认知干预对精神分裂症患者自知力的影响

目的探讨认知干预对首发精神分裂症患者自知力的影响。方法将120例首发精神分裂症患者按入院顺序分为对照组和观察组各60例，两组均接受抗精神病药物治疗和常规健康教育，观察组在此基础上予认知干预。采用简明精神病评定量表、自知力与治疗态度问卷及自制的治疗依从性调查表，分别于治疗前、治疗8周后对两组患者进行测评。结果两组患者治疗前简明精神病评定量表、自知力与治疗态度、治疗依从性的测评分比较无统计学意义（P〉0．05），治疗8周后各项测评分比较有统计学意义（P〈O．05）。结论认知干预有助于恢复精神分裂症患者自知力、提高治疗依从性。     

健康教育对改善精神分裂症患者服药依从性的作用

目的探讨健康教育对改善精神分裂症患者服药依从性的作用。方法将100例住院精神分裂症患者随机分为研究组50例和对照组50例,均予药物治疗,研究组在此基础上给予健康教育干预。在入院1周内和出院时对两组患者进行简明精神病评定量表、自知力与治疗态度问卷及服药依从性评定和对比分析。结果入院时,两组患者的简明精神病评定量表、自知力与治疗态度问卷分差异无显著性意义(P>0.05),出院时差异有显著性意义(P<0.05);两组患者入院1周内服药依从性比较差异无显著性意义(P>0.05),入院6周后研究组的服药依从性高于对照组(P<0.05)。结论在精神分裂症治疗过程中实施健康教育可提高患者的服药依从性。     

关爱随访对首发精神分裂症患者出院康复和生活质量的影响

目的探讨关爱随访对首发精神分裂症患者康复和生活质量的影响。方法将我院收治的140例首发精神分裂症出院患者按随机数字表法分为观察组和对照组,每组70例,两组患者在住院期间均予系统性抗精神病药物治疗及护理,出院后对照组实施常规出院指导及门诊随访,观察组在此基础上实施关爱随访。随访时间为6个月。分别在出院时、随访6个月末采用服药依从性问卷、简明精神病量表(BPRS)、精神分裂症生活质量量表(SQLS)对两组患者进行评估比较。结果随访6个月末,观察组服药依从性明显高于对照组,BPRS评分、SQLS评分明显低于对照组,差异均具有统计学意义(P0.01、P0.05)。结论关爱随访有助于提高首发精神分裂症患者的服药依从性,可改善患者的精神症状,提高患者的生活质量。     

药物依从性治疗对首发精神分裂症病人预后的影响

[目的]探讨药物依从性治疗对首发精神分裂症病人预后的影响。[方法]将80例首发精神分裂症病人随机分为对照组与观察组各40例。对照组采用精神科常规健康教育,观察组采用药物依从性治疗方法进行干预。对两组病人随访6个月,并分别于干预前、干预后3个月、6个月时采用自知力与治疗态度问卷(ITAQ)、简明精神病量表(BPRS)、社会功能缺陷筛选量表(SDSS)及服药依从性、复发率对两组病人进行评定。[结果]两组干预后3个月、6个月BPRS、ITAQ及SDSS评分比较差异均有统计学意义(P0.05)。两组干预后3个月、6个月时服药依从性及复发率比较差异有统计学意义(P0.05)。[结论]药物依从性治疗能够增加首发精神分裂症病人对疾病及治疗的认识,提高服药依从性,减少复发,对恢复社会功能有一定的促进作用。     

“希望重塑”团体心理辅导对住院精神分裂症患者服药依从性的影响

目的探索"希望重塑"团体心理辅导对住院精神分裂症患者服药依从性的影响。方法选取本院住院精神分裂症患者120例,按随机数字表法将其分为研究组和对照组各60例,对照组采用精神科常规治疗及护理,研究组在此基础上实施为期12周的"希望重塑"团体心理辅导干预,观察对比两组12周后药物依从性评定量表(MARS)、服药依从性行为主观评价量表(MAQ)、简明依从性评定量表(BARS)的分值变化。结果经过12周的"希望重塑"干预,研究组与对照组在服药依从性评定量表(MARS)(χ2=6.720,P0.05)、服药依从性行为主观评定量表(MAQ)(χ2=4.821,P0.05)、简明依从性评定量表(BARS)(χ2=8.571,P0.05)方面差异有统计学意义。结论 "希望重塑"团体心理辅导可以提高住院精神分裂症患者服药的依从性。     

健康行为教育对精神分裂症患者的康复作用

目的探讨健康行为教育对精神分裂症患者康复的作用。方法 2009年1-6月,按随机数字表法将100例精神分裂症患者分为观察组和对照组各50例,在系统抗精神病药物治疗的基础上,对照组患者实施常规健康教育,观察组患者实施健康行为教育,并随访1年。采用简明精神病评定量表(brief psychiatric rating scale,BPRS)、社会功能缺陷筛选量表(social disability screening schedule,SDSS)、自编服药依从性调查表及统计疾病复发率比较两组患者健康教育的效果差异。结果观察组患者1年后BPRS、SDSS评分明显降低,与对照组比较差异有统计学意义(P<0.01),观察组患者教育前后自身比较差异有统计学意义(P<0.01);服药依从性及疾病复发率两组比较差异均有统计学意义(均P<0.01)。结论健康行为教育能明显缓解精神分裂症患者的精神症状,对改善社会功能、提高服药依从性、降低疾病复发率、维持身心健康水平有重要作用。     

