截肢工伤患者转归的调查及影响因素分析

目的 调查截肢工伤患者的生存状况并探讨其影响因素,为促进截肢工伤患者重返工作、融入社会制订干预措施。 方法 查阅本中心社会康复科的档案资料（包括基本信息、辅导记录、出院后跟进记录等）,采用卡方检验和非条件Logistic回归分析探讨影响截肢工伤患者转归的相关因素。 结果 本次共入选研究对象253例,其中138例（54.55%）重返工作岗位。单因素分析结果表明：年龄、婚姻状况、公司性质、户籍、受伤部位与截肢工伤患者的转归不相关(P>0.05);年龄、性别、文化程度、社保归属地、伤残级别与截肢工伤患者转归具有相关性(P<0.05)。多因素分析进一步证实：性别、文化程度、伤残级别是影响截肢工伤患者重返工作的重要因素。 结论 本研究入选截肢工伤患者复工率低于一般国际水平,除与本身因素有关外,工伤保险政策因素也会限制截肢工伤患者转归。     

女性工伤职工结局调查分析

目的了解女性工伤职工重返工作岗位的状况及其主要影响因素。方法查阅本中心社会康复科的档案资料,包括基本信息、辅导记录、出院后跟进记录,采用单因素分析及二分类Logistic回归分析影响女性工伤职工的因素。结果本次共有研究对象232名,其中149名(64.2%)回归工作岗位,缺勤中位数为206.5 d。单因素分析表明,年龄、婚姻、缺勤时间、文化程度与女性工伤职工结局不相关(P0.05);社保归属地、户籍、受伤严重程度与女性工伤职工结局相关(P0.05)。结论女性工伤职工大部分能回归工作。除受伤严重程度外,一些体制性因素也影响女性工伤职工重返工作岗位。     

个案管理技术在工伤职工重返工作中的应用

目的:通过研究个案管理技术在推动工伤职工重返工作过程中的作用,分析工伤职工再就业问题,探讨协助工伤职工再就业的有效方法。方法:选择5位伤残情况不同的工伤职工作为研究对象,将个案管理的介入工作分为4个时期,在工伤职工的住院康复和重返工作过程中采用了评估、康复辅导、干预和管理、就业支援与随访等个案管理技术方法,协助工伤职工实现再就业,并对再就业问题进行比较分析。结果:经过出院后6个月的就业随访,1位返回了原公司不同工作岗位,1位在新公司实现再就业,2位实现自雇创业,1位多次尝试创业未成功。结论:工伤职工在再就业过程中存在多种影响因素;个案管理技术对工伤职工的重返工作有帮助,可以应用于工伤职业康复服务中。     

就业潜能培训项目在工伤职工重返工作中的应用

摘要 目的：通过研究就业潜能培训项目在工伤职工重返工作过程中的应用,探讨就业潜能培训项目对工伤职工重返工作的作用。 方法：选取5例完成就业潜能培训项目的职工,在参加常规职业康复训练的基础上进行就业潜能培训,训练前后对职工进行自我效能感和就业准备的评估,结合其他面谈资料及出院后6个月进行电话随访跟进就业情况,并对就业情况进行比较分析。 结果：经过出院后6个月的随访,2案例返回原公司原工作岗位,1例返回原公司不同工作岗位,1例在新公司实现再就业,1例未能返回工作岗位。 结论：就业潜能培训项目可以协助提高工伤职工的自我效能感和就业准备度,可在常规职业康复训练的基础上增加类似的培训项目,有利于推动工伤职工重返社会。     

下肢外伤工伤职工重返工作岗位及影响因素分析

正下肢骨折是临床常见的创伤性疾病,近年来骨外伤的发生概率呈上升趋势,工伤是导致其受伤的原因之一。由于下肢是行走活动的主要肢体,其功能障碍可导致严重的生活质量下降~([1]),重返工作岗位对其生存质量有正向及独立的影响~([2])。因此,重返工作岗位不仅可以减少家庭乃至社会的经济负担,还可以减轻职工本人的心理压力,提升其生存质量。对于下肢外伤的工伤职工,重返工作岗位是必然的选择,有多种因素影响其重返工作岗位,本文尝试了解下肢外伤工伤职工的基本状况及主要影响因素,以更好地了解下肢外伤工伤职工一般资料与能否成功返回工作岗位的影响关系。     

