Predicting improvement in stroke patients referred for inpatient rehabilitation.

An historical prospective study of prediction of improvement and final disposition of 105 patients with a stroke was carried out over a 2-year period in the rehabilitation service of a hospital providing long-term care. Patients were referred a mean of 37.8 days after the stroke, and were evaluated for total function and for mental status, perception, communication and motor ability at the time of admission and every 2 to 3 weeks thereafter. At the time of admission 26% of the patients were able to care for themselves; at the time of discharge 59% were able to do so, but 44% of these could not return home, primarily because of unfavourable social and environmental circumstances. In contrast, 35% of the patients unable to care for themselves went home because their families were willing to provide extra care. Neither the total function score nor the neurologic subtest scores at the time of admission predicted improvement. The presence of sphincter control and a lower age were the only significant predictors of improvement.     

医院就诊肠易激综合征患者精神障碍共病的临床观察

目的 通过人格及精神障碍评估问卷了解医院就诊肠易激综合征(IBS)患者精神障碍的共病状况.方法 顺序纳入2008年11月至2010年3月北京大学第三医院消化科门诊就诊、符合罗马Ⅲ标准的IBS患者83例,由经过培训的人员通过人格诊断问卷4(PDQ-4)、复合型国际诊断交谈(CIDI)表进行人格障碍、躯体形式障碍及其他精神障碍诊断.结果 83例IBS患者中男43例,女40例,年龄(38±14)岁.其中便秘型20例(24.1%)、腹泻型31例(37.3%)、混合型15例(18.1%)、未分型17例(20.5%).(1)62例(74.7%)患者被检出1型或多型人格障碍,性别差异无统计学意义,其中以强迫和回避为特征的焦虑-抑制类(C组)人格障碍最多(58例,69.9%).存在人格障碍者躯体形式障碍检出率为46.8%(29/62),高于无人格障碍者[19.0%(4/21),P=0.025].(2)IBS患者的CIDI-3.0精神障碍终生患病率44.6%(37例),显著高于对照组,性别差异无统计学意义.焦虑与心境障碍是最多见的精神障碍共病类型,分别为21例(25.3%)和19例(22.9%).物质滥用和依赖、间歇性暴发障碍分别检出9例(10.8%)和7例(8.4%).腹泻型IBS患者精神障碍共病率最高(58.1%,18/31),但不同IBS亚组之间精神障碍检出率差异无统计学意义.(3)IBS患者中33例(39.8%)存在躯体形式障碍,性别差异无统计学意义.各亚组间躯体形式障碍检出率差异无统计学意义.焦虑障碍同时合并躯体形式障碍者为61.9%(13/21),显著高于无焦虑障碍者[32.3%(20/62),P=0.016].结论 综合医院消化科就诊的IBS患者精神障碍共病较为常见,尤其是焦虑障碍和心境障碍.存在人格偏离及焦虑障碍的IBS患者更容易出现躯体形式障碍,消化专业医师应对此有充分认识并予以恰当治疗建议.

Abstract：

Objective To assess the prevalence of psychiatric comorbidities in patients referred for irritable bowel syndrome(IBS)with questionnaires for mental disorders.Methods A total of 83 IBS patients at our hospital were enrolled and assessed with the Personality Diagnostic Questionnaire for DSM-IV,version 4(PDQ-4)and Composite International Diagnostic Interview,version 3.0 and 2.1(CIDI-3.0 & CIDI-2.1)by trained interviewers.Such items as personality dysfunction,mental disorder and somatization disorder were examined.Results The male-female ratio was 1.08/1.Their mean age was(38±14)years old.Among them,20 patients(24.1%)were constipation-predominant,31(37.3%)diarrheapredominant,15(18.1%)mixed and 17(20.5%)unclassified type.(1)Sixty-two(74.7%)patients scored positive for any personality dysfunction.There was no significant gender difference.The cluster C (anxious-fearful)personality disorder was most commonly found in IBS patients(n=58,69.9%).The prevalence of somatoform disorders plus personality dysfuntion was 46.8%(29/62).It was significantly higher than those without personality dysfunction[19.0%(4/21),P=0.025].(2)Thirty-seven patients (44.6%)had a lifetime CIDI-3.0 diagnosis.It was significantly higher than that in the general population.There was no gender difference.Anxiety and mood disorders were the most common types of psychiatric comorbidities[n=21(25.3%)and n=19(22.9%)respectively].The lifetime prevalence of alcohol or nicotine abuse and(or)dependence and intennittent explosive disorder were 10.8%(n=9)and 8.4%(n=7).Psychiatric comorbidities were most commonly found in diarrhea-predominant patients(58.1%).But there was no significant difference among the subgroups.(3)Thirty-three patients(39.8%)had somatoform disorders.Neither gender nor subgroup differencc wag observed.The IBS patients with anxiety disorders presented significantly more somatoform disorders than the remainders[61.9%(13/21)vs 32.3%(20/62),P=0.016 1.Conclusion Such psychiatric comorbidities as anxiety disorders and mood disorders are common in patients referred for IBS.The patients with personality dysfunction and(or)anxiety were more likely to suffer somatoform disorders.A gastroenterologist should grasp a thorough knowledge and make appropriate therapeutic recommendations for those patients.     

