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关键词： 肝脏良性脂肪性肿瘤   CT   诊断   鉴别  

摘要： 目的 探究肝脏良性脂肪性肿瘤的CT诊断与鉴别诊断价值分析.方法 回顾性分析2018年2月～2019年2月我院收拾的20例肝脏良性脂肪性肿瘤患者行CT检查的临床资料.结果 肝脏脂肪瘤16例,肝脏血管平滑肌脂肪瘤4例,因病区肿瘤内含有特殊性脂肪,因此CT表现典型.病理检查有助于进一步对肝脏脂肪瘤和肝脏血管平滑肌脂肪瘤进行确诊.结论 肝脏良性脂肪性肿瘤在临床少较为少见,应用CT检查有助于提高检查诊断,利于术前定性诊断,对疑难不典型病变,可增强扫描、动态扫描加以鉴别诊断,以提高临床诊断的准确率.

关键词： 超声检查   妇产科   急腹症   诊断鉴别  

摘要： 对妇产科临床急腹症患者采用超声检查的方式进行诊断与鉴别,有重要临床意义.本文选择2019年3月至2020年2月期间我院收诊的70例急腹症患者作为临床研究对象,给予其超声检查,并将检查结果与病理检查结果进行比较.以病理诊断结果作为参照标准,采用超声检查得到的数据情况进行比较,结果发现超声检查总计有2例诊断失误,诊断符合率为97.14％,p>0.05.从各个检查出的病症情况来看,除黄体破裂和异位妊娠各诊断失误1例外,其余均诊断无误.诊断结果对比仍不存在统计学差异,p>0.05.针对妇产科急腹症患者,采用超声检查方式对患者病症进行鉴别与诊断,具有极高的诊断率,能够作为临床治疗依据加以使用,可以在临床中推广使用超声检查方式.

关键词： 心理护理   创伤   应激障碍   焦虑症  

摘要： 目的:研究创伤后应激障碍焦虑症患者行心理护理干预的临床应用效果.方法:随机选取2017年8月-2019年8月期间我院接收的创伤后应激障碍焦虑症患者80例,根据不同护理方式分成观察与对照两组,两组患者分别采取心理护理和常规护理,对比两种护理方式的效果.结果:同对照组比较发现,观察组添加心理护理干预后,患者焦虑抑郁情绪均明显改善,护理治疗依从性及生存质量均显著提高,两组数据差异较为明显(P＜0.05).结论:对创伤后应激障碍焦虑症患者护理中添加心理护理干预,可使患者的不良心理状态有效改善,增强患者治疗信心及依从性,从而提高患者生存质量.

