A cross-sectional study on the nurses’attitude towards rapid response system activation for clinically deteriorated patients

Background:Hospitals have reported that implementing rapid response system activation(RRS)activation has increased patient safety.As a result,there has been growing interest in identifying factors that lead to successful RRS activation.While introducing an automated RRS activation system has prompted nurses to be more vigilant about monitoring vital signs,it has not necessarily encouraged them to conduct thorough patient assessments to identify early signs of deterioration.Purpose:The current study aimed to assess nurses’attitudes towards RRS activation for clinically deteriorated patients in the clinical units of King Abdul-Aziz Hospital.Methods:A descriptive cross-sectional research design was utilised in the study,and 144 nurses working in the medical and surgical units of King Abdul-Aziz Hospital were recruited to participate using a convenient non-probability sampling technique.Results:The study’s findings reported that nurses have a positive attitude towards RRS benefits(Mean=3.70;SD=0.70).Their overall attitude towards RRS activation among clinically deteriorated patients is still low positive(Mean=2.71;SD=0.61).The nurses’attitudes towards RRS benefits significantly differ among nationalities and the clinical area/unit where they were assigned,with a P-value of 0.0194 and 0.000,respectively.Attitudes towards RRS barriers significantly differ among nationality(P-value=0.0037),education level(P-value=0.0032),area of assignment(P-value=0.020),and whether they have a good understanding of abnormal observations(P-value=0.0122).Regarding the nurses’attitude towards management belief,the significant result is only with the clinical area/unit of assignment with a P-value of 0.000.Conclusion:The current study found a low positive attitude towards RRS activation among ward nurses,especially given that monitoring vital signs is critical to their job.Nurses may fear being perceived as clinically inept for redundant activations caused by poor quality,but their attitude towards activating the RRS in clinical deterioration is still largely negative.This is because most RRSs rely on ward nurses to recognise clinical deterioration and manually alert responders through phone calls,hospital communication systems,or face-to-face communication.

Trust in Clinical Practice: A Systematic Review

Background: The aim of this study is to gain a better understanding of the true importance of trust in clinical practice by looking at how it is formed, how it affects clinical practice, and how to improve it. Methods: Using the PRISMA-ScR checklist, a review of the literature was performed to identify research evaluating the importance of trust in the doctor-patient relationship. After thorough screening and removal of duplicates, 21 articles were used in the literature review. Results: The classifying themes that emerged in the selected articles were What Makes Trust and Effects of Trust. The theme of What Makes Trust garnered two subthemes as well: Impact of Doctor-Patient Relationship on Trust and Impact of Shared Decision-Making on Trust. Further to that, the overarching themes found were slightly more specific. They were Traits of Trust, Mistrust and Barriers to Trust, Positive Effects of Trust and the Effects of a Lack of Trust. We found that the best way to improve trust was to improve communication between the patient and the doctor. Additionally, we found that the biggest barrier to a trusting doctor patient relationship was a stigmatised condition, followed by a perception of a financially-motivated doctor. Finally, we found that a lack of trust can prevent patients from seeking and receiving proper treatment. Conclusions: With a better understanding of how trust is built and the extent of the role it plays in clinical practice, we hope that this growing knowledge can improve the practice of many doctors in the future. It is certain that more research needs to be done in this area, especially focusing on vulnerable and stigmatised populations such as chronic pain patients.

Clinical Utilization of Nursing Process in Improving Patient’s Outcome and Its Associated Factors: A Cross-Sectional Study among Nurses and Midwives Working at Njombe Regional Referral Hospital, Tanzania

