中国版脑卒中简明ICF核心要素量表在康复中的应用

目的探讨国际中文版脑卒中简明《国际功能、残疾和健康分类》(ICF)核心要素量表在脑卒中康复评定中的应用。方法180 例脑卒中患者接受规范康复2 个月。于治疗前、治疗结束时及治疗后6 个月,采用中国版脑卒中简明ICF 核心要素量表、Barthel 指数(BI)、功能综合评定量表(FCA)、世界卫生组织残疾评定量表(WHODASⅡ)进行评定。结果BI、FCA、WHODASⅡ评分与ICF核心量表总分及各成份分相关(P<0.05)。结论ICF核心量表是一种有效的脑卒中患者功能评定工具。     

急性腰痛康复评定新量表——ADL恢复量表和功能性能力自信量表

日常生活活动恢复(RADL)量表和功能性能力自信量表(FACS)是两个有关急性腰痛康复评定的新量表。RADL量表以回复“习惯”或“通常”活动为恢复指标,用以评定急性腰痛患者日常活动恢复情况;FACS量表则用于评定急性腰痛患者在康复过程中自我功效的作用。两个量表在信度、效度、内部一致性、变化的敏感性,辩别能力等方面均表现出较好的心理测试性能,因此均为新的、标准化测试方法,对急性腰痛的康复评定具有较好的实用价值。     

帕宁治疗肝肾阴虚型帕金森病的临床研究

目的:观察帕宁治疗帕金森病的运动症状、非运动症状及中医证候方面的临床疗效;方法 :将符合标准的60例肝肾阴虚型帕金森病患者随机分为2组,治疗组与对照组各30例。2组均给予基础治疗的同时,治疗组加以帕宁方药,进行临床疗效的评定;结果:治疗组的肝肾阴虚中医证候积分量表评定、UPDRS量表评定、24项汉密尔顿抑郁量表(HAMD)评定、蒙特利尔认知评估(Mo CA)量表评定、帕金森病睡眠量表(PDSS)评定均较治疗前有明显改善(P0.01);结论:帕宁方药能较好的改善帕金森病患者的运动症状和非运动症状,提高患者的生活质量,值得临床进一步应用。     

社区康复对后遗症期脑卒中偏瘫患者的影响

目的观察社区综合康复治疗对后遗症期脑卒中偏瘫患者的运动功能及日常生活活动(ADL)能力的影响。方法155例后遗症期脑卒中患者随机分为康复干预组(76例)和对照组(79例),分别在入组时和康复干预1个月、3个月时采用简化Fugl-Meyer运动功能量表(FMA)评定肢体运动功能,改良Barthel指数(MBI)、功能综合评定量表(FCA)评定ADL能力。结果两组患者入选时简化FMA量表、MBI、FCA量表评分无显著性差异,康复干预组在治疗1个月末时MBI、FCA量表评分明显改善(P<0.01),但随病程延长至3月时,提高幅度减缓,简化FMA量表评定无明显改善(P>0.05)。对照组患者入组前后简化FMA量表评定无改善(P>0.05),MBI、FCA量表评分随病程延长,有退化趋势。结论社区综合康复治疗对后遗症期脑卒中患者的运动功能恢复效果不明显,但可以改善其ADL能力,提高患者生存质量。     

ICF-CY自理项量表应用于脑性瘫痪儿童评定的信度和效度研究

目的研究《国际功能、健康和残疾分类儿童青少年版》(ICF-CY) 自理项量表在脑瘫儿童评定中的信度和效度。方法选择50 例脑瘫儿童,采用ICF-CY自理项量表、功能性独立测量量表(WeeFIM)和儿童能力评估量表(PEDI)进行评定。ICF-CY自理项量表信度检验采用kappa 一致性分析方法;ICF-CY自理项量表与WeeFIM 和PEDI 同步效度采用Spearman 相关分析。结果ICF-CY自理项8 个类目重测信度kappa 值为0.806~0.932,信度优;ICF-CY自理项8 个类目评定者间信度kappa 值为0.690~0.882,信度中到优;ICF-CY自理项评分与WeeFIM 和PEDI 评分的Spearman 相关系数为-0.832 和-0.767(P<0.01)。结论采用ICF-CY自理项量表对脑瘫儿童进行日常生活自理评定可靠、有效。     

