肠造口患者焦虑抑郁的认知治疗及护理

目的评估肠造口患者焦虑及抑郁状态并观察认知疗法的疗效。方法通过对14例肠造口患者进行抑郁自评量表（SDS）和焦虑自评量表（SAS）测评，计算评分并与国家常模比较，应用认知疗法进行干预后重新测评，治疗前后评分比较。结果肠造口患者SDS和SAS评分明显高于国家常模（P〈0．001），应用认知疗法干预后SAS、SDS评分较治疗前明显下降（P〈0．001）。结论肠造口患者具有明显的焦虑、抑郁情绪，认知疗法可有效消除上述不良情绪。     

凶险型前置胎盘剖宫产手术中护理配合的应用效果分析

目的 观察优质护理对凶险性前置胎盘剖宫产手术的临床运用价值。方法 我院 2021 年 8 月至 2022 年 8 月收治的 60 例 凶险型前置胎盘剖宫产手术患者,随机将分为对照组和观察组,每组各 30 例。对照组实行常规护理,观察组实行优质护理。 对比两组患者抑郁自评量表（SDS）、焦虑自评量表（SAS）评分、并发症发生率、生活质量评分以及护理质量。结果 观察组 抑郁自评量表（SDS）、焦虑自评量表（SAS）评分低于对照组（P<0.05）。观察组并发症发生率低于对照组（P<0.05）。观 察组生活质量评分高于对照组（P<0.05）。观察组护理质量高于对照组（P<0.05）。结论 凶险型前置胎盘剖宫产手术实施优质 护理,能够减少并发症,提升生活质量,改善不良情绪。     

腹泻型肠易激综合征患者的生活质量和心理特征分析

目的探讨腹泻型肠易激综合征（D-IBS）患者的生活质量和心理特征及两者之间的关系。方法在我院门诊连续选取160例D-IBS患者,应用汉化版简明健康调查量表（SF-36）、Zung焦虑自评量表（SAS）和抑郁自评量表（SDS）对其进行评分,分别与国内常模进行比较,并分析生活质量评分与焦虑抑郁评分之间的关系。结果 D-IBS患者SAS和SDS得分比国内常模均明显升高（P〈0.05）,生活质量方面生理功能、心理职能、躯体疼痛、一般健康状况、精力、社会功能、情感职能、精神健康等各个维度分值比国内常模均有明显降低（P〈0.05）。160例患者中78例合并焦虑状态,93例合并抑郁状态,焦虑状态发生率48.8%,抑郁状态发生率58.1%,D-IBS患者SAS和SDS得分比国内常模均明显升高（P〈0.05）。经Pearson相关分析显示：生活质量评分与焦虑抑郁评分之间呈负相关（P〈0.05）。结论 D-IBS患者存在焦虑抑郁心理障碍,生活质量明显受损,焦虑抑郁等不良精神心理因素是影响其生活质量主要因素之一。     

不孕症女性患者焦虑抑郁状况及相关因素分析

目的：了解不孕症女性患者心理健康状况,探讨相关影响因素。方法对144例不孕妇女进行症状自评量表（SCL-90）和抑郁自评量表（SDS）、焦虑自评量表（SAS）评定,并与对照组作比较。结果不孕症女性患者中,焦虑发生率为25.0％（36/144）,抑郁发生率为20.8％（30/144）, SCL-90筛查阳性率为18.8％（27/144）。不孕症女性患者的SAS评分、 SDS评分、 SCL-90焦虑及精神病性因子评分均高于对照组（P均＜0.01）。 SCL-90总分及其他因子评分与对照组比较差异无统计学意义（ P＞0.05）。不孕类型、与家庭成员关系、受教育程度、家庭经济是不孕症女性患者焦虑抑郁情绪的影响因素（ P＜0.05）。年龄、 BMI、不孕年限则与SAS评分、 SDS评分、 SCL-90总分无关（ P＞0.05）。结论不孕症女性患者普遍存在焦虑及抑郁,因此在不孕症的治疗中,要重视对患者进行心理干预。     

护理干预对喉癌患者焦虑抑郁的影响

目的探讨护理干预对喉癌患者焦虑、抑郁的影响。方法采用SDS(抑郁自评量表)、SAS(焦虑自评量表)评定患者情绪状况,并给予护理干预,比较护理干预前后的SDS、SAS评分。结果喉癌患者存在明显的焦虑及抑郁心理,护理干预后SDS、SAS比较有统计学意义(P<0.05)。结论对喉癌患者实行护理干预能减轻其焦虑抑郁情绪,提高患者生活质量。     

