脑梗死短期住院患者康复效益研究

目的:应用功能独立性评价量表(FIM)探讨脑梗死短期住院患者康复效益。方法:本研究为随机对照研究。选择65例脑梗死患者,随机分为康复治疗组和对照组,两组药物治疗基本相同。治疗组每天进行以Bobath法为主的康复训练,对照组只进行关节活动度训练和物理因子治疗,两组患者均采用FIM量表进行测量,将两组患者入院、出院值,住院期间获得值,以及康复效益进行配对分析。结果:①两组患者入院、出院时功能独立检查运动分、认知分、总分无显著性差异(P>0.05),康复组、对照组住院期间功能独立检查改变均有显著性差异(P<0.05),两组患者FIM改变值比较仅运动项有显著性差异(P<0.05)。②两组患者住院效率分别为:0.43分/天和0.37分/天,两者相比无显著性差异(P>0.05)。结论:脑梗死短期住院患者进行早期康复治疗只能提高FIM中的“运动项”得分,但在提高患者整体ADL功能上并无积极意义,强调住院时间过短并不利于脑梗死患者康复效益的提高。     

功能独立测量的临床运用分析

目的：通过分析功能独立测量（ＦＩＭ）在临床运用的情况,探讨其作为康复科常规残疾测量的价值。方法：用ＦＩＭ对１５７例康复科住院患者进行测量,并对不同病种入出院ＦＩＭ值进行配对分析,计算康复效益。结果：脑卒中、脊髓损伤、脑外伤及其他疾病患者的ＦＩＭ运动分、认知分及总分均有明显改变（Ｐ＜０．０１）;颈椎病、腰腿痛患者运动分有改变（Ｐ＜０．０１）,其康复效益较高;周围神经损伤患者出入院ＦＩＭ运动分、认知分、总分均无明显变化（Ｐ＞０．０５）,其康复效益低。结论：ＦＩＭ能反应康复过程中患者功能独立情况的变化,且与不同病种的功能独立情况相符合,可作为康复科常规测量方法     

康复护理对脑卒中病人的生命质量的影响

目的探讨早期康复护理对脑卒中病人神经功能恢复和生命质量改善的意义。方法将32例脑出血和35例脑梗塞患者随机分为康复组和对照组。结果无论是脑出血还是脑梗塞患者出院时和随访时,患者功能均有改善,但是康复组明显优于对照组(P<0.05)。结论提示早期康复护理对脑卒中患者神经功能的恢复和生命质量的改善有一定效果。     

Barthel指数对脑卒中患者住院康复效果的预测

目的：探讨Barthel指数(BI)对脑卒中患者治疗前后功能状态改变的预测效果。方法：采用回顾性研究的方法．将脑卒中患者227例的临床资料进行分析。根据患者入院时BI积分，分为严重功能障碍组、重度功能障碍组、中度功能障碍组、轻度功能障碍组和功能良好组。应用BI评定患者康复治疗前和出院时的日常生活活动能力。结果：入院时中度功能障碍患者的平均BI增分和增分速率均明显高于其他各组。提示BI积分41～60的脑卒中患者可作为住院康复治疗的首选对象．并可初步预测患者经过康复治疗后可能获得良好康复效果。结论：中度功能障碍患者比重度及轻度功能障碍患者具有更高的功能获得。     

康复指导对脑卒中患者出院前后运动功能的影响

我院对1997年10月至1999年6月收治的30例脑卒中患者进行出院康复指导,并与30例未进行康复指导的脑卒中患者进行对比,报告如下:1　临床资料两组患者均经ＣＴ或ＭＲＩ检查、临床确诊。指导组30例,男20例,女10例;年龄:50岁以下6例,51岁～60岁9例,60岁以上15例;其中脑出血10例,脑梗塞19例,混合型脑卒中1例。对照组30例,男18例,女12例;年龄50岁以下5例,51岁～60岁10例,60岁以上15例;其中脑出血9例,脑梗塞21例。康复评定运动功能采用Ｂｒｕｎｎｓｔｒｏｍ分级评定法评定上、下肢和手的功能〔1〕;运用改良的Ｂａｔｈｅｌ指数量表〔2〕评定ＡＤＬ,分…     

