Psychological reactions and processes following replantation surgery: a study of 50 patients

Fifty consecutive patients admitted for replantation surgery received a psychiatric evaluation. In 28 percent of the patients there was evidence of preaccident psychopathology. Fifty-four percent of the patients reported a recent stressful life event predating the accident. Fifty-four percent of the patients were assessed as having an adverse postoperative emotional reaction. The presence of preaccident psychopathology, evidence of family dysfunction, and a history of a recent stressful life event were positively linked with an adverse postoperative emotional reaction. In addition, patients with hand or arm replants were significantly less likely to require a psychiatric intervention than patients with leg replants. The psychological processes pertaining to the replantation journey are described in five stages: the preaccident period, the initial response, the stage of uncertainty, the recognition of loss, and acceptance and reintegration. Finally, the role of a liaison psychiatrist on a replantation unit is outlined and further research is strongly urged.     

THE NEUROLOGICAL PROGRAM OF THE VETERANS ADMINISTRATION

The reorganization of the medical department of the Veterans Administration has given considerable impetus to neurology, a part of the division of psychiatry and neurology. The neurologic service of the V. A. is the largest in the world today, and is constantly increasing. This service is made available to veterans through hospitals and regional offices within the designated area, which are branch administrative offices under the central office.A residency training program for specialization is under the direction of a deans'' committee in every large medical center. This committee, which is formed from the faculties of medical schools, also approves the visiting medical staffs of hospitals. The neurologic program consists of a number of special activities, which include residency training for certification, neurologic diagnosis, rehabilitation of patients with chronic illness, electroencephalography, epilepsy, aphasia and research. The paraplegia program is now a separate service, but is also participated in by the neurologist. Both the neurologist and the psychiatrist are interested in the patient with organic psychosis, and the neurologist also works in close relationship with the neurosurgeon.There is need for neurologists in the V. A., which offers attractive opportunities in clinical practice and in research, as well as inducements of advancement and adequate financial returns.     

Psychological consequences of myocardial infarction: a self-regulation perspective on health-related quality of life and cardiac rehabilitation

The aim of this review was to gain insight into prevalence of and interventions targeted specifically at psychological distress and health-related quality of life (HRQL) after a myocardial infarction (MI). For this purpose, self-regulation theory was introduced as frame of reference. Psychological distress and a reduction in HRQL after an MI are prevalent and can, for some patients, be persistent. This can negatively influence secondary prevention efforts, adherence, return to work and progression of the underlying coronary heart disease. At the same time, the effectiveness of cardiac rehabilitation programmes in improving HRQL is inconclusive. By starting off from a theoretical framework, effective strategies can be either identified or developed. Self-regulation theory is concerned with the process of goal setting and goal attainment and offers a model for explaining well-being and quality of life. The usefulness of this theory is supported by empirical evidence. Psychological factors derived from this theoretical framework (e.g. higher order goal disturbance) are associated with psychological distress and HRQL in the short and medium term after an MI and should thus be the target of cardiac rehabilitation programmes.     

综合康复方案联合心理干预对老年肌少-骨质疏松症患者的影响

摘要 目的：探讨综合康复方案联合心理干预对老年肌少-骨质疏松症（SOP）患者的影响,以期为SOP患者的康复提供合理方案。方法：前瞻性选取徐州医科大学附属医院2021年3至2021年8月收治的64例老年SOP患者为研究对象,按照随机数字表法将所有的患者分为观察组和对照组,每组32例。对照组予以常规干预,观察组在对照组的基础上予以综合康复方案联合心理干预。观察两组患者骨骼肌肉恢复情况、机体功能、骨密度以及心理状况。结果：干预6个月后两组患者外周骨骼肌质量（ASM）、外周骨骼肌指数（SMI）以及握力均较干预前以及干预3个月后上升,且观察组高于对照组（P<0.05）。干预6个月后两组患者平衡测试、4 m步速测试、5次椅上坐-站测试评分均较干预前以及干预3个月后上升,且观察组高于对照组（P<0.05）。干预6个月后两组患者骨密度较干预前以及干预3个月后上升,且观察组高于对照组（P<0.05）。干预3个月后以及干预6个月后两组患者心理痛苦与管理筛查工具量表（DMSM）、汉密尔顿焦虑量表（HAMA）、汉密尔顿抑郁量表（HAMD）评分均较干预前下降,且观察组低于对照组（P<0.05）。结论：综合康复方案联合心理干预可促进老年SOP患者骨骼肌肉恢复,提升机体功能,改善骨密度及心理状况,是老年SOP患者的理想康复方案,值得临床借鉴应用。     

