海训士兵心理健康状况与应对方式相关性研究

目的研究海训期间士兵的心理健康水平及其与应对方式的关系，为部队士兵的心理健康教育提供科学依据。方法采用症状自评量表(SCL-90)和简易应对方式问卷(SCSQ)，测评480名海训士兵的心理健康状况和应对方式，并进一步分析两者的相关性。结果海训士兵SCL-90中的躯体化、恐怖和精神病性因子分值显著高于国内常模；SCSQ中积极应对方式和消极应对方式都显著低于常模；士兵的消极应对方式得分与SCL-90各因子得分呈显著正相关。结论应高度重视海训士兵心理健康状况：消极应对方式不利于士兵的心理健康．要优化和锻炼士兵对生活事件的积极应对方式和态度。     

陆军士兵海训应对方式及其相关因素的探讨

目的 研究某陆军部队士兵参加海训的应对方式及其相关因素,为提高部队官兵心理卫生工作的有效性提供科学依据。方法 应用简易应对方式问卷(scsQ)、症状自评量表(scL-90)和自制调查问卷对某部海训士兵进行心理测评。结果 海训士兵积极应对方式得分和消极应对方式得分均显低于常模;海训士兵的消极应对方式得分与scL-90各因子得分呈正相关。此外,大专以上化士兵、老兵、非独生子女士兵的积极应对方式得分显高于各自相应的对照组;而老兵、城镇士兵和对海训无顾虑士兵的消极应对方式得分显低于各自相应的对照组。结论 海训士兵的应对方式有待于进一步积极引导。应对方式和心理健康水平密切相关;化程度、军龄、户籍来源、是否为独生子女以及对海训的顾虑程度也是应对方式的相关因素。     

海训应激对战士心理和体能的影响

目的研究海训对战士心理和体能的影响,为身心卫生保健、提高部队战斗力提供依据。方法对参加海训士兵在训练前和训练末期,采用自行设计的调查表和常规方法检测,对某师两个团共445名士兵进行问卷调查和体格检查。结果海训前期与海训末期比较,士兵对濒海训练的态度比较有显著性差异（P〈0．05）;强化训练后游泳方面的体能比较有显著差异（P〈0．05）,海训后期心率、收缩压和舒张压较海训前期均有显著改善（P〈0．05）,肌肉痉挛比较均有显著性差异（P〈0．05）。结论受训士兵濒海训练应激心理适应能力及体能方面都得到了增强,但有23．37％的士兵对海训热情不高,心理负担较重。科学指导下,有效的、循序渐进的海训方法和针对性地对海训士兵进行心理健康疏导,对提高海上训练水平、减少海训伤、提高部队战斗力有指导意义。     

传染性非典型肺炎患者心理健康状况调查

目的：了解传染性非典型肺炎(severe acute respiratory syndrome．SARS)患者在患病期间的心理健康状况及特点。方法：对3l例SARS患者采用症状自评量表(SCL-90)测查其心理健康状况并进行统计分析。结果：SARS患者最普遍出现的心理症状是强迫，程度最轻及最少出现的心理症状是恐怖；其SCL-90各因子得分大部分均高于国内常模，其中躯体化、抑郁、焦虑和精神病性四项因子得分明显高于国内常模，具有统计学显著差异(P&;lt;0．05)；已婚患者除恐怖因子外，其他各因子得分均高于未婚者；女患者所有因子的得分均高于男患者，但彼此的得分差异均无统计学显著意义。结论：SARS患者在疾病应激状态下，较易出现各种不良心理，采取有效的心理干预措施是十分必要的。     

中等职业医学生心理健康状况调查

[目的]了解某中等职业卫生学校医学生心理健康状况。[方法]采用中学生心理健康诊断量表(MHT)对某中职卫生学校244名二年级医学生进行调查。[结果]总体过度焦虑检出率为2.05%,学习焦虑因子得分最高;护理专业学生仅在学习焦虑和恐怖倾向两个因子上得分显著高于非护理专业学生,女生学习焦虑、对人焦虑、自责倾向、恐怖倾向因子得分显著高于男生。[结论]该校中职医学生总体心理健康状况良好,女生心理健康状况普遍比男生差。     

中等职业医学生心理健康状况调查

[目的]了解某中等职业卫生学校医学生心理健康状况.[方法]采用中学生心理健康诊断量表（MHT）对某中职卫生学校244名二年级医学生进行调查.[结果]总体过度焦虑检出率为2.05％,学习焦虑因子得分最高;护理专业学生仅在学习焦虑和恐怖倾向两个因子上得分显著高于非护理专业学生,女生学习焦虑、对人焦虑、自责倾向、恐怖倾向因子得分显著高于男生.[结论]该校中职医学生总体心理健康状况良好,女生心理健康状况普遍比男生差.     

