四川江油地震伤员康复状况分析

目的: 分析江油地区地震伤员的人数、伤情及功能障碍、康复现状及需求，指导下一步康复医疗工作。方法: 对江油地区8所医院、卫生院188例伤员进行现场调查与分析。结果：伤员分类为：骨折86.2%、截肢2.1%、颅脑损伤2.7%、脊髓损伤1.1%、其他8.0%。部分伤员已经全部恢复功能，仍然有104例伤员(55.3%)有显著日常生活活动能力和参与能力障碍，需要进一步康复医疗；162例骨折伤员中15%需要再次手术。结论: 地震伤员目前仍然有很大的比例需要继续康复医疗。骨折后功能障碍是康复重点。需要高度重视骨折不愈合的再次手术和康复问题。     

地震挤压伤截肢伤员的康复护理

目的：结讨论地震挤压伤截肢伤员的康复护理干预措施。方法：对5·12地震后我科地震康复中心收治的30例截肢伤员，由治疗小组成员进行康复评定，对存在的护理问题进行综合康复护理干预，干预前后进行比较。结果：接受综合康复综合护理干预后，地震截肢伤员在生理、心理、社会功能等方面均有显著改善（P〈0．05）。结论：针对地震伤员的护理问题进行综合康复护理干预，可有效提高伤员的残损功能，改善伤员的整体康复效果，促进其早日回归社会。     

小组治疗模式在地震截肢伤员康复中的作用

目的探讨小组治疗模式在地震截肢伤员康复过程中的影响。方法对5·12汶川地震后收治我科的85例截肢伤员，采用以骨科医生、骨科护士、物理治疗师、职业治疗师、心理咨询师、志愿者、社会工作者、伤员及家属等共同参与的小组治疗模式对地震截肢伤员实施综合康复措施，评价其康复效果。结果接受综合治疗干预后，85例地震截肢伤员在生理、心理、社会功能等各方面均有显著改善（P〈0．05）。结论针对地震截肢伤员的问题以小组治疗模式进行干预可明显提高伤员的整体康复效果及生存质量。     

地震后脑外伤伤员功能状况调查分析

目的通过调查在五一二汶川地震中受伤的脑外伤伤员，以了解地震后脑外伤患者的功能状况特点。 方法调查在四川大学华西医院脑外科及重症监护室住院治疗的地震后脑外伤伤员共计38例，使用格拉斯哥昏迷量表（GCS）评定患者脑损伤严重程度；采用简明精神状态量表（MMSE）评定认知功能；使用改良Ashworth法评定肌张力；采用Bobath三级平衡分级评定平衡功能；使用改良Barthel指数评定日常生活活动能力。 结果对调查数据分析后发现，地震后脑外伤伤员平均年龄为46岁，男女比例为1.9∶1；轻度脑损伤27例（占71.1%），中度脑损伤4例（占10.5%），重度与极重度脑损伤共7例（占18.4%）。对非昏迷地震伤员进一步调查后发现，偏瘫等运动控制障碍者有7例（占22.6%），失语5例（占16.2%），认知功能障碍20例（占64.5%），关节活动度下降13例（占34.2%），肌张力障碍11例（占28.9%），肌力下降14例（占45.2%），坐位平衡功能障碍12例（占50%），立位平衡功能障碍21例（占87.5%），日常生活自理能力障碍34例（占89.5%）。 结论地震后脑外伤伤员功能障碍有其特殊性，有必要建立一个系统的地震后脑外伤康复治疗体系，从而根据地震伤员特点给予科学的康复管理及治疗。     

四川绵竹地区地震伤员社区康复需求调查分析

目的 了解四川绵竹地区地震伤员出院返家后的功能障碍、家居环境、职业回归及心理状况,为社区康复的开展提供依据.方法 对四川绵竹地区123例出院伤员进行家庭回访,评估其功能障碍、家居环境情况,对其职业回归、经济收入、心理情况进行问卷调查.结果 123例伤员中,骨折66.7%、脊髓损伤17.1%、挤压伤及周围神经损伤11.4%、截肢3.2%、脑外伤1.6%,其中56.9%需要接受家庭康复指导.85.7%的脊髓损伤伤员需要家居环境改造.65.5%的18～59岁男性没有就业并愿意接受职业培训.123例伤员中,8.9%创伤后应激障碍综合征阳性.结论 四川绵竹地区地震伤员返家后仍需要进一步的社区康复,及时全面的社区康复对其家庭回归和社会回归意义重大.     

