老年期痴呆患者行为和精神症状的调查及护理对策

目的 探讨老年期痴呆患者的行为和精神症状及护理措施.方法 对收治的56例老年期痴呆患者进行了行为和精神症状的调查与分析,并针对其症状采取适合的护理措施.结果 痴呆的行为和精神症状(BPSD)发生率达94.64%,针对行为和精神症状采取了饮食和心理护理,加强对症护理并预防和治疗躯体疾病.结论 加强老年痴呆的护理质量对于提高痴呆患者的生存质量,减轻照顾者负担具有重要的临床意义.     

老年期痴呆患者行为和精神症状的调查及护理对策

目的探讨老年期痴呆患者的行为和精神症状及护理措施。方法对收治的56例老年期痴呆患者进行了行为和精神症状的调查与分析,并针对其症状采取适合的护理措施。结果痴呆的行为和精神症状（BPSD）发生率达94．64％,针对行为和精神症状采取了饮食和心理护理,加强对症护理并预防和治疗躯体疾病。结论加强老年痴呆的护理质量对于提高痴呆患者的生存质量,减轻照顾者负担具有重要的临床意义。     

老年痴呆患者生活质量的研究进展

本文通过阐述老年痴呆患者逐年增多,随认知功能减退,自理能力下降,影响痴呆患者的生活质量,已成为家庭和社会的负担这个现状,归纳了日常生活功能、经济状况、认知功能、精神行为症状、照顾者知识技能等是影响老年痴呆患者生活质量的主要因素。采取全程护理,实施家庭环境管理,对照顾者技术知识健康教育,行为干预训练,建立、完善社区老年服务网络等护理干预措施来提高痴呆老人生活质量,指出如何进一步提高痴呆患者的生活质量是今后研究的主要方向。     

痴呆患者护理过程中的抗拒行为及应对策略

痴呆患者的照护抗拒行为是与照护活动密切相关的精神行为反应,了解该行为并制定相应的干预措施,对于痴呆护理服务具有重要的现实意义。文章系统介绍了抗拒照护的概念与行为表现、产生原因与后果、常用护理评估工具与干预措施,以期为痴呆患者的长期照护提供参考。     

家庭环境因素对居家痴呆患者精神行为症状的影响因素研究

目的 探讨家庭环境因素对居家痴呆患者精神行为症状的影响,以期为居家痴呆患者精神行为症状的干预提供参考。方法 采用便利抽样法,选取2021年1月至2022年1月就诊于丽水市人民医院神经内科门诊,且经诊断有精神行为症状的193例居家痴呆患者为调查对象,采用独立样本t检验、x²检验、秩和检验进行差异性分析,多因素线性回归进行影响因素分析。结果 家庭环境与居家痴呆患者精神行为症状显著相关(r=-0.906,P<0.001),患者因素(年龄、文化程度、痴呆严重程度)、家庭环境因素(隐私性与社交性、稳定性/可预测性、个性化刺激)与居家痴呆患者精神行为症状得分的多因素线性回归得分差异有统计学意义(P<0.05)。结论 居家痴呆患者年龄、文化程度、痴呆严重程度及家庭环境中隐私性与社交性、稳定性/可预测性和个体化刺激是其精神行为症状的影响因素,需针对可改变因素加强预防,以期降低居家痴呆患者精神行为症状的发生率。     

老年期痴呆伴发精神行为症状的护理研究进展

<正>当今社会老年人群日益庞大,老年相关的疾病也逐渐增加。老年期痴呆作为老年期的常见疾病逐渐引起重视。此类患者认知功能及生活自理能力逐渐减退,晚期患者因功能严重受损,需要消耗大量的社会卫生资源进行医疗及护理。而老年期痴呆患者常伴有明显的精神行为症状,如幻觉、妄想、情感症状和激越攻击等,因此造成护理难度的明显增加[1]。1痴呆的精神行为症状1.1概念痴呆的行为和精神症状(BPSD)也被称为     

痴呆患者精神行为症状的非药物管理研究进展

精神行为症状在痴呆患者中发生率很高,给治疗和护理带来挑战。非药物治疗是应对大部分精神行为症状的首选照护方法。本文对痴呆患者精神行为症状非药物管理进展进行综述,以期为临床医护人员提供参考和指导。     

自我角色认同护理干预对住院老年期痴呆患者激越行为的影响

目的观察自我角色认同护理干预方法对住院老年期痴呆患者激越行为的影响。方法便利抽样选取2014年7-9月在上海市长宁区精神卫生中心住院的41例老年期痴呆患者为研究对象,采用随机数字表法将其分为干预组19例与对照组22例,对照组患者接受老年期痴呆常规护理,干预组在常规护理的基础上,接受自我角色认同干预,为期12周。采用激越行为量表(Cohen-Mansfield agitation inventory,CMAI)在干预前及干预后6、12周时对患者进行测量。结果干预组干预后6周时CMAI总分、躯体性攻击行为、语言性激越行为较干预前明显改善,差异有统计学意义(均P0.05);干预12周时CMAI总分、躯体性攻击行为、躯体性非攻击行为、语言性激越行为均较干预前明显改善,差异有统计学意义(均P0.05)。对照组患者干预后6、12周的CMAI总分及各分项评分,与干预前比较,差异均无统计学意义(均P0.05)。与同期对照组比较,干预6周后躯体性攻击行为评分,干预12周后的CMAI总分、躯体性攻击行为、躯体性非攻击行为及语言性激越行为评分均明显降低,差异均有统计学意义(均P0.05)。结论自我角色认同护理干预能有效改善住院老年期痴呆患者的激越行为症状。     

PRECEDE-PROCEED模式健康教育对养老护理员关于老年期痴呆患者护理知信行的干预效果分析

目的 分析PRECEDE-PROCEED模式健康教育对养老护理员关于老年期痴呆(痴呆)患者护理知识、信念、行为的影响.方法 随机抽取某养老机构的104位护理员作为实验组,另抽取其他养老机构的101位护理员作为对照组,分别给予PRECEDE-PROCEED模式和普通模式健康教育干预,并于干预前后对他们进行痴呆护理的知信行调查评估.结果 实验组经过PRECEDE-PROCEED模式干预后,护理员的痴呆护理知识、信念、行为方面均较干预前具有显著改变和提高,与对照组比较,行为方面得分差异有统计学意义(P＜0.05).结论 PRECEDE-PROCEED模式的护理健康教育,能有效提高养老护理员的护理水平,有助于进一步提高老年痴呆患者的生活质量.     

麻痹性痴呆患者精神行为症状的中医辩证护理

目的:探讨麻痹性痴呆患者精神行为症状中医辩证护理效果。方法:选取2013年1月~2015年1月于我院接受治疗的麻痹怀痴呆患者为研究对象,随机分为观察组43例和对照组41例,观察组采用中医辨证施护,对照组采用常规施护。比较两组患者的神经精神症状评分及生活质量评分。结果:观察组住院1周及出院前生活质量评分均高于对照组(P0.05),神经精神症状均较对照组低(P0.05)。结论:中医辨证施护能有效减轻麻痹性痴呆患者的精神行为症状,改善病情,提高患者的生活质量。     

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.     

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.