McKenzie疗法治疗腰椎间盘突出症的近期和远期疗效观察

目的:探讨McKenzie疗法对腰椎间盘突出症患者的近期和远期治疗效果。方法:将76例病人随机分为观察组和对照组,观察组采用牵引、推拿和McKenzie疗法治疗,对照组采用牵引和推拿治疗。观察两组患者治疗前、治疗后即时和治疗后10个月的腰椎功能评分及治疗后10个月的复发率。结果:两组间近期疗效差异不明显(P>0.05),但观察组治疗时间缩短(P<0.05);治疗后10个月观察组复发率明显低于对照组(P<0.01),腰椎功能评分则明显高于对照组(P<0.01)。结论:McKenzie疗法在缩短腰椎间盘突出症患者的治疗时间,提高远期疗效上有明显作用。     

Mckenzie疗法配合推拿与关节松动术治疗腰椎间盘突出症的疗效观察

目的 :探索麦肯基 (Mckenzie)疗法配合推拿与关节松动术治疗腰椎间盘突出症的临床疗效。方法 :将 5 6例患者随机分为试验组和对照组 ,试验组采用Mckenzie疗法配合推拿、关节松动术、腰椎牵引进行治疗 ,对照组采用理疗 (超短波、中频电疗 )配合腰椎牵引进行治疗。结果 :试验组腰椎功能治疗后评分和改善指数明显高于对照组 (P <0 0 1)。结论 :麦肯基 (Mckenzie)疗法配合推拿与关节松动术治疗腰椎间盘突出症疗效好、病人适应强。     

McKenzie法结合运动疗法及腰椎牵引治疗腰椎间盘突出症

目的：探讨McKenzie法结合运动疗法及牵引治疗腰椎间盘突出症的临床疗效及其力学效应。方法：90例确诊患有该病的患者随机分为2组各45例，A组采用McKenzie法结合运动疗法及牵引，B组采用中医推拿配合中频电疗及牵引治疗。治疗前后均使用日本矫形外科学会（JOA）下背痛评分标准评分，并进行疗效评价。结果：治疗前2组患者JOA下背痛评分差异无统计学意义；治疗20d后2组JOA评分与治疗前比较均有提高（P〈0．01），2组间比较，A组明显高于B组（P＜0．05）。临床疗效比较，A组痊愈率及总有效率均明显高于B组（P〈0．05）。结论：McKenzie法结合运动疗法及腰椎牵引治疗腰椎间盘突出症能显著提高康复疗效。     

McKenzie疗法联合中频电疗在腰椎间盘突出症患者中的应用效果研究

目的观察McKenzie疗法联合中频电疗在腰椎间盘突出症患者中的应用效果。方法选取符合纳入标准的120例腰椎间盘突出症患者随机分为观察组和对照组,每组各60例。对照组给予中频电疗,观察组在中频电疗的基础上配合McKenzie疗法进行治疗,分别于治疗前后评定患者疼痛、腰痛以及临床疗效,并比较6个月复发率。结果治疗两个疗程后,两组患者疼痛视觉模拟评分均降低,且观察组低于对照组(P<0.01);两组患者腰痛评分均增加,且观察组高于对照组(P<0.01),治疗6个月后观察组复发率明显低于对照组,差异有统计学意义(P<0.01)。结论McKenzie疗法联合中频电疗临床治疗效果优于单纯中频电疗,能够加速患者症状好转,明显改善腰椎间盘突出症患者的症状,提高患者生活质量,减少复发。     

McKenzie法联合腰椎牵引等治疗腰椎间盘突出症的疗效观察

目的观察McKenzie法联合腰椎牵引等治疗腰椎间盘突出症的疗效。 方法将60例腰椎间盘突出症患者分为治疗组及对照组，2组均给予腰椎牵引、超短波及中频电疗，治疗组同时辅以McKenzie治疗，对照组则辅以推拿、按摩治疗。于治疗前、治疗2周后分别采用McKenzie腰椎评定表、日本骨科协会下背痛评价表（JOA评分）及疼痛目测类比评分法（VAS）对2组患者进行评定；同时于治疗结束1年及2年后分别对2组患者进行随访。 结果2组患者治疗后JOA、疼痛VAS评分及腰椎运动缺失程度均较治疗前明显改善（P＜0.01），且以治疗组疼痛VAS评分的改善幅度较显著，明显优于对照组水平（P＜0.05）。治疗结束1年后随访发现2组患者复发率间差异无统计学意义(P&rt;0.05)，2年后治疗组复发率明显低于对照组(P＜0.05)。 结论在腰椎牵引、超短波及中频电疗基础上辅以McKenzie治疗，能进一步缓解腰椎间盘突出症患者疼痛，抑制病情复发，该联合疗法值得临床推广、应用。     

倒悬推拿法治疗腰椎间盘突出症的临床疗效

目的:观察倒悬推拿疗法治疗腰椎间盘突出症的临床疗效,并探讨其起效机制。方法:腰椎间盘突出症患者120例,随机分为2组各60例,倒悬组用倒悬推拿疗法,对照组采用常规推拿及牵引治疗。结果:治疗18 d后,倒悬组痊愈及总有效率明显优于对照组(50.0%、93.3%与23.3%、75.0%,P<0.01)。结论:倒悬推拿疗法治疗腰椎间盘突出症具有较好的疗效。     