关键词： 磁珠   耳穴   PTSD   乳腺癌   微信小程序   中医综合治疗  

摘要： 目的:乳腺癌为世界范围内女性最高发的恶性肿瘤,其发病率在中国呈逐年升高的趋势。手术的创伤、治疗引起的各种身体不适副作用、对死亡的恐惧、肿瘤的复发转移等等,都易使患者对生活产生悲观情绪,引发精神疾病,也被称之为创伤后应激障碍(post-traumatic stress disorder,PTSD),影响患者的生存和生活质量。但是大多数患者的PTSD都未被及时治疗。目前西医针对PTSD的治疗主要是一些精神类药物。而我们传统的中医有很多疗法,如中药、针灸推拿、耳穴、五音疗法、食疗、八段锦、太极拳等。其中很多疗法具有疗效确切、操作简单、无痛无创、可以自行操作的特点,对于中国人来说更易接受。我们希望将中医的治疗方法综合归纳,制作一个能让乳腺癌患者自我调理PTSD的微信小程序,使足不出户自我治疗成为现实。本研究旨在:①探究自我管理微信小程序的疗效是否优于传统门诊综合治疗;②探究增加了磁珠耳穴治疗的磁珠版小程序疗效是否优于无磁珠耳穴治疗的旧版小程序。方法:本研究采用前瞻性随机对照临床试验,将176例符合纳入标准的乳腺癌PTSD患者按照随机原则以1:1:1:1的比例,分为小程序有磁珠组、小程序无磁珠组、门诊有磁珠组、门诊无磁珠组,每组44例,每组患者均接受西医规范治疗及中药辨证治疗。小程序有磁珠组按照微信小程序的指引,进行为期12周的症状中医综合自我管理,并按照小程序中的教程,自行磁珠耳穴治疗;小程序无磁珠组进行为期12周的症状中医综合自我管理,不进行磁珠耳穴治疗。使用小程序进行干预的患者微信群中,每2周会有专家团队进行线上沟通交流。门诊有磁珠组,进行为期12周的中医综合治疗(治疗内容与微信小程序相同,但是由门诊医生引导进行),并由医生进行磁珠耳穴治疗;门诊无磁珠组于门诊医生引导下,进行为期12周的中医综合治疗,且不进行磁珠耳穴治疗。门诊组每2周前往门诊一次接受治疗。观察分析干预前后四组患者的PTSD自评量表(PCL-C)、焦虑自评量表(SAS)、抑郁自评量表(SDS)、抑郁量表(HAMD)、症状自评量表(SCL-90)、失眠严重指数(ISI)评分的变化。并进行卫生经济学评估。采用SPSS 23.0软件进行统计学分析,得出结论。本研究微信小程序设计部分借助现代信息化技术,基于微信平台,有专业软件技术人员设计。小程序包括五个模块:①PTSD相关知识介绍②PTSD相关自评量表③症状管理路线④PTSD相关知识链接⑤磁珠耳穴贴压教程。结果:1.基线比较:四组患者的一般资料和干预前PTSD自评量表(PCL-C)、焦虑自评量表(SAS)、抑郁自评量表(SDS)、抑郁量表(HAMD)、症状自评量表(SCL-90)、失眠严重指数(ISI)评分无显著性差异(P>0.05)。2.同组干预前后疗效比较:干预后,四组患者的PTSD自评量表(PCL-C)、焦虑自评量表(SAS)、抑郁自评量表(SDS)、抑郁量表(HAMD)、症状自评量表(SCL-90)、失眠严重指数(ISI)评分均有改善。与干预前相比,差异具有统计学意义(P<0.05)。3.组间干预前后疗效比较:①小程序有磁珠组各个量表干预前后的差值均数皆大于小程序无磁珠组,差异具有统计学意义(P<0.05)。②小程序有磁珠组各个量表干预前后的差值均数皆大于门诊有磁珠组,其中PCL-C、SAS、SDS、HAMD、SCL-90的差异具有统计学意义(P<0.05);ISI的差异不具有统计学意义(P>0.05)。③小程序无磁珠组各个量表干预前后的差值均数皆大于门诊无磁珠组,其中SDS、HAMD、SCL-90的差异具有统计学意义(P<0.05);PCL-C、SAS、ISI的差异不具有统计学意义(P>0.05)。④门诊有磁珠组各个量表干预前后的差值均数皆大于门诊无磁珠组,其中SDS、HAMD、SCL-90、ISI的差异具有统计学意义(P<0.05);PCL-C、SAS的差异不具有统计学意义(P>0.05)。4.四组患者在干预过程中均未出现不良反应。5.相较于门诊中医综合治疗干预,使用自我管理微信小程序干预节约了治疗的额外支出(包括挂号费、路费等),并减免了患者前往医院就诊挂号、路途、候诊等精力体力的消耗。结论:1.在中医理论指导下,中医心理治疗、中医康复锻炼、传统音乐疗法、中医食疗、磁珠耳穴贴压治疗相结合的中医综合治疗可以明显改善乳腺癌患者PTSD和焦虑抑郁等不良情绪。并能明显改善乳腺癌PTSD患者的睡眠状况。2.乳腺癌PTSD患者使用自我管理微信小程序进行干预的效果优于在门诊医生引导下进行干预。应该在临床工作中推广使用。3.采用磁珠耳穴贴压对改善乳腺癌PTSD患者的不良情绪有协同增效的作用。4.使用自我管理微信小程干预的卫生经济学效益优于门诊中医综合治疗。

关键词： First-episode psychosis   employment   education   disability   NEET   CSC  

摘要： Pathways to employment are typically interrupted by first-episode psychosis (FEP) which strikes during the developmentally critical time of young adulthood. This paper reports on the key moments and messages that influenced the developing employment, education, or disability trajectories of young adults in the years following completion of Coordinated Specialty Care (CSC) for FEP. Nineteen semi-structured interviews were conducted with young adults with both lived experience of a FEP and a CSC program, from a critical case sample of 10 persons who were involved in an advocacy group. Results indicate that family support and expectations, disability narratives from mental health professionals, the realities of the modern labor market, and university disability support strongly influenced the pathway to employment, education, or disability, and that these were influenced by multiple structural realities such as family SES, disability policies, and treatment ideology, and the capacity of the labor market and universities. This paper concludes that CSC services should create a unified plan to address the structural barriers that challenge those from marginalized families, reevaluate traditional disability ideology in mental health treatment, and better support new pathways to secure employment and education for all young adults with FEP.