家属参与式护理干预对老年帕金森患者社会支持及自我效能的影响

目的探讨家属参与式护理干预对老年帕金森患者社会支持及自我效能的影响.方法将120例老年帕金森患者按随机数字表法分为两组,每组60例,对照组予以常规护理干预,研究组在对照组基础上予以家属参与式护理干预,观察3个月.干预后评定两组遵医行为,干预前后采用蒙特利尔认知评估量表评定认知功能,汉密顿焦虑量表评定焦虑情绪、汉密顿抑郁量表评定抑郁情绪,一般自我效能感量表评定自我效能感,社会支持评定量表评定社会支持程度,简明健康状况量表评定生活质量.结果(1)干预后研究组遵医嘱用药、控制情绪、按时作息、合理饮食、坚持适量运动各项评分均显著高于对照组(P<0.01);(2)干预后两组汉密顿焦虑量表、汉密顿抑郁量表评分较干预前显著下降(P<0.01),研究组评分均显著低于对照组(P<0.01);(3)干预后两组蒙特利尔认知评估量表、一般自我效能感量表及社会支持评定量表各维度评分较干预前显著升高(P<0.01),研究组各量表评分均显著高于对照组(P<0.01);(4)干预后两组简明健康状况量表评分较干预前持续升高(P<0.01),研究组干预后各时点评分显著高于对照组(P<0.01).结论家属参与式护理干预能显著缓解老年帕金森患者的负性情绪,增强自我效能感及社会支持程度,改善遵医行为、认知功能及生活质量,提高治疗效果,值得在临床推广应用.     

脑损伤认知障碍康复评定的进展

认知障碍在脑损伤患者中发病率高 ,对其进行准确客观的康复评定是重点 ,也是难点。量表是主要评定方法 ,脑损伤专用量表已引起人们的重视 ,神经行为认知状态检查表 (NCSE)和洛文斯顿作业疗法认知评定成套测验 (LOTCA)是近年发展起来的量表 ,具有很好的运用前景。脑损伤认知障碍评定量表正在不断地完善之中。     

胃癌患者生活质量的测评及其影响因素

胃癌患者生活质量评定的现状和影响胃癌患者生活质量的主要因素如下:①胃癌患者生活质量的评定目前还没有一个较为公认的办法。目前的测评过程借鉴了心理学的方法,采用量表的形式来了解患者的生活质量,由患者自己来评定。②常用的量表有:行为表现量表(KarnofskyPerformanceStatus,KPS)、疾病影响程度量表(SicknessImpactProfile,SIP)、癌症患者生活功能指标(TheFunctionalLivingIn-dex-Cancer,FLIC)、欧洲癌症研究与治疗组织(EuropeanOrganizationforResearchandTreatment)的EORTCQLQ-C30系列量表、癌症治疗功能评价(FunctionalAssessmentofCancerTherapy,FACT)系列量表、胃肠疾病生活质量指数量表(GastrointestinalQualityofLifeIndex,GIQLI)量表。③影响胃癌患者生活质量的主要因素有:文化程度、收入水平、医疗费用的支付方式、是否与子女一起居住、性格类型、治疗的效果等。④不同的治疗方法对胃癌患者的生活质量有较大的影响,如手术方式、化疗方案、心理支持治疗的应用、止痛治疗的效果等因素。     

