The community mental health nurse: a new professional role

This review of recent literature explores the similarities and differences between the work of community psychiatric nurses and their mental handicap counterparts. The comparisons which have been made between groups of nurses are related to the authors own research studies. These included an observations study of one community mental handicap nursing team and a national survey of all such teams in England and Wales. The importance of trade union membership, the place of the Community Psychiatric Nursing Association and the implication of joint training courses are discussed. The emergence of a new professional role that of the 'community mental health nurse' is discussed and the implications which this might have for the future organization of community psychiatric nursing services is outlined.     

Sense of coherence among elderly somatic patients: predictive power regarding future needs of care

The main aim was to study the predictive power of sense of coherence regarding future needs of care among elderly patients evaluated as medically ready for discharge from somatic emergency care. A secondary aim was to study the consistency of sense of coherence over time among patients with this kind of experience. The sample consisted of 53 Swedish patients (mean age 82.8 years, SD = 6.6 years) who had completed their medical treatment at surgical or orthopaedic departments. The predominant diagnosis was lower limb fractures. Sense of coherence was assessed twice, on the day the patient was evaluated as medically ready for discharge and 1 month later. On the second assessment occasion, 28 patients had returned to their homes, 17 were staying at institutions, and eight had died. Patients who returned to their homes reported the strongest sense of coherence while still in hospital. Patients who were staying at institutions scored lowest on the overall sense of coherence scale and on the comprehensibility subscale. Patients who died before the second measurement occasion scored lowest on the meaningfulness subscale. A correlation of 0.51 was noted between the two assessments of sense of coherence, indicating a moderate temporal consistency.     

Causes, management and morbidity of acute hypoglycaemia in adults requiring hospital admission

In the community, acute hypoglycaemia is commonly caused by therapies for diabetes mellitus or the excessive consumption of alcohol. Although most episodes do not require admission to hospital, little information is available on the causes and outcome of those that do. We retrospectively surveyed adult patients admitted to a large urban teaching hospital with acute hypoglycaemia in a 12-month period, identifying 56 admissions of 51 patients. Forty-one had diabetes mellitus, 33 (80%) of whom were receiving treatment with insulin. The others had hypoglycaemia induced by excessive consumption of alcohol or by deliberate self-poisoning with insulin. A history of psychiatric illness and/or chronic alcoholism was common. Neurological manifestations of hypoglycaemia were the principal reason for admission, observed on 50 occasions (89%), and 11 events (20%) had precipitated convulsions. Although many patients (59%) had received treatment for hypoglycaemia before admission, hypoglycaemia recurred in 16% of patients in hospital. Four patients (7%) died following admission, but in only one case was this the direct result of hypoglycaemia. However, within 15 months of the index hypoglycaemia event, a further six patients (11%) had died, mostly of causes unrelated to hypoglycaemia. Patients who require hospital admission for treatment of hypoglycaemia have a high incidence of neurological manifestations, a high rate of mental illness and other medical disorders, and may represent a high-risk subgroup with a poor long-term prognosis.      

铝与血管性痴呆发病机制的相关性探讨

目的对缺血性脑卒中(不论有无痴呆)患者进行脑脊液(CSF)中铝含量进行测定,探索老年性痴呆的发病机制。方法观察组为缺血性脑卒中患者,对照组为整形外科患者。取两组患者的CSF,用原子吸收光谱进行CSF的铝含量测定,然后用韦氏智力量表及长谷川简易量表对患者智能进行测定。结果第1次检测结果:观察组铝含量为(81.6±8.9)ng/L,对照组为(35.6±2.2)ng/L(t=35.17,P<0.001)。第2次检测结果:观察组铝含量为(76.8±6.7)ng/L,韦氏成人智力量表均值低于75分,智力水平低于平常水平。对照组25例,铝含量为(14.0±1.2)ng/L(t=34.55,P<0.001)。第3次检测结果:观察组铝含量为(100.6±7.8)ng/L,长谷川简易量表均值为10.48分,为中等以下痴呆。对照组铝含量为(32.3±0.1)ng/L(t=14.92,P<0.001)。3次检测结果中观察组患者的铝含量均较对照组增加。结论VD及AD可能有相同的致病原因,中枢神经系统铝中毒。     

基于光电传感器的多段脉搏波传播速度检测系统的研制

采用了一种以反射式和透射式红外光光电传感器和单片机为基础,用同步检测心电信号、桡动脉脉搏波、手指脉搏波信号来测定桡动脉和外周动脉脉搏波传播速度的方法,研制一种无创的多段脉搏波传播速度检测系统。在软件编程中脉搏波周期信号的识别是以心电R波峰值为基准,同时再根据它们之间的时延关系进一步确定脉搏波的波峰与波谷的范围,提高检测准确性及精度。该系统通过检测心电、桡动脉脉搏波和手指脉搏波信号可获得多段脉搏波传播速度参数,具有较高的检测精度和良好的应用前景。     

Large particle hyaluronic acid for the treatment of facial lipoatrophy in HIV‐positive patients: 3‐year follow‐up study

Objectives

Facial lipoatrophy can be a stigmatizing side effect of antiretroviral (AVR) treatment for HIV‐infected patients. We sought to evaluate the long‐term efficacy and safety of a new formulation of hyaluronic acid that can be injected in larger amounts and into deeper skin layers during 3 years of follow‐up.

Methods

Twenty patients received injections of Restylane SubQ^™. Refill treatment was offered at 12 and 24 months. Treatment effects were evaluated using ultrasound, the Global Aesthetic Improvement Scale, visual analogue scale (VAS) and the Rosenberg self‐esteem scale.

Results

Seventeen patients remained at 36 months. Mean (± standard deviation) total cutaneous thickness increased from 6 ± 1 mm at baseline to 12 ± 1 mm (P<0.001) at 36 months. Response rate (total cutaneous thickness >10 mm) was 70%. Fifteen patients classified their facial appearance as very much or moderately improved. VAS increased from 39 ± 25 to 70 ± 20 (P<0.05) and higher self‐esteem scores were reported. Local swelling and tenderness after treatment was common. Persistent papules found in several patients after treatment were removed effectively with hyaluronidase injections. Three patients, treated only at baseline, still had higher total cutaneous thickness scores at 36 months.

Conclusions

Our results indicate that a large particle hyaluronic acid formulation is a durable and well‐tolerated dermal filler for treating HIV‐positive patients with facial lipoatrophy.