人-环境-作业模式促进脑卒中后手和上肢功能的康复

一侧肢体功能障碍是脑卒中后的典型症状,其中手和上肢功能障碍严重影响着作业表现,使患者的生活受到不同程度的限制。本文基于人-环境-作业(personenvironment-occupation,PEO)模式,从人、环境、作业活动和作业表现等方面,探讨脑卒中患者手和上肢功能的康复治疗,以期提升人们对中国脑卒中患者作业治疗内涵的理解。通过作业治疗,可以改善患者的行为表现,减轻功能受限程度,增强日常生活的活动能力,从而提高患者的生活质量。     

Atypical performance patterns on Delis–Kaplan Executive Functioning System Color–Word Interference Test: Cognitive switching and learning ability in older adults

Introduction: Cognitive set shifting requires flexible application of lower level processes. The Delis–Kaplan Executive Functioning System (DKEFS) Color–Word Interference Test (CWIT) is commonly used to clinically assess cognitive set shifting. An atypical pattern of performance has been observed on the CWIT; a subset of individuals perform faster, with equal or fewer errors, on the more difficult inhibition/switching than the inhibition trial. This study seeks to explore the cognitive underpinnings of this atypical pattern. It is hypothesized that atypical patterns on CWIT will be associated with better performance on underlying cognitive measures of attention, working memory, and learning when compared to typical CWIT patterns. Method: Records from 239 clinical referrals (age: M = 68.09 years, SD = 10.62; education: M = 14.87 years, SD = 2.73) seen for a neuropsychological evaluation as part of diagnostic work up in an outpatient dementia and movement disorders clinic were sampled. The standard battery of tests included measures of attention, learning, fluency, executive functioning, and working memory. Analyses of variance (ANOVAs) were conducted to compare the cognitive performance of those with typical versus atypical CWIT patterns. Results: An atypical pattern of performance was confirmed in 23% of our sample. Analyses revealed a significant group difference in acquisition of information on both nonverbal (Brief Visuospatial Memory Test–Revised, BVMT–R total recall), F(1, 213) = 16.61, p < .001, and verbal (Hopkins Verbal Learning Test–Revised, HVLT–R total recall) learning tasks, F(1, 181) = 6.43, p < .01, and semantic fluency (Animal Naming), F(1, 232) = 7.57, p = .006, with the atypical group performing better on each task. Effect sizes were larger for nonverbal (Cohen’s d = 0.66) than verbal learning (Cohen’s d = 0.47) and semantic fluency (Cohen’s d = 0.43). Conclusions: Individuals demonstrating an atypical pattern of performance on the CWIT inhibition/switching trial also demonstrated relative strengths in semantic fluency and learning.     

Behavioral Ratings of Executive Functioning Explain Instrumental Activities of Daily Living beyond Test Scores in Parkinson’s Disease

Objective: Executive dysfunction is common in Parkinson’s disease (PD), yet the relationship between executive functioning (EF) and instrumental activities of daily living (IADLs) is inconsistent. This inconsistency may be due to the limited relationship between EF test scores and behaviors. Rating scales provide a potential way to supplement test scores in predicting patient’s ability to complete IADLs by capturing a wide range of EF behaviors in their everyday environment. We hypothesized that informant-rated EF would provide incremental validity in predicting IADLs above and beyond EF test scores. Methods: Eighty-five patients were selected from a clinical neuropsychological database of PD patients evaluated for deep brain stimulation surgery at The Johns Hopkins Hospital between September 2006 and January 2015. Hierarchical regression was completed to determine the relationship between an EF behavioral rating scale (i.e., FrSBe), EF test scores, and IADLs. Results: The EF behavioral rating scale added incremental validity to neuropsychological test scores in predicting IADLs. Conclusions: Behavioral ratings of EF may provide additional information about how PD patients’ EF is influencing their everyday life.     

