智能适老辅具在失能老年人照护中的应用进展

阐述智能适老辅具的类型、智能适老辅具在失能老年人照护中所起的作用,综述我国智能适老辅具的应用现状,提出相应对策,包括构建辅具行业标准、探索辅具租赁模式、打造实用高效辅具、加强用户隐私保护,以期为在国内开发与应用智能适老辅具提供参考.     

养老机构老年人智能辅具使用意愿的描述性质性研究

目的 探究养老机构老年人对智能辅具使用意愿，以期为推广应用智能辅具提供参考。方法 采用描述性质性研究，通过目的抽样法选取三所重庆市养老机构18位老年人进行半结构式访谈，运用内容分析法对访谈资料进行整理分析。结果 提取出5个主题和9个亚主题：绩效期望(促进生活自理、解决照护问题、满足个性化需求),外界影响(政府引导、媒体宣传、熟人介绍),促成因素(机构环境支持、管理制度健全、专业资源支撑),低自我效能感，感知风险。结论 尽管多数老年人认为智能辅具对自己有益，但其使用意愿受到多种因素影响；本研究综合分析结果后提出了相应对策，以期推动智能辅具在养老机构的应用。     

基于案例推理-规则推理混合推理的脊髓损伤智能辅具适配系统

摘要 目的：康复辅具适配可以有效帮助脊髓损伤(spinal cord injury, SCI)患者康复。现阶段,我国正面临着辅具适配服务人员总量不足,分布不均和基层工作人员专业能力不足等多重问题,因此,本研究提出了基于案例推理-规则推理混合推理的脊髓损伤患者智能辅具适配系统。 方法：本研究基于临床的125例SCI病例信息,建立了SCI案例库,首先基于案例推理（case-based reasoning, CBR）通过K近邻(k-nearest neighbor, KNN)和相似度检测算法查找相关历史案例集的辅具适配组合,然后利用基于规则推理（rule-based reasoning, RBR）对辅具适配组合进行修正,最终输出适配的辅具组合。 结果：本研究对25个SCI患者适配辅具来实现算法验证。结果显示：推荐移动类辅具、矫形器类辅具、个人生活自理类辅具和沟通和信息类辅助器具平均命中率分别为：83.66%、96%、85%和92%。平均召回率分别为：50.69%、62.67%、49.78%和24%。 结论：本系统利用CBR方法提高了决策的效率, RBR提高了决策的针对性。通过运用在线辅具适配系统,有效缓解了康复辅具适配率低和康复人才全国性缺乏和区域性分配不均的问题,具有良好的应用前景。     

沟通辅具个体化设计通用评估支持体系的建构

在参考国外沟通辅具评估项目和成功评估个案，结合我国特殊教育实际情况的基础上形成沟通辅具评估的项目体系，采用评估沟通辅具性能对应的障碍者能力，根据障碍者能力得出再设计建议的方法，建构沟通辅具个体化设计通用评估支持体系，帮助我国临床特教教师和康复工作者掌握沟通辅具的评估方法。     

广东省工伤职工辅助器具应用现状与研究——以广东省工伤康复医院为例

目的:以广东省工伤康复医院为例调查2021～2022年度广东省工伤职工辅助器具(以下简称辅具)应用现状,总结现阶段工伤职工辅具配置特点、存在的困难与改善建议,为完善工伤辅具配置管理提供参考依据。方法:本研究采用资料分析法、电话随访、数据统计等方法收集工伤职工的病种分布、配置辅具种类、各病种人均配置辅具数量、金额及日常生活能力提高情况;比较新旧版辅具配置政策调整幅度及统计分析新增辅具租赁服务现状。结果:156例广东省工伤职工适配辅具共739件,人均配置数量为4.4件,人均配置辅具金额为2.7万元,配置辅具后各类患者日常生活能力均较配备前明显提高,改良的巴氏指数(MBI)平均提高(8.7±10.9)分。结论:广东省工伤职工辅助器具配置及应用在种类及支付金额方面均较前改善,配置适当辅具能提高工伤职工日常生活自理能力。建议引入辅具配置评估机制,并推广医疗救治期的辅具租赁服务。     

