穿戴式外骨骼助行器改善脑卒中患者步行能力的随机对照研究

摘要 目的：探究穿戴式外骨骼助行器对脑卒中患者步行能力的影响。 方法：将30例脑卒中患者随机分为观察组（15例）和对照组（15例）。两组均接受临床药物治疗和常规康复训练,观察组使用Kickstart穿戴式外骨骼助行器进行步行训练;对照组进行常规步行训练;每组步行累计时长≥1h/d,5d/周,共4周。两组干预前后测试内容包括计时“起立-行走”测试（TUG）、10m步行测试（10MWT）、6min步行测试（6MWT）和三维步态测试。 结果：干预前后的组内比较,观察组的TUG、10MWT、6MWT有极显著性差异（P<0.01）,步速、步幅和健侧步长具有显著性差异（P<0.05）,步态周期、步频和患侧步长无显著性差异（P＞0.05）;对照组的TUG、6MWT有极显著性差异（P<0.01）,10MWT有显著性差异（P<0.05）,步态参数指标均无显著性差异（P＞0.05）。两组干预前后差值组间比较,TUG和6MWT有显著性差异（P<0.05）,而10MWT和所有步态参数指标无显著性差异（P＞0.05）。 结论：4周Kickstart穿戴式外骨骼助行器的步行训练对脑卒中患者的步行能力有一定的积极影响。     

运动康复训练对冠心病慢性心力衰竭患者心功能的影响

目的 观察12周运动康复训练对冠心病慢性心力衰竭（CHF）患者心功能的影响。 方法 采用随机数字表法将70例冠心病CHF患者分为观察组及对照组。2组患者均给予基础药物治疗，观察组患者在此基础上辅以运动康复训练。于治疗前、治疗12周后分别采用6分钟步行试验（6MWT）检查患者运动耐力情况；采用心脏彩超检查患者左心室舒张末期内径（LVEDD）、左心室射血分数（LVEF）及左心室短轴缩短率（FS）；采用明尼苏达心力衰竭生活质量问卷（MLHFQ）评定患者生活质量情况；采用化学发光免疫法检测患者血浆N-末端脑钠肽前体（NT-pro-BNP）水平；采用酶联免疫吸附法检测患者血浆白介素-10（IL-10）、转化生长因子（TGF）-β1含量等。 结果 经12周运动干预后，发现观察组患者总有效率明显优于对照组（P<0.05）；与对照组比较，观察组患者6MWT、左心LVEF、FS均明显提高（P<0.05）；左心LVEDD、MLHFQ评分、血浆NT-pro-BNP、IL-10及TGF-β1含量均显著降低（P<0.05）。 结论 运动康复干预能显著改善冠心病CHF患者心功能及生活质量，值得临床进一步推广、应用。     

全责护理模式在慢性心力衰竭患者康复训练中的应用效果

目的观察全责护理模式在慢性心力衰竭患者康复训练中的应用效果。方法采用随机数字表法将86例患者随机分为观察组（n=43）和对照组（n=43）;16名护士分为A、B两组,A组实行全责护理模式,B组实行责任制和功能制相结合的护理模式;观察组由A组护士负责康复训练4周,对照组由B组护士负责康复训练4周。比较两组患者人院时和出院时的射血分数（EF）、6rain步行试验的距离（6MWT）和出院时患者对康复训练知识的知晓率和满意度得分之间的差异。结果入院时两组EF、6MWT比较,差异无统计学意义（t值分别为1．598,1．523;P均〉0．05）。出院时观察组EF（54．13±9．12）、6MWF（402．63±74．81）,均高于对照组EF（43．26±8．57）、6MWT（336．16±75．82）,两组比较差异有统计学意义（t值分别为2．093,2．145;P均〈0．05）;各组EF、6MWT出院与入院时比较,差异有统计学意义（t值分别为2．681,2．010,2．791,2．185;P均．〈0．01）。出院时两组患者满意度得分比较,差异有统计学意义（t=2．145,P〈0．05）。结论全责护理模式用于慢性心力衰竭患者的康复训练中可取得显著效果。     

聚焦解决模式对改善老年慢性阻塞性肺疾病患者运动耐力的影响

目的 探讨聚焦解决模式对老年慢性阻塞性肺疾病（COPD）患者运动耐力的影响。方法 将100例老年COPD患者随机分为对照组和干预组各50例。对照组采用常规护理方法,干预组在此基础上采用聚焦解决模式的干预措施,干预前后采用6分钟步行测试（6MWT）进行评估。结果 干预组在干预后6MWT得分（422.84±54.53米）大于对照组（392.15±35.44米）,两者相比有显著性差异（P<0.05）。结论 聚焦解决模式可显著提高慢性阻塞性肺疾病患者的运动耐力。     

基于跨理论模型的运动干预对社区老年膝关节炎患者的影响研究

目的 评价基于跨理论模型的运动干预对社区老年膝关节炎患者运动依从性的长期效果。 方法 采用集群随机对照试验的方法,选择北京市14个社区,以社区为单位进行随机分组,纳入189例符合入选标准的老年膝关节炎患者。该研究共持续48周,其中干预时间0~24周,随访时间24~48周。试验组实施基于跨理论模型的运动干预,对照组实施常规居家运动指导。比较两组运动依从性、自我效能、决策均衡和膝关节疼痛程度。 结果 共有156例患者（试验组87例,对照组69例）完成了研究。干预24周时,试验组运动依从性得分为（7.58±1.29）分,对照组得分为（5.00±1.53）分;干预36周时,试验组运动依从性得分为（6.55±1.28）分,对照组得分为（3.89±1.53）分;干预48周时,试验组运动依从性得分为（5.56±1.00）分,对照组得分为（3.16±1.31）分,两组比较,差异均具有统计学意义（P<0.05）。试验组患者的运动自我效能、感知益处高于对照组,感知障碍和膝关节疼痛程度低于对照组（P<0.05）。 结论 基于跨理论模型的运动干预能够长期改善老年膝关节炎患者的运动依从性,优化运动自我效能和决策均衡,降低膝关节疼痛症状。     

