Challenges to recovery following early psychosis: Nursing implications of recovery rate and timing

Early intervention in first episode psychosis is based on an indicated prevention approach that has early illness identification and timely recovery as primary goals. Nurses are instrumental in helping individuals and families achieve both aims. To better understand recovery following a first episode, a prospective cohort of 260 individuals participating in a three-year early intervention program was monitored for achievement of recovery outcomes. Two outcome measures were used to examine the recovery rate and timing of the cohort: (1) partial recovery was comprised of two criteria: (a) symptom control (psychosis and mania), and (b) daily functioning, and 2) comprehensive recovery was measured by three criteria: (a) symptom control; (b) daily functioning; and, (c) quality of life. Survival analysis, including the Kaplan-Meier statistic, and Cox hazard regression were used to examine the cohort's rate and timing for both measures. One hundred and seventy-four individuals attained partial recovery with half (51.1%) reaching the target within nine months. Comprehensive recovery was achieved by 59 individuals (22.7%), primarily in year two and three of treatment. Issues impacting quality of life delayed recovery for the majority of program participants. The gap between psychosis remission and satisfaction/fulfillment with one's everyday life is troubling, but could be improved with stronger nursing support and influence. Sharing the recovery experience with individuals and families that supports their life goals and the discovery of meaning, hope and purpose in the face of illness is the work of nurses. Suggestions for strengthening nursing's impact are considered.     

Effects of two volatile anesthetics (sevoflurane and halothane) on the hypothalamic noradrenaline release in rat brain

There are marked increases in noradrenaline (NA) release during emergence from general anesthesia induced with volatile anesthetics. These changes in NA in the posterior hypothalamus of the rat were assessed by intracranial microdialysis. Sevoflurane and halothane in equipotent concentrations were used to obtain the same depth of anesthesia. NA release increased similarly with the two agents during recovery. However, NA release remained elevated longer with halothane, from which recovery was also slower.     

Arterial spin labeling hyperperfusion in Rasmussen's encephalitis: Is it due to focal brain inflammation or a postictal phenomenon?

Background and purpose

The study evaluated the utility of arterial spin labeling (ASL) perfusion imaging in Rasmussen's encephalitis (RE).

针刺对于脑梗死恢复期头痛及吞咽障碍的干预及治疗作用

脑梗死具有高死亡率、高残障率和高复发率的特点,且发病有年轻化趋势。脑梗死恢复期头痛及吞咽障碍对患者的日常生活能力造成严重影响,导致患者的生命质量下降,给人们经济带来沉重的负担。现通过检索各大中英文数据库,对筛选出的临床试验文献进行深入剖析,并针对目前针刺治疗存在的问题提出发展性的建议,为今后针刺治疗脑梗死恢复期的临床诊疗方法以及作用机制研究提供科学依据和崭新思路。     

Neurobehavioral Dynamics Following Chronic Sleep Restriction: Dose-Response Effects of One Night for Recovery

Objective:

Establish the dose-response relationship between increasing sleep durations in a single night and recovery of neurobehavioral functions following chronic sleep restriction.

Design:

Intent-to-treat design in which subjects were randomized to 1 of 6 recovery sleep doses (0, 2, 4, 6, 8, or 10 h TIB) for 1 night following 5 nights of sleep restriction to 4 h TIB.

Setting:

Twelve consecutive days in a controlled laboratory environment.

Participants:

N = 159 healthy adults (aged 22-45 y), median = 29 y).

Interventions:

Following a week of home monitoring with actigraphy and 2 baseline nights of 10 h TIB, subjects were randomized to either sleep restriction to 4 h TIB per night for 5 nights followed by randomization to 1 of 6 nocturnal acute recovery sleep conditions (N = 142), or to a control condition involving 10 h TIB on all nights (N = 17).

Measurements and Results:

Primary neurobehavioral outcomes included lapses on the Psychomotor Vigilance Test (PVT), subjective sleepiness from the Karolinska Sleepiness Scale (KSS), and physiological sleepiness from a modified Maintenance of Wakefulness Test (MWT). Secondary outcomes included psychomotor and cognitive speed as measured by PVT fastest RTs and number correct on the Digit Symbol Substitution Task (DSST), respectively, and subjective fatigue from the Profile of Mood States (POMS). The dynamics of neurobehavioral outcomes following acute recovery sleep were statistically modeled across the 0 h-10 h recovery sleep doses. While TST, stage 2, REM sleep and NREM slow wave energy (SWE) increased linearly across recovery sleep doses, best-fitting neurobehavioral recovery functions were exponential across recovery sleep doses for PVT and KSS outcomes, and linear for the MWT. Analyses based on return to baseline and on estimated intersection with control condition means revealed recovery was incomplete at the 10 h TIB (8.96 h TST) for PVT performance, KSS sleepiness, and POMS fatigue. Both TST and SWE were elevated above baseline at the maximum recovery dose of 10 h TIB.