重度失能老人使用辅具的满意度及影响因素研究

目的:调查重度失能老人辅具使用现状,探讨影响失能老人辅具使用满意度的因素,探知其满意度心理偏向,为后续服务提供方向与参考。方法:采用便利抽样法抽取成都市躯体重度失能老人4883例作为研究对象,使用Mao等修订的魁北克辅助科技使用者满意度评估量表(QUEST2.0)进行问卷调查,采用单因素分析和多元线性回归分析探讨影响辅具使用满意度的影响因素。结果:失能老人对辅具的总体满意度为49.12±9.73(3.77±0.75),总体满意度偏度值为-0.063(负偏态),整体满意度在一般和满意之间。通过多元线性回归分析满意度的影响因素,结果显示:年龄、照顾者类型、接受辅具健康教育、接受辅具适配指导是正向独立影响因素(均P<0.05);文化程度、支付照顾者费用是负向独立影响因素(均P<0.05)。结论:失能老人辅具使用满意度在一般与满意之间,有提升空间,加强辅具人才的专业化和职业化建设、加强辅具健康教育及适配指导、广泛开展宣传、提高群众对辅具的认知,可有效提高辅具使用者的满意度,体现“以人为本”、“专业化”的健康服务价值观。     

安徽省5市残疾人辅具适配现状调查

目的:通过调查并分析安徽省5市残疾人的残疾类型、辅具供需及使用中存在的困难情况,为省内更科学开展残疾人辅具适配工作收集必要的参考数据。方法:抽取安徽省东西南北中5个地级市,每个市再随机抽取8个社区和∕或自然村作为最终的调查区域,对上述区域内成年残疾人(不包括精神疾病)的辅具适配状况进行问卷调查,并从回收的调查表中抽取20%—30%进行入户调查或电话回访核实,以确保调查内容的真实及准确度。结果:受调查的残疾人共1382例,其中74.7%有肢体残疾,13.5%有视觉障碍,13.4%有听觉障碍,6.0%有言语障碍,有智力障碍者仅占1.6%;各市残疾类型中均以肢体残疾为主,智力障碍最少;65.2%需要辅具协助日常生活,而这些人中53.7%目前无辅具;辅具由自己制作或购买的有203例,占全部辅具的49.8%;使用辅具是否存在困难项目中46.7%选择有困难;使用辅具有困难的原因中43.5%因残疾而无法自己穿戴或使用辅具,37.5%选择了家庭环境限制辅具使用。结论:安徽省5市残疾人涵盖各类残疾,各地区残疾类型存在差异;辅具需求量大,辅具供应不足;近半数拥有辅具残疾人使用中存在困难情况,家庭环境限制辅具使用的情况不容忽视。     

计算机辅助器具适配方法与挑战

计算机辅具,如特制的鼠标键盘、语音输入、读屏放大软件等,可以帮助功能障碍者更有效率地使用计算机,是他们获得全面康复的重要手段。计算机辅具适配需要根据使用者的需求、所处环境、身体功能等进行评估,遵循由简到繁原则,购买、改造或设计安全易用、经济易得的产品。我国计算机辅具适配服务刚刚起步,急需建立专业评估团队,设立科学的服务流程,研发多样的产品,引发各界关注,寻求更多的经费支持。     

安徽省辅助器具工作人员现状调查

目的:对安徽省部分地市各级残联辅具相关人员一般状况、工作能力等进行调查。方法:对安徽省具有代表性的部分地市各级残联的辅具相关工作人员进行较广泛问卷调查。结果:安徽省11个市71个工作单位共108名辅具相关工作人员接受了调查:66.7%为大专及以下学历;57.4%收入为2000~4000元∕月;满足目前收入的占56.5%;热爱目前工作的占88.0%;在"您是如何获得辅具适配工作知识及能力的"条目下,86.1%选择参加培训班,46.3%选择了自学;受调查人员认为参加培训班(79.6%)以及进修学习(61.1%)能更有效地提高其工作能力;认为安徽省目前辅具适配工作人员总体能力很好的占53.7%;56.2%认为辅具适配人员数量未完全满足实际需要;了解"残疾儿童辅具适配"、"彩金项目辅具适配"等政策的较多,其余辅具适配政策被了解的甚少(均10%)。结论:我省辅具相关工作人员总体还较年轻,学历偏低,待遇不高,对目前相关政策了解不足;我省残联系统目前还存在着辅具工作人员配置不足,专业水平不高,工作能力有欠缺等问题。     

基于决策树和逻辑回归算法的辅具适配模型研究与实现

目的：为实现辅具适配过程中用户自主自助及辅具适配的精准预测,研究建立辅具适配模型。方法：通过调查问卷的方式收集到102份辅具配置信息作为数据集,基于决策树和逻辑回归算法建立辅具适配模型。使用python语言实现模型并绘制主要参数对模型性能的影响,优化后,计算准确率、召回率和F1分数评价模型的预测能力。结果：基于决策树算法建立模型准确率达到0.91,且召回率和F1分数性能指标分别为0.91和0.90。基于逻辑回归算法建立的模型性能较低。结论：本研究以患者使用辅具目标等信息为特征建模。基于决策树算法建立的模型性能优于逻辑回归模型,具有实用价值。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.