Current trends in cardiac rehabilitation

Cardiac rehabilitation can reduce mortality and morbidity for patients with many types of cardiac disease cost-effectively, yet is generally underutilized. Rehabilitation is helpful not only for patients who have had a myocardial infarction but also for those with stable angina or congestive heart failure or those who have undergone myocardial revascularization procedures, a heart transplant or heart valve surgery. The beneficial effects of rehabilitation include a reduction in the rate of death from cardiovascular disease, improved exercise tolerance, fewer cardiac symptoms, improved lipid levels, decreased cigarette smoking, improvement in psychosocial well-being and increased likelihood of return to work. Rehabilitation involves a multidisciplinary team that focuses on education, individually tailored exercise, risk-factor modification and the optimization of functional status and mental health. Current research trends in this area include the evaluation of new secondary-prevention modalities and alternative program options, such as home-based rehabilitation.     

Objectives and Program of the A.M.A. Committee on Nursing

The continued achievement of high standards of patient care in the preventive, curative, and restorative aspects of illness depends upon a harmonious, collaborative relationship between medicine and nursing. In an effort to protect and foster an enduring alliance of understanding and cooperation between these 2 major health professions, the Committee on Nursing has instituted a continuing program of liaison, communication, education, and research. The Committee has authorized publication of the following report on its objectives and program.     

Retentissement sexuel, conjugal et social d’une population d’hommes stériles consultants en Andrologie: le point de vue du psychiatre de liaison

Material and methods

The study population consisted of 39 subjects divided into two groups: 21 azoospermic males and 18 oligoazoospermic males. These men were selected in andrology departments over a period of six months. The andrology and liaison psychiatry departments of Lille university hospital established a general infertility questionnaire. This semi-structured questionnaire comprising 40 questions was based on clinical experience and describes the clinical and symptomatic context of infertility. An individual 50-item questionnaire was then used to analyse the psychosocial, marital and sexual effects of male infertility and the representation of the psychiatrist in the andrology department.

Results

One third of patients discovered the diagnosis of infertility when the biologist gave them the results of the semen analysis. Our patients initially envisaged marital, psychological and social problems, but very few sexual problems. They imagined that infertility was more disturbing for women than for men, from a psychological and sexual point of view. 82% of our subjects imagined that their partner had no sexual problems. 48.7% of them thought that their partner had no psychological difficulties related to their infertility. The oligoasthenospermia group considered that the partner had significantly more “psychological difficulties” compared to the azoospermia group. 41% of our patients felt guilty towards their partner because of their infertility diagnosis. 10.3% of patients presented sexual disorders before the diagnosis of male infertility and 25.6% presented sexual disorders after this diagnosis. Contrary to data in the literature, a major change of sexuality was not observed in the majority of the couples after the diagnosis. When sexuality changed, it generally consisted of a reduction of the frequency of sexual relations. Among the patients who reported sexual difficulties, only 40% related them to infertility. 50% did not report any relationship between the psychological difficulties related to infertility and the sexual difficulties. Contrary to the data in the literature, neither the loss of spontaneity during sexual relations, nor the complementary investigations necessary for artificial insemination had any influence on sexuality. 89.8% of our patients are ready to change their sexual practices in order to be more fertile without causing any sexual or psychological problems. However, only 34.3% of patients reported a concern about reproductive efficacy during sexual relations. A more marked sexuality/reproduction dissociation was observed in oligoazoospermic males than in azoospermic males. 28.2% of patients reported that talking about their sexual and/or psychological problems with a psychiatrist was helpful.

