脑瘫儿童精细运动功能测试量表的效度和反应度研究

目的:分析脑瘫患儿精细运动功能测试(FMFM)量表的效度和反应度。方法:共有612例大于6个月的脑瘫患儿参加了本研究,男423例(69.1%),女189例(30.9%);平均年龄(30.6±25.5)个月;其中痉挛型四肢瘫224例(36.6%)、痉挛型双瘫208例(34.0%)、痉挛型偏瘫122例(包括2例单瘫)(19.9%)、徐动型30例(4.9%),肌张力障碍型20例(3.3%),共济失调型8例(1.3%)。分析FMFM量表精细运动能力分值的平行效度(与PDMS-FM原始分的Pearson相关分析)、结构效度(样组间差异分析)和反应度(效应尺度)。结果:FMFM量表精细运动能力分值PDMS-FM量表原始分之间的相关系数为0.95;能有效地区分同一偏瘫患儿健侧和患侧上肢精细运动能力分值之间差异,同时也能有效地区分相同月龄段双瘫和四肢瘫患儿精细运动能力之间的差异;此外本量表具有较好的效应尺度。结论:FMFM量表具有良好的效度和反应度,可以有效地评定脑瘫患儿精细运动能力。     

中文版上肢技巧质量量表在脑性瘫痪患儿上肢功能评定中的信度和效度

目的:评估中文版上肢技巧质量量表(quality of upper extremity skills test,QUEST)在痉挛型脑瘫患儿上肢功能评定中的信度和效度。方法:将英文版QUEST翻译并完善成中文版,研究对象为75例在我院就诊的痉挛型脑瘫儿童,检测其重测信度及评定者间信度。同时进行Peabody运动发育量表的精细运动部分(peabody developmental motor scale fine motor,PDMS-FM),精细运动能力(fine motor function measure scale,FMFM),分析PDMS-FM原始分、FMFM各区分数与中文版QUEST各分测试项原始分之间的相关性,评估量表的平行效度。结果:中文版QUEST分测试项得分及总分具有优良的重测信度及评估者间信度(ICC值均0.890),中文版QUEST分测试项原始分与PDMS-FM、FMFM各区原始分间具有较好的平行效度(Pearson/Spearson秩相关系数分别为r1=0.563—0.816、r2=0.389—0.830)。结论:中文版QUEST量表具有良好的信度和效度,可以作为评估痉挛型脑瘫患儿上肢运动功能的首选方法。     

小于3岁痉挛型脑性瘫痪儿童粗大运动与精细运动发育的相关性研究

目的比较小于3岁痉挛型脑性瘫痪儿童粗大运动与精细运动发育之间的相关性。方法以同时接受粗大运动功能测试量表（GMFM）评定和精细运动功能评定量表（FMFM）评定的193例小于3岁的痉挛型脑性瘫痪儿童为研究对象，比较GMFM各项分值与FMFM分值在不同月龄和类型患儿中的相关程度，通过多元逐步回归分析确定GMFM5个功能区分值对FMFM分值的影响程度。结果在不同月龄和类型的脑性瘫痪患儿中，GMFM各项分值与FMFM分值具有良好的相关性（r=0．26～0．85，P〈0．05），多元逐步回归分析结果显示GMFM的A区和B区分值对FMFM分值的影响力较大，校正决定系数为0．748，A区的作用更为强烈。结论小于3岁的痉挛型脑性瘫痪儿童的粗大运动与精细运动存在着良好的相关性，对不同年龄和类型的脑性瘫痪儿童都应该重视粗大运动与精细运动训练相结合，同时必须加强基本运动功能训练。     

中文版上肢技巧质量测试量表信度和效度的初步研究

目的：探讨中文版上肢技巧质量测试量表（QUEST）的信度和效度,为其在国内临床应用提供理论依据.方法：经原著者允许并授权后,将英文版QUEST量表翻译成中文.研究对象为70例在康复中心就诊的痉挛型脑瘫儿童,随机选取30例检测重测信度（间隔2周）,随机选取30例检测评分者间信度.50例同时接受Peabody精细运动发育量表（PDMS-FM）与中文版QUEST量表测试,分析PDMS-FM原始分与中文版QUEST量表各分测试原始分之间的相关性,确定两者之间的平行效度.结果：中文版QUEST量表的各分测试原始分具有良好的重测信度及评估者间信度（ICC值＞0.90）,中文版QUEST量表与PDMS-FM测试的各项分测试原始分测试具有良好的平行效度（Pearson相关系数为0.717～0.921）.结论：本次研究确立了中文版QUEST量表具有良好的信度和效度,是一种可以有效评估痉挛型脑瘫患儿上肢技巧质量的工具.     

ICF-CY活动项在脑性瘫痪儿童中信度和效度的研究

目的：分析研究国际功能、健康和残疾分类儿童青少年版（ICF-CY）活动项在脑性瘫痪儿童中信度和效度;探讨ICF-CY活动项的临床实用价值.方法：选择50例脑性瘫痪儿童,采用ICF-CY活动项、粗大运动功能评定量表、Peabody运动发育量表、PEDI儿童能力评估量表进行评定.评定者间信度采用kappa一致性分析方法;同步效度采用Spearman相关分析.结果：ICF-CY活动项除“利用交通工具到处移动”外的14个类目kappa值为0.650～0.902,信度中到优;ICF-CY活动项除“利用交通工具到处移动”外其他项目的总分与GMFM-88、Peabody、PED1评分的Spearman相关系数分别为-0.967、-0.832、-0.874（P＜0.01）.结论：采用ICF-CY活动项对脑性瘫痪儿童进行运动评定可靠有效.     

