骨科围手术期超前镇痛及护理干预的疗效观察

目的观察骨科围手术期超前镇痛及护理干预的临床效果。方法选择2011年3月至2012年10月在我科住院的骨科手术患者228例,采用随机双盲对照的方法分成2组。A组超前镇痛及护理干预包括:合理评估、COX-2抑制剂超前镇痛、多模式/个体化镇痛、有效的护患沟通与健康宣教;B组术后给予传统的镇痛泵(PCA)进行镇痛。手术后两组患者根据疼痛程度、VAS数字疼痛评分法、镇痛药物使用、患者满意度进行对照比较。结果通过超前镇痛及护理干预,减轻了骨科围手术期患者术后疼痛感、提高了患者的满意度。结论应用超前镇痛及护理干预对骨科围手术期镇痛有满意疗效。     

小牛血去蛋白提取物注射液联合高压氧治疗高血压脑出血的疗效分析

目的探讨小牛血去蛋白提取物注射液联合高压氧对高血压脑出血患者神经功能康复和预后的影响及其临床实用价值。方法参照1995年全国脑血管疾病会议修订的标准,收集80例高血压性脑出血患者,随机分为治疗组(40例)和对照组(40例);对照组给予开颅手术、控制血压、脱水降低颅内压、高压氧和胞二磷胆碱等综合治疗,治疗组在给予对照组治疗基础上应用小牛血治疗,评定两组患者神经功能评分,并进行统计学分析。结果治疗组总有效率为82.5%,高于对照组的65%,差异有统计学意义(P<0.05),2组治疗后神经功能缺损评分降低,与治疗前比较差异均有统计学意义(P<0.05);且治疗组改善情况优于对照组,差异有统计学意义(P<0.05)。结论小牛血去蛋白提取物注射液联合高压氧辅助治疗高血压脑出血疗效确切,安全性高。     

Low knowledge and perceived Hepatitis C risk despite high risk behaviour among injection drug users in Kathmandu,Nepal

BackgroundIn Nepal, prevalence of Hepatitis C (HCV) among injecting drug users (IDUs) has been measured at 50% and knowledge of the virus is low. Rehabilitation and harm reduction attendees constitute populations to whom health care providers can deliver services. As such, characterizing their drug use and risk profiles is important for developing targeted service delivery. We measured drug use and risk patterns of IDUs participating in residential rehabilitation as well as those contacted through needle exchanges to identify correlates of drug use frequency, risky injection practices as well as HCV testing, knowledge and perceived risk.MethodsWe collected cross-sectional data from one-on-one structured interviews of IDUs contacted through needle-exchange outreach workers (n = 202) and those attending rehabilitation centres (behaviour immediately prior to joining rehabilitation) (n = 167).ResultsRoughly half of participants reported injecting at least 30 times in the past 30 days and individuals with previous residential rehabilitation experience reported frequent injection far more than those without it. About one in fourteen respondents reported past week risky injection practices. Participants were over three times as likely to report risky injection if they consumed alcohol daily (17.2%) than if they did not (5.0%) (p = 0.002). Those who reported injecting daily reported risky injection practices (11.9%) significantly more than non-daily injectors (1.8%) (p < 0.001). Respondents reported high HCV infection rates, low perceived risk, testing history and knowledge. HCV knowledge was not associated with differences in risky injecting.ConclusionTreatment centres should highlight the link between heavy drinking, frequent injection and risky injecting practices. The link between rehabilitation attendance and frequent injection may suggest IDUs with more severe use patterns are more likely to attend rehabilitation. Rehabilitation centres and needle exchanges should provide testing and education for HCV. Education alone may not be sufficient to initiate change since knowledge did not predict lower risk.     

护理干预对粘连性肠梗阻术后康复的影响研究

目的探讨护理干预对粘连性肠梗阻术后康复的影响。方法将40例行手术治疗的粘连性肠梗阻患者随机分为观察组和对照组各20例。对照组仅予以常规护理,观察组在对照组护理基础上实施护理干预。观察并比较2组进食时间、下床时间、住院时间及术后并发症情况。结果观察组护理干预后进食时间、下床时间、住院时间短于对照组,且并发症发生率为5.0%,低于对照组的20.0%,差异均有统计学意义(P<0.05)。结论护理干预可促进粘连性肠梗阻患者术后早日康复。     

Treatment of cognitive impairment in patients with multiple sclerosis

Introduction: Identifying and treating cognitive impairment in patients with multiple sclerosis (MS) is increasingly recognized as a crucial step in selecting the most appropriate treatment for the individual. Currently, the neuropsychological tests used to assess patients are time-consuming and require specialist training to administer; consequently, cognitive impairment in MS is underdiagnosed. Many treatments are available for MS, including disease-modifying drugs (DMDs) and symptomatic therapies, but what are their effects on cognitive performance?

Areas covered: This article will review published studies describing the cognitive effects of DMDs and symptomatic treatments for MS.

