社区精神疾病患者免费服药服务流程建立与实施

目的探讨社区精神疾病患者免费服药规范化服务流程的建立与实施。方法选择2011—2012年上海市长宁区重性精神疾病患者160例,给予免费服药规范化流程服务,观察患者按时复诊、配药和药物不良反应发生情况。结果 2012年社区精神病患者按时复诊、规范用药等较2011年均有提升,疾病复发率降低0.45%。结论规范化免费服药服务流程的建立与实施,推动了医院与社区联动机制,对提高社区精神病患者的药物治疗和安全性起到了积极有效的作用。     

个案管理对精神疾病免费服药患者康复的作用

目的:探讨个案管理对精神疾病免费服药患者康复的作用。方法:选择松江区享受免费服药的贫困精神病患者80例,每月至少1次给予免费门诊、康复指导、健康教育,并选用阳性与阴性症状量表(PANSS)、自知力与治疗态度问卷(ITAQ)、日常生活质量量表(ADL)进行半年1次随访和评估。结果:入组18个月后,患者阳性与阴性症状量表平均分显著下降(P<0.01);自知力与治疗态度问卷评分比入组前明显升高(P<0.01);日常生活质量量表评分比入组前显著下降(P<0.01)。结论:个案管理有利于控制患者精神症状,提高患者对自身疾病的认识,从而提高患者的生活质量。     

精神科陪护亲属健康知识教育对患者疾病转归的影响

目的 探讨精神科陪护亲属和患者的健康教育对患者疾病转归的影响.方法 将104名精神科住院患者家属随机分为研究组和对照组,每组52名.两组均接受常规入院宣教、住院和出院指导,研究组在此基础上由专业护士对患者与陪护亲属进行健康教育和家庭干预方法教育.于住院2 周末对陪护亲属进行精神疾病家庭护理常识问卷测评;患者出院前进行护理人员满意度调查问卷测评;出院随访6 个月由陪护亲属填写患者康复情况调查表,了解患者疾病转归情况.结果 研究组护理知识的掌握程度、对护理工作的满意度均显著高于对照组,出院随访6 个月患者康复效果明显优于对照组.结论 对患者与陪护亲属实施健康教育和家庭干预技能教育,既能有效提高患者的临床疗效和服药依从性,又能有效提高患者陪护亲属的家庭健康教育技能,有效地促进了患者社会功能的康复.     

抑郁症患者及家属的家庭心理干预效果评价

目的探讨家庭心理干预对抑郁症患者及其家属的影响。方法将200例抑郁症患者及家属随机分为两组各100例，研究组患者在接受常规治疗的基础上，与家属同时接受集体与个别心理干预；对照组仅对患者进行常规抗抑郁治疗。观察1a。家庭心理干预前及干预1a末采用焦虑自评量表、流调用抑郁自评量表评定两组焦虑抑郁状况，家庭负担量表评定家属的护理负担，自编家属认知状况调查表评定家属对疾病知识的掌握程度和护理技能，功能失调性状况评定量表评定社会功能，统计患者的服药依从率、复发率，并进行对比分析。结果家庭心理干预后，研究组家属焦虑自评量表、流调用抑郁自评量表、家庭负担量表评分均较干预前显著下降（P均〈0．01），各量表评分均显著低于对照组（P均〈0．01）；研究组家属中94．05％认为家庭心理干预效果好，对抑郁症相关知识、药物治疗、护理技能等方面的知晓率显著高于对照组（P均〈0．01）；患者的服药依从率显著高于对照组，年复发率及功能失调性状况量表总分均显著低于对照组（P均〈0．01）。结论家庭心理干预能显著提高家庭支持系统水平，有助于提高患者的治疗依从性，降低复发率，促进心理和社会功能康复。     

对门诊抑郁症患者实施家庭干预的效果分析

目的评价对门诊抑郁症患者实施家庭干预的效果。方法选取2014年8月至2015年8月在北京市某精神专科医院门诊定期复诊的抑郁症患者208例,分为观察组和对照组。两组在接受常规治疗和护理指导的同时,观察组实施家庭干预2个月,采用汉密顿抑郁量表、一般自我效能感量表及服药依从性评定标准对患者进行评定。结果干预后,观察组的汉密顿抑郁量表评分低于对照组(P0.01),一般自我效能感量表评分、服药依从性高于对照组(P0.01)。结论家庭干预能改善门诊抑郁症患者的抑郁情绪,提高患者自我效能水平和服药依从性。     

