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1.
Emergent cricothyroidotomies for trauma: training considerations 总被引:1,自引:0,他引:1
King DR Ogilvie MP Velmahos G Alam HB Demoya MA Wilcox SR Mejaddam AY Van Der Wilden GM Birkhan OA Fikry K 《The American journal of emergency medicine》2012,30(8):1429-1432
Background
Emergent cricothyroidotomy remains an uncommon, but life-saving, core procedural training requirement for emergency medicine (EM) physician training. We hypothesized that although most cricothyroidotomies for trauma occur in the emergency department (ED), they are usually performed by surgeons.Methods
We conducted a retrospective analysis of all emergent cricothyroidotomies for trauma presentations performed at 2 large level I trauma centers over 10 years. Operators and assistants for all procedures were identified, as well as mechanism of injury and patient demographics were examined.Results
Fifty-four cricothyroidotomies were analyzed. Patients had a mean age of 50 years, 80% were male, and 90% presented as a result of blunt trauma. The most common primary operator was a surgeon (n = 47, 87%), followed by an emergency medical services (EMS) provider (n = 6, 11%) and an EM physician (n = 1, 2%). In all cases, except those performed by EMS, the operator or assistant was an attending surgeon. All EMS procedures resulted in serious complications compared with in-hospital procedures (P < .0001).Conclusions
(1) Prehospital cricothyroidotomy results in serious complications. (2) Despite the ubiquitous presence of EM physicians in the ED, all cricothyroidotomies were performed by a surgeon, which may present opportunities for training improvement. 相似文献2.
Nicholas G. Wysham Richard A. Mularski David M. Schmidt Shirley C. Nord Deborah L. Louis Elizabeth Shuster J. Randall Curtis David M. Mosen 《Journal of critical care》2014
Purpose
Communication in the intensive care unit (ICU) is an important component of quality ICU care. In this report, we evaluate the long-term effects of a quality improvement (QI) initiative, based on the VALUE communication strategy, designed to improve communication with family members of critically ill patients.Materials and Methods
We implemented a multifaceted intervention to improve communication in the ICU and measured processes of care. Quality improvement components included posted VALUE placards, templated progress note inclusive of communication documentation, and a daily rounding checklist prompt. We evaluated care for all patients cared for by the intensivists during three separate 3 week periods, pre, post, and 3 years following the initial intervention.Results
Care delivery was assessed in 38 patients and their families in the pre-intervention sample, 27 in the post-intervention period, and 41 in follow-up. Process measures of communication showed improvement across the evaluation periods, for example, daily updates increased from pre 62% to post 76% to current 84% of opportunities.Conclusions
Our evaluation of this quality improvement project suggests persistence and continued improvements in the delivery of measured aspects of ICU family communication. Maintenance with point-of-care-tools may account for some of the persistence and continued improvements. 相似文献3.
Objectives
Specific types of error should be identified and corrected in each laboratory to ensure quality results. The objectives of this study were:- -
- to identify and classify the causes of biological specimen rejections,
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- to determine the specimen rejection rates (SRRs) in terms of pre-preanalytical errors and with respect to collection areas, and
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- to identify an appropriate quality indicator (QI) for the preanalytical phase in a university hospital clinical laboratory.
Design and methods
Data on rejected biological specimens in the laboratory information system from January 2013 to January 2014 were analyzed. SSRs according to the type of pre-preanalytical error and collection area were determined.Results
In total, 971,780 biological specimens were received during the period and 26,070 (2.7%) specimens were rejected based on our laboratory rejection criteria. The most frequent reason for the rejection was the clotted specimen (55.8% of total rejections), followed by inadequate volume (29.3% of total rejections). Most of the clotted specimens were received from adult hospital inpatient services (54.3%), followed by pediatric hospital inpatient services (26.8%). High rates of inadequate volume were also observed in samples originating from adult and pediatric hospital inpatient services, especially in the premature, neonatal, intensive care, and oncology units.Conclusions
The SSR of clotted specimens was selected as the QI for the preanalytical phase in our laboratory. The selected QI will help to define the effects of our specific interventions and corrective actions, and thus allow monitoring of quality improvement in our hospitals. 相似文献4.
