大剂量中西药物硬膜外腔灌注治疗椎动脉型颈椎病的临床研究

目的观察大剂量中西药物硬膜外腔灌注治疗椎动脉型颈椎病的临床效果。方法以2005-01—2006-10中西药物硬膜外腔灌注治疗椎动脉型颈椎病119例为研究对象，随机分为大剂量中西药物硬膜外腔灌注治疗组（89例）和单纯静脉注射用药治疗对照组（30例），分别观察和记录治疗前后临床主要自觉症状的模拟评分，评定治疗效果。结果大剂量硬膜外腔灌注结束时即刻开始观察，治疗后所有临床主要自觉症状的模拟评分较治疗前均显著降低（P〈0．01）；与对照组比较，各观察阶段均有显著疗效。结论大剂量中西药物硬膜外腔灌注治疗颈椎病有令人满意的的疗效。     

Current Physiotherapy Practice of New Referrals to a Regional Paediatric Cystic Fibrosis Service

This paper reviews the physiotherapy practice and management of 85 cystic fibrosis patients referred to a Regional unit for comprehensive assessment. Following assessment, recommendations were made to the patients and referring units. Physiotherapy treatment was found to be sub-optimal in several areas. We suggest that, on the basis of our results, assessment/review at a Regional Cystic Fibrosis Centre would be beneficial to cystic fibrosis patients.     

The role of safety behaviors in exposure-based treatment for panic disorder and agoraphobia: Associations to symptom severity,treatment course,and outcome

The potentially detrimental effects of safety behaviors during exposure therapy are still subject to debate. Empirical findings are inconsistent, and few studies have investigated effects of idiosyncratic safety behavior manifestations during exposure or in everyday life.These limitations might be due to a lack of appropriate measures that address individual safety behaviors. We examined psychometric properties and predictive value of the Texas Safety Maneuver Scale (TSMS), a questionnaire specifically targeting safety behaviors in panic disorder and agoraphobia. Effects of safety behavior use, both during everyday life and during therapy, were examined using data from a multicenter RCT of N = 268 patients that aimed at evaluating efficacy and mechanisms of action of two variants of an exposure-based therapy. The TSMS total score demonstrated good internal consistency (α = 0.89), and it showed significant correlations with selected measures of baseline anxiety and impairment. The proposed factor structure could not be replicated. Frequent safety behavior use at baseline was associated with actual safety behavior during exposure exercises. Pronounced in-situ safety behavior, but not baseline safety behavior was associated to detrimental treatment outcome. The results underline the relevance of a rigorous safety behavior assessment in therapy. The actual relationship between safety behavior use and treatment outcome is yet to determine.     

Discovery of previously undetected intellectual disability by psychological assessment: A study of consecutively referred child and adolescent psychiatric inpatients

Intellectual disability is associated with an increased risk of behavioral disturbances and also complicates their treatment. Despite increases in the sophistication of medical detection of early risk for intellectual disability, there is remarkably little data about the detection of intellectual disability in cases referred for psychiatric treatment. In this study, we used a 10-year sample of 23,629 consecutive child and adolescent admissions (ages between 6 and 17) to inpatient psychiatric treatment. Eleven percent (n = 2621) of these cases were referred for psychological assessment and were examined with a general measure of intellectual functioning (i.e., WISC-IV). Of these cases, 16% had Full Scale IQs below 70. Of the cases whose therapists then referred them for formal assessment of their adaptive functioning (i.e., ABAS-II) 81% were found to have composite scores below 70 as well. Only one of the cases whose Full Scale IQ was less than 70 had a referral diagnosis of intellectual disability. Cases with previously undetected intellectual disability were found to be significantly more likely to have a diagnosis of a psychotic disorder and less likely to have a diagnosis of mood disorder than cases with IQs over 70. Disruptive behavior disorder diagnoses did not differ as a function of intellectual performance. These data suggest a high rate of undetected intellectual disability in cases with a psychiatric condition serious enough to require hospitalization and this raises the possibility that many such cases may be misdiagnosed, the basis of their problems may be misconceptualized, and they may be receiving treatments that do not take into account their intellectual level.     