Background: Improvement of patient care in any hospital depends primarily on the quality of nursing care. Nursing care is enhanced by the nursing process, which outlines the nursing activities to be provided for a patient. Methods and Materials: A cross sectional design employing quantitative methods was conducted in Njombe RRH in December 2021. Quantitative data were collected from nurses and midwives from all wards by simple random sampling techniques using a sample-size calculator. SPSS version 26.0 was used to analyse data whereby a p-value of 0.05 was considered a decision mark for the significance of the result;Chi-square and Logistic regression respectively were used to find out the association and its strength between variables. Result: Majority of the respondents, 41 (85.4%), had inadequate knowledge and 33 (68.8%) found them people with a negative attitude to the nursing process. Significantly, there is an association between knowledge and clinical utilization (AOR 2.24;95% CI: 1.6 - 2.5;P 0.04), attitude and clinical utilization (AOR 4.32;95% CI: 1.8 - 3.7;P Conclusion: A knowledge gap in relation to the utilization of the nursing process and a negative attitude were noted to be associated significantly with the utilization of the nursing process among nurses and midwives. It is recommended on-job training, supportive supervision, and Value Clarification and Attitude Transformation (VCAT) are the best interventions to address the knowledge gap and negative attitudes respectively.

DxR Clinician结合SP在医学生临床思维教学中的应用

目的:探讨DxR Clinician虚拟教学结合标准化病人的教学方法在医学生临床思维教学中的应用效果。方法:选取海南医学院2020级临床新医科(1)班和(2)班,分为试验组和对照组,分别采用基于DxR Clinician虚拟教学结合标准化病人教学法和标准化病人教学法,通过临床思维能力、医患沟通能力、心理状态来评价教学效果。结果:试验组学生的临床思维能力、医患沟通能力得分高于对照组;自我感知心理状态得分低于对照组。结论:DxR Clinician虚拟教学结合标准化病人教学方法,适用于三年级临床医学本科生诊断学教学,可有效地培养学生的问诊、临床思维能力,提升医患沟通能力、减轻学生医患沟通时的心理压力,值得在以后的教学中进一步推广使用。

Evaluation of Clinical Outcomes of ses Stent in Patients with Coronary Artery Disease After Intracoronary Stenting in Small Vessels

Background:Limited data are available for sirolimus-eluting stent(SES,Cypher)implantation in patients with coronary artery disease in small vessels.The clinical longtermoutcomes of SES in patients with coronary artery disease after intracoronary stenting in small vessels has not been yet evaluated.

Clinical Characteristics, Imaging Findings and Surgical Outcomes of Chiari Malformation Type I in Pediatric and Adult Patients

A growing number of children and adolescents are being diagnosed as Chiari malformation type I （CM- I ） for behavioral disorders, developmental delay, seizures, or abnormal orpharyngeal function. The aim of this study was to compare the clinical characteristics, imaging findings and surgical outcomes of CM- I in pediatric and adult patients. Between January 2014 and June 2017, 84 patients with CM- I underwent surgical treatment in our department. We divided the patients into two groups： pediatric group （n=l 1, age 〈18 years） and adult group （n=73, age 〉18 years）. Data on clinical characteristics, imaging findings, surgical outcomes, and prognosis were retrospectively reviewed and compared between these two groups. For clinical presentation, scoliosis （36.4%） and developmental delay （36.4%） were more common in pediatric patients, whereas, sensory disturbance （58.9%） and motor weakness （41. 1%） were more common in adult patients. Imaging findings showed that the incidence of hydrocephalus and craniovertebral junctional abnormalities was significantly higher in pediatric group than in adult group （P〈0.05）. Compared to adult group, pediatric group showed a better improvement or resolution of syrinx and tonsillar herniation after surgical treatments （P〈0.05）. The total Chicago Chiari Outcome Scale （CCOS） score in pediatric patients at the last follow- up was significantly higher than that in adult patients （P=0.002）. In conclusion, the clinical characteristics and imaging findings appeared to be different in pediatric and adult patients with CM- I. The surgical outcomes of pediatric patients were shown to be significantly better than those of adult patients.