Conclusion

Many contradictions and underestimations were observed in the answers to the questions. We confirmed the existence of a psychological and sexual distress, but which was quantitatively less severe than that described in “gynaecological” populations. However, a real psychological and sexual distress does exist in our population, which is why we propose from the outset a psychosomatic and sexological treatment of infertility in order to prevent the onset of these sexual difficulties. Our questionnaire was based on clinical experience and helped our patients to identify their psychological and sexual difficulties related to infertility and its treatment. It would therefore be useful for the practitioner, andrologist or psychiatrist, to help the patient express the effects related to this “new medicalized sexuality”.     

早期心脏康复对老年急性心肌梗死PCI术后心功能及心理状态的影响

摘要 目的：探讨早期心脏康复对老年急性心肌梗死（acute myocardial infarction, AMI）患者经皮冠状动脉介入（percutaneous coronary intervention, PCI）术后心功能及心理状态的影响。方法：2018年1月~2018年12月间成功实施PCI的62例老年AMI患者随机分为研究组（n=31）和对照组（n=31），同时选择30例健康体检者作为健康组。对照组按照《中国经皮冠状动脉介入治疗后康复程序》给予常规康复训练，研究组结合根据6 min步行试验（6min walking test, 6MWT）制定个性化的康复训练方案，包括院内、院外心脏康复干预、心理干预及随访，为期6个月。比较两组术后心功能、心理状态、终点事件的发生情况。结果：康复后6个月，两组左心室舒张末期内径(left ventricular end-diastolic diameter, LVEDD)、左室收缩末期内径（left ventricular end-systolic diameter, LVESD）、左心室射血分数(left ventricular ejection fraction, LVEF)各心功能指标均较康复前明显提高，且研究组明显优于对照组(P<0.05)。研究组康复后6个月LVEF与健康组比较，差异无统计学意义(P>0.05)。康复后6个月，两组90项症状自评量表（symptom check list-90, SCL-90）各项目中除敌对、偏执外，其余项目评分均显降低，且研究组躯体化、强迫症状、抑郁、焦虑、精神病性显著低于对照组(P<0.05)。康复随访期间，研究组终点事件的总发生率9.7%，显著低于对照组25.8%，且6 min步行距离（6 min walking distance, 6MWD亦较对照组明显增加(P<0.05)。结论：早期心脏康复可明显促进老年AMI患者PCI术后心功能恢复，改善心理状态，降低术后不良终点事件发生风险。     

Psychological rehabilitation after myocardial infarction.

The value of psychological counselling in rehabilitating patients after myocardial infarction was assessed. A total of 143 men who had recently had a myocardial infarction were randomly allocated to either a group receiving intensive rehabilitation or a control group, their outcome being examined after six months. Patients with neurotic, introverted personalities had a poor outcome in the control group but a satisfactory outcome when rehabilitated. Neurotic personalities responded to help, and rehabilitative measures did not increase neurosis. In addition all patients with a negative attitude towards their illness and future had a poor outcome but those with a positive attitude did well. Selection by simple methods of patients who would benefit from psychological rehabilitation seems desirable.     

A Psychiatric Home Care Program: A Report on Three Years' Experience (1962-1964)

The activities covering a three-year period of a psychiatric home care treatment program attached to a psychiatric unit of a general hospital are described. A detailed account of its operation and the roles played by each member of the team is given. This service frequently provides a substitute for hospitalization in the management of both acute and chronic psychiatric states and thereby constitutes an important preventive measure in the field of public health. Even if the initial attitude of the patient is negative it is possible to gain the co-operation of the family who become a useful ally in the treatment. The co-operation of the patient is not as essential as has been thought. The traditional role of the psychiatrist is reversed by virtue of his attending the patient at home. The active participation of social agencies is an integral part of the treatment.     

Guidelines for the use of intravenous thrombolytic agents in acute myocardial infarction. Ontario Medical Association Consensus Group on Thrombolytic Therapy.

