从机动卫勤人员的基础心肺复苏考核看再培训

目的通过对机动卫勤分队成员基础心肺复苏考核结果的分析,提出机动卫勤分队成员存在的问题及改进措施。方法依据战伤救治规则和军队医院机动卫勤分队训练教材,结合平时训练要求,制定基础心肺复苏再培训方法及考核评分标准,对114名参考人员采用抽签排序以确定考核顺序和考台。结果培训前,机动卫勤分队成员基础心肺复苏操作考核优良率和及格率分别为29.4%和56.9%,再培训后分别为87.9%和100%,经检验,有统计学意义(P<0.01);军医培训前后得分分别为(31.6±13.2)分和(49.9±7.2)分,护士为(39.1±10.6)分和(53.0±5.4)分,其他非临床人员为(26.8±10.6)分和(50.3±4.3)分,各类人员的考核成绩在培训前后均有统计学意义(P<0.01)。结论机动卫勤分队人员定期再培训、再考核是提高机动卫勤分队战伤救治水平的必要手段。     

The effect of changing mediolateral center of pressure on rearfoot eversion during treadmill running

IntroductionAtypical rearfoot eversion is an important kinematic risk factor in running-related injuries. Prominent interventions for atypical rearfoot eversion include foot orthoses, footwear, and taping, yet a running gait retraining is lacking. Therefore, the aim was to investigate the effects of changing mediolateral center of pressure (COP) on rearfoot eversion, subtalar pronation, medial longitudinal arch angle (MLAA), hip kinematics and vertical ground reaction force (vGRF).MethodsFifteen healthy female runners underwent gait retraining under three conditions. Participants were instructed to run normally, on the lateral (COP lateral) and medial (COP medial) side of the foot. Foot progression angle (FPA) was controlled using real-time visual feedback. 3D measurements of rearfoot eversion, subtalar pronation, MLAA, FPA, hip kinematics, vGRF and COP were analyzed. A repeated-measures ANOVA followed by pairwise comparisons was used to analyze changes in outcome between three conditions. Data were also analyzed using statistic parameter mapping.ResultsRunning on the lateral side of the foot compared to normal running and running on the medial side of the foot reduced peak rearfoot eversion (mean difference (MD) with normal 3.3°, p < 0.001, MD with COP medial 6°, p < 0.001), peak pronation (MD with normal 5°, p < 0.001, MD with COP medial 9.6°, p=<0.001), peak MLAA (MD with normal 2.3°, p < 0.001, MD with COP medial 4.1°, p < 0.001), peak hip internal rotation (MD with normal 1.8°, p < 0.001), and peak hip adduction (MD with normal running 1°, p = 0.011). Running on the medial side of the foot significantly increased peak rearfoot eversion, pronation and MLAA compared to normal running.SignificanceThis study demonstrated that COP translation along the mediolateral foot axis significantly influences rearfoot eversion, MLAA, and subtalar pronation during running. Running with either more lateral or medial COP reduced or increased peak rearfoot eversion, peak subtalar pronation, and peak MLAA, respectively, compared to normal running. These results might use as a basis to help clinicians and researchers prescribe running gait retraining by changing mediolateral COP for runners with atypical rearfoot eversion or MLAA.     

A prospective,randomized controlled trial of inpatient versus outpatient continence programs in the treatment of urinary incontinence in the female

Seventy-four patients presenting with a mixed pattern of urinary symptoms were randomly allocated to undergo either inpatient or outpatient continence programs as initial treatment, without prior urodynamic investigation. Both programs consisted of physiotherapy, bladder retraining, fluid normalization, dietary advice and general support and advice. Nine out of 39 in the outpatient group and 8 out of the 35 of the impatient group failed to complete the study. There was a significant decrease in frequency, nocturia, number of incontinent episodes and visual analog scores for both groups. In addition the outpatients had a significant reduction in loss on pad testing, and a significantly greater improvement in their visual analog score. In each group 63% were cured or improved to the extent that they did not require further treatment. Staff costs per outpatient were half those for an inpatient. We conclude that outpatient conservative treatment as detailed above is a successful first-line treatment of urinary incontinence in women. It is as successful and possibly better than inpatient treatment, and is significantly cheaper.     

