老年功能性便秘患者的心理评估及护理对策

目的：分析老年功能性便秘患者的心理状况,并提出相应护理对策。方法：功能性便秘患者35例（便秘组）和正常对照组32例均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）评定。结果：便秘组HAMD、HAMA总分及SCL-90量表中躯体化、抑郁、焦虑、强迫等单因子分均明显高于对照组（P〈0.05,0.01）。结论：心理因素在老年功能性便秘患者的发病中起到一定作用,加强针对性的护理措施有利于提高治疗效果。     

癌症患者抑郁状态的心理社会因素分析

目的分析癌症患者与抑郁有关的心理社会因素。方法对81例癌症患者进行症状自评量表(SCL-90)、社会支持评定量表(SSRS)、艾森克人格评定量表(EPQ)、防御方式问卷(DSQ)、生活事件量表(LES)以及汉密尔顿抑郁量表(HAMD)的评定,60例健康体检者为正常对照组,行SCL-90、EPQ、DSQ评定。结果并发症重的癌症患者HAMD得分要高于无并发症及并发症轻者;癌症抑郁组SCL-90总分、总均分、躯体化分、强迫状态分、抑郁分、焦虑分、其他分显著高于非抑郁组与对照组;癌症抑郁组EPQ的N因子分与非抑郁组及对照组比较有显著性差异;且负性生活事件多,强度大。结论躯体症状的严重程度、负性生活事件、癌症患者的人格特征、心理防御机制使用不当与癌症患者抑郁情绪的发生和持续有关。     

狂犬病患者家属的心理状态调查分析及心理干预

目的 探讨狂犬病患者家属的心理状态,为心理评估和心理干预提供依据.方法 采用焦虑自评量表(SAS)、症状自评量表(SCL-90)评定患者家属的心理状态,并与采取健康教育、心理干预后的心理进行比较.结果 狂犬病患者家属SAS总分及SCL-90中躯体化、人际关系、抑郁、焦虑、强迫症状等因子分值明显高于对照组(P＜0.05或P＜0.01).经过健康教育与综合性心理干预后狂犬病患者家属的SAS总分及SCL-90中躯体化、抑郁及焦虑等因子分值显著降低(P＜0.05或P＜0.01).结论 狂犬病患者家属存在抑郁、焦虑、躯体化症状群等负性情感;健康教育与综合性心理干预能缓解和改善抑郁、焦虑等负性情感.     

老年功能性消化不良的心理评估及护理干预分析

目的分析老年功能性消化不良患者的心理状态并探讨相关护理对策。方法使用抑郁自评量表（SDS）、焦虑自评量表（SAS）以及症状自评量表（SCL-90）对功能性消化不良患者（观察组）及同期健康体检者（对照组）分别进行心理评估。结果观察组患者的SDS、SAS评分情况明显高于对照组,差异有统计学意义（P〈0．05）;2组SCL-90评分的躯体化、强迫、抑郁和焦虑等指标情况经比较差异有统计学意义（P〈0．05）。结论老年功能性消化不良患者易发生抑郁、焦虑等不良心理反应,需实施相关护理干预。     

越鞠丸联合度洛西汀治疗伴有躯体焦虑抑郁症的临床观察

目的:观察越鞠丸联合度洛西汀治疗伴有躯体焦虑抑郁症的疗效。方法:将90例伴有躯体焦虑的抑郁症患者随机分为对照组和观察组各45例,2组给予度洛西汀治疗,观察组联用越鞠丸。疗程8周,用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、症状自评量表(SCL-90)评定疗效,采用副反应量表(TESS)评定不良反应。结果:2组治疗前后HAMD总分和躯体因子评分差异均有统计学意义(P0.05);与对照组比较,治疗后第4周末、第6周末、第8周末观察组的HAMD评分差异均有统计学意义(P0.05),观察组治疗后第8周末躯体因子评分差异有统计学意义(P0.05),TESS评分差异有统计学意义(P0.05)。结论:越鞠丸联合度洛西汀能有效改善抑郁症患者的躯体焦虑症状和抑郁症状,还可能减轻度洛西汀的不良反应。     