华西医院ICU地震伤员功能障碍特点的临床研究

目的：了解ICU病房地震伤员的功能障碍的特点，为临床康复治疗提供依据。方法：运动功能评定应用MMT方法；运用关节角度尺评定关节活动度（ROM）；利用被动关节活动法评定肌张力、痉挛评定选用改良的Ashworth分级法；坐位平衡和站位平衡采用平衡反应试验评定；日常生活活动（ADL）能力选用国际通用的Barthel指数量表评定。由我科研究生作为评定人员。结果：①ICU病房地震伤员以骨折患者为主，占70％，神经系统损伤占20％，挤压综合症和肺挫伤各占5％；②女性骨折比例高于男性，为11：3；神经系统损伤没有多大差异；截肢和瘫痪的患者中，男性高于女性，比例分别为4：1和3：2；肺部感染以女性更为明显，为7：1；③47．6％的地震伤员关节活动受限（评定21人），93．3％的肌力下降（评定15人），15．8％肌张力下降（评定19人），36．8％肌张力增高（评定19人），30．0％的坐位平衡下降（评定10人），96．4％站立平衡下降；④ADL能力100％受限（评定20人），其中洗澡、修饰、如厕、平地行走45m、上下楼梯受限均为100％，95％地震伤员进食能力下降，90％穿衣能力受限，35％大便失禁，60％小便控制能力下降，多数使用导尿管，95％地震伤员床椅转移能力下降；⑤40％出现肺部感染。结论：关节活动度受限、肌力下降、肌张力异常、平衡功能障碍、ADL能力受限及肺部感染是ICU地震伤员主要功能障碍。早期康复介入、维持和改善关节活动度、肌力训练、减张和牵伸训练、平衡训练、呼吸训练、站立和行走训练及ADL能力训练应当作为康复治疗的基本原则和方法。     

地震伤员下肢假肢装配前后的综合康复治疗

目的观察地震伤员下肢假肢装配前后综合康复治疗的效果。 方法安装假肢前后对地震伤员采取综合康复治疗,包括:残端处理(按摩和拍打、残肢塑型)、运动疗法(关节活动度训练、肌力训练、平衡功能训练、站立与步行训练等)、物理治疗、心理治疗。 结果42例残肢中，残端有溃疡或窦道、残肢肿胀、髋膝关节屈曲挛缩、残肢痛分别占74%、72%、41%和5%，残肢肌力明显减退。经综合康复治疗后，残肢无肿胀、溃疡或窦道完全愈合，残肢形状、关节活动度和肌力明显改善，已达到假肢装配条件，均装配假肢，并获得良好的功能。假肢行走功能结局,良好：20例（51%）；一般：17例（44%）;较差：2例(5%)。 结论地震后截肢不良残肢发生率高，安装假肢前后对地震伤员采取综合康复治疗, 确保假肢装配成功十分必要。     

华西医院地震康复中心地震挤压伤截肢伤员的伤情分析

目的：了解地震截肢伤员的伤情特点，为其康复提供依据。方法：2008年6月～2008年12月31日，华西医院康复中心收治33例地震伤截肢患者，观察分析其伤情特点和康复治疗变化。结果：男性15例（45．5％），女性18例（54．5％）；男性与女性的年龄相比无统计学意义（P〉0．05）；10～19岁青少年45．45％；学生51．52％，在职人员33．33％；重物砸伤占78．79％；膝上截肢占43．90％，上肢截肢21．95％，下肢78．05％；截肢合并症13种，肾功衰最多，占28．57％；手术次数平均2．55次；残端有2例愈合差，有14名培养出细菌；日常生活活动能力Barthel指数入院时50．92±16．76，出院时77．77±14．37。结论：地震截肢伤员伤情重，残端情况差，康复治疗效果明显。     

都江堰友爱学校地震伤员康复状况调查分析

目的分析全国首家无障碍学校——四川省都江堰友爱学校地震伤员的伤情、功能障碍、康复现状及需求,为下一步康复医疗提供依据。方法对105例在校伤员进行现场功能评估,采用截肢身体意象评估量表(AB IS),对40名截肢伤员进行问卷调查。结果 105例伤员中,骨折44例(41.9%)、截肢40例(39%)、挤压伤15例(14.2%)、脑外伤6例(5.7%);大都存在的不同程度、多种功能障碍问题,其中肌力减退62例(59.1%),肌肉萎缩32例(30.2%),关节活动度(ROM)受限49例(46.7%),瘢痕粘连增生70例(66.7%),感觉障碍14例(13.3%),关节挛缩32例(30.5%),步态异常23例(21.9%),生活不能完全自理26例(24.8%)。结论 105例伤员均有不同程度的康复需求,需要进一步的康复指导与治疗;伤员的心理状况也需要关注。     

应用加拿大作业活动测量表对120例地震伤员的作业活动和疗效分析

目的：分析120例地震伤员的作业活动需求，并给予治疗，观察疗效。方法：120例地震伤员在入院和出院时均应用加拿大作业活动测量表（COPM）进行作业活动测评，包括自理、生产及休闲三大类。根据测评结果制定康复治疗计划及假肢的安装，并对伤员作业活动的表现和满意度进行评价。结果：入院时伤员自认为重要并需要亟待解决的作业活动中，自理活动需求频数明显多于生产活动和休闲活动（P〈0.01）；经过平均55.2d的康复治疗后，出院时伤员对自己的作业活动表现总分和作业活动满意度总分明显高于入院时（P〈0.01）。结论：COPM能确认地震伤员亟待解决的作业活动，对临床治疗有指导意义，同时能评价康复疗效。     

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.     

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.     

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.     

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.