Anxious attachment and psychological distress in cardiac rehabilitation patients

This study investigated the relevance of anxious attachment to the differentiation of psychologically distressed and non-psychologically distressed cardiac patients. Attachment is a biologically based behavioral system in which proximity to a special other is sought or maintained to achieve a sense of safety and security. Anxious attachment, as the name denotes, fails to achieve the function of attachment in the sense of individuals having little or no confidence in the availability of their attachment figures. Empirically, three scales (feared loss of the attachment figure, proximity seeking and separation protest) capture the features of anxious attachment as elaborated by Bowlby. These scales were administered to 178 cardiac rehabilitation patients drawn from the cardiac rehabilitation program of the Calgary General Hospital. The results indicate that feared loss and proximity seeking differentiated psychologically distressed from non-psychologically distressed patients. The implications of this finding for the understanding of psychologically distressed cardiac patients are discussed.     

The role of illness perceptions in the attachment-related process of affect regulation

Abstract

Based on the predictions of the attachment theory and the Common Sense Model of illness perceptions, the current study focused on the role played by illness perceptions in explaining the path linking attachment orientations to negative affect during recovery from cardiac illness. We predicted two putative mechanisms: (1) illness perceptions would mediate the direct association between attachment-related insecurity (especially attachment anxiety) and levels of distress at follow-up and (2) illness perceptions would interact with attachment orientations (attachment avoidance in particular) in explaining patients' distress. The sample consisted of 111 male patients admitted to the Cardiac Care Unit of the Meir Medical Center, located in the central region of Israel. Patients completed a measure of attachment orientations during hospitalization (baseline). One month later, patients' illness perceptions were measured. Patients' depression and anxiety symptoms were measured at baseline and at the six-month follow-up. The associations between attachment-related anxiety and anxiety symptoms at follow-up were fully mediated by illness perceptions. Attachment-related avoidance was found to interact with illness perceptions in the prediction of depressive symptoms at follow-up. The findings shed light on the possible dynamics among personality, cognitive appraisals, and affect regulation efforts when coping with illness.     

冠心病多支血管病变完全血运重建的长期疗效观察

为分析冠心病多支血管病变(MVD)患者经皮冠状动脉介入治疗(PCI)进行完全血运重建术后长期的临床疗效,我们收集了2004年5月~2008年5月589例接受PCI的冠心病患者,其中实施完全性血运重建(CRV)461例(78.3%),不完全性血运重建(IRV)128例(21.7%),对比分析两组病例PCI术后随访1年以上的结果。结果显示IRV组患者中完全闭塞病变、3支血管病变的比例均高于CRV组(P0.01);CRV组PCI成功率明显高于IRV组(94.8%vs87.5%,P0.05)。提示多支冠状动脉病变完全性血运重建能够获得更好的长期临床疗效论。     

青年颈心综合征避免误诊为冠心病的临床诊疗策略

通过对临床收集的187例青年(≤45岁)颈心综合征患者的临床资料进行分析。探讨青年颈心综合征临床误诊为冠心病的原因及避免误诊的诊疗策略。目的在于帮助临床医师对青年颈心综合征进行识别,注意如何与冠心病心绞痛相鉴别,对防止病情延误,尽早明确诊断积极治疗,排除冠心病,减少诊疗费用及避免冠脉造影的风险意义很大。     

Why Do Police Arrest Victims of Domestic Violence? The Need for Comprehensive Training and Investigative Protocols

After all the positive changes in the criminal justice system over the last ten to fifteen years concerning the response to incidents of domestic violence, there remains the problem of battered women who are arrested as perpetrators of domestic violence. The reasons for these arrests are complex and varied. They range from the patriarchal structure of criminal justice agencies, to the staffing of these agencies, and finally to the inappropriate and inadequate training of police officers. This article includes real life examples of cases where victims were arrested, and why these arrests occurred. It also includes suggestions on how to minimize these illegal arrests.     

心脏病外科治疗之趋势——微创

在近20年间,伴随着科学技术的发展以及医疗水平的提高,微创已经成为了外科医生行使手术的重要选择之一;由于国家生活水平的提高,患者不但追求高生存率,同时提出了更高的要求——低病痛,快恢复期,伤口美观等,微创外科得到了越来越多的人的青睐。本文主要探讨了微创心脏外科的分类(小切口技术,电视胸腔镜辅助心脏外科技术,机器人辅助心脏外科技术)以及各种新技术在心脏外科领域所存在的优势和不足,同时辩证地指出了心脏外科的未来发展趋势以及在发展过程中可能存在的一系列矛盾,同时指出了医疗为患者个体服务的观点。     

心脏生物起搏器的研究现状及展望

心脏生物起搏器是近年来心脏起搏的研究热点,目前主要集中在三种基因治疗策略:(1)使心肌细胞的β2受体表达上调增加心率;(2)转染起搏电流基因使心室肌细胞产生自主起搏功能;(3)改变心室肌细胞钾电流的平衡,使心室肌细胞产生自律性.心脏生物起搏器应用于临床仍面临许多问题,但是随着分子生物学和基因工程技术的发展,心脏生物起搏器必将造福于人类.     

IABP在心脏直视手术围术期低心排的应用

为了探讨主动脉内球囊反搏（IABP）治疗心脏手术围术期低心输出量综合征（LCOS）的临床疗效,对16例心脏手术围术期LCOS患者,经过股动脉放置IABP导管于降主动脉内进行左心辅助治疗,IABP治疗前、后监测患者连续有创动脉收缩压（SABP）、有创平均动脉压（MABP）、中心静脉压（CVP）、动脉血氧分压（PaO2）、心率（HR）、尿量和血管活性药物的使用。结果显示,IABP辅助治疗时间25h～116h,平均（78．5±40．5）h。行IABP治疗后,SABP、MABP、PaO2较术前明显提高（P〈0．05）,HR、CVP明显下降（P〈0．05）,尿量增加,血管活性药物使用量明显减少（P〈0．05）,12例患者心功能好转而脱离IABP,11例（69．3％）存活,4例死于心源性休克,1例死于多器官功能不全综合征（MODS）。提示正确及时地使用IABP能明显改善心脏手术围术期LCOS患者的血流动力学指标,减少血管活性药物的使用,建议对有适应证者应尽早应用,适时撤离。     

超声心动图与心血管造影X线引导下先心病介入封堵治疗的比较

目前先天性心脏病介入治疗已成为介入心脏病学的新热点,而先心病介入治疗离不开影像学引导,目前临床上常用的影像学引导方式主要有超声心动图和心血管造影两种,本文针对两者优缺点,从治疗方式、疗效、费用等方面进行比较,为临床治疗思路提供借鉴。     

客观认识心脏介入治疗

心脏介入治疗技术作为当代心血管领域里先进技术的代表,已在我国很多医院广泛应用,取得了良好的疗效。然而,近年来由于医疗卫生体制的不完善,导致某些医务人员对它的认识出现了偏差,甚至滥用心脏介入治疗技术,给国家和患者带来沉重的负担。因此笔者认为有必要客观认识它,规范它在临床上的应用,使其真正做到为患者解除疾苦。