综合康复疗法对急性期脑卒中患者的疗效观察

目的：观察综合康复治疗对急性期脑卒中患者的神经功能缺损程度、运动功能及日常生活活动能力（ADL）的影响。方法：选择急性脑卒中患者146例，随机分为综合康复治疗组（80例）和常规康复治疗组（66例），治疗30天后采用Fugl-Meyer运动功能评定、神经功能缺损评定量表及Barthel指数进行评估。结果：两组患者在治疗前神经功能缺损积分、Fugl-Meyer运动功能及ADL积分上比较无显著性意义（P〉0．05），治疗后较治疗前改善非常明显（P〈0．01），综合康复组与常规康复治疗组比较有显著性差异（P〈0．05）。结论：综合康复与常规康复治疗均可降低急性期脑卒中患者神经功能缺损积分，提高肢体运动功能及13常生活活动能力，但综合康复的临床疗效要优于常规康复疗法。     

社区康复对脑卒中患者运动功能和日常生活活动能力的影响

目的：探讨影响社区脑卒中患者运动功能和日常生活活动能力康复效果的相关因素。方法：282例脑卒中患者随机分为社区康复组172例和对照组110例，社区康复组进行康复治疗和随访，对照组只进行随访。于入组和治疗5个月后，应用Barthel指数（BI）、临床神经功能缺损评分量表（NIM）对两组患者进行评定。结果：治疗5个月后，社区康复组和对照组的NIM和ADL评分比较，康复组效果优于对照组（P〈0．05）。新病例康复组和既往病例康复组NIM和ADL评分比较，新病例组优于既往病例组（P〈0．05）。结论：社区康复治疗对提高患者运动功能和ADL的恢复作用显著：社区康复治疗介入时间越早对患者运动功能和ADL恢复的作用越明显。     

早期综合康复治疗对脑卒中后抑郁的影响

目的：探讨早期综合康复治疗对脑卒中后抑郁的治疗效果。方法：脑卒中患者126例分为早期康复组62例和对照组64例，均进行常规药物对症治疗。康复组同时配合早期综合康复训练。治疗前后2组均进行欧洲卒中评分（ESS）、ADL及情感状态（HAMD）评分比较。结果：治疗1、3及6个月时ADL、ESS及HAMD评分，康复组均明显高于对照组（P〈0．05或P〈0．01）。结论：早期综合康复治疗能显著促进脑卒中患者神经功能的恢复，有效减少抑郁的发生。     

综合康复对重症脑卒中患者残疾功能改善的作用

目的：探讨综合康复对重症脑卒中患者残疾功能改善的作用。方法：选择重症脑卒中患者80例分为康复组50例和对照组30例。康复组患者入院后生命体征稳定48h起即给予早期综合康复，病情好转或出院后恢复期继续给予社区或家庭综合康复与指导；对照组仅给予简单康复与指导。两组分别于1周内、1，3，6，12个月时用GCS、NIHSS、FMA、ADL进行阶段量化评分，所得数据采用SPSS10．0软件统计。结果：两组间GCS在1个月时差异有统计学意义（P〈0．05）、3个月时NIHSS、FMA差异有统计学意义（P〈0．01），6个月时ADL差异有统计学意义（P〈0．05），12个月时ADL差异有统计学意义（P〈0．05）。结论：综合康复对重症脑卒中患者残疾功能改善有着重要作用。     

早期康复对脑卒中后焦虑、抑郁症状的影响

目的 观察早期康复对脑卒中后焦虑、抑郁症状的影响。方法 137例脑卒中偏瘫患者分为康复组（70例）和对照组（67例），均进行神经内科常规药物治疗，康复组患者同时接受早期康复治疗；对两组患者分别于治疗前和治疗3个月后进行Bathel指数（BI）、Fugl—Meyer运动量表（FMMS）、汉密尔顿抑郁量表（HAMD）和汉密尔顿焦虑量表（HAMA）测试。结果 治疗3个月后，康复组患者的HAMD、HAMA、BI和FMMS、评分与治疗前有显著性差异（P〈0．05～0．01），与对照组治疗后亦有显著性差异（P〈0．05）；对照组的BI、FMMS评分与治疗前有显著性差异（P〈0．05）；康复组抑郁发生率22．86％，焦虑发生率5．71％，对照组分别为40．30％和16．42％．两组间有显著性差异（PG0．05）。结论 早期康复对脑卒中患者的焦虑及抑郁症状有明显的改善作用。     

