变速变负荷运动训练联合玻璃酸钠治疗膝关节骨性关节炎的成本-效果研究

目的:探讨变速变负荷(VVR)运动训练联合玻璃酸钠(SH)治疗膝关节骨性关节炎(OA)患者的成本-效果。方法:90例OA患者随机分为3组各30例,观察组膝关节SH注射和变速变负荷(VVR)下肢肌力测定训练系统进行膝关节运动训练;理疗组膝关节给予石蜡疗法、脉冲磁场、药物离子导入及高频电微波治疗;对照组仅行膝关节SH注射治疗。治疗前后分别采集3组患者康复介入时至康复治疗5周后的直接医疗费用,以及各费用的详细构成。结果:治疗5周后,疼痛目测类比评分法(VAS)评分,3组与治疗前比较均下降;Lysholm膝关节功能量表(LKSS)和VVR下肢肌力评定均有提高,与理疗组和对照组比较,观察组表现更突出(P0.05),理疗组与对照组比较差异无统计学意义。观察组治疗后各项指标每改善1分所耗费的相关成本费用明显低于理疗组和对照组(P0.05)。结论:应用VVR运动训练联合SH局部注射治疗OA是经济、有效的治疗方案。     

运动训练结合玻璃酸钠治疗膝关节骨性关节炎患者关节功能改善分析

目的：评价膝关节功能训练联合玻璃酸钠注射液（施沛特）对膝关节骨性关节炎患者关节功能改善的状况。方法：选择92例膝关节骨性关节炎患者,随机分为2组,一组接受玻璃酸钠注射液膝关节内注射治疗,每周1次,连续5次为1疗程。另一组同样完成1疗程的玻璃酸钠注射液膝关节内注射治疗,但在完成第2次玻璃酸钠注射液关节内注射时开始膝关节功能训练,功能训练持续6个月,评价两组患者膝关节功能改善的差异。结果：膝关节内注射玻璃酸钠注射液联合膝关节功能训练组在改善膝关节功能方面优于单纯膝关节内注射玻璃酸钠注射液组。结论：膝关节内注射玻璃酸钠注射液联合膝关节功能训练能够对膝关节骨性关节炎起到温和持久的关节功能改善作用。     

腓骨沉降术配合玻璃酸钠关节腔注射对膝关节内侧间室骨性关节炎的临床研究

【】 目的：研究腓骨沉降术配合玻璃酸钠关节腔注射对膝关节内侧间室骨性关节炎的临床疗效。方法：将40例膝关节内侧间室骨性关节炎的患者随机分为两组,实验组(腓骨沉降术配合玻璃酸钠关节腔注射组)20例,对照组(玻璃酸钠关节腔注射组)20例,比较实验组和对照组在治疗后1周、2周、3周的视觉模拟疼痛评分变化(visual analog scale,VAS)、膝关节活动度(range of motion ,ROM)。结果：实验组患者在治疗后1周、2周、3周的VAS评分和对照组比较差异具有统计学意义(P ＜ 0．05);实验组患者在治疗后1周、2周、3周的ROM与对照组比较差异有统计学意义(P ＜ 0．05)。结论：腓骨沉降术配合玻璃酸钠关节腔注射对膝关节内侧间室骨性关节炎的临床疗效优于玻璃酸钠关节腔注射。     

玻璃酸钠关节腔内注射在治疗膝关节骨性关节炎中的临床应用

目的探讨玻璃酸钠关节腔内注射在治疗膝关节骨性关节炎中的临床应用价值。方法将166例膝关节骨性关节炎患者随机分为研究组86例和对照组80例。研究组患者近1周内未服用任何消炎止痛药物及激素等对骨关节炎有治疗作用的药物,能够接受玻璃酸钠关节腔内注射的研究方案而不配合其他治疗;而对照组患者给予理疗、关节功能保护及口服非甾体类抗炎药等。治疗3个月后,采用日本整形外科学会的《膝关节功能评定表》对两组患者膝关节功能进行评测,统计两组患者的疗效情况,并进行比较。结果研究组患者膝关节功能综合评分明显高于对照组;研究组疗效优良的百分率为87.21%,而对照组疗效优良的百分率为67.50%,两组比较,差异均有非常显著性意义(P0.01)。结论两种治疗方法对膝关节骨性关节炎疼痛均有缓解效果,但玻璃酸钠关节腔内注射的镇痛效果更持久,疗效更佳,更能明显地改善膝关节功能。     

