长期住院慢性精神分裂症患者的生活质量

目的:评估长期住院的慢性精神分裂症患者的生活质量,并分析影响因素。方法:纳入2004-01/08在北京回龙观医院住院的慢性精神分裂症患者163例。以年龄、性别、受教育程度为匹配条件,按照2∶1的比例选择本院职工及医院所在社区内82例健康自愿者为对照组。采用健康状况调查问卷进行生活质量评价:包括36个条目,归纳为8个分量表:生理机能,生理职能、躯体疼痛、一般健康状况、精力、社会功能、情感职能和精神健康。分数越高,表明该方面的功能状况越好,生活质量越高。结果:发放调查问卷245份,收回有效问卷245份。①精神分裂症患者健康状况调查问卷各维度评分均低于对照组,两组比较差异有显著意义。②相关分析发现长期住院的慢性精神分裂症患者健康状况调查问卷评分与阳性与阴性症状量表评分、副反应量表呈负相关(P<0.05～0.001)。健康状况调查问卷评分与性别呈正相关(P<0.05～0.001),与年龄、婚姻状况、病期、住院时间、目前状态、躯体疾病呈负相关(P<0.05～0.001)。结论:长期住院的慢性精神分裂症患者的生活质量低下,影响因素包括精神病状态、药物副反应、年龄、性别、病期、住院时间、婚姻状况、躯体疾病。     

The inter‐rater reliability between nurse‐assessors clinically assessing infection of chronic wounds using the WUWHS criteria

The aim of this study was to determine the inter‐rater reliability between one expert‐nurse and four clinical‐nurses who were asked to clinically assess infection of chronic wounds by using the World Union of Wound Healing Societies (WUWHS) criteria. A quasi‐experimental design was used to collect the data. In comparison to phase 1 in which ‘open questions’ were asked, in phase 2 a pre‐printed form (checklist) was introduced. In both phases, 55 chronic wounds were clinically assessed. For each WUWHS criterion the inter‐rater reliability of signs and symptoms was expressed by Cohens Kappa (κ). A substantial agreement (κ ≥ 0·6) was considered as adequate. In both phases pocketing (p < 0·02), and erythema (p < 0·004) scored statistically significant results. Phase 2 showed higher inter‐rater agreements compared with phase 1 (three substantial agreements (easily bleeding/friable granulation tissue, delayed healing, increasing exudate), an almost perfect‐ and a perfect agreement for malodour and pain, respectively. According to the results it can be concluded that the clinical assessment of infection of chronic wounds may be better supported by a pre‐printed form than making use of an ‘open questions’ form. To provide this with a higher level of evidence, there is need for more well conducted studies.     

