两种肌内效贴贴扎方法对脑卒中后偏瘫痉挛期患者肩痛的效果

目的观察两种贴扎方法对脑卒中后偏瘫痉挛期患者肩痛的疗效。方法 2015年10月至2017年9月,75例脑卒中后偏瘫痉挛期肩痛患者随机分为A组(n=25)、B组(n=25)和对照组(n=25)。三组常规治疗相同,A组和B组分别运用两种贴扎方法进行治疗。治疗前、治疗4周后,分别采用视觉模拟评分(VAS)评定患侧肩痛,Fugl-Meyer评定量表(FMA)评定上肢运动功能,改良Barthel指数(MBI)评定日常生活活动能力。结果治疗4周后,三组VAS评分均显著降低(P0.001),A组和B组均低于对照组(P0.05),A组明显低于B组(P0.01);三组FMA和MBI评分均显著升高(P0.001),A组和B组均高于对照组(P0.05),A组高于B组(P0.05)。结论肌内效贴联合康复训练能有效减轻脑卒中偏瘫痉挛期患者的肩痛,提高上肢运动功能和日常生活活动能力;且不同的贴扎方法,疗效不一。     

肩胛控制训练对偏瘫患者上肢功能及肩痛的影响

目的 探讨肩胛控制训练对偏瘫患者上肢功能及肩痛的影响.方法 60例偏瘫患者分成观察组30例与对照组30例.对照组采用常规训练方法 ,观察组在对照组训练方法 的基础上加入肩胛骨控制训练.于治疗前后对患者的上肢功能及肩痛程度进行评定.结果 训练后两组患者上肢Fugl-Meyer运动功能评分较治疗前明显提高(P<0.01),观察组上肢功能优于对照组(P<0.05).训练后两组患者肩痛症状较训练前明显减轻(P<0.01),观察组较对照组改善更为明显(P<0.05).结论 肩胛控制训练对改善偏瘫患者上肢功能、缓解肩痛有治疗意义.     

强化肩胸关节训练对卒中致偏瘫后肩痛及肩关节功能障碍的疗效

目的:观察强化肩胛胸壁关节运动训练对治疗卒中后偏瘫患者肩痛及肩关节功能障碍的疗效。方法:选取60例脑卒中后偏瘫伴有肩痛及肩关节功能障碍的患者,应用随机数字表法分为治疗组和对照组,每组各30例。2组均予以脑卒中后偏瘫肩痛及肩关节功能障碍的常规康复方法治疗,治疗组在常规治疗的同时再予以8周的强化肩胛胸壁关节运动训练。运用Constant-Murley肩关节功能评分量表(Constant-Murley Shoulder Function Score Scale,CMS)、基本概念视觉模拟疼痛评分法(Visual Analogue Scale,VA S)、Fugl-Meyer Motor A ssessment简式Fugl-meyer上肢运动功能评分量表(Fugl-Meyer Motor A ssessment Fugl-meyer Simple Upper Limb Motor Function Score,FMA-UE)对患者情况进行评估。评估时间分别是治疗前、治疗4周后、治疗8周后。结果:治疗4周后与治疗前相比,两组在CMS评定量表中5个方面都有好转(P0.05),VAS疼痛得分明显降低(P0.05),FMA-UE上肢功能评定也有显著好转(P0.05);治疗8周后,治疗组和对照组CMS 5个方面,VAS,FMA-UE都有显著好转,且与治疗4周后相比,两组各方面也都有明显好转(P0.05)。治疗4周后,只有VAS疼痛得分治疗组明显低于对照组(P0.05);治疗8周后,两组CMS评分除却力量测试上无明显区别(P0.05)外,其他4个方面以及FMA-UE上肢功能评定、VA S疼痛得分上都存在明显区别(P0.05),并且治疗组优于对照组。结论:对于卒中后偏瘫患者的肩痛及肩关节功能障碍,常规综合康复治疗方法以及强化肩胛胸壁关节运动训练都有着不错的治疗效果,然而强化肩胛胸壁关节运动训练对缓解肩痛及改善肩关节功能障碍的疗效更为显著。     