腓骨沉降术配合玻璃酸钠关节腔注射治疗膝关节内侧间室骨性关节炎的临床研究

目的:研究腓骨沉降术配合玻璃酸钠关节腔注射治疗膝关节内侧间室骨性关节炎的临床疗效。方法:将40例膝关节内侧间室骨性关节炎的患者随机分为两组:实验组(腓骨沉降术配合玻璃酸钠关节腔注射组)20例和对照组(玻璃酸钠关节腔注射组)20例,比较两组在治疗1周、2周、3周后的视觉模拟疼痛评分变化(VAS)、膝关节活动度(ROM)。结果:实验组在治疗1周、2周、3周后的VAS评分和ROM与对照组比较,差异均具有统计学意义,P0.05。结论:腓骨沉降术配合玻璃酸钠关节腔注射治疗膝关节内侧间室骨性关节炎的临床疗效优于玻璃酸钠关节腔注射,值得临床推广应用。     

中药药熨结合玻璃酸钠治疗膝关节骨性关节炎的观察与护理

目的：探讨中药药熨疗法治疗膝关节骨性关节炎的临床疗效。方法：随机将122例膝关节骨性关节炎患者分为观察组（62例）和对照组（60例）,观察组采用中药药熨疗法和关节腔内注射玻璃酸钠;对照组用单纯关节腔内注射玻璃酸钠。结果：观察组的疗效优于对照组。结论：中药药熨结合玻璃酸钠治疗膝关节骨性关节炎有较好的临床疗效。     

熏洗方联合玻璃酸钠关节腔内注射治疗膝骨性关节炎临床疗效观察

目的:观察熏洗方联合玻璃酸钠注射治疗膝骨性关节炎的临床疗效。方法:选取轻中度膝骨性关节炎患者60例,随机分为实验组和对照组各30例。实验组采用名老中医丁锷的经验方熏洗方外用联合玻璃酸钠注射液关节腔内注射治疗,对照组30例采用单纯玻璃酸钠注射液关节腔注射治疗,5周为1个疗程。通过观察2组患者膝关节治疗前后的疼痛视觉模拟评分(VAS)、Lysholm评分变化及临床疗效。结果:实验组治疗后的VAS评分显著低于对照组,Lysholm评分显著高于对照组;实验组的有效率显著高于对照组,差异有统计学意义。结论:熏洗方可以显著改善膝骨性关节炎患者的临床症状,提高患者生活质量,改善患者膝关节功能,值得临床推广使用。     

中西医结合治疗膝关节骨性关节炎73例疗效观察

目的为探讨中药内服、熏洗配合玻璃酸钠关节内注射治疗膝关节骨性关节炎的临床疗效。方法将73例膝关节骨性关节炎患者分为两组：治疗组（补益肝肾中药内服、通经活络洗方熏洗配合玻璃酸钠关节内注射）43例,对照组（玻璃酸钠关节内注射）30例,分别观察并比较其临床疗效和改善关节功能的疗效。结果显示治疗组临床疗效及镇痛和改善关节功能的效果均优于对照组（JP〈0．05）。结论表明中药内服外洗配合玻璃酸钠关节内注射治疗膝关节骨性关节炎,具有较好的临床疗效及缓解疼痛和改善关节功能的作用。     

丹参注射液联合玻璃酸钠腔内注射治疗膝骨性关节炎

目的:观察丹参注射液联合玻璃酸钠腔内注射治疗膝骨性关节炎的疗效。方法:选取我院收治的120例膝骨性关节炎患者为研究对象,随机分为研究组和对照组各60例。研究组给予丹参注射液+玻璃酸钠注射液治疗,对照组给予玻璃酸钠注射液治疗,观察两组临床治疗优良率,比较两组治疗前及随访1年后膝关节功能、生活质量。结果:研究组临床治疗优良率高于对照组(P<0.05);治疗前两组膝关节功能及生活质量比较无明显差异(P>0.05),治疗后两组均有所改善,且研究组改善程度优于对照组(P<0.05)。结论:丹参注射液联合玻璃酸钠腔内注射治疗膝骨性关节炎疗效显著,可有效改善患者生活质量,促进早期恢复,预后良好。     

电针结合玻璃酸钠关节内注射治疗膝骨性关节炎

目的探讨电针结合玻璃酸钠关节内注射治疗膝骨性关节炎的临床疗效。方法将确诊患者随机分为治疗组55例和对照组54例。前者接受电针结合玻璃酸钠关节内注射综合疗法,后者仅行玻璃酸钠关节内注射治疗。治疗前、后分别测定膝关节运动功能,计算治疗有效率并对生活质量进行评估。结果治疗后,两组膝关节运动功能评分均显著提高,治疗组高于对照组(P<0.001)。治疗后5周,治疗组的有效率高于对照组(P<0.05),两组患者的生活质量均显著改善(P<0.001)。其中,治疗组的生活质量明显优于对照组(P<0.001)。结论电针配合玻璃酸钠关节内注射是一种治疗膝骨性关节炎的有效方法。     

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.     

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.     

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.     

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.