Principles of economic evaluation for interventions of chronic musculoskeletal pain

Economic evaluation is attracting increasing attention to inform policy makers, insurers and other payers of the value of existing and new treatment modalities. Hence, it is desirable to assess not only the medical but also the economic consequences the new treatments produce. The available literature on economic evaluation revealed an urgent need for sound economic evaluation studies in the field of chronic musculoskeletal pain. Due to the generally weak methodology, the intended purpose of economic evaluation to help set funding priorities has often been bypassed. Although in general therapists have no direct responsibility for allocating scarce resources in the field of musculoskeletal pain, they are confronted with the results of these decisions in their everyday work. A clear understanding of the main principles of economic evaluation studies might therefore be advantageous. This paper addresses important methodological issues in economic evaluation research, such as the techniques for economic evaluation studies and the analytic perspective. In addition, the paper pays attention to the inclusion of costs and outcomes in economic evaluation research, sensitivity analysis, discounting, incremental analysis and ratios, and collecting of data.Further emphasis is placed on the transparent reporting of methods and study results. A clear reporting may help therapists and other researchers interpret the results of published studies and apply them to their own studies, and it may help decision makers generalize results from one setting to another.     

Principles of prehospital care of musculoskeletal injuries

Prehospital management of musculoskeletal injuries in the traumatized patient is based on the application of a few basic principles in an orderly but expeditious manner. The patient must be assessed for immediate life-threatening conditions involving airway, respiratory, and circulatory functions while the cervical spine is protected. Resuscitative efforts to reestablish and preserve an adequate circulating volume of oxygenated blood must follow, using airways, oxygen therapy, and fluid replacement through MAST trousers and intravenous fluids. Cardiac function must be maintained as well. Respiratory function must be monitored and assisted as required. Finally, neurologic status must be assessed and monitored. Secondary assessment of all pertinent history and physical findings is made to delineate all other injuries that do not pose an immediate threat to the life or limb of the patient. Definitive care follows but is limited to basic resuscitation, stabilization, and immobilization techniques under medical control through telemetry and radio communication. Immediate definitive care of the traumatized patient requires the expeditious intervention of the trauma team in a hospital setting with surgical, blood banking, radiographic, laboratory, and other hospital-based capabilities available. Field management of the traumatized patient is directed at the expeditious delivery of the viable patient to the trauma team. In the multiply traumatized patient with severe injuries to several organ systems, prehospital care may need to be expedited to provide this patient the in-hospital care required to save his or her life. Appropriate treatment in such life-threatening trauma situations will consist of a rapid primary assessment, airway and cervical spine control, appropriate respiratory and cardiovascular assistance, gross whole body fracture immobilization using a backboard, and immediate transport. For less severely injured patients, primary assessment, resuscitation, stabilization, full secondary assessment, initial definitive care, and immobilization should be completed before transport begins.     

肩关节周围炎患者对关节松动手法与传统手法治疗的接受率比较

目的:关节松动手法应用于肩关节周围炎(简称肩周炎)的治疗已多年以对照观察的方法研究关节松动手法和传统手法对肩周炎治疗作用的不同效果。方法:回顾性分析肩周炎患者598例,其中251例采用传统手法结合超短波治疗,347例采用关节松动手法结合超短波治疗,评价两组患者对手法治疗的接受率、各组患者治疗前后的关节活动度及好转或痊愈的治疗次数。结果:①关节松动手法组和传统手法组,治疗接受率分别为89.05%81.67%,差异有显著性意义(P<0.05)。②关节松动手法组的治疗次数为(30.50±6.57)次,较传统手法组犤(24.13±4.89)次犦少,差异有显著性意义(P<0.05)。③两组患者肩关节活动度治疗后较治疗前有明显改善。④治愈分别为150,101例,好转分别为159,104例。结论:关节松动手法治疗肩周炎可以改善关节活动度,较传统手法治疗轻柔,患者易接受。     

Ethical considerations in chronic musculoskeletal disease

Chronic diseases compromise the life of the sufferer, encumber their families, and exert intractable burdens on the health-care system. With the aging of the population, such conditions have become the primary determinants of morbidity and mortality and the leading cause of disability in our society. Despite the serious challenges they impose, the ethical discourse engendered by them has lagged behind that of acute care medicine. Of particular relevance are the challenges to individual autonomy, as the dilemmas arising in the chronic care setting have not only medical but personal and societal dimensions, may require the input of multiple participants, and resolve over longer periods of time. As such, the conventional model of autonomy is often inadequate to address problems in the chronic care setting. This paper deals with this dilemma through an examination of a clinical scenario. A framework for the exploration of ethical problems in the chronic care setting is thus presented.     

肌肉骨骼超声对类风湿关节炎疾病活动度的评估价值

目的 探索肌肉骨骼超声对类风湿关节炎疾病活动度的评估价值.方法 以2018年2月14日至2020年2月21日收治的172例疑似类风湿关节炎患者为研究对象,以病理诊断为金标准将患者分为类风湿关节炎组(阳性组,86例)和非类风湿关节炎组(阴性组,86例),均进行肌肉骨骼超声检查.分析肌肉骨骼超声的诊断效能.结果 阳性组的血...     

New options for treating gallstone disease.

