高原环境对领悟社会支持及社交回避与苦恼的影响

目的探索高原环境对领悟社会支持及社交回避与苦恼的影响。方法采用领悟社会支持量表（multidimensional scale of perceived social support,MSPSS）及社交回避及苦恼量表（social avoidance and distress scale,SADS）对1325名在高原环境生活1年以上的青年（高原组）和1181名生活在内地的青年（内地组）进行测查比较分析。结果高原组SADS总分、回避因子、焦虑因子得分均高于内地组,差异有统计学意义（P〈0．05）;而内地组MSPSS得分高于高原组,差异有统计学意义（P〈0．01）。高原组各量表相关分析显示,MSPSS及各因子测查结果与SADS及各因子测查结果呈负相关（P〈0．05）。结论生活在高原环境的青年领悟到的社会支持低,在社交方面回避倾向及内心苦恼的感受较为严重。     

康复训练对脑梗死大鼠认知功能、海马内突触素和神经颗粒素表达的影响

目的观察康复训练对脑梗死大鼠认知功能、突触素以及颗粒素表达的影响。方法48 只脑梗死Wistar 成年雄性大鼠随机分成模型组和康复组各24 只,康复组于术后5 d 开始康复训练,分别在术后15 d、25 d、35 d 进行认知功能及突触素(Syn)和神经颗粒素(Ng)阳性表达观察。结果康复组神经功能评分、各项运动能力评分、Y-迷宫测定、Syn 和Ng 阳性表达均优于模型组(P<0.05)。结论康复训练可通过增加突触素和神经颗粒素表达,改善脑梗死大鼠的神经功能、运动功能和认知功能。     

丰富环境对缺血性脑卒中小鼠海马区Bcl-2和Bax蛋白表达和认知功能的效果

目的探讨丰富环境干预对缺血性脑卒中小鼠空间学习记忆能力,以及海马区凋亡相关蛋白Bcl-2和Bax表达的影响。方法清洁级成年雄性C57BL/6小鼠42只,接受永久性左侧大脑中动脉栓塞术。术后3 d,将造模成功的小鼠32只随机分为标准饲养组(n=16)和丰富环境组(n=16)。另选8只小鼠为假手术组。假手术组和标准饲养组置于标准环境中饲养,丰富环境组置于丰富环境中饲养。21 d后,行Morris水迷宫测试,Western blotting和免疫荧光染色检测海马区Bcl-2和Bax蛋白水平。结果与标准饲养组相比,丰富环境组逃避潜伏期缩短(P<0.05),目标象限内停留时间、停留距离和穿过原有平台次数增加(P<0.05);Bcl-2水平升高(P<0.05),Bax水平降低(P<0.05)。结论丰富环境可以改善缺血性脑卒中小鼠空间学习和记忆功能,可能与抵制海马区细胞凋亡有关。     

人参皂甙Rd对高原大鼠运动疲劳后学习记忆及海马CA1区超微结构的影响

目的:观察人参皂甙Rd对高原运动疲劳后大鼠学习记忆能力及海马CA1区超微结构改变的影响。方法:健康成年Wistar大鼠24只,由兰州用汽车直接引入青海省可可西里高原,随机分为对照(A)组、生理盐水重度疲劳(B)组及人参皂甙重度疲劳(C)组各8只;A组正常饲养,不运动;采用跑台运动方式建立重度疲劳模型,B、C组分别腹腔给予生理盐水(2mg/kg)或人参皂甙Rd(2mg/kg);Morris水迷宫测试大鼠学习记忆能力,HE染色观察大鼠海马组织形态学改变,透射电子显微镜观察海马CA1区神经元超微结构的改变。结果:与A组相比,B组大鼠逃避潜伏期显著延长(P0.01),海马CA1区超微结构发生病理性改变,C组大鼠逃避潜伏期较B组缩短(P0.05),海马CA1区超微结构病理性改变减轻。结论:人参皂甙Rd可缓解高原环境重度疲劳导致的大鼠学习记忆能力减退及海马神经元损伤。     

