步行锻炼对慢性乙型肝炎患者肝功能和生活质量的影响

目的 为验证运动疗法促进肝功能恢复的假设，探讨步行锻炼对慢性乙型肝炎患者肝功能和生活质量的影响。方法 73例慢性乙型肝炎患者每天进行30min以上的匀速步行锻炼。持续2个月，同时给予药物治疗，68例对照组仅进行药物治疗。于开始步行锻炼和药物治疗前以及治疗结束后1周内，分别检测HBVM（HbsAg、抗-HBs、HbcAg、抗-Hbe及抗-HBc）、HBVDNA、肝、肾功能、血糖和血脂、血常规。采用健康调查简易量表（medical outcomes study,SF-36)评定生活质量指数（QLI）。结果 两组患者的多数肝功能指标均较治疗前有显著改善（x^2=2.784,P&;lt;0.05），但组间差异不明显（x^2=1.956-2.312,P&;gt;0.05）。治疗后步行锻炼组的SF-36生活质量问卷得分不仅明显高于治疗前（t=2.1-2.8,P&;lt;0.01-0.05），同时也伏于对照组（t=2.1-2.4,P&;lt;0.05）。两组的完全反应、部分反应和无反应例数分布接近，无明显差异（x^2=2.784,P&;gt;0.05）。结论 短期步行锻炼能显著改善慢性乙型肝炎患者的生活质量，但对肝功能指标影响不大。     

体能和呼吸肌锻炼对慢性阻塞性肺疾病患者运动耐受能力和生活质量的影响

目的探讨体能锻炼和呼吸肌锻炼对慢性阻塞性肺病患者运动能力和生活质量的影响。方法选择2003-07/12中国医科大学一院呼吸科门诊慢性阻塞性肺疾病缓解期患者49例,随机分成肺康复组(n=26)与对照组(n=23)。肺康复组进行药物治疗同时给予体能锻炼和呼吸肌锻炼,对照组仅在门诊取药治疗。两组均坚持治疗及锻炼24周。分别在治疗前及治疗后进行运动耐力和生活质量的评定。运动耐力采用6min步行距离评定,生活质量采用生活质量评分方法评定。生活质量评分方法根据质量高低依次为1,2,3,4分。1分为最好,分数越高则生活质量越差。结果①治疗后肺康复组患者6min步行距离较治疗前明显延长犤(412.53±58.12),(328.73±52.13)m,P<0.01犦。②治疗后肺康复组生存质量评分的总均分较治疗前有所降低(2.19±0.35,2.64±0.42,t=5.64,P<0.01);对照组治疗前后评分相似(2.60±0.36,2.62±0.41,t=1.64,P>0.05)。结论体能锻炼和呼吸肌锻炼改善了慢性阻塞性肺疾病患者的运动耐受能力和生活质量。     

太极拳运动对慢性心脏衰竭患者心功能及生活质量的影响

目的观察太极拳对慢性心脏衰竭患者心功能及其生活质量的影响。 方法将慢性心脏衰竭患者61例采用随机数字表法分为太极拳组(31例)及对照组(30例)。2组患者均给予常规药物治疗,对照组患者保持原生活习惯,太极拳组患者则进行太极拳锻炼,每日1次,每次≥30min。2组患者均于治疗前（入组后当天）和治疗6个月后（治疗后）进行左心室射血分数（LVEF）、左心室舒张末期内径（LVEDd）、6min步行距离（6-MWT）、脑钠肽（BNP）、肌钙蛋白T（cTNT）检测,并采用汉化版简明健康状况调查表（SF-36）评定2组患者治疗前后的生活质量。 结果治疗后,对照组患者仅cTNT的含量与组内治疗前比较,差异有统计学意义(P<0.05),而太极拳组患者的6-MWT、BNP和cTNT分别为（371±26）m、（432±57）ng/L和（872±74）ng/L,与组内治疗前和对照组治疗后比较,差异均有统计学意义(P<0.05)。治疗后,对照组患者SF-36量表中各项评分与组内治疗前比较,差异均无统计学意义(P>0.05),而太极拳组患者SF-36量表中各项评分与组内治疗前和对照组治疗后比较,差异均有统计学意义 (P<0.05)。 结论太极拳运动可显著提高慢性心脏衰竭患者的心功能和生活质量。     

