32例自体血回输在外伤性脾破裂手术中应用的临床研究

目的研究分析在外伤性脾破裂手术中的自体血回输的适应症、流程、安全性等问题。方法选取2010年1月—2013年1月间入院治疗的单纯外伤性脾破裂患者32例,应用自体血液回收技术回输,注意流程的严密性、科学性,加强护理干预操作。结果 32例患者通过自体血回输,有效扩充了血容量,平安度过危险期,均安全出院。32例患者中自体回输血量28160mL,占总引流血量49060mL的57.40%,其中最小回输550mL,最多1400mL,平均回输880mL。其中7例患者应用异体输血共2870mL,占总输血量的10.21%。3例发热患者2例伤口感染经对症处理后恢复正常,无溶血反应,未见持续出血、输血后并发症、过敏反应、细菌污染等疾病。结论外伤性脾破裂中应用自体血回输,操作简便,安全可靠,患者并发症较少,并且减少了血资源的浪费和异体输血排异反应及传染疾病的发生率。     

Life Review in Family Psychotherapy

A number of theorists and clinicians have recognized the value of life review as a therapeutic tool in waking with the elderly. Few, however, have used review in marriage and family psychotherapy. This paper provides a brief overview of life review and explores possible ways of expanding its application in marriage and family work. in addition to summarizing the central characteristics of life review, this paper also identifies possible outcomes and limitations, and then, through case example, explores the relevance of life review for maniage and family psychotherapy.     

Effects of audit and feedback on professional practice in Geriatric Acute Care Units

PurposeTo evaluate the effects of audit and feedback on service delivery and patient functioning in Austrian Geriatric Acute Care Units.MethodsQuality initiative based on a standardised documentation form (core and optional data set) and a web-based performance feedback with peer comparison in 18 Geriatric Acute Care Units, representing 40% of all Austrian units. Main outcome measures were compliance with desired practice of geriatric care (comprehensive geriatric assessment [CGA], therapeutic consequences), discharge characteristics and mortality.ResultsOverall 22,279 patient records were documented between 2008 and 2010. Active involvement in the web-based feedback system was indicated by a high frequency of data queries per year, 1401, 3148 and 2883 for 2008, 2009 and 2010, respectively. The mean completion rate for CGA tests increased from 73% in 2008 to 78% in 2010 (P < 0.05). For centres with completion of core and optional data (n = 8), the average number of documented therapeutic interventions increased from 4.4 to 5.0 (P < 0.05). Those aspects of CGA focusing on activities of daily living, mobility and cognition prompted the greatest degree of corresponding therapeutic interventions (> 90%). A lower intervention rate was induced by the nutritional assessment (< 20%). Mortality and discharge characteristics such as level of care and percentage of patients living at home after discharge did not change over the time.ConclusionFollowing implementation of a web-based performance feedback with peer comparison in Austrian Geriatric Acute Care Units, an improvement in health care professionals’ compliance with desired practice of geriatric care, but not in patients’ discharge characteristics, was observed.     

Feasibility and effects of home-based smartphone-delivered automated feedback training for gait in people with Parkinson's disease: A pilot randomized controlled trial

BackgroundInertial measurement units combined with a smartphone application (CuPiD-system) were developed to provide people with Parkinson's disease (PD) real-time feedback on gait performance. This study investigated the CuPiD-system's feasibility and effectiveness compared with conventional gait training when applied in the home environment.MethodsForty persons with PD undertook gait training for 30 min, three times per week for six weeks. Participants were randomly assigned to i) CuPiD, in which a smartphone application offered positive and corrective feedback on gait, or ii) an active control, in which personalized gait advice was provided. Gait, balance, endurance and quality of life were assessed before and after training and at four weeks follow-up using standardized tests.ResultsBoth groups improved significantly on the primary outcomes (single and dual task gait speed) at post-test and follow-up. The CuPiD group improved significantly more on balance (MiniBESTest) at post-test (from 24.8 to 26.1, SD∼5) and maintained quality of life (SF-36 physical health) at follow-up whereas the control group deteriorated (from 50.4 to 48.3, SD∼16). No other statistically significant differences were found between the two groups. The CuPiD system was well-tolerated and participants found the tool user-friendly.ConclusionCuPiD was feasible, well-accepted and seemed to be an effective approach to promote gait training, as participants improved equally to controls. This benefit may be ascribed to the real-time feedback, stimulating corrective actions and promoting self-efficacy to achieve optimal performance. Further optimization of the system and adequately-powered studies are warranted to corroborate these findings and determine cost-effectiveness.     

Influence of intra‐oral sensory impairment by anaesthesia on food comminution and mixing in dentate subjects

Sensory input from sensory receptors regarding food morsels can affect jaw motor behaviours during mastication. The aim was to clarify the effects of intra‐oral sensory input on the food‐comminuting and food‐mixing capacities of dentate subjects. Eleven dentate subjects without sensory dysfunction in their oro‐facial region participated in this study. Local anaesthesia was achieved on the periodontal structures and on the oral mucosa of the subjects' preferred chewing side by injecting a lidocaine solution with adrenalin. At baseline (control) and after anaesthesia, data on the subjects' food‐comminuting and food‐mixing capacities were gathered. The food‐comminuting capacity was quantified by measuring the degree of pulverisation of peanuts (objective hardness; 45·3 [Newton, N]) after a prescribed 20 chewing strokes. The food‐mixing capacity was measured as the degree of immixture of a two‐coloured paraffin wax cube after 10 chewing strokes. Wax cubes of three different hardness levels were used (soft, medium and hard: 20·3, 32·6 and 75·5 [N], respectively) and were chewed in random order. After anaesthesia, the subjects' food‐comminuting capacity significantly decreased (P < 0·001), as did the food‐mixing capacity for each hardness level of the wax cubes (P < 0·01). A significant correlation was observed between the objective hardness values and the anaesthesia effects for the food‐mixing capacity (P < 0·05), indicating that after anaesthesia, deterioration of the mixing capacity increased as the hardness increased. In conclusion, intra‐oral sensory input can affect both food‐comminuting and food‐mixing capacities.     

Quantified self and human movement: A review on the clinical impact of wearable sensing and feedback for gait analysis and intervention

The proliferation of miniaturized electronics has fueled a shift toward wearable sensors and feedback devices for the mass population. Quantified self and other similar movements involving wearable systems have gained recent interest. However, it is unclear what the clinical impact of these enabling technologies is on human gait. The purpose of this review is to assess clinical applications of wearable sensing and feedback for human gait and to identify areas of future research. Four electronic databases were searched to find articles employing wearable sensing or feedback for movements of the foot, ankle, shank, thigh, hip, pelvis, and trunk during gait. We retrieved 76 articles that met the inclusion criteria and identified four common clinical applications: (1) identifying movement disorders, (2) assessing surgical outcomes, (3) improving walking stability, and (4) reducing joint loading. Characteristics of knee and trunk motion were the most frequent gait parameters for both wearable sensing and wearable feedback. Most articles performed testing on healthy subjects, and the most prevalent patient populations were osteoarthritis, vestibular loss, Parkinson's disease, and post-stroke hemiplegia. The most widely used wearable sensors were inertial measurement units (accelerometer and gyroscope packaged together) and goniometers. Haptic (touch) and auditory were the most common feedback sensations. This review highlights the current state of the literature and demonstrates substantial potential clinical benefits of wearable sensing and feedback. Future research should focus on wearable sensing and feedback in patient populations, in natural human environments outside the laboratory such as at home or work, and on continuous, long-term monitoring and intervention.