物理因子治疗剂量的改良

目的：探讨物理因子治疗剂量改良的可行性，实用性，先进性，提高临床治疗效果。方法：进行3个方面改良：（1）首次治疗剂量加倍；（2）多种物理因子协同治疗；（3）增加治疗次数。结果：试验组使用改良的物理因子治疗剂量，起到了物理效能协同，互补，增效作用，即时效应明显，延长了镇痛时间，血浆β-内啡肽含量增高，两组比较，P＜0．01。结论：改良的在子治疗剂量能明显提高临床疗效。     

糖尿病的物理因子治疗

糖尿病治疗应是综合治疗,但实际上,物理治疗（尤其是运动治疗）并未引起每个医生和病人的重视,介绍糖尿病的矿泉浴,高压氧治疗和常见并发症糖尿病性神经病变和糖尿病足的物理治疗。     

糖尿病的物理因子治疗

糖尿病治疗应是综合治疗 , 但实际上 , 物理治疗 ( 尤其是运动治疗 ) 并未引起每个医生和病人的重视 . 介绍糖尿病的矿泉浴、高压氧治疗和常见并发症糖尿病性神经病变和糖尿病足的物理治疗 .     

综合物理因子治疗慢性前列腺炎

慢性前列腺炎 (ｃｈｒｏｎｉｃ ｐｒｏｓｔａｔｉｔｉｓ ,ＣＰＴ)是泌尿科常见病、多发病 ,症状多样化 ,病程长 ,且易复发 ,临床药物治疗效果差 ,我们采用了电脑中频、磁疗、毫米波 3种物理因子综合治疗ＣＰＴ患者 45例 ,取得满意效果 ,报告如下。1　资料与方法1.1　病例选择82例ＣＰＴ患者均符合诊断标准[1] ,经泌尿外科转入理疗科。随机分为综合物理因子治疗组 (Ａ组 ) 45例 ,对照组 (Ｂ组 ,药物治疗 ) 3 7例。Ａ组年龄 2 4～ 62岁 ,平均 3 6岁 ,病程 4个月～ 5年 ,1年以内 2 1例 ,2年以内 15例 ,3～ 5年以内 9例。Ｂ组年龄 2 0～ 5 8岁 ,…     

顽固性呃逆的综合物理因子治疗

顽固性呃逆患者 9例 ,其中男 5例 ,女 4例 ;年龄 3 5～ 67岁 ,平均 5 2 .48岁 ;病程 3ｄ～ 3月 ,平均 6.72ｄ ,其中胃大部切除术后 1例、胃空肠吻合术后 1例、胆囊摘除术后 2例、肺叶切除术后 1例 ,其余 4例患者中 ,有 1例因受强烈精神刺激产生神经官能症、癔病 ,持续呃逆达 3个月 ,剩下 3例均有胃肠功能紊乱病史。本组病例均首先采用中、西医治疗 ,即采用镇静药舒乐安定、苯巴比妥 ,安定药盐酸氯丙嗪、盐酸丙嗪 ,镇痛安眠药颅痛定等 ;还配合使用钙离子通道阻滞剂硝苯吡啶或硝酸甘油、亚硝酸异戊酯类及抗胆碱能药物阿托品、颠茄合剂和制酸药…     

不同物理因子治疗纤维织炎疗效分析

为寻找一种疗效满意的治疗纤维织炎的方法，对120例纤维织炎患者分别采用不同的物理因子治疗，结果用电脑中频加超短波治疗组总有效率95％，音频电流加红外线治疗组总有效率80％。     

物理因子联合药物治疗带状疱疹的疗效分析

带状疱疹多于冬、春季发病 ,其特点为神经疼痛 ,尤以夜间为甚 ,影响睡眠 ,患者皮肤出现粟粒状如绿豆大小的簇集性丘疹 ,伴有水泡且不融合 ,多呈带状分布。我科采用物理因子联合药物治疗该症 ,疗效显著。现报道如下。一、资料与方法共选取 94例我院 2 0 0 1年 3月～ 2 0 0 3年 5月间收治的带状疱疹患者 ,将其分为治疗组及对照组。治疗组 48例 ,其中男 44例 ,年龄 3 7～ 85岁 ;女 4例 ,年龄 42～ 85岁。对照组 46例 ,其中男 3 9例 ,年龄 46～ 83岁 ;女 7例 ,年龄 5 7～ 82岁。 2组患者一般情况、病程及病情等经统计学分析 ,差异均无显著性意义…     