系统疗养管理对高血压患者血压、精神状态及疾病认知的影响

目的探讨系统疗养管理对高血压患者血压、精神状态及疾病认知的影响。方法将2008年2月至2009年1月某疗养院91例高血压患者按随机数字表法分为实验组（n=47）与对照组（n=44）。在原有药物治疗基础上,实验组患者采用系统疗养管理,对照组患者进行常规疗养管理。疗养结束和疗养结束半年后,分别对两组高血压患者的血压控制情况、精神状态以及对高血压的疾病认知情况进行对比分析。结果疗养结束时,两组患者的降压效果的差异无统计学意义（P〉0.05）;疗养结束半年后实验组患者的血压控制效果明显优于对照组,差异有统计学意义（P〈0.05）。疗养前两组患者精神状态的差异无统计学意义（P〉0.05）;疗养结束时及疗养结束半年后,实验组患者的焦虑自评量表（self-rating anxiety scale,SAS）与抑郁自评量表（self-rating depressive scale,SDS）评分均优于对照组,差异有统计学意义（P〈0.05）。疗养结束时,实验组患者在心理调节和生活习惯及运动上的评分优于对照组,差异有统计学意义（P〈0.05）;疗养结束半年后,两组患者在高血压知识掌握和行为改善情况各项上的差异均有统计学意义（均P〈0.05）。结论疗养院护士采用系统疗养管理对于高血压患者控制血压和坚持健康行为有效,有利于促进高血压患者的康复。     

Relationship of the Built Environment on Nursing Communication Patterns in the Emergency Department: A Task Performance and Analysis Time Study

IntroductionThe physical layout of the emergency department affects the way in which patients and providers move within the space and can cause substantial changes in workflow and, therefore, affect communication patterns between providers. There is no 1 ED design that enables the best patient care, and quantitative studies looking at ED design are limited. The goal of this study was to examine how different ED designs, centralized and decentralized, are associated with communication patterns among health care professionals.MethodsA task performance, direct observation time study was used. By developing a novel tablet-based digital mapping tool using a cloud-based mapping platform (ArcGIS), data on provider actions and interactions were collected and mapped to a precise location within the emergency department throughout an entire nursing shift.ResultsThe difference in the duration of nurse-physician interactions between the 2 ED designs was statistically significant. Within the centralized design, nurse-physician interactions totaled 14 minutes and 38 seconds compared with 30 minutes and 11 seconds in the decentralized design (t = 2.31, P = 0.02). More conversations between nurses and physicians occurred inside the patient’s room in the decentralized design.DiscussionOur findings suggest that the ED design affects communication patterns among health care providers and that the design has the potential to affect the quality of patient care.     

Effects of loratadine/montelukast on vigilance and alertness task Performance in a simulated cabin environment

Introduction  Sedating effects of some medications used to treat allergic rhinitis (AR) symptoms can impair an individual’s ability to function optimally. The objective of this study was to characterize the effects of a single dose of loratadine/montelukast (L/M) versus placebo and diphenhydramine on daytime somnolence and psychomotor performance in healthy volunteers. Methods  In this single-center, randomized, double-blind, placebo- and activecontrolled,three-way crossover study, healthy volunteers received single doses of placebo, L/M 10 mg/10 mg, and diphenhydramine 50 mg. Subjects (n=23) were evaluated under simulated cabin pressure using the following tools: Vigilance and Tracking Task (VigTrack), measuring vigilance and tracking performance; the Multi-Attribute Task Battery (MAT), measuring ability to perform multiple tasks simultaneously; and the Stanford Sleepiness Scale (SSS), measuring sedative effects of medication, at baseline and each hour from 1 to 6 hours postdose. Safety was monitored via adverse events and vital signs. Results  Performances on VigTrack and MAT from 1 to 6 hours after dosing were not significantly different between L/M and placebo groups; in contrast, diphenhydramine resulted in significant impairment of tracking for up to 5 hours (P≤0.01) and vigilance performance for up to 3 hours (P≤0.05) on VigTrack versus placebo. Scores of subjective sleepiness as measured by SSS were similar for patients treated with L/M versus placebo, whereas significant increases in sleepiness occurred between 1–5 hours posttreatment in diphenhydraminetreated patients versus placebo-treated patients (P≤0.05). Conclusions  L/M is similar to placebo in effects on daytime somnolence and psychomotor performance. L/M treatment resulted in significantly less sleepiness and impairment of vigilance and tracking than diphenhydramine.     

