Algorithm of life quality evaluation for patients with psychosomatic diseases

AIM: To elaborate the algorithm for evaluation of quality of life (QL) in patients with psychosomatic diseases. MATERIAL AND METHODS: AMPI, Spilberger-Khanin anxiety test, the procedures 'general state, activity, mood" and "personality differential". RESULTS: The algorithm of QL evaluation comprises a questionnaire consisting of 48 questions divided into 3 blocks. Quality of the somatic state was assessed by restrictions in exercise, self-care, everyday activity. A psychological component of QL was determined by the presence of depression, anxiety, emotional effects on everyday and professional activity; the social component--by relations in office, family, medical personal. The procedure was standardized, so QL should be considered as high at 97-144 points, good 87-96, satisfactory 44-86, unsatisfactory results were at 26-43 points, poor--at 0-25 points. CONCLUSION: The proposed technique of QL of psychosomatic patients proved its validity and reliability. Therefore, it can be recommended for design of psychosocial and medical rehabilitative measures as well as for assessment of efficacy of these measures.     

Patients referred to a pain management clinic: beliefs, expectations and priorities

AIM: This paper is a report of a study to explore patients' pain-beliefs and emotions at the point of referral to a pain clinic, their expectations of the clinic and their priorities for improvement in aspects of their lives affected by pain. BACKGROUND: Chronic pain is a common experience and, although the percentage of people with pain referred to pain clinics is increasing, they often experience complex journeys through the healthcare system. Patients' beliefs about pain have been shown to influence their experience of pain and treatment outcomes, with a focus on the organic cause of pain reported. METHODS: Three focus groups were convened with 18 participants. Ten statements about pain were distributed to each participant and ranked according to their priorities. The data were collected in 2002-2003. FINDINGS: The participants' beliefs were dominated by the search for a firm diagnosis and cure. Participants held three main beliefs; that the cause of the pain must be established; that other people do not believe in the pain of a person without a firm diagnosis; and that painkillers are a way of 'fobbing you off'. Participants had little knowledge and few concrete expectations of the pain clinic. Their main priorities for improvement were 'less pain', 'some pain free times', and being able to do more 'everyday things'. CONCLUSION: Staff delivering pain management services must understand patients' beliefs and expectations and explain their own perspectives in order to provide a sound basis for working together.     

A prospective evaluation of the management of acute pyelonephritis in adults referred to urologists

In order to assess whether it is appropriate and clinically efficient to admit adults with 'clinically diagnosed' acute pyelonephritis (APN) under urologists, as is current practice in many NHS hospitals, a prospective study was undertaken over nine months in an NHS teaching hospital. Thirty-nine patients with clinical APN were admitted to the urology unit; all were pyrexial and 30 (77%) had typical features of rigor, flank pain and irritative lower urinary tract symptoms. Twenty-one (54%) had positive urine cultures, 31 (79%) had parenteral antibiotics, while another three (7%) had oral agents initially. The remaining five (14%) were continued on agents initiated by their GPs before admission. Thirty-three (85%) had imaging procedures with eight significant anomalies being noted. Urgent invasive intervention was required in only four (10%) patients; length of stay varied from one to 25 days. Uncomplicated moderate to severe APN in adults may be treated safely without the need for admission to the urology unit, either in the outpatient setting or on an acute admissions observation ward. Complicated cases requiring intervention can be transferred to the urologist once recommended investigations have been undertaken. This care pathway may help to reduce cancellations of elective urological cases and is likely to be more cost-effective for the NHS by reducing unnecessary admissions.     

Contemporary approaches to evaluation of psychosomatic status in patients with alimentary tract diseases

The authors present the results of psychosomatic status evaluation performed in 159 patients with biliary dyskinesia, chronic gastritis, and somatoform disturbances. The examination was done using questionnaires, scales, and computer methods. Computer diagnostic methods were proved to be most effective and allowed for quantitative evaluation of psychosomatic disturbances in patients with gastrointestinal diseases.     

