老年慢性阻塞性肺疾病合并肺结核误诊32例分析

目的总结老年慢性阻塞性肺疾病合并肺结核误诊原因及教训。方法回顾性分析32例老年慢性阻塞性肺疾病合并肺结核延误诊断的临床资料。结果老年慢性阻塞性肺疾病并发肺结核易发生误诊。结论老年慢性阻塞性肺疾病患者因慢性阻塞性肺疾病（COPD）合并肺结核症状多样、表现无特异性,体征,影像学,辅助检查不典型易延误诊断与治疗,延误诊断与多元因素有关。     

老年慢性阻塞性肺疾病患者抑郁发病情况及影响因素分析

目的：探讨老年慢性阻塞性肺疾病（COPD）患者抑郁发病情况及影响因素,为老年慢性阻塞性肺病患者抑郁症的预防和治疗提供理论依据。方法：选取本院2012年1月-2013年6月收治的135例老年慢性阻塞性肺疾病患者作为研究对象,采用CES-D抑郁量表进行调查,分析抑郁发病情况及其影响因素。结果：135例COPD患者中共55例发生抑郁,发病率40.74%。年龄、吸烟情况、病情严重程度以及COPD病程是影响COPD患者抑郁发病情况的独立危险因素（P〈0.05）。病情严重程度是最强因素。结论：老年慢性阻塞性肺病患者抑郁发病率较高,年龄、吸烟情况、病情严重程度以及COPD病程是影响COPD患者抑郁发病情况的独立危险因素,应针对性给予情感支持和心理干预。     

老年慢性阻塞性肺疾病合并肺结核感染的临床观察

目的研究老年慢性阻塞性肺疾病合并肺结核感染的临床表现,指导临床诊断和治疗老年慢性阻塞性肺疾病合并肺结核感染的临床观察。方法回顾性分析2012年1月-2013年10月在医院进行诊治的老年慢性阻塞性肺疾病合并肺结核感染的患者92例,48例患者具备典型的肺结核症状的老年慢性阻塞性肺疾病患者视为治疗组,对于初治患者采用2RHZE/4HR方案,对于复治患者采用3DLVE/6DLE治疗方案;44例不具备典型肺结核症状的老年慢性阻塞性肺疾病患者,按一般的慢性阻塞性肺疾病进行治疗为对照组,对比两组患者临床指标,数据采用SPSS13.0进行统计分析。结果经过15~30d的治疗后,治疗组患者中双肺斑片状阴影消失的34例占70.8%,44例对照组患者中双肺斑片状阴影消失的患者12例占29.2%,经检验治疗组患者双肺斑片状阴影消失的比例明显高于对照组,差异有统计学意义(P<0.05%);48例治疗组患者中空洞闭合或缩小的患者13例占27.1%,44例对照组患者中空洞闭合或缩小的患者26例占59.1%,经检验治疗组患者空洞闭合或缩小的比例明显低于对照组,差异有统计学意义(P<0.05%)。结论应加强对老年慢性阻塞性肺疾病合并肺结核感染的临床诊断,对于确诊的患者,临床医护人员应根据老年患者自身的情况,制定相应的化疗方案,选择不良反应小的抗结核药物对老年慢性阻塞性肺疾病合并肺结核的患者进行长期的治疗。     

53例维吾尔族老年慢性阻塞性肺疾病合并肺结核的治疗体会

目的探讨维吾尔族老年慢性阻塞性肺疾病(COPD)合并肺结核的有效治疗措施。方法对53例住院维吾尔族老年慢性阻塞性肺疾病合并肺结核病人的临床资料进行回顾性分析。结论对维吾尔族老年慢性阻塞性肺疾病合并肺结核应早识别、早诊断,正规治疗,改善患者预后。     

老年慢性阻塞性肺疾病合并左心衰竭诊治经验探讨

目的探讨老年慢性阻塞性肺疾病合并左心衰竭的诊断和治疗特点。方法以2008年1月至2011年1月期间本院收治的56例老年慢性阻塞性肺疾病合并左心衰竭的患者为研究对象,分析其发病特点、诱发因素、治疗方法及效果。结果部分患者在入院时即存在慢性阻塞性肺疾病合并左心衰竭,也可入院后并发;诱发因素为呼吸道感染、劳累、输液过多过快等;多合并1种或2种基础疾病;主要临床表现为呼吸困难、咳嗽和咳痰、端坐呼吸等,听诊肺部均有干、湿性音;给予强心、利尿、扩血管等药物治疗及氧疗,积极治疗基础疾病等治疗措施,51例经治疗后好转出院,出现药物副作用9例,5例死亡。结论慢性阻塞性肺疾病可损伤患者的心功能,并且高血压、冠心病、糖尿病等基础疾病的存在也使老年慢阻肺患者易并发左心衰竭,临床上应注意鉴别诊断,强心、利尿、扩血管药物治疗效果良好,但应注意防止副作用。     

