Occupational Therapy Practice in Hospital-based Stroke Rehabilitation?

Abstract

Background: Occupational therapy after stroke represents a complex intervention. Objective: The aim of this observational study was to document the content of occupational therapy stroke rehabilitation in an Australian general rehabilitation ward. Methods: A behavioural mapping tool recorded 22 occupational therapy sessions at five-minute intervals for nine participants with stroke (mean age 70.6 years, 88.9% female). Results: The mean session length was 41 minutes. The focus of therapy was predominantly at body functions (mean 16.5 minutes) and motor and perceptual impairments were addressed most often. Conclusion: The overall amount of occupational therapy provided was consistent with session lengths reported from effective stroke units and recommended by stroke guidelines. However, the results highlight the difficulties for occupational therapists working within the hospital environment, including practice that was largely restricted to the level of impairment and basic activities of daily living.     

Mapping and Ablation of a Perisinusal Atrial Tachycardia with Noncontact Mapping

Perisinusal atrial tachycardia may represent a challenging situation due to unsustained burst characterizing the arrhythmia, sensitivity to bumping, and potential complications including sinus node ablation. This case describes the use of a noncontact mapping system to map and ablates this arrhythmia. Benefit of this technology is described. (PACE 2013; 36:e11–e14)     

T1 mapping in myocarditis – headway to a new era for cardiovascular magnetic resonance

Myocarditis is a major cause of cardiac morbidity and mortality, particularly in young patients. A spectrum of challenges besets this condition, from establishing the diagnosis to effective treatment. Endomyocardial biopsy remains the diagnostic gold standard, despite its invasiveness, low diagnostic yield and a paucity of consequential management pathways. Cardiac magnetic resonance by Lake Louise criteria has contested to become the non-invasive diagnostic alternative by providing confirmation of disease. The advent of T1 mapping now allows a high diagnostic accuracy in confirmation and exclusion of disease, discrimination of stages and activity of disease. Alongside the research into the mechanisms and potential therapeutic targets, cardiac magnetic resonance confidently claims a prime role within a modern diagnostic pathway in clinically stable patients with suspected myocarditis.     

Developing Effective Hospice Staff Support Groups: Pilot Test of an Innovative Training Program

Although hospice staff support groups are frequently cited as a valuable resource in coping with hospice work stress, few guidelines exist for implementing a successful group experience. This article summarizes a pilot study of a 12-week audiotape staff support group training program for hospice and oncology workers developed collaboratively by the author and the UCLA California Self-Help Center. Two West Coast hospice groups participated in the study. Group members reported a high degree of satisfaction with the tape program and their group experience. Burnout scores were not significantly affected by the group experience. Preliminary data on coping strategies, implications for the development and strengthening social support networks in the hospice, and suggestions for future research efforts are discussed.     

定量磁敏感图对脑微出血的诊断价值

目的 探讨定量磁敏感图(quantitative susceptibility mapping,QSM)在脑微出血(cerebral microbleeds,CMBs)中的临床应用价值。方法 对122例拟诊脑血管病患者进行头颅MRI常规序列扫描(包括T1、T2、T2FLAIR序列)并做SWI及QSM序列成像检查,这些患者全部在1周内做了头颅CT平扫,全部患者检查成功,分别获得基底节区及基底节区以外区域的CMBs个数,并做相应统计学分析。结果 122例拟诊脑血管病患者中,80例有CMBs,42例未检出,二者共检出CMBs 481个,其中QSM序列共检出CMBs 481个,SWI序列共检出CMBs 447个,比较2种序列对CMBs总的检出率,差异有统计学意义(P<0.05),2种序列对基底节及基底节外区CMBs检出率,差异具有统计学意义(P<0.05)。结论 QSM序列对CMBs检出率优于SWI序列,是一种准确可靠的诊断CMBs的影像学方法。     

EnSite标测下射频消融对特发性右室流出道室性早搏患者的疗效及心肌酶学影响

目的 探讨EnSite标测指导下射频消融治疗特发性右室流出道室性早搏的临床效果及对心肌损伤的影响.方法 回顾性分析我院2013年1月至2016年1月收治的84例右室流出道室性早搏行射频消融手术治疗患者的临床资料,对比两组患者的手术效果.结果 本组中50例患者在常规电生理标测指导下实施射频消融手术(常规组)、34例患者在EnSite标测指导下射频消融治疗(EnSite组).EnSite组患者的标测时间、射频消融时间、X线曝光时间、手术时间均显著的低于常规组,差异具有统计学意义(P＜0.05).术前,EnSite组和常规组的室性早搏数量对比,差异不具有统计学意义(P＞0.05);术后,EnSite组的24 h室性早搏数量显著低于常规组(P＜0.05);术后72 h,EnSite组的CK、CK-MB、cTnT、AST、LDH、Mb、HBDH水平显著低于常规组(P＜0.05).结论 EnSite标测指导下射频消融治疗特发性右室流出道室性早搏能显著缩短操作时间、减轻对患者心肌造成的损伤,手术效果可靠.     

医院软件评测的实践与体会

在我国医药体制改革不断深化、互联网产业迅猛发展的今天,医院信息系统是现代化医院运营的必要技术支撑和基础设施,实现医院信息系统的目的就是为了以更现代化、科学化、规范化的手段来加强医院的管理,提高医院的工作效率,改进医疗质量,从而树立现代医院的新形象,这也是未来医院发展的必然方向。作为信息系统开发或集成中的一个必要组成部分,如何有效的组织和管理软件评测活动是格外重要的一环,本文将结合医院系统的评测实践经验,从软件评测的基础理论出发,探求利用系统、全面、科学的评测设计和有效地评测组织实施,独立、客观、公正、定量地分析评估和报告被测系统的整体状况,提交系统存在的缺陷,提出系统的改进建议,通过缺陷修改使系统达到一个稳定可靠的质量状态。     

Sentinel lymphadenectomy after neoadjuvant chemotherapy for breast cancer may reliably represent the axilla except for inflammatory breast cancer

Background After neoadjuvant chemotherapy, women with locally advanced breast cancer (LABC) undergo a modified radical mastectomy or lumpectomy with axillary lymph node dissection (ALND) and radiotherapy. Sentinel lymphadenectomy (SL) is accepted for axillary evaluation in early breast cancer. We assessed the feasibility and predictive value of SL after neoadjuvant chemotherapy. Methods Eligible women received neoadjuvant therapy for LABC and were scheduled to undergo a definitive surgical procedure. Vital blue dye SL was attempted followed by level I and II axillary dissection. Results SL was successful in 29 of 34 patients (detection rate, 85%). Thirteen patients (45%) had positive nodes, and eight (28%) had negative nodes on both SL and ALND. In five patients (17%), the sentinel node was the only positive node identified. Overall, there was a 90% concordance between SL and ALND. The false-negative rate and negative predictive value were 14% and 73%, respectively. Among the subgroup without inflammatory cancer, the detection and concordance rates were 89% and 96%, respectively. The false-negative rate was 6%, and the negative predictive value was 88%. Conclusions SL after neoadjuvant chemotherapy may reliably predict axillary staging except in inflammatory breast cancer. Further studies are required to assess the utility of SL as the only mode of axillary evaluation in these women.