我国的工伤康复现状

工伤康复是利用现代康复的手段和技术,整合各种资源,为工伤致残人员提供医疗康复、教育康复、职业康复及社会康复等服务,促使残疾人能重返社会,最大限度地恢复和提高其身体功能和生活自理能力,尽可能恢复或提高伤残职工的职业劳动能力,从而促进工伤人员全面回归社会和重返工作岗位的实践活动。现就我国工伤康复现状阐述如下。     

广东地区工伤职业康复者复工特点及影响因素分析

目的:观察广东地区职业康复者的复工特点,研究出院后7天内、8—180天、半年内的复工影响因素。方法:回顾性研究,从病历库搜集广东地区2015年1月—2017年5月间由各地劳动能力鉴定委员会批准职业康复期的工伤职工病历资料及出院后回访资料,按照入选标准和排除标准进行筛查,纳入样本775例,描述样本不同时期的复工特点,采用单因素分析及二分类logistic回归分析出院后7天内、8—180天、半年内的复工影响因素。结果:①出院后7天内复工率为52.7%,半年内复工率为74.2%;②二分类logistic回归分析显示出院后7天内复工影响因素有工作安置方式、学历、参保地、就业意愿(P0.05);8—180天复工的影响因素有性别、工种、就业意愿(P0.05);半年内复工的综合影响因素有工作安置方式、性别、工种、参保地、伤残级别、就业意愿(P0.05)。结论:①累计复工比例呈现出院后7天内快速增长、随后半年内增幅放缓;②工作安置方式、性别、学历、工种、参保地、伤残级别、就业意愿影响工伤职工复工,不同时间段影响因素存在不同。     

工作模拟评估用于工伤职业司机重返工作岗位风险评估的研究

目的:研究使用工作模拟评估预测工伤职业司机重返工作岗位风险情况,并检测其有效性。方法:依据162例工伤职业司机参加工作模拟评估情况给予重返工作岗位建议。3个月后,通过电话随访确定其就业情况,对比分析工作模拟评估的预测有效性,同时分析影响工作模拟评估预测效力的因素。结果:工作模拟评估结果与职业司机实际安全就业情况一致性K系数为0.489。单因素二元Logistics回归分析显示患者出院时就业意愿(OR=1.821,CI:1.238-2.678)、雇佣关系(OR=0.583,CI:0.379-0.896)及企业性质(OR=0.710,CI:0.527-0.956)可影响工作模拟评估的预测效力,多因素二元Logistics回归分析显示患者出院时就业意愿(OR=1.718,CI:1.151-2.564)和单位性质(OR=0.724,CI:0.530-0.988)为影响工作模拟评估预测能力的重要因素。结论:工作模拟评估是一种有效的受伤职业司机复工风险的评估方法,但需考虑患者就业愿意和单位性质等。     

BTE Primus工作模拟训练系统对手外伤患者重返工作的影响

摘要 目的：观察BTE工作模拟训练对手外伤患者的职业康复疗效,探讨有效的恢复工伤职工职业劳动能力的方法。 方法：应用BTE工作模拟训练系统对120例手部受伤的工伤职工进行平均49.73±23.59d的工作模拟训练,出院后再进行6个月的就业情况跟踪。 结果：出院后6个月内重返原公司原工作岗位62人(51.67%),原公司改变工种33人(27.50%) ,重新再就业14人(11.67%),待业或休假7人(5.83%),继续寻求治疗4人(3.33%)。 结论：应用BTE工作模拟训练能够提高手外伤患者的职业劳动能力,有利于促进工伤职工重返工作岗位。     

工伤职工职业康复及重返社会的行动研究

目的探讨对工伤职工实施包括职业康复及社区回归在内的完整康复计划的原则与方法。方法从跟进的371例工伤职工中抽取14个深入跟进的康复个案为样本，从性别及家庭角色差异、伤残部位及程度、康复的进展、工伤赔偿方式等方面，分析工伤后的职业康复及回归社区状况，整理出有关工伤职工职业康复及社区回归的影响因素。结果影响工伤职工职业康复和社区回归的因素包括工伤职工残疾部位与程度、性别与家庭角色差异，以及工伤补偿与工伤康复政策和跨专业团队提供的工伤康复服务管理模式等。结论完整的工伤康复计划需要考虑工伤职工的基本医疗康复、职业康复及社区康复需要，及早提供适当的支持和指引，建立一站式全面深入跟进的工伤康复服务管理模式。     

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.     

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.     

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.     

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.     

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.     

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.