上海市某社区慢性病患者生活事件应激水平及与心理健康风险关系

目的探讨上海市某社区慢性病患者生活事件应激水平及与心理健康的风险关系。方法选取上海市某社区300例慢性病患者以及年龄、性别配对的300例健康人群,分别设为观察组与对照组。采用修订版生活事件量表(LES)调查2组家庭生活、社交、工作/学习以及生活事件总得分,采用症状自评量表(SCL-90)评价2组心理健康情况,并对LES条目与SCL-90条目进行相关性分析。结果 LES量表中,观察组家庭生活、社交、工作/学习以及生活事件总得分均显著高于对照组(P0.01);SCL-90量表中,观察组抑郁、躯体化、恐怖、强迫、焦虑、精神病症状评分均显著高于对照组(P0.01);2组偏执、人际关系、敌对评分差异无统计学意义(P0.05);家庭生活、社交、工作/学习以及生活事件总得分与抑郁、躯体化、恐怖、强迫、焦虑、精神病症状均呈正相关(P0.01),与偏执、人际关系、敌对无相关性(P0.05)。结论上海市某社区慢性病患者生活事件应激水平较高,心理健康状况较差,生活事件应激水平与心理健康状况具有明显的相关性。     

阿尔茨海默病照料者心理健康状况分析

目的 调查阿尔茨海默病(AD)照料者的心理状况.方法 采用自行设计的调查表及症状自评量表(SCL-90),汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)对75例AD患者及65例非AD患者的主要照料者进行测查.结果 AD患者照料者的SCL-90总分、总均分、阳性项目数、阳性项目均分、躯体化、强迫、人际关系、抑郁、焦虑、敌对等因子分以及HAMD、HAMA量表评分高于非AD患者照料者(P<0.05～0.01).结论 AD患者的照料者心理健康水平低于非AD患者照料者,焦虑和抑郁情绪障碍是主要的心理问题.     

脑卒中患者的心理变化及心理护理

【】 目的：初步调研在综合性医院脑卒中住院患者的心理变化及心理护理。方法： 采用90项症状自评量表(Symptom Check List-90,SCL-90)、汉密尔顿焦虑量表(Hamilton Anxiety Scale,HAMA)、汉密尔顿抑郁量表(Hamilton Depression Scale,HAMD)对80例脑卒中患者及健康志愿者80例进行测评。结果：脑卒中患者的SCL-90总均分、躯体化、强迫、人际关系、抑郁、焦虑、精神病性及其他饮食睡眠因子分、HAMA、HAMD均高于健康组(p＜0.01)。结论：脑卒中患者心理健康水平较差,焦虑、抑郁是脑卒中患者常见心理障碍,经心理护理后,脑卒中患者焦虑、抑郁状态明显改善。     

狂犬病患者家属的心理状态调查分析及心理干预

目的探讨狂犬病患者家属的心理状态,为心理评估和心理干预提供依据。方法采用焦虑自评量表(SAS)、症状自评量表(SCL-90)评定患者家属的心理状态,并与采取健康教育、心理干预后的心理进行比较。结果狂犬病患者家属SAS总分及SCL-90中躯体化、人际关系、抑郁、焦虑、强迫症状等因子分值明显高于对照组(P<0.05或P<0.01)。经过健康教育与综合性心理干预后狂犬病患者家属的SAS总分及SCL-90中躯体化、抑郁及焦虑等因子分值显著降低(P<0.05或P<0.01)。结论狂犬病患者家属存在抑郁、焦虑、躯体化症状群等负性情感;健康教育与综合性心理干预能缓解和改善抑郁、焦虑等负性情感。     

心理护理对脑卒中抑郁焦虑患者心理健康水平的影响

目的观察心理护理对脑卒中抑郁焦虑患者心理健康水平的影响。方法选取2015年3月~2016年9月我院生殖的脑卒中抑郁焦虑患者72例,按建档顺序分为对照组和观察组各36例。对照组给予常规护理,观察组在此基础上给予心理护理干预。采用HAMA(汉密尔顿焦虑量表)、HAMD(汉密尔顿抑郁量表)、SCL-90(症状自评量表)评估对比两组入院及出院时焦虑、抑郁状态与心理健康水平。结果入院时,两组HAMA、HAMD、SCL-90评分比较,无显著性差异(P0.05),出院时观察组HAMA、HAMD、SCL-90评分均低于对照组,差异有统计学意义(P0.05)。结论心理护理能提高脑卒中抑郁焦虑患者心理健康水平,改善焦虑、抑郁状态。     

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.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.