Negative Mood, Perceived Self-Efficacy, and Personal Standards in Dysphoria: The Effects of Contextual Cues on Self-Defeating Patterns of Cognition

The present study investigated the effects of mood-related cues on the relation between performance standards and self-efficacy perceptions in dysphoric and nondysphoric individuals. Participants' personal standards and self-efficacy perceptions for various everyday activities were assessed. In the absence of mood-related cues, dysphoric participants, unlike nondysphorics, held standards that slightly exceeded their self-efficacy perceptions. A cue that highlighted the potential influence of mood on self-judgments eliminated the difference between dysphoric and nondysphoric participants. A cue that highlighted a potential external source of current mood magnified the group difference, leading dysphoric individuals to strongly exhibit a self-defeating cognitive pattern in which they adopted standards that far exceeded their self-efficacy levels. The cues also moderated the strength of relations between mood and personal standards. Current affect appears to play a role in the construction of standards and self-efficacy perceptions, and different affective processes may operate in the self-judgments of dysphoric versus nondysphoric individuals.     

探索学习环境对脑梗死大鼠学习记忆能力及缺血侧海马区微血管密度的影响

目的研究探索学习环境对局灶性脑梗死大鼠学习记忆能力及缺血侧海马区微血管密度的影响。方法 80只Sprague-Dawley大鼠开颅电凝右侧大脑中动脉,随机分为标准环境组(SE组,n=40)和探索学习环境组(LE组,n=40)。分别于术后7d、28 d进行Morris水迷宫测试;术后1 d、3 d、7 d、14 d、28 d,CD34免疫组织化学法测定海马区微血管密度。结果 LE组Morris水迷宫测试成绩显著优于SE组(P0.001)。术后7 d起,LE组缺血侧海马区微血管密度高于SE组(P0.05)。结论探索学习环境可促进脑梗死大鼠微血管新生,有利于学习记忆功能恢复。     

Effects of a Revised Preclinical Curriculum on Students' Perceptions of Their Cognitive Behaviors,Attitudes to Social Issues in Medicine,and the Learning Environment

Background: A modular, systems-based preclinical curriculum acceptable to faculty members who had rejected problem-based learning was introduced in 1997.

Purpose: To evaluate to what extent the new curriculum is meeting some of its major goals.

Methods: We administered selected scales from 3 survey instruments to the last 2 classes in the old curriculum and the first 3 in the new curriculum. We also compared our results with those from other medical schools that had used the same scales.

Results: The new curriculum has had positive effects on students' perceptions of the learning environment (effect sizes mostly small to medium, d =. 03 to. 60) but less effect on their attitudes to social issues in medicine or on their preference for conceptualization versus memorization when studying (most effect sizes below small; largest d =. 26). Our results are similar to those for problem-based learning curricula for the learning environment scales and to traditional curricula for the cognitive behavior scales.

Conclusions: Some of the goals for the new curriculum are being achieved almost to the levels reported for problem-based curricula.     

Assessment of Pulmonary Mechanics in Mechanical Ventilation: Effects of Imprecise Breath Detection, Phase Shift and Noise

Objective. In mechanical ventilation, the assessment of pulmonary mechanics, mainly of total compliance (Crs), total resistance (Rrs), and intrinsic positive end-expiratory pressure (PEEPint), is clinically important. By using airway pressure (Paw) and flow (Vaw), the least squares fit (LSF) method allows the continuous calculation of these parameters. The objective of this work was to study the influence of imprecise breath detection, phase shift between airway pressure and flow signals, and noise on the determination of Crs, Rrs, and PEEPint. Methods. Paw and Vaw were mathematically simulated as well as recorded in mechanically ventilated patients. Crs, Rrs, and PEEPint were computed off-line using the LSF method. The boundaries of the breath data window and the phase relationship between Paw and Vaw signals were manipulated and noise was superimposed. Results. Both simulated and patient data gave similar results. Crs and Rrs were not sensitive to imprecise breath detection. If the first portion of the breath was missed, the mean relative error on PEEPint was 20% or 53% when the exact beginning of inspiration was missed by 0.1 or 0.3 sec, respectively. Paw lag of 66 ms with respect to Vaw yielded a relative error of –15 ± 4% (mean ± SD) for Rrs, –5 ± 2% for Crs, and +13 ± 16% for PEEPint. Paw lead of 66 ms with respect to Vaw yielded a relative error of +5 ± 4% for Rrs, +7 ± 3% for Crs, and +14 ± 18% for PEEPint. Noise had very little impact on the accuracy of Crs, Rrs, and PEEPint. Conclusions. We conclude that the LSF method allows the assessment of Crs, Rrs, and PEEPint even with high levels of noise in patients with normal lungs provided that Paw and Vaw signals are precisely synchronised and a reliable breath detection algorithm is used.     