PDCA循环对慢性乙型肝炎患者生存质量、不良情绪及治疗依从性的影响

目的探讨PDCA循环对慢性乙型肝炎患者生存质量、心理状态及治疗依从性的影响。方法选取该院2018年3月至2019年3月治疗的慢性乙型肝炎患者78例, 随机均分为观察组和对照组, 每组39例。对照组行常规护理, 观察组行PDCA循环护理, 分析两组患者生存质量、心理状态及治疗依从性。结果干预前两组生活质量MOS SF-36各项评分差异不显著;干预4 w、8 w后观察组生活质量MOS SF-36各项评分结果均显著优于对照组, 差异有统计学意义(P<0.05);干预前两组HAMA、HAMD评分差异不显著;干预4 w、8 w后观察组HAMA、HAMD评分结果均显著优于对照组, 差异有统计学意义(P<0.05);干预前两组治疗依从性评分差异不显著;干预4 w、8 w后观察组治疗依从性评分结果均显著优于对照组, 差异有统计学意义(P<0.05)。结论 PDCA循环护理模式能够显著提高慢性乙型肝炎患者生存质量、心理状态, 提高患者治疗依从性。     

复方甘草酸苷联合丹参治疗慢性乙型肝炎50例疗效观察

目的观察复方甘草酸苷注射液联合丹参治疗慢性乙型肝炎对肝功能及肝纤维化指标的影响。方法随机选取100例慢性乙型肝炎患者,50例为治疗组,50例为对照组,两组在性别、年龄、病程、HBV标记物、肝功能检验等方面差异均无统计学意义(P<0.05)。治疗组用复方甘草酸苷注射液联合丹参注射液进行治疗,对照组用还原性谷胱甘肽注射液进行治疗,疗程两组均为3周,观察其肝功能及肝纤维化指标的变化。结果治疗组对肝功能及肝纤维化指标方面的改善明显优于对照组(P<0.05)。结论复方甘草酸苷注射液联合丹参治疗慢性乙型肝炎患者具有良好的抗纤维化疗效。     

摄食训练结合舌压抗阻反馈锻炼康复方案对重症脑卒中患者吞咽功能的影响

目的：探讨摄食训练结合舌压抗阻反馈锻炼康复方案对重症脑卒中患者的影响。方法：选取2020年1月1日～2022年12月31日收治的108例重症脑卒中患者,按随机数字表法分为对照组和观察组各54例,对照组采用常规康复指导,观察组在对照组基础上实施摄食训练结合舌压抗阻反馈锻炼康复方案,两组均治疗6周。比较两组治疗前后吞咽功能[采用Rosenbek渗透-误吸量表(PAS)]、吞咽障碍程度(VGF)、生活质量[采用吞咽障碍特异性生活质量量表(SWAL-QOL)]、肺炎发生率、日常生活活动能力[采用改良Barthel指数(MBI)]、神经功能指标[采用国际协作性脑卒中试验(ISS)]及生活质量[采用36项健康调查问卷(SF-36)]。结果：治疗后,两组PAS、VGF评分低于治疗前(P<0.01),且观察组低于对照组(P<0.05);两组SWAL-QOL评分高于干预前(P<0.01),且观察组高于对照组(P<0.05);观察组ADL评分、SF-36评分高于对照组(P<0.01),肺炎发生率、ISS评分低于对照组(P<0.01)。结论：摄食训练结合舌压抗阻反馈锻炼康...     