Introduction
In 1999, the Accreditation Council for Graduate Medical Education identified 6 general competencies in which all residents must receive training. In the decade since these requirements went into effect, practice-based learning and improvement (PBLI) and systems-based practice (SBP) have proven to be the most challenging competencies to teach and assess. Because PBLI and SBP both are related to quality improvement (QI) principles and processes, we developed a QI-based curriculum to teach these competencies to our fellows.Methods
This experiential curriculum engaged our fellows in our neonatal intensive care unit's (NICU's) structured QI process. After identifying specific patient outcomes in need of improvement, our fellows applied validated QI methods to develop evidence-based treatment protocols for our neonatal intensive care unit.Results
These projects led to immediate and meaningful improvements in patient care and also afforded our fellows various means by which to demonstrate their competence in PBLI and SBP. Our use of portfolios enabled us to document our fellows' performance in these competencies quite easily and comprehensively.Discussion
Given the clinical and educational structures common to most intensive care unit–based training programs, we believe that a QI-based curriculum such as ours could be adapted by others to teach and assess PBLI and SBP. 相似文献5.
Khan AA Chaudhry SA Hassan AE Rodriguez GJ Suri MF Lakshminarayan K Qureshi AI 《The American journal of emergency medicine》2012,30(8):1535-1539
Objective
The objective of this study is to determine the number of primary stroke centers (PSCs) that exist concurrently (synergic relationship) with designated higher level trauma centers (level I or level II trauma centers) and associated characteristics.Methods
We identified all PSCs certified by the Joint Commission or local state authorities in 2010. Concurrently, all the higher level trauma centers (designated level I or level II) were identified using data collected from the trauma information exchange program. Additional data was collected from the Accreditation Council for Graduate Medical Education and the American hospital directory.Results
A total of 788 existing designated PSCs were identified in 2010; coexisting PSC-trauma centers were found in 252 centers (32%) with PSCs coexisting with level I trauma centers in 138 hospitals (17.5%). The remaining 536 PSCs (68%) are based in hospitals without trauma centers. There was a higher proportion of residency training programs including neurology, neurosurgery, and general surgery in coexisting PSC-trauma centers (P < .001). In a proof-of-concept analysis in 1 state, PSCs with level I trauma facilities were found to have the highest rates of thrombolytic administration as compared with PSCs with level II trauma centers and PSCs without trauma facilities (12.8% vs 3.8% vs 4.9%)(P < .0001). Primary stroke centers with level I trauma facilities were also more likely to follow the drip-and-ship paradigm (5.7% vs 1.8% vs 0.9%) (P < .0001).Conclusions
Despite evidence of higher capability among institutions with coexisting PSC-trauma centers, two thirds of PSCs are in hospitals without advanced trauma systems. These findings have implications for establishing stroke systems in the United States. 相似文献6.
Daphne Wezenberg Lucas H. van der Woude Willemijn X. Faber Arnold de Haan Han Houdijk 《Archives of physical medicine and rehabilitation》2013
Objectives
To determine the relative aerobic load, walking speed, and walking economy of older adults with a lower-limb prosthesis, and to predict the effect of an increased aerobic capacity on their walking ability.Design
Cross-sectional.Setting
Human motion laboratory at a rehabilitation center.Participants
Convenience sample of older adults (n=36) who underwent lower-limb amputation because of vascular deficiency or trauma and able-bodied controls (n=21).Interventions
Not applicable.Main Outcome Measures
Peak aerobic capacity and oxygen consumption while walking were determined. The relative aerobic load and walking economy were assessed as a function of walking speed, and a data-based model was constructed to predict the effect of an increased aerobic capacity on walking ability.Results
People with a vascular amputation walked at a substantially higher (45.2%) relative aerobic load than people with an amputation because of trauma. The preferred walking speed in both groups of amputees was slower than that of able-bodied controls and below their most economical walking speed. We predicted that a 10% increase in peak aerobic capacity could potentially result in a reduction in the relative aerobic load of 9.1%, an increase in walking speed of 17.3% and 13.9%, and an improvement in the walking economy of 6.8% and 2.9%, for people after a vascular or traumatic amputation, respectively.Conclusions
Current findings corroborate the notion that, especially in people with a vascular amputation, the peak aerobic capacity is an important determinant for walking ability. The data provide quantitative predictions on the effect of aerobic training; however, future research is needed to experimentally confirm these predictions. 相似文献7.
