中青年冠心病患者冠脉介入治疗后精神心理改变及影响因素调查分析

应用焦虑、抑郁自评量袁对84例行冠脉介入治疗的中青年冠心病患者分别进行术前、术后3个月的问卷调查,分析其变化的影响因素后进行综合评价。发现此类人群大多有焦虑、抑郁倾向,其发病率与性别有关而与年龄无关;其影响因素与对疾病的认识、医疗保险、家庭结构有一定相关性。     

从指南看冠心病降脂治疗的现状及分析

层出不穷的试验研究和不断更新的指南使人们对冠心病防治的认识不断加深,但指南的实施和普及却不理想,大多数冠心病患者并未真正受益于降脂治疗。现就NCEP-ATP指南的更新和目前冠心病患者降脂治疗的现状、主要影响因素(患者的依从性、医务工作者的医疗质量、药物有效性以及效价比与经济条件)及可能的改善措施做一综述。     

冠心病诊治中的过度医疗

近年来,过度医疗问题引起了医学伦理学界的普遍关注。过度医疗是一个经济现象,同时也是一个伦理问题．确切的说是一个医学一社会问题。结合冠心病过度医疗的特点,从医学伦理学角度剖析冠心病过度医疗的原因,并提出了医者、患者、医疗机构和社会针对冠心病过度医疗应采取的措施。     

Predictive value of neuropsychological assessment; with regards to life expectancy among cardiac bypass surgery patients

This follow-up study to Keith et al. (2002) sought to explore relations between the cognitive, neuropsychological, and psychosocial sequelae of cardiopulmonary bypass surgery (CPB) and survival. A neuropsychological test battery including the state portion of the State-Trait Anxiety Inventory (S-STAI), reaction time, visual attention (VFA), rotor pursuit, visual spatial memory, verbal memory and paired associations (PA) was administered. PA (P < .05), VFA and S-STAI scores were related with 5–7 year survival. After the Benjamini-Hochberg method was employed to control for multiple comparisons only S-STAI scores remained significant. Results of logistic regression indicate that pre-CPB surgery scores on the S-STAI accurately predicted 5–7 year survival and mortality in 66% and 83% of cases respectively.     

Religious beliefs,patient–doctor interaction and resilience as predictors for treatment decisions and health outcomes of heart patients

Treatment decision-making in chronic illness poses long-lasting effects on the health status of patients. In Western individualistic cultures, they are independently taken by the individual in collaboration with doctors contrary to the collectivistic Indian context, where it’s decided by families with little or no involvement of patients. Religious beliefs, patient–doctor interaction, and resilience measures of 100 CAD patients were used to assess their religious beliefs, patient–doctor interaction, and resilience (predictors). Hierarchical Regression Analysis was conducted to test for the significance of the proposed model. Religious beliefs, patient–doctor interaction, and resilience collectively predicted the significant change in decision-making styles, somatic symptoms, anxiety, social dysfunctions, depression, and general health total of the participants. While the treatment decision-making is heavily contingent upon the social factors namely – religious beliefs, patient–doctor interaction, and resilience, there may yet be some underlying psychological factors that have not been explored in the present study.     

Negative emotions and coronary heart disease: Causally related or merely coexistent? A review

Negative emotions have been claimed to be a cause of coronary heart disease (CHD) as well as a consequence of cardiovascular disorders. Early case studies of cardiac disorders of soldiers in battle drew attention to the possibility that strong negative emotional states could cause CHD. Subsequent reports of reactions to natural disasters supported the notion that intense negative emotions could precipitate somatic disorders such as CHD. Since then, numerous studies have investigated relations between negative emotions and CHD. Over the years, retrospective studies have found, for example, that negative emotions are often present before the occurrence of CHD. Cross-sectional studies have indicated that symptoms of depression and anxiety are often present in CHD patients. Prospective studies have shown that the likelihood of CHD tends to be higher for people with negative emotions than for those without them. The main symptoms of negative emotional states that seem to be most closely associated with CHD are nervousness, getting easily upset, feeling fatigue, being indecisive, having sleep disturbances, being usually worried about something, and feeling that others would be better off if oneself were dead. Although the findings appear to support the notion of causal connections between negative emotions and CHD, they fail to provide conclusive proof of such relations. An alternative explanation that could also account for the findings is simply that negative emotions and CHD often coexist.     

Meditation and Appropriation: Best Practices for Counselors Who Utilize Meditation

Support for meditation is found across academic communities and popular culture. Although the application of meditative practices has yielded positive treatment outcomes, larger purposes of the practice are perhaps lost in the empirically driven West, thus driving a risk of appropriation. In response, the authors outline 4 implications for best practice for counselors who aspire to engage in the culturally responsible use of meditative practices.     

后路椎弓根内固定治疗胸腰段骨折不同植骨方法临床疗效比较

为了比较后路椎弓根螺钉复位内固定治疗胸腰段骨折不同植骨方法的临床疗效,2002年1月-2006年9月,经后路椎弓根螺钉复位内固定手术治疗胸腰段骨折140例。比较分析各组伤椎高度矫正丢失,脊柱后凸成角矫正丢失,脊髓神经功能恢复,内固定失效及腰背疼痛并发症情况。结果显示,伤椎前、后缘高度比值和脊柱后凸成角术前4组差异不具有显著性意义,椎弓根螺钉复位内固定结合不同植骨融合方法,可以减少单纯内固定矫正丢失和内固定失效及腰背疼痛并发症。经椎弓根椎体内植骨可增加前中柱的稳定性,临床治疗优于脊柱后方植骨融合。     

医患关系不和谐的原因

由于政府监管部门的缺位与越位导致医疗市场混乱,医疗资源配置不合理与效率低下,医院为了自身利益而鼓励医务人员多收费,医务人员成了给钱治病的经济人,再加上舆论的推波助澜,社会保障体系不健全,以及医疗需求的刚性,医患间的信息不对称,患者对医疗预期值超越了当今的科技水平,导致医患矛盾越演越烈.