Analytical study of care quality and moral distress in clinical situations and patient care

Objective: Nursing profession conventionally meets a high standard of ethical behavior and action. One of the ethical challenges in nursing profession is moral distress. Nurses frequently expose to this phenomenon which leads to different consequences such as being bored by delivering patient care that decline care quality and make it challenging to achieve health purposes. This study was conducted to investigate the association between the aspects of moral distress and care quality.Methods: In this descriptive–analytical study, 545 nurses of intensive and cardiac care units and dialysis and psychiatric wards were recruited by census sampling. Three questionnaires, Sociodemographics, Moral Distress Scale, and Quality Patient Care Scale, were distributed among the participants and collected within 9 months. Data analysis was conducted by descriptive statistics, analysis of variance, and the least significant difference in SPSS 13.Results: Investigating moral distress domains(ignoring patient, decision-making power, and professional competence) and care quality domains(psychosocial, physical, and communicational) demonstrated that in being exposed to moral distress, ignoring patient had no effect on psychosocial domain(P=0.056), but decision-making and professional competence of moral distress had positive effect on psychosocial, physical(bodily), and communication domains of care quality.Conclusions: Because moral distress domains are effective on patient care quality, it is recommended to enhance the knowledge of nurses, especially beginners, about moral distress, increase their strength alongside standardizing nursing services in decisionmaking domains, improve the professional competence, and pay attention to patients.

Clinical Observation on Treatment of 78 Patients of B-Thalassemla with Bushen Ylsul (补肾益髓) Method and Study on Its Molecular Mechanism

Objective: To study the treatment of B-Thalas-semia (ThE) with Chinese herbal medicine for Bushen Yisui (BSYS), its theoretical base and molecular mechanism. Methods: Seventy-eight patients with ThE were treated with BSYS recipe (consisted of 11 Chinese herbal drugs as Dogwood fruit, Fleeceflower root, prepared Rehmannia root and turtle shell, etc.) orally taken, 3 times per day, 10 g/time, 3 months as one therapeutic course. Hemoglobin (Hb), red blood cell (RBC), reticulocyte (Ret) and hemoglobin F (HbF) were checked every month. At the same time, PAGE, PVR, PCR-SSCP, RT-PCR, DNA series analysis, mRNA gene expression analysis techniques were used to conduct the systematic gene analysis in patients to study the molecular mechanism of TCM treatment from aspects of gene mutation, gene expression and control-regulation. Results: All the blood criteria in patients after BSYS treatment were improved significantly with clinical symptoms

Evaluation Nursing Students’ Views of Improved Competence Development after Clinical Supervision: An Educative Approach to the WHO Patient Safety Model

Bachelor of Science Nursing (BSN) students’ education comprises both theories and practical aspects. Access to resources is required for the development of a professional identity, which includes gaining technical knowledge and receiving feedback, guidance as well as social and emotional support from clinical supervisors. The aim of this study was to evaluate BSN students’ views of professional development after clinical supervision (CS) during their undergraduate education. An additional aim was to illuminate how competence development was related to the WHO Patient Safety Educational Model. A cross-sectional study was conducted, in which CS was measured as part of a survey completed by a sample of nursing students after their clinical placement at two time-points, namely 2012 and 2013. Statistical descriptive and inferential analyses were used and differences in the responses between Time 1 and Time 2 compared. The benefit of CS for nursing students’ competence development revealed a positive significant relationship between students’ Interpersonal skills and the factor Improved care/skills. There were differences in terms of variables related to the Importance value of CS and Professional skills. The results can be used to inform undergraduate nursing education leaders, teachers and practice partners on individual, group and organisational level in order to enhance patient safety and highlight the importance of CS for BSN students’ professional development.

Clinical Observation on Treatment of 50 Patients with Candidal Vaginitis by Chinese Herbal Medicine Combined with Canesten

From January 2001 to January 2002, 50 patients of candidal vaginitis were treated by Kushen powder (KSP,苦参散) combined with Canesten as the treatment group, and controlled by a control group including another 50 patients treated with Canesten alone. The therapeutic results were satisfactory and reported as follows.

DETERMINATION OF SERUM HARRINGTONINE IN PATIENTS WITH ANLL AND ITS CLINICAL IMPLICATION

Harringtonine(H) level in serum was quantified by high-performance liquid chromatographic (HPLC) technique and its pharmacokinetic parameters were determined in 11 patients with ANLL after 4 hours continuous infusion of 4 mg of H. 74 serum samples over the range of H administered 1-6 mg/d were also determined, the dose of H administered paralleled the mean serum H concentration, but the highest concentration were 1.6-7 folds higher than the lowest under the same doses. It seems that the dosage of harringtonine must be individualized in order to achieve better antileukemia effect. It was found that under the similar serum H concentration the marrow blast decrease index (MBDI) in types M4 and M5 of ANLL is much more greater than in M2 after the first course of chemotherapy and in 3 patients of M2, the serum H level and the MBDI show positive correlation.