阿尔茨海默症病人康复锻炼后的效果观察

[目的]探讨阿尔茨海默症病人康复锻炼的效果。[方法]选取60例阿尔茨海默症病人为对照组,未实施康复锻炼;选取60例阿尔茨海默症病人为观察组,实施康复锻炼。采用简易智能状态检查量表(MMSE)评定病人的精神状况,采用Barthel指数评定病人的日常生活能力,采用SF-36量表评定病人的生活质量,采用阿尔茨海默症评估量表认知分量表(ADAS-cog)评定病人的认知功能,采用功能独立性评价量表(FIM)评定病人的躯体功能,采用总体衰退量表(GDS)评定病人的痴呆程度,比较两组病人治疗前后各评定指标的改变情况、康复治疗效果。[结果]治疗后两组病人的精神状况总评分、生活质量总评分、日常生活能力评分、躯体功能评分均明显升高,而认知功能评分、痴呆程度评分均明显下降。治疗后观察组病人的精神状况总评分、生活质量总评分、日常生活能力评分、躯体功能评分均明显高于对照组,观察组病人的认知功能评分、痴呆程度评分均明显低于对照组,观察组病人总有效率(93.3%)明显高于对照组(63.3%),经比较差异均有统计学意义(P0.05)。[结论]康复锻炼可明显改善阿尔茨海默症病人的精神状况,显著改善病人的认知功能和躯体功能,显著提高病人的日常生活能力和生活质量,临床效果显著。     

Frenchay活动量表对于我国脑卒中患者评定的效度研究

目的探讨Frenchay活动量表在我国脑卒中患者应用中的效度。方法选取脑卒中患者和正常人各39例。由同一评定者用Frenchay活动量表分别对两组受试者评定2次。首次评定患者时,评定Barthel指数1次。两个量表比较采用Spearman相关系数检验,两组Frenchay活动量表评分比较采用配对t检验。结果在脑卒中组中,Frenchay活动量表与Barthel指数的相关系数为0.727(P<0.001),各项得分和总分明显低于正常对照组(P<0.01)。结论Frenchay活动量表适用于我国脑卒中的评定。     

Clinical Trial Updates and Hotline Sessions presented at the Scientific Session 2007 of the American heart association

This article provides information and commentaries on trials which were presented at Clinical Trial Updates and Hotline Sessions presented at the Scientific Sessions 2007 of the American Heart Association in Orlando, Florida. The comprehensive summaries have been generated from the oral presentations and the webcasts of the American Heart Association. Most reports have not been published as full papers and therefore have to be considered as preliminary data, as the analysis may change in the final publications. The following papers are discussed: TRITON TIMI-38, EVA-AMI, BRIEF-PCI, RACE, MASS Stent, HF-ART, STITCH, CORONA, ILLUMINATE, CORE-64, OAT Substudy, AFCHF, MASCOT, RETHINQ, MASTER I, POISE, COUMA-GEN, HIJ-CREATE, PROVIDENCE I, CAUSMIC, IC-BMC, IC/IM BMCs.     

Caring as a slave morality: Nietzschean themes in nursing ethics

BACKGROUND: Sceptical arguments about 'caring' can be divided into three categories. First, it is suggested that, while caring is no doubt an admirable thing in itself, it is just one ideal among others. Secondly, it is claimed that caring is not really a virtue at all, and that it should be regarded as more of a vice, because it promotes favouritism, injustice, and self-deception. Thirdly, there is a worry that caring is not politically realistic, and that its advocates underestimate the powerful organizational and social structures which conspire to subvert nursing. AIM: This paper outlines a fourth, and more radical, type of scepticism, which explains why caring is subject to these drawbacks. In doing so, it considers the relation between caring, phenomenology and holism in nursing discourse, and the way in which all three fit together to form the 'caring paradigm'. METHODS: The paper adopts a genealogical approach, borrowed directly from Nietzsche's Genealogy of Morality. That book argues that the values associated with caring are the expression of a profound resentment, harboured by the slaves (weak, powerless, timorous) against the nobles (strong, powerful, self-confident). Caring represents an inversion, a sort of 'fantasy revenge', in which the nobles can be portrayed as 'evil', while the slaves portray their own weakness as 'good'. Taking its cue from Nietzsche, the paper shows that the Genealogy narrative can be transposed into a modern health care context, with nurses as the 'slaves' and the medical profession as the 'nobles'. CONCLUSIONS: The ideology of caring is, in the Genealogy's terms, a slave morality. It represents an attack on the 'medical-scientific model', motivated by resentment, and designed to establish nursing's superiority. Its effects have been debilitating, and it has prevented nursing from becoming a 'noble' (that is, a properly scientific) discipline.     

