琥珀酰明胶容量治疗对脑死亡后血清TNF—α、IL－1β、IL－6水平的影响

为了观察脑死亡后不同液体容量治疗对血清肿瘤坏死因子－α（TNF—α）、白细胞介素－1β（IL-1β）和白细胞介素－6（IL－6）等炎症介质水平改变的影响,选用巴马小型猪15只,随机分为3组各5只,即对照组（C组）、4％改良琥珀酰明胶组（MFG组）及乳酸林格氏液组（RL组）。C组不建立脑死亡模型,给与乳酸林格氏液30ml·kg^-1·d^-1～40ml·kg^-1·d^-1。MGF组和RL组为脑死亡组,采用颅内加压法建立脑死亡模型,MFG组给与4％改良琥珀酰明胶溶液30ml·kg^-1·d^-1,RL组给与乳酸林格氏液30-40ml·kg^-1·d^-1。分别于麻醉后及首次判定脑死亡后3、16、12、18和24h留取血样,检测血清中TNF-α、IL-1β、IL--6水平。结果发现MGF组较RL组血压和心率平稳;RL组TNF--α、IL-1β和IL-6水平自脑死亡后3h点开始逐渐升高;MFG组TNF--α、IL--1β和IL-6水平脑死亡后3h点开始亦升高,但升高幅度均较RL组低;三组间自脑死亡后3h点开始,组间比较差异有统计学意义。提示脑死亡后血清炎症介质TNF—α、IL-1β和IL--6释放增加,琥珀酰明胶可抑制脑死亡后TNF--α、IL--6、IL-1β等炎症介质的释放,减轻炎症反应,改善机体状况。     

规范化治疗体系对抑郁症治疗依从性的干预研究探讨

抑郁症的药物治疗是一个长期的过程,因此治疗依从性极其重要,然而,因疾病特点、药物、医患等多方面原因,导致治疗依从性较差,如何提高治疗依从性成为备受关注的问题。国内外相关研究较多,其中系统规范的随诊模式,抑郁症及药物知识的教育,心理治疗及对家庭成员相关知识的教育干预等均被证实确实有效。本文就各种干预方法进行探讨,以期确立系统规范的随诊、治疗体系,提高治疗依从性。     

体外循环术后患者延迟撤机的危险因素分析

为了探讨ICU内体外循环术后患者延迟撤机的危险因素,收集了2005年5月～2007年10月我院体外循环术后患者共305例,根据患者机械通气时间分为延迟撤机组（机械通气时间≥24h）和早期撤机组（机械通气时间〈24h）,对患者术前基础血糖、白蛋白、肌酐及射血分数（EF）,术中是否应用球囊反搏术、转机时间（CPB）、主动脉阻断时间（ACC）及输血量,术后生命体征、肾功能、24h引流量、APACHEⅡ评分及机械通气时间等围手术期临床指标进行回顾性分析。结果显示,患者年龄、术前白蛋白和EF,CPB、ACC、是否行球囊反搏术,术后APACHEⅡ评分、血糖、肌酐、血小板、APTT、氧合指数、是否再次行开胸探查术等围手术期参数差异有显著性（P〈0．05）;Logistic多元回归分析显示低EF（EF〈40％,OR=6．07）、CPB（〉234min,OR=4．69）及ACC时间（〉172min,OR=4．32）延长、术后高APACHEⅡ评分（〉16,OR=5．36）是体外循环术后延迟撤机患者预后的主要影响因素。提示体外循环术后患者EF低、CPB（〉234min,OR=4．69）及ACC时间延长、术后APACHEⅡ评分高是延迟撤机的主要危险因素。     

SLE患者焦虑抑郁影响因素调查分析

为了探讨SLE（systemic lupus erythematosus）即系统性红斑狼疮患者焦虑抑郁心理影响因素,应用Zung焦虑自评量袁（Self—rating anxiety scale,SAS）和抑郁自评量表（self—rating depression scale,SDS）,对36例系统性红斑狼疮患者进行检测,辅以自行设计因素调查表进行相关因素调查。结果显示,SDS和SAS均分为49．70±11．3和42．13±8．9,与国内常模比较,差异有统计学意义,P〈0．01。单因素分析显示：对疾病的恐惧感、对病情了解程度、治疗效果、药物副作用、家庭经济状况、家庭支持、婚姻关系、睡眠质量、担心事业受影响、躯体症状的反复出现、社交娱乐活动受限、担心医护不精心12项因素与SLE患者抑郁焦虑状态的发生显著相关,P〈0．01。证明SLE患者抑郁焦虑心理与对疾病的恐惧感、治疗效果、家庭经济状况、睡眠质量等因素相关,这为心理干预提供了依据。     

