ICU镇静药物的选择：苯二氮卓还是非苯二氮卓

2013年美国危重症医学会新发布的镇静、镇痛、谵妄治疗指南中指出,苯二氮卓类镇静药物的使用是ICU重症患者谵妄发生的独立危险因素,推荐ICU镇静优先采用非苯二氮卓类镇静药物以改善临床预后.的确,大量的研究表明以右美托咪定为代表的非苯二氮卓类药物相比苯二氮卓类镇静药,能明显缩短重症患者机械通气时间、ICU住院时间、减少ICU费用,并减少ICU谵妄的发生.然而事物总有两面性,ICU镇静不只是单凭药物调整便能顺理成章完成的事情.相比依据指南盲从简单的停用某种药物,建立完整的疼痛、躁动、谵妄评估系统,制定个体化镇静计划,保证机械通气有效性显得更为重要.     

The role of goal adjustment in symptoms of depression,anxiety and fatigue in cancer patients receiving psychosocial care: A longitudinal study

Objective: This study examined whether cancer patients reported increases in their goal adjustment capacities while receiving psychosocial care and whether these increases were related to changes in symptoms of depression, anxiety and fatigue. Goal adjustment was conceptualised as two independent capacities: goal disengagement (i.e. disengage from unattainable goals) and goal reengagement (i.e. reengage into new goals).

Design: This naturalistic, longitudinal study focused on 241 cancer patients receiving psychosocial care at one of the seven psycho-oncology institutions in the Netherlands. Data was collected before the start of psychosocial care (T1) and nine months thereafter (T2). Hierarchical regression analysis was used to examine the research questions.

Main Outcome Measures: Goal adjustment, symptoms of depression, anxiety and fatigue.

Results: At group level, patients reported small increases in goal disengagement (d = .22) but no significant change in goal reengagement (d = .09). At an individual level, 34% of cancer patients reported an increase in goal disengagement and 30% reported an increase in goal reengagement. Increases in goal reengagement were significantly associated with decreases in both depressive and anxiety symptoms, but not to changes in fatigue.

Conclusion: Findings indicate that particularly improvements in goal reengagement are beneficial for cancer patients’ psychological functioning.     

Depression,anxiety and social support in rheumatoid arthritic women without and with a spouse

Abstract

A comparison was made of income and physical, social and psychological aspects of health between 22 female patients who had never married, 127 patients living with a spouse and 53 patients who were widowed or divorced. No significant differences were found between never married patients and patients living with a spouse. The widowed or divorced patients however had a lower income, reported less potential support, more depression and anxiety than the patients who were never married and those living with a spouse. The relationship of social support to depression and anxiety was investigated in spouseless patients (n=75) and in those living with a spouse (n=127). In both groups of patients, less potential support was found to be related to more anxiety. In addition, pain was found to contribute significantly to depression and to anxiety only in the patients living with a spouse. With regard to the latter, it is suggested that the debilitating influence of pain on the relationship with the partner might have been the mediating factor.     

如何成为一名优秀的骨科医生

目前,由于医疗模式的转变,除了对患者本身疾病的治疗外,患者的满意程度和生命质量也成为衡量治愈率高低的一个标准。因此,加强医护人员培养教育,提升医疗服务质量任重而道远。这篇文章探讨了成为一名优秀的临床医护人员所应具备的品质和能力特征。     

Exploring Counselor-Client Agreement on Clients’ Work Capacity in Established and Consultative Dyads

Counselor-client agreement on the work capacity of clients living with serious mental illnesses informs the counseling relationship and facilitates accurate assessments of client eligibility for public programs. In this exploratory mixed-methods study, we assessed counselor-client agreement on clients’ work capacity in 61 established therapeutic dyads and compared it with 30 dyads involved in an initial assessment session. Intraclass correlation coefficients and mountain plots were used to examine counselor-client agreement. Results revealed moderate counselor-client agreement of work capacity for both dyads. Counselor interviews illuminated sources of discordance. These results have practical implications for assessing the work capacity of clients.     

癌症患者满意度测评：层面理论的应用

目的：探讨癌症患者的满意度状况,构建癌症患者满意度量表,以期为癌症病人的临床心理干预提供参考依据。方法：应用层面理论构建癌症患者满意度量表,对85例癌症病人进行调查,将所得数据进行统计分析。结果：层面理论可以用于患者满意度调查;患者满意度结构呈柱状分布。结论：基本完成了癌症患者满意度评定量表的设计和编制。     

卫生资源配置与改善医患关系

从基本卫生资源配置角度来探讨如何改善医患关系,认为基本卫生资源配置失衡是引起医患纠纷的重要因素,从而指出公平优先原则指导下的基本卫生资源配置有利于改变医患关系紧张的现状,并据此观点提出实现基本卫生资源配置公平优先的相关保障措施.     

System-of-Care Practice Review Scores as Predictors of Behavioral Symptomatology and Functional Impairment

The longitudinal comparison study of the national evaluation of the Comprehensive Community Mental Health Services for Children and Their Families Program assesses factors in service delivery systems that may shape the impact of systems of care. We evaluated the extent to which services embodying the principles of a system of care, as measured by the System-of-Care Practice Review (SOCPR), affect clinical outcomes for children being served in federally-funded systems of care and matched comparison communities. The participants included 75 children and families selected for participation in the SOCPR. Results indicated that experience of services embodying system-of-care principles at a high level was associated with lower symptom and impairment scores one year after entry into services. Children in systems of care were rated to have experienced high levels of system-of-care principles implemented within their services, and their symptom severity and functional impairment did not vary as a function of their experiences. Children in matched comparison communities had more variable rated experiences of system-of-care principles within their services, and their symptom severity and functional impairment decreased as their experiences of the principles increased.     

老龄患者人工关节置换术时骨水泥反应综合征的危害及其应对策略

人工关节置换术在老龄化社会中的客观需求性愈来愈突出,而老龄患者在人工关节置换术时发生的骨水泥反应综合征是一个不容忽视的严峻问题。笔者指出了老龄患者人工关节置换术时骨水泥反应综合征的严重危害性,剖析了这种并发症的可能原因,并且对它的有效预防措施和急救处理策略进行了深刻的思考。