围产期脑损伤高危儿早期康复治疗的临床观察

目的:通过分析围产期脑损伤高危儿早期康复治疗的方法和效果,探讨降低脑性瘫痪(脑瘫)的发生率和减轻脑瘫的伤残程度的有效途径。方法:对195例平均月龄为(2.50±1.45)个月的高危儿进行早期康复治疗,治疗前或治疗初期明确诊断脑瘫者34例,平均确诊月龄(4.42±2.17)个月。可疑脑瘫161例。康复评定采用Gesell量表、小儿神经系统检查法及脑瘫功能评定等综合方法。结果:在平均月龄(9.65±3.00)个月时治疗结果显示,34例明确诊断脑瘫患儿中,19例(55.9%)正常,12例(35.3%)临界正常,3例(8.8%)异常。可疑脑瘫的161例高危新生儿中,154例(95.7%)正常,7例(4.3%)临界正常,无一例异常。140例颅脑影像学异常者中,120例(85.7%)正常,17例(12.1%)临界正常,3例(2.14%)异常。早产儿、低出生体重儿、窒息儿、缺氧缺血性脑病患儿、高胆红素血症儿等高危新生儿的脑瘫发生率也明显降低。结论:对围产期脑损伤高危儿的早期康复治疗可以降低脑瘫后遗症的发生。脑瘫的早期康复治疗可以达到临床治愈的效果。     

早期干预防治小儿脑性瘫痪的临床观察

目的:回顾总结我院开展小儿脑瘫康复五年三个阶段的方法和效果,探讨对高危儿实行早期干预对防治脑瘫的效果。方法:第一阶段,等患儿上门,患儿年龄大,程度重的多;第二阶段,保健与康复相结合,在系统保健过程中发现异常,及时治疗;第三阶段,高危儿早期干预,对有高危因素的新生儿,分为干预组和观察组,对干预组重点监测,追踪指导。结果:第二阶段早期诊断和超早期诊断率高于第一阶段,两个阶段早期(超早期)诊断率相比差异有显著性意义(P<0.05)。患儿坚持2个疗程以上者增多,正常化人数增多:第一阶段4/47,(8.5%);第二阶段9/58,(15.5%)。第三阶段高危儿早期干预组中枢性协调障碍数在6个月内18例,高于高危儿观察组(11例),经过早期干预到1岁时,干预组无脑瘫发生,观察组有脑瘫7例,其他脑损伤4例。CDCC测试结果干预组MDI≤69的2例(0.7%),PDI≤69的4例(1.4%)明显高于观察组48例(17%)、62例(22%),甚至高于正常对照组4例(4%)、6例(6%)。结论:早期干预能提高(超)早期诊断率,使患儿在最佳时期接受治疗,疗效显著,达到正常化可能性。     

200例脑瘫患儿早期异常表现及早期康复的观察

目的对脑瘫患儿早期（4个月以前）的异常表现进行追踪总结，以便早期诊断，把握最佳康复机会，尽早治疗，对降低残疾发生率，减轻家庭和社会负担具有重要意义。方法对在甘肃省康复中心诊治的200例脑瘫患儿追问其在4个月以前，尤其是新生儿期的表现进行总结分析。结果早产、窒息、黄疸、颅内出血等高危因素的患儿有192例具有早期异常表现，8例未发现异常，越早干预治疗，效果越好。结论脑瘫高危儿观察早期的异常表现，对早期诊断、早期治疗，降低残疾的发生率是非常重要的。     

早期综合康复护理干预对高危新生儿预后的影响

目的探讨早期综合康复护理干预对高危新生儿脑瘫预防及智能发育等的影响。方法将163例高危新生儿随机分为干预组83例和对照组80例,对照组只接受常规治疗及定期评估;干预组在此基础上施行早期环境干预和综合康复功能训练。结果干预组第30天新生儿行为神经(NBNA)评分及3、6、12、18、24个月的发育商(DQ)均明显高于对照组(P<0.01),干预组头颅CT复查(3个月时)及后遗症发生率均明显低于对照组(P<0.01,P<0·05)。结论对高危新生儿施行早期环境干预和综合康复功能训练,可降低脑瘫及智能低下的发生率,对提高患儿存活质量和整体人口素质有重要意义。     

早期干预降低高危儿脑瘫发生率的临床研究

目的 探讨对脑瘫高危儿进行早期干预降低脑性瘫痪发生率的临床效果.方法 将2006-07 -2010-12在我院产科出生或在新生儿科就诊的180例具有脑瘫高危因素的患儿随机分为研究组(早期干预)和对照组(未早期干预)各90例.两组患儿均给予常规治疗及育儿指导,研究组患儿在3个月内开始接受早期的综合性康复训练.结果 1岁时研究组脑性瘫痪发生率为3.33％,对照组为12.22％.两组比较差异具有统计学意义(P＜0.05).早期干预组儿童3月龄、6月龄及1岁时的智力发育指数和运动发育指数均明显优于非干预组,两组间差异比较有统计学意义(P＜0.05).结论 早期给予康复干预是预防或减少高危患儿脑瘫发生的有效手段,同时可提高高危儿的生活质量.     