Can Motor Measures Tell Us If Someone Is Trying? An Assessment of Sincerity of Effort in Simulated Malingering

Several studies have focused on detection of simulated injury or submaximal effort using forced-choice measures of memory. However, few studies have examined the role of motor performance in patient effort, and no studies have examined motor functioning in an injury simulation. In this study, we administered measures of motor strength, motor speed, and attention and a forced-choice memory measure to 30 participants instructed to simulate brain injury and 30 participants instructed to perform to the best of their abilities. Simulators' level of performance and variability were significantly different from those of participants instructed to give maximal performance. Variables derived from motor measures may serve as useful supplemental indicators of incomplete effort.     

Management decisions for adolescent idiopathic scoliosis significantly affect patient radiation exposure

Background contextAdolescent idiopathic scoliosis (AIS) patients treated before the 1990s have a 1% to 2% increased lifetime risk of developing breast and thyroid cancer as a result of ionizing radiation from plain radiographs. Although present plain radiographic techniques have been able to reduce some of the radiation exposure, modern treatment algorithms for scoliosis often include computed tomography (CT) and intraoperative fluoroscopy. The exact magnitude of exposure to ionizing radiation in adolescents during modern scoliosis treatment is therefore unclear.PurposeTo determine the difference in radiation exposures in patients undergoing various forms of treatment for AIS.Study designRetrospective cohort.Patient samplePatients aged 9 to 18 years with a diagnosis of AIS, followed and/or treated with nonoperative or operative management for a minimum of 2 years.Outcome measuresNumber of radiographs and total radiation exposure calculated.MethodsThe charts and radiographs of patients managed for AIS at a single institution between September 2007 and January 2012 were reviewed. Patients were divided into three groups: operative group, braced group, and observation group. Patient demographics, Cobb angles, and curve types were recorded. The number of radiographs per year that each patient received and the total radiation dose were recorded. The plain radiographic radiation exposure was then combined with the direct exposure recording from ancillary tests, such as fluoroscopy and CT, and a radiation exposure rate was calculated (mrad/y). A single-factor analysis of variance (α=0.01) with a Tukey honest significant difference post hoc analysis was used to test significance between groups.ResultsTwo hundred sixty-seven patients were evaluated: 86 operative, 80 brace, and 101 observation. All groups had similar demographics and curve type distribution. The mean initial Cobb angle at presentation was significantly different between the groups: operative (57°±11°), brace (24°±7.9°), and observation (18°±9.4°) (p<.01). There was a significant difference among the groups in terms of the mean number of radiographs received per year; operative group, 12.2 (95% confidence interval [CI]: 10.8–13.5; p<.001); braced group, 5.7 (95% CI: 5.2–6.2; p<.001), and observed group, 3.5 (95% CI: 3.160–3.864; p<.001). The operative group received 1,400 mrad per year (95% CI: 1,350–1,844; p<.001), braced group received 700 mrad per year (95% CI: 598–716; p<.001), and observed group received 400 mrad per year (95% CI: 363–444; p<.001). Importantly, 78% of radiation in the operative group was attributable to the operative fluoroscopy exposure.ConclusionsSignificant differences exist in the total radiation exposure in scoliosis patients with different treatment regimens, with operative patients receiving approximately 8 to 14 times more radiation than braced patients or those undergoing observation alone, respectively. Operative patients also receive more than twice the radiation per year than braced or observed patients. Almost 78% of the annual radiation exposure for operative patients occurs intraoperatively. Because children are notably more sensitive to the carcinogenic effects of ionizing radiation, judicious use of present imaging methods and a search for newer imaging methods with limited ionizing radiation should be undertaken.