电话随访在出院精神疾病患者中的应用

目的:探讨电话随访对提高精神疾病患者出院后的疾病康复和降低复发率的改善效果。方法:将193例出院后的精神疾病患者随机分为研究组97例和对照组96例,研究组患者接受定期电话随访及出院指导,对照组患者仅接受出院指导。4周后,全部患者接受自行设计的调查表进行效果评价。结果:研究组患者在遵医行为、健康行为及疾病复发方面均优于对照组(P<0.01)。结论:电话随访有助于提高精神疾病患者出院后的遵医行为及健康指导依从性,减少疾病复发,提高患者的生活质量。     

家庭健康教育对精神分裂症患者家庭负担影响研究

目的探讨家庭健康教育在改善精神分裂症患者家庭负担中的作用。方法157例精神分裂症患者随机分为2组，即研究组（79例）和对照组（78例）。对照组采用常规药物治疗，研究组在药物治疗的基础上，接受为期6个月的家庭心理健康教育。比较基线及随访6月末2组的简明精神病评定量表（BPRS）及家庭负担量表（FBS）得分，并比较2组患者的用药依从性。结果6月末BPRS总分改善值研究组显著高于对照组（p〈0.01）；治疗后研究组FBS总分及多个维度评分低于治疗前（p〈0.05），低于治疗后的对照组（p〈0.05），服药依从性高于对照组（p〈0.05）。结论家庭健康教育能显著减轻精神分裂症患者的家庭负担，促进患者疾病康复。     

以家庭为中心的护理干预对精神分裂症患者家庭功能和疾病负担的影响

目的 探讨以家庭为中心的护理干预对精神分裂症患者家庭功能和疾病家庭负担的影响.方法 将108例病程＜5年的精神分裂症患者随机分为研究组（n=53）和对照组（n=55）,两组均予抗精神病药物治疗和一般健康教育,研究组在此基础上合并以家庭为中心的护理干预,随访时间至患者出院后1年.采用家庭功能量表（FAD）、疾病家庭负担量表（FBS）和简明精神病评定量表（BPRS）于入组时和出院后1年末评定两组患者家庭状况和精神症状.结果 入组时两组患者BPRS、FAD、FBS评分比较均无统计学意义（P＞0.05）;出院1年后,研究组BPRS评分为（24.60±7.87）、FAD总的功能评分为（26.8±3.7）及FBS总分为（20.60±9.91）,均低于对照组[（28.91±8.72）,（30.1±3.4）,（30.76±12.27）分],差异均有统计学意义（t值分别为2.61,4.67,4.57;P＜0.05）,研究组FAD各因子分及FBS量表家庭经济负担、家庭日常活动、家庭娱乐活动、家庭成员心理健康情况4个因子分均低于对照组,差异有统计学意义（P＜0.05）.结论 以家庭为中心的护理干预模式可提高精神分裂症患者的家庭功能,降低家庭疾病负担,改善疾病预后.     

对住院精神分裂症患者实施疾病认知心理教育50例效果研究

目的:探讨对住院精神分裂症患者实施疾病认知心理教育的方法和效果。方法:将100例患者按照住院病区不同分为研究组和对照组各50例。对照组按常规进行抗精神疾病药物治疗和护理,研究组在此基础上实施系统性疾病认知心理教育(健康教育、发病情景录像回放、心理剧),干预时间为8周。采用自知力与治疗态度问卷(ITAQ)、服药依从性量表、简明精神疾病评定量表(BPRS)进行临床护理效果评定。结果:两组患者干预前后ITAQ评分、BPRS评分比较及两组患者干预后服药依从性比较差异均有统计学意义(P<0.01)。结论:疾病认知心理教育能够帮助住院精神分裂症患者恢复和提高自知力,提高治疗依从性,改善病情,促进康复。     

