高等职业教育“临床作业疗法”考核办法初探

高职课程考试是教学中的一个重要环节,直接关系到教学质量的优劣。为提高学生的学习效果,强化学生实践技能的掌握,我们针对目前高职考试中存在的问题,结合我院开办该专业5年来的教学经验,对"临床作业疗法"的考核办法进行了一些改革,旨在促进高职康复治疗技术专业的课程教学质量的提高。     

高职临床作业疗法教学内容与方法的研究

本文根据目前高职教育的特点,结合本院开办该专业5年来的教学经验,对"临床作业疗法"的教学内容及教学方法改革进行一些探索。     

Gerontic Occupational Therapy and Patient Education: Perceptions,Barriers, and Needs

ABSTRACT

The purpose of this study is to understand current practice of patient education by occupational therapy practitioners who work with the geriatric population. A 30-item survey was sent to 97 practitioners in the Indianapolis area. Seventy-eight (80.4%) returned the survey. Respondents reported that activities of daily living and safety were two topics taught most frequently. Verbal instructions and demonstrations were two main strategies of patient education. Clients’ cognitive function was the biggest factor considered when providing written information. Most respondents used written materials developed by their facilities. Over half of the respondents perceived that clients sometimes had difficulty understanding educational content. Time constraints and limited resources of educational materials were two main barriers to patient education. The majority of practitioners reported that they needed education materials that cover the topic of safety. Further research on developing effective and efficient patient education strategies for gerontic occupational therapy practitioners is encouraged.     

Mindfulness in Physical and Occupational Therapy Education and Practice: A scoping review

Background: Mindfulness practices provide numerous benefits for individuals with a variety of health issues. Recent research has highlighted the benefits of mindfulness for health professionals. The potential benefits for physical and occupational therapists or students however, are currently unclear.

Objectives: To perform a scoping review on the effects of mindfulness practices among physical (PT) and occupational therapists (OT) and students of those disciplines.

Methods: Eligible published articles in English were identified through a literature search of MEDLINE, PsycINFO, Cochrane Library, and AMED from the inception of databases to November 2015. Titles, abstracts, and full-text articles were screened for the selection of relevant papers. Articles identified as editorials, correspondences, commentaries, case reports, abstracts alone, and review papers were excluded.

Results: Six studies (two qualitative studies, one quantitative study, one mixed-method study, and two experimental studies) met the inclusion criteria. Three studies focused on PT/OT students, two on clinicians and one on current clinicians who had previously failed a course. These studies highlighted the potential benefits of mindfulness for physical and occupational therapists. They should be interpreted with caution however, due to the small number of relevant studies, high heterogeneity in mindfulness interventions and methodological limitations.

Conclusions: There is a paucity of research on the effects of mindfulness among physical and occupational therapists and students of those disciplines. The lack of relevant studies makes a systematic review challenging but the findings of the current studies suggest potentially promising effects.     

高职作业治疗技术课程建设②

作业治疗技术是康复治疗技术专业的核心课程之一,作业治疗技术课程建设的好坏直接影响康复治疗技术专业学生的培养质量。本文从课程标准的制定、教材、教学方法及课程评价等方面介绍了作业治疗技术课程建设过程中所进行的一些改革。     

Evaluation of the Usefulness of 2 Prediction Models of Clinical Prediction Models in Physical Therapy: A Qualitative Process Evaluation

Objective

The purposes of this study were to (1) evaluate the usefulness of 2 prediction models by assessing the actual use and advantages/disadvantages of application in daily clinical practice and (2) propose recommendations to enhance their implementation.

Methods

Physical therapists working in 283 practices in the area of Breda (the Netherlands) were invited to participate in this study. Two prediction models were presented: (1) to predict persistent shoulder pain and (2) to predict the preferable treatment in nonspecific neck pain. Participants were asked to apply both models in practice. After 2 months, their opinions about the usefulness of both models were gathered during a focus group meeting or by using an online questionnaire in order to identify the most important advantages/disadvantages of each prediction model.

Results

In total, 46 physical therapists (13.8%) of 39 practices participated. Evaluative data were available from 32 participants who used the shoulder model 102 times and the neck model 126 times. For the shoulder model, the most frequent advantage (mentioned 14 times) was that it enabled physical therapists to estimate a motivated prognosis, that is, a prognosis based on the score of the model. The most frequent mentioned disadvantage was that participants expressed their doubts about the validity of the model because the model initially was developed for usage in a general practice setting. For the neck model, the most frequently mentioned advantage (29 times) was that the model was easy to interpret. The most important disadvantage (mentioned 14 times) was that the model only takes a few treatment options into account.

