早期脑卒中偏瘫的康复护理训练与自我锻炼的效果对比

目的：探讨早期脑卒中偏瘫的康复护理的疗效。方法：将134例脑卒中偏瘫患分为两组，67例采用药物与康复训练同步进行为康复组，67例采用单纯药物治疗及未经指导的自我锻炼为对照组，采用简式Fugl-Meyer运动功能评分，改良Barthel指数为初期，末期评定，结果：7周后两组进行评评，康复组患肢运动，日常生活能力比对照组明显提高，结论：早期康复护理训练可促进患肢功能恢复，降低致残率。     

早期脑卒中偏瘫的康复护理训练与自我锻炼的效果对比

目的探讨早期脑卒中偏瘫的康复护理的疗效。方法将134例脑卒中偏瘫患者分为两组,67例采用药物与康复训练同步进行为康复组,67例采用单纯药物治疗及未经指导的自我锻炼为对照组。采用简式Fugl-Meyer运动功能评分,改良Barthel指数为初期、末期评定。结果7周后两组进行评价,康复组患肢运动、日常生活能力比对照组明显提高。结论早期康复护理训练可促进患肢功能恢复,降低致残率。     

早期康复护理对脑卒中偏瘫功能恢复的影响

目的：探讨早期康复护理对脑卒中偏瘫功能患康复的影响。方法：126例急笥脑卒中患,随机分为两组,均用神经内科治疗和早期良肢位摆放。康复组缺血性脑卒中入院第1－2天,出血性脑卒中入院第7－14天即实施康复护理训练,分为卧,坐,站,走4期。对照组系未经指导的自我锻炼,结果：4周结束后,两组患进行ADL（Barthel)及患肢运动功能综合评定,康复组康复情况优于对照组,差异有高度显性（P＜0．001）,结论：早期康复护理训练,可明显改善肢体运动功能主ADL能力,提高患的生活质量,减少住院时间。     

早期康复护理干预对脑卒中偏瘫患者日常生活活动能力的影响

目的:探讨早期康复护理干预对脑卒中偏瘫患者日常生活活动能力(ADL)的影响。方法:将118例脑卒中偏瘫患者随机分为康复组和对照组各59例,对照组按神经内科护理常规进行护理,康复组由责任护士按护理程序实施系统化早期康复护理干预,包括基础护理、心理护理、早期患肢康复锻炼、语言功能锻炼、吞咽功能锻炼、日常生活能力训练。采用Barthel指数对两组患者干预前后ADL进行评定比较。结果:两组干预后Barthel指数均较干预前明显升高(P<0.01),康复组干预后Barthel指数明显高于对照组(P<0.01)。结论:早期康复护理干预能提高脑卒中偏瘫患者ADL,降低致残率,改善生活质量。     

早期康复对急性脑卒中ALD的促进作用

目的 探讨早期康复治疗对急性脑卒中偏瘫患者上、下肢运动功能和日常生活活动能力的影响。方法 选择急性脑卒中偏瘫患者96例,随机分为康复组和对照组（每组48例）。用前瞻性研究方法对两组进行比较分析。康复组在给予物治疗的同时,还进行正规的康复训练;对照组仅给予药物治疗。分别于入选治疗前24h和治疗后6－8周进行测评。采用Brunnstrom分级法评定运动功能,采用Barthel指数评定日常生活活动能力（ADL）。结果 经6－8周治疗后,两组在Barthel指数和Brunnstrom分级上均有一定程度的改善,康复组的改善幅度明显优于对照组（P＜0．01）。结论 急性脑卒中偏瘫患者接受早期康复治疗,能明显改善肢运动功能,提高日常生活活动能力。     

早期康复护理对脑卒中患者肢体运动功能的影响

目的探讨早期康复护理介入对脑卒中偏瘫患者肢体运动功能的影响。方法将200例脑卒中偏瘫患者分为康复组100例和对照组100例,康复组在常规治疗护理的基础上,从患者入院第1天开始即设计良好的肢体位置,进行患肢按摩和肢体的被动活动。对照组按传统的脑血管病治疗护理方法,患者肢体处功能位,急性期卧床静养限制活动。结果两组患者经1个月的治疗和康复护理后,康复组患侧上下肢体运动功能改善程度明显高于对照组(P<0.01)。结论早期康复护理介入能明显改善患肢运动功能和ADL能力。     

良肢位摆放对脑卒中偏瘫患者早期康复护理效果的影响

目的分析良肢位摆放对脑卒中偏瘫患者早期康复护理效果的影响。方法 2014年1月~2015年6月选取早期应用良肢位摆放护理的45例脑卒中偏瘫患者为研究组,选择同一时间内仅在护理的后期使用良肢位摆放的45例脑卒中偏瘫患者为对照组,比较2组患者在护理前后的日常生活能力和患肢运动能力。结果 2组患者护理前后的日常生活能力和患肢运动能力评分明显增高(P0.05),而且研究组患者提高程度明显优于对照组(P0.05)。结论良肢位摆放可明显提高脑卒中偏瘫患者早期康复护理效果,有利于促进患肢功能的恢复。     

空气波压力治疗对缺血性脑卒中偏瘫患者康复效果的观察

目的观察空气波压力治疗对急性缺血性脑卒中患者康复的效果。方法将139例急性缺血性脑卒中偏瘫患者按入院顺序分为观察组70例和对照组69例。对照组予常规康复护理,观察组在常规康复护理基础上加用空气波压力治疗仪辅助治疗。采用简式Fugl-Meyer评分法、巴氏指数评分法测评患者康复护理前后患肢运动功能及日常生活活动能力。结果康复护理后观察组患肢运动功能及日常生活活动能力较干预前显著提高,且优于对照组。结论脑卒中偏瘫患者早期进行空气波压力辅助治疗能提高康复效果。     

早期康复护理干预对改善脑卒中病人ADL的探讨

目的探讨早期康复护理干预对急性脑卒中偏瘫患的运动功能、平衡功能、日常生活活动能力（ＡＤＬ）的影响。方法脑卒中偏瘫患６０例,对其中３０例患实施早期康复计划（康复组）,另外３０例人予神经内科一般治疗（对照组）。结果两组治疗前,治疗后一个月分别给予Ｆｕｇｌ－Ｍｅｙｅｒ评测法和ＦＩＭ评测法,对患肢体的残损程度和活动功能进行评定,经过统计学检验得出：治疗前评测,两组无明显差异（Ｐ＞０．０５）。治疗后     

急性脑卒中偏瘫患者65例早期康复干预效果观察

目的:探讨急性脑卒中偏瘫患者早期康复干预的效果.方法:将130例急性脑卒中偏瘫患者随机分为康复组和对照组各65例,均接受常规药物治疗、基础护理,康复组患者同时应用必要的康复治疗及护理,治疗4周后肢体功能按Fugl-Meyer测评,日常生活活动能力(ADL)用Barthel(BI)指数进行评价.结果:治疗后两组Fugl-Meyer、BI积分与治疗前比较有显著性差异(P＜0.01),康复组明显优于对照组(P＜0.01).结论:早期康复干预有利于急性脑卒中患者偏瘫功能的恢复,能明显提高其运动功能及日常生活活动能力.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

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.     

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.