中医针灸结合综合康复训练治疗小儿孤独症的疗效观察

目的:观察中医针灸结合综合康复训练治疗小儿孤独症的临床疗效。方法:选取2015年6月~2017年7月我院收治的孤独症患儿64例,随机分为对照组和实验组各32例。对照组采用综合康复训练,实验组在对照组基础上联合中医头穴针灸治疗,比较两组治疗前后行为评分(ABC)量表、孤独症评分(CARS)及社会生活能力(SM)评分情况。结果:治疗前,两组ABC、CARS及SM评分比较无显著性差异(P>0.05);治疗后,两组均有所改善,且观察组改善程度优于对照组(P<0.05)。结论:采用中医针灸结合综合康复训练治疗小儿孤独症,可有效缓解患儿临床症状,改善社会生活能力,有利于疾病的转归和预后。     

行为分析疗法联合语言训练对孤独症患儿的康复效果观察

目的探讨行为分析疗法联合语言训练对孤独症患儿的康复效果。方法采用便利抽样法选择某院2017年1月至2018年6月收治的孤独症患儿60例,随机数表法分为观察组和对照组,每组各30例。对照组给予物理治疗、听觉及感觉统合训练等常规康复治疗,观察组给予行为分析疗法联合语言训练。观察两组干预效果。结果观察组总有效率86.7%,对照组为66.7%,观察组优于对照组,P0.05;两组患儿经干预后孤独症儿童行为量表(ABC)均较治疗前明显下降,且观察组治疗后ABC评分明显低于对照组,P0.05;两组儿童孤独症评定量表(CARS)评分均较治疗前明显下降,且观察组治疗后CARS评分明显低于对照组,P0.05。结论行为分析疗法联合语言训练治疗孤独症,能有效改善患儿躯体应用能力,帮助患儿的功能障碍恢复,对孤独症患儿的康复具有非常重要的价值。     

超低频经颅磁刺激联合康复训练对孤独症谱系障碍儿童的疗效

目的:探讨超低频经颅磁刺激联合康复训练包括应用行为分析疗法、言语治疗、感觉统合训练对孤独症谱系障碍儿童的治疗效果。方法:选择60例孤独症谱系障碍儿童进行临床研究,随机分为观察组和对照组,每组各30例;2组患儿均接受应用行为分析疗法、感觉统合训练和言语治疗,观察组在对照组的基础上加用超低经颅磁刺激治疗。治疗前后分别采用孤独症行为量表(ABC)和儿童孤独症评定量表(CARS)进行评估,并比较2组核心症状的改善率,以观察临床治疗效果。结果:治疗12周后,2组的ABC及CARS评分均较治疗前明显减少(P0.05)。治疗后,观察组的核心症状总改善率明显高于对照组(P0.05)。结论:超低频经颅磁刺激联合应用行为分析疗法、言语治疗和感觉统合训练可能会更有效地改善孤独症谱系障碍儿童的临床症状。     

综合干预对农村孤独症儿童行为症状及智力发育的影响

目的 探讨综合干预对农村孤独症儿童行为症状及智力发育的影响.方法 对80例农村孤独症患儿进行早期综合干预.在干预前和干预后6个月,采用儿童孤独症评定量表(CARS)、孤独症儿童行为检查量表(ABC)、丹佛发育筛查测验(DDST)对干预效果进行评估.结果 干预前后孤独症患儿各个量表得分比较,差异均有统计学意义(P＜0.05或P＜0.01).结论 早期综合干预能改善农村孤独症患儿的行为症状及智力发育,对其早日回归社会起着重要作用.     

医院康复训练联合家庭康复护理干预在自闭症患儿中的效果观察

目的 观察医院康复训练联合家庭康复护理干预在自闭症(ASD)患儿中的效果。方法 选取就诊的80例ASD患儿,根据随机数字表法分为对照组和观察组各40例。对照组应用常规护理,观察组在对照组基础上联合应用家庭康复护理,均护理2个月,比较两组孤独治疗评估量表评分(ATEC)、孤独症行为量表评分(ABC)、儿童孤独症评定量表(CARS)评分与护理满意度。结果 护理2个月后,观察组TEC、ABC与CARS评分低于对照组,护理满意度高于对照组,差异有统计学意义(P0.05)。结论 医院康复训练联合家庭康复护理干预能显著提高ASD患儿语言与社会交往能力,促使患儿康复,且护理满意度较高,值得推广。     

