以头晕为主诉的无症状性脑梗死患者焦虑状态的临床分析

目的:探讨以头晕为主诉的无症状性脑梗死(ACI)患者的情绪状态及临床体验并观察抗焦虑/抑郁治疗的疗效.方法:对98例ACI患者采用汉密尔顿焦虑抑郁量表进行筛查,并根据ICD-10的诊断标准做出诊断后,给予抗焦虑/抑郁药物治疗和支持性心理治疗,以治疗前后的汉密尔顿焦虑量表(HAMA)的减分率和临床症状缓解程度来评定疗效.结果:处于焦虑状态的ACI患者,医检证实均有脑血管系统的轻微病损,头晕史0.5～7年,有心悸、气短、眩晕发作、失眠等自诉躯体症状,67.55%伴有高血压;经帕罗西汀和支持性心理治疗,100%显效,临床症状缓解.结论:以头晕为主诉的ACI患者,若经改善脑血流循环治疗无效者,则应实施抗焦虑/抑郁药物治疗和支持性心理治疗,可望获得良好疗效.     

Biochemical Changes after Vertical Banded Gastroplasty for Morbid Obesity

A prospective study of biochemical changes after vertical banded gastroplasty for morbid obesity, in 94 patients (10 males and 84 females, ages ranging from 18 to 59 years) has been carried out. Liver function tests and electrolyte estimations were performed preoperatively, during hospitalisation for surgery, at 6 weeks and at 6 months postoperatively, and demonstrated no significant changes in liver function in these patients 6 months after surgery. The study concludes that there is no increase in the risk of liver damage or electrolyte disturbance after vertical gastroplasty, but that there may be subtle hepatic changes present as gall bladder disease developed in 18 patients postoperation (19%).     

Product review

Abstract

The purpose of this paper is to review the phenomenon of same-sex attraction in married men. As well as looking at a variety of reasons that gay and bisexual men provide for getting married, the author describes a model that incorporates a variety of possible theoretical explanations. Finally, practical implications for therapists are provided, focusing on identity development and support.     

Planning and evaluating innovations in nursing practice by measuring the ward atmosphere

A controlled evaluation of nurses' and patients' perceptions of the hospital ward atmosphere served to both define problems and evaluate the corrective changes that were implemented in a psychiatric day hospital. The results indicated that nurses and patients held similarly unfavourable views of the ward at a baseline assessment, including low levels of support, involvement, spontaneity and programme clarity. This finding then served as the basis for systematic changes, including staff training, the regrouping of patients, and revising the therapeutic programme. A repeat evaluation then indicated that these changes had significantly improved the ward atmosphere from the perspective of both nurses and patients. It is concluded that this approach holds considerable promise for the implementation of changes in nursing practice.     

Prevalence of auditory hallucinations in nurses in mental health

Seventy-nine nurses and student nurses working in the mental health field were asked to complete a questionnaire that asked about the prevalence of their experience of events that might be considered as examples of auditory hallucinations. Eighty-four per cent of the 55 nurses who returned the questionnaire described having experiences that might be described as auditory hallucinations. This level of prevalence is broadly consistent with other studies, and the difference between voices considered to indicate 'schizophrenia' and voices perceived as normal or unimportant is discussed. The relevance of these findings for the process of diagnosis and for the attitudes of nurses working in the mental health field towards voices reported by clients is highlighted.     

Distribution of lung disease

Radiologists rely on imaging patterns to arrive at a diagnosis. The different morphological patterns in the lungs are well known, but less emphasis has traditionally been placed on the pattern of distribution. This important feature greatly assists in the differential diagnosis regarding many pulmonary diseases and is the focus of this article. Chest radiographs often result in a narrow differential if one understands the regional differences and microenvironments within the lung and takes into consideration the ancillary imaging findings. High-resolution computed tomography offers additional information at the level of the secondary pulmonary lobule to fine-tune the distribution pattern and, consequently, the differential diagnosis. Disease distribution is often as important as the morphologic appearance of the disorder. This article will approach pulmonary diseases from the perspective of distribution patterns, highlighting the more common patterns. The goal of this review article is to give radiologists a conceptual framework that may be applied in their daily work environment.     

Child outcome following mid-trimester amniocentesis: development, behaviour, and physical status at age 4 years

Summary. Four-year-old children whose mothers had mid-trimester amniocentesis ( n = 88) were compared with children whose mothers chose not to have the procedure ( n = 46). Intelligence, visual-motor-perccptual skills, language, behaviour, social competence, temperament, physical growth, hearing, and middle-ear function were measured using standardized procedures. Health histories were obtained by maternal report. The results suggest that the wide range of developmental and behavioural variables studied is not influcnced by removal of amniotic fluid in the mid-trimester. However, mothers who had amniocentesis were more likely to report a history of ear infections in their child ( P = 0.04). In support of this finding were the results of audiological assessment which demonstrated a trend toward a higher rate of bilateral middle-ear impedance abnormalities in children whose mothers had amniocentesis ( P = 0.06). Further study of the upper respiratory system is recommended to explore potential long-term sequelae of mid-trimester amniocentesis.     

The patient''s experience of diabetes and its treatment: construction of an attitude scale by a semantic differential technique

An instrument for measuring attitudes towards diabetes and self-care was constructed by a semantic differential technique. The instrument contained nine adjective pairs. Factor analysis classified these into four factors: self-esteem/autonomy, object evaluation, quality of life supporting factor and self-strength/vulnerability. The reliability coefficient of test-retest by 28 nurses/nurse tutors was 0.93. Fifty diabetic patients completed the attitude scale for testing the validity of the instrument. Male patients had a more positive attitude towards diabetes than females. Those who had had diabetes for less than 10 years were more positive than those with a longer duration of the disease. A higher degree of education, well-performed self-monitoring of blood glucose and achievement of good metabolic control were all associated with a more negative attitude towards diabetes. A group of nurses/nurse tutors who also completed the attitude scale had a more negative attitude towards diabetes than the investigated groups of patients.