关键词： Bystander   CPR   PTSD  

摘要： Problem: Cardiopulmonary resuscitation (CPR) is endorsed by the American Heart Association (AHA) as an early intervention to aid in resuscitation events. With increasing use of compression-only CPR by bystanders, it is important to assess the psychological effects and possible outcome of posttraumatic stress disorder (PTSD). A literature review was performed and determined that although there are studies including psychological effects on family member witnessed CPR and bystander CPR, there is gap in literature regarding PTSD in family member performed CPR. Purpose: The goal of this study is to determine prevalence of PTSD in those who perform CPR on relatives. Research Questions: Is there an increased incidence in PTSD in those who perform CPR on adult family members in a prehospital setting with an unsuccessful outcome compared to witnesses who did not perform CPR? Methods: Subjects are recruited after unsuccessful resuscitation events if they performed CPR on an adult family member prior to hospital arrival or if they only witnessed. Informed consent, demographic data, and role in resuscitation will be collected from subjects before using the PTSD Symptom Scale Interview (PSS-I) at six months and twelve months post-resuscitation. Outcomes: Using the PSS-I at both six and twelve months after resuscitation, data will be collected and outcomes regarding PTSD symptom severity will be recorded. Benefit: This design can assess prevalence of PTSD in those who perform CPR on a family member, which may help clinicians, researchers, and potential subjects better understand the relationship between PTSD and traumatic events such as CPR to more effectively treat those affected.

关键词： 创伤后应激障碍   心理问题   官兵  

摘要： 军人作为担任特殊任务的群体,面对比普通人更多的应激源,创伤后应激障碍等不良应激反应的发生是影响军队战斗力的重要因素,因此本文对创伤后应激障碍状况下官兵心理健康进行分析并采取相应的干预措施,对提高创伤后应激障碍状况下官兵的心理适应能力,从而提高部队战斗力有重要意义。

关键词： 血常规检验   地中海贫血   缺铁性贫血   诊断  

摘要： 分析在地中海贫血和缺铁性贫血过程中采用血常规检验的效果。方法:以2017年1月-2018年12月本院儿童体检3个月-6岁100例贫血患者为对象,分别设置两组,其中一组为轻型地中海贫血组,另一组为缺铁性贫血组,每组50例,均对其开展血常规检验,观察其检验结果,同时,另取本院同期50例健康体检者作为对照组,对比三组血常规检查结果。结果:地中海贫血组HB、RBC依次为(109.3±13.1)g/L和(4.2±0.7)×1012/L,均高于缺铁性贫血组的(82.1±11.9)g/L和(3.0±0.5)×1012/L;缺铁性贫血组MCHC、MCV检验结果为273.9±6.4g/L、70.3±4.8fl,均大大低于对照组的338.9±5.7g/L、89.4±3.2fl,(P<0.05),但其RDW检验结果为19.9±2.6%,高于对照组的12.7±1.4%(P<0.05);地中海贫血组MCHC、MCV均比对照组患者低(P<0.05);地中海贫血组RDW检验结果上均大大低于缺铁性贫血组(P<0.05),但MCHC检验结果明显大于缺铁性贫血组,P<0.05。结论:在临床诊断和鉴别缺铁性贫血以及地中海贫血的过程中,采用血常规检验可获得显著效果。

关键词： Recruitment   Retention   Barriers   Trial   Carer   Psychotic disorders  

摘要： Objective Carers play an important role within the UK mental health system. Those carers who support persons with psychosis can experience a reduction in their own physical and mental health. As part of the Caring for Caregivers (C4C) trial, we piloted a writing intervention (Positive Written Disclosure) that has been shown to improve wellbeing in other populations. Although we reached our recruitment target, we encountered several barriers that made recruitment slower than anticipated. This paper synthesises the process data collected during the C4C trial that relates to the barriers to recruiting and retaining psychosis carers. Results We encountered four main carer-specific barriers to the recruitment and retention of participants in our study. These were: (1) poor relationship with mental health clinicians, (2) conflicting with the care recipient's (CR) needs, (3) lack of spare time, and (4) lack of services for mental health carers. The interventions to assist carers need to be informed by robust evidence and this requires trials that reach their recruitment targets. By sharing our practical experiences other researchers and clinicians can modify their practices to minimise recruitment difficulties and delay. Trial registration ISRCTN79116352. Retrospectively registered (before the final participant was recruited) on 23rd January 2017