重大车祸伤存活患者创伤后成长与心理健康的关系

目的调查重大车祸伤存活患者创伤后成长与心理症状的关系。方法采用创伤后成长评定量表和症状自评量表对88例车祸伤后存活患者进行调查。结果车祸伤患者创伤后成长总分为(85.73±15.66)分,症状自评量表的躯体化、焦虑、抑郁、恐怖和偏执得分高于全国常模(P<0.01),年龄、躯体化、抑郁、焦虑、恐怖和精神病性对创伤后成长具有预测作用。结论车祸伤存活患者存在一定水平的心理正性成长,心理护理中促进这种成长有可能有助于减轻患者心理症状。     

Effectiveness of Home- and Community-Based Rehabilitation in a Large Cohort of Patients Disabled by Cerebrovascular Accident: Evidence of a Dose-Response Relationship

Objectives

To (1) assess the effectiveness of home- and community-based rehabilitation (HCBR) in a large cohort of individuals with disabilities secondary to cerebrovascular accident (CVA); and (2) evaluate the responsiveness to treatment of the Mayo-Portland Adaptability Inventory (MPAI-4) to changes resulting from HCBR in this patient group.

Design

Retrospective analysis of program evaluation data for treatment completers and noncompleters.

Setting

HCBR conducted in 7 geographically distinct U.S. cities.

Participants

Individuals with CVA (n=738) who completed the prescribed course of rehabilitation (completed course of treatment [CCT]) compared with 150 individuals who were precipitously discharged (PD) before program completion.

Intervention

HCBR delivered by certified professional staff on an individualized basis.

Main Outcome Measures

Mayo-Portland Adaptability Inventory (MPAI-4) completed by professional consensus on admission and at discharge.

Results

With the use of analysis of covariance, MPAI-4 total scores at discharge for CCT participants were compared with those of PD participants, with admission MPAI-4, age, length of stay, and time since event as covariates. CCT participants showed greater improvement than PD participants (F=99.48, P<.001) with a moderate effect size (partial η²=.10). Group differences and effect sizes were similar for the 3 index scores: Ability (F=75.96, P<.001; partial η²=.08), Adjustment (F=99.67, P<.001; partial η²=.10), and Participation (F=69.15, P<.001; partial η²=.07).

Conclusions

Individuals in the CCT group who received the entire planned course of HCBR showed greater improvement on all MPAI-4 indexes than those in the PD group who were discharged before completing the prescribed program. This dose-response relationship provides evidence of a causal relationship between treatment and outcome.     

Relation between spasticity,weakness and contracture of the elbow flexors and upper limb activity after stroke: An observational study

Purpose. Understanding the relationship between the motor impairments and their impact on physical activity will allow rehabilitation after stroke to be based on scientific principles. The aims of this study were to determine: (i) the relative contribution of weakness and spasticity to contracture, and (ii) the relative contribution of all three impairments to limitations in physical activity during the first 12 months after stroke.

Method. This longitudinal observational study charted the evolution of weakness (loss of maximal force), spasticity (stretch-evoked EMG) and contracture (loss of joint range) of the elbow flexors and limitations in upper limb activity (Motor Assessment Scale) for a year after stroke in 27 subjects who had suffered a first stroke. Spasticity was measured as abnormal reflex activity, weakness was measured as loss of maximum isometric torque, contracture was measured as the difference in range of motion between the affected and intact side, and limitations in physical activity were measured on a clinical scale.

Results. The major independent contributors to contracture were spasticity for the first four months after stroke (p = 0.0001 – 0.10) and weakness thereafter (p = 0.01 – 0.05). However, the major and only independent contributor to limitations in physical activity throughout the year was weakness (p = 0.0001 – 0.05).

Conclusions. For the first time, from a longitudinal study, the findings show that spasticity can cause contracture after stroke, consistent with the prevailing clinical view. However, weakness is the main contributor to activity limitations.     

院前救治急性脑卒中患者特征分析

回顾性分析2011年1月1日至12月31日期间院前救治的797例脑卒中患者资料,该人数占同期院前急救人数的10.4％,男性平均（67±14）岁,女性平均（72±14）岁（P＜0.01）,随年龄增长脑卒中人数增加（P＜0.05）.9：00～ 10：00是高发时段（61例,占7.7％）,凌晨4：00 ～5：00发病率最低（9例,占1.1％）.送至三级甲等医院人数552例,占69.3％,以患方自主择院为主（626例,78.5％）.急救反应时间（接警至到达现场时间）平均13.49 min,10 min内318例（39.9％）,急救总耗时平均38.11 min.     