重庆市医用放射工作人员非癌发病探讨

目的 研究职业X射线暴露对放射工作人员非癌疾病的影响。方法 选取1980年普查四川省重庆市辖区内医用X射线工作者为调查对象。2020年,选取之前的91家医疗机构,分布在重庆市41个区县,其中三级医疗机构53家,运用前瞻性队列研究的方法,第5次随访1980年重庆市医用X射线放射工作人员(放射组)和同医院同时期非放射科工作人员(对照组)的个人信息、职业射线接触情况、疾病史等信息。分析该队列各系统疾病发病率、各系统疾病相对危险度(RR)及其95%置信区间。结果 该队列共计937人,共统计非癌疾病359例。放射组与对照组相比,其心血管系统、眼科和其他未分类疾病的相对危险度(RR)分别为1.50、2.03和2.64(χ²=5.97、3.97、4.25,P <0.05)。调整混杂因素的结果显示,女性放射组中心血管系统、眼科和消化系统等疾病发病率的RR普遍高于对照组(RR=2.33、2.59、7.55;χ²=7.28、4.17、8.64,P<0.05);在25~29岁参加工作人员中,放射组成员心血管系统、眼科等疾病发病率的RR普遍高于对照组(RR=2.26、5.07;χ²=8.22、4.91,P<0.05);累积剂量分组中,放射组与对照组比较,心血管系统、眼科和消化系统等疾病发病率的RR普遍较高(RR=1.86、2.91、3.59;χ²=9.83、8.21、5.58,P<0.05)。结论 受到长期职业照射的X射线工作者非癌发病危险增高,其中心血管系统、消化系统、眼科疾病等发病危险可能与这种职业照射有关。     

Effects of two‐year testosterone replacement therapy on cognition,emotions and quality of life in young and middle‐aged hypogonadal men

The aim of the study was to examine the effects of two‐year testosterone replacement therapy on cognitive functioning, emotional state and quality of life in young and middle‐aged men with hypogonadotropic hypogonadism. Nineteen males diagnosed with hypogonadotropic hypogonadism participated in the study. Cognitive functions were assessed by Trail Making Test and Digit Span Test of Wechsler Adult Intelligence Scale. Emotional state was evaluated by Profile of Mood States. Quality of life was evaluated by WHO Brief Quality of Life Questionnaire. Changes after two‐year testosterone replacement therapy were detected in Trail Making A (42.9 ± 22.3 vs. 36.2 ± 22.5, p = .050) and B (90.6 ± 55.3 vs. 65.6 ± 21.4, p = .025) tests, showing improvement in attention and visual scanning abilities, executive function and psychomotor speed, as well as in Digit Span Test forward score (5.4 ± 2.0 vs. 6.1 ± 2.6, p = .046), showing improvement in attention capacity and psychomotor speed. No significant differences were observed in emotional state and quality of life. In conclusion, beneficial effect in cognitive functioning (improved attention and visual scanning ability, executive function and psychomotor speed), but not in emotional state and quality of life, was observed in young and middle‐aged hypogonadal men after two‐year testosterone replacement therapy.     

对工作场所F类铀化合物空气浓度限值的推导探讨

目的 从辐射和化学危害角度分别推算F类铀化合物导出空气浓度,为工作场所职业危害因素的管理与评价提供参考.方法 用模拟计算的方法,分别推算F类铀化合物达到个人年剂量限值、急慢性机体损害效应阈值时工作场所的空气浓度.结果 正常运行情况下,将工作场所空气中F类铀化合物浓度控制在5 μg/m³以内,可以满足辐射危害和化学危害控制的要求;短时间开放性接触时,控制在1.1 mg/m³是可以接受的.结论 制定F类铀化合物空气浓度限值是可行的.     

Therapists' Roles in Pressure Ulcer Management in Persons With Spinal Cord Injury

Background:

Among veterans with spinal cord injury (SCI), severe pressure ulcers (PrU) are treated by interdisciplinary rehabilitation teams in SCI units.

Method:

Cross-sectional survey administered to therapists attending a conference of the Therapy Leadership Council in SCI.

Participants:

Respondents included physical therapists (PTs; n  =  24) and occupational therapists (OTs; n  =  15).

Main Outcome Measurements:

Wound care practices as indicated by 75% or more of participants as “usual practice.”

Results:

In general, therapist involvement with wound care was initiated by physician order (eg, electrical stimulation) or postsurgery protocols. “Usual practice” after tissue healing included progressive range of motion; initial remobilization (first sitting after wound healing); progression of sitting time including assessment of skin tolerance; instruction in pressure relief maneuvers/techniques; and instruction in safe transfers. Practices in prevention of a new ulcer included education and evaluation of seating posture/positioning.

Conclusions:

Results indicate that centers may delegate responsibilities for management of ulcers differentially by discipline. A limitation was that we were unable to determine whether these centers were the same or different for OT and PT respondents. Although sample size was small and some sites had multiple respondents, the survey showed a growing role for OTs and PTs in PrU treatment. Because 75% of each discipline reported that there were usual practices, including patient education and remobilization protocols, this area requires further study to determine the clinical outcomes in terms of preventing PrUs and recurrence.     