Erik Grauwmeijer Majanka H. Heijenbrok-KalGerard M. Ribbers MD PhD 《Archives of physical medicine and rehabilitation》2014
Objectives
To evaluate the time course of health-related quality of life (HRQoL) after moderate to severe traumatic brain injury (TBI) and to identify its predictors.Design
Prospective cohort study with follow-up measurements at 3, 6, 12, 18, 24, and 36 months after TBI.Setting
Patients with moderate to severe TBI discharged from 3 level-1 trauma centers.Participants
Patients (N=97, 72% men) with a mean age ± SD of 32.8±13.0 years (range, 18–65y), hospitalized with moderate (23%) or severe (77%) TBI.Interventions
Not applicable.Main Outcome Measures
HRQoL was measured with the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), functional outcomes with the Glasgow Outcome Scale (GOS), Barthel Index, FIM, and Functional Assessment Measure, and mood with the Wimbledon Self-Report Scale.Results
The SF-36 domains showed significant improvement over time for Physical Functioning (P<.001), Role Physical (P<.001), Bodily Pain (P<.001), Social Functioning (P<.001), and Role Emotional (P=.024), but not for General Health (P=.263), Vitality (P=.530), and Mental Health (P=.138). Over time there was significant improvement in the Physical Component Summary (PCS) score, whereas the Mental Component Summary (MCS) score remained stable. At 3-year follow-up, HRQoL of patients with TBI was the same as that in the Dutch normative population. Time after TBI, hospital length of stay (LOS), FIM, and GOS were independent predictors of the PCS, whereas LOS and mood were predictors of the MCS.Conclusions
After TBI, the physical component of HRQoL showed significant improvement over time, whereas the mental component remained stable. Problems of disease awareness seem to play a role in self-reported mental HRQoL. After TBI, mood status is a better predictor of the mental component of HRQoL than functional outcome, implying that mood should be closely monitored during and after rehabilitation. 相似文献8.
Tânia M. Mendonça Maria T. Terreri Carlos H. Silva Morun Bernardino Neto Rogério M. Pinto Jamil Natour Claudio A. Len 《Archives of physical medicine and rehabilitation》2013
Objective
To determine the effects of Pilates exercises on health-related quality of life (HRQOL) in individuals with juvenile idiopathic arthritis (JIA).Design
Randomized, prospective, single-blind trial.Setting
Outpatient clinic of pediatric rheumatology and the rehabilitation department.Participants
Children (N=50) with JIA according to the International League of Associations for Rheumatology criteria.Interventions
Participants were randomly assigned into 2 groups. In group I (n=25), the participants were given a conventional exercise program for 6 months. Patients in group II (n=25) participated in a Pilates exercise program for 6 months.Main Outcome Measures
The primary outcome measure was HRQOL, as measured by the Pediatric Quality of Life Inventory version 4.0 (PedsQL 4.0). The secondary outcome measures provided an estimate of the clinical relevance of the primary outcome results and included joint pain intensity (according to a 10-cm visual analog scale), disability (according to the Childhood Health Assessment Questionnaire), joint status (using the Pediatric Escola Paulista de Medicina Range of Motion Scale), and the total PedsQL 4.0 score.Results
All participants completed the study. The scores of the PedsQL 4.0 differed significantly between groups, indicating that Pilates exercises increased these scores when compared with the conventional exercise program. Group II participants showed significant improvements in the 10-cm visual analog scale-joint pain, Childhood Health Assessment Questionnaire, and Pediatric Escola Paulista de Medicina Range of Motion Scale.Conclusions
The use of Pilates exercises had a positive physical and psychosocial impact on HRQOL in individuals with JIA. Future multicenter studies with a follow-up beyond the period of treatment using more objective parameters will be useful to support the results of the present study. 相似文献9.