Recent advances in plant hepatoprotectives: a chemical and biological profile of some important leads

Medicinal plants have been traditionally used for treating liver diseases since centuries. Several leads from plant sources have been found as potential hepatoprotective agents with diverse chemical structures. Although, a big list of hepatoprotective phytomolecules was reported in the scientific literature, only a few were potent against various types of liver damages. Of which, silymarin, andrographolide, neoandrographolide, curcumin, picroside, kutkoside, phyllanthin, hypophyllanthin, and glycyrrhizin have largely attracted the scientific community. This review focuses discussion on the chemistry, biological activity, mode of action, toxicity, and future prospects of these leads.     

吞咽障碍患者服药管理的最佳证据总结

目的检索、评价和总结吞咽障碍患者服药管理的最佳证据。方法运用循证护理的方法,针对吞咽障碍患者服药管理提出问题,系统检索UpToDate、BMJ、乔安娜布里格斯研究所(Joanna Briggs Institute,JBI)图书馆、Cochrane Library、加拿大安大略注册护士协会网站、英国国家临床医学研究所指南库、苏格兰学院间指南网、美国国立指南网、国际网络指南网、加拿大医学会临床实践指南、美国心脏/脑卒中协会网站、PubMed、CINAHL、英国NEWT网站、中国生物医学文献数据库、医脉通、中国知网等数据库或网站,检索时限为建库至2021年1月,文献类型涵盖临床决策、临床实践指南、证据总结、系统评价、专家共识。由3名研究者对检索到的文献进行评价和证据提取。结果共纳入12篇文献,其中临床决策2篇、指南2篇、证据总结6篇、专家共识2篇。总结了8个方面的最佳证据,包括医护人员教育和培训、用药前筛查和评估、多学科合作、代偿性方法、口服固体剂型的选择、碾碎药物的管理、胃肠营养管用药、用药效果监测和记录。结论该研究针对吞咽障碍患者服药管理进行证据总结,为建立吞咽障碍患者服药规范流程、实践...     

慢性病和功能障碍老年人身体活动的健康效果：系统综述的系统综述

目的 基于世界卫生组织国际分类家族(WHO-FICs)构建身体活动对慢性病和功能障碍老年人健康及健康相关状况的干预效果范畴及架构。方法 运用《国际疾病分类第十一次修订本》(ICD-11)和《国际功能、残疾和健康分类》(ICF)对老年人的健康及健康状况进行系统分析。检索PubMed、CBM、Scopus、Web of Science、Embase、中国知网、维普、万方等数据库,收集建库至2022年8月8日关于身体活动干预对慢性病和功能障碍老年人健康及健康相关状况康复效果的系统综述进行综述。结果 最终纳入系统综述11篇,来自6个国家,共涉及316项相关随机对照试验和28 169名参与者,主要包括老龄化、公共健康、康复、身体锻炼等领域。与老年人健康状况相关的疾病主要集中于痴呆、帕金森病、精神分裂症、抑郁症、认知障碍,骨质疏松症、关节炎、肌少症,慢性心力衰竭、冠心病、高血压、脑卒中,2型糖尿病,慢性肺病。干预方案中,活动形式有平衡、功能和耐力训练、灵活性训练,步行、伸展、上下肢训练、瑜伽、气功、太极拳等,活动频率每周1～7次,活动强度为中度,活动持续时间4周～10年。健康结局涉及降低疾病风险,...     