常压模拟高住低练对红细胞相关指标和促红细胞生成素、低氧诱导因子-1mRNA表达影响的研究与进展

目的:常压模拟高住低练训练法是近年来提出来的一种新型的高原训练方法,可以解决传统高原训练中存在的不足。就高住低练训练法对红细胞相关指标和促红细胞生成素、低氧诱导因子-1基因表达的影响作一综述,旨在促进高住低练训练法在中国的发展和应用,使其更好地为运动员竞技水平的提高服务。资料来源:应用计算机检索PubMed1972-01/2005-12的相关文章,同时根据相关的参考文献检索了部分文章,检索词“simulated living high-training low training(HiLo),indices of red blood cell,effect;erythropoietin(EPO)、Hypoxia inducible factor-1(HIF-I),Gene”限定语言种类为English,同时计算机检索http://cnki.hunnu.edu.cn1996/2006的相关文章,限定文章种类为中文,检索词“:高住低练,红细胞相关指标,影响,促红细胞生成素,低氧诱导因子,基因。”资料选择:对资料进行初审,选取实验包括常压模拟高住低练运动模型中关于红细胞相关指标和促红细胞生成素基因、低氧诱导因子-1基因表达的影响方面的文献,查找相关文献的全文,判断是否确实是相关研究。纳入条件:①随机对照实验研究。②实验包括对照组与干预组。排除条件:①综述文献。②重复的同一研究。资料提炼:共查找到90篇相关研究文章,38篇符合纳入标准。排除的52篇系为同一研究和综述文献。资料综合:Levine在高住低练训练法的试验发现:高住低练训练组最大摄氧量平均增加了5%,红细胞平均增加了9%,运动能力得到改善,而对照组无论是最大摄氧量、红细胞、还是运动能力均无显著性变化。②高住低练训练法能促使低氧诱导因子-1的产生而对促红细胞生成素的调控,使促红细胞生成素的产生和血红素浓度的变化,促红细胞生成素增加引起红细胞量和Hb浓度的增加;血红素浓度增加可以提高血液运输氧的能力和组织氧化能力。居住在适宜高度(大于2000～2500m),通过持续增加促红细胞生成素的量,诱导红细胞和血红素浓度的增加,改善氧运输能力、提高最大摄氧量,可以有效地提高运动成绩。③高住低练训练法引起低氧诱导因子-1mRNA表达,其如何对促红细胞生成素进行调控和信号的转达,高住低练训练法导致血液成分变化对运动能力的影响等问题的研究。可以更清楚地认识高住低练训练法对机体运动能力影响的机制,为提高运动成绩提供帮助。结论:高住低练训练法可促进促红细胞生成素、低氧诱导因子-1基因表达和红细胞的生成,提高血红蛋白浓度和红细胞比容,而有效地提高运动员的运动能力。     

认知矫正治疗对慢性精神分裂症患者临床症状和社会功能的影响

目的:观察认知矫正治疗对慢性精神分裂症患者临床症状和社会功能的改善作用。方法:选择2003-01/08在北京回龙观医院住院的慢性精神分裂症患者104例。均符合CCMD-Ⅲ及DSM-Ⅳ关于精神分裂症诊断标准;年龄25～55岁;病程≥2年;病情稳定,处于迁延、残留或部分缓解状态;药物治疗状况稳定,近期无换药打算;纳入对象或家属同意入组并签署知情同意书。应用随机数字表法将患者分认知矫正治疗组和对照组,每组52例。在相近药物治疗的基础上,认知矫正治疗组以Ann Delahunty和Rodney Morice等制定的神经认知矫正手册(汉化)为治疗工具,在治疗师的指导下进行认知作业练习,内容包括认知灵活性、工作记忆、计划执行功能3大功能模块。对照组予以相同时间的工娱治疗,主要包括有治疗师指导的操作性音乐治疗和舞蹈治疗。治疗前后两组患者分别进行PANSS、住院精神患者社会功能缺陷量表和护士观察量表的评定。结果:实验共纳入慢性精神分裂症患者104例,认知矫正治疗组44例,对照组46例进入结果分析,14例脱落。①治疗前后两组患者PANSS量表总分以及阴性症状量表、复合量表、一般精神病理量表、反应缺乏量表4个分量表的评分均有下降,组内比较差异有显著性意义(t=2.12～4.59,P<0.05);减分情况在两组间差异不明显(P>0.05)。②两组患者的社会功能缺陷量表总分在治疗后均有下降,与治疗前比较,差异有显著性意义(t=3.89,2.04,P<0.05);两组间比较,差异无显著性意义(P>0.05)。认知矫正治疗组治疗后护士观察量表的总病情以及总消极、迟滞2个分量表评分下降,与治疗前比较差异有显著性意义(t=1.49,1.19,2.81,P<0.05);其中迟滞项的减分在两组间比较,差异具有显著性意义(F=4.97,P<0.05)。③社会功能量表的改善与词语流畅性的改善呈正相关(R2=0.36,P<0.05),护士观察量表中总病情与积极两项评分的改善也与言语流畅性测验的改善正相关(R2=0.37,0.34,P<0.05)。结论:认知矫正治疗能在一定程度上改善精神分裂症患者的社会功能,并与部分认知功能的改善相关,但对临床症状无明显改善作用。     

Ischaemic preconditioning of the graft in adult living related right lobe liver transplantation: impact on ischaemia�Creperfusion injury and clinical relevance

Background

Ischaemic preconditioning (IPC) of the right liver graft in the donor has not been studied in adult-to-adult living related liver transplantation (LRLT).