Kavalci C Pekdemir M Durukan P Ilhan N Yildiz M Serhatlioglu S Seckin D 《The American journal of emergency medicine》2007,25(4):391-395
Objective
Tau protein localizes in the axons of neuron cells, and it is released secondarily from the central nervous system because of hypoxia and trauma. In the present study, it was aimed to investigate the value of serum tau protein levels in diagnosing intracranial pathologies in minor head trauma.Methods
Patients were categorized into 2 groups: those without intracranial lesions in head CTs (group 1) and those with lesions in head CTs (group 2). Serum tau protein levels were determined.Results
Group 1 (n = 55) median serum tau protein level was 16.29 pg/mL (2.12-215.97 pg/mL) and group 2 (n = 33) median serum tau protein level was 18.39 pg/mL (2.19-714.47 pg/mL). Statistical analysis revealed no significant difference between the 2 groups for tau protein values, sex, age, mechanism of trauma, and Glasgow Coma Scale score.Conclusion
It is suggested that serum tau protein has limited value in minor head trauma. 相似文献10.
Patricia L. Sinnott Vilija Joyce Pon Su Lisa Ottomanelli Lance L. Goetz Todd H. Wagner 《Archives of physical medicine and rehabilitation》2014
Objective
To estimate the cost-effectiveness of a supported employment (SE) intervention that had been previously found effective in veterans with spinal cord injuries (SCIs).Design
Cost-effectiveness analysis, using cost and quality-of-life data gathered in a trial of SE for veterans with SCI.Setting
SCI centers in the Veterans Health Administration.Participants
Subjects (N=157) who completed a study of SE in 6 SCI centers. Subjects were randomly assigned to the intervention of SE (n=81) or treatment as usual (n=76).Intervention
A vocational rehabilitation program of SE for veterans with SCI.Main Outcome Measures
Costs and quality-adjusted life years, which were estimated from the Veterans Rand 36-Item Health Survey, extrapolated to Veterans Rand 6 Dimension utilities.Results
Average cost for the SE intervention was $1821. In 1 year of follow-up, estimated total costs, including health care utilization and travel expenses, and average quality-adjusted life years were not significantly different between groups, suggesting the Spinal Cord Injury Vocational Integration Program intervention was not cost-effective compared with usual care.Conclusions
An intensive program of SE for veterans with SCI, which is more effective in achieving competitive employment, is not cost-effective after 1 year of follow-up. Longer follow-up and a larger study sample will be necessary to determine whether SE yields benefits and is cost-effective in the long run for a population with SCI. 相似文献11.
Background
Thromboprophylaxis for deep vein thrombosis (DVT) after lower-extremity trauma could include rivaroxaban, an oral medication that does not need laboratory monitoring.Objective
To assess rivaroxaban’s efficacy in preventing DVTs after pelvic trauma compared to its historical incidence.Materials and Methods
All patients admitted with pelvic fractures in a 12-month period followed a standardized thromboprophylaxis protocol: 1) rivaroxaban 10 mg/day within 24 h of injury or upon hemodynamic stability; 2) pre-operative, post-operative, and 30-day extremity ultrasound; 3) ventilation-perfusion scintigraphy for clinical signs of pulmonary embolus; and 4) a 45-, 90-, and 120-day re-evaluation. Rivaroxaban administration ceased the day of surgery and restarted 12 h post-operatively or upon hemodynamic stability, continuing for 30 days. Excluded patients had severe neurological or hepatosplenic injuries, heparin hypersensitivity, or hemodynamic instability.Results
Of 113 patients assessed, 84 patients (66 males), average age 46.6 years (range 19–69 years), were included. They had isolated pelvic trauma (n = 37), associated lower limb injuries (n = 47), average Injury Severity Score 21.4 (range 16–50), and average Glasgow Coma Scale score 13.6 (range 9–15). Patients receiving thromboprophylaxis soon after their fracture (n = 64) had a lower incidence of DVT than those receiving delayed thromboprophylaxis (n = 20) (p = 0.02). One patient (1.2%) died from a pulmonary embolus; 13 had asymptomatic below-the-knee DVTs. Rivaroxaban did not increase intra- or post-operative bleeding in surgical wounds.Conclusions
DVT incidence after pelvic fractures is reduced by administering antithrombotics within 24 h of injury or, if the patient is hemodynamically unstable, 24 h after stabilization. Rivaroxaban is a safe and effective method of providing this thromboprophylaxis. 相似文献12.