老年慢性阻塞性肺疾病患者营养不良发生情况及相关危险因素

目的 探讨老年慢性阻塞性肺疾病患者营养不良发生情况及相关危险因素。方法 选取2019年10月至2021年10月本院收治的老年慢性阻塞性肺疾病患者152例的临床资料。统计老年慢性阻塞性肺疾病患者营养不良发生情况,分析老年慢性阻塞性肺疾病患者发生营养不良的危险因素。结果 152例老年慢性阻塞性肺疾病患者有64例发生营养不良(营养不良组),营养不良发生率为42.11%;将剩余88例营养良好患者纳入营养良好组。营养不良组年龄≥70岁、自理能力下降、处于抑郁状态、吸烟、有慢性胃病、有肺心病、厌食、FEV1/FVC<50%、动脉血PaO₂<60 mmHg的比例均高于营养良好组,差异均有统计学意义(均P<0.05);两组性别、文化程度、住院时间比较,差异均无统计学意义(均P>0.05)。多因素logistic回归分析结果显示,年龄≥70岁、自理能力下降、处于抑郁状态、有慢性胃病、有肺心病、厌食、FEV1/FVC<50%、动脉血PaO₂<60 mmHg是老年慢性阻塞性肺疾病患者发生营养不良的独立危险因素(均P<0.0...     

慢性阻塞性肺疾病患者的合并症分析

目的 通过对慢性阻塞性肺疾病合并症的认识,减少漏诊、误诊现象,提高诊治水平.方法 分析2006年3月至2009年9月住院的慢性阻塞性肺疾病患者合并症情况.结果 慢性阻塞性肺疾病患者250例,Ⅰ级98例,Ⅱ级89例,Ⅲ级51例,Ⅳ级12例.有合并症165例(66.0%),合并肺炎61例、高血压50例、支气管哮喘28例、冠心病17例、肺结核17例、糖尿病11例、肺癌8例.结论 慢性阻塞性肺疾病患者常合并其他疾病,给诊断、治疗带来困难,应引起高度重视.     

慢性阻塞性肺疾病患者的合并症分析

目的 通过对慢性阻塞性肺疾病合并症的认识,减少漏诊、误诊现象,提高诊治水平.方法 分析2006年3月至2009年9月住院的慢性阻塞性肺疾病患者合并症情况.结果 慢性阻塞性肺疾病患者250例,Ⅰ级98例,Ⅱ级89例,Ⅲ级51例,Ⅳ级12例.有合并症165例(66.0%),合并肺炎61例、高血压50例、支气管哮喘28例、冠心病17例、肺结核17例、糖尿病11例、肺癌8例.结论 慢性阻塞性肺疾病患者常合并其他疾病,给诊断、治疗带来困难,应引起高度重视.     

老年慢性阻塞性肺疾病合并肺结核的临床分析

目的:分析老年慢性阻塞性肺疾病合并肺结核的临床特点及诊疗体会。方法:回顾性分析60例慢性阻塞性肺疾病合并肺结核患者的临床资料,将其作为观察组,另选择同期60例单纯肺结核患者为对照组,比较两组的临床症状及治疗效果。结果:观察组的咯血、胸痛及消瘦等症状发生比例显著高于对照组(P0.05),而两组的咳嗽咳痰发生比例差异无显著性(P0.05)。观察组的临床总有效率为88.33%,对照组临床总有效率为98.33%,观察组总有效率显著低于对照组(P0.05)。结论:慢性阻塞性肺疾病合并肺结核患者咯血、胸痛、消瘦等症状比较常见,且治疗难度大于单纯肺结核患者。临床诊断中要注意鉴别,以免发生误诊、漏诊。     

慢性阻塞性肺疾病患者的合并症分析

目的 通过对慢性阻塞性肺疾病合并症的认识,减少漏诊、误诊现象,提高诊治水平.方法 分析2006年3月至2009年9月住院的慢性阻塞性肺疾病患者合并症情况.结果 慢性阻塞性肺疾病患者250例,Ⅰ级98例,Ⅱ级89例,Ⅲ级51例,Ⅳ级12例.有合并症165例(66.0%),合并肺炎61例、高血压50例、支气管哮喘28例、冠心病17例、肺结核17例、糖尿病11例、肺癌8例.结论 慢性阻塞性肺疾病患者常合并其他疾病,给诊断、治疗带来困难,应引起高度重视.     