运动处方改善老年慢性阻塞性肺疾病患者肺功能的效果

目的探讨运动处方改善老年慢性阻塞性肺疾病（chronic obstructive pulmonary disease,COPD）患者肺功能的效果。方法为55例缓解期COPD患者制订运动处方,在干预前、干预6个月后进行生活质量、6 min步行试验（6-minute walking test,6 MWT）测定与肺功能检测。结果干预6个月后患者6MWT、肺功能和生活质量明显改善,干预前后比较,差异具有统计学意义（均P＜0？01）。结论对老年COPD患者按运动处方进行肺功能康复训练,可有效改善患者肺功能,延缓病情进展,提高患者生存质量。     

八段锦联合呼吸康复训练在食管癌术后病人中的应用效果

目的:探讨八段锦联合呼吸康复训练在食管癌术后病人中的应用效果。方法:选取2020年1月—2022年5月行食管癌手术病人65例，随机分为干预组33例和对照组32例。对照组接受常规康复训练，干预组在此基础上进行八段锦联合呼吸康复训练，从入院开始至干预12周。比较干预前、干预后6周及干预后12周两组病人6 min步行距离、肺功能、营养状况及生活质量得分。结果:干预后6周、12周两组6 min步行距离、营养状态各指标比较差异均有统计学意义（P<0.05）；干预后12周干预组各项肺功能指标及生活质量量表各维度得分、总分均优于对照组（P<0.05）。结论:八段锦联合呼吸康复训练可以有效改善食管癌手术病人的营养状态和肺功能，提高运动耐力和生活质量。     

PRECEDE-PROCEED健康教育模式在慢性心力衰竭患者中的应用

目的 探讨PRECEDE-PROCEED健康教育模式在慢性心力衰竭患者中的应用效果。方法 选取2021年1月—2022年1月医院收治的慢性心力衰竭患者80例为研究对象,按组间基本特征具有可比性的原则分为对照组和观察组,每组40例。对照组患者采取常规健康教育护理干预,观察组患者实施PRECEDE-PROCEED模式健康教育护理干预,出院后进行为期24周的随访观察。比较两组患者干预前后心功能[美国纽约心脏病协会（NYHA）分级标准分为Ⅰ级、Ⅱ级、Ⅲ级、Ⅳ级]、Zung焦虑自评量表（SAS）和抑郁自评量表（SDS）评分、6 min步行距离（6MWT）、心力衰竭自我护理指数量表（SCHFI）及明尼苏达心力衰竭生活质量量表（MLHFQ）评分。结果 健康教育前,两组慢性心力衰竭患者心功能、SAS与SDS评分、6 min步行距离、自我护理能力与生活质量量表评分的比较,差异无统计学意义（P>0.05）。健康教育后,观察组患者心功能改善情况优于对照组,SAS、SDS评分低于对照组,6MWT长于对照组,SCHFI评分高于对照组,MLHFQ评分低于对照组,组间比较差异均有统计学意义（P<0.05...     

心理干预对脑卒中后抑郁患者生存质量的影响

目的：探讨心理干预对脑卒中后抑郁（PSD）情绪和生存质量的影响。方法：选择我科脑卒中患者89例,采用Zung抑郁自评量表（SDS）评估,将其中出现不同程度抑郁症状的患者42例随机分成治疗组（21例）和对照组（21例）,两组均接受常规康复训练,并每日口服氟西汀20mg。治疗组在此治疗基础上介入心理干预治疗4周。两组患者在治疗前后进行Zung SDS及生存质量（QOL）测评。结果：治疗前两组患者的QOL指数差异无显著性意义,治疗4周后,治疗组的QOL指数得分明显高于对照组（P<0.05）,SDS评分明显低于对照组（P<0.01）,其差异具有显著性意义。结论：心理干预能使脑卒中患者生存质量有明显改善,可提高康复治疗的总体疗效。     

基于目标管理法的健康教育在慢性阻塞性肺疾病患者中的应用效果

目的：探讨基于目标管理法的健康教育在慢性阻塞性肺疾病患者中的应用效果。方法：将120例慢性阻塞性肺疾病患者按随机数字表法分为干预组和对照组,各60例。对照组给予呼吸科常规健康教育;干预组在对照组基础上实施基于目标管理法的健康教育。干预前、干预6个月后采用自我管理水平量表、生活质量量表、呼吸困难量表对两组患者进行评价并比较。结果：干预6个月后,干预组患者自我管理各维度得分优于对照组,差异具有统计学意义（P<0.05）。干预组FEV1%预计值、6 min步行距离优于对照组,且呼吸困难程度低于对照组,差异具有统计学意义（P<0.05）;两组患者体质量指数无统计学差异（P>0.05）。干预前,两组患者的生存质量比较无统计学差异（P>0.05）;干预后,两组患者的生存质量均有所提升,干预组患者的评分高于对照组,差异具有统计学意义（P<0.05）。结论：基于目标管理法的健康教育有利于改善老年COPD患者的自我护理行为,改善患者的肺功能相关指标,提高患者的生存质量。     

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.