Relationship between ankle frontal plane kinematics during different functional tasks

Increased inversion following lateral ankle sprain and in patients with chronic ankle instability (CAI) is thought to contribute to recurrent injury and feelings of instability, however, there are no biomechanic assessment tools readily available to evaluate for excessive inversion prior to or following lateral ankle sprains. Before establishing a clinically useful biomechanic assessment tool, it is important to understand whether there is a relationship in the extent of ankle frontal plane motion across various tasks to help determine if one task or a combination of tasks would be most appropriate when evaluating patients. The purpose of this preliminary study was to analyze the relationship between ankle frontal plane kinematics during walking, step-down, and jump-landing tasks. Fifty-six recreationally active adults (gender = M:26;F:30, age = 21.2 ± 3.2, height = 171.3 ± 8.0 cm, mass = 75.6 ± 15.4) volunteered. Main outcome measures were ankle frontal plane motion at initial contact and peak inversion during aerial phases across 3 tasks (walking, step-down, and jump-landing). Relationships between ankle frontal plane kinematics were analyzed by Pearson product-moment correlation coefficient (r). There were strong correlations in peak inversion during the aerial phase between the step-down and walking (r = 0.68; p < 0.001) and step-down and jump-landing (r = 0.75; p < 0.001) and at initial contact between step-down and walking (r = 0.73; p < 0.001) and step-down and jump-landing (r = 0.72; p < 0.001). Moderate correlations were identified during aerial (r = 0.32; p = 0.015) and at initial contact (r = 0.46; p < 0.001) between walking and jump-landing. The strong relationship between the amount of inversion exhibited across various tasks suggest that a single evaluation test may be sufficient in the identification of abnormal ankle biomechanics.     

Visual feedback gait re-training in overweight children can reduce excessive tibial acceleration during walking and running: An experimental intervention study

BackgroundBeing overweight may increase the risk for developing stress fracture, as overweight adults and children were reported to have greater pressure peaks and rates under the heel during walking when compared with their normal-weight counterparts. Biofeedback gait retraining was shown to reduce ground impact magnitude in adults but not yet in children.Research questionThe study examined whether overweight children have greater tibia peak positive acceleration (PPA) at ground impact during fast walking and running compared to healthy weight children, and whether visual feedback gait retraining program can be used to reduce PPA in overweight children.MethodsTwenty five overweight and 12 healthy weight children participated in the study. Overweight children were randomly assigned into either feedback group or control no-feedback group of 8 sessions training program over 2-weeks. Tibia PPA at ground impact output from a wearable inertial sensor attached to the tibia was the feedback displayed on a monitor placed in front of the treadmill during walking and running.ResultsCompared to healthy weight children, overweight participants showed significant greater PPA values in running (p < 0.05), but not in fast walking. Feedback group significantly reduced PPA by 16% (p < 0.01), and these changes persisted at the 1-month follow-up.SignificanceTibia PPA may be used in evaluating overweight children as a risk assessment to potential injuries due to high ground impact during running. Gait retraining using real-time feedback of tibia PPA may be useful in rehabilitation programs to reduce ground impact in overweight children.     

Breathing evaluation and retraining in manual therapy

Patients with back and neck pain commonly seek body work yet there are some who do not experience full recovery with the typical tool kit of manual therapy, education and exercise, suggesting the need for additional clinical approaches. Epidemiological literature linking back pain with breathing difficulties suggests one possibility. Altered motor control associated with back and neck pain appears to negatively impact breathing mechanics, which may have negative consequences on respiratory chemistry. Changes in respiratory chemistry can have profound effects on body system function.Altered breathing has been recognized for many years as a potential source of a wide variety of unexplained symptoms. There has been controversy around accurate diagnosis with symptoms and questionnaires often being the only methods used. Capnography, which is routinely used in critical care settings, offers an objective measure of respiratory chemistry providing physiological data on which to base a diagnosis of poor breathing. Capnography can also be used as biofeedback to guide breathing retraining.     

大学生抑郁自评高分者的团体归因训练

目的：探索团体归因训练改善大学生抑郁情绪的效果。方法：对3组研究组进行团体归因训练,比较训练前后贝克抑郁自评问卷（BDI）、归因方式问卷（ASQ）和自尊量表（SES）的得分情况,并与对照组进行比较。结果：研究组的学生训练前后的文字描述及抑郁程度（t=7.17,P〈0.001）、归因方式（t=-5.66,P〈0.001）及自尊（t=5.00,P〈0.01）均有显著改善,研究组与对照组各问卷前后所测差值间差异显著：抑郁得分差值比较（t=4.98,P〈0.001）,归因方式（t=-5.31,P均〈0.001）,自尊（t=3.74,P〈0.01）。结论：抑郁的团体归因训练在改善大学生的抑郁情绪中效果良好。     

培养与发展慢性伤口、造口等专科护士的探讨

目的:介绍慢性伤口、造口等专科护士的设立和培养,探讨该角色的发展价值。方法:借鉴国内外先进的管理经验,设立造口治疗师等专科护士的角色,开设慢性伤口、造口等专科护理门诊,建立相关制度、培训方法、工作职责及管理、评价方法等。结果:慢性伤口、造口等专科护士的设立和发展有助于提高医疗护理服务质量,节省护士人力,减轻病人经济负担,有效减少并发症的发生,并在护士的继续教育和临床教学中发挥积极作用。结论:结合医院实际培养慢性伤口、造口等专科护士,开展高级临床专科护理符合护理学科发展的需要,具有良好的发展前景。