早期心理干预对急性脑卒中后抑郁患者预后的影响

目的：评估早期心理干预对急性脑卒中伴抑郁患者功能康复的影响。方法 78例急性脑卒中伴抑郁患者分为干预组38例及对照组40例，均接受常规临床治疗，干预组同时给予心理干预。结果：与治疗前比较，治疗3周后2组神经功能缺损积分下降，ADL能力提高，抑郁症状减轻（P〈0．05或0．01），2组间比较，干预组优于对照组（P〈0．05或0．01）。结论：脑卒中治疗过程中及时识别伴有抑郁的患者。并给予心理干预对患者的康复有积极作用。     

重症脑室出血患者的康复护理

目的：探讨康复护理对脑室出血患者的临床疗效。方法；重症脑室出血患者70例，分为康复组与对照组各35例，均进行内科常规治疗和护理，康复组同时加强患者良姿体位的摆放，循序渐进的进行患肢主被动关节活动，床边平衡、站立及行走训练等系统的康复护理。结果：经过60d的治疗，神经功能缺损（CSS）评分与治疗前比较，2组均明显降低（P〈0．01），2组问比较康复组下降更显著（P〈0．05）；ADL缺陷程度评分，康复组显著高于对照组（P〈0.01）；临床疗效比较，康复组显效率及有效率均优于对照组（均P〈0.01）；康复组死亡率亦低于对照组（P〈0．05）。结论；在常规护理基础上增加系统的康复护理对重症脑室出血患者的神经功能恢复及ADL改善具有良好促进作用。     

冠状动脉旁路移植术后序贯性机械通气20例治疗效果观察与护理

目的：探讨三级康复整体护理方案对脑卒中偏瘫患者神经功能缺损程度及日常生活能力（ADL）的影响。方法：将129例脑卒中患者随机分为护理组、康复组和对照组各43例,三组均给予常规内科治疗、护理,康复组接受三级康复治疗,护理组在康复组的基础上给予三级康复整体护理;在脑卒中发病后2周内、1个月末、3个月末及6个月末采用美国国立卫生研究院脑卒中量表（NIHSS量表）、改良的Barthel指数评价患者临床神经功能缺损程度、日常生活能力恢复情况。结果：护理组患者在1个月末、3个月末及6个月末的NIHSS评分、MBI评分明显优于对照组（P〈0.05）,3个月末与6个月末的NIHSS评分、MBI评分明显优于康复组（P〈0.05）。结论：实施三级康复整体护理方案能够有效地降低脑卒中偏瘫患者神经功能缺损程度,提高ADL。     

早期康复护理对急性脑血管病患者神经功能及生活能力的影响

目的：探讨早期康复护理对急性脑血管病患者神经功能及生活能力的影响。方法：将70例急性脑血管病患者随机分为康复组和对照组各35例，对照组给予神经内科常规治疗与护理，康复组在对照组基础上进行分阶段早期康复护理。4周末对两组神经功能缺损评分和日常生活活动能力（ADL）评分进行比较分析。结果：治疗后，康复组神经功能缺损评分及ADL评分分别为4，4&;#177;1，9分及59．3&;#177;6．0分；对照组神经功能缺损评分及ADL评分分别为6．9&;#177;2．4分及37，8&;#177;4．2分，两组比较均有显著性差异（P〈0．05）。结论：早期康复护理对急性脑血管病患者神经功能及日常生活活动能力的恢复具有促进作用。     

综合康复治疗对脑卒中患者运动功能障碍的疗效

目的 探讨综合康复治疗对脑卒中患者运动功能障碍的疗效。方法 121例急性脑卒中患者随机分为康复组（59例）与对照组（62例），康复组采用综合康复治疗（运动再学习和Bobath疗法）；对照组给予一般康复治疗，如针灸、理疗。采用临床神经功能缺损评分、改良巴氏指数评分（MBI）、Fugl-Meyer运动功能评分（FMA）在治疗前后对两组患者进行评定。结果 治疗前。两组患者的临床神经功能、FMA和MBI评分无显著性差异（P〉0．05）；治疗后，两组的评分均较治疗前明显改善（P〈0．01），但康复组改善的程度大于对照组（P〈0．05）。结论 综合康复治疗可促进脑卒中患者运动功能的恢复，对预后有良好影响。     

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.     

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.     

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.     

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.     

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.