足部矫形器在下肢运动损伤中的应用

总结足部矫形器治疗下肢运动损伤的装配方法、临床应用和生物力学原理。     

感觉运动足部矫形器在足踝康复中的应用研究进展

近30年来,感觉运动足部矫形器（SMFO）被应用到神经系统疾病患者、竞技运动员和普通人群中,对足部畸形矫正、创伤或术后功能康复、运动损伤预防、慢性疼痛治疗等有明显的改善和治疗效果。本文在梳理国内外现有文献的基础上,系统地阐述了SMFO的起源、发展、原理、结构及功能,总结了其在可复性平足、内八字步态、先天性尖足等儿童常见足踝畸形,儿童脑瘫、腓骨肌萎缩症等神经性疾病,以及常见疼痛和运动损伤康复中的应用研究进展。     

肩部矫形器在脑卒中后异常步态康复中的研究进展

脑卒中后偏瘫通常对人体运动能力和稳定性产生不利影响,患者常因肌无力、双侧肢体肌张力失衡、感觉异常、关节和姿势控制不良等出现肩关节半脱位、异常步态。肩部矫形器常用于脑卒中偏瘫的早期预防或治疗肩关节半脱位,但目前仍存在争议。为探索肩部矫形器除预防和治疗肩关节半脱位外的作用,为肩部矫形器的选择及佩戴提供理论依据,该文阐述了肩部矫形器可能改善脑卒中后异常步态的机制,分类对比不同类型肩部矫形器对脑卒中后异常步态的矫正效果。     

下肢骨肿瘤保肢术后应用免荷式矫形器辅助康复治疗效应分析

目的观察免荷式矫形器在下肢骨肿瘤保肢术后康复中的作用.方法对43例应用免荷式矫形器辅助处理治疗下肢骨肿瘤的患者进行疗效观察与分析.结果43例患者配戴免荷式矫形器后均可以早期站立及行走,患肢功能和生活质量得到改善.结论免荷式矫形器能起到外固定、免荷、稳定关节和预防并发症的作用.     

矫形器介绍（一）

矫形器是用于人体四肢躯干某些部位．通过力的作用以预防．矫正畸形，治疗骨骨节及神经肌肉疾患．补偿其功能的支具．支架．夹板等器械的总称。本期主要介绍肩外展矫形器、髋矫形器。     

矫形器介绍(一)

矫形器是用于人体四肢躯干某些部位,通过力的作用以预防,矫正畸形,治疗骨骨节及神经肌肉疾患,补偿其功能的支具,支架,夹板等器械的总称,本期主要介绍肩外屉矫形器、髋矫形器.     

下肢矫形器的应用特点

矫形器主要用于肢体运动功能障碍的治疗与康复,预防、矫正肢体畸形或代偿肢体丧失.下肢矫形器是用于整体或部分下肢的矫形器,是使用最早、最广泛的矫形器.本文应用PubMed数据库和中国期刊全文数据库检索2001-01/2007-12的相关文献52篇,最终纳入19篇进行综合分析.重点了解下肢矫形器的分类、特点及功能,以及如何根据患者的功能障碍确定矫形器的装配.综合评价应用设计适宜的下肢矫形器矫正脊髓损伤后截瘫、脑卒中后偏瘫、脑性瘫痪后遗症、先天性马蹄内翻足的临床疗效,并探讨其未来发展趋势.     

膝踝矫形器对脑卒中偏瘫患者步行周期的影响

脑卒中偏瘫治疗后期,一般采用矫形器疗法补充残损功能。使用矫形器治疗脑卒中偏瘫,国内外都有不少的研究报告。１９９７年日本学者宽原美等提出早期使用下肢矫形器有利于运动疗法的实施〔１～３〕。他的研究基点在于使用下肢矫形器实现早期站立活动,能预防快速肌萎缩。１９９８年我们在这种思想的启示下将膝踝矫形器（ｋｎｅｅａｎｋｌｅｆｏｏｔｏｒｔｈｏｓｅｓ,ＫＡＦＯ）用于重度偏瘫的早期治疗亦获得了较好的治疗效果〔５〕,但是关于膝踝矫形器对脑卒中偏瘫步行周期影响的研究报告并不多见。我们收集了１８例资料完整的该类病例。…     

矫形器和自助具在偏瘫上肢的应用

对中风后偏瘫上肢应用矫形器和自助具进行了综述。根据上肢矫形器的功能 ,可将其分为4大类 :主要用于支持、制动和预防畸形的矫形器 ,矫正挛缩畸形的矫形器 ,主要用于减轻痉挛的夹板和用于恢复运动功能的动力性夹板 ,对常见的日常生活自助具也作了简单介绍 ,介绍了应用矫形器的原则和注意事项 ,应根据病情选择合适的矫形器 ,配合其他多种康复措施综合治疗 ,才能提高康复效果。     

