自知力教育对精神分裂症患者自知力及服药依从性的影响

目的探讨自知力教育对精神分裂症患者自知力恢复及服药依从性的影响。方法将淄博市第五医院精神分裂症患者60例随机分为研究组和对照组,每组30例。研究组在常规抗精神病药物治疗的基础上进行自知力教育,对照组单纯采用抗精神病药物治疗,均治疗6周。以自知力与治疗态度问卷(ITAQ)和简明精神病量表(BPRS)进行评定,观察两组患者自知力恢复情况及服药依从性变化。结果研究组ITAQ评分显著高于对照组,服药依从性从性明显提高,两组比较差异有显著性意义(P<0.05)。研究组BPRS评分显著低于对照组,差异有显著性意义(P<0.01)。结论自知力教育可有效恢复精神分裂症患者自知力。     

认知行为治疗对精神分裂症住院患者疗效的影响

目的探讨认知行为治疗对住院精神分裂症患者疗效的影响。方法在药物治疗的同时,对157例住院精神分裂症患者辅以认知行为治疗(治疗组),对照组则单纯使用抗精神病药治疗(154例),疗程2个月。采用简明精神病评定量表(brief psychiatricrating scale,BPRS)、自知力及治疗态度问卷(insight and treatment attitudes questionnaires,ITAQ)、治疗依从性及住院患者护理观察量表,比较两组患者的疗效。结果治疗组和对照组的显效率分别为62.42%和34.41%,有显著性差异;两组患者治疗前后的BPRS、ITAQ、治疗依从性及住院患者护理观察量表评分均有统计学差异(P<0.01);两组患者治疗后的各项评分均有统计学差异(P<0.01)。结论对住院精神分裂症患者辅以认知行为治疗能明显提高疗效,改善治疗依从性,促进患者自知力恢复。     

自知力教育对门诊精神分裂症患者自知力及服药依从性的影响

目的探讨自知力教育对门诊精神分裂症患者自知力恢复及服药依从性的影响.方法将60例首次门诊治疗精神分裂症患者随机分为对照组及观察组各30例,对照组常规药物治疗,观察组在常规药物治疗基础上进行自知力教育.分别于首次就诊时、2周、4周、8周复诊时进行简明精神病评定量表(BPRS),自知力与治疗态度问卷表(ITAQ)测定以及服药依从性评定.结果首次就诊和2周、4周复诊时2组BPRS量表,ITAQ及服药依从性差异无显著性(P>0.05),门诊治疗8周后观察组ITAQ评分显著高于对照组,BPRS评分显著低于对照组,服药依从性明显提高,差异有显著性意义(P<0.05);ITAQ与服药依从性,BPRS评分呈显著负相关.结论对门诊精神分裂症患者进行自知力教育可以有效恢复患者自知力,提高服药依从性,促进疾病恢复.     

自知力教育对门诊精神分裂症患者自知力及服药依从性的影响

目的探讨自知力教育对门诊精神分裂症患者自知力恢复及服药依从性的影响.方法将60例首次门诊治疗精神分裂症患者随机分为对照组及观察组各30例,对照组常规药物治疗,观察组在常规药物治疗基础上进行自知力教育.分别于首次就诊时、2周、4周、8周复诊时进行简明精神病评定量表（BPRS）,自知力与治疗态度问卷表（ITAQ）测定以及服药依从性评定.结果首次就诊和2周、4周复诊时2组BPRS量表,ITAQ及服药依从性差异无显著性（P〉0.05）,门诊治疗8周后观察组ITAQ评分显著高于对照组,BPRS评分显著低于对照组,服药依从性明显提高,差异有显著性意义（P〈0.05）;ITAQ与服药依从性,BPRS评分呈显著负相关.结论对门诊精神分裂症患者进行自知力教育可以有效恢复患者自知力,提高服药依从性,促进疾病恢复.     

