An ergonomic approach to reducing back/shoulder stress in hospital nursing personnel: a five year follow up

The purpose of the study was to determine the impact of an ergonomic program on perceived stress ratings, injury rates and patient care. After implementation of the ergonomic program, the perceived stress ratings by nursing staff were lower than those ratings at the control hospital and the patients felt more comfortable and secure during patient handling tasks than the patients at the control hospital. Eighteen months after ergonomic interventions, the back and shoulder injuries were reduced, and the lost workdays and restricted/transitional days were decreased. Five years after the implementation, the back and shoulder injuries continued to decrease as well as the lost workdays and restricted days. At the control hospital, the back and shoulder injury rates, the lost workdays, and the restricted days remained stable throughout the study period.     

慢性下腰痛患者自我管理行为及影响因素分析

目的 调查慢性下腰痛患者自我管理行为现状,分析其影响因素。方法 应用便利抽样,于2019年1月-12月采用一般资料、慢性病自我管理行为量表、下腰痛疾病知识问卷、慢性病自我效能量表、社会支持评定量表对226例慢性下腰痛患者进行调查,采用多重线性回归分析探讨自我管理行为的影响因素。结果 慢性下腰痛患者自我管理行为总分(21.76±7.82)分；疾病知识、自我效能、社会支持、治疗方式、辅助工具使用史进入回归方程,解释慢性下腰痛患者自我管理行为总变异的51.3%。结论 慢性下腰痛患者自我管理水平较低,社会支持、疾病知识、自我效能、治疗方法、辅助工具应用史是其主要影响因素。建议在进行自我管理健康教育时,应考虑患者个体特点,采用针对性、适合的健康教育方式,提供多渠道健康信息获取方法,鼓励家庭参与,提高患者疾病知识和社会支持水平,增强自我效能,从而改善自我管理行为。     

斜方肌肌电图在肌萎缩侧索硬化早期诊断中的应用

目的 探讨斜方肌肌电图在检测肌萎缩侧索硬化(ALS)延髓部下运动神经元损害中的价值.方法 对100例ALS患者、80例颈椎病患者和100名健康志愿者进行斜方肌肌电图检测,AKS组和颈椎病组同时进行胸锁乳突肌、第一骨间肌、腹直肌、胫前肌肌电图检测,比较3组肌电图的差异.颈椎病组中43例患者进行手术前后斜方肌肌电图比较.结果 ALS组中,病程≤8个月的患者斜方肌肌电图自发电位的出现率高于病程>8个月者[分别为21/30(70%)和28/70(40%),X~2=7.56,P=0.004];斜方肌肌电图与胸锁乳突肌肌电图异常率比较差异无统计学意义.ALS组[波幅(1086.9±152.6)μV,时限(17.2±6.5)ms,多相波23.6%±3.4%]与对照组[波幅(606.7±82.7)μV,时限(11.6±1.8)ms,多相波12.8%±2.2%;q=9.27、4.57、4.12,均P<0.01]、ALS组与颈椎病组[术前,波幅(615.7±90.3)μV,时限(12.1±2.0)ms,多相波13.5%±2.4%]间运动单位动作电位(MUAP)各参数比较,差异有统计学意义(q=8.32、4.25、4.23,均P<0.01).颈椎病患者手术前后斜方肌肌电图MUAP各参数无明显变化,5例术后发现少量自发电位.结论 斜方肌肌电图可作为检测ALS延髓部下运动神经元损害的辅助手段,特别是早期可见自发电位增多. 1.6±1.8)ms,多相波12.8%±2.2%;q=9.27、4.57、4.12,均P<0.01]、ALS组与颈椎病组[术前,波幅(615.7±90.3)μV,时限(12.1±2.0)ms,多相波13.5%±2.4%]间运动单位动作电位(MUAP)各参数比较,差异有统计学意义(q=8.32、4.25、4.23,均P< .01).颈椎病患者手术前后斜方肌肌电图MUAP各参数无明显变化,5例术后发现少量自发电位.结论 斜方肌肌电图可作为检测ALS延髓部下运动神经元损害的辅助手段,特别是早期可见自发电位增多. 1.6±1.8)ms,多相波12.8%±2.2%;q=9.27、4.57、4.12,均P<0.01]、ALS组与颈椎病组[术前,波幅(615.7±90.3)μV,时限(12.1±     