不同材料矫形器的生物学性能

背景：矫形器通过力的作用以预防、矫正畸形,达到治疗骨骼、关节、肌肉和神经疾患并补偿其功能的效果。目的：介绍了矫形器的分类,不同材料矫形器的性能及应用效果。方法：以＂矫形器,生物学性能,先天性马蹄内翻足,婴幼儿＂为中文关键词,以＂orthosis,Congenital ClubFoot＂为英文关键词,采用计算机检索中国期刊全文数据库、PubMed数据库（1996-01/2010-12）相关文章。纳入与矫形器材料、以及先天性马蹄内翻足治疗相关内容的文献,排除重复研究或Meta分析类文章,共入选20篇文章进入结果分析。并回顾性分析应用低温热塑板或高温热塑板,根据3点力作用原理设计制作静态足踝矫形器或动态足踝矫形器,结合手法推拿等综合治疗婴幼儿先天性马蹄内翻足96例（106足）临床效果。结果与结论：文章重点从矫形器的分类、矫形器的材料、矫形器的基本作用及临床验证几方面进行了叙述。目前常用的矫形器材料主要有金属材料（钢材和铝合金）、皮革、橡胶、塑料及各种纤维等。临床验证结果：随访1年优86例（93足）;良8例（10足）;可2例（3足）。提示选用高温热塑板制作成静态踝足矫形器或动态踝足矫形器治疗婴幼儿先天性马蹄内翻足早期效果满意。     

NEWS AND INNOVATIONS

Representative Frank R. Wolf, Chairman of the U.S. House of Representatives Subcommittee on Commerce, Justice, State, and the Judiciary, Committee on Appropriations; and Representative James C. Greenwood, Chairman of the Subcommittee on Oversight and Investigations, Committee on Energy and Commerce, requested that the U.S. Government Accounting Office (GAO) investigate OxyContin Abuse and Diversion. The GAO is the audit, evaluation and investigative arm of Congress. On December 23, 2003, the GAO submitted a 57 page report to the Representatives describing the outcomes of the investigation.

The full report includes appendices that describe the scope and methodology of the investigation, summaries of FDA changes to the original approved OxyContin label, databases used to monitor abuse and diversion of OxyContin and oxycodone, and comments from the FDA and DEA. This special report is an abstract of the GAO report and includes the conclusions and recommendations for action form the full report.     

络病的治法和用药特点

络脉是经络系统的一个有机组成部分,是由经脉支横别出的分支。每一络脉系统包括大络、系络、缠络、孙络、浮络等。络脉系统是沟通体内外,保障脏腑气血灌注的功能性网络,也是维持机体内稳态的重要结构,是气血津液输布的桥梁和枢纽,由各种因素而导致络脉痹阻,气血津液运行不畅的一类病变统称为络病。络病的治法主要有辛润通络法、辛温通络法、辛香通络法、清宣通络法、芳香透络法、清热通络法、祛瘀活络法、剔痰透络法、虫蚁搜络法、补气通络法、滋润通补法、温润通补法、柔肝和络法等。     

Brief history of quality movement in US healthcare

The current healthcare quality improvement infrastructure is a product of a century long experience of cumulative efforts. It began with an acknowledgement of the role of quality in healthcare, and gradually evolved to encompass the prioritization of quality improvement and the development of systems to monitor, quantify, and incentivize quality improvement in healthcare. We review the origins and the evolution of the US healthcare quality movement, identify existing initiatives specific to musculoskeletal care, outline significant challenges and opportunities, and propose recommendations for the future. Elements noted to be associated with successful healthcare quality improvement efforts include the presence of physician leadership, infrastructural support, and prioritization of healthcare quality within the culture of the organization. Issues that will require continued work include the development of a valid and reliable evidence base, accurate and replicable performance measurement and data collection methods, and development of a standard set of specialty specific performance metrics, with accurate provider attribution, risk adjustment and reporting mechanisms.     

Experiences of AIDS-dedicated nurses in alleviating the stress of AIDS caregiving

From the beginning of the AIDS epidemic, there have been individuals dedicated to the care of patients with AIDS. However, there has been little research regarding their perceptions and experiences of AIDS caregiving and the strategies they use to alleviate the stress and promote their willingness to care. Based on the experiences of 12 nurses at one hospital, who had chosen to work on an AIDS-dedicated unit, this exploratory study, conducted in 1998, explored the following: the physical, emotional or spiritual risks and stresses associated with AIDS caregiving; factors that provide resistance to the stresses of AIDS caregiving and promote a willingness to care; and strategies recommended by AIDS-dedicated nurses in caring for patients with AIDS. The data reveal important themes related to the physical stress of AIDS caregiving, specifically being aware of risks, but not paralysed by fear, and bombardment of the senses. The coping strategies of nurses included taking the risk in their stride, reframing the risk, and protecting oneself. The emotional stress of AIDS caregiving included witnessing suffering, experiencing unresolved grief, accepting diversity, being emotionally connected, distress from the dismantling of the AIDS unit and work demands, and declining team spirit. Coping strategies included balancing personal and professional life, releasing pain, respecting yet controlling feelings, managing demands, and asking for help. Nurses maintained their spiritual perspective. They experienced through AIDS caregiving a greater sense of shared humanity and a new perspective of life. Findings indicate that AIDS-dedicated nurses use many coping strategies. The experiences of these nurses can assist clinicians, educators and administrators in supporting nurses' caregiving and promoting the quality of care offered to patients with AIDS.     

