Effects of self poisoning with maprotiline.

Self poisoning with maprotiline was studied in 41 patients (43 episodes) consecutively admitted to an intensive care unit. Thirty five patients had taken more than one drug or alcohol. Fifteen patients were in coma grade III or IV; 17 patients were still not conscious after 24 hours in the intensive care unit. Among six patients given ventilation the mean duration of ventilation in the five who recovered was 36 hours. Three patients had a cardiorespiratory arrest, and one patient died. Twenty eight patients had a QRS interval of 100 ms or more, and 15 patients had seizures. In six patients seizures were precipitated by physostigmine. Cardiotoxicity after overdosage of maprotiline is equal to if not greater than that found after overdosage of conventional tricyclic antidepressants. Overdosage of maprotiline is more often associated with seizures than overdosage with tricyclic antidepressants. Physostigmine further increases the risk of seizures and should not be used in cases of overdosage of maprotiline.     

Trends in deliberate self poisoning and self injury in Oxford, 1976-90.

OBJECTIVE--To review trends in deliberate self poisoning and self injury (attempted suicide) over 15 years (1976-90) on the basis of general hospital referrals. DESIGN--Prospective data collection by computerised monitoring system. SETTING--Teaching general hospital. SUBJECTS--All patients aged 15 and over (n = 9605) referred to the hospital after episodes (n = 13,340) of deliberate self poisoning or self injury. MAIN OUTCOME MEASURES--Rates based on population of Oxford city; changes in substances used for self poisoning; history and repetition of attempts; and rates of admission to the hospital and of referral to the psychiatric service. RESULTS--Attempted suicide rates for women declined during the late 1970s and early 1980s but increased again during the late 1980s. Those for men remained relatively steady throughout the period. Highest mean annual rates occurred in women aged 15-19 (711/100,000) and in 20-34 year old men (334/100,000). The proportion of overdoses with paracetamol increased from 14.3% (125/873) in 1976 to 42% (365/869) in 1990 (chi 2 for trend = 481, p less than 0.01). Throughout the period the proportions of referred patients admitted to hospital and of those attempting suicide for the first time (over two thirds) did not decrease. Annual rates of repetition of attempts by women declined from 15.1% (257/1700) in 1976-8 to 11.9% (161/1356) in 1987-9 (chi 2 for trend = 7.8, p less than 0.01). Lower repetition rates occurred in women admitted to hospital and referred to the psychiatric service (431/4585, 9.4%) than in those not referred (42/235, 17.9%; chi 2 = 17.2, p less than 0.0001). CONCLUSIONS--Rates of attempted suicide declined in the 1970s and early 1980s, in women, but there are probably at least 100,000 hospital referrals a year in England and Wales because of this problem. Prevention of paracetamol self poisoning requires urgent attention, and psychosocial assessment should be conducted with as many of those who attempt suicide as possible.     

Prevalence of excessive or problem drinkers among patients attending somatic outpatient clinics: a study of alcohol related medical care.

The prevalence of alcohol related morbidity was studied among 2038 patients attending somatic outpatient clinics. A further 76 patients had refused the study, giving an overall drop out rate of 3.6%. Several methods were combined so as to detect as many patients with problem drinking as possible. According to the criteria and definitions employed 17% of men (confidence interval 15% to 19%) and 4% of women (confidence interval 3% to 5%) were excessive consumers of alcohol or problem drinkers. The highest proportion of such patients--that is, 17%--was noted in the emergency rooms (27% of men, 8% of women). At other clinics the proportions varied from 11% to 17% of men and from 2% to 4% of women. The strongest relations between overconsumption of alcohol and consultation at the clinic were among patients attending the medical outpatient clinic and the emergency rooms; in 86% (confidence interval 75% to 97%) and 88% (confidence interval 81% to 95%) of problem drinkers attending these clinics, respectively, alcohol was related to the consultation. Consultations were related to alcohol in 82% of women with excessive or problem drinking and 73% of men defined in this way. There was a tendency to a higher proportion of men with excessive or problem drinking in the age group 40-49 years. These findings show that among patients classified as excessive or problem drinkers attending somatic outpatient clinics there was a close relation between alcohol consumption and utilisation of medical resources, especially in women.     

Comparison of mortality of patients with heart attacks admitted to a coronary care unit and an ordinary medical ward.

