危重患者免疫低下与感染

心血管疾病是近年来发病率快速增长的疾病之一，其发病的病理生理机制一直是医学界研究的热点。众所周知，机体各器官、组织和细胞间的联系主要依赖于神经、内分泌和免疫系统，其中内分泌系统的作用范围广泛，效果缓慢而持久。激素是由内分泌细胞合成并释放的化学信使物质，通过内分泌、旁分泌、自分泌、胞内分泌或神经分泌多种方式对全身各个脏器发挥调节作用，维持机体内环境的稳定。激素水平的变化又可影响心脏和血管内皮的形态与功能。近期大量研究表明，内分泌系统功能紊乱可能是心血管病变的前奏。     

危重患者中心静脉导管相关性感染16例临床分析

目的了解危重患者中心静脉导管相关性感染（CVC—RI）的原因及影响因素。方法以回顾性调查方法对ICU中16例发生CVC—RI患者的年龄、导管留置时间、置管部位及细菌学检查结果进行统计分析。结果CVC—RI与年龄无明显相关,但与导管留置时间、置管部位有关。CVC—RI病原菌中以革兰阳性菌、革兰阴性菌和真菌有关。结论应尽量选择锁骨下静脉置管,减少置管留置时间,注意各种操作的无菌技术,对于CVC—RI的预防有积极作用。     

85例糖尿病并发心血管疾病的护理体会

<正>糖尿病是一组病因和发病机理尚未完全阐明的内分泌代谢疾病。糖尿病的心血管并发症包括冠心病、周围动脉疾病等。随着糖尿病的发病率不断增加,糖尿病应视为心血管疾病非常重要的危险因素。笔者旨在针对住院期间糖尿病并发心血管病特点,进行观察分析,从而正确地实施护理对策,提高其生活质量。     

糖尿病病人应防盲

糖尿病是一种常见的代谢内分泌全身性疾病,威胁糖尿病病人生命最严重的为心血管病变的各种并发症,且非常广泛和发展迅速,它还可以引起眼部疾患,严重者可致失明,这无异于雪上加霜,应引起糖尿病患者对防盲的高度警惕。     

提高内分泌代谢功能

提到内分泌代谢系统以及与他们相关的一些疾病与健康问题,我们首先应该明确一个问题,那就是内分泌系统涉及到很多器官。我们常说的内分泌腺包括甲状腺、甲状旁腺、肾上腺、胰岛,而他们又有不同的功能,比如甲状腺负责合成与分泌甲状腺素及三碘甲状腺原氨酸,促进能量代谢、物质代谢和生长发育;     

糖尿病病人应防盲

糖尿病是一种常见的代谢内分泌全身性疾病,威胁糖尿病病人生命最严重的为心血管病变的各种并发症,且非常广泛和发展迅速,它还可以引起眼部疾患,严重者可致失明,这无异于雪上加霜,应引起糖尿病患者对防盲的高度警惕。     

创伤危重患者静脉留置导管相关性血流感染的危险因素及护理对策

目的 探讨为创伤危重患者行静脉留置导管抢救时,预防导管相关性血流感染的护理对策. 方法 对医院2007年1月-2008年12月的创伤危重患者静脉置管抢救情况进行回顾性分析与总结. 结果 对转送专科治疗的1032例创伤危重患者,随机追踪观察406例,其中经四肢静脉置管334例,锁骨下静脉置管62例及股静脉置管10例,未发现1例导管相关性血流感染病例. 结论 重视创伤危重患者静脉留置导管的无菌操作、护理和监控,可杜绝导管相关性血流感染的发生,是降低患者死亡率和致残率的关键措施之一.     