高龄患者跌倒风险因素分析及围术期护理干预

目的探讨围手术期高龄患者发生意外跌倒的风险因素及实施风险因素分级护理干预的效果。方法将2008年1月—2010年1月129例高龄住院患者(年龄≥65岁)作为对照组,分析患者发生意外跌倒的危险因素,并实施骨科常规护理;将2010年1月—2012年1月136例高龄患者(年龄≥65岁)作为观察组,对危险因素量化评分,前瞻性实施护理干预措施。比较2组患者风险事件发生率、护理服务满意度。结果观察组患者意外跌倒发生率为1.5%,显著低于对照组的7.8%;对照组患者满意度为82%,显著低于观察组的98%。结论在骨科病区进行意外跌倒风险因素分级管理,实施护理干预措施,不仅能够减少高龄患者住院期间意外跌倒不良事件的发生率,而且可以提高三级甲等医院的优质服务水平,值得临床推广应用。     

日本福岛核事故后北京地区食品放射性污染的监测与分析

目的 分析北京地区蔬菜和原奶样品受日本福岛核事故放射性核素污染的监测结果,评价此次核事故对北京地区食品造成的放射性污染程度.方法 启动核应急监测体系,使用高纯锗γ谱仪测量系统对北京地区的蔬菜和原奶样品的放射性污染水平进行监测.结果 2011年4月2日北京通州露天荠菜样品中首次检测出微量人工放射性核素131Ⅱ,2011年4月2日-6月30日采集的蔬菜样品中131Ⅰ活度的最大值为海淀野草样品(3.03 Bq/kg),原奶样品中未检测到人工放射性核素.结论 监测到的露天蔬菜中131Ⅰ来自福岛核事故释放,远低于1986年切尔诺贝利核电站事故对北京地区造成的放射性污染程度,其对公众所致有效剂量极其微小,未对该地区居民产生明显的健康影响.     

广东省部分医院运输事故伤害住院病例原因分析

目的分析2010年广东省部分地区运输事故伤害住院患者状况,为制定防制策略提供依据。方法在广东省伤害城市监测点深圳市、珠海市各选3家二级以上共6家医院,农村点南雄市、新兴县、连平县各选取1家市(县)人民医院,收集2010年1月1日至2010年12月31日所有伤害住院病历首页,对其中运输事故伤害住院病例分析。结果广东省9家综合医院因运输事故伤害住院病例5427例,占伤害住院病例的28.3%,男女性别比为2.24∶1(3752/1675),运输事故伤害高发于冬季(33.5%),43.7%的伤害病例为流动人口,以骑摩托车人员在运输事故中损伤最多(36.3%),头部损伤2227例(41.1%),住院天数中位数为10 d,住院费用中位数为5468.97元。结论广东省运输事故伤害不容忽视,流动人口的交通运输安全已成为严重的公共卫生问题。     

武警部队反恐处突车载手术检验方舱车的研制

目的:围绕如何展开"反恐处突、抢险救灾"医疗保障任务,研制车栽手术检验方舱车,具有集成度高、机动性强、救治功能齐备、操作方便等特点。方法:以总后定型野战手术车为基本技术形式进行改装,将车载方舱划分为外科手术和医技检验2个舱。结果:可同时实现手术和检验2种功能,无需再搭建帐篷和装卸展开相关医疗装备,增加了原帐篷内手术和检验不具备的空调、电暖、消毒灭菌功能,2人展收作业只需20 min。结论:手术检验方舱车集成度高、机动性强、反应速度快,在平时可以车代库;应对突发事件、自然灾害时,可在第一时间出发,展开现场救治。     

社区护士糖尿病知识掌握情况调查分析

目的 了解社区护士糖尿病知识的掌握情况,并对存在问题找出对策。方法 采用随机整群抽样的方法,对静安区5家社区卫生服务中心的320名护士进行糖尿病相关知识问卷调查,其中有效问卷320份。结果 本次调查320名护士,糖尿病知识测试总分最高为47分,最低为20分,平均为(37.72±4.32)分,良好39人,一般112人,较差169人。结论 社区护士糖尿病知识掌握情况不理想,不能满足现今社会的需求,应采取切实有效的培训方式加强对社区护士糖尿病知识的教育。     

Short-term feeding outcomes after neonatal brain injury

BackgroundAlthough brain injury is known to be associated with feeding outcomes in preterm and unwell neonates, these groups are frequently excluded from studies of neonatal feeding development. This paper aims to identify the short-term feeding outcomes of infants with neonatal brain injury.MethodsA retrospective cohort analysis was undertaken to ascertain the incidence of feeding disorders (full/partial tube feeding at 40 weeks) among infants with brain injury admitted to a UK neonatal unit between 2013 and 2017.Results202 surviving infants with neonatal brain injury were included in the study. Feeding disorders were common among infants with brain injury (preterm 34%, term 34%) compared to infants without significant neurological comorbidities (preterm 9%, term 3%). The likelihood of feeding disorders increased with injury severity.ConclusionsAll infants with neonatal brain injury should have access to a specialist feeding therapist to maximise their feeding potential and provide support to families.