冠心病系统心理学干预治疗的临床研究

目的探讨冠心痛心理障碍的消除和控用途径．方法时ｍ的冠ｃ病患者随机分为Ａ、Ｄ两组，分别实行或不实行系统心理学干于治疗，其它治疗功同，进行临床时抵研究．结果－理学于于治疗组回型行为改善明显（Ｐ＜０．ｏｆ）．Ｍ并紧上庄素及去甲肾上腺素显著下降，临床症状及ＥＣＧＳＴ－－Ｔ显著好转（Ｐ＜ｏ．ｍ），ｄ了理治疗组的临床效果优于对照组．结论冠心病急者进行系统心理学干预治疗．对于控制和改善冠心病的临床表现具有重要意义．     

认知心理干预对抑郁症患者的影响

目的:探讨认知心理对抑郁症患者的影响。方法:选择70例抑郁症患者为研究对象,随机分为观察组和对照组,每组各35例。两组患者均给予盐酸帕罗西汀联合富马酸喹硫平药物口服治疗12周;观察组患者在此基础上给予认知心理干预。比较治疗前、后,两组患者的汉密顿抑郁量表(HAMD)得分和汉密尔顿焦虑量表得分(HAMA)变化及GQOLI-74生活质量量表评价患者生活质量。结果:治疗后,观察组患者的HAMD、HAMA得分均明显低于对照组(P<0.05),而心理功能与社会功能得分均显著高于对照组水平(P<0.05)。结论:在盐酸帕罗西汀联合富马酸喹硫平药物治疗抑郁症患者的基础上,采用认知心理干预有助于患者的抑郁、焦虑程度和促进其认知功能恢复。     

Prevalence of active Helicobacter pylori infection among patients referred for endoscopy in Brunei Darussalam

INTRODUCTION: The prevalence of Helicobacter pylori (H. pylori) infection has been reported to vary between and even within countries. We retrospectively assessed the prevalence among patients referred for endoscopy in our local setting. METHODS: 4,700 patients, who had endoscopy and H. pylori testing for the first time over a five-year period, were reviewed. RESULTS: The mean age was 45.4 +/- 17.1 years (male 51.1 percent), with racial breakdown similar to the national breakdown. The main indications for endoscopy were dyspepsia (59.6 percent), anaemia (12.6 percent), gastrointestinal bleeding (9.4 percent) and gastro-oesophageal reflux (7.6 percent). The overall prevalence of H. pylori was 26.9 percent, highest in the 30-39 years (30.3 percent) age group. This was higher in males compared to females (30.3 percent versus 23.3 percent, p-value is less than 0.001). Among the racial groups, the expatriate (35.3 percent, p-values are less than 0.001) and the indigenous (31.3 percent, p-values are less than 0.001) groups had significantly higher prevalence rates compared to the Malays (25.9 percent) and the Chinese (23.2 percent). Patients with dyspepsia had the highest prevalence (29.8 percent) compared to the other indications. In patients with peptic ulcer disease, the prevalence rate was 46.9 percent. Over the five-year period, there was a decline in prevalence from 32.3 percent to 25.6 percent. This trend was seen in the Malays and the Chinese, but not the indigenous and the expatriate groups. CONCLUSION: Similar to reported data from the regions, prevalence of H. pylori infection varies, with the Malays and the Chinese having the lowest prevalence rate. The prevalence among those with peptic ulcer disease was lower than reported. There was also a decline in the overall prevalence.     

心理护理干预对宫颈癌患者的心理影响

目的:对宫颈癌患者进行心理调查分析,寻找负性心理特征,并给予相应的心理护理干预。方法:64例宫颈癌患者(宫颈癌组)和50例子宫肌瘤患者(对照组)应用症状自评量表(SCL-90)进行测评,并根据测评结果给予相应的护理干预。结果:干预前,两组患者SCL-90总分及各因子分均高于正常常模范围(P<0.05);宫颈癌SCL-90的总均分及各因子分中F1(躯体化症状)、F2(强迫症状)、F3(人际敏感)、F4(抑郁)和F5(焦虑)等的均分均明显高于对照组;通过手术及护理干预4 d后,与术前比较,两组SCL-90均分及各因子均分明显下降,差异有统计学意义(P<0.05),两组间比较,宫颈癌组仍明显高于对照组,两组比较差异有统计学意义(P<0.05)。结论:宫颈癌患者的负性心理状态的护理干预是一个长期过程,应通过各种手段给予患者良性影响,以提高患者的生存期及生活质量。     

心肌标记物在脓毒症患者预后评估中的意义

目的 探讨心肌标记物脂联素（adiponectin, APN）、脑利钠肽（brain natriuretic peptide, BNP）和肌钙蛋白-I（troponin-I, cTn-I）在脓毒症患者预后评估中的意义。方法 采用前瞻性队列研究,纳入2016—2018年4月入住同济大学附属同济医院EICU且符合入组标准的脓毒症患者125例。收集患者详细病史资料,监测患者入院当天APN、BNP、cTn-I、Lac、IL-6、IL-8及TNF-α水平及入院后第1、3、7天心肌标记物动态监测,以住院期间死亡作为观察终点。结果 125例脓毒症患者中存活94例,死亡31例。生存组与死亡组在呼吸频率、心率、平均动脉压、氧合指数、ICU住院天数之间差异有统计学意义（P＜0.05）。死亡组入院时危重评分（APACHE Ⅱ、SOFA、qSOFA）、BNP（第3、7天）、cTn-I（第7天）、IL-6及TNF-α水平明显高于存活组（P＜0.05）,而APN水平则明显低于存活组（P=0.012）。APN水平与IL-6、TNF-α、BNP、cTn-I之间均存在显著负相关性（P＜0.05）。生存预后曲线显示,入院时BNP＞1200pg/mL、cTn-I＞0.11ng/mL、APN＜1016.05pg/mL,其住院期间死亡风险明显增加。结论 心肌标记物及其动态监测对脓毒症患者预后评估有一定的临床价值。APN水平升高对脓毒症患者是保护因素,监测血APN水平对脓毒症严重程度及预后判断有一定的指导意义。