Neuroelectrophysiological indexes and clinical characteristics of patients with peroneal muscular atrophy: Retrospective analysis of 24 cases

BACKGROUND: Peroneal muscular atrophy (PMA) is characterized by insidious onset, gradually progressive course of disease, very mild disability degree and easily subjecting to missed diagnosis and misdiagnosis. Nerve conductive velocity is helpful in the diagnosis of atypical cases. OBJECTIVE: To retrospectively analyze the characteristics of clinical manifestation, electromyogram (EMG), motor and sensory nerve conduction velocity of patients with PMA. DESIGN: Retrospective case analysis. SETTING: Department of Neurology, Guangzhou First People's Hospital. PARTICIPANTS: Twenty-four patients with PMA, including 16 males and 8 females, aged 5-68 years old, admitted to Guangzhou First People's Hospital between March 1996 and January 2006 were recruited. Informed consents were obtained from all the patients. METHODS: All the patients subjected to EMG and detection of nerve conduction velocity at distal end of four extremities with a Keypoint evoked potential/ EMG instrument (Denmark). Sensory and motor conduction velocity, EMG changes of upper and lower extremities were observed, and relationship of neuroelectrophysiological characteristics and clinical symptoms was analyzed. MAIN OUTCOME MEASURES: Changes in sensory and motor conduction velocity, EMG and clinical manifestations of 24 patients. RESULTS: ① All the patients suffered from insidious onset and gradually progressive course of PMA. Muscular atrophy of lower extremity was found in 14 patients, and that of upper extremity in 5 patients. ②Routine nerve conduction study showed that sensory and motor conduction velocity were stepped down, especially in 16 patients with typeⅠPMA (demyelinating pattern, nerve conduction velocity below normal level 50%). Motor nerve conduction velocity of median nerve, ulnar nerve, common peroneal nerve and tibial nerve averaged 34.8 m/s, 37.2 m/s, 16.5 m/s and 17.4 m/s, respectively; Sensory nerve conduction velocity of median nerve, ulnar nerve and sural nerve averaged 27.9%, 24.6 m/s and 3.1 m/s, respectively. Slowing conduction velocity and muscular strength involvement were disproportionate, i.e. myasthenia was relatively lessened, sensory and motor conduction velocities were greatly decreased. Nerve conduction velocity in distal end of two lower extremities was not detected in 8 patients, but who could still walk. CONCLUSION: ①PMA of patients is characterized by insidious onset and gradually progressive course of disease. Clinical symptom is the base to diagnose PMA. ②Neuroelectrophysiological study is a simple and easy-to-operate means with good reproducibility in diagnosing PMA. Patients with abnormal myasthenia in lower extremity can be detected in the early stage.

Clinical features of multiple trauma patients combined with spine and spinal cord injuries

Objective To analyze the clinical features of the multiple trauma patients combined with spine and spinal cord injuries.Methods A retrospective study was performed in143multiple trauma patients combined with spine and spinal

A CLINICAL ANALYSIS OF 7878 PATIENTS WITH TUMORS IN THE HEAD AND NECK

7878 patients with tumors in the head and neck were analyzed in a period of twenty years. All the diagnosis were confirmed by pathologic examination. There were 5485 cases (69.62%) of malignant tumors. Nearly an half of malignant tumors were in the nasopharynx (49.32%). Among the malignant tumors of the nasopharynx, 2698 were carcinoma (99.34%) and only 18 (0.66%) sarcoma. Nine of them were under 10 years of age, the youngest patient was 3 years old, and this is rare in our county. The incidence of head and neck tumors was 37.66% and that of the head and neck malignancies was 26.22% of tumors in the whole body. This study indicates that incidence of malignant tumor in head and neck was rather higher, it is worth to improve ths procedure of treatment and prevention.