What does it take to let go? An investigation into the facilitating and obstructing factors of forgiveness–the therapist's perspective

The phenomenon of forgiveness, initially neglected by psychotherapists due to its religious connotation, is finding increasing recognition as a transformative process involving the injured party in a profound way. This thesis is based on therapists’ experiences with clients who have been emotionally wounded. However, its content may be of relevance also for those who are struggling to forgive as well as those who are in a position to help others undergoing this process. Fifteen practitioners, most of them highly experienced, from eleven different countries on four different continents, have shared their observations and experiences by filling in an e-mail administered in-depth questionnaire. The topic has been approached with the following study objectives: the nature of forgiveness, intrapersonal and interpersonal factors affecting forgiveness, and the role of the therapist in the client's process of letting go. A qualitative research design has been applied for the data analysis, to identify the major themes of each research question, representing the facilitating and obstructing conditions relevant for forgiveness. Since the danger of premature forgiveness emerged as a recurrent concern, a “forgiveness chart” has been developed, assigning the analysed data to relevant categories: A reference tool designed to support a genuine process of letting go.     

唐山市三甲医院住院费用的灰色关联分析

利用灰色关联分析方法探索引起“看病贵”的主要因素,并提出有效的策略和措施。以唐山市2所三甲医院2004年出院的800名住院患者的医疗费用为研究对象,利用灰色关联分析法进行分析。提出灰色关联模型更加科学和合理;药费是造成外科疾病医疗费用过高的关键因素;需进一步改革医疗服务价格体系。     

患者认知因素对病人满意度的影响与对策研究

揭示了患者的认知因素对满意度的重要影响,提出医务工作者应改变仅是从自我做起,提高病人满意度的传统做法,强调要注重从患方入手,既要降低病人不现实的期望值,又要提高病人对医护服务的感知度.这样,在付出等量医技服务的情况下,通过矫正患者的认知误区,改善患者的认知状况,可获得更高的病人满意度.     

癌症患者生存质量研究进展

随着癌症患者生存时间和生存人数的增加,生存者本人和家属更加重视生存质量。本文总结分析近年来国内外癌症患者生存质量的研究状况,以期在癌症治疗过程中,不仅关注躯体功能和疾病本身以及由治疗带来的症状和体征,同时注重心理和社会职能。     

《中国人群死亡及其危险因素：流行水平、趋势和分布》的研究思路

回顾了该研究的思路,指出进行这样的研究,关键是建立一个有代表性的监测系统,针对同一监测人群,开展综合监测,发展规范的现场工作程序,确保获得高质量数据。建立标准的、动态的人口库、出生、死亡和危险因素个案库,是完成这项研究的前提,世界卫生组织专家称这是中国人在流行病学监测中的天才创新。     

Models of misbelief: Integrating motivational and deficit theories of delusions

The impact of our desires and preferences upon our ordinary, everyday beliefs is well-documented [Gilovich, T. (1991). How we know what isn’t so: The fallibility of human reason in everyday life. New York: The Free Press.]. The influence of such motivational factors on delusions, which are instances of pathological misbelief, has tended however to be neglected by certain prevailing models of delusion formation and maintenance. This paper explores a distinction between two general classes of theoretical explanation for delusions; the motivational and the deficit. Motivational approaches view delusions as extreme instances of self-deception; as defensive attempts to relieve pain and distress. Deficit approaches, in contrast, view delusions as the consequence of defects in the normal functioning of belief mechanisms, underpinned by neuroanatomical or neurophysiological abnormalities. It is argued that although there are good reasons to be sceptical of motivational theories (particularly in their more floridly psychodynamic manifestations), recent experiments confirm that motives are important causal forces where delusions are concerned. It is therefore concluded that the most comprehensive account of delusions will involve a theoretical unification of both motivational and deficit approaches.