集束化护理在预防ICU病人中心静脉导管相关性血流感染的应用

目的：探讨集束化护理对预防ICU病人中心静脉导管相关性血流感染的作用。方法：将入住在ICU,有中心静脉置管的危重症病人80例分为对照组和观察组各40例：对照组给予常规护理,而观察组则给予集束化护理干预,比较2组病人的住院时间、导管留置时间、并发证及中心静脉导管相关性血流感染发生率等指标。结果：（1）观察组导管平均留置时间（P=0.000 1）、平均住院时间（P=0.002 5）均低于对照组;（2）观察组的CVC-RI发生率为5.0%,显著低于对照组的22.5%（x2=5.165,P=0.048）;观察组的CRBSI发生率为2.5%,显著低于对照组的20.0%（x2=6.135,P=0.029）。结论：入住ICU有中心静脉置管的病人实施集束化护理干预后,可明显缩短置管时间和住院时间,减少并发证,降低导管相关性血流感染的发生率。     

史轶蘩 情系内分泌事业

正2013年2月13日,中国工程院院士史轶蘩因病医治无效在京逝世,享年85岁。中国工程院院士史轶蘩是我国现代内分泌学奠基人之一,虽有诸多头衔,但她更喜欢人们叫她史医生。她对待工作一丝不苟,眼里不揉沙子;她把医院当成家,每天穿着白大衣往来于门诊、病房和实验室;人们对她敬畏的同时还有点怕,因为她直言不讳,敢于批评;人们爱戴她,因为她严谨背后透着温情,让人心生温暖。她的一生,是坚守科学精神的一生,全力推动中国内分泌学事业发展的一生。     

肾移植术后肺部感染的诊断和鉴别诊断

2型糖尿病是一种临床常见的内分泌代谢疾病，随着病程的逐步进展，可出现胰岛B细胞功能的减退及胰岛素抵抗的加重，继而导致多系统、多脏器的进行性损害。2型糖尿病的传统治疗模式，包括英国糖尿病前瞻性研究（UKPDS），即合理控制饮食、适当运动、口服降糖药等，当口服降糖药失效时，使用胰岛素治疗的阶梯模式。     

血液净化在危重病中的应用

近年来有大量证据表明，糖尿病致死、致残的主要原因为心、脑血管功能障碍或病变，而导致糖尿病心、脑血管功能障碍或血管病变与糖脂代谢紊乱、动脉粥样硬化、高血压、自主神经病变密切相关。因此，加强对糖尿病心脑血管病变的认识，早期全面控制糖尿病，积极预防和延缓糖尿病心脑血管并发症的发生与发展，对降低糖尿病患者的病死率与致残率具有十分重要的意义。     

机械通气在急危重症中的应用现状

临床急危重症的终末期大多都会出现呼吸窘迫甚至呼吸功能不全,故如何维持呼吸功能、改善通气、纠正缺氧、防止二氧化碳潴留,使机体有可能度过基础疾病所致的呼吸功能障碍已经成为抢救危重病人的一项重要措施。机械通气技术的出现适时地解决了这个问题。随着对疾病本身认识的不断深入,电子和机械技术水平的不断提高以及呼吸机的性能的日臻完善,使得机械通气应用的范围越来越广,现已经成为抢救危重病人的重要措施。目前由于呼吸机的应用日益广泛,使心搏骤停、急性呼吸功能不全等危重病人的预后大为改善,是急危重病医学治疗方面的重大进展之一…     

Employing persons with serious mental illness

Data from various national surveys find that approximately half the population with mental disorders is gainfully employed across the entire range of occupations; such persons have an employment rate of about two-thirds that of the general population. More than a third of persons with serious mental illness also work, and many hold high-status positions. Among those with schizophrenia, a diagnosis associated with high impairment, only slightly more than a fifth are at work, and 12 percent are working full time. Approximately two-thirds are enrolled in federal disability insurance programs. Our analyses indicate considerable diversity of jobs among persons with various mental disorders. Most persons with mental illness want to work, and some with even the most serious mental disorders hold jobs requiring high levels of functioning. Educational attainment is the strongest predictor of employment in high-ranking occupations among both the general population and persons with mental disorders.     