传染性非典型肺炎患者心理健康状况调查

目的:了解传染性非典型肺炎(severeacuterespiratorysyndrome,SARS)患者在患病期间的心理健康状况及特点。方法:对31例SARS患者采用症状自评量表(SCL-90)测查其心理健康状况并进行统计分析。结果:SARS患者最普遍出现的心理症状是强迫,程度最轻及最少出现的心理症状是恐怖;其SCL-90各因子得分大部分均高于国内常模,其中躯体化、抑郁、焦虑和精神病性四项因子得分明显高于国内常模,具有统计学显著差异(P<0.05);已婚患者除恐怖因子外,其他各因子得分均高于未婚者;女患者所有因子的得分均高于男患者,但彼此的得分差异均无统计学显著意义。结论:SARS患者在疾病应激状态下,较易出现各种不良心理,采取有效的心理干预措施是十分必要的。     

边防某部士兵夏季进驻执勤点前后心理健康状况调查

目的 探讨边防部队士兵夏季进驻执勤点前后心理健康状况,为提高执勤士兵的心理健康水平提供依据.方法 于夏季进驻执勤点前后,对边防某部308名士兵采用症状自评量表进行心理健康状况测评分析,并与中国军人常模比较.结果 本组士兵进驻执勤点前症状自评量表人际关系、抑郁、恐怖及精神病性因子分均显著低于中国军人常模(P＜0.01);进驻执勤点后除躯体化、恐怖因子分与进驻执勤点前无显著变化外(P＞0.05),其余各因子分均较进驻执勤点前显著升高(P＜0.01),强迫、抑郁、焦虑、偏执及精神病性因子分均显著高于中国军人常模(P＜0.05或0.01).进驻执勤点后,士兵主要表现为麻木、困惑,情感迟钝,缺乏耐心及自制力,易愤怒,与他人交流不畅,人际关系紧张等心理应激反应.结论 边防部队士兵夏季进驻执勤点后心理健康水平降低,予以有针对性的健康教育及心理干预,对提高执勤士兵的心理健康水平,确保顺利完成执勤任务具有重要意义.     

北京市三甲医院护士心理健康现状的调查分析

目的 探讨北京市三甲医院不同科室、不同学历及不同护龄护士的心理健康水平的关系.方法 2009年10月至2010年2月采用症状自评量表(SCL-90)调查北京市三甲医院180名护士的个性特征和心理健康状况.结果 护士心理状况不佳的检出率为19.73%,在躯体化、强迫、焦虑、敌对、恐怖、精神病性6个因子和总分上的得分高于全国常模,其中躯体化、人际敏感和精神病性因子得分与常模比较差异显著.护龄与躯体化和抑郁因子呈显著正相关,职称与恐怖因子呈显著负相关.不同科室护士在人际敏感、恐怖及精神病性方面的SCI-90评分比较差异显著.结论 护士的心理健康状况低于一般人群,突出表现在躯体化和精神病性2个方面.     

慢性乙型肝炎患者的心理健康状况及心理干预研究

目的 了解慢性乙型肝炎(乙肝)患者的心理健康状况和心理干预的效果.方法 采用症状自评量表(SCL-90)对152名住院慢性乙肝患者的心理健康状况进行测查,随机将其中90例患者分为干预组50例和对照组40例,只对干预组实施心理干预,然后对2组患者的心理健康状况进行评估.结果 慢性乙肝患者SCL-90得分显著高于常模.在干预前,干预组与对照组的心理健康状况差异无统计学意义.在实施心理干预后,除恐怖、偏执外,其他各因子及总分干预组均低于对照组.对心理健康状况的改善,心理干预辅助药物治疗优于单纯药物治疗.结论 慢性乙肝患者的心理健康状况比一般人差.心理干预能有效改善慢性乙肝患者的心理健康状况.     

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.     

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.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.