心理门诊中躯体功能障碍伴心理障碍患者的临床特点及治疗分析

目的探讨心理门诊中有明显躯体功能障碍伴心理障碍患者的临床特点及治疗分析。方法在心理门诊患者中选择有明显躯体障碍者进行明尼苏达多项人格调查表(MMPI)检测,根据患者临床表现检测结果找出患者的临床特点及治疗要点。结果病程长、病情重、躯体障碍多而求治于心理门诊的患者经MMPI检测伴发疑病症、抑郁、癔病、精神衰弱者增多。结论有明显躯体功能障碍伴心理障碍的患者应采取躯体、心理双重治疗,可减少不必要的检查治疗费用,减少患者的痛苦及缩短病程。     

Responding to a violent incident: physical restraint or anger management as therapeutic interventions

By finding more feasible alternatives to managing aggression which can be effectively used in health care settings, as well as expanding nursing knowledge on the detrimental effects of restraints, forensic clinicians can use their creativity and resources to enhance the quality of life for their patients using beneficial therapeutic alternatives to restraint. A closer examination of alternatives to managing aggressive behaviour leads the author to the introduction of a case study, promoting non-touch interventions. The importance of this paper lies in reorienting forensic clinicians away from the perceived ideologies of physical restraint as a primary intervention, moving towards the productive use of anger management.     

Assessment of the therapeutic alliance in physical rehabilitation: a RASCH analysis

Purpose: To investigate the psychometric properties of the Working Alliance Inventory Theory of Change Inventory (WATOCI) in physical rehabilitation. Methods: RASCH analysis was used to examine the validity, internal consistency, reliability and discriminative properties of the 16-item WATOCI. Data was obtained from a randomized controlled trial, which employed the WATOCI to measure the alliance between physical therapists and patients with chronic low back pain. Results: The results indicated that 7 items on the 16-item WATOCI should need to be improved for use in physiotherapy settings. The resulting 9-item version of the WATOCI was found to be a uni-dimensional tool for measuring alliance, however, demonstrated a ceiling effect. Conclusions: There are several items in the WATOCI that require re-wording and/or re-contextualization prior to its use in clinical practice. Specifically, items relating more to the element social interaction did not discriminate well in this population and one solution may be to provide a therapy-specific context. Items regarding how well the patient understood the purpose of the treatment discriminated best between patients and this area is recommended for further development in the tool’s assessment. It is recommended that future research address these issues prior to its use in clinical settings.

Implications for Rehabilitation

• Chronic low back pain is defined as a condition in which pain has persisted for greater than 12 weeks. It is considered a complex condition as many forms of treatment only provide small to moderate effects for pain relief.

• The relationship between a patient and therapist that develops during the course of treatment has been found to influence treatment effects in various settings including for patients with chronic low back pain undergoing physiotherapy. However, current tools for assessing the patient-therapist relationship have been developed for use in psychotherapy settings, and have not been validated for use in other rehabilitation settings.

• In a sample of chronic low back pain, patients undergoing physiotherapy in primary care in Australia, the WATOCI, a common assessment tool of the patient-therapist relationship was used. A RASCH analysis of the WATOCI in this population revealed that many of the items were not assessing the construct and in most cases need to be re-contextualized to suit a physical-rehabilitation setting.

• Previous research has highlighted that the patient-therapist relationship is an important concept that appears to influence treatment effects; however, this research shows that it is proving difficult to measure this concept in clinical research and practice. Further development of this construct through focus groups and expert opinion is needed to fully assess the construct underlying the patient-therapist relationship in physical rehabilitation.

     

高压氧治疗急性缺血性脑卒中的剂量优化

目的:探讨高压氧疗法(HBOT)治疗急性缺血性脑卒中(AIS)的最佳治疗剂量.方法:在PUBMED数据库、EMBASE医药学数据库、MEDLINE、中国知网全文数据库(CNKI)搜索已发表的高压氧疗法治疗AIS的相关文献,根据纳入和排除标准收集文献.所提取的数据包括高压氧舱内氧分压(pO2,ATA)、每次HBOT时总吸氧时间(Ts)、总治疗次数(Nt)、治疗有效率.HBOT的总治疗剂量(DHBOY)按下列公式计算:DHBoT=pO2×Ts×Nt.当治疗有效率达到最高时,所对应的DHBOY为最佳治疗剂量.用线性回归的方法探索DHBOY与治疗有效率的关系.结果:根据纳入和排除标准,共收集19篇文献,共涉及700例患者,根据公式计算得出DHBOY与治疗有效率呈正相关关系,当平均DHBOT处于30-32治疗剂量单位(UMD)时,治疗有效,最高可达100％;当DHBOT＜13.5UMD,疗效甚微.结论:本研究显示,治疗AIS时DHBOY与治疗有效率呈正相关关系;当DHBOY处于30-32UMD时,治疗有效.     

