRI和病理特点。方法回顾性分析经手术病理证实的6例肝内胆管囊腺瘤和2例肝内胆管囊腺癌的影像及临床病理资料，将病变的影像表现与其病理大体形态及组织学表现作对照分析。结果6例肝内胆管囊腺瘤，女4例、男2例；2例肝内胆管囊腺癌均为女性病人；8例病人平均年龄55岁。所有病灶均表现为多房囊性肿块，肿瘤囊腔各分房内常为多种液体成分，在CT上可表现为不同密度、在MRI上可表现为不同信号强度。囊内出现多发大小不等的壁结节在胆管囊腺癌内更常见，囊内有分隔但无壁结节只见于胆管囊腺瘤。在7例CT扫描中，4例胆管囊腺瘤和1例胆管囊腺癌可见囊壁或分隔上钙化，囊壁、囊内分隔及囊内结节均为轻、中度延迟增强。肿瘤中出现卵巢样间质见于3例胆管囊腺瘤和1例胆管囊腺癌，且均为女性病人。结论肝内胆管囊腺瘤和囊腺癌是肝脏不常见的囊性肿瘤，影像上多房、囊内有分隔且各分房囊内密度或信号不一致，高度提示肝内胆管囊腺瘤或囊腺癌的诊断，如囊内伴有多发大小不等的结节，则进一步提示囊腺癌的可能。但影像学表现不能区分肿瘤中有无卵巢样间质。