精神分裂症病人照料者精神负担的相关因素分析

目的探讨精神分裂症患者的住院期间的医疗护理费用、非医疗费用和患者照料者的精神负担及其相关因素。方法入选组精神分裂症患者238例，精神分裂症患者住院期间直接经济负担和照料者误工所致的间接经济负担通过直接调查获得，应用单因素方差分析和逐步线性回归分析的方法来分析照料者精神负担的相关影响因素。结果开放式管理模式下家庭的经济负担较高于封闭式管理模式下患者家庭的经济负担，两者比较差异有统计学意义（P〈0．05）；对家庭关系的影响，处于封闭式管理模式下的患者家庭受的影响大于开放式，两者比较具有统计学差异（P〈0．05）；并且应激水平与疾病家庭负担量表（FBS），出院时生活质量量表（SQLS）、出院时日常生活功能量表（ADL）的分值呈正相关，而与入院时SQLS、入院时ADL、病程的分值呈负相关。结论影响照料者应激水平最主要因素是其家庭负担；患者出院时精神分裂症病人生存质量、日常生活能力下降严重程度，是增加病人照料者应激水平的重要因素。     

2014年山东省青岛市201例手足口病重症病例经济负担调查

目的 了解山东省青岛市手足口病重症病例的经济负担，分析其影响因素，寻求减轻经济负担的方法和途径。方法 选取国家疾病监测信息报告系统中2014年青岛市报告的手足口病重症病例，采取问卷调查及医院收费系统查询相结合的方法，收集病例就医过程、相关费用等信息，估算手足口病重症病例经济负担。结果 共调查手足口病重症病例201例，总经济负担为3 736 707元，其中，直接经济负担为3 347 603元，间接经济负担为389 104元。多因素logistic回归分析结果表明，手足口病重症病例经济负担的主要影响因素是病原学类型、住院前就诊医疗机构数量、确诊医疗单位。结论 青岛市手足口病重症病例的经济负担较重。提高参保率和基层医疗单位的重症手足口病诊疗能力，控制和降低发病率将有效减轻手足口病对社会的经济负担。     

老年期痴呆患者在社区、老人院与住院中的经济负担研究

目的:探讨老年期痴呆患者的医疗护理费用及其相关因素。方法:分别对266例社区、老人院和精神病医院的老年期痴呆患者进行经济负担的调查。采用自编经济负担调查表、自编患者情况调查表、简易精神状态检查表、日常生活功能量表、临床评定量表、简明精神病量表、Hachinski缺血指数量表等进行评估,分析其经济负担及影响因素。结果:直接经济负担方面住院组、老人院组、社区组差异有显著性(P<0.01),住院组患者的费用显著高于社区组患者。费用的高低与支付方式、躯体疾病及痴呆严重程度、缺血指数、日常生活功能总分呈正相关。结论:如在社区通过改善患者的认知状态和预防脑血管危险因素,加强日常生活能力训练,便能降低经济负担。     

精神分裂症240例院外服药情况分析

目的探讨精神分裂症患者院外服药情况与复发率的关系。方法采用自制调查表对240例精神分裂症患者出院后停药时间、停药原因、住院次数、复发年限、再入院药物选取、再入院预后情况及复发率进行跟踪调查分析。结果患者出院后停药时间越早，患者复发率越高，停药原因以出现不良反应与缺乏有效监督、担心影响工作、生活等为主。结论精神分裂症患者药物维持治疗与复发率关系密切，提高患者服药依从性对降低复发率至关重要。     

新疆恶性肿瘤病人住院时经济负担的分析

目的计算恶性肿瘤患者住院期间直接经济负担和间接负担,为制定恶性肿瘤家庭防治策略提供依据。方法现场调查恶性肿瘤病人住院时各种费用及陪护情况,并与当地提供的住院陪护价格相比较。结果206例恶性肿瘤病人住院一次家庭总的费用支出为5272996元,其中直接经济负担为4874093元,占总负担的92.43%,每个家庭的平均直接负担为23660.64元,间接经济负担为398903元,占总负担的7.57%,每个家庭的平均间接负担为1936.42元。恶性肿瘤病人治疗费用在直接经济负担中所占比重较大,以治疗费用比同期的家庭收入大于4进行logistic回归分析,选入变量为家庭人口、确诊至今时间、病程、本次住院天数和医疗保障形式5个影响因素;间接经济负担以住院陪护为主,晚期病人的陪护损失要高于早期和中期病人。结论晚期恶性肿瘤病人的住院费用大,住院时间长,陪护负担重,应从家庭角度出发提倡晚期癌症病人回归社区、回归家庭。     