中医经络微创疗法对腰椎间盘突出症腰椎功能及疼痛程度的影响

目的探讨中医经络微创疗法对腰椎间盘突出症腰椎功能及疼痛程度的影响。方法选取收治的60例腰椎间盘突出症患者,按随机数表法分为对照组和观察组各30例。对照组口服塞来昔布胶囊治疗,观察组在对照组基础上实施中医经络微创疗法。治疗后,对两组腰椎功能及疼痛程度进行比较。结果治疗后,观察组ODI指数评分及临床症状评分相比对照组低,差异有统计学意义(P<0.05);两组VAS评分及腰部关节活动度均有改善,但观察组改善效果优于对照组,差异有统计学意义(P<0.05)。结论中医经络微创疗法治疗腰椎间盘突出症,可有效改善腰椎功能,缓解疼痛程度,进而提高治疗效果。     

三步针罐疗法治疗急性旁侧型腰椎间盘突出症60例疗效观察及护理

目的:探讨三步针罐疗法治疗急性旁侧型腰椎间盘突出症的临床疗效及护理方法.方法:将120例急性旁侧型腰椎间盘突出症患者随机分为两组各60例,观察组采用三步针罐疗法治疗,对照组采用常规针刺治疗,3个疗程后采用目测类比评分法对两组病例的疼痛进行评估,应用腰椎疾患治疗成绩评分表对腰椎功能状态进行临床评定,以临床症状、体征、改善情况评定疗效,并进行组间比较.结果:两组镇痛效果、腰椎改善指数均优于治疗前(P<0.01),观察组镇痛效果、腰椎改善指数高于对照组(P<0.05),观察组治愈率、总有效率优于对照组(P<0.01,P<0.05).结论:三步针罐疗法是目前临床治疗旁侧型腰椎间盘突出症较理想的无创性方法,配合恰当的护理,可实现良好的疗效.     

神经松动术结合推拿治疗腰椎间盘突出症

目的:观察神经松动术结合传统腰椎推拿对腰椎间盘突出症的治疗效果。方法:腰椎间盘突出症患者50例,随机分为2组各25例,均进行传统腰椎推拿手法治疗,观察组配合神经松动术治疗。治疗前后采用疼痛视觉模拟评分(VAS)、直腿抬高(straight leg raise,SLR)及JOA评分评定2组疗效。结果:治疗4周后,2组VAS评分均较治疗前明显下降,且观察组更低于对照组(均P<0.01);SLR和JOA评分均较治疗前明显提高,且观察组显著高于对照组(均P<0.05)。结论:神经松动术结合传统腰椎推拿手法治疗腰椎间盘突出症效果较好,明显优于单一腰椎推拿手法治疗。     

麦肯基疗法在腰椎间盘突出症护理中的应用

目的:探讨麦肯基疗法在腰椎间盘突出症护理中的应用效果。方法:将178例腰椎间盘突出症患者随机分为对照组和观察组各89例,对照组采用常规腰椎牵引和中频电疗,观察组采用常规腰椎牵引和麦肯基疗法进行康复护理指导。结果:观察组与对照组疗效比较有显著性差异(P<0.01)。结论:采用麦肯基疗法对腰椎间盘突出症患者给予康复护理指导疗效显著,可降低复发率。     

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.     

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.     

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.     

Advance Care Planning

Predictors of patient wishes and influence of family and clinicians are discussed. Research findings on patient decision-making relating to preferences in end-of-life care are described. Advance directives and durable powers of attorney are defined and differentiated. Most patients have not participated in advance care planning and the need for more effective planning is documented. Appropriate times for discussions of such planning are described. Scenarios discussed include terminal cancer, chronic obstructive pulmonary disease, AIDS, stroke, and dementia. Patient satisfaction is discussed, as is a structured process for discussions about patient preferences. Results of patient responses to hypothetical scenarios are described. Invasiveness of interventions, prognosis and other factors that favor or discourage patient preferences for treatment are discussed. Findings resulting from research funded by the Agency for Healthcare Research and Quality (AHRQ) are discussed. This research can help providers offer end-of-life care based on preferences held by the majority of patients under similar circumstances.     

Spiritual Dimensions of Nursing Practice. edited by V. B. Carson

The Cochrane Library of Systematic Reviewsis published quarterly. Issue one for 2004 of the library was published in February 2004. This issue contains 3,329 reviews and protocols of which 1,921 are fully published reviews. The trials database now stands at over 400,000 records with an additional 4,427 one-page summaries of non-Cochrane reviews in the NHS database of reviews of effectiveness (DARE). This version of the library contains the results of an extensive search for RCTs on EMBASE. The latest library contains 84 new reviews, seven are considered relevant to practitioners in pain and palliative care. References are published in the same format as the citation for Cochrane reviews.     

Évaluation,par l’imagerie ultrasonore,du recrutement musculaire,de la force motrice et de la détente verticale du quadriceps après électromyostimulation (cas de 15 étudiants de l’INJS)

The increase of strength seems to be an element of performance in some sports.