Integrative Medicine in the Oncology Setting,What Does the Research Show?

Most oncology patients are using some form of complementary alternative medicine (CAM). These can include acupuncture, massage, yoga, homeopathy, energy work, spiritual healers, vitamins and supplements, mind-body interventions, diets, and many other modalities. Although many of these interventions are safe and beneficial, some of them can be harmful. Unfortunately, because of time constraints, knowledge deficits, and the acuity of our patients, assessment of the use of CAM is often overlooked. As nurse practitioners, we must educate ourselves about the evidence for safety and efficacy of these interventions.     

四维面积应变评价不同左心室构型高血压患者的左心室功能

目的评价四维应变成像技术面积应变（4D-area strain）检测高血压不同左心室构型患者左心室收缩功能的价值。 方法收集2015年2月至8月浙江省杭州市余杭中医院确诊的原发性高血压患者125例,根据Ganan分类法分为：正常构型组45例（A组）、向心性重构组25例（B组）、向心性肥厚组25例（C组）及离心性肥厚组30例（D组）。另选取本院体检中心40名健康人作为健康对照组（N组）。采用4D-area strain检测各组与健康对照组常规左心室收缩功能指标与整体面积应变（GAS）、节段面积应变（RAS）值,进行相互比较。组间整体面积应变与对应的节段面积应变比较采用多样本均数方差分析,多个均数间的两两比较采用LSD-t检验。 结果（1）常规心功能：A、B、C、D及N组左心室舒张末期容积（EDV）、心搏量（SV）及心输出量（CO）测值比较,差异均无统计学意义（F =0.679、3.829、0.600,P均>0.05）,收缩末期容积（ESV）、射血分数（EF）、球形指数（Spl）、舒张末期重量（EDMass）测值比较,差异均有统计学意义（F=3.829、6.596、2.653、2.604,P均<0.05）;D组ESV测值与N、A、B、C组比较,差异有统计学意义（t =2.011、2.244、3.685、2.278,P均<0.05）;B组ESV测值与N组比较,差异有统计学意义（t=2.170,P<0.05）;B组EF测值与N、A、D组比较,差异有统计学意义（t =2.452、3.514、4.949,P均<0.05）;D组EF测值与N、C组比较,差异有统计学意义（t=2.849、3.486,P均<0.05）;D组SpI测值与N、A、B、C组比较,差异有统计学意义（t =2.854、2.941、3.200、2.979,P均<0.05）;C组EDMass测值与N、A组比较,差异有统计学意义（t=2.170、2.087,P均<0.05）;D组EDMass测值与A、B、N组比较,差异有统计学意义（t=2.668、2.081、3.762,P均<0.05）。（2）GAS：A、B、C、D各组与N组GAS测值比较,差异均有统计学意义（t=7.950、7.361、8.959、11.277,P均<0.01）,且随左心室重构程度加重差异更为明显;A、B组GAS测值分别与D组比较,差异均有统计学意义（t =3.332、2.102,P均<0.05）,A组GAS测值与C组比较,差异有统计学意义（t=3.134,P<0.05）。（3）RAS：D组所有节段与N组比较,差异均有统计学意义（第1~17节段,t分别为2.967、3.793、4.896、4.001、2.375、4.169、4.077、2.137、4.652、4.016、5.230、6.267、5.735、2.143、2.353、5.429、4.128,P均<0.05）;A、B、C 3组与N组比较,基底段的前间隔壁、后间隔壁、前侧壁,中间段的前侧壁,心尖段的前壁、侧壁、心尖帽,差异均有统计学意义（A-N：t=2.667、3.084、3.574、4.771、3.182、4.806、3.567,P均<0.05;B-N：t=2.702、2.868、2.179、3.130、3.302、3.203、3.093,P均<0.05;C-N：t=4.927、5.600、4.276、6.577、6.198、5.190、5.441,P均<0.05）;A、B、C 3组与N组心尖间隔段比较,差异均无统计学意义（t=0.934、1.562、1.879,P均>0.05）。 结论4D-area strain为不同左心室构型高血压患者左心室收缩功能的检测提供一种新方法,尤其是对早期收缩功能的检测更为敏感。     