针灸联合中药热敷对慢性腰肌劳损患者腰椎功能、疼痛程度及生活质量的影响

【目的】探讨针灸联合中药热敷对慢性腰肌劳损患者腰椎功能、疼痛程度及生活质量的影响。【方法】选取2016年1月至2018年12月在本院诊治的70例慢性腰肌劳损患者作为研究对象,根据数字奇偶法分为对照组与现察组,每组35例,其中对照组给予针灸治疗,观察组在对照组基础上加用中药热敷治疗。比较两组患者临床疗效、视觉糢拟评分(VAS)、Oswestry功能障碍指数(CODI)、简易生活质量调查量表评分(SF-36)。【结果】治疗2周后,观察组总有效率为94.29%(33/35),显著高于对照组的77.14%(27/35),其差异有统计学意义(χ^2=4.200,P=0.040)。治疗前,两组患者VAS、CODI、SF-36比较差异均无统计学意义(P>0.05);治疗后,两组患者VAS、CODI、SF-36均优于治疗前,且观察组优于对照组,其盖异均有统计学意义(均P<0.05)。【结论】针灸联合中药热敷治疗慢性腰肌劳损患者,临床疗效显著,可减轻慢性腰肌劳损患者的疼痛程度,改善患者腰椎功能障碍情况,提高患者的生活质量,值得临床推广应用。     

生物信息红外肝病治疗仪治疗慢性乙型肝炎的疗效观察与护理

目的:观察生物信息红外肝病治疗仪治疗慢性乙型肝炎的疗效。方法:将98例慢性乙型肝炎患者随机分两组,对照组49例,予以常规药物治疗;治疗组49例,在常规药物治疗的基础上加用生物信息红外肝病治疗仪照射肝区。观察治疗前后患者临床症状、体征、肝功能及其生物化学指标的变化。结果:治疗1个月后,治疗组的谷丙转氨酶、谷草转氨酶、总胆红素指标明显降低(P<0.05),白蛋白升高(P<0.05),同时乏力、纳差、腹胀、肝区不适症状明显好转,治疗组优于对照组(P<0.05,P<0.01)。结论:生物信息红外肝病治疗仪治疗慢性乙型肝炎疗效显著,能改善肝脏微循环,调动人体的免疫功能,协同药物治疗作用,促进肝病康复。     

社会支持对慢性乙型肝炎患者生活质量的影响

目的:调查慢性乙型肝炎患者的社会支持状况,分析其与生活质量的关系。方法:以2002-12/2004-12高州市人民医院收治的58例慢性乙型肝炎患者为观察对象,年龄≥18岁。所有患者接受生活质量自评量表测评,≥124.30分为高评分组(n=41),<124.30分为低评分组(n=17),应用社会支持评定量表评价慢性乙型肝炎患者的社会支持水平,分析社会支持水平与生活质量的相关性。总体生活质量分数为50～250分,分数越高表示生活质量越高。社会支持评定量表得分越高,说明患者获得越多的社会支持。结果:58份问卷均完整合格,全部纳入分析。58例慢性乙型肝炎患者的总体生活质量的平均分为(124.30±25.34)分。①主观支持评分:高评分组在与朋友、同事、邻居和家庭成员关系等4项上的评分均高于低评分组(t=2.132～2.459,P<0.05)。②客观支持评分:高评分组患者在近1年居住环境、既往遇到困难时获得的经济支持和精神安慰来源3项上得分均高于低评分组(t=2.113～2.358,P<0.05)。③个人利用度:高评分组患者在遇到烦恼时的倾吐方式、求助方式以及参与各类团体组织活动等3项上得分高于低评分组(t=2.127～2.235,P<0.05)。结论:高生活质量者不论主观支持、客观支持还是个人利用度方面评分结果均高于低生活质量者,说明慢性乙型肝炎患者的生活质量与社会支持程度密切相关。     

