系统化家属健康教育对精神分裂症患者康复的影响

目的:探讨系统化家属健康教育对精神分裂症患者康复的影响。方法:精神分裂症患者112例随机分为观察组和对照组各56例,并配对纳入其家属,2组患者在常规治疗护理的同时进行健康教育,在此基础上,观察组家属实施系统化健康教育,对照组家属施予传统的健康宣教。采用精神分裂症知识问卷、简明精神疾病评定量表(BPRS)、社会功能缺陷筛选量表(SDSS)、服药依从性测评表分别于入组时及出院1年末进行评定,并于出院1年末统计复发率。结果:出院1年末,2组家属精神分裂症知识掌握情况均明显优于入组时(P<0.01),且观察组更优于对照组(P<0.01);2组患者BPRS、SDSS评分均明显低于入组时(P<0.01),且观察组更低于对照组(P<0.01);观察组患者服药依从性明显高于入组时及对照组出院1年末(P<0.01)。观察组出院1年复发率明显低于对照组(P<0.01)。结论:对患者家属进行系统化健康教育能明显提高家属精神分裂症知识的掌握程度,提高患者服药依从性,改善其精神症状及社会功能,减少复发,更有利于精神分裂症患者的康复。     

健康教育对首发精神分裂症病人自知力恢复、服药依从性及复发的影响

目的: 探讨健康教育对首发精神分裂症病人自知力恢复、服药依从性及复发的影响.方法: 将112例首发精神分裂症病人随机分为健康教育联合氯丙嗪组(健康教育组)及单用氯丙嗪治疗组(对照组)各56例,分别于入院和出院时进行简明精神病量表(BPRS)、自知力与治疗态度问卷(ITAQ)及服药依从性评定,并对两组临床疗效达显进(痊愈 显著进步)以上的出院病人进行为期 2年的随访,以了解其复发情况.结果:两次BPRS评分两组间比较,差别均无显著性意义(P>0.05);入院时ITAQ评分两组间比较,差别无显著性意义(P>0.05),但出院时健康教育组ITAQ评分明显高于对照组(P<0.01);入院时服药依从性两组间比较,差别无显著性意义(P>0.05), 但出院时健康教育组服药依从性改善明显优于对照组(P<0.05);2年内,健康教育组复发率明显低于对照组(P<0.01).结论: 健康教育不仅有助于首发精神分裂症病人的治疗,而且可降低其复发率.     

院外延续健康教育对首发精神分裂症的应用效果

目的探讨院外延续健康教育对首发精神分裂症患者的干预效果。方法随机将100例首次精神分裂症发病患者分为观察组、对照组各50例。2组患者住院期间均给予常规护理,出院后进行常规门诊随访及健康教育。观察组患者在常规护理的基础上出院后采取电话随访、定期家访及集体督导等多种干预措施进行院外延续健康教育。采用自设的服药依从性调查表比较2组患者治疗依从性,采用BPRS量表评价患者的疾病情况及复发率。结果观察组出院半年、1年后BPRS评分均明显低于对照组(P0.05),随访1年内复发率为14.0%明显低于对照组复发率为38.0%,差异具有统计学意义(χ2=7.48,P0.01);观察组服药依从性优于对照组,差异具有统计学意义(χ2=8.05,P0.01)。结论院外延续健康教育有利于促进家属参与患者治疗,提高精神分裂症患者服药依从性,降低疾病复发率。     

手机短信支持在精神分裂症出院患者延续护理中的应用

目的:探讨手机短信支持在精神分裂症出院患者延续护理中的应用及效果观察。方法:选择精神分裂症出院患者86例,按出院先后顺序依次分为观察组和对照组各43例,两组出院后均给予抗精神病药物维持治疗,观察组在此基础上定期向患者发送健康宣教、服药指导及服药提醒等内容的手机短信。比较出院1年两组简明精神疾病评定量表(BPRS)评分、服药依从性及复发情况。结果:出院1年观察组BPRS评分、服药依从性明显优于对照组(P0.01,P0.05);复发率明显低于对照组(P0.01)。结论:将手机短信支持应用于精神分裂症出院患者延续护理中,能明显提高患者服药依从性,巩固疗效,减少疾病复发。     

对精神分裂症患者家属进行健康教育的效果观察

目的 探讨对精神分裂症患者家属进行健康教育的效果.方法 将2007年8月～2008年7月入院的精神分裂症患者的家属140例,随机分为观察组和对照组,各70例.对照组家属给予一般性健康教育,观察组家属在一般性健康教育基础上,实施有计划的、系统的健康教育干预.2组患者均接受系统的抗精神病药物治疗.比较2组家属对精神分裂症相关知识的了解程度及出院6个月后怠者的治疗依从性.结果 观察组家属对精神分裂症相关知识的了解评分高于对照组家属(p＜0.05);出院后6个月观察组怠者的服药依从性、再住院率及冲动情况优于对照组患者(均p＜0.05),差别有统计学意义.结论 做好精神分裂症患者家属的健康教育,可以提高怠者家属对精神分裂症相关知识了解的水平,增强患者的治疗依从性.     