液体按摩术治疗颈肩腰腿痛疗效观察

１９８９年５月至６月，在张泽涛教授的亲临指导下，运用液体按摩术治疗颈肩腰腿痛患者１７９例，并对５０例进行了远期疗效随访观察。结果表明，近期疗效有效率达９５．５％，远期疗效总有效率达９６．９％。     

Reducing Anesthesia Use for Pediatric Magnetic Resonance Imaging: The Effects of a Patient- and Family-Centered Intervention on Image Quality,Health-care Costs,and Operational Efficiency

Children with complex medical problems who require anesthesia are known to be at risk for acute adverse physiologic events related to anesthesia. The risks of anesthesia include short- and long-term psychological and neurobehavioral issues. Magnetic resonance imaging (MRI) has emerged as the standard of care for diagnosis and follow-up of many conditions, and more children are being subjected to anesthesia to ensure acceptable motion-free image quality of the MRI scans. The aim of this study was to evaluate the effectiveness of an anesthesia-free patient- and family-centered intervention through an analysis of MRI quality, health-care costs, and operational efficiency as compared with other approaches. This study retrospectively reviewed patient data extracted from electronic medical records of children aged 3-17 years, who underwent outpatient MRI at an urban academic medical center from 2015 to 2016. A total matched sample size of 500 children, 125 per group, was used to investigate the outcome variables including the quality of magnetic resonance image, health-care cost, and procedural time. The groups included are as follows: (1) intervention group, patient- and family-centered preparation of the child, and no anesthesia given (PFC/NA); (2) comparison group, no structured preparation, and no anesthesia given (SC/NA); (3) comparison group, certified child life specialist preparation, and anesthesia given (CCLS/A); (4) comparison group, no structured preparation, anesthesia given (SC/A). The PFC/NA intervention group was found to have significantly lower costs (p < .0001) and shorter procedure times (p < .0001), and 96.8% of the MRI images were of acceptable or better quality than those of the SC/A and CCLS/A groups. The PFC approach provides a way for children to undergo outpatient diagnostic MRI without the need for anesthesia, thus reducing risk, costs, and procedure time.     

Zopiclone’s Residual Effects on Actual Driving Performance in a Standardized Test: A Pooled Analysis of Age and Sex Effects in 4 Placebo-Controlled Studies

Background

In many European countries, Canada, and Japan, the nonbenzodiazepine zopiclone is now among the most frequently prescribed hypnotic drugs. This finding can be explained by the growing view among physicians that zopiclone is more effective and safer than conventional benzodiazepines. However, in 4 studies using similar procedures, it has been shown that zopiclone 7.5 mg causes moderate to severe impairment in driving performance.

Objective

The goal of the present article was to review these studies and analyze the pooled data to determine whether the severity of effects is modified by the sex and age of the subjects.

Methods

The driving data of the placebo and zopiclone 7.5 mg evening treatment periods from a total of 4 studies conducted at Maastricht University were included in this pooled analysis. All studies were conducted according to balanced double-blind, crossover designs. The effects on driving were always measured the next morning, between 10 and 11 hours after administration, by using a standardized highway driving test. A total of 101 healthy volunteers of both sexes in equal proportions (with no reports of insomnia) participated. Subjects comprised young volunteers (age range, 21–45 years) in 3 studies and older volunteers (age range, 55–75 years) in the fourth study.