康复介入对首发精神分裂症患者社会功能的影响

目的探讨康复干预对精神分裂症患者社会功能恢复的影响。方法将84例首发精神分裂症患者随机分为观察组和对照组各42例。两组维持药物治疗,观察组在接受药物治疗的同时,接受系统的康复干预。于治疗前及治疗后应用简明精神病评定量表（BPRS）、住院精神病患者康复疗效评定量表（IPROS）、社会功能缺陷筛选量表（SDSS）综合评价患者的康复情况。结果 84例精神分裂症患者均进入结果分析,简明精神病评定量表（BPRS）治疗前33.0±7.1,治疗后21.3±6.2,住院精神病患者康复疗效评定量表（IPROS）治疗前50.7±5.0,治疗后20.5±3.4,社会功能缺陷筛选量表（SDSS）治疗前10.3±2.9,治疗后1.8±1.7,差异有统计学意义（P〈0.01）。结论综合康复治疗能训练精神分裂症患者生活自理能力和社会适应能力,使患者获得自我价值和自我效能感的认可,并能改善患者的社会功能。     

同辈教育对精神分裂症患者康复的影响

目的:探讨同辈教育对精神分裂症患者的康复的影响。方法:将140例住院精神分裂症患者随机分为观察组和对照组各70例,两组均接受抗精神病药物系统治疗,观察组在此基础上给予同辈教育8周,对照组未进行其他处理;采用精神病评定量表(BPRS)、自知力与治疗态度问卷(ITAQ)及服药依从性分别于干预前及干预后8周末进行比较;出院1年后随访复发情况,并采用自测健康能力量表(SRHMS)与治疗前进行比较。结果:干预后两组BPRS、ITAQ、服药依从性、复发率、SRHMS总分及各因子比较差异有统计学意义(P0.05,P0.01)。结论:对精神分裂症患者实施同辈教育,能显著改善患者对疾病的认识能力,提高其服药依从性。     

认知行为干预对首发精神分裂症患者远期疗效的影响

目的：探讨认知行为干预对首发精神分裂症患者远期疗效的影响。方法：对104例首次发病、经住院治疗处于恢复期的精神分裂症患者随机分为研究组及对照组，研究组54例，对照组50例。研究组给予抗精神病药物治疗的同时给予认知行为干预，对照组只给予抗精神病药物治疗。采用精神分裂症阳性症状量表（SAPS）、阴性症状量表（SANS）、简明精神病评定量表（BPRS）、自知力及治疗态度问卷（ITAQ）和社会功能缺陷筛选量表（SDSS）对两组患者进行2年内康复状态评估。结果：2年末研究组BPRS、ITAQ、SDSS评分明显优于对照组，两组间差异性比较，有显著性意义（P〈0．01）；研究组服药依从性明显优于对照组，两组间差异性比较有显著性意义（P〈0．01）；研究组复发率和再入院率明显低于对照组，两组间差异性比较有显著性意义（P〈0．01）；结论：对首发精神分裂症患者进行认知行为干预，有助于改善精神分裂症残留症状，降低社会残疾程度，对保持精神分裂症患者良好的远期疗效具有积极作用。     

人性化护理干预在精神分裂症患者中的应用及效果观察

目的:探讨人性化护理干预在精神分裂症患者中的应用方法及临床效果。方法:将120例精神分裂症患者随机分为观察组和对照组各60例,对照组给予抗精神分裂症药物治疗和常规精神科护理,观察组在对照组基础上给予人性化护理干预。比较两组患者干预后简明精神病评定量表、护士用住院患者观察量表(NOISE)、住院精神分裂症患者康复疗效评定量表(IPROS)评分。结果:两组患者干预后简明精神病评定量表、NOISE、IPROS评分比较差异均有统计学意义(P<0.05)。结论:人性化护理干预可改善精神分裂症患者病情,提高生活质量,值得临床推广。     

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.     

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.     

Molecular characterization of virulence and antimicrobial resistance profile of Shigella species isolated from children with moderate to severe diarrhea in northeastern Brazil

Molecular characterization of virulence and antimicrobial resistance profiles were determined for Shigella species isolated from children with diarrhea in Fortaleza, Brazil. Fecal specimens were collected along with socioeconomic and clinical data from children with moderate to severe diarrhea requiring emergency care. Shigella spp. were isolated by standard microbiological techniques, and we developed 4 multiplex polymerase chain reaction assays to detect 16 virulence-related genes (VRGs). Antimicrobial susceptibility tests were performed using disk diffusion assays. S. flexneri and S. sonnei were the predominant serogroups. S. flexneri was associated with low monthly incomes; more severe disease; higher number of VRGs; and presence of pic, set, and sepA genes. The SepA gene was associated with more intense abdominal pain. S. flexneri was correlated with resistance to ampicillin and chloramphenicol, whereas S. sonnei was associated with resistance to azithromycin. Strains harboring higher numbers of VRGs were associated with resistance to more antimicrobials. We highlight the correlation between presence of S. flexneri and sepA, and increased virulence and suggest a link to socioeconomic change in northeastern Brazil. Additionally, antimicrobial resistance was associated with serogroup specificity in Shigella spp. and increased bacterial VRGs.     

护理干预对面部中重度寻常型痤疮的临床疗效影响分析

目的研究护理干预对面部中重度寻常型痤疮的临床疗效影响。方法选取本院在2014年4月~2016年7月诊治的136例面部中重度寻常型痤疮患者,随机分为研究组与对照组,每组68例;所有患者均依据其情况给予对应的治疗,其中对照组在治疗期间给予常规护理,研究组在对照组的基础上再给予综合性护理干预,比较两组的治疗效果及护理满意度情况等。结果患者在接受治疗和护理后,研究组中度与重度患者的治疗效果较对照组均明显提高(P0.05),研究组护理满意度较对照组明显增高(P0.05)。结论对面部中重度寻常型痤疮患者在其治疗期间给予综合性护理干预,具有良好的效果。