Fugl—Meyer量表在社区脑卒中康复疗效评定中的应用

目的：运用Fugl—Meyer量表评定社区脑卒中康复疗效、判断其可行性。方法：对313例社区脑卒中偏瘫的患者分康复治疗组和对照组，运用偏瘫实用训练技术进行康复治疗3个月。治疗组在康复治疗前、治疗1个月、治疗2个月、治疗3个月利用Fugl—Meyer量表对肢体功能进行评定。对照组仅做定期跟踪康复评定。评定内容同治疗组。结果：①康复治疗前后肢体运动功能有明显改善，治疗前后Fugl～Meyer评分差异有高度显著性（P〈0．001）。②康复治疗组较对照组效果好，治疗2个月后两组间Fugl—Meyer评分差异有高度显著性（P〈0．001）。结论：运用Fugl—Meyer量表可显示出社区脑卒中患者的康复疗效，该量表可以在社区作为评定标准使用。     

家庭康复计划对脑卒中偏瘫患者运动功能恢复的影响

目的 观察家庭康复计划对脑卒中偏瘫患者运动功能恢复的影响。方法 将64例脑卒中偏瘫患者随机分为康复计划组和对照组各32例，两组患者住院期间均接受系统康复治疗。出院回家后，康复计划组严格按照康复计划所规定的时间和内容进行康复训练．并每2周来康复门诊评估指导一次；对照组在每天训练与否、训练时间和训练内容等方面完全由自己掌握。采用Fugl—Meyer评测法（FMA）及改良Barthel指数（MBI）分别于治疗前、治疗5个月后对两组患者进行评定。结果 治疗5个月后，两组患者的FMA评分和MBI评分均较治疗前显著提高（P〈0．001），但康复计划组的康复效果显著优于对照组（P〈0．001）。结论 家庭康复计划可以明显促进脑卒中偏瘫患者运动功能的恢复。     

功能位及肢体运动护理对脑卒中患者运动功能和日常生活活动能力的影响

目的 探讨早期康复护理对偏瘫患者肢体运动功能的影响。方法 脑卒中偏瘫患者69例随机分，康复组和对照组。对康复组患者给予早期康复护理及功能训练，对照组只接受常规的神经内科治疗与护理。分别于2，4周后采用Barthel指数和简化Fugl—Meyer运动功能评分法对患者进行评定，并对治疗前后的结果进行对照分析。结果 进行早期康复护理和功能训练的患者，Barthel指数和简化Fugl—Meyer得分明显高于对照组患者。结论 脑卒中偏瘫患者给于早期康复护理和功能训练能明显提高患者的肢体运动功能和生括自理能力，降低致残率。     

不同发病性质脑卒中患者早期功能损伤特点和康复效果的相关性分析

目的 探讨不同发病性质脑卒中患者发病早期的功能损伤特点及其与康复治疗后功能独立性的相关程度。方法 将79例住院脑卒中患者分为脑出血组和脑梗死组。治疗前，采用欧洲脑卒中量表（ESS）评定患者神经功能损伤情况，采用改良巴氏指数（MBI）评定患者日常生活活动能力，采用简明精神状态检查量表（MMSE）评定患者认知功能，采用Sheikh法躯干控制测定（Sheikh法）评定患者躯干控制能力，采用Fugl—Meyer平衡量表（FMB）评定患者平衡功能，采用Fugl—Meyer运动量表（FMA）评定患者肢体运动功能。康复治疗1个月后，采用功能独立量表（FIM）对患者功能独立性进行评定。结果 组间比较显示，脑出血患者治疗前日常生活活动能力（MBI）、躯干控制能力（Sheikh法）、平衡能力（FMB）以及治疗后功能独立性（FIM）评分均较脑梗死组低（P〈0．01）。直线相关分析表明，除脑出血组FMA评分和FIM评分中度相关（P〈0．005）。脑梗死组MMSE评分和FIM评分低度相关外（P〈0．05），2组其余初评指标均与FIM评分高度相关（P〈0．001）。多元线性回归分析发现，脑出血组中，MMSE评分、FMB评分、ESS评分为FIM评分有意义的自变量；脑梗死组中，MBI评分、MMSE评分、ESS评分、FMA评分为FIM评分有意义的自变量。结论脑出血患者发病早期．日常生活活动能力、躯干控制能力和平衡能力较脑梗死患者差，经康复治疗后，其功能独立性较脑梗死组差。脑出血患者发病早期的平衡功能、认知功能和神经功能缺损与其治疗后功能独立性依次相关；脑梗死患者发病早期的认知功能、神经功能缺损、日常生活活动能力、肢体运动功能则与其治疗后功能独立性依次相关。     

社区家庭康复护理对城市社区脑卒中病人心理状况的影响

[目的]探讨社区家庭康复护理对城市社区脑卒中病人心理状况的影响。[方法]将34倒首发脑卒中出院病人随机分成两组，干预组由社区护士按“小组教育＋康复训练＋文体疗法”方案实施干预；对照组为传统的家庭疗养，不施加干预。评价两组病人入组时及1个月、3个月时：心理状况（抑郁状态问卷，DIS）和偏瘫肢体的运动功能（简化Fugl—Meyer运动功能评定量表FIM）。[结果]两组间FIM、DIS评分比较，干预后1个月及3个月时干预组FIM评分高于对照组、DIS评分低于对照组，差异有统计学意义（P〈0．05）。[结论]社区家庭康复护理干预能明显改善城市社区脑卒中病人的心理状况，促进神经功能康复，改善预后。     

