台湾省康复医学教育概况

60年代末,台湾省由于流行脊髓灰质炎,乃逐步建立了一些康复医疗结构。近10年来,残疾者对康复医疗服务的需求更为迫切,为适应客观的需要,该省采取多种形式,培养康复医学各种专业人才,大中型医院陆续成立了康复医学科。台湾省康复医疗成员包括康复专科医师、物理治疗师、作业治疗师、语言治疗师、假肢装具技师、心理治疗师、职业咨询师、社会工作者以及康复护士等。 1 康复专科医师:台湾省规定,医学院校毕业后,需经教学医院康复医学专业训练3年,考试合格,才能授以康复医师的职称,至今共录取113名。     

出诊医师电话医疗指导创伤病人对院前急救效果的影响

目的 探讨出诊医师电话医疗指导创伤患者对院前急救效果的影响。方法 选取2019年2月-2020年2月南昌急救中心采取常规院前急救期间收治的创伤患者126例作为对照组，另选取2020年3月-2021年3月南昌急救中心采取出诊医师电话医疗指导的院前急救期间收治的创伤患者126例作为观察组。比较两组预后情况、确定性手术治疗时间、住院时间和急救满意度。结果 观察组治疗总有效率为96.03%，高于对照组的87.30%，确定性手术治疗时间、住院时间均短于对照组，急救满意度评分高于对照组，差异有统计学意义（P＜0.05）。结论 出诊医师电话医疗指导能够提升创伤患者院前急救效果，有助于患者疾病康复，提升急救满意度。     

基于不良事件发生率分析徐州市康复专科医院医疗资源现状

目的:以不良事件发生率为切入点,分析徐州市康复专科医院医疗资源状况。方法:调查分析2017年1月—2020年12月徐州市120所康复专科医院(包含有医院中设置康复医学科的医院)发生跌倒例数、争吵不良事件例数、康复医疗专业人力资源状况、床位数等,探讨不良事件与医疗资源之间的相关性。结果:2017年—2020年徐州康复专科医院共发生不良事件315起,其中2017年81起,2018年59起,2019年79起,2020年96起,引起不良事件前3位原因是就诊排队、治疗仪分配和电梯拥挤;调查显示,徐州市现有康复病床2 675张,占应配备比的57.98%,现有康复医师402人,康复护士432人,康复治疗师808人,分别占规划百分比的31.07%、16.69%和31.22%。结论:不良事件发生的根本原因在于徐州市医疗康复资源的缺乏,有待通过优化医疗配置、分级诊疗、加大投入等措施使康复医学健康发展,使更多病人通过康复早日回归家庭。     

放射科医疗服务投诉原因分析

目的 分析医院放射科医疗服务投诉的原因.方法 对我院放射科2001年1月～2010年1月发生的57例医疗服务投诉从社会和医学的角度,结合实际工作进行分析.结果 医疗服务投诉主要原因有:医患双方医疗服务理念存在差异、医疗服务单向道德规范的局限性、医务人员责任心不强、医患双方沟通不畅、患者及家属缺乏医学知识、医疗设备与医院发展不协调、科室日常管理缺乏规范性、新闻媒体的报道有失公允.结论 放射科医疗服务投诉的原因是多方面的,医院管理者、临床医师、放射科医务人员都应采取针对性措施,提高医疗服务质量,减少医疗投诉.     

