小儿川崎病56例分析

目的探讨川崎病（KD）的，临床表现形式、误诊原因、变化、诊断及治疗。方法收集2003年1月至2006年2月在我科住院的56例患者资料，对其临床表现、诊断及治疗进行分析。结果首诊KD入院36例，初诊时误诊20例，冠状动脉受累36例，使用丙种球蛋白、阿斯匹林、潘生丁等治疗，无一例死亡。结论KD，临床诊断缺乏特异性，临床表现复杂，特别是不典型川崎病，易误诊和漏诊，动态观察病情变化，及时做心脏彩超极为重要。     

高血压并发心房颤动患者护理干预效果的观察

目的去除心房颤动诱发因素,及时观察、正确处理并发症。方法对高血压并发心房颤动进行仔细的病情观察、提出护理目标,制定护理措施。结果预防和减少了并发症的发生。结论正确的观察及护理措施对高血压并发心房颤动具有积极意义。     

Studying the social construction of cancer-related fatigue experience: the heuristic value of Ethnoscience

Objectives

Patients’ lived experience of illness and health is receiving increased attention in the medical field. Understanding patients’ perspective and experiences is an undoubted asset for efficient health interventions and improved clinical concordance. Patients’ experiences of care and cure, however, are influenced by the cultural setting in which these experiences take place. This implies that health interventions should be “ecological” and attuned to the specific sociocultural context of the patients.

Methods

Our research group is conducting a cross-cultural qualitative study aimed ad exploring how fatigue (a symptom very common in cancer) is perceived and manifested by patients in different countries (Canada, Thailand, England and Italy). In order to achieve this, the study was design according to the method of Ethnoscience, that appeared to us the best suited to explore the meanings that patients attribute to their state and the linguistic patterns they use to describe it. In this paper we will describe in details the process of Ethnoscience and will discuss the heuristic value of this research approach.

Results

Ethnoscience was an effective research strategy for exploring how beliefs and values shape symptoms and the behavioural manifestations of cancer related fatigue.

Conclusions

This paper discusses the heuristic value of Ethnoscience and its applicability to the study of health relate topics, particularly those where issues of social construction are important.

Practical implications

Ethnoscience is a promising and innovative research approach, able to cast light on the way people experience and make sense of their illness.     

'Often there is a good deal to be done, but socially rather than medically': the psychiatric social worker as social therapist, 1945-70

Seeking to align psychiatric practice with general medicine following the inauguration of the National Health Service, psychiatric hospitals in post-war Britain deployed new treatments designed to induce somatic change, such as ECT, leucotomy and sedatives. Advocates of these treatments, often grouped together under the term 'physical therapies', expressed relief that the social problems encountered by patients could now be interpreted as symptomatic of underlying biological malfunction rather than as a cause of disorder that required treatment. Drawing on the British Journal of Psychiatric Social Work, this article analyses the critique articulated by psychiatric social workers based within hospitals who sought to facilitate the social reintegration of patients following treatment. It explores the development of 'psychiatric social treatment', an approach devised by psychiatric social workers to meet the needs of people with enduring mental health problems in hospital and community settings that sought to alleviate distress and improve social functioning by changing an individual's social environment and interpersonal relationships. 'Physical' and 'social' models of psychiatric treatment, this article argues, contested not only the aetiology of mental illness but also the nature of care, treatment and cure.     

Illness perceptions in patients with fibromyalgia

Objective

Former studies in chronic diseases showed the importance of patients’ beliefs and perceptions. The Revised Illness Perception Questionnaire was developed to assess these illness perceptions. Our goal was to investigate psychometric properties of the IPQ-R for Fibromyalgia Dutch language version (IPQ-R FM-Dlv) and to describe illness perceptions of participants with FM.

Methods

196 patients completed the IPQ-R FM-Dlv. Internal consistency, domain structure and inter domain correlations were calculated and compared to the IPQ-R English language version. Scores were compared with chronic fatigue syndrome (CFS), rheumatoid arthritis (RA), and coronary heart disease (CHD).

Results

Most psychometric properties were comparable to those of the original IPQ-R. Participants showed a lack of understanding of their illness, expected their FM to be chronic and to have a lot of negative consequences on functioning. In 17 out of 24 domains significant differences were found between FM and CFS, RA, and CHD patients.

Conclusion

The IPQ-R FM-Dlv showed acceptable psychometric properties, although some aspects need closer examination. Illness perceptions of FM patients on the Dutch questionnaire were non-comparable to CFS, RA, and CHD patients on the English questionnaire.

Practice implications

The IPQ-R FM-Dlv can be used to assess illness perceptions of Dutch FM patients.     

Psychological responses to cardiac diagnosis: Changes in illness representations immediately following coronary angiography

Objective

Coronary angiography is a commonly used diagnostic test for ischemic heart disease. Little is known, however, about how undergoing the procedure impacts on the ways in which individuals perceive their illness. We sought to explore patients' reactions to an angiogram in terms of changes in symptom appraisal, perceived consequences of their condition, and patients' illness concern and emotional response to their condition after the receiving diagnostic results.

Methods

The Brief IPQ was administered to patients undergoing a diagnostic coronary angiogram (N=57) before and immediately following the procedure. Changes in illness representations were then compared between patients diagnosed with diseased arteries and patients with normal arteries.

Results

We found that the number of symptoms patients associated with their condition, illness consequences, and illness emotion decreased for patients receiving normal results but remained unchanged for patients receiving results showing diseased arteries. Illness concern decreased significantly for both patient groups.