Clinical study of recombinant human brain natriuretic peptide in patients with acute myocardial infarction complicating congestive heart failure

Objectives To observe the efficacy and safety of recombinant human brain natriuretic peptide(rh-BNP) on patients with acute myocardial infarction complicating congestive heart failure.Methods 40 patients with acute myocardial infarction complicated by congestive heart failure were randomly divided into control group and treatment group of 20 cases.The control group,15 cases of acute anterior myocardial infarction,5 cases of acute inferior wall myocardial infarction, 15 males and 5 females,aged 55-70 years,mean age 58±12 years;treated 16 cases of acute anterior myocardial infarction,4 cases of acute myocardial infarction,16 males and 4 females,aged 56-70 years,mean age 59±11 years;two groups of age,gender,severity of disease and vascular lesions no significant difference and comparable(P】0.05).Conventional group were given aspirin,clopidogrel, statins,Inotropic,diuretic and vasodilator therapy.In the con- ventional treatment group based on the use of recombinant human brain natriuretic peptide(new bios,Tibet Pharmaceutical Co.,Ltd.Chengdu Nuodikang biopharmaceutical production, usage:1.5μg/Kg intravenous injection(impact), then 0.0075μg-0.01μg/(kg·min)infusion rate).Continuous medication 72 h.The clinical symptoms observed for 3 days in patients before treatment and after treatment,heart rate,blood pressure and left ventricular ejection fraction (LVEF) and tumor necrosis factor(TNF-α),brain natriuretic peptide(BNP) levels were measured.Results In control group,8 cases markedly effect,5 cases effect and 7 cases no effect,the total effective rate was 65%;In treatment group,13 cases markedly effect,6 cases effect and 1 cases no effect,the total effective rate was 95%,compared with two groups P New bios treatment group significantly increased cardiac index(CI) in patients with heart failure and left ventricular ejection fraction(LVEF) than the control group(all P【0.05),further reduce the levels of tumor necrosis (TNF-α) and brain natriuretic peptide(BNP).Conclusions rh-BNP can improve symptoms and heart function,reduced plasma tumor necrosis factor(TNF-α) and BNP levels of acute myocardial infarction patients with congestive heart failure,the treatment safe and reliable.As small sample size observed,larger sample to be accumulated to further evaluate its efficacy and safety.

Predictive clinical features of cardioembolic infarction in patients aged 85 years and older

Objective To assess predictive clinical factors of cardioembolic infarction in very old patients(85 years of age and older).Methods Prospective hospital-based stroke registry("The Sagrat Cor Hospital of Barcelona Stroke Registry")is an acute-care teaching hospital in Barcelona,Catalonia,Spain.From 956 first-ever cardioembolic stroke patients included in the stroke registry over a 24-year period,639 were younger than 85 years of age and 317 were 85 years or older(mean age:88.9 years).Demographics,clinical characteristics,risk factors and early outcome were compared.Predictors of cardioembolic infarction in the oldest age group were assessed by multivariate analyses.Results In a logistic regression model based on demographics,risk factors,clinical features and complications,female gender(odds ratio[OR]=1.74,95%confidence interval[CI]:1.27–2.39),heart failure(OR=2.27,95%CI:1.46–3.56),altered consciousness(OR=1.76,95%CI:1.28–2.42),and infectious complications(OR=2.01,95%CI:1.39–2.91)were predictors of cardioembolic stroke in the oldest age group.By contrast,heavy smoking,heart valve disease,hypertension,headache,early seizures,sensory deficit,and involvement of the posterior cerebral artery were independently associated with cardioembolic stroke in the younger group.Conclusions Identification of a differential clinical profile of cardioembolic stroke between patients aged 85 years or more and those younger than 85 years helps clinicians to the optimal management of ischemic infarction in the oldest segment of the population.