日常生活活动能力量表在脑卒中患者康复过程中的临床使用情况调查

目的调查和分析日常生活活动能力量表在脑卒中患者康复过程中的临床使用情况。方法选取2016年1月至2017年12月全市医疗机构设有康复科的118名康复医师和康复治疗师作为调查研究对象,应用我院自行设计制订的调查问卷对日常生活活动能力量表在脑卒中康复过程中的临床使用情况进行调查和分析。结果在脑卒中患者康复过程中日常生活活动能力量表MBI和FIM使用1年以上的比率均相对较高,均处于50%以上;而在脑卒中康复过程中日常生活活动能力量表FAI和Lawton IADL从未使用过的比率则均相对较高,均处于75%以上。在脑卒中康复过程中康复日常生活活动能力量表MBI,FIM被认可的比率均相对较高,均处于65%以上;而在脑卒中康复过程中日常生活活动能力量表FAI,Lawton IADL被认可的比率均相对较低,均处于20%以下。与5年以上工龄相比,在脑卒中康复过程中2～5年工龄的康复医师和康复治疗师对日常生活活动能力量表MBI,FIM的认可率均明显高于5年以上工龄的康复医师和康复治疗师,差异均具有统计学意义(P 0. 05)。结论日常生活活动能力量表在脑卒中康复过程中应用较为单一,在保证基础性日常生活能力康复评价的同时,还应加强对工具性生活能力康复的评价,从而提升脑卒中患者的康复效果。     

中医康复临床实践指南·脑卒中

脑卒中具有发病率高、死亡率高、致残率高和复发率高的特点。循证医学研究证实,脑卒中康复是降低其致残率最有效的方法。现阶段中医康复具有良好的医疗基础。制订脑卒中中医康复指南最重要的目的是梳理脑卒中中医康复的治疗行为,提高康复诊疗效果。本指南从范围、术语和定义、诊断、康复管理、康复评定、不同功能障碍的康复、中医辨证分型及治疗等方面对脑卒中诊疗流程进行梳理,适用于中医康复科、中西医结合康复科、针灸科、推拿科等临床医师。本指南具有较好的适用性及有效性。     

康复医师在康复评定中的角色

康复评定体系包括传统的初、中、末期评定和门诊咨询、出院随访等[1] 。将康复评定外延进行适当扩展可促使康复评定和治疗范围延伸。康复医师在康复评定中承担领导和协调、管理者的角色。强调康复医师在康复评定和治疗中的管理者责任 ,目的是使康复评定内涵扩展并在康复医疗活动中起到其应有的作用。康复医学的发展对康复医学科专业人才提出了越来越高的要求 ,而康复评定在整个康复医学体系中是较为薄弱的一环[2 ] 。对康复评定的理解和重视程度不够、康复评定不规范、康复评定对康复治疗的指导性不强等 ,是国内普遍存在的问题。笔者根据本…     

2012年上半年本刊审稿专家名录

著名疼痛医学专家韩济生院士曾提出呼吁：应更快地形成我国完整的疼痛性疾病诊疗体系和研究体系。在努力达到这一目标的过程中,加强康复医学领域疼痛（尤其慢性疼痛）亚专科的建设无疑具有十分重要的作用,因为康复医师每日都要处理大量的疼痛性疾病或与疼痛有关的康复问题;而康复医学对某些类型的疼痛可运用多种物理因子、中西医结合康复疗法,以及通过生理—心理—行为的综合途径全面地减轻患者的疼痛和功能的缺失,这是康复医学明显的优势所在。在当今疼痛医学以多学科模式（multidisciplinary approach）,由各相关学科以其独特的视角、技术、资源而蓬勃开拓疼痛评估、治疗的新技术和新的服务方式的形势下,康复医师也必须加强与相关学科的沟通、联系、合作,相互学习。本着这一宗旨,本刊在本期以疼痛的治疗和康复处理为重点,刊登了一组文章,包括：倪家骧教授的《神经病理性疼痛的微创介入治疗》、朱毅讲师等的《康复医学在多学科疼痛治疗发展的作用》,以及其他几篇有关带状疱疹后神经痛的治疗、颈源性头痛的治疗、原发性三叉神经痛的治疗的研究文章,值得参考。 此外,本期还刊登了由王茂斌教授撰写的特约稿——《关于康复医疗服务体系建设的若干问题》,该文介绍了近期我国卫生部提出的关于康复医疗服务体系建设的相关政策,分析了我国目前在康复医疗体系建设中主要存在的问题,提出了解决这些问题的几点建议,值得注意。     