双侧运动训练对脑卒中恢复期上肢运动功能障碍的疗效

目的探讨双侧运动训练对脑卒中恢复期偏瘫患者上肢运动功能障碍的治疗效果。方法 52例偏瘫患者随机分成治疗组(n=26)和对照组(n=26)。治疗组采用双侧运动疗法,对照组采用传统神经发育法训练患侧上肢,共治疗6周。分别于治疗前后采用Fugl-Meyer评定的上肢部分(FMA-UE)和改良Barthel指数(MBI)进行评定。结果两组治疗后,FMA-UE、MBI评分均较治疗前明显改善(P0.01),治疗后治疗组FMA-UE、MBI评分显著高于对照组(P0.001)。结论双侧运动训练能显著提高脑卒中恢复期偏瘫患者的上肢运动功能及日常生活活动能力。     

推拿疗法结合肩胛带稳定性训练对脑卒中后偏瘫患者肩痛和上肢运动功能的影响

目的 观察推拿疗法结合肩胛带稳定性训练对脑卒中后偏瘫患者肩痛及上肢运动功能的影响。 方法 选取符合入组标准的脑卒中患者96例,采用随机数字表法分为推拿组、易化组和对照组,推拿组,每组患者32例。3组患者均给予神经内科常规药物治疗,推拿组在此基础上接受推拿疗法结合肩胛带稳定性训练,易化组则增加易化技术结合肩胛带稳定性训练,对照组仅增加易化技术治疗。3组患者均于治疗前、治疗4周后（治疗后）以及治疗结束6个月后（随访时）进行疗效评定。评定标准包括采用Fugl-Meyer上肢运动功能评价(FMA-UE)评定患者的上肢功能;采用改良的Barthel指数(MBI)评定患者的日常生活活动能力;采用视觉模拟评分法(VAS)评定患者的肩部疼痛。 结果 治疗后和随访时,3组患者的FMA-UE、MBI和VAS评分与组内治疗前比较,差异均有统计学意义（P<0.05）,其中推拿组随访时的FMA-UE、MBI和VAS评分分别为（48.13±15.0）分、（79.25±15.12）分和（1.49±1.34）分。推拿组和易化组治疗后以及随访时的FMA-UE、MBI和VAS评分与对照组同时间点比较,差异均有统计学意义(P<0.05)。 结论 推拿疗法结合肩胛带稳定性训练可明显缓解脑卒中患者的肩痛并改善其上肢的运动功能。     

镜像视觉反馈和肌电生物反馈对脑卒中偏瘫患者上肢功能的影响

目的研究镜像视觉反馈(MVF)、任务导向训练和肌电生物反馈(EMGBF)对脑卒中偏瘫患者上肢功能的恢复的作用。方法 90例脑卒中偏瘫患者采用随机数字表法分为对照组(n=30)、EMGBF组(n=30)和MVF组(n=30)。所有患者均接受常规康复治疗和任务导向性训练,EMGBF组在此基础上加EMGBF,MVF组在EMGBF组的基础上加MVF,共8周。治疗前后进行Fugl-Meyer运动功能评定(FMA)、Carroll手功能评定(UEFT),并测定偏瘫上肢相关肌电积分。结果治疗后,所有患者上肢FMA评分,UEFT评级和上肢肌肉肌电积分均较治疗前改善(P0.05)。组间比较,EMGBF组各项指标均优于对照组(P0.05),MVF组优于其他两组(P0.05)。结论镜像视觉反馈结合肌电生物反馈可以更有效地促进脑卒中偏瘫患者上肢功能的改善。     

肩胛带稳定性人脸模式训练对脑卒中病人肩痛的影响

[目的]探讨脑卒中病人实施肩胛带稳定性人脸模式训练在肩痛防护中的效果。[方法]将80例脑卒中病人随机分为对照组和观察组各40例,对照组病人按照Brunnstrom分级评定实施常规肩痛病房日常生活活动能力(ADL)管理措施,观察组在此基础上进行肩痛的认知强化教育和肩胛带稳定性人脸模式训练。干预前和干预后4周采用简式Fugl-Meyer运动量表(FMA)评定肢体运动功能,采用Barthel指数法(MBI)评定日常生活活动能力,视觉模拟评分法(VAS)评定疼痛程度。[结果]两组病人干预后VAS评分降低,且观察组低于对照组(P0.05);两组病人FMA和MBI评分升高,且观察组高于对照组(P0.05)。[结论]加强肩痛的认知强化教育和肩胛带稳定性人脸模式训练可明显缓解肩痛及提高病人日常生活活动能力和上肢运动功能。     