Conclusions:

Neurobehavioral deficits induced by 5 nights of sleep restricted to 4 h improved monotonically as acute recovery sleep dose increased, but some deficits remained after 10 h TIB for recovery. Complete recovery from such sleep restriction may require a longer sleep period during 1 night, and/or multiple nights of recovery sleep. It appears that acute recovery from chronic sleep restriction occurs as a result of elevated sleep pressure evident in both increased SWE and TST.

Citation:

Banks S; Van Dongen HPA; Maislin G; Dinges DF. Neurobehavioral dynamics following chronic sleep restriction: dose-response effects of one night for recovery. SLEEP 2010;33(8):1013–1026.     

创伤失血性休克的治疗进展

目的：探讨创伤失血性休克的治疗现状,从而有效地指导临床工作.方法：应用PubMed、SpringerLink、中国知网医学全文期刊等数据库,查阅近年来相关文献,总结创伤失血性休克的治疗方法及其临床疗效.结果：现阶段,创伤失血性休克的治疗以限制性液体复苏、改善微循环为主,抗炎性介质、抗氧自由基、抗内毒素及中医中药等治疗显示出较好的临床前景,但仍处于辅助地位.结论：把液体复苏、免疫、炎症反应调控和抗氧化等临床治疗手段与细胞内氧复苏相结合是休克治疗领域发展的方向.     

对住院精神分裂症患者恢复期心理护理干预的探讨

目的探讨住院精神分裂症患者恢复期的心理卫生状况及心理护理干预效果。方法将76例处于恢复期的住院精神分裂症患者随机分为两组，封其中的38例追行心理谩理干预（干预组），并与对照组（未干预组）退行比较。采用SCL-90（症状自评量表）于干预前和干预后4周末造行量表抨定。枯果住院精神分裂症患者恢复期的主要心理闪题为抑郁、焦虑、人际关系、强迫、敌对、偏执等。干预组在干预后4周末SLC-90的焦虑、抑郁、人际关系3个因子分与干预前相比有非常显着性差异（P〈0.01）。强迫、敌对、偏执3个因子分有显着性差异（P〈0.05）。其他各项因子分差异无显着性（P〉0．05）；而对照组各因子分干预前后相比无显着性差异（P〉0．05）。干预后两组在SCL-90的焦虑、抑郁、人际关系、强迫、敌对、偏执等6个因子分比较有显着性差异（P〈0.05）。结论心理护理干预能明显改善住院精神分裂症患者恢复期的心理卫生状况，促进病人的康复。     

表面改性TiNi记忆合金棒的回复力学实验研究

采用直径为6~7 mm钛铌涂层T iN i记忆合金棒与未经表面改性的T iN i记忆合金棒,相变温度平均为33.0℃,低温下在三点弯卡具上进行预弯,挠度分别为5.0、10.0、15.0和20.0 mm,保持位移恒定,分别在37℃及50℃的生理盐水溶液恒温水浴箱中测量其三点弯回复力变化特性。结果表明,T iN i记忆合金棒的回复力随回复温度、棒直径、变形量增加而增加;经钛铌表面喷涂后6 mm及6.5 mm棒的回复力有一定降低,但7 mm棒回复力没有显著性差异。依照以上数据可以为临床设计脊柱侧弯矫形棒提供参考。     

Effect of hydrotherapy on the signs and symptoms of delayed onset muscle soreness

This study independently examined the effects of three hydrotherapy interventions on the physiological and functional symptoms of delayed onset muscle soreness (DOMS). Strength trained males (n = 38) completed two experimental trials separated by 8 months in a randomised crossover design; one trial involved passive recovery (PAS, control), the other a specific hydrotherapy protocol for 72 h post-exercise; either: (1) cold water immersion (CWI: n = 12), (2) hot water immersion (HWI: n = 11) or (3) contrast water therapy (CWT: n = 15). For each trial, subjects performed a DOMS-inducing leg press protocol followed by PAS or one of the hydrotherapy interventions for 14 min. Weighted squat jump, isometric squat, perceived pain, thigh girths and blood variables were measured prior to, immediately after, and at 24, 48 and 72 h post-exercise. Squat jump performance and isometric force recovery were significantly enhanced (P < 0.05) at 24, 48 and 72 h post-exercise following CWT and at 48 and 72 h post-exercise following CWI when compared to PAS. Isometric force recovery was also greater (P < 0.05) at 24, 48, and 72 h post-exercise following HWI when compared to PAS. Perceived pain improved (P < 0.01) following CWT at 24, 48 and 72 h post-exercise. Overall, CWI and CWT were found to be effective in reducing the physiological and functional deficits associated with DOMS, including improved recovery of isometric force and dynamic power and a reduction in localised oedema. While HWI was effective in the recovery of isometric force, it was ineffective for recovery of all other markers compared to PAS. An erratum to this article can be found at