Rita K. Bode Allen W. Heinemann Allan J. Kozlowski Christopher R. Pretz 《Archives of physical medicine and rehabilitation》2014
Objective
To provide self-scoring templates for the FIM instrument's motor and cognitive scales that enable clinicians to monitor progress during rehabilitation using equal-interval Rasch-calibrated measures instead of ordinal raw scores.Design
Secondary analysis of a prospective, observational cohort study.Setting
Six geographically dispersed hospital-based rehabilitation centers in the United States.Participants
Subset of consecutively enrolled individuals with new traumatic spinal cord injuries discharged from participating rehabilitation centers (N=1146).Intervention
Not applicable.Main Outcome Measures
Subscores of the FIM instrument, including a 13-item motor scale, a 5-item cognitive scale, an 11-item (without sphincter control items) motor scale, a 3-item transfer scale, a 6-item self-care scale, a 3-item self-care upper extremity scale, and a 3-item self-care lower extremity scale.Results
KeyForms for the FIM instrument scales allow clinicians and investigators to estimate patients' functional status and monitor progress. In cases with no missing data, the look-up tables provide more accurate estimates of patients' functional status.Conclusion
Clinicians can use KeyForms and look-up tables for FIM instrument subscales to monitor patients' progress and communicate improvement in equal-interval units. 相似文献13.
Jennifer Eadie Alexander T. van de Water Chris Lonsdale Mark A. Tully Willem van Mechelen Colin A. Boreham Leslie Daly Suzanne M. McDonough Deirdre A. Hurley 《Archives of physical medicine and rehabilitation》2013
Objective
To determine the feasibility of a randomized controlled trial investigating the effectiveness of physiotherapy for sleep disturbance in chronic low back pain (CLBP) (≥12wks).Design
Randomized controlled trial with evaluations at baseline, 3 months, and 6 months.Setting
Outpatient physiotherapy department in an academic teaching hospital.Participants
Participants with CLBP were randomly assigned to a walking program (n=20; mean age ± SD, 46.4±13.8y), supervised exercise class (n=20; mean age ± SD, 41.3±11.9y), or usual physiotherapy (n=20; mean age ± SD, 47.1±14.3y). The 3-month evaluation was completed by 44 participants (73%), and 42 (70%) participants completed the 6-month evaluation.Interventions
Participants received a physiotherapy-delivered 8-week walking program, an 8-week group supervised exercise class (1 class/wk), or 1-to-1 usual physiotherapy (advice, manual therapy, and exercise).Main Outcome Measures
Sleep was assessed by the self-reported Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Pittsburgh Sleep Diary, and objective actigraphy.Results
Groups were comparable at baseline. Most (95%, n=57) of the participants had sleep disturbance. The acceptability of actigraphy was excellent at baseline (58 of 60 participants), but dropped at 3 months (26 of 44 participants). There were improvements on the PSQI and ISI in all groups at 3 and 6 months, with predominantly medium effect sizes (Cohen d=0.2–0.5).Conclusions
The high prevalence of sleep disturbance indicated the feasibility of good recruitment in future trials. The PSQI would be a suitable screening tool and outcome measure alongside an objective nonobtrusive sleep outcome measure. The effectiveness of physiotherapy for sleep disturbance in CLBP warrants investigation in a fully powered randomized controlled trial. 相似文献14.