Recommendation for standardized selection of sociomedical (insurance medical) assessment of work disability

Two study populations were examined, one for obtaining a frequency distribution of incapacity for work periods, the other for tracing the qualitative aspects of incapacity for work cases. Quantitative appraisal showed that 16% of all cases accounted for 49% of total incapacity time. Qualitative (microanalytic) appraisal of these 16% traced but a few disease groups responsible, amply dealt with in literature on chronic conditions. A shortcoming of apparently rather minor relevance in the individual case, has moreover been found to be systematic: prolonged incapacity for work periods inadequately explained by the diagnoses given on the incapacity certificate. Not least for this reason, appraisal by the insurance medical examination service should occur after three months at the latest. The criteria for initial selection are outlined in terms of three months incapacity for work, frequent recurrence of incapacity periods, and a catalogue of a few diagnostic groups.     

Prospective evaluation of the clinical utility of quantitative bleeding severity assessment in patients referred for hemostatic evaluation

Summary. Background: Quantitative bleeding assessment tools (BATs) have been used to describe the severity of the bleeding phenotype in patients with von Willebrand disease. Objectives: To evaluate the clinical usefulness of a BAT for the diagnosis of mild bleeding disorders (MBDs) in previously undiagnosed patients. Methods: We prospectively assessed 215 patients who were consecutively referred for evaluation of bleeding symptoms (n = 71), abnormal laboratory clotting test results (n = 105) or family investigation (n = 39) at two second‐level centers. The bleeding history was assessed by a young investigator who administered the BAT instrument, and also by a senior physician who independently evaluated the patient and made the final diagnoses. Sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) were computed for a predefined bleeding score (BS) cut‐off (BS of > 3). Receiver operating characteristic curves were used to establish a diagnostic prediction rule. Results: Assuming the prevalence of MBD in the general population to be ～ 1%, a normal BS (≤ 3) had a very high NPV (99.2%). The PPVs in patients referred for hemostatic or family evaluation at second‐level clinics were estimated to be 71.0% and 77.5% (assuming MDB prevalences of 20% and 50%, respectively, in these settings). Measurement of BS in addition to activated partial thromboplastin time significantly increased the diagnostic efficiency of the BAT instrument (NPV of 99.6%). Conclusions: BAT use improves the evaluation of patients with suspected MBD, and we propose its use in a clinical prediction guide based on BAT and activated partial thromboplastin time for the exclusion of patients with suspected MBD in a low‐prevalence setting.     

Sex differences in the adequacy of pain management among patients referred to a multidisciplinary cancer pain clinic

Few studies have evaluated sex differences in the adequacy of pain management in cancer. Existing studies have been marked by methodological limitations and results have been mixed. The present study sought to determine whether sex was associated with pain severity and pain management in cancer patients newly referred by their primary oncology team to a multidisciplinary cancer pain clinic. One hundred thirty-one cancer patients completed the Brief Pain Inventory-Short Form and medical chart review was conducted to obtain patients' clinical characteristics and pain treatment data. There were no differences between males and females in ratings of worst pain in the last week. Females were significantly less likely to have been prescribed high potency opioids by their primary oncology team and significantly more likely to report inadequate pain management as measured by Pain Management Index scores. These results suggest a sex bias in the treatment of cancer pain and support the routine examination of the effect of sex in cancer pain research.     

腹膜透析的营养评估与处理

蛋白质能量营养不良(Protein-energy malnutri-tion,PEM)是进展期慢性肾衰竭(chronic renal failure,CRF)和维持透析病人(maintenance dialysis,MD)中十分常见的现象。据不同文献报告MD成年病人蛋白质能量营养不良的发生率为18％～70％,成为MD病人死亡和出现并发症的主要原因之一。     

The whys and wherefores of getting patients to give up smoking

Smoking-related diseases are responsible for the majority of premature deaths in industrialized societies. It is 50 years since the link between smoking and lung cancer was first established, since when a gradually increasing number of smoking-related illnesses have been identified. The treatment of patients suffering smoking-related illnesses consumes a large proportion of health care budgets. The ever-increasing costs of health care, in part due to the advent of new therapeutic techniques, could be offset by a concerted effort to reduce the number of people smoking. Various strategies, particularly if used in combination, have been shown to produce acceptable smoking cessation rates. At present there appears to be a reluctance on the part of governments to fund a concerted, co-ordinated programme to encourage and assist people to stop smoking. In the absence of such support it is important for all health professionals to provide sensible advice and support to help their patients to stop smoking.     