自我管理训练对精神分裂症康复期患者的影响

目的:探讨自我管理训练对精神分裂症康复期患者的影响。方法:将100例精神分裂症康复期患者随机分为观察组和对照组各50例,对照组进行常规护理,观察组在此基础上进行自我管理训练,随访1年,比较两组患者入院时、出院时及出院1年时的简明精神病评定量表(BPRS)、自知力与治疗态度问卷量表(ITAQ)评分,及出院1年患者的服药依从性、复发率。结果:观察组出院1年BPRS评分、ITAQ评分、服药依从性、复发率均优于对照组(P<0.05)。结论:自我管理训练能提高患者服药依从性,对预防复发和改善预后有明显的促进作用。     

认知领悟治疗对精神分裂症患者服药依从性的影响

目的探讨认知领悟治疗对精神分裂症患者服药依从性和复发的作用.方法将100例精神分裂症患者随机分为研究组(50例)和对照组(50例),两组均进行系统的抗精神病药物治疗和一般的健康教育,研究组在此基础上进行认知领悟治疗,并于入组前,出院时,出院后1年、2年分别使用简明精神病评定量表(BPRS)、自知力与治疗态度问卷量表(ITAQ)及自编服药依从性调查表评定.结果出院时,出院后1年、2年ITAQ评分,服药完全依从率及复发率两组比较差异有显著性意义(P<0.05);BPRS评分出院时两组差异无显著性意义(P>0.05),出院后1年、2年两组比较差异有显著性意义(P<0.05).结论认知领悟治疗能有效提高精神分裂症患者服药依从性,降低复发率.     

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。     

心理教育对精神分裂症自知力、服药依从性及复发影响的2年随访

目的探讨心理教育对首发精神分裂症患者自知力、服药依从性及复发的影响。方法将136例首发精神分裂症患者随机分为心理教育联合氯氮平组(研究组)及单用氯氮平治疗组(对照组)各68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以上出院的患者进行为期2年的随访,以了解其复发情况。结果(1)两次BPRS评分两组间比较,差别均无显著性意义(t=0.27,1.28,P>0.05);(2)入院时ITAQ评分两组间比较,差别无显著性意义(t=0.15,P>0.05),但出院时研究组ITAQ评分明显高于对照组(t=8.32,P<0.01);(3)入院时服药依从性两组间比较,差别无显著性意义(χ2=0.29,P>0.05),但出院时研究组服药依从性改善明显优于对照组(χ2=7.75,P<0.05);(4)2年内研究组复发率明显低于对照组(χ2=8.15,P<0.01)。结论心理教育不仅有助于首发精神分裂症患者的治疗,而且可降低其复发率。     

综合护理干预在中年女性精神分裂症患者中的应用

目的:探讨综合护理干预在中年女性精神分裂症患者中的应用效果。方法:选择我院收治的98例中年女性精神分裂症患者为研究对象。根据其就诊顺序编号尾数的单双号分为对照组和观察组各49例,对照组给予精神科常规护理,观察组施行综合护理干预。比较两组服药依从性,并采用简明精神病评定量表(BPRS)、社会功能缺陷筛选评定量表(SDSS)、自知力与治疗态度问卷量表(ITAQ)对两组病情程度、社会功能缺陷程度、自知力进行评价。结果:观察组护理后BPRS评分、SDSS评分与对照组比较差异有统计学意义(P0.05),观察组护理后ITAQ评分高于对照组(P0.05),观察组服药依从高于对照组(P0.05)。结论:对中年女性精神分裂症患者实施综合护理干预可改善其临床症状、提高治疗效果,且能提高患者的服药依从性。     

药物依从性治疗对首发精神分裂症病人预后的影响

[目的]探讨药物依从性治疗对首发精神分裂症病人预后的影响。[方法]将80例首发精神分裂症病人随机分为对照组与观察组各40例。对照组采用精神科常规健康教育,观察组采用药物依从性治疗方法进行干预。对两组病人随访6个月,并分别于干预前、干预后3个月、6个月时采用自知力与治疗态度问卷(ITAQ)、简明精神病量表(BPRS)、社会功能缺陷筛选量表(SDSS)及服药依从性、复发率对两组病人进行评定。[结果]两组干预后3个月、6个月BPRS、ITAQ及SDSS评分比较差异均有统计学意义(P0.05)。两组干预后3个月、6个月时服药依从性及复发率比较差异有统计学意义(P0.05)。[结论]药物依从性治疗能够增加首发精神分裂症病人对疾病及治疗的认识,提高服药依从性,减少复发,对恢复社会功能有一定的促进作用。     

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.     

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.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.