多媒体辅助围术期心理护理在体外循环心脏手术围手术期中的应用

目的 观察多媒体辅助心理护理对体外循环心脏手术患者围手术期负性情绪的干预效果。方法 将2014年5月至2017年5月江苏大学附属医院胸心外科60例拟行体外循环心脏手术的患者按随机数字表法随机分为两组。对照组予常规访谈式围手术期心理护理;观察组采用访谈辅以多媒体形式进行心理护理。分别于手术前后1～2周进行焦虑自评量表(SAS)评估、抑郁自评量表(SDS)和心理弹性量表（CD - RISC）评分。结果 手术前两组患者焦虑、抑郁程度及心理韧性评分差异均无统计学意义（均P>0.05）;手术后两组患者SAS、SDS及CD-RISC评分差异均有统计学意义（均P<0.05）;术后对照组大学及以上文化程度患者焦虑、抑郁程度改善比大学以下文化程度患者更明显（P<0.05）,而观察组不同文化程度患者SAS、SDS及CD-RISC评分差异均无统计学意义（P>0.05）。结论 围手术期多媒体健康教育,改善了患者尤其是低文化程度患者的负性情绪,有利于患者恢复。     

临终患者亲属心理障碍89例多因素分析

目的探讨临终患者亲属心理障碍的影响因素,为临终关怀提供理论指导。方法选用焦虑自评量表(SAS)、抑郁自评量表(SDS)评价亲属的情绪障碍,采用临终患者的生活质量(QOL)、社会支持、生活满意度(LSIA)、焦虑抑郁(HAD)、疼痛分级(VRS)以及亲属应激(RSS)等指标作为相关因素,对89例老年临终住院患者亲属进行评定,并以50例普通老年住院患者亲属的RSS、SAS、SDS作为对照。结果临终患者亲属RSS、SAS、SDS评分明显高于对照组(P<0.01);女性亲属应激及焦虑抑郁水平高于男性(P<0.05或P<0.01)。多元回归分析显示:SAS评分与SDS、RSS正相关,与患者的QOL负相关;SDS与SAS、RSS、亲属年龄正相关,与患者的社会支持负相关。结论临终患者亲属存在较高的心理应激水平和焦虑抑郁情绪,且女性高于男性;焦虑抑郁水平受多种因素影响。应给予针对性护理措施。     

舒适护理对普外科留置胃管患者的护理效果及其负性情绪改善分析

目的 分析舒适护理对普外科留置胃管患者的护理效果及负性情绪改善效果。方法 选择本院普外科住院的120例留置胃管患者,随机分成对照组和观察组各60例,对照组给予常规护理,观察组在对照组基础上给予舒适护理,对比两组焦虑自评量表（SAS）评分、抑郁自评量表（SDS）评分、Kolcaba简化的舒适状况量表（GCQ）评分、不良反应总发生率。结果 观察组护理后SAS评分、SDS评分均低于对照组,GCQ评分高于对照组（P<0.05）。结论 舒适护理可有效减轻普外科留置胃管患者心理焦虑、抑郁等不良情绪,提高舒适度。     

老年高血压患者血压水平与其失眠、抑郁及焦虑状况的相关性

目的 探讨老年高血压患者血压水平与其失眠、抑郁及焦虑状况的相关性。方法 选取2018年12月至2021年12月石家庄市第一医院收治的老年高血压患者200例,其中血压控制不达标高血压患者67例为A组,血压控制达标高血压患者133例为B组,并以同期老年健康查体志愿者30名为对照组。收集三组匹兹堡睡眠质量指数量表评分（PSQI）、睡眠时间、焦虑自评量表评分（SAS）、抑郁自评量表评分（SDS）、血压水平、血压控制达标率等。比较不同血压控制达标情况患者的PSQI评分、睡眠时间、SAS评分、SDS评分,分析患者PSQI评分、睡眠时间、SAS评分、SDS评分与血压水平的关系,并分析患者PSQI评分、睡眠时间、SAS评分、SDS评分对其血压控制达标率的影响。结果 A组和B组的收缩压、舒张压、PSQI评分、SAS评分、SDS评分均高于对照组而睡眠时间短于对照组,差异有统计学意义（P<0.05）;且A组收缩压、舒张压、PSQI评分、SAS评分、SDS评分均高于B组,睡眠时间短于B组,差异有统计学意义（P<0.05）。Pearson线性相关分析结果显示,老年高血压患者收缩压、舒张压与其PSQI...     

