Complete heart block and death following lamotrigine overdose

Context.?Lamotrigine is used for both seizure and psychiatric disorders. Overdoses typically follow a benign course. Case details.?A 19-year-old male with bipolar disorder ingested 4?g of lamotrigine. The patient suffered from multiple seizures, charcoal aspiration, respiratory arrest, prolongaton of the QRS interval on electrocardiogram, complete heart block, multiorgan failure and ultimately death. Discussion.?We describe the emergency department (ED) and ICU course for this patient and briefly review the toxic effects of lamotrigine and the pharmacokinetics with and without hemodialysis.     

Prevalence of Subjectively Experienced Symptoms in a Population Sample of Women with Special Reference to Women with Arterial Hypertension

The patients' reasons for encounter were recorded in 10278 personal doctor—patient contacts in nine Norwegian municipalities over a two-month period, and were classified according to a simplified version of the WHO “Reason for Encounter Classification”. A two-dimensional classification system was used where each reason was classified according to the location and type of problem. Symptoms and complaints made up 64.9% of all encounters. Most of the encounters were related to the musculo-skeletal, circulatory and female genital systems. The most frequent single reason for encounter was pain in the musculo-skeletal system (15.5% of all encounters). Psychological and social reasons were rather infrequent 3.1% and 0.3%. Compared with the frequencies of psychiatric and social diagnoses recorded in general practice, this indicates a discrepancy between the patient's own opinion of problems and the doctor's interpretations. Females had a significantly higher contact rate than males, mainly due to problems related to the genital system, inclusive of the breast.     

68例慢性乙型肝炎患者对疾病认知及心理和行为问卷调查

目的 了解患者对慢乙肝疾病相关知识认知、对疾病的心理和行为应对情况,以更好评估慢乙肝患者对疾病的认知、防治需求,对待疾病的态度和行为,疾病带给慢乙肝患者的心理压力,为慢乙肝患者的健康管理、心理干预提供依据.方法 对在2011年1月至2013年6月到昆明医科大学第二附属医院肝胆胰内科门诊就诊和住院的68位慢乙肝患者在诊疗前后进行个人访谈和问卷调查,并由受过专业培训的医护人员对问卷调查中发现的问题进行一对一的指导.结果 大部分患者知道疾病的一般知识,对疾病缺乏较深层次的认识.宣教前与宣教后患者在乙肝传播途径、带来的后果认知、加重肝损伤因素的认知及保护家人不受感染的措施等方面问卷得分进行t检验,P＜0.05具有统计学意义.对自我护理和预防保健没有充分认识,患者对乙肝相关疾病知识的认识和了解与文化程度和病程长短有关,69.1％的患者存在一定的心理问题.结论 医护人员加强对慢乙肝相关疾病知识的深度和广度的宣传,针对患者的心理问题给予积极的心理疏导,争取社会支持系统对患者提供有针对性的帮助,提供准确的健康指导和连续的干预,促进患者主动采纳健康行为建议,对监测和防控患者的病情发展,对慢性乙肝患者的未来的健康管理有重要意义.     

低年资护士心理契约与工作满意度、离职倾向的相关性研究

目的:了解低年资护士心理契约、工作满意度、离职倾向之间的关系,提出有针对性的心理契约管理方案.方法:采用问卷调查法对362名低年资护士进行调查.结果:离职倾向处于中等水平,组织责任的感知和工作满意度呈偏低水平;组织规范责任、排班满意度对离职倾向最具预测力.结论:医院管理者应从组织责任履行的不足之处着手,侧重于低年资护士工作不满意的项目,满足其个体化需求,降低离职率.     

