脑卒中后抑郁症相关心理社会因素的对照研究

目的 探讨脑卒中后抑郁症相关的心理社会因素,以指导心理干预,提高生活质量。方法 30例卒中后抑郁患者为研究组,42例卒中后无抑郁患者为对照组。以医学应对问卷、社会支持评定量表(SSRS)和Barthel指数(BI)为评定工具,对两组患者分别进行评定。结果研究组面对量表分显著低于对照组(P<0.05),而屈服量表分显著高于对照组(P<0.01)。研究组SSRS评分显著低于对照组(P<0.01)。两组BI评分差异无显著性(P>0.05)。结论 有针对性的心理教育性干预并加强社会支持可能对防治卒中后抑郁起重要作用。     

Stroke Unit care in Italy. Results from PROSIT (Project on Stroke Services in Italy). A nationwide study

Abstract The future challenge for improving stroke patients’ outcome will be to implement new Stroke Units (SUs) worldwide. However the best SU model remains uncertain. The aim of this study was to evaluate the number of SUs and the quality characteristics of acute stroke care in Italy. We conducted a SU survey in Italy, interviewing the directors of the hospital wards that discharged at least 50 acute stroke patients a year. A SU was defined as an acute ward area with stroke-dedicated beds and staff. To compare the quality of care provided in SUs with that in general wards (GWs) we investigated the characteristics of five domains: hospital setting, unit setting, staffing, process of care and diagnostic investigations. We identified 68 SUs and 677 GWs. Multivariate logistic regression analyses demonstrated that SUs compared to GWs had higher quality scores in unit setting (ROC area=0.9721), staffing (ROC area=0.8760) and care organisation (ROC area=0.7984). The hospital setting (ROC area=0.7033) and the availability of rapid diagnostic investigations (ROC area=0.7164) had lower power in discriminating SU from GW. In Italy in 2003/04 only 9% of the hospital services had organised SU care. The study demonstrated that SUs admitted more than 100 patients per year, had more monitoring equipment and staffing time, and practised multidisciplinary meetings and early mobilisation. The utility of these structural and performance characteristics needs validation from outcome studies.     

脑卒中急性期白细胞反应及临床意义

脑卒中急性期大多数患者白细胞增多，表现为中性粒细胞计数与白细胞总数增高，脑出血组白细胞增高姓率高于脑梗塞组，而中性粒细胞增高发生率二组间无差别，外周血白细胞增高与临床神经功能缺损程度评分有密切关系，中性粒细胞计数越高，近期神经功能预后则越差。     

Reliability of the Functional Independence Measure with Occupational Therapists

This paper reports an inter-rater reliability study on the Functional Independence Measure (FIM). The FIM measures inpatient burden of care, as reflected in 18 self care items, rated on a seven point scale from dependent to independent. The subjects were 40 occupational therapists, divided according to experience with the FIM and randomly assigned to a FIM training or non-training group. Subjects rated video tapes of four stroke patients on transfers, bathing, dressing, grooming, toileting and eating items from the FIM. Rater consensus was calculated using the intraclass correlation coefficient (ICC), percentage agreement and a measure of disagreement. Rating accuracy was measured by comparisons with an expert rater. Ratings were most reliable when done by clinicians with no prior FIM experience, from the FIM training group. It is strongly recommended that all clinicians undergo FIM training before using this tool to ensure acceptable reliability.     

2型糖尿病患者卒中一级预防的现况调查

目的 了解2型糖尿病患者住院前及住院期间卒中各危险因素的干预状况，发现临床实践与证据之间的差距，提高临床医生对卒中一级预防的认识，指导今后的临床治疗。方法 本调查为横断面调查研究，回顾性调查167例2型糖尿病患者住院前及住院期间对卒中主要危险因素的干预情况。结果 被调查的患者中，入院前有46.7%的患者有高血压；36.0％的患者有吸烟史；19.8％的患者存在冠状动脉粥样硬化性心脏病，0.6％的患者有心房颤动；23.4％的患者有脂代谢异常。出院前有56.9％的患者被诊断高血压；81.4％的患者存在脂代谢异常。入院前与出院前对血压的药物干预率差异无统计学意义（分别为75.6%及80.0%，P >0.05）；入院前后的降脂治疗（分别为25.6%及69.1%，P <0.01）及降糖治疗（分别为82.0%及97.6%，P <0.01）的差异均有统计学意义。结论 2型糖尿病患者院前对危险因素干预的达标率较低，应加强2型糖尿病患者及临床医生对卒中一级预防的认识，提高卒中卒中相关危险因素的干预率。     

尼麦角林在脑血管病中的应用

尼麦角林是一种麦角生物碱衍生物，广泛应用于脑血管病患者认知障碍的治疗。多项临
床前研究显示，尼麦角林对于认知障碍的改善可能与以下因素有关：尼麦角林除能够改善脑循环，
促进神经递质释放外，还具有营养神经及抗氧化等作用。目前的研究认为，尼麦角林能够改善患者
卒中后抑郁相关的情绪障碍以及有效改善血管性痴呆，提高患者的日常生活能力。同时，尼麦角林具
有良好的安全性，目前暂无尼麦角林治疗导致纤维化或麦角中毒的研究报道。本文就尼麦角林在神
经系统的作用机制、临床疗效及安全性进行综述，以期为临床应用提供参考。     

An Independent Evaluation of Four Quantitative Emergency Department Crowding Scales

Background Emergency department (ED) overcrowding has become a frequent topic of investigation. Despite a significant body of research, there is no standard definition or measurement of ED crowding. Four quantitative scales for ED crowding have been proposed in the literature: the Real‐time Emergency Analysis of Demand Indicators (READI), the Emergency Department Work Index (EDWIN), the National Emergency Department Overcrowding Study (NEDOCS) scale, and the Emergency Department Crowding Scale (EDCS). These four scales have yet to be independently evaluated and compared. Objectives The goals of this study were to formally compare four existing quantitative ED crowding scales by measuring their ability to detect instances of perceived ED crowding and to determine whether any of these scales provide a generalizable solution for measuring ED crowding. Methods Data were collected at two‐hour intervals over 135 consecutive sampling instances. Physician and nurse agreement was assessed using weighted κ statistics. The crowding scales were compared via correlation statistics and their ability to predict perceived instances of ED crowding. Sensitivity, specificity, and positive predictive values were calculated at site‐specific cut points and at the recommended thresholds. Results All four of the crowding scales were significantly correlated, but their predictive abilities varied widely. NEDOCS had the highest area under the receiver operating characteristic curve (AROC) (0.92), while EDCS had the lowest (0.64). The recommended thresholds for the crowding scales were rarely exceeded; therefore, the scales were adjusted to site‐specific cut points. At a site‐specific cut point of 37.19, NEDOCS had the highest sensitivity (0.81), specificity (0.87), and positive predictive value (0.62). Conclusions At the study site, the suggested thresholds of the published crowding scales did not agree with providers' perceptions of ED crowding. Even after adjusting the scales to site‐specific thresholds, a relatively low prevalence of ED crowding resulted in unacceptably low positive predictive values for each scale. These results indicate that these crowding scales lack scalability and do not perform as designed in EDs where crowding is not the norm. However, two of the crowding scales, EDWIN and NEDOCS, and one of the READI subscales, bed ratio, yielded good predictive power (AROC >0.80) of perceived ED crowding, suggesting that they could be used effectively after a period of site‐specific calibration at EDs where crowding is a frequent occurrence.