人文关怀护理对血液肿瘤住院患者焦虑抑郁情绪及满意度的影响

目的:探讨人文关怀护理对血液肿瘤住院患者焦虑抑郁情绪及满意度的影响。方法:选择2015年11月~2016年4月血液肿瘤住院患者102例,将其随机等分为对照组和观察组,对照组采用常规护理,观察组采用人文关怀护理。比较两组患者焦虑自评量表(SAS)、抑郁自评量表(SDS)评分和住院患者满意度量表评分。结果:观察组患者SAS,SDS得分低于对照组(P<0.05),满意度得分高于对照组(P<0.05);干预后观察组患者SAS、SDS评分仍低于全国常模(P<0.05)。结论:人文关怀护理能够有效改善血液肿瘤患者焦虑、抑郁情绪,提高患者满意度,应大力推广应用。     

Evaluation of health-related quality of life and influencing factors in patients with Crohn disease

ObjectiveWe assessed levels of anxiety and depression in patients with Crohn disease (CD) to identify predictors of health-related quality of life (HRQOL).MethodsIn this case-control study, we enrolled 50 adult patients with CD and 50 matched, healthy controls. All participants completed self-administered questionnaires including the Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), Short Form-36 Health Survey (SF-36), and Short Inflammatory Bowel Disease Questionnaire (IBDQ, patients only). We analyzed the relationship between HRQOL and influencing factors.ResultsMean total scores on the SAS, SDS, and SF-36 were significantly different between patients and controls. IBDQ scores among patients in the active phase of CD were significantly lower than those in remission phase. SF-36 scores were significantly lower in patients with CD compared with healthy controls. SF-36 scores among patients with active CD were significantly lower than scores among those in remission, and SF-36 scores in patients without complications were significantly higher than in those with complications. SF-36 scores in patients with good nutritional status were also significantly higher than scores in malnourished patients with CD.ConclusionsDepression, anxiety, disease activity, complications, and nutritional status were predictive factors of decreased HRQOL in patients with CD.     

The Psychological and HRQoL related Aftermaths of Extra Corporeal Membrane Oxygenation Treatment: A Cross‐Sectional Study

ObjectivesTo assess symptoms of post-traumatic stress disorder, anxiety, depression and health related quality of life in a sample of adult patients treated with veno-arterial extracorporeal membrane oxygenation.Design and settingThis is a cross-sectional study. The population were all patients discharged (2008–2018) from a thoracic surgical intensive ward at a tertiary university hospital in Norway. A sample of 20 patients was recruited.Main outcome measuresSymptoms of post-traumatic stress disorder were assessed using Impact of Events Scale-Revised, while symptoms of depression and anxiety were assessed using Hospital Anxiety and Depression Scale. RAND 36-Item Short Form Health Survey was applied to measure health-related quality of life.ResultsSymptoms of post-traumatic stress disorder were reported by 40% of the participants. Twenty percent reported symptoms of depression and anxiety. Compared to the general population, participants reported poorer health-related quality of life on all domains, and significantly worse on the domains physical function, general health and social function.ConclusionPatients in our study reported symptoms of post-traumatic stress disorder, anxiety, depression and impaired health-related quality of life following treatment with veno-arterial extra corporeal membrane oxygenation. Addressing possible emotional and psychological distress could represent a potential major improvement in health care provided to this group. Further research is needed to incorporate prophylactic methods, such as identifying vulnerable patients and implement corresponding interventions, into clinical practice.     

Clinical evaluation of natalizumab for formulary consideration

Importance of the field: Natalizumab is a monotherapy for relapsing forms of multiple sclerosis (MS) and maintaining remission in Crohn's disease (CD). Evaluation of natalizumab's clinical relevance must be performed before considering its place in treatment of these diseases.

Areas covered in this review: MEDLINE and PubMed searches were performed using the keywords multiple sclerosis, Crohn's disease, natalizumab and clinical trials. The manufacturer's product information was consulted to extract additional data. Pivotal clinical trials included: Natalizumab Safety and Efficacy in Relapsing Remitting Multiple Sclerosis (AFFIRM), Safety and Efficacy of Natalizumab in Combination With Interferon Beta-1a in Patients With Relapsing Remitting Multiple Sclerosis (SENTINEL), Efficacy of Natalizumab as Active Crohn's Therapy (ENACT)-1 and 2 and Efficacy of Natalizumab in Crohn's Disease Response and Remission (ENCORE).

