Sleep time and sleep-related symptoms across two generations – results of the community-based RHINE and RHINESSA studies

Study objectivesTo analyze the association between sleep-related symptoms and sleep length in parents and their children in relation to other risk factors in both generations.MethodThe participants were parents (n = 5,855, age 54.3 ± 6.5 years, 45.2% men) who participated in the community-based Respiratory Health in Northern Europe (RHINE) study and one random member of their adult offspring (n = 5,855, age 30.2 ± 7.7 years, 41.5% men) who participated in the Respiratory Health in Northern Europe, Spain and Australia (RHINESSA) study. Both generations responded to identical questionnaires on sleep symptoms, including difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), early morning awakening (EMA), snoring, nocturnal sweating, nocturnal gastroesophageal reflux (nGER), sleep time and excessive daytime sleepiness (EDS). Insomnia was defined as either, or both, DIS and DMS in combination with EDS.ResultsAll sleep variables except nocturnal sweating were more common in offspring whose parents had reported the same symptom. After adjusting for age, gender, BMI, smoking, physical activity, education, center and parents' total number of children, there were independent associations between sleep symptoms in parents and offspring for DIS (adj. OR, 95% CI: 1.52, 1.20–1.93), DMS (1.34, 1.15–1.56), snoring (1.45, 1.15,1.83), nGER (1.65, 1.15–2.37), insomnia (1.39, 1.13–1.73), short sleep time (<6 h/night) (2.51, 1.72–3.68) and EDS (1.48, 1.26,1.72). There were no independent relationships between symptoms in parents and offspring for EMA, nocturnal sweating or long sleep time (>9 h/night).ConclusionThe familiar aggregation of many sleep disturbances was not explained by investigated lifestyle and environmental factors. This supports a heritable factor in sleep problems.     

PICC的X线分析

目的:旨在探索PICC末端位置的合理区间。方法:观察79例患者PICC末端位置、置管后的近、远期临床表现以及100例正常胸片肺门位置。结果:导管末端位于第一前肋端至右肺门上方时,少有不良反应。结论:导管末端位置以第一前肋端至右肺门上方为宜。     

PICC使用过程中的异常问题及护理

目的 探讨PICC使用过程中的异常问题及护理措施,提高外周静脉置入中心静脉导管的成功率,减少术后并发症.方法 回顾性分析2007年6月～2008年11月在我科放置PICC导管的62例患者的病历资料.结果 成功置管61例,1例送管未成功.其中贵腰静脉55例,正中静脉6例,头静脉1例.发生静脉炎4 例,置入颈内静脉1例,导管部分脱出1例,导管堵塞2例.62例患者除2例危重患者非导管原因死亡外,均顺利出院或完成化疗周期,正常拔管.结论 针对PICC常见异常问题,进行预防及处理,可提高PICC的成功率,减少术后并发症.     

Problem‐maintaining circles: Case illustrations of formulations that truly guide therapy

The cognitive behaviour therapy (CBT) emphasis on treatment relevance in assessment, and on evidence‐based intervention, has led to an increasing focus on problem maintenance factors (vs. precipitants) in both its models of psychopathology and in its individual case formulations. This article describes the reasons for this growing focus, and presents a generic CBT model based on the functional analysis of “problem‐maintaining circles” (PMCs) of causes. Some samples of the profuse literature implicating PMCs in many psychological disorders are presented, and the utility of PMC‐based functional analysis, case formulation, or modelling of psychopathology is advanced, not only as a guide to selection of therapeutic interventions, but as an alternative to standard psychiatric diagnosis. A sampling of a taxonomy of such PMCs is presented. And finally, the clinical application of PMC‐based functional analysis, case formulation, and treatment selection is illustrated in five case illustrations drawn from a recent clinical caseload.     

160例老年患者预防中心静脉导管感染的护理管理

目的预防中心静脉导管(PICC)深静脉输液的感染。方法对160例患者PICC输液进行置管的部位、方法、时间与导管相关性感染关系的观察。结果160例患者PICC未发生相关性感染,但进行家庭护理不当致感染的有6例。结论护士正规操作,规范管理可以预防感染的发生,指导家属护理及随访是非常必要的。     

PICC置管与浅静脉留置技术在脑血管意外患者治疗中的应用比较

目的:探讨外周导入中心静脉置管(PICC)在脑血管意外患者治疗中应用效果。方法:75例患者置管按照住院的先后顺序分为PICC组37例和浅静脉留置组38例,分别观察及比较两种方法置管成功率、置管留置时间的长短以及并发症发生情况。结果:PICC置管成功率94.6%(35/37),浅静脉留置成功率97.4%(37/38)。PICC组导管留置时间明显长于浅静脉留置技术组,具有统计学意义(P﹤0.01);PICC组并发症发生率为8.1%,浅静脉留置技术组为47.3%,P﹤0.01。结论:PICC导管的穿刺简便,安全可靠,留置时间长,并发症发生率低,患者痛苦小,在临床值得推广应用。     

STAGO COMPACT CT全自动血凝仪的系统维护

目的：探索全自动血凝仪的系统维护方法，保证血凝结果的质量，提高仪器的使用寿命。方法：对血凝仪4年使用中的经验和教训的总结，将仪器本身中的维护功能常规化操作，制定出操作的先后顺序，并加入自创的一些方法，制定出SIAGOGO COMPACT CT全自动血凝仪的系统维护对策。结果：使用1年来证明减少了仪器小故障的常发。结论：经过使用此系统维护，作者认为此方法对此类仪器进行系统维护是行之有效的，应该对此系列仪器也是—个好的维护对策。可进行推广。     

PICC 与颈内静脉插管在肿瘤患者化疗中的应用比较

 目的 比较经外周静脉穿刺中心静脉插管（PICC）和颈内静脉插管在肿瘤患者化疗中的优缺点。方法 观察34例PICC插管和30例颈内静脉插管的插管成功率、穿刺时间、导管留置时间、液体流速和穿刺并发症。结果 与颈内静脉插管相比较，发现PICC插管的一次成功率较高，为88．2％（P〈0．05），穿刺时间较短，平均操作时间为13．38±5分钟（P〈0．01），导管留置时间明显延长，平均128天（P〈0．01）。PICC导管的主要并发症为导管堵塞、周围静脉炎和导管相关感染，颈内静脉导管的主要并发症为导管相关感染和误入动脉。结论 PICC和颈内静脉插管均存在各自的优缺点。与颈内静脉插管相比，PICC是一种较为安全、易于掌握的插管方法，对于长期化疗或静脉输液的病人，应首选PICC插管。     

升降餐桌在PICC置管患者中的应用

随着外科肿瘤患者的逐年上升,术后需要化疗的患者也逐渐增多。PICC置管是术后化疗患者治疗的最好途径,它留置时间长,化疗药不易渗出,风险小。PICC置管需要选择仰卧位,上肢外展90°。保持患者合适的体位,方便护士操     

耐高压注射型双腔PICC导管在头颈部肿瘤患者中的应用与护理

目的探讨耐高压注射型双腔PICC导管在头颈部肿瘤患者中的应用与护理。方法回顾性分析158例置入耐高压注射型双腔PICC导管患者在头颈部肿瘤患者中的应用效果。结果158例患者中导管堵塞及皮肤过敏样改变发生率为34．8％及13．2％，导管相关感染及导管脱出发生率各为4．4％，穿刺点渗液发生率为5．0％．静脉炎和静脉血栓发生率为0％及1．2％。结论耐高压注射型双腔PICC导管与普通PICC导管相比，可以同时满足两路静脉输液的需要、可注射造影剂，值得在临床上推广应用。