重症颅脑损伤患者人工气道标准化管理效果

目的:探讨重症颅脑损伤患者人工气道标准化管理的效果。方法:选取2017年1月～2018年1月105例重症颅脑损伤患者为研究对象,将其中50例采取人工气道常规管理的患者纳入对照组,将55例采取人工气道标准化管理的患者纳入观察组,比较两组并发症发生率、病死率、机械通气时间、ICU治疗时间及医疗费用。结果:观察组并发症发生率、病死率、机械通气时间、ICU治疗时间及医疗费用均显著低于对照组(P 0. 05)。结论:在重症颅脑损伤患者人工气道管理中开展标准化管理,可有效预防并发症、病死情况的发生,缩短ICU治疗时间,促进患者康复。     

临床护理带教风险管理对策

医疗风险无处不在，它贯穿着医疗、护理的全过程。即诊断、治疗和康复的全过程。只要存在医疗活动，就有医疗风险。临床带教风险管理是指临床护理带教过程中，对病人、家属、陪伴或探视者可能产生伤害的潜在的风险进行识别、评估、采取正确的行动的过程。目的在于对带教过程中可能导致上述人员损伤的潜在的危险因素进行确认、评估及采取正确的措施，通过持续专业的、法律的教育及培训，让临床带教老师了解自己在带教工作中面临的风险，规范自己的带教行为，减少可能被病人起诉的情况和差错事故的发生，降低风险的发生。     

Stroke rehabilitation: a geropsychological perspective

Rehabilitation medicine and geriatric medicine are similar in their concern for functional improvement in the face of chronic medical conditions. Although many patients served by rehabilitation medicine fall within the geriatric age range, a knowledge of normal aging does not necessarily inform clinical decision making or research practices in rehabilitation. Using stroke as an example of a disorder affecting primarily geriatric patients and requiring the technology of rehabilitation, ways in which age might affect assessment of outcome are examined. Three areas dealing with conceptual and methodologic issues--depression, neurochemical interventions, and family--are highlighted. The final section outlines recommendations for research on rehabilitation outcome of geriatric stroke patients.     

医疗体操对脑卒中偏瘫恢复期的应用效果评价

目的探讨医疗体操在脑卒中偏瘫患者恢复期的应用效果。方法选择2011年1～7月收治于神经内科的脑卒中偏瘫恢复期患者114例,随机分为医疗体操组58例和对照组56例,两组患者均接受神经内科常规药物治疗,医疗体操组在此基础上给予系统的医疗体操训练,对照组则为一般康复训练。分别于入组时及治疗1个月采用Berg平衡量表及Barthel ADL指数对卒中患者的平衡能力及日常生活活动能力进行评定。比较两组平衡功能改善程度以及日常生活活动能力的提高程度。结果治疗1月后,两组患者的平衡能力与日常生活能力都有一定的改善,但与对照组比较,医疗体操组在Berg平衡量表及Barthel ADL指数中的评分明显优于对照组(P<0.05)。结论医疗体操作为一项运动疗法,能够较好地提高脑卒中偏瘫患者的平衡能力及日常生活能力,从而有效改善患者的生活质量。     

脑卒中偏瘫患者配合康复治疗的疗效观察

目的：探讨康复治疗脑卒中患者临床神经功能和日常生活活动能力（ADL）的影响。方法：将60例脑卒中偏瘫患者随机分为康复组（30例）和对照组（30例）进行临床对照研究,两组均常规进行神经内科治疗,康复组加以运动疗法,对每例患者入院时、出院时分别进行临床神经功能缺损评分、Bathel指数（MBI）评分。结果：康复组与对照组在入院时临床神经缺损评分及ADL评分比较差异无统计学意义（P〉0.05）,而出院时两组上述评分比较差异有统计学意义（P〈0.01）。结论：配合康复的临床疗效优于单独药物治疗。     