酒精性肝病患者健康相关生存质量研究

目的研究酒精性肝病患者健康相关生存质量及其与疾病严重程度的关系以及对比酒精性肝病与慢性乙型肝炎患者健康相关生存质量的差别。方法 2010年12月至2011年10月收治的70例男性酒精性肝病患者(非肝硬化组45例,肝硬化组25例),56例男性慢性乙型肝炎患者(非肝硬化组24例,肝硬化组32例)以及42例男性健康对照组受试者参与试验。所有受试者回答SF-36V2(中文版)量表,通过SF-36V2软件计算出:生理功能、生理职能、躯体疼痛、总体健康、活力、社会功能、情感职能、精神健康共8个维度,以及躯体健康总评和精神健康总评。使用协方差分析对比健康对照组,酒精性肝病非肝硬化组,以及酒精性肝病肝硬化组健康相关生存质量;对比酒精性肝病与慢性乙型肝炎患者健康相关生存质量。结果和健康对照组相比,酒精性肝病患者随着疾病的加重,SF-36V2各维度评分明显降低(P<0.05)。酒精性肝病非肝硬化组患者较慢性乙型肝炎非肝硬化组患者仅生理功能、生理职能、活力、躯体健康总评四项评分轻度受损(P<0.05)。酒精性肝病肝硬化组与慢性乙型肝炎肝硬化组患者SF-36V2各维度评分相似(P>0.05)。结论酒精性肝病患者健康相关生存质量降低,且病情越重,健康相关生存质量越差。酒精性肝病患者健康相关生存质量与慢性乙型肝炎患者相似。     

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.     

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.     

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.     

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.     

Clinical Trial Updates and Hotline Sessions presented at the European Society of Cardiology Congress 2007

This article provides information and commentaries on trials which were presented at the Hotline and Clinical Trial Update Sessions at the European Society of Cardiology Congress 2007 in Vienna. The key presentations were performed by leading experts in the field with relevant positions in the trials or registries. It is important to note that unpublished reports should be considered as preliminary data, as the analysis may change in the final publications. The comprehensive summaries have been generated from the oral presentation and the webcasts of the European Society of Cardiology and should provide the readers with the most comprehensive information of relevant publications.     

Balance and Boundaries in Grief Counseling: An Intervention Framework for Volunteer Training

Volunteers or paraprofessional counselors are commonly used to provide supportive care to the bereaved. These counselors generally are trained in basic listening skills, providing a generic, nonspecific approach to intervention that remains to be proven effective. The present paper outlines a framework that provides paraprofessionals with a broader model for intervention with the bereaved. Attention to boundaries as a helper and balance in the grief recovery are central to the model. Interventions are described that provide the paraprofessional counselor with more options for tailoring their counseling strategy to the individual. These include techniques that are presumed to be more specific to the enhancement of grief recovery.     

A new method for the simultaneous analysis of unmodified and modified urinary nucleosides and nucleobases by high performance liquid chromatography

Details are given of a new, rapid and simple pre-fractionation method and an isocratic high performance liquid chromatography system suitable for parallel analysis of nucleosides and nucleobases from urine and other biological fluids. The quantitative recovery and excellent reproducibility of the method is demonstrated by analysis of representative standard RNA catabolites. The advantage of this new method for application to biological samples is discussed.     

Adsorption of Charged Non-albumin Bound Drugs by Amorphous Silica

We investigated the in vitro drug adsorption of PQ 10150 sodium silicate gel (AIS, Santa Clara, CA) with particle size of 230 um and surface area of 400 nr/g. We observed 99% to 88% adsorption of gentamicin; a mean 91 % of disopyramide; a mean 89% of quinidine at low concentration, falling to 75% at higher concentration. Insulin was 88% adsorbed at low concentrations but less so (65%) at higher concentrations. We observed a mean 83 % adsorption of procainamide, a mean 84% of N-acetyl procainamide, 74% oflidocaine, 73% of amitriptyline; and 44% of desipramine. We found an average 14% reduction of total digoxin concentration when serum containing digoxin (2 to 33 ng/mL) was exposed to sodium silicate, while the reduction in free digoxin concentration was 16%. Five percent ethosuximide was also removed. The adsorption of theophylline, phenobarbital, acetaminophen, phenytoin, ethylene glycol, methotrexate, salicylate, thiocyanate and diazepam was minimal and not significant. We conclude that significant amounts of charged, non-albumin bound drugs can be removed by PQ 10150 sodium silicate gel.