2014—2023年西安市某三甲综合医院AECOPD住院患者的流行病学特征及费用结构研究

目的探讨2014—2023年西安市某三甲综合医院慢性阻塞性肺疾病急性加重(AECOPD)住院患者的流行病学特征及费用结构研究。方法收集某院2014年1月—2023年12月的AECOPD住院患者的病案首页信息(n=6748),回顾性分析其人口学特征、临床特征的分布及住院费用构成情况,并采用结构变动度分析不同年度住院费用的结构变动情况。结果2014—2023年主诊确诊为AECOPD患者占本机构所有住院患者4.81‰,10年间AECOPD住院患者的构成比呈持续下降趋势(χ2=1083.351,P<0.001);不同年度中AECOPD住院患者的性别、职业、医疗付费方式、来源的分布均有统计学差异(P<0.05);不同年度AECOPD住院患者的季节分布有统计学差异(χ2=157.328,P<0.001);不同年度AECOPD住院患者住院天数分布之间有统计学差异(χ2=83.463,P<0.001);不同年度中AECOPD患者的住院次数、入院病情、是否合并症或并发症、是否有药物过敏史以及是否有再次住院计划的构成比之间均有统计学差异(P<0.05);不同年度AECOPD住院患者的结局之间有统计学差异(χ2=153.367,P<0.001);AECOPD患者次均住院费用呈2014—2016年逐步升高,2016—2023年逐步下降的趋势(P<0.01);不同年度AECOPD患者住院费用中均以药品费用和诊断费用为主;2014—2022年AECOPD住院患者次均费用整体住院的结构变动度(DSV)为41.62%,其中2012年与2013年住院费用的DSV最大(22.69%),2017年与2018年的DSV最小(4.23%)。结论近10年AECOPD住院患者的构成比和病死率整体呈下降趋势;AECOPD住院患者中70~79岁组构成比最高,主要分布在冬季;10年间次均住院费用整体呈下降趋势,费用构成主要以药品费和诊断费用为主,药品费用成逐年下降的趋势,诊断费用呈逐年增加的趋势,说明医疗政策改革在优化住院费用结构、控制费用不合理增长中的作用显著。

Patient Satisfaction Related to Their Eye Health Examination at Lúrio University Clinic in Nampula, Mozambique during COVID-19

Introduction: Patient satisfaction is defined as the extent of agreement between what a patient expects to receive from his or her health experience and the perception of the level of care he or she actually receive. With the COVID-19 pandemic, many practices have to adapt to provide health ensuring patients’ safety in first instance. Eye care procedures may be delayed during the pandemic, so eye safety is more important than ever, and it doesn’t only focus on the examination room, all the clinic compartments must be adjusted to ensure that no patient is infected by COVID-19 within the clinic. The aim of this study was to assess the satisfaction of patients who attended the Lúrio University Clinic for eye care during COVID-19. Material and Methods: This is a quantitative, descriptive and cross-sectional study conducted from December 30th, 2020 to April 30th, 2021. A systematic random sampling method was used to enrol 173 participants. Data were collected using an identification form and the patient satisfaction survey. Ethical clearance was obtained from the Lúrio University Bioethical Committee review board, and informed consent term was also received from the participants before data collection. Results: 173 participants (84 women, 48.6% and 89 men, 51.4%) completed the survey with the mean age of 31.14 and standard deviation of ±14.6 years. We found that 98.3% of the participants were satisfied (63.6% satisfied and 34.7% extremely satisfied) with the eye care provided in Lúrio University Clinic. Conclusion: Most of the patients were satisfied with the eye health examination provided in Lúrio University clinic, thus the directions for future research of the study are now opened.

Clinical manifestation and humoral immuno-function of myasthenia gravis patients with abnormal and normal thymus gland