探索疗养院建立卒中康复单元的模式

目的为患者提供康复的早期介入,最终使患者获得更好的临床效果,提高患者生存质量。方法疗养院建立卒中康复单元,将环境与医疗、疗养与康复结合起来。结果疗养院建立卒中康复单元,有利于形成专病疗养、专科康复特色,大大提高了整体康复效果。结论疗养院应建立卒中康复单元,以适应现代康复医学的发展形势,形成一套具有疗养特色的卒中康复单元,规范卒中单元病人的入出院模式,平时将脑卒中防治扩展到家庭、社区,战时将卒中单元应用于部队战创伤救治和康复护理。     

Effects of assigning physical therapists exclusively to the acute-phase stroke patient ward

[Purpose] In April 2014, an additional health insurance system aiming to maintain or improve activities of daily living levels was newly established by the Japanese government. The purpose of this study was to determine the influence of this new medical system for rehabilitation on patient management (e.g., activities of daily living level and length of hospital stay) in an acute-phase stroke patient ward. [Participants and Methods] All patients were admitted to the stroke patient ward in our hospital and were registered between January 2012 and December 2019. We assessed the differences in the time to initiation of rehabilitation, length of hospitalization, implementation rate of rehabilitation, and Barthel Index between the period before the start of the new medical system (Prior period) and after this system was started (Post period). [Results] Significant improvements were observed in the initiation of rehabilitation and the difference in the Barthel Index scores after the start of the new medical system. Although the length of hospitalization and implementation rate of rehabilitation did not differ significantly, both indicators gradually improved after the start of the new system. [Conclusion] Our results suggest that the new medical system for rehabilitation is beneficial for patient management in the acute-phase stroke patient ward.     

藏药药浴应用于脑卒中康复的卫生经济学评价

目的:探讨藏药药浴应用于脑卒中康复的经济学价值。方法:基于多中心随机对照试验,本研究纳入脑卒中患者403例,入组患者随机分为常规康复组202例和藏药药浴组201例(常规康复加藏药药浴)。两组患者均接受常规康复治疗标准方案,包括常规物理治疗60min/d,强化抗痉挛治疗60min/d,作业治疗30min/d,每周5天,治疗4周。藏药药浴组在常规康复治疗基础上,加用藏药药浴20min/d,每周5天,治疗4周。采用Fugl-Meyer评分(FMA)、改良Barthel评分(MBI)分别在治疗前、治疗2周后、治疗4周后评估运动功能和日常生活活动能力,记录全部医疗花费。卫生经济学指标采用成本效果比,以直接医疗费用与FMA和MBI评分变化值的比值评价。同时计算藏药药浴组的增量成本效果比(ICER),以进一步衡量其成本效果。结果:治疗4周后,常规康复组FMA值、MBI值较治疗前分别提高(6.92±8.48)分和(7.78±9.49)分;藏药药浴组FMA值、MBI值较治疗前分别提高(10.26±10.86)分和(11.05±12.00)分。FMA每提高1分,直接医疗费用常规康复组为3064.22元,藏药药浴组为2343.90元,较常规康复组节省720.32元;MBI评分每提高1分,常规康复组直接医疗费用为2725.51元,藏药药浴组为2176.33元,较常规康复组节省549.18元。ICER分析结果也提示藏药药浴组较常规康复组具有更好成本效果。结论:脑卒中常规康复结合藏药药浴的综合治疗比单纯常规康复治疗具有更好的成本效果。     

