Poster 2: When are deconditioned patients ready for acute rehabilitation?

Objectives: To assess ability of a medical acuity screening protocol to classify accurately deconditioned patients at risk for medical disruptions of acute rehabilitation. Design: Prospective comparison of 2 equivalent samples of consecutive admissions, 2 months apart, each divided into medically stable and unstable groups before admission. Setting: Acute rehabilitation unit, community hospital. Participants: 30 consecutive adult admissions to acute rehabilitation for deconditioning between September 25, 2000, and November 29, 2000; and 31 between February 1, 2001, and April 30, 2001. Interventions: Deconditioned rehabilitation candidates were screened for medical instability (protocol available), grouped as medically stable or unstable, reviewed with a physiatrist, and tracked prospectively. First sample findings were discussed with admitting physiatrists in multidisciplinary teams before the second sample. Main Outcome Measures: Planned completion of acute rehabilitation versus unplanned discharge due to acute medical setback, and length of rehabilitation stay. Results: Admission medical stability was associated with subsequent acute medical setbacks (Fisher exact test, P=.004). Medically unstable admissions had 6:1 odds of a medical disruption. Predictive success was associated with days from acute hospital to rehabilitation admission (Fisher exact test p=0.01). All predictive errors occurred with patients admitted to rehabilitation in less than 18 days from hospital admission. Medical disruptions of acute rehabilitation declined from the first (38.7%) to the second sample (16.7%). Conclusions: Data-driven team consensus about preadmission medical acuity screening preceded a decline in medical disruptions of acute rehabilitation among deconditioned patients.     

中美护理层级管理研究进展

目前,国内经济的飞速发展和社会老龄化的现状,使公众对优质护理的需求越来越高。临床护理实践过程中,因病种、病情、治疗等不同,对护士专业素质要求不尽相同,配备相应能力的护士是提高临床护理质量的有效途径之一[1]。近年来,国内护理管理     

听力障碍婴幼儿家庭早期干预研究进展

本文综述听力障碍婴幼儿家庭早期干预计划的发展,包括早期干预的组成、参与人员与效果。     

Article 13: Acupuncture in stroke rehabilitation: what does recent evidence really say?

Objective: To reexamine recent stroke-acupuncture studies using “relative improvement” on outcome measures, as opposed to simple endpoint raw score, as the primary clinical outcome. Data Sources: Using the recent Sze meta-analysis published in Stroke (2002) as an organizing schema, clinical trials involving stroke patients by Gosman-Hedstrom (1998), Johansson (1993, 2001), Sallstrom (1996), Sze (2002), and Wong (1999) were reexamined. Study selection: Studies were evaluated using the criterion of “relative improvement” as the primary outcome measure. The studies focused on the use of acupuncture compared with various control conditions across studies, including sham acupuncture, shallow acupuncture, transcutaneous electroneural stimulation, and subliminal electric stimulation. Data Extraction: Relative improvement on standardized measures used in the studies reviewed, focusing on disability (eg, FIM™ instrument) and impairment (eg, Fugl-Meyer Assessment). Data Synthesis: Evidence that acupuncture is effective in stroke rehabilitation is stronger when using relative improvement as a criterion than when using endpoint raw scores only—the procedure used by most recent researchers. Conclusions: Acupuncture may be helpful as an adjunct rehabilitation treatment. A number of methodologic issues need to be addressed in future research, including the most appropriate definition of a stroke clinical outcome, and the timeframe within which acupuncture effects are observed.     

Poster 21: Does severe left ventricular dysfunction impact the result of cardiac rehabilitation?

Objective: To evaluate the effect of severe left ventricular dysfunction on the improvement of functional capacity (FC) in cardiac patients undergoing phase 2 of a cardiac rehabilitation program (CRP). Design: Retrospective cohort study. Setting: Hospital-based CRP. Participants: 199 male cardiac patients. Group 1 (n=169) had a left ventricular ejection fraction (LVEF) >30% (age, 66.2±9.8y); group 2 (n=30) had a LVEF ≤30% (age, 69.0±8.1y). Intervention: 10 weeks, thrice weekly, of phase 2 CRP, consisting of 60 minutes of supervised exercise to reach the target heart rate determined by the Karvonen method. Main Outcome Measures: We measured FC before and after completion of the CRP and the improvement expressed in percents of FC before the CRP. The FC results were compared using the Student t test. Results: FC in both patient groups improved after the CRP. In group 1 patients, FC increased from 5.6±2.3 metabolic equivalents (METS) before the CRP to 7.5±2.6 METS after the CRP (P<.01). In group 2 patients, FC increased from 4.7±2.1 METS before the CRP to 6.2±2.2 METS after the CRP (P<.01). Before the CRP, group 2 patients had significantly lower FC compared with group 1 patients (P<.05). Similarly, after the CRP, the FC of group 2 patients remained lower than FC of group 1 patients (P<.05). However, the percentage of improvement for group 1 patients (40.6%±34.3%) did not differ significantly from the percentage of improvement for group 2 patients (39.9%±34.5%). Conclusions: The CRP improved FC of all cardiac patients, including those with severe left ventricular dysfunction. Patients with severe left ventricular dysfunction have lower FC before and after the CRP. However, the FC of these patients improved to the same degree as the patients with better left ventricular function. These findings are important in designing strategies for the CRP in patients with severely impaired LVEF.     