A consensus group convened under the auspices of the Ontario Medical Association produced guidelines for the use of intravenous thrombolytic agents in acute myocardial infarction. The guidelines, updated to December 1988, include the following points. 1) Any hospital that routinely accepts the responsibility for looking after patients with acute myocardial infarction could offer thrombolytic therapy if monitoring facilities are available and if the staff are experienced in the treatment of cardiac rhythm disturbances. 2) Before treatment, all patients must be carefully screened for factors predisposing to hemorrhagic complications. 3) A physician should be clearly designated as responsible for the care of the patient receiving an infusion and be available in the event of problems. 4) For the two approved agents the usual dosages are as follows: streptokinase, 1.5 million units given over 1 hour; and tissue-type plasminogen activator (tPA), 100 mg over 3 hours, delivered as 60 mg in the first hour (of which 6 to 7 mg should be given as a bolus in the first 1 to 2 minutes) and then an infusion of 20 mg/h over the next 2 hours. 5) Intravenous thrombolytics should be considered for any patient with presumed acute myocardial infarction, as suggested by prolonged chest pain or other appropriate symptoms and typical electrocardiographic changes. Expeditious treatment is critical, since myocardial necrosis occurs within hours. 6) Emergency angiography is indicated for patients with hemodynamic compromise and no apparent response to streptokinase or tPA and in those with recurrent chest pain suggestive of acute myocardial infarction despite an apparent response to intravenous thrombolysis. Angiography before discharge is recommended for patients with postinfarction angina or evidence from noninvasive testing of significant residual ischemic risk. 7) There is insufficient evidence to choose between streptokinase and tPA on the basis of the two most important outcome measures: patient survival and myocardial preservation. More conclusive evidence comparing tPA, streptokinase and another promising agent, acylated plasminogen-streptokinase activator complex, will be available in 1989-90.     

Erectile dysfunction after myocardial infarction--myth or a real problem?

Erectile dysfunction is a common problem whose relation to cardiovascular diseases has scientifically been proved, but it has not been studied sufficiently in patients recovering from myocardial infarction. The objective of this study was to establish the frequency of erectile dysfunction in patients recovering from myocardial infarction. We examined 89 patients (aged 30 to 75 years) included in the program of cardiac rehabilitation after myocardial infarction. The results were compared with 91 healthy examinees of the same age. Even 82% of the patients who recovered from myocardial infarction have problems with erectile dysfunction, compared to 42.9% of healthy examinees. The prevalence of erectile dysfunction increases with the age in both groups. In the group of patients recovering from myocardial infarction aged 30 do 39 years, the erectile dysfunction decreased after 6 months, while in other age subgroups and between controls, there were no significant changes in erectile dysfunction prevalence during the analysed time period. We concluded that erectile dysfunction is a significant problem in patients recovering from myocardial infarction. It should be recognized on time in order to provide a better life quality for the patient with a multidisciplinary approach.     

Psychological rehabilitation after myocardial infarction: multicentre randomised controlled trial.

OBJECTIVE: To evaluate rehabilitation after myocardial infarction. DESIGN: Randomised controlled trial of rehabilitation in unselected myocardial infarction patients in six centres, baseline data being collected on admission and by structured interview (of patients and spouses) shortly after discharge and outcome being assessed by structured interview at six months and clinical examination at 12 months. SETTING: Six district general hospitals. SUBJECTS: All 2328 eligible patients admitted over two years with confirmed myocardial infarction and discharged home within 28 days. INTERVENTIONS: Rehabilitation programmes comprising psychological therapy, counselling, relaxation training, and stress management training over seven weekly group outpatient sessions for patients and spouses. MAIN OUTCOME MEASURES: Anxiety, depression, quality of life, morbidity, use of medication, and mortality. RESULTS: At six months there were no significant differences between rehabilitation patients and controls in reported anxiety (prevalence 33%) or depression (19%). Rehabilitation patients reported a lower frequency of angina (median three versus four episodes a week), medication, and physical activity. At 12 months there were no differences in clinical complications, clinical sequelae, or mortality. CONCLUSIONS: Rehabilitation programmes based on psychological therapy, counselling, relaxation training, and stress management seem to offer little objective benefit to patients who have experienced myocardial infarction compared with previous reports of smaller trials.     