过渡期护理模式对癫痫患者心理及疗效的影响

目的：探讨过渡期护理模式对癫痫患者心理及疗效的影响。方法将60例出院癫痫患者随机均分为研究组和对照组各30例,两组患者出院后均要求按医嘱常规服用抗癫痫药物维持治疗,对照组返院随访或复查时由门诊护士给予一般的心理护理。研究组在上述基础上,实施过渡期护理干预。出院6个月后对两组患者采用症状自评量表（ SCL－90）、Morisky的服药依从性问卷及疗效评价标准进行评价。结果干预前两组患者的SCL－90各因子评分比较均较高,差异无统计学意义（均P＞0．05）,而干预后研究组患者的SCL－90各因子分值均低于对照组,差异具有统计学意义（ P＜0．01）;干预后研究组患者治疗依从性明显高于对照组（ P＜0．01）;疗效亦明显优于对照组（ P＜0．01）。结论过渡期护理模式能显著提高癫痫患者的治疗依从性,可降低疾病的复发率,对改善其不良心理等方面有积极的促进作用。     

儿童遗传性心律失常的诊治进展

回顾在遗传性心律失常领域最新发表的相关研究,主要关注与儿童心源性猝死关系密切的离子通道病,包括长QT综合征（LQTS）、短QT综合征（SQTS）、Brugada综合征（BrS）和儿茶酚胺敏感性多形性室性心动过速（CPVT）,总结它们在发病机制及诊治方面的进展。     

The acoustic characteristics of the skull

Many investigators have stated that the difficulties of imaging with acoustical energy through the skull result from the marked attenuation of the energy by the skull. In the literature measurements of total attenuation have been confused with those for absorption.Measurements made by us show that absorption by compact bone varies between 2–3 dB cm^?1 MHz^?1 and, in the low megaHertz region appears to be directly proportional to frequency.It has also between shown that the convoluted inner surface of the ivory bone of the inner table of the skull may degrade the collimation and directionality of the beam by refraction.Cancellous bone, such as is present in the dipole of the skull, greatly attenuates the energy. It is postulated that this largely results from scattering. It is also postulated that the energy propagates through cancellous bone as two components, one in the soft tissues and the other partly in the bony spicules. Observations suggest that attenuation due to scattering much more markedly affects the latter of these components and scatters more greatly the higher frequencies in a pulse of broad bandwidth.The energy in each component has varying propagation paths so that the later cycles in the pulse of each component are subject to increasing interference as a result of the variations in propagation times. The two components moreover may have different propagation times so that interference may occur between the pulses of each component as well.All of these phenomena degrade the collimation, coherence, directionality, beam width, pulse length, frequency and other properties of the ultrasonic energy upon which imaging through the skull depends.The interference effects described above are least for the first cycle in the pulse which usually is not the cycle of highest amplitude. Since, in the free field, most of the energy is concentrated around the beam axis, most of the energy in the field which is deflected from its normal propagation path is deflected away from the beam axis. Thus the directionality of the beam is least degraded in the beam axis. The effects of the skull in degrading the properties of the ultrasonic pulse would therefore be lessened if the amplitude of the first cycle of the pulse and the directionality of its energy could be used for imaging.     

Organ Preservation: Current Concepts and New Strategies for the Next Decade

SUMMARY: Organ transplantation has developed over the past 50 years to reach the sophisticated and integrated clinical service of today through several advances in science. One of the most important of these has been the ability to apply organ preservation protocols to deliver donor organs of high quality, via a network of organ exchange to match the most suitable recipient patient to the best available organ, capable of rapid resumption of life-sustaining function in the recipient patient. This has only been possible by amassing a good understanding of the potential effects of hypoxic injury on donated organs, and how to prevent these by applying organ preservation. This review sets out the history of organ preservation, how applications of hypothermia have become central to the process, and what the current status is for the range of solid organs commonly transplanted. The science of organ preservation is constantly being updated with new knowledge and ideas, and the review also discusses what innovations are coming close to clinical reality to meet the growing demands for high quality organs in transplantation over the next few years.     