What the reader will gain: AFFIRM and SENTINEL showed improvements in progression of MS. ENACT-1 failed to show a significant effect, but the follow-up trials ENACT-2 and ENCORE were able to demonstrate a response to natalizumab.

Take home message: Two trials on efficacy of Tysabri for treatment of MS demonstrated positive results. Efficacy for CD was mixed. More research demonstrating head-to-head evidence against other agents is necessary to determine if Tysabri's benefits are significant.     

Predictors of health-related quality of life in patients with obstructive sleep apnoea

Title. Predictors of health-related quality of life in patients with obstructive sleep apnoea Aim. This paper is a report of a study to identify the common symptoms and demographic and physiological factors of obstructive sleep apnoea that are predictive of health-related quality of life in a Chinese population. Background. Health-related quality of life impairment in obstructive sleep apnoea is an increasingly important consideration, but little is known about the factors that influence quality of life in this population. Method. A total of 108 Chinese patients with newly diagnosed obstructive sleep apnoea were recruited in 2003 and assessed for health-related quality of life, daytime sleepiness, depression and anxiety. Associations between symptoms, demographic and physiological factors and quality of life were examined by Pearson linear correlation. Hierarchical multiple regression were used to determine predictors of overall quality of life and its dimensions. Results. Forty-six patients (42·6%) had depressed mood and 21 (19·4%) were anxious. Fifty-nine (54·6%) were hypersomnolent. The severity of symptoms of sleepiness, depression, and anxiety was statistically significantly inversely correlated with each domain and the total score for health-related quality of life. No statistically significant correlation was observed between disease severity and quality of life. Controlling for age and gender, anxiety and sleepiness predicted 45·2% of the variance of overall quality of life (R² = 0·452, P < 0·001). Anxiety was the strongest predictor of overall and each domain of health-related quality of life. Conclusion. Assessment of mood in patients with obstructive sleep apnoea should be an essential part of nursing practice. Comprehensive evaluation of symptoms, especially mood disturbance, is important for improving quality of life for these patients.     

Effects of Ai Chi on balance,quality of life,functional mobility,and motor impairment in patients with Parkinson’s disease*

Purpose: In this study, we aimed to investigate effects of Ai Chi on balance, functional mobility, health-related quality of life, and motor impairment in patients with Parkinson’s disease.

Method: This study was conducted as an open-label randomized controlled trial (ISRCTN26292510) with repeated measures. Forty patients with Parkinson’s disease stages 2 to 3 according to the Hoehn and Yahr Scale were randomly allocated to either an Ai Chi exercise group or a land-based exercise control group for 5 weeks. Balance was measured using the Biodex-3,1 and the Berg Balance Scale. Functional mobility was evaluated using the Timed Up and Go Test. Additionally, health-related quality of life and motor activity were assessed with the Parkinson’s Disease Questionnaire-39 and the Unified Parkinson’s Disease Rating Scale-III.

Results: Although patients in both groups showed significant improvement in all outcome variables, improvement of dynamic balance was significantly greater in the Ai Chi group (p?p?p?=?0.002), Parkinson’s Disease Questionnaire-39 (p?p?Conclusion: Our results suggest that an Ai Chi exercise program improves balance, mobility, motor ability, and quality of life. In addition, Ai Chi exercise was more effective as an intervention than land-based exercise in patients with mild to moderate Parkinson’s disease.

• Implications for rehabilitation

• Ai Chi exercises (aquatic exercises) may help improve balance, functional mobility, health-related quality of life, and motor ability in patients with mild to moderate Parkinson’s disease more efficiently than similar land-based exercises.

• Ai Chi exercises should be considered as a rehabilitation option for treatment of patients with mild or moderate Parkinson’s disease.

     

The effect of family-authored diaries on posttraumatic stress disorder in intensive care unit patients and their relatives: A randomised controlled trial (DRIP-study)