Anti-tumor effects of interleukin 2 against genitourinary cancer--basic study and clinical application

In order to establish an optimum mode for systemic administration of recombinant interleukin 2 (rIL-2), the effects of rIL-2 (Biogen, Switzerland) on lymphocyte-mediated cytotoxicity against established renal carcinoma cell line Caki 1. KU-2 and freshly prepared renal carcinoma cells were studied. Augmentation of cell-mediated cytotoxicity by rIL-2 was dose- and time-dependent. The results indicated that the optimal dose of rIL-2 was 100 to 500 units (Jurkat units)/ml, and that cytotoxicity increased significantly even at a low concentration such as 4 units/ml. We thus chose daily administration of multiple repeated dose for inpatients. To prevent withdrawal from the therapy as a result of un-tolerable adverse effects, the daily dose was set at 1 x 10(6) units, and rIL-2 was given to 17 patients with advanced genitourinary cancer. Two-hour intravenous drip infusions containing 5 x 10(5) units of rIL-2 was given daily two times to inpatients and after at least 28 days of this mode of administration, subcutaneous injection at a dose of 1 x 10(6) units was given 6 days a week to outpatients. In 12 patients with renal cell carcinoma, 2 patients showed complete response; 1 patient partial response; 7 patients no change, and 2 patients progressive disease. In patients with carcinoma of the prostate or bladder carcinoma, all patients were no change from criteria of Japan Society for Cancer Therapy, however, marked decrease in serum acid-phosphatase and improvement of performance status in 1 patient with carcinoma of the prostate, and massive necrosis of tumor accompanied by disappearance of severe leg edema in a patient with bladder carcinoma were observed.     

Management of “psychosomatic” problems in clinical practice

Skilled interviewing and investigation are essential in the diagnosis and treatment of “psychosomatic” illness, the term “psychosomatic” being used in its more colloquial sense to refer to illness characterized by somatic symptoms and related psychopathologic disorders but without organic disease.Treatment of these patients is difficult. They respond best to a psychologically oriented physician who is able and willing to take final responsibility for both physical and psychological care. The hazards of ignoring the psychosocial dimension in patient management are emphasized. Although the family physician generally is the most appropriate therapist, there may be a role for a “liaison physician”, a specially trained consultant who is thoroughly familiar with both physical and psychological processes and their interaction.     

Cerebral complications in juvenile rheumatoid arthritis.

The antecedents of myocardial infarction have been reviewed in 102 patients (117 episodes) undergoing a program of rehabilitation. The year prior to the first attack was characterized by business and social problems, with some weight gain; in the week before the attach there was added tiredness, poor general health and, in some cases, increasing anginal pain. Heavy lifting and/or unusual exercise were common immediately before or during an attack; five attacks were related to the shovelling of wet snow.Both bed and the normal place of work were uncommon sites for an attack. More than 50% of patients had 30 minutes'' warning of infarction. The relevance of these findings to a safe program of therapeutic exercise is discussed.     

Effect of oral nimodipine on cerebral infarction and outcome after subarachnoid haemorrhage: British aneurysm nimodipine trial.