神经外科患者医院感染的目标性监测

目的了解神经外科住院病人医院感染情况和危险因素,制定预防控制措施。方法采取目标性监测方法,对某医院神经外科住院患者进行医院感染率和危险因素的调查。结果共调查住院患者958例,发生医院感染96例,106例次,医院感染发生率为10.02%、例次感染率11.06%。病人接受气管切开、吸痰、使用呼吸机、留置导尿管等侵入性操作构成医院感染主要危险因素;病人昏迷、住院时间较长、长期大量使用抗菌药物与感染的发生有一定相关性。结论该医院神经外科是医院感染的高发科室,危险因素较多,应采取综合的干预措施才能有效地降低医院感染的发生。     

音乐疗法在言语康复中的应用进展

音乐和言语可能有着共同的神经通路。近年来音乐疗法在言语康复中的作用逐渐引起康复医学界的重视。本文将就音乐疗法促进言语功能恢复的疗效和作用机制以及治疗方案的制定进行综述。     

Blutdruckvariabilit?t und Barorezeptorfunktion Klinische und wissenschaftliche Relevanz

Zusammenfassung Der menschliche Blutdruck unterliegt nicht nur infolge körperlicher und psychischer Aktivität oder pharmakologischer Maßnahmen, sondern auch spontan mehr oder weniger ausgeprägten Schwankungen. Diese Variabilität des arteriellen Blutdrucks ist sowohl von pathophysiologischem als auch von klinischem Interesse. Ein weithin bekanntes Beispiel für einen ausgeprägten Blutdruckanstieg ist als "Weißkittel- oder Praxishochdruck" geläufig. Diese gelegentlich ausgeprägte Blutdruckvariabilität kann durchaus Folgen für die Diagnostik und Therapie einer arteriellen Hypertonie haben. Einige Studien haben darüber hinaus gezeigt, daß das Ausmaß hypertoner Endorganschäden und auch die Prognose von Bluthochdruckpatienten signifikant mit der zirkadianen Blutdruckvariabilität assoziiert sind. Vor diesem Hintergrund ist zu diskutieren, inwieweit eine optimale antihypertensive Behandlung neben der eigentlichen Blutdrucksenkung auch die Blutdruckvariabilität optimieren muß, zumal die bislang untersuchten antihypertensiven Medikamente, wenn überhaupt, einen ungünstigen Effekt auf die Blutdruckvariabilität ausüben. Der arterielle Blutdruck wird im wesentlichen durch die Funktion des Barorezeptorreflexes konstant gehalten. Auch hier sind verschiedene Krankheiten und Situationen bekannt, in denen die Sensitivität dieses Reflexbogens, die letztendlich eine Interaktion zwischen Blutdruck- und Herzfrequenzvariabilität darstellt, reduziert ist. Derartige Zustände werden unter anderem bei Patienten mit einer Niereninsuffizienz, unter einer Medikation mit bestimmten Pharmaka oder auch bei Exposition mit Noxen wie Nikotin beobachtet. Auch die gestörte Barorezeptorfunktion wird als weiterer kardiovaskulärer Risikofaktor angesehen. Dies überrascht nicht, da zwischen der Barorezeptorfunktion auf der einen Seite und der Blutdruck- und Herzfrequenzvariabilität andererseits enge Interaktionen bestehen. Abstract The human arterial blood pressure shows not only exogenic alterations, but also spontaneous fluctuations. This blood pressure variability has both scientific and clinical relevance. A well-known phenomenon is the so-called "white coat hyptertension" which may severely affect diagnosis and therapy of essential hypertension. Furthermore, several studies have provided evidence that the degree of end-organ damage in hypertensive patients is closely related to the circardian blood pressure variability. Therefore, it is tempting to suggest that an optimal antihypertensive treatment should take an improvement of the blood pressure variability into consideration. Among other mechanisms modulating the arterial blood pressure, the baroreflex function has to mentioned. Diseases like chronic renal failure, treatment with drugs like ciclosporine A and also smoking have been shown to reduce the baroreflex sensitivity. As the baroreflex sensitivity mainly reflects interactions between the blood pressure variability on the one hand and the heart rate variability on the other hand, it is nor surprising that also a reduced baroreflex function is an independent cardiovascular risk factor.     