BackgroundCritical illness and mechanical ventilation may cause patients and their relatives to experience symptoms of posttraumatic stress, anxiety, and depression due to fragmentation of memories of their intensive care unit (ICU) stay. Intensive care diaries authored by nurses may help patients and relatives process the experience and reduce psychological problems after hospital discharge; however, as patients particularly appreciate diary entries made by their relatives, involving relatives in authoring the diary could prove beneficial.ObjectivesThe objective of this study was to explore the effect of a diary authored by a close relative for a critically ill patient.MethodsThe study was a multicenter, block-randomised, single-blinded, controlled trial conducted at four medical-surgical ICUs at two university hospitals and two regional hospitals. Eligible for the study were patients ≥18 years of age, undergoing mechanical ventilation for ≥24 h, staying in the ICU ≥48 h, with a close relative ≥18 years of age. A total of 116 relatives and 75 patients consented to participate. Outcome measures were scores of posttraumatic stress symptoms, anxiety, depression, and health-related quality of life three months after ICU discharge.ResultsRelatives had 26.3% lower scores of posttraumatic stress in the diary group than in the control group (95% confidence interval: 4.8–% to 52.2%). Patients had 11.2% lower scores of posttraumatic stress symptoms in the diary group (95% confidence interval: −15.7% to 46.8%). There were no differences between groups in depression, anxiety, or health-related quality of life.ConclusionA diary written by relatives for the ICU patient reduced the risk of posttraumatic stress symptoms in relatives. The diary had no effect on depression, anxiety, or health-related life quality. However, as the diary was well received by relatives and proved safe, the diary may be offered to relatives of critically ill patients during their stay in the ICU.     

内镜下切开术治疗原发性克罗恩病肛管直肠狭窄的初步探讨

目的 评价内镜下切开术(ES)治疗原发性克罗恩病肛管直肠狭窄的临床疗效.方法 回顾性分析2018年9月-2019年12月在该院接受ES治疗的原发性克罗恩病肛管直肠狭窄患者的临床资料.结果 13例患者共接受22次ES治疗,人均治疗次数(1.7±0.6)次,狭窄长度0.5～10.0 cm,中位数1.5 cm,狭窄直径0.2...     

Predictors of quality of life in people with Parkinson’s disease: evidence for both domain specific and general relationships

Abstract

Purpose: To assess the determinants of health-related quality of life (HrQoL) in people with Parkinson’s disease (PD). Method: Eighty-one people with a diagnosis of idiopathic PD took part in a cross-sectional questionnaire-based study. Measures were collected in a community setting and included established determinants of HrQoL (demographic, clinical and cognitive variables) but also included a wide range of mental health variables (depression, anxiety and stress) and, for the first time, positive psychological functioning (optimism and self-esteem). HrQoL was measured by the full version of the Parkinson’s Disease Questionnaire (PDQ-39) which includes eight domains of functioning. Results: Mental health measures (depression, anxiety and stress) were more influential than any other block of determinants and influenced a broader array of HrQoL domains including physical ones. There was some evidence of domain-specific relationships, e.g. between physical determinants and the more physically-oriented HrQoL domains, and between mental health determinants and emotional well-being. However, cognitive ability did not influence the HrQoL domain of cognitive impairment. Conclusions: The contribution of a multi-disciplinary approach is crucial given the many variables which affect HrQoL; in particular, significant overall improvements on HrQoL are unlikely if only physical rehabilitation is offered. Rehabilitation is likely to be beneficial in terms of HrQoL only if it is planned and delivered holistically.

• Implications for Rehabilitation

• Interventions to improve physical function may have only limited impact on quality of life and might be limited to more physical HrQoL domains.

• Psychological interventions have the potential to improve quality of life over a wider range of both emotional and physical HrQoL domains.

• Clinician-measured level of functioning does not necessarily translate into patient-perceived levels of functional ability and relatively small objective decreases in ability can be appraised much more significantly disabling by people with PD.

     

High post surgical opioid requirements in Crohn's disease are not due to a general change in pain sensitivity

Crohn's disease (CD) is a painful inflammatory bowel disease with complex multigenic inheritance. Suggested on the basis of a few isolated reports CD patients require significantly higher post operative opioid doses than patients undergoing comparable severe abdominal surgery. Crohn's disease therefore may be a suitable model for the identification of novel pain susceptibility genes. In order to confirm this observation and to elucidate the underlying molecular mechanisms, we investigated if higher opioid needs of CD patients are due to a general change in pain sensitivity. Quantitative sensory testing (QST) was applied to a subgroup of patients and polymorphisms in the μ‐opioid receptor (OPRM1) and catechol‐O‐methyltransferase (COMT) were investigated. Significantly increased post operative opioid requirements in CD patients were confirmed and QST assessment demonstrates that CD patients do not display increased pain sensitivity in terms of lowered thresholds to thermal and mechanical stimuli. The data also suggest that common variants in OPRM1 and specific ‘high pain sensitivity’ COMT haplotypes may not be the cause of high opioid needs. The results indicate that a more complex pathway is involved in the greater post operative opioid demand in CD. Therefore the presence of other, as yet unknown, genes could modulate opioid requirements in CD patients.