脑瘫儿童功能独立检查的测量研究

采用儿童功能独立检查法（ＷｅｅＦＩＭ）对３０例脑瘫（ｃｅｒｅｂｒａｌｐａｓｌｙ，ＣＰ）儿童进行测量，并与儿童适应行为量表（ＣＡＢＳ）比较，探讨儿童功能独立检查在ＣＰ儿童残疾组类使用的有效性，统计结果显示３０例ＣＰ儿童的ＷｅｅＦＩＭ总分和适应证商数（ＡＤＱ）基本呈正态分析，ＷｅｅＦＩＭ总分，分组及各维度与ＡＤＱ之间的总体相关系数为０．７９５１与ＣＡＢＳ独立功能因子，ＣＡＢＳ认知功能因子，ＣＡＢＳ社会     

脑卒中病损评估量表中的运动功能部分的有效性研究

目的：探讨脑卒中病损评估量表中的运动功能部分（ＳＩＡＳＭ）对脑卒中偏瘫患者进行运动功能评定的有效性和可行性。方法：应用ＳＩＡＳＭ对５３例脑卒中偏瘫患者的运动功能进行评测,并与简式ＦｕｇｌＭｅｙｅｒ运动功能评价法（ＦＭＡ）及Ｂａｒｔｈｅｌ指数评定法（ＢＩ）进行相关分析比较。结果：ＳＩＡＳＭ总分与ＦＭＡ总分显著相关（ｒ＝０．９５４５,Ｐ＜０．００１）,ＳＩＡＳＭ上肢分与ＦＭＡ上肢分显著相关（ｒ＝０．９７７６,Ｐ＜０．００１）,ＳＩＡＳＭ下肢分与ＦＭＡ下肢分显著相关（ｒ＝０．９３２９,Ｐ＜０．００１）,ＳＩＡＳＭ总分、ＳＩＡＳＭ上肢分、ＳＩＡＳＭ下肢分与ＢＩ得分均显著相关（ｒ１＝０．７６９４,ｒ２＝０．６３０１,ｒ３＝０．７５５２,Ｐ＜０．００１）。结论：ＳＩＡＳＭ是有效的,并且简便、实用,能敏感地反映偏瘫患者运动功能的变化,值得在国内推广应用     

脑梗塞患者日常生活活动能力与脑血流量的关系

目的：研究脑梗塞患者日常生活活动能力（ＡＤＬ）与脑血流量（ＣＢＦ）的关系。方法：随机选择６０例脑梗塞患者，发病３天及１个月后分别评定Ｂａｒｔｈｅｌ指标，Ｆｕｇｌ－Ｍｅｙｅｒ肢体运动功能积分，１３３Ｘｅ吸入法测定ＣＢＦ。结果：２次Ｂａｒｔｈｅｌ指数评分差值与大脑平均血流量差值呈正相关，ｒ＝０．７８，Ｐ＜０．０１；亦与病灶及其周围区血流量差值呈正相关，ｒ＝０．９２，Ｐ＜０．０１；Ｆｕｇｌ－Ｍｅｙｅｒ肢体运动功能评分差值与大脑平均血流量差值、病灶及其周围区血流量差值亦呈正相关，ｒ＝０．８９及０．８４，Ｐ＜０．０１。结论：脑血流量的恢复有利于ＡＤＬ、肢体运动功能的恢复。     

选择性脊神经后根切断术前的医疗康复残疾测量初探

目的：探讨选择性脊神经后根切断术（ＳＰＲ）术前的医疗康复残疾测量和功能预后预测。方法：使用儿童功能独立检查（ＦｕｎｃｔｉｏｎａｌＩｎｄｅｐｅｎｄｅｎｔＭｅａｓｕｒｅｆｏｒＣｈｉｌｄｒｅｎ,简称ＷｅｅＦＩＭ）和临床神经肌肉系统障碍程度分级的方法评定２３例痉挛性脑瘫（ＳｐａｓｔｉｃＣｅｒｅｂｒａｌＰａｌｓｙ,ＳＣＰ）患者的功能状态。结果：各年龄组ＷｅｅＦＩＭ总分、行动和步行等与障碍程度的排序是一致的,结论：ＷｅｅＦＩＭ可作为基本的功能预后预测指标为ＳＰＲ手术及手术前后康复治疗方案的制定提供依据。     