维持性血液透析患者营养状况与睡眠关系研究

目的探讨维持性血液透析患者营养状况与睡眠的关系,为临床治疗护理提供依据,从而提高患者的生存质量。方法采用便利取样法,使用匹兹堡睡眠质量指数量表、综合主观性营养评估量表及自设的一般情况调查表调查中山大学附属第一医院等7家医院424例维持性血液透析患者的营养及睡眠状况。结果有93.2%的患者匹兹堡睡眠质量指数总分≥5分,33.0%存在中重度营养不良。多重线性回归显示:除了睡眠效率及使用催眠药物外,营养状况得分与睡眠指数得分呈负相关且有统计学意义(P<0.05)。结论血液透析患者营养状况越好,睡眠质量越好,所以加强营养的监控及做好饮食的护理是必不可少的。     

痰液诱导技术的临床应用进展

痰液诱导(sputum induction,SI)技术于1992年由Pin等[1]首先提出,是指以高渗氯化钠溶液雾化吸入,诱导无痰或少痰受检者产生足量痰液,以对下气道分泌物中的细胞及其他液相成分进行分析研究的一种无创的检测方法。它具有经济、无创、精确、重复性较好等优点,能客观地反映气道状态且与气道活     

公共场所集中空调通风系统微生物污染状况调查

目的了解公共场所集中空调通风系统微生物污染状况。方法通过直接采集空调系统积尘和冷凝水作细菌检测,对吉林省30家公共场所集中空调通风系统微生物污染进行了监测。结果 30家公共场所集中空调通风系统共150个送风口,送风中细菌总数超标率为18.00%,真菌总数超标率为10.67%,β溶血性链球菌等致病菌未检出。所有风管内表面积尘中,细菌总数和真菌数均不超标。共采集27份冷却水,嗜肺军团菌检出率为33.33%;共采集29份冷凝水,嗜肺军团菌的检出率为10.34%。结论吉林省公共场所集中空调通风系统存在一定程度的污染,应加强集中空调通风系统各环节的清洁和消毒工作。     

病原微生物实验室Ⅱ级生物安全柜防护性能评价

目的评价病原微生物实验室Ⅱ级生物安全柜的防护性能。方法采用安德森采样器采样方法和通过相关仪器,以粘质沙雷菌气溶胶为防护对象进行Ⅱ级生物安全柜防护性能评价。结果所评价的36台Ⅱ级生物安全柜下降气流的平均合格率为91.7%,流入气流合格率为43.7%,气流模型合格率为43.9%。人员保护合格率为72.2%,样品保护合格率为88.9%,交叉污染合格率为88.9%。结论所测试的Ⅱ级生物安全柜存在较大的气溶胶泄漏风险,对实验操作人员保护性能较差。     

糖尿病患者尿路感染病原菌分布及耐药性研究

目的研究糖尿病患者尿路感染病原菌分布及其耐药性,指导临床合理使用抗菌药物。方法采用临床病原学标本检测和药敏试验方法,对某医院2011-2012年住院糖尿病合并尿路感染患者尿标本进行了监测与分析。结果糖尿病合并尿路感染患者尿标本检出的病原菌中,革兰阴性杆菌占75.42%,革兰阳性球菌占15.25%。革兰阴性杆菌中大肠埃希菌、克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌分居前4位,革兰阳性菌中主要是肠球菌,还检出部分真菌。药敏试验结果显示,革兰阴性杆菌对亚胺培南与哌拉西林/他唑巴坦等抗菌药物较敏感,肠球菌对替考拉宁、利奈唑胺和万古霉素全部敏感,但对氨苄西林、红霉素、克林霉素、利福平、青霉素等耐药率较高。结论糖尿病患者尿路感染以革兰阴性杆菌为主,只对少数抗菌药物敏感,应加强监测和药敏试验,合理使用抗菌药物。     

Abstract 1: Are fluoroscopic caudal epidural steroid injections effective in the management of chronic low back pain?

