急性ST段抬高型心肌梗死患者院前延误的相关因素

本研究的目的是评估急性心肌梗死患者院前延误的原因,包括社会经济学和个人因素等。选取327例急性ST段抬高型心肌梗死(STEMI)患者,详细记录患者人口学资料,受教育水平,婚姻状况,何种方式就诊于医院及院前延误时间。35.7%的患者在症状发作的2小时内到达医院,7.9%患者在症状发作24小时后到达医院。经多因素回归分析,已婚,高学历,既往有心肌梗死病史,将自己的症状归结为心脏原因,具有的疼痛症状和非疼痛症状数量多,发病时不在家,发病时有陪同者,发病后呼叫EMS是院前延误时间短的相关因素(P0.05)。增加患者对心血管症状和危险因素的认识,教育患者一旦出现症状,立即呼叫急救系统可能缩短院前延误时间。     

辽西地区急性ST段抬高型心肌梗死救治延迟影响因素分析

了解目前辽西地区急性ST段抬高型心肌梗死患者院前及院内救治延迟的状况和影响因素。连续入选就诊于锦州医科大学附属第一医院发病在12h内并行直接经皮冠状动脉介入治疗(PCI)的急性ST段抬高型心肌梗死患者82例。性别、交通情况、发病地点及对疾病的认知是症状入门(S2D)时间的影响因素。交通情况、对疾病的认知是S2D时间3h的独立预测因素。谈话时间、导管室人员到达时间及准备手术时间是入门球囊(D2B)时间的主要影响因素。建立急性心肌梗死救治项目是D2B时间90min的保护预测因素。建立急性心肌梗死救治项目前后比较,D2B时间明显缩短,说明该项目对缩短D2B时间有重要意义。     

脑梗死的溶栓治疗——离我们到底有多远？

急性脑梗死是我国的常见病、多发病,目前最有效的药物治疗手段是进行溶栓治疗.但我国的溶栓率还比较低,与发达国家相比仍有很大差距.主要原因为老百姓知晓率低、院前延误、城市急救系统运力不足、卒中中心的建设不够及医源性因素等几个方面,以后应该加强溶栓宣传、加强城市急救中心建设、加强卒中中心建设及对各级医院的神经科医生进行相关培训,提高接受溶栓患者的比例,从而让更多的患者受益.     

PCI术后患者的血糖管理

经皮冠状动脉介入治疗(PCI)已成为冠心病治疗及急性心肌梗死(AMI)血运重建的有效手段。取得令人满意的效果,而被临床广泛接受和应用。在冠心病患者中糖代谢异常发生率显著高于一般人群。有研究显示高血糖是引起冠状动脉支架再狭窄的独立危险因素。因此糖尿病患者PCI术后必须进行严格的血糖管理。根据目前研究结果,可能血糖目标定为餐前血糖7.8mmol/L,且随机血糖10.0mmol/L较为合适。     

急性心肌梗死中医治疗的两点策略——附临床资料回顾性分析

急性心肌梗死(AMI)是临床常见的急重症,现代医学已在循证医学基础上建立了诊疗指南,为临床诊治决策提供依据.相比而言.以辨证论治为特色的中医药缺乏循证依据.对AMI诊治过程中如何发挥中医药治疗的价值,认为不能停留在传统的概念上,应选择正确治疗策略,提高疗效.     

急性心肌梗死合并心源性休克的治疗进展

心源性休克(CS)是急性心肌梗死死亡的最主要原因。急诊再血管化治疗PCI或者冠状动脉旁路移植术(CABG)对于降低急性心肌梗死(AMI)合并CS的病死率有积极的意义。目前还没有哪个随机对照试验明确PCI或CABG哪种更好,但目前的治疗倾向于急诊PCI。合并CS的AMI患者直接多支血管PCI治疗获益增加。对于血压偏低的患者,去甲肾上腺素应该作为缩血管药物的一线选择。靶目标平均血压维持在65mmHg~70mmHg,因为更高的血压不增加临床获益。最佳的多器官功能不全综合征治疗是CS治疗的基石。经皮机械辅助装置临床应用逐渐广泛,可以提高冠状动脉的灌注,但也加剧炎症反应、出血等风险。     