Work-related stress and resources of psychosomatic patients compared to the general population

Work-related stress is an important determinant of the development of psychosomatic complaints and of the success of psychosomatic treatments. In order to specify work-related stress and resources in relation to the general population, 461 consecutive inpatients in psychosomatic rehabilitation were compared to matched pairs (age, sex, occupational status) from a representative community survey, the German Socio-economic Panel (GSOEP). Psychosomatic inpatients reported overall higher work stress than their matched pairs of the general population, the rank order of the stress factors as well as sociodemographic and occupational determinants were comparable. Patients also rated resources lower than their matched pairs. They reported much higher strains due to conflicts with supervisors and found less support among their colleagues. The items studied are useful to describe work stress profiles of psychosomatic rehabilitation patients and serve as a basis for therapeutic work.     

Diagnostic evaluation and management of patients with syncope

This article focuses on the evaluation of patients with syncope, a symptom not a disease. Syncope is a transient loss of consciousness associated with loss of postural tone with spontaneous recovery. The authors discuss the utility of an indications for different diagnostic tests, the indications for hospital admission, and the management of patients with certain known causes of syncope, including vasovagal and arrhythmic.     

State and trait anxiety and depression in patients affected by gastrointestinal diseases: psychometric evaluation of 1641 patients referred to an internal medicine outpatient setting

Objectives: To evaluate state and trait form of anxiety and current depression in patients affected by gastrointestinal diseases. Methods: We studied 1641 outpatients with gastrointestinal disorders, consecutively referred to our Internal Medicine outpatients from 1997 to 2005. State and trait anxiety were assessed by the State and Trait Anxiety Inventory. Current depression was assessed by the Zung self‐rating depression scale. Results: Among patients, 1379 (84.1%) showed state anxiety, 1098 (67%) showed trait anxiety and 442 (27%) showed current depression. The number of gastrointestinal diseases was directly correlated to state anxiety (p < 0.001) and trait anxiety (p = 0.04). Females showed higher levels of anxiety and depression than males (p < 0.001). State anxiety was related to food allergies (p < 0.001), small intestinal bacterial overgrowth (SIBO) (p = 0.001), Hp infection (p = 0.01) and ulcerative colitis in active phase (p = 0.03). Trait anxiety was related to irritable bowel syndrome (IBS) (p < 0.001), Helicobacter pylori (Hp) infection (p = 0.001), food allergies (p = 0.001) and SIBO (p = 0.001). Current depression was related to IBS (p < 0.001) and coeliac disease (p = 0.01), SIBO (p = 0.02). A predicted probability of 0.77 ± 0.16 to have state anxiety, of 0.66 ± 0.12 to have trait anxiety and of 0.39 ± 0.14 to have depression was found in these patients. Conclusions: Most of the patients who seek medical consultation for gastrointestinal problems show an associated affective disorder. These patients should be managed by a team including gastroenterologists, psychologists and/or psychiatrists, or by a gastroenterologist having expertise in the treatment of psychological disorders.     

Duration of spiral after-effects in psychosomatic patients (a psychophysiologic study and analysis of data using multivariate procedures)

In a psychophysiological study the spiral after-effect, as measured by means of the Archimedes spiral, was investigated in 182 patients with psychosomatic disorders including duodenal ulcers, ulcerative colitis, anorexia nervosa, asthma and heart neurosis and compared with the results obtained in a control group of healthy volunteers (n = 30). Using multivariate data analysis it was possible to divide the total group of psychosomatic patients into various different subgroups which parallelled the subdivision from the clinical point of view. Moreover, the objectivation of the influence of psychotherapy lasting for 6 weeks on the duration of the after-effect was shown by this technique. These results suggest that the determination of the duration of the spiral after-effect may be of value in clinical psychodiagnostics.     

基于5M1E分析法的现场管理模式在自行来院高危胸痛患者中的应用

目的:探讨基于5M1E分析法的现场管理模式在自行来院高危胸痛患者中的应用效果。方法:选取2017年7月—2018年10月自行前往首都医科大学附属北京潞河医院就诊的高危胸痛患者263例为研究对象,其中以2017年7月—2018年2月行常规模式就诊患者为常规模式组（ n=128）,以2018年3—10月行基于5...