Berg平衡量表对痉挛型脑瘫儿童平衡功能评定的信度研究

目的:检验Berg平衡量表对痉挛型脑性瘫痪儿童平衡功能评定的信度,为Berg平衡量表在脑瘫儿童的临床应用提供客观依据。方法:选取20例脑瘫儿童,每例在1周内分别同时接受2位治疗师2次Berg平衡量表测试评分;并使用等级间相关系数(ICC)检验Berg平衡量表的组间及组内信度。结果:Berg平衡量表的组间信度ICC=0.941-0.977,组内信度ICC=0.963-0.988,且95%可信区间集中(P0.001)。结论:Berg平衡量表用于评定痉挛型脑性瘫痪儿童的平衡功能时具有较好的信度。     

Wolf运动功能测试量表的标准效度和评定者内部信度研究

目的：研究脑卒中偏瘫患者上肢运动的Wolf运动功能测试量表（WMFT）的标准效度和评定者内部信度研究。方法：22例脑卒中慢性期患者在2周内由同一测试者进行WMFT的检查，并与Fugl—Meyer评价量表上肢部分进行效度分析。结果：两次WMFT计时组内相关系数（ICC）为0．990，95％置信区间为0．977—0.996；两次WMFT动作质量分级组内相关系数（ICC）为0．988．95％置信区间为0.970—0．995。WM丌计时与WMFT动作质量分级相关系数为-0.971（P〈0．001）。WMFT计时与FMA上肢评分相关系数为-0．732（P〈0．001），WMFT动作质量分级与FMA评分相关系数为0．838（P〈0．001）。结论：WMFT具有好的重测信度和标准效度。     

脑瘫患者粗大运动功能问卷的编制

目的编制脑瘫患者粗大运动功能问卷(CP-GMFQ),同时确定该问卷的信度、效度和反应度。方法共有160例脑瘫患者和家长参加此项研究,选取最初的27例对象进行重测信度研究(间隔7～18 d);在对所有研究对象进行GMFQ调查的同时进行中文版脑瘫粗大运动功能分级系统(GMFCS)和脑瘫粗大运动功能测试量表(GMFM)评价,确定GMFQ的平行效度;对随机选出的21例对象采用效应尺度进行反应度研究,在间隔3～7个月后再次进行GMFQ调查和GMFM评估;随机选取30例对象,进行GMFQ调查和GMFM测试所需时间的比较。结果GMFQ分具有良好的重测信度(ICC=0.9940);与GMFM各项分值和GMFCS评价之间具有良好的平行效度(相关系数=0.77～0.92);GMFQ分的效应尺度(0.34)介于GMFM88百分比与GMFM66分值之间;GMFQ调查的测试时间(平均4.7±1.6 min)显著少于GMFM测定(平均17.7±4.6 min)(P<0.001)。结论GMFQ具有良好的信度、效度和反应度,可以简便易行、科学合理地评价脑瘫患者的粗大运动功能。     

功能综合评定量表信度和效度的研究

目的 研究功能综合评定（functional comprehensive assessment,FCA)量表在评测脑血管病患者中的信度和效度。方法 运用FCA量表对10例脑血管病患者进行量表的信度和效度的研究，应用组内相关系数（intraclass correlation coefficients,ICC)表示量表的可信度，将FCA量表与简易精神状态检查表（mini-mental state examination,MMSE)评测法和Barthel指数（BI）评分法进行量表的效度研究。结果 FCA量表的信度较好，量表的决评分ICC＞0．9；FCA总分与BI、MMSE具有较好的相关性（P＜0．001），FCA运动评分与BI相关程度较高（r=0.993,P&;lt;0.001),FCA认知评分与MMSE也有较高的相关性（r=0.909,P&;lt;0.001)。结论 FCA具有较好的重测信度和效度，可作为脑血管病患者综合功能评定的评测量表。     

脑卒中影响量表的测试研究

目的探讨应用汉化的脑卒中影响量表（SIS）的可行性。方法使用汉化的SIS量表对130例中老年首发脑卒中患者发病后1个月时的生存质量进行评定，并对其中的105例患者在发病后进行为期3个月的随访评定。根据结果对该量表的信度、效度、反应度和可行性进行全面分析。结果SIS量表8个分量表和总量表中表示内部一致性的克朗巴赫α系数（Cronbach’s α）均〉0．8，重测结果的组内相关系数ICC（intraclasscorrelation coefficients，IOC）值均〉0．7（P〈0．05）。各分量表的Pearson相关系数均〉0．5（P〈0．05）。因子分析法提取的8个因子总共解释总体变量的80％。情绪、ADL／IADL、移动能力、参与4个方面及总分方面的变化差异有显著性（P〈0．05）。结论汉化SIS量表具有良好的信度、效度、反应度和可行性，可应用于临床和社区护士对中老年脑卒中患者的生存质量和护理效果的评定。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.