慢性阻塞性肺疾病急性加重期床旁监测最大吸气流速的意义

对５２例慢性阻塞性肺疾病（ＣＯＰＤ）患者进行床旁最大吸气流速（ＭＩＦＲ）监测。结果：ＣＯＰＤ急性加重期ＭＩＰＲ较缓解期明显降低（Ｐ＜０．０５），后者较正常人ＭＩＦＲ亦显著降低（Ｐ＜０．０５）；急性加重期伴ＣＯ＿２潴留者ＭＩＦＲ值低于无ＣＯ＿２潴留者（Ｐ＜０．０５）。ＭＩＦＲ与ＰａＣＯ＿２呈负相关（ｒ＝－０．６２，Ｐ＜０．００５），与最大通气量（ＭＶＶ）呈正相关（ｒ＝０．６１，Ｐ＜０．００５），直线回归方程分别为：Ｙ（ＰａＣＯ＿２）＝６７．４－１４．３ＭＩＦＲ（Ｌ／ｓ），Ｙ（ＭＶＶ）＝９．８＋１９．３ＭＩＦＲ（Ｌ／ｓ）。提示：ＭＩＦＲ是准确反映肺功能损害程度的可靠指标，并能提示预后，对及时发现吸气肌疲劳，进行合理治疗有指导作用。     

适应行为量表在脑瘫评估中的应用

将儿童适应行为评定量表应用于脑性瘫痪（ＣＰ）患儿的功能评估中，并将ＣＰ患儿按现有临床分级标准分为轻度、中度、重度三级，计算其与适应商数（ＡＤＱ）之间的相关性，统计表明临床分级与ＡＤＱ之间有高度相关性（ｒ＝０．９２），与独立、认知和社会／自制三个因子量表分之间亦有显著相关性。说明ＡＤＱ能可靠地反映ＣＰ患儿的功能情况，是有效的评估工具。同时，它能排除年龄因素的影响，有利于更客观地进行横向对比和康复前后     

功能独立测量的临床运用分析

目的：通过分析功能独立测量（ＦＩＭ）在临床运用的情况,探讨其作为康复科常规残疾测量的价值。方法：用ＦＩＭ对１５７例康复科住院患者进行测量,并对不同病种入出院ＦＩＭ值进行配对分析,计算康复效益。结果：脑卒中、脊髓损伤、脑外伤及其他疾病患者的ＦＩＭ运动分、认知分及总分均有明显改变（Ｐ＜０．０１）;颈椎病、腰腿痛患者运动分有改变（Ｐ＜０．０１）,其康复效益较高;周围神经损伤患者出入院ＦＩＭ运动分、认知分、总分均无明显变化（Ｐ＞０．０５）,其康复效益低。结论：ＦＩＭ能反应康复过程中患者功能独立情况的变化,且与不同病种的功能独立情况相符合,可作为康复科常规测量方法     

B超测量腹部脂肪的研究

用Ｂ超检查５２例病人腹部脂肪，测定指标为体重指数（ＢＭＩ）、腰围与臀围比（Ｗ／Ｈ）、皮下脂肪厚度（Ａ）、腹内脂肪厚度（Ｂ）脂肪指数（ＦＩ）、内脏脂肪指数（ＵＶＩ）及血糖（ＢＳ）、胆固醇（ＣＨ）、甘油三酯（ＴＧ）。结果表明：ＢＭＩ与Ｂ相关（ｒ＝０．７３，Ｐ＜０．００１），Ｗ／Ｈ与Ｂ相关（ｒ＝０．４９，Ｐ＜０．００１）；ＢＭＩ与ＦＩ相关（ｒ＝０．８７，Ｐ＜０．００１），其回归公式：ＢＭＩ＝１５．７１５＋０．２８３ＦＩ；Ｂ／Ａ与ＵＶＩ相关（ｒ＝０．９９９５），说明了Ｂ超测定腹部脂肪的可行性。提出ＦＩ可替代ＢＭＩ对肥胖程度的判断，ＦＩ≥２９（ＢＭＩ≥２４）诊断为肥胖症；Ｂ／Ａ可用于肥胖的分型，腹内型抑或皮下型。     