自我管理教育对首发精神分裂症患者社会功能及其生活质量的影响

目的 探讨自我管理教育对首发精神分裂症患者社会功能及其生活质量的影响.方法 将116例首发精神分裂症患者随机分为观察组和对照组各58例,其中脱落5例.对照组常规用抗精神病药治疗和一般的健康教育,观察组在此基础上实施自我管理教育,并随访1年.采用简明精神病量表(BPRS)、住院患者护士观察量表(NOSIE-30)、社会功能缺陷量表(SDSS)和生活质量综合评定问卷(GQOLI),分别于入组时及随访结束时进行评估.结果 入组时,所有量表评分两组间比较,差异均无显著性意义(P＞0.05);但随访结束时,观察组患者的BPRS、NOSIE-30中的总消极因素及SDSS评分均明显低于对照组(P＜0.01),而NOSIE-30总分、总积极因素及GQOLI评分均明显高于对照组(P＜0.01),差异均有统计学意义.结论 自我管理教育有助于改善首发精神分裂症患者的精神症状,促进其社会功能的恢复,提高其生活质量.     

家庭行为训练对精神分裂症复发影响的研究

目的:探讨家庭行为训练对降低精神分裂症患者复发率、改善生存质量的作用.方法:将100例临床康复出院的精神分裂症患者随机分为家庭行为训练组和对照组.采用简明精神病评定量表(BPRS)、生存质量量表、家庭负担会谈量表对两组家庭及患者进行1年后的状态评估.结果:半年及1年末训练组患者BPRS评分明显优于对照组,两组间差异有显著意义(P＜0.05或P＜0.01);1年末训练组在生存质量、生活领域、心理领域、独立性领域及社会关系领域因子评分上明显优于对照组,两组间比较差异有显著性意义(P＜0.05或P＜0.01);1年内训练组复发率(6.3%)明显低于对照组(23.9%),两组间差异有显著性意义(P＜0.05).结论:家庭行为训练可以改善患者的生存质量,降低复发率,减轻家庭负担.     

奥瑞姆自理理论联合健康教育对首发偏执型精神分裂症女性患者的影响

目的:探讨奥瑞姆(Orem)自理理论联合健康教育对首发偏执型精神分裂症女性患者的影响。方法:选取2017年5月1日～2019年5月1日收治的72例首发偏执型精神分裂症女性患者为研究对象,按照随机数字表法将其分为观察组和对照组各36例,两组均给予抗精神病药物治疗,对照组给予常规护理干预,观察组给予Orem自理理论联合健康教育;干预前、干预4周后比较两组精神症状[采用精神病评定量表(BPRS)]、认知功能[采用霍普金斯词语学习测验修订版(HVLT-R)、斯特鲁色词测验(SCWT)]、自理能力[采用自护能力测定量表(EACA)]、生活质量[采用精神分裂症患者生活质量量表(SQLS)]。结果:干预4周后,两组BPRS、SQLS评分均低于干预前(P0.01),且观察组均低于对照组(P0.05,P0.01);干预4周后,两组HVLT-R、SCWT、EACA评分均高于干预前(P0.01),且观察组均高于对照组(P0.05,P0.01)。结论:Orem自理理论联合健康教育能改善首发偏执型精神分裂症女性患者的精神症状、认知功能,并有效提高其自理能力、生活质量水平,有助于患者康复。     

院外健康教育对精神分裂症患者康复的作用

目的探讨院外健康教育对精神分裂症患者康复的作用。方法将解放军406医院215临床部2014-06—12出院的80例精神分裂症患者随机分为干预组和对照组,每组各40例,两组均给予药物院外维持治疗,干预组接受半年系统的院外健康教育。出院时和半年后分别行简明精神病量表(BPRS)测评,并统计两组的复发率。结果 BPRS测评分比较,出院时,对照组平均评分(24.62±3.14)分,干预组平均评分(24.78±3.37)分,两组差异无统计学意义(P0.05),半年后,对照组平均评分(25.16±6.7)分,干预组平均评分(21.79±5.95)分,干预组显著低于对照组(P0.05);复发率比较,半年后干预组复发率(10%)显著低于对照组复发率(30%)(P0.05)。结论精神分裂症患者出院后行院外健康教育能显著改善病情,降低恢复期精神分裂症患者复发率,对院外精神分裂症患者的康复起到重要作用。     

精神分裂症全程护理干预60例护理体会

目的:探讨精神分裂症患者遵医行为的干预方法.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,对照组给予常规护理,观察组在此基础上进行生活技能康复训练、社会功能康复训练、健康教育全程护理干预.结果:1年后,观察组遵医率明显优于对照组(P＜0.01),生活质量综合评分显著高于对照组(P＜0.01),复发率明显降低(P＜0.01).结论:全程护理干预能提高精神分裂症患者遵医行为,提高社会适应性和生活质量,降低复发率.     

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.