Overview of Lymphedema for Physicians and Other Clinicians: A Review of Fundamental Concepts

Lymphedema has historically been underrated in clinical practice, education, and scholarship to the detriment of many patients with this chronic, debilitating condition. The mechanical insufficiency of the lymphatic system causes the abnormal accumulation of protein-rich fluid in the interstitium, which triggers a cascade of adverse consequences such as fat deposition and fibrosis. As the condition progresses, patients present with extremity heaviness, itchiness, skin infections, and, in later stages, dermal fibrosis, skin papillomas, acanthosis, and other trophic skin changes. Correspondingly, lymphedema results in psychological morbidity, including anxiety, depression, social avoidance, and a decreased quality of life, encompassing emotional, functional, physical, and social domains. For this review, we conducted a literature search using PubMed and EMBASE and herein summarize the evidence related to the fundamental concepts of lymphedema. This article aims to raise awareness of this serious condition and outline and review the fundamental concepts of lymphedema.     

Sitting biomechanics part I: review of the literature

OBJECTIVE: To develop a new sitting spinal model and an optimal driver's seat by using review of the literature of seated positions of the head. spine, pelvis, and lower extremities. DATA SELECTION: Searches included MEDLINE for scientific journals, engineering standards, and textbooks. Key terms included sitting ergonomics, sitting posture, spine model, seat design, sitting lordosis, sitting electromyography, seated vibration, and sitting and biomechanics. DATA SYNTHESIS: In part I, papers were selected if (1) they contained a first occurrence of a sitting topic, (2) were reviews of the literature, (3) corrected errors in previous studies, or (4) had improved study designs compared with previous papers. In part II, we separated information pertaining to sitting dynamics and drivers of automobiles from part 1. RESULTS: Sitting causes the pelvis to rotate backward and causes reduction in lumbar lordosis, trunk-thigh angle, and knee angle and an increase in muscle effort and disc pressure. Seated posture is affected by seat-back angle, seat-bottom angle and foam density, height above floor, and presence of armrests. CONCLUSION: The configuration of the spine, postural position, and weight transfer is different in the 3 types of sitting: anterior, middle, and posterior. Lumbar lordosis is affected by the trunk-thigh angle and the knee angle. Subjects in seats with backrest inclinations of 110 to 130 degrees, with concomitant lumbar support, have the lowest disc pressures and lowest electromyography recordings from spinal muscles. A seat-bottom posterior inclination of 5 degrees and armrests can further reduce lumbar disc pressures and electromyography readings while seated. To reduce forward translated head postures, a seat-back inclination of 110 degrees is preferable over higher inclinations. Work objects, such as video monitors, are optimum at eye level. Forward-tilting, seat-bottom inclines can increase lordosis, but subjects give high comfort ratings to adjustable chairs, which allow changes in position.     

Hospital Management of Acute Iron Ingestion

Abstract

This overview summarizes the major and minor side effects and drug interactions of fluoxetine. The adverse reactions include the “serotonin syndrome”, cardiovascular complications, extrapyramidal side effects such as akathisia, dyskinesias, and parkinsonian-like syndromes and an apparently increased risk of suicidality. Fluoxetine-induced mania and hypomania, seizures and sexual disorders are evaluated along with minor symptoms of allergic reactions, stuttering, hematological changes, psoriasis, and inappropriate secretion of the antidiuretic hormone. The major fluoxetine-drug interactions involve the amino acids L-dopa and L-tryptophan, anorexiants, anticonvulsants, antidepressants, anxiolytics, calcium channel blockers, cyproheptadine, lithium salts, and drugs of abuse. The underlying mechanism and the paradoxical effects of fluoxetine are addressed.