During a 32-month period 2047 patients suspected of having heart attacks were admitted to hospital and were followed up prospectively. Out of 1480 eventually found to have definite or probable myocardial infarction, 483 had initially been admitted to an ordinary medical ward because of the shortage of coronary care unit (CCU) beds. More patients aged over 65 had been admitted to a ward than to a CCU, and more patients aged 65 or less had been admitted initially to a CCU. Within each age group, however, patients admitted initially to a CCU were clinically similar to those admitted initially to a ward. There was a higher proportion of successful resuscitations among patients admitted to a CCU, but there was no significant difference in mortality in either age group between patients admitted to a CCU and a ward.     

Prevalence of HBV and HCV markers in patients of specialized medical institutions

240 medical histories of patients admitted to Moscow clinical narcological hospital No. 17 with "opium addiction" diagnosis in 2000 and 2003 (120 histories for each year) were analyzed. From 1997 to 2003 4220 patients registered in narcological dispensary of Cherepovets city (Vologda region) were tested for HBsAg and anti-HCV. It has been shown that in new injection opiate drug users young patients (15 - 19 y.o.) predominated (41.7%). Tendency to development of drug addiction in younger age was revealed - in 2003 compared to 2001 percent of new injection drug users aged 11 - 14 years admitted to hospital raised in 1.5 times. In 2000 and 2003 in Moscow markers of HIV and/or HBV/HCV infection were detected in 84.2 and 91.7% of injection drug users respectively. Maximal rates of HBV and HCV infection in injection drug users in Cherepovets city were detected in 2001 - 11.7 and 83.1% respectively. Leading role of injection drug users in maintenance of HBVand HCV epidemic process activity in Russia was established.     

不同护理对2型糖尿病病人自我效能的影响

目的:探讨不同护理模式对2型糖尿病患者自我效能的影响.方法:将126例2型糖尿病患者随机分为试验组和对照组,对照组实施常规护理,试验组除实施常规护理外,由专人根据患者实际情况实施个案护理,比较两组自我效能差异.结果:实施个案护理后,糖尿病患者的自我效能改变与对照组相比有统计学意义(P＜0.05).结论:应用个案护理可显著提高2型糖尿病患者自我效能.     

Prevalence of bloodborne infective agents among people admitted to a Canadian hospital.

OBJECTIVE: To determine the prevalence rates of hepatitis B surface antigen (HBsAg) and antibodies to the human immunodeficiency virus (anti-HIV) and the hepatitis C virus (anti-HCV) among people admitted to an urban Canadian hospital. DESIGN: Anonymous unlinked serosurvey. SETTING: A 420-bed teaching hospital in Toronto. PARTICIPANTS: All 3000 patients admitted to the hospital on weekdays from January to June 1990. An attempt was made to exclude those who were readmitted during the study period. INTERVENTIONS: Serum samples from all the patients were tested for HBsAg and anti-HIV, and 1306 samples were also tested for anti-HCV by means of enzyme immunosorbent assays; reactions were confirmed by means of specific antibody neutralization or immunoblot assay. MAIN RESULTS: The prevalence rates of HBsAg, anti-HIV and anti-HCV were 2.1% (95% confidence interval [CI] 1.6% to 2.6%), 0.6% (95% CI 0.3% to 0.9%) and 0.5% (95% CI 0.1% to 0.9%) respectively. CONCLUSIONS: This is the first report defining rates of infection with these bloodborne agents among patients admitted to a Canadian hospital. The observed rates likely reflect the patient population served by our hospital and do not necessarily apply to other Canadian centres. The results support the use of universal precautions in health care settings.     

Mortality in elderly patients admitted for respite care.

OBJECTIVE--To determine whether admitting elderly patients to hospital to give temporary relief to their carers is associated with increased mortality. DESIGN--Prospective multicentre study comparing the mortality of patients admitted on a one off or rotational basis with that experienced while they were awaiting admission. SETTING--A wide range of urban and rural district general, geriatric or long stay, and general practitioner hospitals. PATIENTS--474 Patients aged 70 or over who had 601 admissions. MAIN OUTCOME MEASURE--Death. RESULTS--16 (3.4%) Of the 474 patients (2.7% of all 601 admissions) died while in hospital during an average stay of 15.7 days whereas 23 (4.9%) patients died while awaiting admission (average waiting time was 34.2 days). The 16 deaths in hospital and the 23 deaths during the longer waiting period correspond to death rates of 19.9 and 12.5 per 10,000 person days respectively. The difference between these of 7.4 is not statistically significant (95% confidence interval -3.6 to 18.3). The estimated relative risk of dying in hospital is 1.59 but the 95% confidence interval is wide (0.84 to 3.01). CONCLUSION--Although the death rates are slightly higher in those admitted to hospital for relief care than in those awaiting admission, the difference was not significant, and the death rate in both groups was reassuringly small.