减重步行训练对脑卒中早期偏瘫患者步行能力恢复的影响

目的探讨减重步行训练对脑卒中早期患者步行能力恢复的影响。方法将60例脑卒中偏瘫患者随机分成2组，减重组30例，行减重步行训练加常规康复治疗；对照组30例，仅行常规康复训练。用Fugl—Meyer下肢运动功能评分、Fugl-Meyer平衡功能评分、改良Ashworth法肌张力评级和Holder步行功能分级进行训练前、后评定。结果经过4周治疗后。2组患者Fugl—Meyer下肢运动功能评分、Fugl-Meyer平衡功能评分、肌张力评级和步行功能分级较治疗前明显改善（P〈0．01），但减重组Fugl—Meyer下肢运动功能评分、肌张力评级、步行功能分级改善均明显优于对照组（P〈0．05）。结论减重步行训练加常规康复治疗对脑卒中早期患者步行功能恢复具有明显促进作用。     

脑卒中患者肢体运动功能的综合康复治疗

对26例脑卒中患者采用以运动疗法为主的综合技术进行康复治疗，以Fugl－Meyer评分法进行功能评定。结果：经综合治疗的患者肢体运动功能，Fugl－Meyer总分比治疗前有极显著性差异（P＜0．01）。而平衡、感觉功能、关节活动度、关节疼痛等治疗后亦较治疗前有明显改进，但无统计学意义。早期（＜3个月）进行治疗的患者其肢体功能评分较非早期组高（P＜0．01）。表明脑卒中偏瘫的综合治疗效果明显，早期治疗效果优于非早期治疗。     

社区康复护理对外伤性截瘫患者生活质量的影响

目的：探讨社区康复护理对截瘫患者生活质量的影响。方法：将63例外伤性截瘫患者随机分为观察组和对照组。对照组按常规进行健康教育和出院指导，观察组出院后由社区进行康复护理。采用FIM量表和改良式Fugl—Meyer量表对患者的活动能力及肢体运动能力进行评分；观察并发症的发生情况。分别于出院时、2个月、6个月进行评定。结果：观察组2个月和6个月FIM和Fugl—Meyer评分明显优于对照组；关节僵硬、肌肉萎缩、骨质疏松等并发症发生率明显低于对照组。结论：社区康复护理能明显改善外伤性截瘫患者的肢体运动功能，增强日常活动能力，降低并发症，可有效地提高患者的生活质量。     

早期肢体康复护理在脑卒中偏瘫患者护理中的意义

目的探究早期肢体康复护理在脑卒中偏瘫患者护理中的意义。方法采用随机数字表法将112例患者随机分为观察组和对照组各56例,对照组采用常规护理方法进行护理,观察组采用早期肢体康复护理方法进行护理,比较治疗后2组患者的日常活动能力、Barthel指数和Fugl—Meyer评分以及治疗效果。结果观察组患者的日常生活活动能力评分、Barthel指数和Fugl—Meyer评分均优于对照组（P〈0．05）,观察组患者治疗的总有效率高于对照组（P〈0．05）。结论早期肢体康复护理在脑卒中偏瘫患者的护理中具有重要意义,值得临床推广。     

早期康复护理对脑卒中偏瘫患者功能恢复的影响

目的探讨早期康复护理对脑卒中偏瘫患者功能恢复的影响。方法将90例脑卒中偏瘫住院患者随机分为实验组45例和对照组45例。实验组给予早期康复护理，对照组给予常规护理。分别于治疗前和治疗后第30d进行评定。肢体运动功能采用简化Fugl—Meyer运动功能评分量表（FMA）评定，日常生活能力采用国际通用量表Barthel指数（BI）评定。结果治疗后，两组FMA、BI与治疗前比较差异有统计学方法（P〈0．01或P〈0．05），实验组FAM、BI较对照组改善更为明显（P〈0．01）。结论早期康复护理可明显提高患者的日常生活能力和肢体运动功能。     

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.     

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.     

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.     

自动化酸碱平衡图在急诊社区获得性肺炎诊治中的应用

目的 探讨自动化酸碱平衡图在急诊科社区获得性肺炎(CAP)患者诊断中的价值.方法 根据病史、肺功能测定结果、慢性阻塞性肺疾病(COPD)诊断标准,将111例CAP患者分为单纯CAP组(56例)和COPD合并CAP组[即慢性阻塞性肺疾病急性加重(AECOPD)组,55例].询问患者病史后即刻抽取动脉血测血气并进行自动化酸碱平衡图分析.结果 血气分析结果显示,AECOPD组动脉血二氧化碳分压(PaCO2,kPa)、HCO3- (mmol/L)、剩余碱(BE,mmol/L)均显著高于CAP组(PaCO2:7.714±2.414比5.896±1.308,HCO3-:30.767±7.185比25.014±3.043,BE:4.345±5.371比-0.354±3.180,均P＜0.01).自动化酸碱平衡图分析结果显示,AECOPD组患者酸碱平衡紊乱高达89.1％,CAP组为66.1％.将AECOPD组和CAP组患者中正常(10.9％、33.9％)、急性呼吸性酸中毒(急性呼酸,12.7％、14.3％)、慢性呼吸性酸中毒(慢性呼酸,49.1％、10.7％)、呼吸性碱中毒(呼碱,7.3％、14.3％)、代谢性酸中毒(代酸,12.7％、17.9％)、代谢性碱中毒(代碱,12.7％、8.9％)综合进行x2分析,差异有统计学意义(x2=24.421,P=0.001),而将正常、急性呼酸、呼碱、代酸及代碱进行x2分析,差异无统计学意义(x2=5.280,P=0.260),提示AECOPD患者慢性呼酸的发生率较单纯CAP患者显著增加.结论 自动化酸碱平衡图能帮助急诊科医师快速识别CAP患者是否存在多重酸碱平衡紊乱,并可快速识别急、慢性呼吸系统疾病.