BACKGROUND： Myasthenia gravis （MG） is an autoimmune disease which mainly affects neuromuscular junctions. The ages, modified Osserman classification and clinical manifestation and humoral immunol function of MG with and without thymic abnormality are different. OBJECTIVE： To explore the clinical manifestation and humoral immuno-function of MG with abnormal and normal thymus gland. DESIGN ： Contrast observation SETTTNG ： Department of Neurology, the Third Affiliated Hospital of Sun Yat-sen University PARTZCZPANTS ： A total of 49 inpatients with MG were selected from the Third Affiliated Hospital of Sun Yat-sen University from March 2000 to August 2005. All the patients had typical clinical manifestation of MG and positive neostigmine test. All the patients knew and agreed the laboratory examinations. There were 22 males and 27 females of 2-69 years old. Chest MRI or CT scan were performed to reveal thymus gland abnormality. According to whether there was tumor in superior mediastinum, all patients were divided into 2 groups, abnormal and normal groups. Normal thymus gland group （n=30） contained 16 males and 14 females of 6-43 years old. Abnormal thymus gland group （n=19） contained 6 male and 13 female of 2-69 years old, METHODS： ① All patients were questioned about initial symptoms. Meanwhile, main clinical manifestations were recorded at hospital admission. ② 7180A automatic biochemical analyzer and automatic microplate reader were used in detecting seroimmunity index. The levels of C3, C4, IgG, IgA, IgM and CH50 in blood serum were analyzed by nephelometry. ③ Clinical classification is based on modified Osserman classification. The patients with MG were divided into six types： I （Ocular myasthenia）, Ⅱ a （Mild generalized myasthenia）, Ⅱb （Moderately severe generalized myasthenia）, Ⅲ （Acute fulminating myasthenia）, Ⅳ（Late se- vere myasthenia）. MAZN OUTCOME MEASURES： ① Differences of initial symptoms and clinical manifestation of two group patients. ② Differences of age of onset and modified Osserman classification of two groups. ③The humoral immuno-functions of two groups were compared. RESULTS： All the 49 patients were involved in the final analysis of results. ① Differences of initial symptoms： Ptosis was the most common initial symptoms in both groups. Patients with ptosis of normal thymus gland were 25 （83%, 25/30）. Patients with ptosis of abnormal thymus gland were 13 （68%, 13/19）. Patients with normal thymus gland： dysphagia 2 （7%, 2/30）, diplopia 4 （13%, 4/30）, fatigue 4 （13%, 4/30）, dysarthria 3, （10 %, 13/30）. Patients with abnormal thymus gland： dysphagia 3 （16%, 3/19）, diplopia 6 （32%, 6/19）, fatigue 3 （16%, 3/19）, dysarthria 2 （10%, 2/19）. ② Differences of clinical manifestation of two groups： Ptosis was the most common clinical manifestation in both groups. Patients with ptosis of normal thymus gland were 29 （97%, 29/30）. Patients with ptosis of abnormal thymus gland were 15 （79%, 15/19）. The rates of fatigue and breathing disorder in patients with abnormal thymus gland were higher than patients with normal thymus gland. Myasthenia crisis occurred in 3 patients （16 %, 3/19） in abnormal thymus gland group, with 1 （3%, 1/30） in abnormal thymus gland group. ③ Differences of age of onset and modified Osserman classification： The rate of type ｜ （63%, 19/30） in patients with normal thymus gland was higher than patients （42%, 8/19） with abnormal thymus gland. The rates of type Ⅱ a, Ⅱ b and Ⅲ （58 %） in patients with abnormal thymus gland were higher than patients （37%, 8/19） with normal thymus gland. But no differences were found between two groups （P 〉 0.05）. Patient number of onset from 20 to 29 year old in abnormal group （47%） was higher than that in normal group （20%）. Comparison of two groups was X2=4.10 and P 〈 0.05.④ Comparison of the humoral immunol indexes of two groups： The levels of IgG, IgA, C3 and CH50 in abnormal group were higher than those in normal group. But no differences were found between two groups （P 〉 0.05）. CONCLUSZON： ① Ptosis was the most common initial symptom and clinical feature in both groups. ② Clinical manifestation in abnormal group were more severe, and ages of onset in abnormal group were more young.③ The humoral immuno indexes of two groups were not significantly different.

Managing suicidal patients in clinical practice

The clinical management of suicidal patients can be very challenging. This paper guides the reader through the basic steps in assessing a subject and deciding the type of treatment to provide. Characteristics of main psychiatric pathologies associated with suicidality are described, with attention to the peculiarities that specific associations may frequently entail.