A taxonomy for classification of stroke rehabilitation services

OBJECTIVE: To develop a taxonomy for use in measuring stroke rehabilitation services. DESIGN: A cross-sectional study using facility-level survey data and extant data files. SETTING: Veterans Administration medical centers (VAMCs). VARIABLES: (1) A list of rehabilitation characteristics, including personnel, physical facilities, coordination of care, and hospital characteristics; and (2) a classification or typology of VAMCs according to the type of postacute stroke care on-site. MAIN OUTCOME MEASURES: Data sources included extant Veterans Administration (VA) computerized databases, VA central office administrative files, and 2 mailed surveys to VA rehabilitation medicine services and stroke acute care services. The rehabilitation taxonomy was derived using 2 methods that assess face and construct validity, respectively: (1) an expert panel rating, using a modified Delphi process, of the clinical importance of each of the rehabilitation characteristics; and (2) a comparison of rehabilitation characteristics across the different types of VAMCs. Variables were included in the final taxonomy if the expert panel reached consensus that the variable was clinically important, or if there were statistically significant differences in these characteristics across the different types of medical centers. RESULTS: Of 67 possible rehabilitation characteristics, a multidisciplinary expert panel reached consensus about the likely clinical importance of 21 rehabilitation characteristics, 11 of which showed statistically significant differences across different types of VAMCs. An additional 9 variables that lacked expert panel consensus differed significantly among the different medical centers. These 30 variables represent a preliminary taxonomy of key rehabilitation characteristics. Among the 20 variables that varied significantly across the different types of medical centers, 18 showed a pattern with the greatest amount of resources and organizational sophistication being found in VAMCs with rehabilitation units, followed by medical centers with geriatric units, and the least amount of resources and organizational sophistication was seen in medical centers whose postacute care services were limited to nursing home or intermediate care. CONCLUSION: Thirty rehabilitation characteristics had face validity and/or construct validity, and can be considered to represent a preliminary taxonomy for measuring stroke rehabilitation services. This study also shows that there are significant differences among hospitals in resources and organization of care deemed to be important for stroke patients.     

Teaching medical students rehabilitation medicine

Purpose.?The principles of rehabilitation medicine will become ever more important across many medical and surgical specialties in view of the rising prevalence of chronic and disabling conditions. Yet rehabilitation medicine has traditionally been unpopular with medical students. This article aims to review the existing evidence of problems in teaching medical undergraduates in rehabilitation medicine and provide published recommendations and practical approaches from our own experience.

Method.?A literature review was carried out to search for publications relating to teaching rehabilitation medicine to undergraduates in order to identify problems that potentially affect undergraduate education in rehabilitation medicine and its future as a medical speciality.

Conclusion.?The lack of consistent undergraduate curriculum, knowledge of rehabilitation medicine and academic opportunities contribute to the inadequate perception of the speciality to the undergraduates. The attitude of medical students towards rehabilitation medicine is important for its future development as a specialty. Further standardisation of teaching rehabilitation medicine at a national level, promoting research activity in this area and increasing the profile of rehabilitation medicine are warranted.     

The Relationship between Rehabilitation and Changes in Depression in Stroke Patients

[Purpose] This study investigated the primary factors behind changes in depressive symptoms among stroke patients after 8 weeks of rehabilitation (physical, occupational, and cognitive therapy). [Methods] This study was conducted using a literature review, and electronic medical records from January, 2008 to December, 2009. Data were collected for 120 subjects with chronic stroke. [Results] Cardiac disorder, left-brain lesion, early-stage depression, activities of daily living, and cognitive function were significant predictors of the changes in depression in chronic stroke patients. [Conclusion] Post-stroke depression can be controlled by rehabilitation. Also, clinicians should comprehend and share the psychological and physical affliction, develop back-up programs, and make them comprehensively available to support the psychological and physical health of subjects with chronic stroke.Key words: Stroke, Rehabilitation, Depression     

The protective effect of subhypothermiaon brain of patient with ischemic cerebrovascular disease on different time

The subhypothermia treatment presents the advantages of decreasing energy metabolism and consumption of lactic acid,reducing release of active amino acid and alleviating inflammatory brain injury by cerebrovascular disease protecting blood-cerebral barrier and stabilize permeability of vessel.OBJECTIVE:To observe the effect of Subhypothermia on brain of patient with acute and severe ischemic cerebrovascular disease in recovery period on different time.