Conclusions

The physical therapists participating in this study reported that both models evaluated in this study were not easy to use in daily practice. Based on the findings of this study, we recommend that these models are modified to meet the practical needs of the therapist, before assessing their impact on daily clinical care and patient outcomes.     

Clinical Uses of Intrathecal Therapy and Its Placement in the Pain Care Algorithm

Intrathecal drug delivery is an effective treatment option for patients with severe chronic pain who have not obtained adequate analgesia from more conservative therapies (eg, physical therapy, systemic opioids, nonsteroidal anti‐inflammatory drugs, antidepressants, and anticonvulsants). This review focuses on, but is not limited to, the 2 agents currently approved by the U.S. Food and Drug Administration for intrathecal analgesia: preservative‐free morphine and ziconotide (a nonopioid, selective N‐type calcium channel blocker). We describe the appropriate use of intrathecal therapy in the management of severe chronic pain, based on current best practices. Topics addressed here include patient selection, trialing, dosing and titration, adverse event profiles, long‐term management, intrathecal therapy for cancer‐related pain, and the placement of intrathecal therapy in the pain care algorithm. In appropriately selected patients with chronic pain, intrathecal therapy can provide substantial pain relief with improved functioning and quality of life. Successful long‐term management requires ongoing patient monitoring for changes in efficacy and the occurrence of adverse events, with subsequent changes in intrathecal dosing and titration, the addition of adjuvant intrathecal agents, and the use of concomitant oral medications to address side effects, as needed. Based on an infrequent but clinically concerning risk of overdose, granuloma, and other opioid‐induced complications, nonopioid therapy with ziconotide may be preferred as a first‐line intrathecal therapy in patients without a history of psychosis or allergy.     

全国231家临床实验室23项干化学 与湿化学检验项目参考区间的比较和分析

目的 该研究拟对目前中国医院检验科干化学检验项目的参考区间与对应湿化学的参考区间进行比较,了解医院检验科干、湿化学检验项目参考区间的差异。方法 采用基于Web方式的室间质量评价(EQA)软件系统,收集参加2014年全国干化学和常规化学(湿化学)参考区间调查的实验室所上报的数据,利用配对t检验和中位数Yates'卡方检验进行统计分析,以确定在同一医疗机构内干化学和湿化学项目的参考区间,以及上下限的中位数之间是否存在差异。结果 231家临床实验室回报了23项干、湿化学检验项目。其中69.6%(32/46)的干、湿化学检验项目参考区间上下限配对比较结果差异存在统计学显著性意义。80.4%(37/46)的干、湿化学检验项目参考区间上下限中位数存在位置与分布的显著性统计学差异。结论 目前中国同一医疗机构干化学与湿化学检验项目参考区间存在一定差异,参考区间上下限的分布和中位数的位置不同,建议建立中国人群干化学检验项目的参考区间。     

台湾地区脑卒中作业治疗的科研发展：以镜像治疗为例

自1990年代起脑卒中康复迈入以任务导向为主的当代疗法新时代,当代疗法包括强制运动疗法（constraint-induced therapy, CIT）、双侧上肢练习（bilateral arm training, BAT）、康复机器人疗法（robot-assisted therapy, RT）以及镜像治疗（mirror therapy, MT）等。其中,镜像治疗乃利用患者正前方的镜子,透过镜子反射出健侧手的运动,观察镜中反射的影像,患者将镜中反射的健侧手影像,重迭于患肢上,藉由视幻觉（visual illusion）,来促进患者患侧运动能力;镜像治疗以脑神经功能重塑理论为基础,具有便利可行、节省人力与花费等优势,而广受关注,近年来陆续有循证研究探究镜像治疗的成效;本文综述了镜像治疗的治疗原则、可能机制以及笔者发表的台湾镜像治疗临床试验与系统评价。笔者科研队伍的科研结果显示,镜像治疗能促进上肢动作控制与温度觉回复,合并感觉输入疗法,则能进一步改善手部精细运动、下肢行走与日常生活功能;镜像治疗的发展具前瞻性,目前笔者正进行并用其它疗法,如非侵入式经颅直流电刺激（transcranial direct current stimulation, tDCS）等相关循证研究;未来镜像治疗的联合疗法及居家化发展,可望为脑卒中康复的科研与实践带来新契机。