HIV testing policy and serious mental illness

OBJECTIVES: Using opinion data from experts, we examined the context of the argument for mandatory testing of psychiatric patients. METHODS: Vignettes were distributed to experts on HIV and mental illness. Respondents were asked to provide appropriateness ratings for different hypothetical clinical decisions regarding HIV management. RESULTS: Respondents were reluctant to impose testing without informed consent in most circumstances. The presence of risk factors or danger to another increased appropriateness ratings modestly. CONCLUSIONS: Despite experts' tendency to emphasize individual rights, public reluctance to mandate testing is unlikely to extend to people with serious mental illness. No argument for mandatory testing can be persuasive if improved voluntary testing can achieve adequate detection rates. Voluntary testing protocols should be studied to determine which successfully identify infected individuals.     

Disparities in the geography of serious mental illness in Israel

ObjectiveThe aim of this research is to test and apply a model of the disparities and variations in serious mental illness (SMI) to estimating prevalence in local areas throughout Israel.MethodsThis study employs a secondary analysis of data from the 2003/2004 Israel National Health Survey of 4859 adults aged 21 and over from the household population of legal residents and citizens. It uses small area estimation methods (SAE), specifically to: (i) estimate and test a multivariate logistic model of disparities in the risk of serious mental illness; (ii) use the foregoing model for computing estimates, using census data, for local areas; (iii) validate these estimates against the rate of psychiatric hospitalizations.ResultsThe model uses standard demographic and socioeconomic variables to successfully predict 92.5% of respondents’ statuses as SMI, with a sensitivity of 26.9%, specificity of 95.9%, and an AUC index of .797. The resulting estimates of the percentage of adults with an SMI in the 16 subdistricts ranged between 3.7% and 7.7%, with a national mean of 5.0%. The estimates have a partial correlation of .63 with rates of psychiatric hospitalization in Jewish localities, but elevated rates have not been validated in Arab localities.ConclusionThe use of small area estimation methods demonstrated the capacity for deriving local prevalence rates of serious mental illness, ones that can be validated against psychiatric hospitalization for the majority population group in Israel.     

Concepts of trust among patients with serious illness

This paper examines conceptions of trust among three groups of respondents diagnosed with either breast cancer, Lyme disease or mental illness. Interviews were carried out using an open-ended interview guide to explore how patients made assessments of trust in their doctors and health care plans. The guide followed a conceptual approach that asked questions about competence, agency/fiduciary responsibility, control, disclosure and confidentiality. Respondents were given ample opportunity to raise other areas of concern. The data were organized using the NUDIST software package for the analysis of non-numerical and unstructured qualitative data. Patients viewed trust as an iterative process and commonly tested their physicians against their knowledge and expectations. Interpersonal competence, involving caring, concern and compassion, was the most common aspect of trust reported, with listening as a central focus. Most patient comments referred to learnable skills and not simply to personality characteristics. Technical competence also received high priority but was often assessed by reputation or interpersonal cues. Patients were much concerned that doctors be their agents and fight for their interests with health care plans. Disclosure and confidentiality were less common concerns; most patients anticipated that doctors would be honest with them and respect their confidences. Patients' responses also appeared to vary by their disease, their socio-demographic characteristics, their involvement with self-help groups, and how their illness conditions unfolded.     

Variability in community functioning of mothers with serious mental illness

In thepost-deinstitutionalization era, everyday community functioning is an important aspect of assessment and treatment of individuals with serious mental illness. The current study focuses on correlates of community functioning among 332 low-income mothers with serious mental illness. Results revealed significant relationships between everyday functioning and a number of demographic, psychiatric, contextual, and mental health treatment variables. Current psychiatric symptoms accounted for the greatest amount of variance and completely mediated the effects of diagnosis and substance abuse history on community functioning; yet contextual variables such as financial worries and social support were also significant predictors, even after controlling for symptoms and other clinical characteristics. Additionally, use of mental health services was a significant moderator of the effect of social stress on community functioning. Implications of results for future research and practice are discussed.