Expert opinion: Some DMDs may improve cognitive performance in patients with MS. None of the symptomatic drug treatments reviewed showed positive effects on cognitive performance, with the possible exception of L-amphetamine, which may improve memory in patients with existing deficits, and methylphenidate, on which more data are needed. Cognitive rehabilitation can improve cognitive performance, but experience with these techniques is limited. Treatment for patients with MS and cognitive impairment should, therefore, include a DMD in combination with a pharmacological or perhaps non-pharmacological cognitive-enhancement strategy. However, the methods used to diagnose cognitive impairment, and to assess the effect of treatment on function over time and need to be refined.     

Does privatisation of vocational rehabilitation improve labour market opportunities? Evidence from a field experiment in Sweden

This paper analyses if privatisation of vocational rehabilitation can improve labour market opportunities for individuals on long-term sickness absence. We use a field experiment performed by the Public Employment Service and the Social Insurance Agency in Sweden during 2008–2010, in which over 4000 participants were randomly offered private and public rehabilitation. We find no differences in employment rates following rehabilitation between individuals who received rehabilitation by private and public providers. Also the average cost of rehabilitation was essentially equal for the two types of providers. This suggests that there are no large efficiency gains from privatising vocational rehabilitation.     

Decision Tool for Clients with Medical Issues: A Framework for Identifying Driving Risk and Potential to Return to Driving

This paper offers occupational therapy generalists and specialists a new framework by which to consider clinical evaluation data and an older adult's driving risk and potential to resume this previously learned skill. Based on Michon's model describing the hierarchy of driving levels, clinical questions identify the factors that may affect a client's fitness to drive. The first part is intended to support clinical judgment of whether a client needs a driving evaluation by a driver rehabilitation specialist. The second part offers a framework to organize clinical data that are already known and determine what other evaluation information is justified and necessary to make a driving recommendation. Methods and rational for use are discussed.     

Driver Rehabilitation Programs: Defining Program Models,Services, and Expertise

This paper highlights the critical need for a diverse span of services targeted at older drivers that is clear and understandable to health care professionals, service providers, and consumers. The paper describes how a panel of expert driver rehabilitation specialists and researchers on older drivers affirmed consensus statements addressing the need for clarification of terms and services. It also presents a new document that describes a spectrum of driver services from education to specific driver rehabilitation services. The document will provide consumers, referral sources, payers, and stakeholders invested in older drivers’ services, with the information to refer the right people to the right service at the right time.     

Visual Concerns that Interfere with Daily Activities in Patients on Rehabilitation Units: A Descriptive Study

The purpose of this study was to estimate the prevalence of patients with visual concerns that interfere with their activities of daily living (ADL) performance in physical rehabilitation units through occupational therapy assessment. Over the two-month study period, 215 adult inpatients from a physical rehabilitation hospital were evaluated using the Brief Vision Screen (BVS) through ADL. The BVS assessed four areas of visual concerns, namely left visual field, focusing, and near- and low-contrast acuity, while patients engaged in ADL. The occupational therapists identified 33% of patients who had at least one area of visual concern, with the largest proportion diagnosed with stroke (55%), followed by pulmonary disease (40%) and joint replacement (35%). When comparing the four areas of visual concerns in the BVS between the two major diagnostic groups (acquired brain injury, ABI and non-acquired brain injury, non-ABI), a significantly higher proportion of patients with ABI were identified as having left hemianopsia concerns compared to patients with non-ABI. No significant difference was observed in other areas of visual concern between the two groups. Findings indicated that visual concerns that interfere with ADL performance among older patients in rehabilitation units are common. The high proportion of patients with pulmonary disease identified as having visual concerns warranted further confirmation and investigation. Preliminary evidence to support the psychometric properties of the BVS for identifying visual concerns in patients on rehabilitation units was established.     

Record linkage is feasible with non‐identifiable trauma and rehabilitation datasets

Objectives : 1) Describe probabilistic linkage (PL) for road trauma and rehabilitation records in New South Wales (NSW) Australia. 2) Determine the accuracy of linkage for these records. Methods : Data were extracted from the NSW Trauma Registry for all road trauma admissions for the years 2009–2012 and from Australasian Rehabilitation Outcomes Centre for January 2009 to June 2013. PL was performed using: age; sex; residential postcode; and date of acute discharge = date of admission to rehabilitation. False matches were cases that linked but were not true matches; they were determined by manual review. Reasons for incomplete linkages were explored. The benefits and limitations of the linked study dataset are described. Results : Of 3,256 road trauma records, 683 were matched to rehabilitation records. Using the field of ‘discharge destination’ from the trauma records, 265 patients with unmatched records were discharged to inpatient rehabilitation (missed matches). This gave an overall 72% linkage rate (or sensitivity) using PL. There were 16 cases of false matches, giving a specificity of 99%. Conclusion : It was feasible to use PL to link road trauma and rehabilitation datasets in the absence of identifiers. However, this needed to be combined with careful manual review before the linked dataset could be used to make inferences on trauma rehabilitation outcomes. Implication : PL may be a cost‐effective way to capture inpatient rehabilitation outcomes of multi‐trauma patients.