OBJECTIVE--To determine the efficacy of oral nimodipine in reducing cerebral infarction and poor outcomes (death and severe disability) after subarachnoid haemorrhage. DESIGN--Double blind, placebo controlled, randomised trial with three months of follow up and intention to treat analysis. To have an 80% chance with a significance level of 0.05 of detecting a 50% reduction in an incidence of cerebral infarction of 15% a minimum of 540 patients was required. SETTING--Four regional neurosurgical units in the United Kingdom. PATIENTS--In all 554 patients were recruited between June 1985 and September 1987 out of a population of 1115 patients admitted with subarachnoid haemorrhage proved by the results of lumbar puncture or computed tomography, or both. The main exclusion criterion was admission to the neurosurgical units more than 96 hours after subarachnoid haemorrhage. There were four breaks of code and no exclusions after entry. One patient was withdrawn and in 130 treatment was discontinued early. All patients were followed up for three months and were included in the analysis, except the patient who had been withdrawn. INTERVENTIONS--Placebo or nimodipine 60 mg was given orally every four hours for 21 days to 276 and 278 patients, respectively. Treatment was started within 96 hours after subarachnoid haemorrhage. END POINTS--Incidence of cerebral infarction and ischaemic neurological deficits and outcome three months after entry. MEASUREMENTS--Demographic and clinical data, including age, sex, history of hypertension and subarachnoid haemorrhage, severity of haemorrhage according to an adaptation of the Glasgow coma scale, number and site of aneurysms on angiography, and initial findings on computed tomography were measured at entry. Deterioration, defined as development of a focal sign or fall of more than one point on the Glasgow coma scale for more than six hours, was investigated by using clinical criteria and by computed tomography, by lumbar puncture, or at necropsy when appropriate. All episodes of deterioration and all patients with a three month outcome other than a good recovery were assessed by a review committee. MAIN RESULTS--Demographic and clinical data at entry were similar in the two groups. In patients given nimodipine the incidence of cerebral infarction was 22% (61/278) compared with 33% (92/276) in those given placebo, a significant reduction of 34% (95% confidence interval 13 to 50%). Poor outcomes were also significantly reduced by 40% (95% confidence interval 20 to 55%) with nimodipine (20% (55/278) in patients given nimodipine v 33% (91/278) in those given placebo). CONCLUSIONS--Oral nimodipine 60 mg four hourly is well tolerated and reduces cerebral infarction snd improves outcome after subarachnoid haemorrhage.     

Continuous ambulatory peritoneal dialysis: one year's experience in a UK dialysis unit.

Thirty-two patients aged 8-63 years trained to manage themselves by continuous ambulatory peritoneal dialysis for end-stage renal failure achieved better steady-state serum biochemistry and much higher haemoglobin and lower serum phosphate concentrations than during treatment with haemodialysis up to one year before. Two patients, however, returned to intermittent haemodialysis because of recurrent peritonitis. Costs of the technique during the first year were less than half those incurred in the first year of home haemodialysis. Nevertheless, the major advantage was the ease with which patient independence and rehabilitation could be achieved. This technique is an appreciable advance over other forms of management for end-stage renal failure. Nevertheless, until it is more refined and long-term problems have been assessed it should probably be used only in established renal units where back-up treatments are available.     

Suchtprobleme im Allgemeinkrankenhaus: Kurzinterventionen im psychiatrischen Konsiliar-Liaison-Dienst

The following case-report presents a patient in a general hospital whose accident was caused by alcohol intoxification. The example shows that addressing the patient in an adequate manner (as it is demonstrated by Motivational Interviewing), a lot of support in changing behaviour can be given by brief interventions and therapy recommendations. A psychiatric consultation liaison service as part of a network with supplementing services esp. for addiction problems, is an important tool for a comprehensive treatment in general hospitals.     

Virtual Reality as an upper Limb Rehabilitation Approach

Cerebrovascular diseases seriously reduce the quality of life of patients. One of the priority tasks of restoring individual independency, daily living and social activity of patients is to restore basic motor skills such as the reaching, manipulating, and bimanual tasks an coordination. For successful recovery of movement necessary to conduct training in real environment, active participation of the patient, and interactive biofeedback that allows the patient to control the correct performance of motor tasks and adjust their own efforts. Evolution of computer technology gives an opportunity to improve the classical approaches in stroke rehabilitation. To make rehabilitation process met necessary terms, in everyday practice often used high technological devices, such as virtual reality (VR) systems. The technical basis of VR is an artificial three-dimensional environment that is created with computer and displayed on the screen. These technologies allow recreating the necessary training environment for motor skills relearning, as well as to provide interactive biofeedback and make rehabilitation process more intensive. This review present an information about history of VR technology developments, experience of upper limb rehabilitation using VR systems and comparative analysis of different VR based rehabilitation approaches.