Conversion to hypertrophic vertebral pseudarthrosis following percutaneous vertebroplasty

To determine the role of percutaneous vertebroplasty (PVP) in bone formation and the union of vertebral pseudarthrosis, we analyzed 14 patients with an average follow-up duration of 21 months. Evaluation methods included back pain (visual analog scale: VAS), wedge angle, dynamic mobility, radiographic remodeling including callus and spur formation, and union status. The Student's t test was used for statistical analysis and a probability of less than 0.05 was determined as a significant difference. Back pain improved in all 14 patients with a VAS score of 57.8 ± 23.5 mm (average ± standard deviation) preoperatively and 14.7 ± 16.4 mm at the final follow-up (P < 0.001). The wedge angle decreased from 21.6° ± 8.3° (average ± standard deviation) preoperatively to 13.2° ± 6.9° at the final follow-up (P < 0.001). Callus formation was seen in four patients. Bony spurs were seen in the affected vertebra in preoperative radiographs in all patients, and were further developed to a solidified form during follow up after PVP. Dynamic mobility of the affected vertebrae was 6.9 ± 2.9 mm preoperatively, which decreased to 1.1° ± 0.7° at the final follow-up (P < 0.001). Notably, all patients showed the dynamic vertebral mobility of 2 mm or less. Nevertheless, only two patients exhibited the dynamic vertebral mobility of 0 mm at the final follow-up, which is referred to as bone union. These findings indicate that PVP serves as a mechanical stabilizer for vertebral pseudarthrosis, which leads to immediate pain relief and segmental bony responses.     

Prevalence of musculoskeletal pain in an elderly Korean population: Results from the Korean Longitudinal Study on Health and Aging (KLoSHA)

The aim of this study is to estimate the prevalence of musculoskeletal (MSK) pain in the upper extremities (UE), low back, and lower extremities (LE) in an elderly population, and to identify related factors. In this cross-sectional cohort study, 1118 Korean elderly subjects were randomly selected from residents aged ≥65 years living in an urban city of Korea. The study data included presence of MSK pain, educational levels, activity levels over a 24 h, monthly income, body mass indices and presence of depression. Estimated age- and gender-standardized prevalences of UE, low back, and LE pain were 62.6%, 72.6%, and 45.7%, respectively. The prevalence of LE pain increased with age, whereas those of UE pain and back pain did not. By multivariate analysis, a female gender and a low income were found to be significantly associated with pain at all sites, and obesity was related with low back and LE pain. Furthermore, an uneducated state was found to be associated with LE pain, and major depressive disorder to be obviously related to UE and LE pain. MSK pain was identified to be a common problem in the elderly Korean population, and a female gender was consistently associated with MSK pain.     

经皮激光汽化减压联合臭氧髓核氧化术治疗椎间盘源性腰痛的效果观察

目的 探讨经皮激光汽化减压联合臭氧髓核氧化术治疗椎间盘源性腰痛的临床疗效.方法 应用医用半导体激光和医用臭氧,在X线引导下采用18G穿刺针经皮穿刺至髓核区,然后由穿刺针导入600μm光导纤维,用脉冲式激光切割、汽化髓核,以每个椎间盘800～1000J切割、汽化,再向椎间盘注入浓度为60μg/ml臭氧约5～8ml,共治疗74例95节腰椎间盘.结果 按照MACNAB标准评定,74例患者术后随访5～36个月,优64例,良6例,可4例,差0例,优良率94.6%.结论 经皮激光汽化减压联合臭氧髓核氧化术治疗椎间盘源性腰痛,疗效佳,操作简便,创伤小,安全性高,恢复快.     