Conclusions

The results demonstrate that diagnostic results can have clear and immediate effects on how patients' view and emotionally respond to their symptoms. The results also suggest that patients cognitively prepare themselves to receive an unfavorable diagnosis and the pattern suggests those receiving normal results modify their perceptions in a positive direction rather than those receiving an unfavorable diagnosis.     

The prediction of self-care behaviors in end-stage renal disease patients using Leventhal's Self-Regulatory Model

OBJECTIVE: To assess the utility of Leventhal's Self-Regulatory Model (SRM) to predict self-care behavior with regard to dietary, medication, and fluid regimes in end-stage renal disease (ESRD) patients. METHODS: In a prospective study, ESRD patients treated via hospital-based haemodialysis (N=73) were screened for cognitive deficits and completed questionnaires that enquired about illness perceptions, coping strategies, knowledge of kidney disease, and psychological distress at Time 1. Physiological proxy measures of self-care behaviors regarding diet (serum potassium levels), fluid intake (mean and standard deviation of interdialytic weight gain), and medication (serum phosphate levels) regimes were collected 3 weeks later at Time 2. RESULTS: Illness representations (emotional and timeline perceptions) predicted self-care behaviors with regard to diet and medication. Emotion-focused coping strategies predicted higher levels of variation in adherence to fluid restrictions. Younger males were less likely to adhere to the fluid restrictions. CONCLUSIONS: The SRM has predictive utility. Psychological interventions should focus on alleviating disease-specific distress and challenging erroneous timeline perceptions in order to increase adherence to dietary and medication regimes in ESRD patients. A more specific measure of coping for ESRD is required to clarify the role of coping strategies in this population. Younger, male patients should be targeted for extra support with fluid restrictions.     

小儿外科危重创伤患者院际转运的临床研究CSCD

Objective To review the clinical data of critical pediatric surgical trauma patients transported from hospital to hospital and provide suggestions for safe and effective transport. Methods Clinical data were retrospectively reviewed for 232 critically injured children actively transported between hospitals from January 2015 to January 2022 analyzed. According to whether or not pediatric trauma score (PTS) was ⩾ 8,they were assigned into two groups of non-serious injury ( PTS > 8 , n = 108 ) and serious injury ( PTS < 8, n = 124 ) . General profiles, causes and sites of trauma, treatment during transport and adverse events of two groups were compared and treatment and outcomes of children with different causes of trauma examined. Results There were 160 boys (69.0%) and 72 girls (31.0%) with an average age of 54 months. The age group of (3 -6) years was the largest number of children ( n = 96,41.3% ) . The median transport distance was 72 km and the total transport time (2.68 ±1.06) hour. Gender (boy/girl:76/32 vs. 84/40) ,age[ <1 year/I -3 years (including 3 years) /3 - 6 years / > 6 years; 11/20/42/35 vs. 13/26/54/31 ] , transport distance (0 - 100 km/ 100 - 200 km/ >200 km) ;62/30/16 vs. 66/41/27) had no statistical significance (P >0.05). However,statistical significance (P <0.05) existed in transit time (2 h;40/45/23 vs. 22/64/38). In terms of causes, collision injury was the most common; as for site, craniocerebral injury was the most common. In terms of causes (collision/height fall/traffic accident/others ;77/12/10/9 vs. 12/52/43/17) and site (craniocerebral injury/limb fracture/multiple injuries/other; 34/38/11/25 vs. 38/26/39/21) ,the differences were statistically significant (P <0.001). No serious adverse events such as respiratory & cardiac arrest occurred during transport. Both groups were treated en route ( mechanical ventilation/sedative analgesics/vasoactive agents/ fluid resuscitation; (3/6/2Z2 vs. 14/16/6/6) and adverse events (airway catheter withdrawal/retention needle withdrawal/cyanosis/cardiac & respiratory arrest; no significant difference between 1/1/1/0 and 3/2/2/0) (P >0.05). After hospitalization;223 children (96.1% ) were operated and 9 (3.9%) received non-surgical treatment. The inter-group difference in composition ratio of surgical treatment was statistically significant ( P < 0.001). Outcome ;221 cases improved/cured (95. 3% ) ,6 disabled/sequelae (2.6%) and 5 (2.2%) died. The inter-group difference in outcome composition ratio was statistically significant (P<0.001). Conclusion Equipped with professional transport team and transport equipment, accurate assessment and communication of condition before transport, close monitoring of the changes of condition during transport and timely treatment after transport, children may undergo timely and effective surgery and receive optimal interventions. Thus it is feasible to improve the safety and prognosis of inter-hospital transport of critically injured children. © 2023, Science and Technology Association of Hunan Province. All rights reserved.     

Prediction of Symptoms and Illness Behaviour From Measures of Life Change and Verbalized Depressive Themes

A new measure of depressiveness in speech content and the Schedule of Recent Experiences are used to predict illness reports and clinic use in two samples of subjects. The results suggest that the more life change the subjects reported, the more depressiveness they verbalized, and that both life change and depressiveness scores predict illness reports and health service users. Multivariate combinations of the measures of life change and depressiveness gave better predictions than either measure alone, and the measure of depressiveness for the most part gave somewhat better predictions than the life change measure. This suggests that it is important to quantify reactions to life events. In addition, it suggests that the two longstanding currents of interest in psychosomatic medicine which concern the importance of life events on the one hand and of affective and intrapsychic events on the other can profitably be integrated.