听觉统合训练联合家庭康复训练在儿童孤独症康复治疗中的应用效果

目的探讨听觉统合训练联合家庭康复训练在儿童孤独症康复治疗中的应用效果,为孤独症患儿治疗提供参考。方法选取2015年7月至2016年12月在我院接受康复治疗的孤独症儿童100例作为研究对象,按照入院顺序编号,采用随机数字表法等分为试验组和对照组,试验组共45例完成研究,对照组共43例完成研究。对照组实施常规康复训练,试验组在对照组的基础上采用听觉统合训练联合家庭康复训练。干预1年后对两组患儿使用孤独症儿童行为评定量表(ABC)、心理教育评定量表中文修订版(C-PEP)中发展量表、孤独症治疗评估量表(ATEC)进行评估。结果干预前两组患儿ABC量表、发展量表、ATEC量表评分比较差异无统计学意义(P 0. 05)。干预1年后两组患儿ABC量表、ATEC量表各维度评分和总分明显低于干预前,试验组明显低于对照组(P 0. 05);干预1年后两组患儿发展量表各维度评分和总分均明显高于干预前,试验组明显高于对照组(P 0. 05)。结论听觉统合训练联合家庭康复训练是治疗儿童孤独症的有效方法,能够明显改善症状,提高发展能力,值得推广应用。     

精神运动联合应用行为分析对孤独症康复效果的影响

目的:探讨精神运动康复学诊疗技术联合应用行为分析训练对孤独症儿童的治疗效果的影响。方法:选取2019年3月至2019年10月江苏大学附属医院儿科儿童康复中心诊治的40例轻到中度孤独症儿童,将其以随机数字表法分为观察组与对照组,每组各20例。对照组给予应用行为分析法训练,观察组的治疗是在对照组基础上给予精神运动康复学诊疗技术,治疗时间为6个月。采用儿童孤独症评定量表(Childhood Autism Rating Scale,CARS)、孤独症儿童行为检查量表(Autism Behavior Checklist,ABC)、Gesell发育量表(Gesell Developmental Scale,GDS)评价两组患儿的康复效果和临床疗效,观察两组干预效果。结果:观察组的CARS评分及ABC评分均低于对照组,差异有统计学意义(P0.05)。观察组的GDS各项评分高于对照组,差异有统计学意义(P0.05)。结论:精神运动康复学诊疗技术联合应用行为分析训练孤独症儿童,可有效改善患儿躯体应用能力,帮助患儿的功能障碍恢复,对孤独症患儿的康复具有非常重要的价值。     

多感官训练系统对孤独症患儿人际交往能力及家属满意度的影响

目的分析多感官训练系统对孤独症患儿人际交往能力及家属满意度的影响。方法选取86例孤独症患儿,随机分为对照组(n=43)与观察组(n=43),对照组实施常规训练模式,观察组在对照组基础上采用多感官训练系统进行训练,比较2组患儿护理前后人际交往状况[采用儿童孤独症评定量表(child autism rating scalc,CARS)和孤独症行为评定量表(autism behavior checklist,ABC)评定]及患儿家属对训练方式的满意度。结果训练前2组患儿CARS和ABC评分差异无统计学意义(P>0.05),训练后2组患儿CARS和ABC评分均降低,且观察组优于对照组(均P<0.05);观察组患儿家属对训练方式的满意度高于对照组(93.02%比76.74%,P<0.05)。结论在孤独症患儿康复训练中,相较于常规训练方式,联合使用多感官训练系统训练,利于提升患儿人际交往能力及患儿家属对训练方式的满意度。     

iPad及软件对孤独症儿童康复训练的效果:4例报道

目的探索以i Pad支持的"语你同行"软件运用于孤独症儿童康复训练中的方式方法。方法 2015年3~9月,将以i Pad支持的"语你同行"软件应用于不同程度的4例孤独症儿童,对其语言能力、行为情绪控制能力、自我意识、目光交流状态进行观察。采用孤独症儿童心理教育量表-3(PEP-3)对其沟通能力进行评估,孤独症儿童行为量表(ABC)评定孤独症儿童行为特征,儿童孤独症评定量表(CARS)评价儿童孤独症严重程度。结果患儿语言能力、行为情绪控制能力提升,问题行为发生减少;自我意识、目光交流状态均提升。PEP-3对应的月龄提升;ABC评分、CARS评分降低。结论 i Pad"语你同行"软件作为沟通媒介可尝试应用于孤独症儿童日常康复训练。     

医疗机构康复训练联合家庭康复训练治疗儿童孤独症效果分析

目的探讨医疗机构康复训练联合家庭康复训练治疗儿童孤独症的临床效果。方法将2012年2月—2015年5月西安市儿童医院收治的128例儿童孤独症随机分为联合组和常规组两组各64例,联合组采用医疗机构康复训练联合家庭康复训练治疗,常规组仅采用医疗机构康复训练治疗。观察比较两组治疗前和治疗12个月后孤独症儿童行为检查量表(ABC)、孤独症治疗评估表(ATEC)及中国版心理教育量表(C-PEP)评分。结果治疗前两组ABC、ATEC及C-PEP各方面评分及总评分比较差异均无统计学意义(P0.05)。治疗12个月后,联合组ABC、ATEC各方面评分及总评分均明显低于常规组,C-PEP各方面评分及总评分均明显高于常规组,差异有统计学意义(P0.05)。结论医疗机构康复训练联合家庭康复训练治疗儿童孤独症可显著改善患儿病情,消除患儿心理障碍。     

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.     

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.     

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.