Objective: To determine the efficacy of fluoroscopic caudal epidural steroid injections (ESIs) as a conservative treatment in patients with presumably chronic lumbar diskogenic pain. Design: Retrospective follow-up study. Setting: Physiatric interventional spine practice in a large, urban, academic institution. Participants: 97 patients from chart review meeting inclusion criteria: (1) predominately axial low back pain of >3 months in duration, (2) failure of conservative treatment (ie, nonsteriodal anti-inflammatory drugs, physical therapy), (3) clinical presentation and magnetic resonance imaging findings consistent with central lumbar disk protrusion and/or degeneration at L4-5 or L5-S1 without stenosis. Intervention: At least 1 fluoroscopically guided caudal ESI. Main Outcome Measures: Successful outcome was determined as follows: (1) pre-post ESI change in Roland-Morris Disability Questionnaire score of ≥2 points, decrease in visual numeric pain scale rating of >50%, and North American Spine Society patient satisfaction score of 1 to 2. Results: Only 19 patients (23%) were determined to have a successful long-term (>2y) outcome and 65 (77%) were deemed failures. Average follow-up was 28.6±15.6 months. Successes were found to differ significantly from failures in preinjection pain scores (8.53 vs 9.09, P=.04) and patient satisfaction (P<.001). There were no significant differences between diagnostic groups (disk herniations=64, degenerative disk without herniation=33). Overall patient satisfaction was 45%. Conclusions: At more than 2 years of follow-up, the efficacy of fluoroscopically guided caudal ESI in patients with chronic lumbar diskogenic pain is limited. Patient satisfaction exceeded the reported rate of efficacy. Patients responding to injection had significantly lower preinjection pain scores. Despite these low success rates, fluoroscopic caudal ESIs remain a viable option to more invasive treatment options for 1 in 4 patients from this population and the offer of at least a single injection should remain part of the treatment algorithm.     

心电图仪导联带菌状况调查及消毒方法研究

目的了解心电图仪各导联的带菌状况,探讨适宜的消毒方法。方法采用涂抹采样和细菌检验方法,对使用后心电图仪导联细菌污染状况进行检测和对各种消毒方法的擦拭消毒效果进行评价。结果经清洁和消毒后的心电图仪导联使用10、20和40人次后,带菌率均为100%,肢体导联夹和胸导联皮球平均污染菌数分别为8.50 cfu/cm2和8.0 cfu/cm2,但未检出致病微生物。分别采用无菌生理盐水、含有效氯500 mg/L消毒剂、75%酒精消毒液或异丙醇复合消毒湿巾擦拭消毒,即刻采样检测均未检出存活菌;使用10人次后即出现污染,且随使用次数增加污染率增加;以含氯消毒剂和异丙醇复合消毒湿巾的消毒持续效果较好。结论心电图仪肢体导联及胸导联随使用次数增加逐渐出现细菌污染,应在使用后采取清洁消毒措施。     

医院检验科离心机的消毒及气溶胶防控

检验科工作量很大,每天都要承担患者血液、体液、分泌物、排泄物等多种临床标本的检验工作,这些标本中血液的标本量最大,并且血液标本都需要离心,分离血清才能检验,其他许多标本也需离心,离心机的利用率非常大,所以,检验科离心机的消毒及气溶胶防控非常重要。     

3～6岁听力障碍儿童的嗓音特点

目的探讨3~6岁听力障碍儿童的嗓音声学特点。方法采自148名3~6岁听障儿童和122名3~6岁健听儿童的声样,检测声样的声学参数值:基频(F0)、基频标准差(F0SD)、基频微扰(jitter)、振幅微扰(shimmer)、声门噪声能量(NNE)、开商(OQ)、速度商(SQ)、幅度商(AQ)、声门频谱斜率(STF)。结果听障儿童F0、SQ、STF、F0SD、jitter高于健听儿童(P<0.05),shimmer、NNE、OQ、AQ与健听儿童无显著性差异(P>0.05)。除3~4岁健听儿童的NNE显著低于5~6岁儿童外(P<0.05),其余各项声学参数值在不同年龄儿童之间均无显著性差异(P>0.05);各项声学参数值在男童和女童间均无显著性差异(P>0.05)。结论听障儿童发声时声带振动速度快、闭合快且激烈,声带振动的稳定性和规律性较差。声学参数F0、F0SD、jitter、shimmer、NNE、OQ、SQ、AQ、STF不受性别影响;除NNE外,也不受年龄影响。     

脊髓损伤恒河猴后肢步态数据处理方法的设计

目的基于Matlab建立一套适用于非人灵长类动物的步态数据处理方法。方法通过VICON系统在3只恒河猴脊髓损伤术后6周进行后肢步态分析测试,获取运动学数据。通过Excel Link将Matlab与Microsoft Excel相结合,实现对运动学原始数据的筛选和提取,并在Matlab环境下进行计算。结果通过计算得到步长、步高以及膝关节和踝关节角度等运动学参数。在0.2km/h、0.5 km/h、0.8 km/h速度下,步长(F=2.869,P=0.088)和步高(F=1.148,P=0.344)均值无显著性差异(P>0.05),表明数据模型可重复。通过计算得到的角度-时间曲线图反映了关节功能和运动变化规律。系统初步实现了足部步态轨迹的描绘,还实现了步态运动的二维/三维轨迹图的生成。结论该系统使得实验原始数据的处理不依赖于VICON系统,计算得到的参数和轨迹描绘可基本满足非人灵长类动物后肢行为学评价的需求。