精神分裂症患者服药依从性与家庭环境的相关性研究

目的：分析精神分裂症患者服药依从性与家庭环境的相关性。方法：对495名精神分裂症患者进行问卷调查。调查工具包括一般资料问卷、家庭环境量表中文版（FES-CV）和精神分裂症患者服药依从性问卷。结果：单因素分析结果显示,年龄、病程、住院次数、就诊方便程度、家庭经济状况、医疗费用情况和家人是否参加过健康教育是精神分裂症患者服药依从性的影响因素（P〈0.05）;精神分裂症患者家庭环境量表各维度得分与国内常模相比均有统计学差异（P〈0.05）;精神分裂症患者服药依从性量表各维度得分与家庭环境量表各维度得分相关（P〈0.05）;分层回归分析显示,亲密度、病程、就诊方便程度和住院次数均为精神分裂症患者服药依从性的影响因素。结论：精神分裂症患者服药依从性与其家庭环境密切相关,应加强对患者家庭的护理干预,以提高患者的服药依从性。     

脑卒中三级康复患者的功能综合评定与费用和时间的关系

目的：探讨脑卒中三级康复患者的费用特点、发病初期FCA评分与三级康复期间各项费用、住院时间的关系。方法：82例脑卒中患者随机分成康复组和对照组,康复组给予规范的三级康复治疗,对照组仅一般的常规内科治疗,每例患者在入选时（V0）采用功能综合评定（FCA）量表进行功能评价,分别采集两组患者自发病到发病后6个月的直接医疗费用、直接非医疗费用和间接费用。结果：两组患者住院时间及总费用均无显著性差异（P均〉0.05）。两组患者入组时（V0）FCA总分与住院时间、直接医疗费用、总费用间呈负相关（P〈0.01—0.05）。康复组入组时（V0）FCA运动部分评分与直接医疗费用、总费用及住院时间间呈负相关（P〈0.01—0.05）;对照组入组时（V0）FCA认知部分评分与直接医疗费用、总费用及住院时间间呈负相关（P〈0.01—0.05）。两组患者住院时间与直接医疗费用、直接非医疗费、总费用间存在着较好的正相关（P〈0.01）,与非住院用药治疗费用之间呈较好的负相关（P〈0.01）。结论：脑卒中患者的直接医疗费用、总费用与发病初期综合功能水平有关;发病初期FCA总分能较好的预测脑卒中患者直接医疗费用、总费用以及住院时间;发病初期FCA运动部分评分能较好的预测接受三级康复治疗的脑卒中患者住院时间、直接医疗费用、总费用;而发病初期FCA认知部分评分能较好的预测没有得到三级康复治疗的脑卒中患者住院时间、直接医疗费用、总费用。     

肝衰竭患者血浆滤过透析过程中心理状况调查及分析

对2012年10月~2014年10月笔者所在医院收治的90例肝衰竭患者开展问卷调查,分析患者的焦虑状态、焦虑诱发原因及焦虑程度的影响因素。结果 90例患者中69例SAS评分超过50分,焦虑发生率为76.67%。对患者焦虑原因进行调查分析发现家庭经济负担、医疗人员治疗经验和预后效果是引发患者焦虑的3个主要原因;90例患者平均SAS评分为(54.25±10.17)分,年龄、学历和医疗费用支付方式是影响患者焦虑状态严重程度的主要危险因素,差异具有显著性(P0.05)。肝衰竭患者血浆滤过透析过程中多存在焦虑状态,家庭经济负担、医疗人员治疗经验和预后效果是引发患者焦虑的3个主要原因,年龄、学历和医疗费用支付方式是影响患者焦虑状态严重程度的主要危险因素。     

精神分裂症预后相关因素研究

为探讨影响精神分裂症患者预后的相关因素,对145例住院的精神分裂症患者进行了研究。结果发现:多因素分析(Logistic回归)筛选出的相关因素为病前性格、病后生活事件、家庭照顾、组织关心和维持治疗;单因索分析(x~2检验)筛选出的相关因索为出生胎次、病前性格、发病年龄、首次入院时病程、病后生活事件、住院总时间、自杀次数、家庭照顾、组织关心和维持治疗。对影响精神分裂症预后的相关因素进行了讨论。     

辗转就诊的精神分裂症608例分析

为探讨精神分裂症辗转就诊而延误治疗的原因,对608例曾辗转就诊的精神分裂症患者进行问卷调查,包括就诊意向的影响因素、就诊处所、就诊次数、经历时间等。结果发现影响患者就诊意向的主要因素为患者家属(51％),就诊处所频度最高的为综合医院内科(44.2％),就诊次数平均为3.8次,经历时间一年以上占56％。提示,造成延误治疗的原因主要是早期症状躯体化,相关人员缺乏精神卫生知识,对精神病存有耻辱感,据此提出了相应的对策。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.