Risa Nakase-Richardson Johanna Tran David Cifu Scott D. Barnett Lawrence J. Horn Brian D. Greenwald Robert C. Brunner John Whyte Flora M. Hammond Stuart A. Yablon Joseph T. Giacino 《Archives of physical medicine and rehabilitation》2013
Objective
To compare the rate and nature of rehospitalization in a cohort of patients enrolled in the National Institute on Disability and Rehabilitation Research Traumatic Brain Injury Model Systems (TBIMS) who have disorders of consciousness (DOC) at the time of rehabilitation admission with those in persons with moderate or severe traumatic brain injury (TBI) but without DOC at rehabilitation admission.Design
Prospective observational study.Setting
Inpatient rehabilitation within TBIMS with annual follow-up.Participants
Of 9028 persons enrolled from 1988 to 2009 (N=9028), 366 from 20 centers met criteria for DOC at rehabilitation admission and follow-up data, and another 5132 individuals met criteria for moderate (n=769) or severe TBI (n=4363).Interventions
Not applicable.Main Outcome Measures
Participants and/or their family members completed follow-up data collection including questions about frequency and nature of rehospitalizations at 1 year postinjury. For the subset of participants with DOC, additional follow-up was conducted at 2 and 5 years postinjury.Results
The DOC group demonstrated an overall 2-fold increase in rehospitalization in the first year postinjury relative to those with moderate or severe TBI without DOC. Persons with DOC at rehabilitation admission have a higher rate of rehospitalization across several categories than persons with moderate or severe TBI.Conclusions
Although the specific details of rehospitalization are unknown, greater injury severity resulting in DOC status on rehabilitation admission has long-term implications. Data highlight the need for a longitudinal approach to patient management. 相似文献15.
Satoshi Yamanouchi Daisuke Kudo Mitsuhiro Yamada Noriko Miyagawa Hajime Furukawa Shigeki Kushimoto 《Journal of critical care》2013
Purpose
This study aimed to investigate the serial changes in plasma levels of mitochondrial DNA (mtDNA) in patients with trauma and severe sepsis and the mechanism of increase in mtDNA levels and the association between the levels and severity.Materials and Methods
We conducted a prospective observational study of patients with trauma having injuries with an Abbreviated Injury Scale score of 3 or higher (n = 37) and patients with severe sepsis (n = 23). The mtDNA concentrations in clarified plasma were measured using real-time quantitative polymerase chain reaction.Results
Concentrations of mtDNA peaked on the day of admission (day 1) in patients with trauma, whereas they increased on day 1 and remained constant until day 5 in patients with sepsis. The mtDNA levels on day 1 correlated with the maximal levels of creatinine phosphokinase in patients with trauma (R2 = 0.463, P < .05) but not in patients with sepsis (R2 = 0.028, P = .43). The mtDNA levels on day 1 were significantly higher in nonsurvivors compared with survivors of trauma (P < .05) but not sepsis.Conclusions
The levels of mtDNA were elevated during traumatic injury and severe sepsis, although time course and prognostic significance differed between the groups, suggesting that the mechanisms of mtDNA release into plasma differ. 相似文献16.
Cindy A. Cheung BS Melanie Rogers-MartelLiliya Golas MD Anna Chepurny James B. Martel Joseph R. Martel 《The American journal of emergency medicine》2014
Background
Ocular trauma is recognized as the leading cause of unilateral blindness. However, few studies to date have focused on the clinical features of hospital-based ocular emergencies. Effectiveness of trauma centers in treating ocular emergencies was compared with treatment in traditional community hospital emergency departments. Demographics, causes, and nature of ocular emergencies, as well as visual outcome in community hospitals emergency departments and trauma centers, were also examined.Methods
Records of 1027 patients with ocular emergencies seen between July 2007 and November 2010 at 3 community hospitals emergency departments and 2 hospitals with level II trauma centers were retrospectively examined. Unpaired t test and Pearson χ2 test were used to determine statistical significance.Results
The incidence of patients requiring ophthalmic intervention was 77.2 per 100?000 in the community hospitals and 208.9 per 100?000 in the trauma centers. Rates of ocular emergencies were higher in middle-aged, white men. Orbital fractures were found in 86% of all orbital contusion cases in trauma centers, whereas 66.7% of patients with fall injuries and open globe diagnoses resulted in legal blindness.Conclusions
The middle-aged, white men are more vulnerable to ocular injuries caused mainly by motor vehicle accidents. The ability of trauma centers to provide comparable increases in vision outcomes, despite treating more severe ocular emergencies, demonstrates the effectiveness of trauma centers. Patients diagnosed as having orbital contusions or who have fall injuries deserve careful evaluation because they are more likely to have more severe sight-threatening injuries. 相似文献17.