老年肌少症患者运动干预的最佳证据总结

目的 评价并总结老年肌少症患者运动干预相关证据,为指导老年肌少症患者运动提供循证依据。 方法 计算机检索UpToDate、乔安娜布里格斯研究所（Joanna Briggs Institute,JBI）图书馆、Cochrane Library、DynaMed、美国指南网、加拿大安大略注册护士协会指南网、苏格兰院间指南网、英国国家卫生与临床优化研究所指南网、国际指南网、加拿大医学会临床实践指南信息库、医脉通、PubMed、Web of Science、中国知网、中国生物医学文献数据库中关于老年肌少症患者运动干预措施的所有证据,包括指南、专家共识、临床决策、证据总结及系统评价,检索时间为建库至2021年2月20日。结果 共纳入16篇文献,包括1篇指南、3篇专家共识、3篇临床决策、9篇系统评价。总结了包含运动评估、运动方式、运动强度、运动时间、运动方案制订原则、管理模式、注意事项、健康教育8个类别的29条证据。结论 运动干预可以有效改善肌少症,该研究证据总结过程科学、严谨,内容较全面,医护人员在证据转化过程中应根据具体情境和患者个体因素选择最佳证据,指导老年肌少症患者安全有效地运动,提高生活质量。     

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.     

女性性受害者心理健康状况及其影响因素分析

目的 探讨女性性受害者心理健康状况及其影响因素.方法 对102名女性性受害者采用症状自评量表、领悟社会支持量表、特质应对方式问卷、自我接纳问卷和一般自我效能感量表进行测评分析.结果 女性性受害者症状自评量表各因子分均显著高于国内常模(P＜0.01);女性性受害者领悟社会支持量表总分和家庭外支持维度评分均与症状自评量表总分及因子分呈显著正相关,家庭内支持维度评分与症状自评量表总分及躯体化、人际关系、抑郁、焦虑、恐怖、精神病性因子分呈显著正相关(P＜0.05或0.01);特质应对方式问卷消极应对维度评分与症状自评量表人际关系、抑郁、敌对因子分呈显著负相关,积极应对维度评分与症状自评量表总分及躯体化、强迫、人际关系、抑郁、焦虑、恐怖、偏执、精神病性因子分呈显著正相关(P＜0.05或0.01);自我接纳问卷的自我接纳维度评分与症状自评量表人际关系、抑郁因子分呈显著负相关,自我评价维度评分与症状自评量表总分及人际关系、抑郁、偏执、精神病性因子分呈显著正相关(P＜0.05或0.01);一般自我效能感量表评分与症状自评量表人际关系、抑郁、精神病性因子分呈显著正相关(P＜0.05或0.01).结论 女性性受害者心理健康水平低于普通人群,其社会支持、积极应对、自我评价、自我效能感对心理健康有负面影响,自我接纳、消极应对能改善人际关系及抑郁情绪.     

血液灌流联合血液透析救治急性重型中毒的疗效观察

目的观察血液灌流联合血液透析对救治急性重型中毒患者的疗效。方法急性药物或食物中毒昏迷患者44例,按治疗方法不同将病例分为治疗组（n=28）与对照组（n=16）。对照组患者常规给予洗胃、吸氧、药物解毒和生命支持等治疗,治疗组患者除上述处理还进行血液灌流和血液透析治疗,观察两组患者昏迷时间、住院天数、治愈率、死亡率、并发症。结果治疗组治愈27例,死亡1例,对照组治愈11例,死亡5例。治疗组昏迷时间、住院天数、死亡率、并发症发生率明显少于对照组（P〈0．01）,治愈率高于对照组（P〈0．01）。结论血液灌流联合血液透析可迅速清除体内的药物或毒物,明显缩短病程、减少并发症,提高急性重症中毒患者的生存率。     

精神科保护性约束实施及解除专家共识

目的 形成《精神科保护性约束实施及解除专家共识》,规范精神科保护性约束实施及解除的相关内容。方法 运用循证方法,按照证据级别高低,检索、评价和汇总该领域的证据,提取精神科保护性约束实施及解除的推荐建议和研究结论,形成共识初稿,通过2轮专家函询及2次专家论证会,结合专家意见,对初稿进行调整、修改和完善,形成共识终稿。结果 2轮函询专家积极系数均为100%,专家权威程度均为0.90,各指标重要性赋值均数均>3.5分,且变异系数均<0.25,专家肯德尔和谐系数分别为0.146和0.166（均P<0.01）。最终对精神科保护性约束应用人群、前提与原则、目的、评估要点、基本要求、记录表、流程图、实施过程中的干预策略、伦理问题及风险、建议共10个部分的推荐意见达成一致。结论 该共识为精神科保护性约束的实践提供指导依据,可使精神科保护性约束行为更规范。