Self-Referral and the Boutique Hospital Industry

Abstract

Six individuals suffering from chronic cervicogenic headache were the subjects of a series of case studies involving manual therapy, exercise, and a home-exercise program. Headache duration ranged from three months to twenty years. During the course of treatment, the subjects maintained a journal tracking duration, frequency, and intensity of their headaches as well as any relieving factors. The purpose of this series of studies was to describe the use of manual therapy and exercise in the treatment of chronic cervicogenic headaches. Subjects were treated using a custom home-exercise protocol; manual therapy involving soft tissue and non-thrust joint manipulation, aerobic conditioning, and resistance exercise. The Pain Disability Index (PDI) was used as the functional improvement scale. The PDI was administered pre-, post- and six months post-treatment. Five of the six subjects reported improvement. These five subjects were seen for an average of 5.9 sessions over an average of 3.8 weeks. The average improvement on the PDI was 29.5% at discharge and 28.8% at 6- month follow-up. The five subjects each reported the need to continue their home exercise program in order to control their headaches at 6-month follow-up. A voluntary decrease in medication intake was also reported by five of the six subjects at discharge. Six-month follow-up showed that these five patients were still taking less medication than reported at time of the intial examination. No follow-up data was available for the patient which reported no improvement. The results of these case studies seem to indicate that a treatment regimen of exercise and manual therapy can be beneficial in the treatment of chronic cervicogenic headaches.     

二维血流显像技术在颈动脉疾病诊断中的价值

目的 探讨（二维血流显像）技术（B-Flow）在颈动脉疾病中的应用价值。方法 本文对240例临床疑似颈动脉疾病患者分别采用黑白二维超声（2D-B/W）、彩色多普勒血流图（CDFI）、血流功率图（PDD和B-Flow）技术进行检查，观察颈总动脉及颈内、外动脉形态、走行，管壁厚度，管腔内血流情况，并进行血流动力学检测。结果 根据所测内膜、内径和斑块等图像特征，可以反映颈动脉硬化及狭窄等情况。B-Flow显像技术是一种新型血管疾病影像学检查方法，能同时显示血流和背景组织结构，与CDFI，PDI技术结合使用，能更清晰显示异常影像，提高颈动脉疾病诊断率。结论 B-Flow技术是一种新技术，是颈动脉疾病检查的新型有价值的影像学方法。     

Two-year survival and neurodevelopmental outcomes after cardiopulmonary resuscitation in neonatal patients after complex cardiac surgery

Aim

To examine survival and neurodevelopmental outcomes in neonates having post-operative cardiopulmonary resuscitation (CPR).

Methods

This inception cohort study included all neonates (6 weeks old or less) who received postoperative CPR (Group 1) after cardiac surgery from 1996 to 2005, matched for heart defect, year of surgery, chromosomal abnormality, and socioeconomic status to two neonates who did not receive postoperative CPR (Group 2). Two-year neurodevelopment was prospectively assessed with Bayley Scales of Infant Development II and Adaptive Behavior Assessment System II. Pre-, intra-, and post-operative variables were collected prospectively. Cardiac arrest variables were collected retrospectively. Predictors of mortality were analyzed by univariate analysis and conditional multiple logistic regression.

Results

There were 29 patients in Group 1, and 58 patients in Group 2. In survivors, there were no significant differences between Groups 1 and 2 in outcomes [mean (SD)] of mental developmental index [84.5 (12.2) vs. 81.0 (18.9)], psychomotor developmental index [82.8 (13.8) vs. 80.1 (21.9)], General Adaptive Composite [84.6 (15.3) vs. 84.3 (19.2)], Motor scale [8.4 (3.2) vs. 8.0 (3.8)], or delay on any of these scales. Two-year mortality [58.6% Group 1; 8.6% Group 2], was associated on conditional multiple logistic regression with CPR (OR 26.6; 95% CI, 5.4, 129.5). In Group 1, on multiple logistic regression, 2-year mortality was associated with minutes of chest compressions (OR 1.04, 95% CI, 1.01, 1.08).

Conclusions

Among neonates having cardiac surgery, CPR is associated with greater mortality. There is no evidence that CPR survivors have different 2-year neurodevelopmental outcomes than those neonates not having CPR.