Forensic mental health nurses' experiences of rebuilding the therapeutic relationship after an episode of physical restraint in forensic services in Ireland: A qualitative study

Few studies have explored how forensic mental health nurses can rebuild the therapeutic relationship following an episode of physical restraint in the acute forensic setting. In this study, we aimed to redress this gap in the literature by exploring with forensic mental health nurses the factors that enable or hinder the rebuilding of the therapeutic relationship following an episode of physical restraint. A qualitative study design was used to capture participants' experiences, views and perceptions of the therapeutic relationship following an episode of physical restraint in the acute forensic setting. Data were collected through individual interviews with forensic mental health nurses (n = 10) working in an acute forensic setting. Interviews were audio recorded, and transcribed verbatim and accounts were analysed using thematic analysis. Four themes were identified: ‘Building a Recovery Focused Therapeutic Relationship’; ‘Authoritarian Role’; ‘Inevitable Imbalance’; ‘Rebuilding the Therapeutic Relationship’; plus two sub-themes ‘Facilitators to rebuilding’ and ‘Barriers to rebuilding’. Findings suggest that an inevitable imbalance exists in building a recovery-focused therapeutic relationship and at times, is hindered by the authoritarian role of the forensic mental health nurse. Recommendations for changes in clinical practice and in upcoming policies should incorporate a dedicated debrief room and protected time for staff to debrief effectively following restraint. Routine post-restraint-focused clinical supervision would also be beneficial to mental health nursing staff.     

健康体检人群血液流变学参数影响因素的logistic回归分析

目的 探讨健康体检人群血液流变学参数的影响因素,为预防相关疾病提供理论依据.方法 分析北京市2010年健康体检人群资料,收集可能与血液流变学参数相关的指标,进行单因素χ2分析,初步筛选其中有统计学意义的指标,并进一步采用logistic回归模型筛选血液流变学参数的影响因素.结果 5 885例健康体检者中血液流变学全血粘度指标3项异常者占5.3%.经单因素分析初步有统计学意义的指标3个,进入logistic回归模型,最终筛选出2个影响因素,分别为性别和年龄.结论 血液流变学特性的改变与性别、年龄有密切关系,男性和中、老年人应定期检测血液流变学,有利于疾病的早期发现与防治.     

静脉低剂量重组组织型纤溶酶原激活物治疗短暂性脑缺血发作的临床对照研究

目的研究和分析静脉低剂量重组组织型纤溶酶原激活物(rt-PA)治疗短暂性脑缺血发作(TIA)的临床效果。方法选取86例TIA患者作为研究对象,根据治疗方式将其分为观察组41例(应用低剂量rt-PA静脉溶栓治疗联合阿司匹林抗血小板治疗)和对照组45例(应用阿司匹林抗血小板治疗)。比较2组患者入院时、治疗第1、3、7、14天时组织型纤溶酶原激活物(t-PA)、纤溶酶原激活物抑制物-1(PAI-1)水平。比较2组患者治疗各时段的TIA控制率,对2组患者进行为期1年的随访,比较患者转为急性脑梗死的比例。结果治疗第1、3天,观察组患者的血浆t-PA水平显著高于对照组(P0.05)。在治疗前、后各时点,2组患者的血浆PAI-1水平的差异均无统计学意义(P0.05)。2组患者各时段TIA控制率的差异无统计学意义(P0.05)。观察组和对照组分别有2例和4例患者于随访期内转为急性脑梗死,2组患者转为急性脑梗死比例的差异无统计学意义(P0.05)。结论在阿司匹林抗血小板治疗的基础上采用静脉滴注低剂量rt-PA进行溶栓治疗,能够提高TIA初期患者的血浆t-PA水平,有助于降低血栓形成风险,但对于患者的血浆PAI-1水平、近期疗效和远期预后的作用并不显著。     

三种物理因子对细菌作用的实验研究

目的　探讨氦—氖激光、微波、紫外线三种物理因子对细菌的作用。方法　三种物理因子作用于常见的伤口致病菌（ 铜绿假单胞菌、金黄色葡萄球菌、大肠埃希氏菌） 。观察照射后１５′、３０′、６０′、１２０′,细菌的生长,繁殖情况。结果　①激光无杀菌作用。②微波、紫外线连续八次照射培养皿为无菌。③三组对细菌的杀伤有明显差异,微波、紫外线组高于激光组。     

数字乳腺X线摄影中辐射剂量相关因素的研究进展

乳腺X线摄影是目前早期发现乳腺癌最有效的检查方法,电离辐射与乳腺癌的产生有很大关系,有效降低辐射剂量是目前研究的热点。本文主要阐述数字乳腺X线摄影在不同阳极靶面/滤过组合、不同曝光模式、不同腺体分型、不同厚度及压力时,患者所受的辐射剂量不同,在保证影像质量的基础上应有效降低辐射剂量。