导言:胸痛中心成立的必要性

正"胸痛中心"这个概念提出的初心是为了减少急性心肌梗死(AMI)发病率和死亡率。世界上第一家胸痛中心出现在1981年美国巴尔地摩地区的一家名叫SLANGLE的医院,随着时代的进步与科学技术的发展,现如今中国所设立的胸痛中心主要诊疗指标是针对急性ST段抬高型心肌梗死(STEMI)而定的,同时要鉴别诊断主动脉夹层、肺动脉栓塞等。胸痛中心的建立和完善已成为衡量AMI患者救治水平的一种标杆。与以往传统的胸痛性疾病住     

急性心肌梗死中医治疗的两点策略——附临床资料回顾性分析

急性心肌梗死(AMI)是临床常见的急重症,现代医学已在循证医学基础上建立了诊疗指南,为临床诊治决策提供依据。相比而言,以辨证论治为特色的中医药缺乏循证依据。对AMI诊治过程中如何发挥中医药治疗的价值,认为不能停留在传统的概念上,应选择正确治疗策略,提高疗效。     

急性ST段抬高型心肌梗死再灌注治疗的急缓之择

急性ST段抬高型心肌梗死(STEMI)最有效治疗方法是再灌注治疗,主要包括直接经皮冠状动脉介入治疗(PCI)和溶栓治疗.只有结合患者、医疗机构的实际情况,合理选择再灌注治疗方案,才能使STEMI患者获益最大化,改善其长期预后.     

急性ST段抬高型心肌梗死患者急诊PCI术后无复流相关因素分析

探讨急性ST段抬高型心肌梗死患者急诊PCI术后发生无复流的相关因素。2015年1月~2017年11月在我院因急性ST段抬高型心肌梗死接受急诊PCI手术的患者453名,根据TIMI血流分级和MBG分级标准将患者分为正常血流组和无复流组,比较这两组患者基本临床资料、造影结果和手术相关资料的差异。通过单变量分析,症状至PCI时间、血糖、Killip分级、干预前血流TIMI分级、血栓负荷程度、病灶血管长度与急诊PCI术后发生无复流有关(P0.05),通过二分类Logistic回归分析,确定症状至PCI时间(OR:1.20;95%CI:0.90~1.54)、血糖(OR:1.08;95%CI:1.03~1.39)、干预前血流TIMI分级(OR:0.92;95%CI:0.79~1.07)、血栓负荷程度(OR:1.40;95%CI:0.96~1.87)、病灶血管长度(OR:1.18;95%CI:1.02~1.37)是急诊PCI术后发生无复流的独立预测因素。     

Together – apart: in touch in a time of separation

This paper explores the experience of working as a Jungian analyst through the various phases of the global COVID-19 pandemic, examining the importance of the physical containing space alongside the analyst’s internal mind and how technology can both help and hinder understanding. A number of clinical vignettes illustrate the challenge of communicating over a distance, paying particular attention to the way countertransference phenomena can become re-attuned. Reference is made to mythology and symbols of hope, and consideration given to the meaning and purpose of the pandemic.     

The Possibility of Meaning in Human Evolution

Science undermines the certitude of non-naturalistic answers to the question of whether human life has meaning. I explore whether evolution can provide a naturalistic basis for existential meaning. Using the work of philosopher Daniel Dennett and scientist Ursula Goodenough, I argue that evolution is the locus of the possibility of meaning because it has produced intentionality, the matrix of consciousness. I conclude that the question of the meaning of human life is an existentialist one: existential meaning is a product of the individual and collective tasks human beings undertake.     

