临床路径结合SOAP评估在临床康复教学中的应用

目的:观察临床路径(CP)结合SOAP评估在康复专业临床带教中,对促进学生自主思考,培养学生临床思维和处理问题能力的积极作用。方法:将47名学生随机分为CP组24名和CP+SOAP组23名,分别进行为期1个月的带教。采用病例汇报评价表和理论考试进行最终的测试。结果:学习1个月后,2组学生在主观资料收集方面的成绩差异无统计学,但CP+SOAP组学生客观资料的收集以及评估、计划和理论考试的成绩均明显优于CP组(均P0.05)。结论:临床路径结合SOAP评估在康复专业临床教学中可以不断地启发学生自主发现问题,自主解决问题,促使学生康复评估能力、康复技术水平以及整体综合实力的提高。     

基于SOAP格式的康复治疗记录软件的设计与应用

目的:探讨康复治疗记录软件的设计与应用。方法:先以word文档形式将主观、客观、评估、计划等内容输入计算机,然后对PT、OT、ST进行选项。结果:成功开发拥有自主知识产权,基于SOAP格式的康复治疗记录的4个模块。结论:基于SOAP格式的电子化康复治疗记录的设计与应用,为规范化康复评估与治疗提供了保证。     

脑卒中患者运动功能评定的方法及其研究进展与问题

目的：通过总结国内外关于脑卒中运动功能评定的文献，以便于在临床科研中，根据不同的需求选择简便、实用、可信度高的运动功能康复评价方法。 资料来源：应用计算机检索CNKI数据库1995-01／2005-09和万方数据库1994—01／1995-01与康复评定相关的文章，检索词为“康复评定”，限定文章用语为中文。同时手工检索1985—01／2002—12与相关康复评定的书籍，限定书籍语言为中文，英文、日文、检索词为“脑卒中，康复，运动功能评定”。 资料选择：纳入标准是与脑卒中运动功能评定相关的文章，选择有代表性的文献，排除重复性文献。 资料提炼：共收集88篇关于脑卒中运动功能评定方面的研究文献。根据纳入标准，排除与脑卒中运动功能评定关系不大的80篇，共8篇文献纳入分析。 资料综合：脑卒中运动功能评定可分为两大类。包括以肌力变化为标准的评价法和以运动模式改变为标准的评定体系。以运动模式改变为标准的评定体系中临床上常采用的有8个评定法，分别是Brunnstrom、Bobath法、上田敏法及Fusl—Meyer评定法、MAS评定法、Rivennead法、landmark评定法和K21genMargrethe评定法。目前最新研究的脑卒中运动功能评定方法为脑卒中病损评估法。 结论：早期而全面的对脑卒中患者运动功能进行评价，有助于了解患者运动障碍的稃度．指导制宰康复方案．观察治疗效果及分析预后．     

康复治疗专业学生社区实习教学效果问卷调查

目的探索康复治疗专业学生社区实习基地规范带教方法和教学管理模式。方法对43名康复治疗专业学生进行问卷调查。结果绝大多数学生对社区康复教学的必要性表示肯定。超过半数学生对教学模式、内容比较满意,但教学效果的满意度低于教学模式及内容。社区康复教学在培养学生服务态度、沟通能力、操作能力方面有优势,在培养学生创造性思维能力、分析归纳能力、激发兴趣性存在明显不足。结论需要将三级医院康复的技术力量与社区康复教学纵向整合,摸索社区康复教学模式,不断提高社区康复师资水平。     

康复治疗影响国际疾病分类因素的分析

目的：加强临床医师和疾病分类人员对康复治疗疾病分类的认识，提高康复治疗疾病分类编码的准确性及病案资料检索利用的质量。方法：利用Foxpro建立病案资料数据库，以国际疾病分类(ICD-9)的编码原则为标准。回顾性检索1998-01／2002-12新桥医院住院进行康复治疗的病例，所有病例以出院的第1诊断为检索对象。结果：检索出康复治疗疾病分类的误码667例，主要发生在循环系统、精神疾患系统、损伤和中毒系统、神经系统、肌肉骨骼系统、影响健康状态系统(V编码)和传染病系统的疾病分类编码。结论：康复治疗疾病分类编码的准确率。直接影响临床、科研及教学对病案信息资料检索利用的质量。     

脑卒中患者生活质量的评估及其影响因素

目的：从国内外脑卒中患者生活质量研究的现状出发，探讨脑卒中患者生活质量的评估及其康复治疗对脑卒中生活质量的影响。资料来源：应用计算机检索Medline1994-01／2004—12的与脑卒中生活质量相关文献，检索词“stroke，quality of life，rehabilitation”，并限定文献语种为English。同时计算机检索万方数据库1998—01／2004—12的与脑卒中生活质量相关文献，检索词“脑卒中，生活质量，康复”，并限定文献语种为中文。资料选择：就检索到的80篇文献进行筛选，选择临床以患者为观察对象的研究，以“脑卒中，生活质量，康复”为主要研究内容的文献15篇，排除综述类文献。资料提炼：共筛选到15篇文章，包括850例患者，按照脑卒中生活质量、脑卒中康复分类，其中6篇与脑卒中生活质量有关，9篇与脑卒中康复有关。资料综合：目前在脑卒中患者生活质量研究中常用的量表有疾病影响问卷、健康质量量表、诺丁汉健康问卷、简短36条目问卷、世界卫生组织生活质量量表、Niemi的中风生存质量研究量表、Frenchav活动指数等10余种，其中后两种为脑卒中专用量表。影响脑卒中患者生活质量的因素有年龄、性别、损害部位及脑卒中类型、有无抑郁及日常生活活动能力水平等，康复治疗可提高脑卒中患者的生活质量。结论：目前国内使用的生活质量量表没有统一规定的评估标准，不便于比较，应积极研制适合中国国情、文化背景的评估量表；针对脑卒中患者的运动功能、语言、认知功能和心理障碍进行康复治疗能有效提高脑卒中患者的生活质量。     