2017年呼吸疾病主要进展

2017年,国内外学者在呼吸系统疾病的临床和基础领域均进行了深入研究,不仅对相关指南进行了更新,并且针对一些临床热点、难点问题达成专家共识,现就2017年呼吸疾病相关进展作一简单介绍。     

家族性噬血细胞性淋巴组织细胞增生症1例并文献复习

目的加强对家族性噬血细胞性淋巴组织细胞增生症（familially hemophagocytic lymphohistiocytosis,FHL）的认识。方法报道确诊为FHL的新病例1例,结合国内外报道的FHL的病例,对该病的临床特点进行汇总分析。结果FHL2常与PRF1基因突变相关,约20%~40%的患者存在穿孔素基因突变。结论对于有阳性家族史,基因诊断明确,应尽早行化疗或者造血干细胞移植。若无家族史,未发现与继发性HLH相关的原发病因,可考虑行基因筛查以明确是否存在FHL的可能。     

COVID‐19 and COVID‐19 vaccine‐related dermatological reactions: An interesting case series with a narrative review of the potential critical and non‐critical mucocutaneous adverse effects related to virus,therapy, and the vaccination

This narrative review article was conducted to lay out a summarized but exhaustive review of current literature over mucocutaneous manifestations in 4 dimensions of SARS‐CoV‐2 pandemic: virus itself, treatment‐related, vaccine‐induced, and alteration of chronic dermatologic diseases following infection. Virus and vaccine‐related were mainly self‐limited and non‐severe. Treatment‐related reactions could be life‐threatening.     

Burkitt's lymphoma of maxillary gingiva: A case report

Burkitt's lymphoma(BL) is an aggressive form of nonHodgkin's B-cell lymphoma with three variants namely endemic, sporadic, and immunodeficiency-associated types. It is endemic in Africa and sporadic in other parts of the world. While the endemic form is widely reported to occur in early childhood and commonly involves the jaw bones, the sporadic form typically presents as an abdominal mass. This presentation reports a rare case of sporadic form of BL clinically manifesting as a generalized gingival enlargement in an immunocompetent adult male which demonstrated an aggressive behavior. The patient reported with a prominent anterior gingival swelling of 6 mo duration which slowly enlarged in size and associated with multiple lymph node involvement. Microscopic examination of the lesion using H, E and immunohistochemical diagnosis confirmed the diagnosis as BL. The patient succumbed to the disease before any therapy could be instituted. Since a wide array of causes can be attributed to gingival enlargements, it is necessary to consider malignancies as one of the important differential diagnosis so as to facilitate the need for appropriate diagnosis and prompt treatment.     

Real‐life effectiveness of biological therapies on symptoms in severe asthma with comorbid CRSwNP

BackgroundWe aimed to evaluate the effectiveness of different antibody therapies on nasal polyp symptoms in patients treated for severe asthma.MethodsWe performed a retrospective analysis of patients with severe asthma and comorbid CRSwNP who were treated with anti‐IgE, anti‐IL‐5/R or anti‐IL‐4R. CRSwNP symptom burden was evaluated before and after 6 months of therapy.ResultsFifty patients were included hereof treated with anti‐IgE: 9, anti‐IL‐5/R: 26 and anti‐IL‐4R: 15 patients. At baseline median SNOT‐20 was similar among groups (anti‐IgE: 55, anti‐IL‐5/R: 52 and anti‐IL‐4R: 56, p = 0.76), median visual analogue scale (VAS) for nasal symptoms was 4, 7 and 8 (p = 0.14) and VAS for total symptoms was higher in the anti‐IL‐4R group (4, 5 and 8, p = 0.002). After 6 months SNOT‐20 improved significantly in all patient groups with median improvement of anti‐IgE: −8 (p < 0.01), anti‐IL‐5/R: −13 (p < 0.001) and anti‐IL‐4R: −18 (p < 0.001), with larger improvement in the anti‐IL‐4R group than in anti‐IgE (p < 0.001) and anti‐IL‐5/R (p < 0.001) groups. VAS nasal symptoms improved by median anti‐IgE: 0 (n.s.), anti‐IL‐5/R: −1 (p < 0.01) and anti‐IL‐4R: −3 (p < 0.001), VAS total symptoms by anti‐IgE: −1 (n.s.), anti‐IL‐5/R: −2 (p < 0.001) and anti‐IL‐4R: −2 (p < 0.001).ConclusionsTreatment by all antibodies showed effectiveness in reducing symptoms of CRSwNP in patients with severe asthma, with the largest reduction observed in anti‐IL‐4R‐treated patients.     

Recalcitrant giant orf recurrence after amputation: A case report and review of the literature

Orf is caused by a parapoxvirus. We present a recurrent, giant digital orf case in a female patient with a history of hairy cell leukemia. In spite of shave excision, the lesion progressed and recurred after digital amputation. Treatment with topical imiquimod cream and systemic subcutaneous interferon alfa‐2a was successful.