Gallstone disease is a major health problem in the United States and in most Western countries. During the past century, cholecystectomy has been the treatment of choice. Recently, new modalities of treatment have been developed, including oral dissolution therapy, extracorporeal shock-wave lithotripsy, percutaneous transhepatic cholecystolitholysis using methyl tert-butyl ether, and laparoscopic cholecystectomy. In selected patients, these new options have been successful in the treatment of gallstones.     

乙酰胆碱酯酶抑制剂治疗阿尔茨海默病的研究

阿尔茨海默病(Alzheimerdisease,AD)是由神经退化失调引起的一种进行性认知和记忆功能丧失的疾病,目前尚无特异性的有效的治疗手段。乙酰胆碱酯酶抑制剂是治疗AD的研究中最活跃的领域。     

自体外周血干细胞移植治疗非霍奇金淋巴瘤的外周血干细胞动员方案临床分析

本研究比较CEP+G-CSF与CVP+G-CSF动员方案对非霍奇金淋巴瘤(NHL)患者外周血造血干细胞动员采集及造血恢复的效果。回顾性分析我科收治的57例NHL患者。分组采用CEP+G-CSF与CVP+G-CSF动员方案进行外周血干细胞动员采集,并于预处理结束后回输外周血干细胞,分析动员效果、不良反应及自身移植后造血恢复情况。结果表明:动员期间所有患者外周血白细胞(WBC)计数均降至1.0×109/L以下,血小板(Plt)数降至40×109/L以下。57例患者均采集成功,CEP+G-CSF动员方案组采集单个核细胞(MNC)数和CD34+细胞数明显高于CVP+G-CSF动员方案组(p=0.002和p=0.019)。预处理后所有病例均达到骨髓抑制,CEP+G-CSF和CVP+G-CSF动员方案组WBC数恢复到≥1.0×109/L的平均时间分别为11.4和12.3天(p﹥0.05),Plt数恢复到≥50×109/L的平均时间分别为18.6和19.3天(p﹥0.05)。结论:自体外周血干细胞移植治疗NHL疗效显著,CEP或CVP联合G-CSF方案行外周血干细胞动员均安全有效,临床效果满意,CEP+G-CSF方案动员外周血干细胞效果更好。     

Computer supported multimodal bed-side monitoring for neuro intensive care

Multimodal monitoring in neuro-intensive care requires computer supported data analysis and archiving. This paper describes a computer system that is able to integrate the results of analysis of intracranial pressure, cerebral perfusion pressure, transcranial Doppler blood flow velocity, jugular bulb oxygen saturation, laser Doppler blood flow, near infrared spectroscopy. A research-oriented software installed in a standard IBM PC equipped with a low-cost analog-to-digital converter allows a broad spectrum of waveform analyses, from calculation of simple mean values to a selective waveform detection and cross-correlation analysis. The architecture for the signal processing algorithm, the principles of system interfacing and data presentation are discussed briefly. Results from two years of multimodal monitoring in neuro-intensive care show that, apart from simple recording of time trends of monitored variables, certain calculated parameters are particularly useful in the continuous assessment of cerebral haemodynamic and compensatory reserves. Such parameters include: transcranial Doppler pulsatility indices, the dependence between blood flow velocity or laser Doppler flux and cerebral perfusion pressure and the correlation coefficient between pulse amplitude and mean intracranial pressure.     

细胞移植治疗帕金森病的研究进展

目的:根据近年细胞移植治疗帕金森病的近况,认识细胞移植治疗帕金森病的最新进展及临床应用前必须解决的技术难题。资料来源:应用计算机检索Pubmed 2000-01/2006-10细胞移植治疗帕金森病的文章,检索词为"Cells transplantation,Parkinson disease",并限定文献种类为English。资料选择:对资料进行初审,选取包括细胞移植与帕金森病相关的文献,开始查找全文。纳入标准:①细胞移植在神经系统疾病中的应用。②细胞移植与帕金森病。排除标准:综述文献、重复研究、Meta分析类文章。资料提炼:共收集到175篇关于细胞移植与帕金森病的文献,纳入30篇文献。资料综合:细胞移植治疗帕金森病的主要细胞来源有肾上腺髓质细胞、胎儿中脑腹侧组织细胞、异种移植、神经干细胞、骨髓干细胞、胚胎干细胞等。其临床应用前仍存在许多技术难题,如移植物的来源、移植部位与方法、移植环境等。随着这些基础研究和临床治疗上难题的解决,细胞移植必将成为治疗帕金森病的重要手段。结论:细胞移植尤其是胚胎干细胞的应用,将为帕金森病的治疗带来新的曙光。     

肌骨超声在焦磷酸钙沉积病的应用价值

焦磷酸钙沉积病为焦磷酸钙晶体沉积于关节透明软骨和纤维软骨,以及关节周围组织,如滑膜、肌腱、滑囊,特征是软骨钙化,急性发作时称假性痛风。焦磷酸钙沉积病的临床表现多样,发病率随着年龄的增加而升高,对其进行准确诊断具有重要意义。目前最为广泛使用的是Ryan-McCarty诊断标准,包括滑液分析中存在焦磷酸钙晶体和典型的影像学下软骨钙化。肌骨超声的应用使其诊断的敏感性及特异性均有增高,本文就焦磷酸钙沉积病的超声应用价值进行综述。