学龄期脑瘫儿童粗大运动功能与智力的相关性初探

目的探讨学龄期脑瘫儿童粗大运动功能与智力的相关性。方法采用脑瘫粗大运动功能分级系统(GMFCS)、韦氏学龄儿童智力量表（WISC）和儿童社会适应行为量表,对93例学龄期脑瘫儿童进行评估。结果粗大运动分级结果与智商无相关性（r=0.184,P>0.05）,粗大运动分级结果与社会适应行为无相关性（r=0.056,P>0.05）。结论学龄期脑瘫儿童粗大运动功能与智力无相关性。     

2型糖尿病血胰岛素样生长因子-1水平与糖尿病肾病的关系

目的 观察２型糖尿病血中胰岛素样生长因子－１（ＩＧＦ－１）水平与糖尿病肾病的关系。方法 用ＥＬＩＳＡ法对５７例２型糖尿病患者血中ＩＧＦ－１浓度进行测定。结果①２型糖尿病患者血ＩＧＦ－１水平显著低于正常人（Ｐ〈０．０１）。糖尿病肾病组血ＩＧＦ－１水平显著高于单纯糖尿病组（Ｐ〈０．０１）;②ＩＧＦ－１与Ｃｃｒ呈正相关（ｒ＝０．３６８,Ｐ〈０．０５）;③ＩＧＦ－１与ＦＰＧ呈负相关（ｒ＝－０．４５７３８,     

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.     

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.     

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.     

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.     

Prospects for the control of neglected tropical diseases by mass drug administration

The prospects for the control of neglected tropical diseases, including soil-transmitted helminthiasis, shistosomiasis, lymphatic filariasis, onchocerciasis and trachoma, through mass drug administration, are exemplified by the elimination of the trachoma as a public-health problem in Morocco. In spite of this and other striking successes, mass drug administration programs are faced with major challenges resulting from suboptimal coverage and lack of efficacy. At current suboptimal coverage rates, programs may need prolongation for an extended period, increasing costs and undermining sustainability. Community participation through health education and information appears to be crucial to improve coverage and to achieve sustainability. Implementation of complementary measures, such as vector control, improved hygiene and environmental sanitation, are important to further control transmission and to prevent re-emergence of the infection and, again, may only be achieved effectively through community-based initiatives. To reduce costs and to relieve pressure on the health system, combining neglected tropical disease programs in areas where diseases coexist and integration with existing control programs for malaria, tuberculosis and HIV/AIDS is advocated. The risk of developing drug resistance is of particular concern in view of the lack of alternative drugs, and reduced treatment efficacy due to emerging resistance is evident for the soil-transmitted helminths and onchocerciasis. Given the risk for the development of drug resistance and the need for a high degree of participation, close attention should be paid to the monitoring of the coverage and efficacy of the different program components.     

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.     

Bacterial meningitis: an update of new treatment options

The outcome of bacterial meningitis critically depends on the rapid initiation of bactericidal antibiotic therapy and adequate management of septic shock. In community-acquired meningitis, the choice of an optimum initial empirical antibiotic regimen depends on the regional resistance patterns. Pathogens resistant to antibacterials prevail in nosocomial bacterial meningitis. Dexamethasone is recommended as adjunctive therapy for community-acquired meningitis in developed countries. In comatose patients, aggressive measures to lower intracranial pressure <20 mmHg (in particular, external ventriculostomy, osmotherapy and temporary hyperventilation) were effective in a case–control study. Although many experimental approaches were protective in animal models, none of them has been proven effective in patients. Antibiotics, which are bactericidal but do not lyse bacteria, and inhibitors of matrix metalloproteinases or complement factor C5 appear the most promising therapeutic options. At present, vaccination is the most efficient method to reduce disease burden. Palmitoylethanolamide appears promising to enhance the resistance of the brain to infections.