心理护理对乙肝合并肝纤维化患者不良心理状态和生存质量的影响

目的探讨心理护理对乙肝合并肝纤维化患者不良心理状态和生存质量的影响。方法本研究共纳入103例乙肝合并肝纤维化的患者作为研究对象,根据起始端心理状态评分,分为不良状态组(≥50分,38例)和正常状态组(50分,65例)。所有患者均进行一般的常规护理和心理护理,3个月后均再次进行心理状态、生存质量及治疗依从性评估。观察并比较两组患者心理护理前后的心理状态、生存质量及治疗依从性评分的变化情况。结果研究开始时不良状态组,心理状态评分明显高于正常状态组(P0.05);生存质量评分均明显低于正常状态组(P0.05);治疗依从性也明显比正常状态组差(P0.05)。经过3个月心理护理后,不良状态组患者心理状态评分明显降低(P0.05);生存质量评分均显著升高(P0.05);治疗依从性也明显得到改善(P0.05);正常状态组患者生存质量评分均显著升高(P0.05)。心理治疗后,两组患者的心理状态评分、生存质量评分比较,差异有统计学意义(P0.05);两组患者治疗依从性差异无统计学意义(P0.05)。结论心理护理能有效改善乙肝合并肝纤维化患者不良心理状态、生存质量和治疗依从性,提高患者治疗依从性,值得在临床上推广应用。     

The prevalence of gastrointestinal symptoms in patients with chronic renal failure is increased and associated with impaired psychological general well-being.

BACKGROUND: Malnutrition occurs frequently in patients with end-stage renal disease (ESRD). Gastrointestinal (GI) symptoms may lead to reduced food intake, resulting in malnutrition and impaired well-being in these patients. The prevalence of GI symptoms in various chronic renal failure (CRF) groups is unexplored. We assessed the prevalence of GI complaints in patients on either haemodialysis (HD), peritoneal dialysis (PD), or in the pre-dialysis stage. Patients with and without diabetic nephropathy were also compared. METHODS: A total of 233 patients with CRF (128 HD, 55 PD, and 50 pre-dialytic patients) completed two self-administered questionnaires: the Psychological General Well-Being (PGWB) index and the Gastrointestinal Symptom Rating Scale (GSRS), which measures GI symptoms. The values were compared with reference values obtained from the general population. The association between GI symptoms and serum (s-)albumin was also studied. RESULTS: The total GSRS score in patients with CRF was significantly higher than the reference values (HD 2.14 (1.97-2.31), PD 2.24 (2.00-2.48), and pre-dialytic patients 2.03 (1.82-2.25) vs controls 1.53 (1.50-1.55; P<0.001). When comparing CRF subgroups there was no overall difference between the groups, but PD patients had more severe reflux and eating dysfunction. In patients with diabetic nephropathy, only eating dysfunction was significantly more common than in the non-diabetic patients. There was a negative correlation between GI symptoms and psychological general well-being in CRF patients (Rho=-0.46, P<0.001) indicating that patients with a high GI symptom profile have impaired psychological general well-being. A negative correlation was found between eating dysfunction and s-albumin (Rho=-0.33, P<0.01). CONCLUSION: The prevalence of GI symptoms is high in patients with CRF and is associated with impairment in psychological general well-being. Presence of dialysis or not, type of dialysis, and presence or absence of diabetes mellitus seem to have limited impact on GI symptoms.     

Incident-related stressors,locus of control,coping, and psychological distress among firefighters in Northern Ireland

This study was an investigation into the associations between incident-related stressors, locus of control, coping, and psychological distress in firefighters in Northern Ireland during the time of political violence. Among 248 male firefighters, greater psychological distress was associated with greater frequency of incident-related negative emotions, external locus of control, less task- and emotion-focused coping, and greater avoidance coping. It was also found that the frequency of exposure to incident-related stressors moderated the association between locus of control and psychological distress and that avoidance coping mediated the relationship between locus of control and psychological distress. Avoidance coping accounted for most of the explained variance in psychological distress. These results point to the potential value of coping-skills training in emergency personnel.     

Community reintegration following acquired brain injury

Objective: To evaluate the interventions and strategies used to enable transition from acute care or post-acute rehabilitation to the community following brain injury.

Methods and main outcomes: A systematic review of the literature from 1980-2005 was conducted focusing on ABI rehabilitation. Five major aspects of community reintegration, including: independence and social integration, caregiver burden, satisfaction with quality of life, productivity and return to driving were considered.

Results: With the exception of one, the majority of interventions are supported by only limited evidence, denoting an absence of randomized controlled trials (RCTs) in the literature. Of 38 studies evaluated for this review, only one RCT was found. That RCT provided moderate evidence that behavioural management, coupled with caregiver education, did not help to improve caregiver burden. Conclusions: Further research, using an interventional approach, is required to advance the evidence base of reintegration into the community following brain injury.