Minimally Invasive Treatments for Benign Prostatic Hyperplasia: Systematic Review and Network Meta-Analysis

PurposeTo review and to compare indirectly the outcomes of minimally invasive therapies for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia.Materials and MethodsA literature search via Medline and Cochrane Central databases was completed for randomized control studies published between January 2000 to April 2020 for the following therapies: Rezum, Urolift, Aquablation, and prostatic artery embolization (PAE). Data on the following variables were included: International prostate symptom score (IPSS), maximum urinary flow rate, quality of life, and postvoid residual (PVR). Standard mean differences between treatments were compared through a meta-analysis using transurethral resection of the prostate (TURP) to assess differences in treatment effect.ResultsThere was no significant difference in outcomes between therapies for IPSS at the 3, 6, and 12-month follow ups. Although outcomes for Rezum were only available out to 3 months, there were no consistently significant differences in outcomes when comparing Aquablation versus PAE versus Rezum. TURP PVR was significantly better than Urolift at 3, 6, and 12 months. No significant differences in minor or major adverse events were noted.ConclusionAlthough significant differences in outcomes were limited, Aquablation and PAE were the most durable at 12 months. PAE has been well studied on multiple randomized control trials with minimal adverse events while Aquablation has limited high quality data and has been associated with bleeding-related complications.     

Symptomatic palliative care for children with neurodisability

Paediatric palliative care and neurodisability are two relatively new, evolving paediatric sub-specialities that have increasing relevance in the current paediatric landscape. For many people palliative care has been synonymous with end of life care, but in paediatrics it encompasses much more and is for all children with life-threatening or life-limiting conditions, from the point of diagnosis. This breadth of focus is demonstrated well through the interface between paediatric palliative care and paediatric neurodisability. In this article we explore this unique interface through the three domains of complex symptom management, advanced care planning and end of life care. We describe the practicalities involved in all three areas and highlight the importance of early referral and the process of “dual” or “parallel” planning. We cover in more depth the specific management of the symptoms: dystonia/abnormalities of muscle tone, seizures, pain, agitation, secretions, respiratory failure, and gut failure.     

Family Caregivers' Subjective Caregiving Burden,Quality of Life,and Depressive Symptoms Are Associated With Terminally Ill Cancer Patients' Distinct Patterns of Conjoint Symptom Distress and Functional Impairment in Their Last Six Months of Life

Context

Family caregivers constitute a critical component of the end-of-life care system with considerable cost to themselves. However, the joint association of terminally ill cancer patients' symptom distress and functional impairment with caregivers' subjective caregiving burden, quality of life (QOL), and depressive symptoms remains unknown.

北京市50家综合医院门诊患者抑郁障碍的调查

目的 了解北京地区综合医院门诊患者抑郁障碍的患病率。方法 随机抽取50家各级综合医院为调查现场，由精神科护士用自制抑郁筛选量表调查各科门诊患者2877例，由精神科医师对筛选阳性和10％的筛选阴性者以美国精神障碍诊断与统计手册第4版（DSM—Ⅳ）为金标准做出诊断。结果 （1）符合DSM—Ⅳ重性抑郁发作者为73例，现患病率为2．54％。其中内、外科患者的患病率（分别为3．03％和3．12％）高于其他科（1.58％）；而性别分布的差异无统计学意义。（2）抑郁障碍总的现患率、年患率和终生患病率分别为3．09％、3．65％和6．16％；其中，重性抑郁障碍分别为1．97％、2．53％和4．48％。（3）检出的73例重性抑郁发作患者中，仅10例（14％）因抑郁求助和接受医生提供的服务，并被正确识别。结论北京综合医院非心理科门诊患者抑郁障碍的现患率为3．09％；患者对抑郁问题而求助医生的比例低。     

综合性医院抑郁症的特点及疗效分析

目的:了解综合性医院神经内科门诊抑郁症的临床特点及抗抑郁治疗的临床疗效.方法:对46例抑郁症患者的临床特点进行研究分析,同时对其中24例患者给予帕罗西汀治疗,对汉密尔顿抑郁评定表(HAMD)的平均总分数、汉密尔顿4因子及临床总体印象量表(CGI)评分在治疗前后进行比较.结果:46例抑郁症患者均以不同程度的躯体症状为主诉,临床表现多种多样,可涉及全身各系统;其中24例抑郁症患者给予帕罗西汀治疗后,汉密尔顿抑郁评定表的平均总分数、汉密尔顿4因子及临床总体印象量表评分分数在治疗后较治疗前显著减少(P＜0.01).结论:了解抑郁症患者躯体症状的临床特点,对于抑郁症的诊断和治疗至关重要.帕罗西汀对抑郁症患者具有明显的抗焦虑作用及早期改善睡眠的作用且整体抗抑郁疗效好.     

181例离退休干部抑郁状况及影响因素的研究

目的 了解离退休干部抑郁状况及有关影响因素。方法对181例离退休干部进行GDS量表评定，并进行相关分析和逐步回归分析。结果离退休干部抑郁症状患病率为25．4％，对其影响的最主要因素为身体状况、生活感觉、性别、家庭关系，标准化回归系数分别为-0．294、0．260、-0．163、-0．169。结论必须从多方面采取综合干预措施，才能改善离退休干部的抑郁状况，从而达到心理健康水平。     

有精神病性症状躁狂发作的临床特征研究

目的探讨有精神病性症状的躁狂发作的临床特征。方法使用自编的一般情况问卷及有精神病性症状的躁狂发作的精神症状调查问卷,共收集135例"有精神病性症状的躁狂发作"患者,并根据患者的精神病性症状是否与心境相协调进一步分成两组(非典型组59例和典型组76例),比较两组间临床资料的异同。结果在有精神病性症状的躁狂发作中,伴有与心境不协调的精神病性症状的非典型躁狂发作占43.7%、伴有与心境协调的精神病性症状的典型躁狂发作占56.3%,非典型躁狂发作在起病形式、病程特点、病前社会功能、病前性格、首发症状及近期疗效与典型躁狂发作相比有显著性差异(P<0.05),典型组在起病形式上以急性起病者居多,病程多表现为间歇性病程,病前社会功能良好,性格以外向者居多,多以情感症状为首发症状及近期疗效相对较好。结论伴有与心境协调的精神病性症状的典型躁狂发作和伴有与心境不协调的精神病性症状的非典型躁狂发作在临床上均极为常见,非典型躁狂发作为躁狂发作的一个特殊的亚型,我们应对其加强认识。