脑卒中偏瘫的康复治疗

近年来,脑卒中发病率明显上升。我国脑卒中发病率为0．39％,病后致残率占对．3％,多为偏瘫、失语的严重残疾[1]。我们从1994年起进行了脑卒中偏瘫的康复治疗,报告如下。资料与方法1.1.一般资料本组脑梗塞患者34例,其中男30例,女4例;脑出血患者8例,均为男性;年龄35～58岁,平均45．6岁。所有患者均进行了详细神经系统检查及头颅CT扫描。本组患者平均发病30．16天开始康复治疗,平均治疗45．12天。12方法12．l本组患者于入院及出院时,均进行肢体运动功能评定和日常生活活动能力（ADI,）评定;肢体运动功能评定按Brunnstrom六级…     

住院康复脑卒中偏瘫患者出院后功能转归的回顾性分析

目的通过对住院脑卒中偏瘫患者出院后的去向与功能转归进行回顾性分析，以明确脑卒中三级康复的必要性。 方法以在我院接受脑卒中康复治疗出院一段时间后再次入院康复治疗的脑卒中偏瘫患者为研究对象，如患者出院后未转入其他康复机构进行治疗、仅进行家庭康复干预则纳入家庭组（共有患者121例），如患者出院后继续转至其它康复机构进行康复治疗则纳入康复组（共有患者47例）。对2组患者一般资料情况、出院及再次入院时Barthel指数（BI）评分、Holden步行功能分级等疗效指标进行分析比较。 结果康复组患者再次入院时其肩痛人次、活动受限关节数量、肌张力≥1+级的关键肌群数量均明显少于家庭组；通过相关性分析发现，家庭组患者再次入院时与初次出院时BI差值与患者发病年龄、合并症数量具有负相关性，与出院时BI评分、Holden步行功能分级具有正相关性；将家庭组BI差值与出院时BI评分、Holden步行功能分级进行曲线回归分析，发现如出院时BI评分≥45分，则患者出院回家后其BI评分可维持稳定，当出院时Holden步行功能分级≥2级，则患者回归家庭后步行功能不至于退步。 结论脑卒中偏瘫患者出院后继续接受机构内康复治疗，能进一步提高其BI评分及Holden步行功能分级，抑制并发症发生；如脑卒中患者出院时BI评分≥45分或Holden步行功能分级≥2级，则患者回归家庭后功能可基本维持，但患者仍需进行适当康复干预以促进功能恢复、预防并发症发生。     

脑卒中患者家属配合功能训练的疗效观察

目的：研究脑卒中患者家属配合功能训练对于偏瘫肢体功能和日常生活活动能力（ADL）的影响。方法：80例脑卒中偏瘫住院患者随机分成两组,治疗组除常规康复治疗外。教会患者家属脑卒中患者共性的康复方案，让患者家属在常规康复治疗时间之外每天给患者多2h的训练：出院后定期随访，做好患者家属的功能训练方法指导；对照组仅进行常规康复治疗,出院后自行功能训练。分别于入院时、住院2个月、出院后3个月对两组进行评定。评价指标采用Barthel指数法和Brunnstrom评分法。结果：2个月出院时两组的日常生活活动能力、运动功能均有改善。出院3个月后治疗组患者的运动功能较出院时明显提高．对照组运动功能无明显改善．差异具有显著性（P〈0．05）。结论：教会患者家属易懂可行且通用的康复技术有利于脑卒中患者偏瘫肢体功能的改善。     

髋部骨折老年患者的康复效果评定

使用功能独立性评定 (functionalindependencemeasure,FIM )工具评定 1 0 0例髋部骨折患者入院和出院时的躯体和认知功能 ,使用Montebello康复因素评分法反映康复效果和效率 ,并于出院后6周对部分患者进行电话FIM调查问卷随访。结果出院时患者整体FIM分数有所改善 ,表明在住院康复期间患者功能改善 ,出院时运动FIM亚项中转移运动项和行动项得分比自理和括约肌控制低 ,在出院后 6周更明显。因此 ,在住院康复领域里改善行动技能和扩大独立转移能力应成为未来改善髋部骨折老年患者功能的目标     

脑卒中偏瘫患者躯干控制能力对ADL的影响

为探讨脑卒中偏瘫患者躯干控制能力与ADL的关系及躯干控制能力的康复效果，对25例住院的脑卒中偏瘫患者入院及出院时各进行一次躯干控制测试（TCT）及Barthel指数评定，并在住院期间进行综合康复治疗。结果：与入院时相比，出院时TCT各分项及总分均有提高（P〈0．001）。入院时TCT总分与Barthel指数呈显著相关（r=0．830）；出院时TCT总分与Barthel指数亦显著相关（r=0．783）。提示：综合康复治疗有助于躯干控制能力改善，TCT可早期预测偏瘫患者的ADL。     

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.     

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.     

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.     

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.     

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.