Objective

To assess the IPC effect of the graft on ischaemia reperfusion injury in the recipient and compare recipient and donor outcomes with and without preconditioned grafts.

Patients and methods

Alternate patients were transplanted with right lobe grafts that were (n =22; Group _Precond) or were not (n =22; Group _Control) subjected to IPC in the living donor. Liver ischaemia–reperfusion injury, liver/kidney function, morbidity/mortality rates and outcomes were compared. Univariate and multivariate analyses were performed to identify factors predictive of the aspartate aminotransferase (AST) peak and minimum prothrombin time.

Results

Both groups had similar length of hospital stay, morbidity/mortality, primary non-function and acute rejection rates. Post-operative AST (P =0.8) and alanine aminotransferase (ALT) peaks (P =0.6) were similar in both groups (307 ± 189 and 437 ± 302 vs. 290 ± 146 and 496 ± 343, respectively). In univariate analysis, only pre-operative AST and warm ischemia time (WIT) were significantly associated with post-operative AST peak (in recipients). In multivariate analysis, the graft/recipient weight ratio (P =0.003) and pre-operative bilirubin concentration (P =0.004) were significantly predictive of minimum prothrombin time post-transplantation.

Conclusions

Graft IPC in the living related donor is not associated with any benefit for the recipient or the donor and its clinical value remains uncertain.     

Retreatment of hepatitis C patients with pegylated interferon combined with ribavirin in non-responders to interferon plus ribavirin. Is it different in real life?

Background  

More than 50% of hepatitis C viruses (HCV)-infected patients do not respond to the classical Interferon (IFN)/Ribavirin (RBV) combination therapy. The aim of this study was to evaluate the efficacy of retreatment with Peg-Interferon alpha-2b (PEG-IFN alpha-2b) plus RBV, in patients with HCV, genotypes 1 or 3, who were non-responders to the previous standard treatment with IFN/RBV.     

Preterm neonatal cardiovascular instability: Does understanding the fetus help evaluate the newborn?

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Intermittent Pringle Maneuver and Hepatic Function: Perioperative Monitoring by Noninvasive ICG-Clearance

Background  

Intermittent Pringle maneuver or selective portal clamping often are used to control inflow during parenchymal liver transection. This study was designed to determinate whether these maneuvers are associated with adverse hepatic function.     

Impact of a clinical pharmacist on medication safety in mental health Hospital-in-the-Home: a retrospective analysis

Background

Integration of clinical pharmacists into multidisciplinary Mental Health Hospital-in-the-Home teams is increasing but little is known about the medication safety contribution these pharmacists make.

Aim

To evaluate whether clinical pharmacist involvement in a Mental Health Hospital-in-the-Home service improved medication safety key performance indicators.

Method

Medical records were retrospectively reviewed of all patients admitted to 2 Western Australian Mental Health Hospital-in-the-Home services from September to November 2015.

Site 1

was a 16-bed service incorporating a clinical pharmacist as part of its multidisciplinary team.

Site 2

was a similarly structured 18-bed service but without clinical pharmacist involvement. The primary outcome measure was completion of medication safety key performance indicators obtained from the Western Australian Government Pharmaceutical Review Policy and mental health-specific best practice guidelines.

Results

Key performance indicators from Site 1 (n?=?75 records), which incorporated a clinical pharmacist, demonstrated significantly (p?<?0.001) higher rates of completion of medication reconciliation [65 (87%) versus 17 (29%)], accurate adverse drug reaction list [73 (97%) versus 34 (58%)], accurate discharge medication list [51 (74%) versus 18 (45%)], accurate medication profile [74 (99%) versus 40 (68%)] and medication chart review [74 (99%) versus 0 (0%)] than Site 2 (n?=?59).

Conclusion

Integrating a clinical pharmacist into a Mental Health Hospital-in-the-Home program significantly improved achievement of medication safety key performance indicators.