有性才会有健康

性是基本的人权。根据我国著名的性学家史成礼教授的研究,性有“三大功能”:生育功能、享乐功能和健康功能。     

Communicating with people with dementia

It can be very difficult to communicate with people with dementia. Each case requires its own unique handling. Not every scenario is covered, as many times your own judgment is what will work, best according to the circumstances. These can change from dawn to evening and from day to day. Never assume things will be the way they were the last time you communicated. Be on your guard. Be adaptable. The article will help get you started to think of your own ways to communicate.     

经方汗证治验

临床上汗证病情复杂,分自汗、盗汗、黄汗和但头汗出,治疗汗证方药诸多,有益气固表、养阴清热和清热除湿等方法,疗效不一。受恩师刘健主任教导和《伤寒论》《金匮要略》病脉证并治启发,以脉证并治、方证对应思想,浅谈桂枝加附子汤、黄芪芍药苦酒汤、柴胡桂枝干姜汤和三物黄芩汤治疗汗证的经验,为经方治疗汗证提供新思路。     

Working with patients with physical disabilities

Medical practices need to make a number of adaptations to ensure that their facilities and staff are accessible to patients and other office visitors with physical disabilities. This article describes 10 specific strategies for preparing your medical practice for patients with disabilities, both inside and outside your office. It describes minimum standards for office doorways, sidewalk inclines, ramps, reception areas, and other adaptations medical offices need to make. The article also describes specific do and don't advice for communicating with patients with physical disabilities. It suggests strategies for preparing written materials for disabled patients, for communicating verbally, and for providing healthcare education. Finally, it suggests an appropriate role for medical practice staff in the delivery of healthcare services to patients with physical disabilities.     

Coping with Children with ADHD: Coping Styles of Mothers with Children with ADHD or Challenging Behaviours

Parents of children with Attention Deficit Hyperactivity Disorder (ADHD) can experience significant levels of stress in their parenting roles, however, little is known about the specific coping strategies used by these parents. This pilot study Investigated the coping strategies used by mothers of children with ADHD. A 34 item questionnaire was developed to identify maternal coping strategies. A cohort of 38 mothers of children with ADHD and a control group of 30 mothers of children without ADHD or any other disability/illness completed the questionnaire. Factor analysis of responses produced three factors: Aggressive/Confrontive Coping, Rational Coping, and Indirect Coping. These factors are similar to coping dimensions proposed by Folkman and Lazarus. Comparisons between the two groups of mothers revealed that mothers of children with ADHD used significantly more Indirect Coping.     

Problems with measuring satisfaction with social care

The measurement of customer satisfaction has become widespread in both healthcare and social care services, and is informative for performance monitoring and service development. Satisfaction with social care services is routinely measured with a single question on overall satisfaction with care, comprising part of the Adult Social Care Survey. The measurement of satisfaction has been problematised, and existing satisfaction measures are known to be under‐theorised. In this article, the process of making an evaluation of satisfaction with social care services is first informed by a literature review of the theoretical background, and second examined through qualitative interviews conducted in 2012–2013 with 82 service users and family carers in Hampshire, Portsmouth and Southampton. Participants in this study were from white British and South Asian backgrounds, and the influence of ethnicity in the process of satisfaction evaluation is discussed. The findings show that the majority of participants selected a positive satisfaction rating even though both positive and negative experiences with services were described in their narratives. It is recommended that surveys provide opportunity for service users and family carers to elaborate on their satisfaction ratings. This addition will provide more scope for services to review their strengths and weaknesses.     

Ending clinical relationships with people with schizophrenia

The potential for the social worker-client relationship to contribute to therapeutic outcomes is not always apparent with clients who have schizophrenia. Their cognitive impairments often make it difficult for these clients to regulate interpersonal boundaries and for social workers to connect with them. Clinical practice is enhanced, however, by recognizing that severely impaired clients have the capacity and desire for relationships with service providers and others. The manner in which the clinical relationship ends is important for maintaining clinical gains and determining whether the client will risk investing in future relationships. The purpose of this article has been to sensitize social workers to the delicate nature of managing the endings of those relationships.