Susan L.K. Yuan Ana A. BerssanetiAmelia P. Marques PhD 《Journal of manipulative and physiological therapeutics》2013
Objectives
This pilot study aimed to evaluate the potential effects of Shiatsu massage on the symptoms of adult patients with primary fibromyalgia, propose a Shiatsu treatment protocol, verify patient acceptability, and evaluate the feasibility for a larger study.Methods
Thirty-four patients aged 33 to 62 years were divided into a Shiatsu group (SG; n = 17), who received full-body Shiatsu twice a week for 8 weeks, and a control group (n = 17), who received an educational booklet. The patients were assessed at baseline and after 8 weeks. Pain intensity was evaluated by the visual analog scale, pressure pain threshold by dolorimetry, anxiety by the State-Trait Anxiety Inventory, sleep by the Pittsburgh Sleep Quality Index, and symptoms impact on patient's health by the Fibromyalgia Impact Questionnaire. The SG was also questioned about adverse effects and level of satisfaction.Results
After treatment, the SG presented statistically significant differences (P < .05) for the change scores of all variables, except state anxiety, compared with the control group. Relative percentage changes were considered clinically relevant for visual analog scale (40.6%), pressure pain threshold (76.4%), Pittsburgh Sleep Quality Index (34.4%), and Fibromyalgia Impact Questionnaire (22.30%). No clinically relevant effects were observed for anxiety after treatment. No adverse effects were reported during the treatment, and about 94% of the patients demonstrated satisfaction with Shiatsu.Conclusion
This pilot study showed the potential of Shiatsu in the improvement of pain intensity, pressure pain threshold, sleep quality, and symptoms impact on health of patients with fibromyalgia. The proposed Shiatsu treatment protocol was feasible and well accepted by the patients. 相似文献18.
19.
Meghan Beier Charles H. Bombardier Narineh Hartoonian Robert W. Motl George H. Kraft 《Archives of physical medicine and rehabilitation》2014
Objective
To determine whether there is an association between improvements in objective measures of physical fitness and performance on cognitive tests in people with multiple sclerosis (MS).Design
Post hoc correlational analysis in which people demonstrating physical improvement were compared with those not demonstrating physical improvement.Setting
Individuals with MS residing in the community.Participants
Adults with clinically confirmed MS (N=88) who participated in a controlled trial of a telephone-based health promotion intervention, chose to work on exercise, and completed the pre- and postintervention assessments.Interventions
Participants were measured for strength (isokinetic dynamometer), aerobic fitness (bicycle ergometer), and cognition (Paced Auditory Serial Addition Test [PASAT], Trail Making Test [TMT]) at baseline and 12 weeks later. Change in fitness was calculated by subtracting each participant's baseline score from the outcome score, and then transforming the difference to a z score. Individuals with a z score ≥1 on any fitness measure were placed in the physically improved group (n=25). All others were in the physically not improved group (n=57).Main Outcome Measures
TMT, PASAT.Results
After controlling for covariates (age, sex, ethnicity, education, disease activity, MS type), there was a significant group-by-time interaction, suggesting that cognitive functioning changed over time based on level of fitness. Participants in the physically improved group demonstrated improved performance on measures of executive functioning after 12 weeks of exercise.Conclusions
The results of this study lend support to the hypothesis that change in fitness is associated with improved executive functioning in people with MS. 相似文献20.
Mohit Kothari Peter Svensson Jim Jensen Trine Davidsen Holm Mathilde Skorstengaard Nielsen Trine Mosegaard Jørgen Feldbæk Nielsen Maysam Ghovanloo Lene Baad-Hansen 《Archives of physical medicine and rehabilitation》2014