Phenotypic plasticity and archetype: a response to common objections to the biological theory of archetype and instinct

Since Jung’s death in 1961, scholars have attempted to integrate growing biological science data into Jungian concepts such as the collective unconscious, instincts and the archetypes. This enterprise has been challenging due to persistent false dichotomies of gene and environment occasionally arising. Recent works by Roesler (2022a, 2022b) for example, have raised objections to the biological theory of archetypes, but the objections are plagued by such dichotomies. The concept of phenotypic plasticity, however, helps to both avoid this problem as well as bridge the gap between competing theories into a more integrated model with solid biological foundations.     

When is it time to stop? When good enough becomes bad enough

This article draws on Winnicott’s concept of the good enough mother to discuss how to know whether a therapeutic situation is good enough to continue or bad enough to end. This dilemma is explored in terms of clinical syndromes, such as anorexia and pathological gambling, but focuses mainly on analyst-initiated endings, which are termed the ‘Casablanca dilemma’, based on an amplification of the ending of the film Casablanca. The author goes on to discuss such one-sided endings, drawing on interviews with 40 analysts and therapists about their clinical experience. A typology of bad enough endings is presented. The psychological differences between a good enough analysis as opposed to a bad enough one are explored through the ideas of Winnicott and Neumann.     

Kann Es Ein Argument Für Den Skeptizismus Geben? Das Epistemische Problem Der Irrtumsmöglichkeit

Summary  Is there any argument for scepticism? The epistemic problem of the possibility of error. Arguments for scepticism rest on the assumption that knowledge claims are fallible. For this reason the concept of knowledge appears to be questionable. Since it is necessary to distinguish doubts from possible doubts, the arguments for scepticism appear to be unconvincing. If we take it into account that we know something that is immune to doubt, we should draw the conclusion that, contrary to scepticism, knowledge claims have to be compatible with being fallible. Thus any knowledge claim is capable of being doubted.     

The transcendent function in Spitteler’s Prometheus and Epimetheus

In August 2020, John Beebe and Steve Myers met via Zoom to discuss their differing interpretations of psychological typology and the different sources within Jung’s writings that influenced their books: Integrity in Depth: Energies and Patterns in Psychological Type (Beebe), and Myers-Briggs Typology vs Jungian Individuation (Myers). The discussion centred on Spitteler’s epic poem Prometheus und Epimetheus, which forms the basis of chapter V of Psychological Types. This is both the largest chapter and one of two chapters that Jung highlighted in the Argentine foreword as containing the essence of the book. Jung’s book is primarily about the transformation of personality rather than the categorization of people. Although it contains a critical psychology that deconstructs the nature of consciousness, that is only one half of the book and a stepping-stone to the other half, which is the reconciliation of opposites with particular emphasis on the relation of consciousness and the unconscious. Jung assumed that readers were already familiar with Prometheus und Epimetheus, an understanding of which sheds light on the nature of the transformation that Jung described – the development of a new attitude towards attitude itself.     

Seeing in the Dark: A View into Dissociation and Healing

In this paper, I will explore the role of art-making, the experience of trauma and dissociation, and the process of working with self-states from an analytic and creative frame. Relevant literature on dissociation, trauma, and the use of art will be discussed. A case involving my work with an adolescent girl who had experienced sexual abuse from a family member will be shared, with an emphasis on the meaningful role images played during the therapeutic process. Both Jungian and psychoanalytic models of conceptualizing and working with dissociation are included, following Donald Kalsched’s (2013) recommendation for a “binocular stance” to treatment, including both a focus on the inner, intrapsychic world and the interpersonal, relational realm, and how art images both illuminated and expressed these realms. Within the therapeutic process, art images allowed the therapist a view into the client’s unconscious process, and created a meeting ground for dissociative barriers to be gradually seen, felt and known, by both therapist and client. The experience of dissociation, in images and in session, provided a reference point for myself and my client, Taylor, to develop a shared understanding and a framework for growth.     

Chapter 6: Biblical Foundations for a Practical Theology of Aging

SUMMARY

This article reviews Biblical sources pertaining to the elderly, particularly the frail elderly. Founded on these sources, implications for elderly with Alzheimer's Disease and other forms of dementia are addressed through a personal perspective informed by writings of Christian mystics.