射频联合三氧治疗椎间盘源性腰痛临床研究

目的探讨射频联合三氧治疗椎间盘源性腰痛的临床疗效。方法腰椎间盘源性腰痛患者60例,随机分3组,每组20例,射频治疗组（A组）,三氧治疗组（B组）,射频联合三氧治疗组（C组）。采用VAS视觉模拟疼痛评分作为疼痛程度评价指标,以改良MacNab标准评估治疗效果。观察治疗后1周、3周、2个月VAS及术后2个月手术优良率。结果3组患者术后症状均有不同程度的缓解,未见不良反应及并发症。术后VAS疼痛分值C组低于其他2组,术后与术前有统计学差异（P〈0．05）,C组术后2个月优良率为16／20例,高于A组和B组（P〈0．05）。结论射频联合三氧治疗椎间盘源性腰痛微创、安全、有效,且疗效优于单独应用射频或三氧治疗。     

锁骨下静脉置管两种回血方法的效果比较

目的探讨锁骨下静脉置管两种回血方法的安全性及实用性。方法将120例锁骨下静脉置管患者随机分为两组,观察组60例,采用将输注0.9%生理盐水的输液器调节开关放置于毛菲式滴管以下5cm处,向上牵拉关闭状态的调节器1cm,观察锁骨下静脉置管管腔回血。对照组60例,采用5ml注射器回抽管腔内回血,见到回血后使用配置的肝素盐水脉冲式封管。结果实验组回血率高于对照组、外露管腔可视回血量均衡4±2cm,护理操作时间≤36s,导管感染率降低（P〈0.05）。结论使用输液器调节开关负压原理回血法较注射器回血法外露管腔可视回血量均衡,护理操作快速、简单,避免因管腔内回血量过多污染输液装置而增加导管感染率,提高了护理工作的安全性、有效性,具有临床实用价值。     

Bone health and back pain: What do we know and where should we go?

Summary  Bone health is generally not considered in patients who present with chronic back pain. Nonetheless, bone health and back pain share common genetic and environmental correlates suggesting a co-dependence. Evidence exists for a relationship between back pain and impaired bone health. Here we present the evidence, theoretic framework and clinical relevance. Bone health and back pain are important determinants of musculoskeletal health. Back pain experienced in youth is a risk factor for future back pain, while suboptimal bone health during development increases the risk of skeletal fragility in later life. Generally, bone health is not considered in patients with chronic back pain who do not demonstrate other well-recognised bone health risk factors or associated conditions. Nonetheless, evidence suggests that back pain and impaired bone health share common environmental and genetic correlates, indicating that bone health ought to be considered in the context of back pain in otherwise healthy individuals. This review describes the likely mechanisms explaining the relationship between back pain and impaired bone health, evidence concerning the relationship and suggestions for future research. A narrative literature search was conducted using CINAHL, Medline, PubMed and Web of Science electronic databases. A history of back pain is associated with decreased bone mineral density in adults, yet this tends to be site-specific. No studies were identified examining this association in youth, yet the negative effects of childhood skeletal trauma and obesity on bone and spinal health provide indirect evidence for an association. Further research is required to clarify the impact of back pain on bone health at different lifespan stages using prospective cohort designs.     

Complementary therapies for back pain: is the evidence getting stronger?

Back pain is the most common reason for using complementary therapies. This analysis of the trial evidence is aimed at determining whether the evidence base for or against complementary therapies for back pain is getting stronger. Two series of systematic reviews conducted with the same methodology 5 years apart were compared. The results suggest that the weight of the evidence has increased between 2000 and 2005 for a number of interventions. The direction of the evidence, however, remained unchanged for all but one therapy. We conclude that the value of complementary therapies in the management of back pain remains encouraging but not fully convincing.