平衡仪与人体平衡功能的评定及干预

背景：随着计算机辅助技术在平衡功能评估领域的应用,平衡的评定和训练有了新的发展.目的：总结国内外平衡能力评估的研究进展及干预策略.方法：以＂Balance,Balance master,Postural control＂为检索词检索PubMed数据库（1996-01/2011-03）;以＂平衡,平衡仪,姿势控制＂为检索词检索中国期刊全文数据库（1996-01/2011-03）的相关文章,对资料进行初审,以平衡能力相关的文献为评价标准,纳入与平衡能力相关的34个研究进行综述.结果与结论：康复医学中平衡功能的研究正从单纯的主观定性研究向客观定量评估转变,平衡仪作为一种客观评定方法,可以定量、客观、准确地评定患者的平衡功能状态,平衡仪可以通过视觉反馈开展平衡功能训练,指导拟定康复计划,进行平衡训练,对评价康复效果具有重要作用.近年来在国外平衡仪已被证实在提高人的平衡能力方面是有效的,因此被越来越多地应用到临床康复中.     

改良PBL教学方法在康复治疗学专业临床实习教学中的应用研究

摘要 目的：探讨问题引导式改良PBL教学方法在康复治疗学专业临床实习教学中的应用效果。 方法：28名参加生产实习的2010级康复治疗学系本科学生按随机数字奇偶数分组法分为PBL教学组(n=14)和传统教学组(n=14),均参加“运动疗法学”生产实习,传统教学组采用传统教学方法,改良PBL教学组采用问题引导式改良PBL教学方法讲授,授课后对学生进行理论、实践技能考试及问卷调查评估。 结果：改良PBL教学组理论考试及实践技能考核成绩明显优于传统教学组（t=5.865,P=0.001;t=7.780,P=0.001)。改良PBL教学组在基础知识掌握度与传统教学组无显著差异(t=2.017,P=0.073),但在学习兴趣及主观能动性、抽象问题理解力、理论联系实际能力、重点难点知识掌握度等方面明显高于传统教学组(t=6.066,P=0.001;t=10.109,P=0.001;t=7.302, P=0.001;t=5.615,P=0.001). 结论：在康复治疗学生产实习教学中,问题引导式改良PBL教学法能较大提高学生的学习兴趣及学习成绩,提高重点难点知识掌握度,培养学生理论联系实际能力,值得在康复治疗学实习课中推广。     

国内外康复医学的教育发展

目的：通过对康复医学的性质和目前国内外康复医学教育的发展概况与培养模式进行分析，寻找国内康复医学教育发展的不足和改进措施，从而推动其健康发展。 资料来源：应用计算机检索Medline 1976-01／2000-12关于康复医学教育的文章。检索词“rehabilitation，development，education”并限定文章的语种类为English。同时利用计算机检索中国期刊全文数据库2000-01／2006-01的相关文章，限定文章语言种类为中文，检索词“康复医学，发展，教育”。 资料选择：对资料进行初审，纳入标准：①西方主要国家康复医学教育（包括物理治疗师、作业治疗师和康复工程师等）的专业设置、课程和学制以及康复医师的认证等资料。②国内设置康复医学或治疗学本科专业、硕士及博士点的大学、课程设置等资料。排除标准：重复性研究。 资料提炼：共收集到符合上述要求的文献15篇，排除3篇重复性研究。12篇符合纳入标准。 资料综合：许多国家按大学本科或专科设立以运动治疗为主要内容的物理治疗专业、作业治疗专业、言语治疗专业，大多数国家采取4年制本科培养，授予理学学位。目前中国康复医学与理疗的本科专业和硕士点均已有20多个，中国大学在康复医学专业和课程设置方面仍有欠缺。 结论：（1）国内康复医学专业需进一步深化，如设立物理治疗、作业治疗、神经康复等更细的专业方向。（2）加强毕业生的继续教育，建立住院康复医生培养和康复医师执业考试制度。（3）在康复医学专业课程设置上增加康复工程、康复医学管理等方面的知识培养。     

以问题为基础的教学法在临床护理教学中的运用

目的：探讨以问题为基础的教学法（Problem-Basedlearning,PBL）在临床护理教学中的应用。方法：采用设问-自主学习-讨论-总结四阶段教学,强调护生自主学习,促进学生理论与实践的有机结合。结果：通过调查问卷,学生在自我指导学习、倾听与记录能力、团队合作精神、相互尊重与宽容、对文献评估能力有很大提高。结论：PBL教学法培养学生发现、解决临床问题的能力,激发创新意识的形成,提高护生实习效果。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.