Promoting functioning and well-being in older CKD patients: review of recent evidence

Osteoporosis, falls, sleep difficulty, cognitive impairment, and depressed mood are major clinical concerns in the geriatric population that are physiologically and psychologically based and are often interrelated. All of these issues have implications for patients’ daily functioning and quality of life (QOL). This review synthesizes recent evidence about these prominent issues in geriatric care and related implications for care of older patients with chronic kidney disease (CKD). Recent evidence about pre-dialysis and dialysis treatment strategies that may help to optimize management of older patients is also considered. Although elderly patients often report better psychosocial adjustment to dialysis than do younger patients, physical functioning and cognitive functioning losses challenge the QOL of many elderly persons. Early management of CKD and attention to anemia, consideration of the benefits of peritoneal dialysis compared with hemodialysis, and inclusion of some form of exercise or regular physical activity in routine care provide key opportunities to enhance the functioning and well-being of older patients.     

Operating room nitrous oxide trace concentrations: a clinical study in ambulatory surgery

Purpose:

This blinded study evaluates the N₂O concentration variations in an ambulatory surgery centre using a small, simple on-line trace gas concentration monitor (GasFinder™ [Medair AB, Delsbo, Sweden]).

Scope:

Thirty-seven day surgical sessions using standardised anaesthesia with propofol/fentanyl induction and sevoflurane/N₂O with larynx mask. Five of 37 time-weighted averages (TWA) were greater than 25 ppm but less than 100. Peak registered concentrations reached 2000 ppm. Eleven sessions showed peak values higher than 100 ppm (range 13-1693).

Conclusions:

This simple, on-line N₂O monitor is a useful tool for detecting deviations from strict gas hygiene.     

新型冠状病毒感染疫情防控期间防护装备所致医护人员皮肤损伤的发生率及流行特征研究

背景　医疗器械相关性皮肤损伤主要发生于危重患者和矫形患者,一直是全球住院患者安全管理和专科护理的研究热点,但尚缺乏关于医护人员的报道。本次新型冠状病毒感染疫情防控期间,大量医护人员奋战在抗击疫情第一线,长时间穿戴防护装备容易引起皮肤损伤,严重危害了医护人员的健康,也增加了其被感染的风险,如何保护医护人员免受伤害成为亟待解决的问题。目的　探讨新型冠状病毒感染疫情防控期间防护装备所致医护人员皮肤损伤的发生率及流行特征,为制定有效的防护对策提供依据。方法　由本课题组研制调研问卷,主要内容包括医护人员的基本情况、防护装备佩戴情况、皮肤损伤情况、针对皮肤损伤的防护措施及损伤后处理情况。问卷通过“问卷星”网站发布,于2020-02-08至2020-02-15通过微信向抗击疫情一线的医护人员进行推送,采用自愿参与、手机“问卷星”在线填写的方法完成调研。1周内完成调研数据收集,建立数据库,并对医护人员的皮肤损伤发生率、损伤类型及流行特征进行统计分析。结果　共回收有效问卷2 901份,来源于我国19个省、3个自治区、4个直辖市的145家医院。其中,男214例（7.38%）、女2 687例（92.62%）,医生147例（5.07%）、护士2 754例（94.93%）。825例（28.44%）医护人员因佩戴防护装备发生皮肤损伤,合计皮肤损伤数量为2 794处。主要皮肤损伤类型为压力性损伤〔771例（26.58%）,人均2.53处〕、潮湿相关性皮肤损伤〔256例（8.83%）,人均2.77处〕、皮肤撕裂伤〔42例（1.45%）,人均3.12处〕。在发生皮肤损伤的825例医护人员中,存在≥2类皮肤损伤者221例（26.79%）。单因素分析显示：对于防护装备所致皮肤损伤发生率,男性高于女性（P<0.05）,31~45岁者高于≤30岁者（P<0.016 7）,工龄>10年者高于工龄<5年者（P<0.016 7）,医生高于护士（P<0.05）,武汉防疫定点医院高于其他医院（P<0.003 3）、其他医院中传染科高于其他科室（P<0.003 3）,三级防护高于二级防护、二级防护高于一级防护（P<0.016 7）,而不同连续佩戴时间医护人员皮肤损伤发生率间无统计学差异（P>0.05）。结论　抗疫防护装备所致医护人员皮肤损伤的发生率较高,并有多种类型、多个部位损伤并存现象,建议采取减压、减轻摩擦力、吸湿、护肤的综合预防措施减少医护人员皮肤损伤,同时关注性别、年龄、工作岗位等人力资源管理因素。