Results

Results show that zopiclone 7.5 mg has significant and clinically relevant performance-impairing effects on driving in the morning, until 11 hours after bedtime ingestion. The effects did not differ between male and female subjects and did not increase with age, at least until 75 years. The effects of zopiclone 7.5 mg are comparable to the effects of a mean blood alcohol concentration between 0.5 and 0.8 mg/mL, which has been associated with a 2- to 3-fold increase in the risk of becoming involved in a traffic accident.

Conclusions

We concluded that patients using an evening dose of zopiclone 7.5 mg should avoid activity in skilled work and participation in traffic the morning after intake. General practitioners’ beliefs regarding the beneficial safety profile of zopiclone may need adjustment, and patients using zopiclone 7.5 mg should be warned accordingly. There is no need to differentiate warnings about zopiclone’s residual impairing effects depending on the sex of the patient.     

奥氮平与齐拉西酮对精神分裂症患者血清催乳素、瘦素及糖脂代谢指标的影响

目的 对比分析奥氮平与齐拉西酮对精神分裂症患者血清瘦素、催乳素及糖脂代谢指标的影响,为优化临床治疗方案提供依据.方法 前瞻性选取2018年1月至2019年12月咸阳市中心医院精神科收治的60例首发精神分裂症患者作为研究对象,采用随机数字表法将患者分为奥氮平组和齐拉西酮组,每组各30例.奥氮平组患者给予口服奥氮平片治疗,...     

曲马多超前镇痛对子宫切除术患者术后疼痛和恶心呕吐的影响

目的观察曲马多超前镇痛对经腹子宫切除术患者术后疼痛和恶心呕吐的影响。方法 2008年11月2009年5月,40例全身麻醉下行经腹子宫切除术的患者,分为超前镇痛组和对照组（n=20）。超前镇痛组和对照组于麻醉诱导前30min分别静脉注射曲马多（3mg/kg）和生理盐水。术后12、24h,观察Bolus次数和芬太尼的用量,患者疼痛评分及术后恶心呕吐的发生率。结果术后12、24h,曲马多超前镇痛组Bolus次数和芬太尼的用量均小于对照组（P〈0.05）,术后恶心呕吐的发生率差异无统计学意义（P〉0.05）。结论经腹子宫切除术手术前给予曲马多超前镇痛能够减少术后镇痛药的需要量,且不增加术后恶心呕吐的发生率。     

When It Hurts,a Positive Attitude May Help. The Moderating Effect of Positive Affect on the Relationship Between Walking,Depression, and Symptoms in Women with Fibromyalgia

Background: Increased exercise is a marker of health in fibromyalgia (FM). However, patients frequently avoid physical activity as a way of minimizing the pain they feel. This deprives them of opportunities to obtain positive reinforcement, increasing functional impact. Aims: This study examines the mediating role of depressive symptoms between walking (as physical exercise), functional impact, and pain, at different levels of positive affect (PA) among women with fibromyalgia. Design: Cross-sectional correlational study. Settings: Mutual aid associations for fibromyalgia in Spain. Participants: 231 women diagnosed with FM. Methods: Moderate mediation analyses were conducted using PROCESS. Results: First, a simple mediation model showed that depression mediated the effect of walking on functional impact, but not on pain. Additionally, the moderated mediated model showed that this effect was significant at medium and high levels of PA, but not when levels of PA were low. Conclusions: Provision of resources focused on positive affect seem to increase the positive effects of walking on functional impact through the reduction of depressive symptoms. Nurses can improve adherence of patients with FM to walking behavior through increasing positive affect.     

The Effects of a Whole-Body Advanced Vibration Exercise Program on Flexibility,Balance, and Strength in Seniors

ABSTRACT

Age-related losses in functional flexibility, balance, and strength contribute to physical disability and increased risk of falls among older adults. While the positive improvements due to balance and strength training are abundant in the research literature, there is little known about the potential impact of whole-body vibration (WBV) exercise on flexibility, balance, and strength changes in older adults. The purpose of this study was to evaluate the effects of 8 weeks of WBV training on functional movements. Nineteen participants (5 males and 14 females; age range: 60–85 years; mean age: 71.4 ± 7.2 years) attended three 15-min training sessions per week, and were evaluated prior to starting WBV training, and again during the fourth and eighth weeks of the exercise program. All participants experienced positive changes in their functional movements, suggesting that WBV training is appropriate for promoting flexibility, balance, and strength in older adults.