强化蹬踏训练对偏瘫患者下肢功能恢复的影响

目的探索强化蹬踏训练对偏瘫患者下肢功能恢复的影响。方法60 例脑卒中后偏瘫患者分为对照组(n=30)和治疗组(n=30),均接受常规运动治疗、作业治疗、针灸治疗和电刺激治疗,治疗组在此基础上增加强化蹬踏训练。于治疗前及治疗8 周后分别采用Berg 平衡量表(BBS)、Fugl-Meyer 下肢运动功能评分量表(FMA-L)、改良Barthel 指数(MBI)、功能性步行分级(FAC)、改良Ashworth 量表(MAS)进行评定。结果治疗后,两组患者的BBS、FMA-L、MBI、FAC、MAS 评分较治疗前均明显改善(P<0.01),治疗组改善情况均优于对照组(P<0.05)。结论强化蹬踏训练可明显改善偏瘫患者下肢功能。     

垂直振动训练对脑卒中偏瘫上肢肌张力和运动功能的影响

目的研究垂直振动训练对脑卒中患者偏瘫上肢肌张力和运动功能的影响。方法将60例脑卒中偏瘫患者随机分为治疗组(n=30)和对照组(n=30)。两组均给予常规肢体功能康复训练,治疗组加垂直振动训练。8周后,比较两组患者改良Ashworth量表(MAS)评分、简化Fugl-Meyer量表(FMA)评分及改良Barthel指数(MBI)评分。结果治疗8周后,两组MAS评分[(1.16±0.32)分和(1.62±0.36)分]、FMA评分[(28.26±4.33)分和(21.24±5.31)分]、MBI评分[(72.8±24.6)分和(55.3±18.7)分]均较治疗前有改善(P0.05),治疗组优于对照组(P0.05)。结论常规肢体功能康复训练配合垂直振动训练能更有效改善脑卒中患者偏瘫上肢的肌张力和运动功能。     

电脑上肢评估训练系统对脑卒中恢复期患者手功能的疗效

目的观察电脑上肢评估训练系统(E-LINK)对脑卒中恢复期患者手功能的临床效果。方法30 例患者分为治疗组(n=16)和对照组(n=14)。两组均接受神经内科治疗及常规康复,治疗组加用E-LINK 进行手功能训练,共治疗12 周。结果治疗后,治疗组最大握力及捏力、Barthel 指数、前臂旋后活动度及上肢Fugl-Meyer 评定评分改善均优于对照组(P<0.05)。结论E-LINK可提高脑卒中偏瘫患者的上肢运动功能和日常生活活动能力。     

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.     

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.     

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.     

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.     

Imaging choices in occult hip fracture

Background: Hip fracture is a common injury, with an incidence rate of > 250,000 per year in the United States. Diagnosis is particularly important due to the high dependence on the integrity of the hip in the daily life of most people. Objectives: In this article we review the literature focused on hip fracture detection and discuss advantages and limitations of each major imaging modality. Discussion: Plain radiographs are usually sufficient for diagnosis as they are at least 90% sensitive for hip fracture. However, in the 3–4% of Emergency Department (ED) patients having hip X-ray studies who harbor an occult hip fracture, the Emergency Physician must choose among several methods, each with intrinsic limitations, for further evaluation. These methods include computed tomography, scintigraphy, and magnetic resonance imaging. Conclusion: We present an evidence-based algorithm for the evaluation of a patient suspected to have an occult hip fracture in the ED. Also outlined are future directions for research to distinguish more effective techniques for identifying occult hip fractures.     

Systematic Reviews Published in the April 2012 Issue of the Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD but monthly online. The April 2012 issue (second DVD for 2012) contains 5045 complete reviews, 2182 protocols for reviews in production, and 17,084 short summaries of systematic reviews published in the general medical literature. In addition, there are citations of 674,000 randomized controlled trials, and 15,400 cited papers in the Cochrane methodology register. The health technology assessment database contains just over 11,000 citations. One hundred and seventeen new reviews have been published in the last 3 months of which 12 have potential relevance for practitioners in pain and palliative medicine. The impact factor of the Cochrane Library stands at 6.186. Readers are encouraged to access the full report for any articles of interest as only a brief commentary is provided.     

Platelets,thrombosis, coagulation,and atherosclerosis

When I first got the invitation to join a medical delegation going to Moldova, I thought for a moment that our destination was the fictional country in the old Marx Brothers movie Duck Soup. On further checking, it turns out that entertaining place was called Freedonia. I now know that Moldova is indeed a real country, bordered on the west by Romania and on the other three sides by the Ukraine. It is a proud country, rich with traditions, and its people are warm, giving, eager to learn ways to improve their healthcare system, and deeply appreciative of our attempts to help them in the task.