临床、保健、康复相结合的脑性瘫痪早期干预模式

目的 探索脑瘫患儿早期发现、早期干预的工作模式。方法临床、保健、康复相结合，采用产前检查、孕妇学校、产时儿科医生进产房、新生儿行为神经评定测定、高危儿抚触训练室、婴儿期儿童保健监测、各街道防治站常规体检筛查转诊等多种形式结合早期发现并干预脑瘫高危儿。结果 此工作模式较模式前显著提高了脑瘫的早期诊断率及康复疗效。结论 临床、保健、康复相结合的方式整合了医疗资源，起到了促进脑瘫早发现、早诊断、早治疗的作用，值得推广。     

68例高危儿的早期干预与护理

[目的]总结高危儿的早期干预与护理。[方法]对68例高危儿实施视听触刺激、前庭功能训练、手功能及肌张力训练及综合康复治疗等早期干预措施及护理配合。[结果]≤6个月患儿痊愈43例,脑瘫1例,7个月～9个月患儿痊愈22例,脑瘫2例。[结论]加强高危儿的早期干预与护理有利于预后。     

脑性瘫痪高危儿肌张力异常情况的分析

目的:通过对6mon以内脑性瘫痪(脑瘫)高危儿初诊时肌张力异常表现和康复治疗后转归的分析,试图为早期干预的介入提供参考依据。方法:155例平均月龄为(2.46±1.46)mon的脑瘫高危儿,来自新生儿或儿科ICU病房及门诊,经临床神经系统检查和发育评定,开始实施早期康复治疗。将其高危病史、肌张力异常表现、康复治疗后的转归等情况进行分析。结果:早产、低出生体重、缺氧缺血性脑病、高胆红素血症等仍是主要的高危因素。多数患儿以肌张力升高为初诊时主要表现,小婴儿常表现为角弓反张;而肌张力低和肢体颤抖可见于2mon以内患儿,并且以后可转为张力升高。这些患儿即使在康复治疗中,也有24例曾被诊断脑瘫,最终少部分遗留轻度后遗症或临界正常。以单纯踝跖屈张力高为主要表现的患儿预后较好。结论:脑瘫高危儿出现肌张力异常表现,应及时进行针对性早期康复治疗。     

任务导向性训练对脑性瘫痪高危儿运动功能的影响

目的:探讨任务导向性训练(TOT)对脑瘫高危儿运动功能的影响。方法:选取2019年3月—2019年12月哈尔滨市儿童医院住院康复治疗的脑瘫高危儿患儿83例,随机分为观察组43例,对照组40例。两组早期干预治疗均采用常规康复治疗,观察组增加任务导向性训练。干预治疗前及12周后,采用粗大运动功能评定量表(GMFM)、精细运动功能评定量表(FMFM)、Peabody运动发育量表(PDMS-2)的粗大运动商(GMQ)、精细运动商(FMQ)评定儿童的运动功能。结果:治疗后两组患儿的GMFM、GMQ、FMFM、FMQ评分与治疗前相比较均有显著性差异(P0.05),治疗后观察组的GMFM、GMQ、FMFM、FMQ评分均明显高于对照组(P0.05)。结论:TOT能更好提高脑瘫高危儿的运动功能,脑瘫高危儿早期干预可以取得较好疗效。     

高危儿脑损伤早期医院与家庭共同干预的效果观察

目的高危儿有发生脑损伤的潜在危险,早期发现脑损伤,进行早期康复治疗是保护高危儿健康,减少残障的关键。通过对高危儿脑损伤的早期医院与家庭干预治疗疗效关系的研究,能够采用一种最有效的方法,降低高危儿致残率。方法研究对象2001-01/2004-05收入沈阳市儿童医院脑瘫康复中心病房住院的患儿,排除无高危因素或年龄超过1岁的患儿。确定为脑损伤的高危儿116例分为两组,在医院综合治疗方法进行早期干预的为治疗组(86例),在家庭干预的为对照组(30例)。结果治疗组86例,达正常化49例,总有效率达97%;对照组总有效率47%,两组比较差异有显著性意义(χ2=32.48,P<0.01)。结论高危儿脑损伤早期干预比单一家庭干预效果佳,医院与家庭相结合干预治疗效果更好。     

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.