应用综合康复护理措施改善老年慢性心衰患者心功能

目的探讨综合康复护理措施对老年慢性心衰患者心功能的影响。方法将110例老年慢性心衰患者随机分为治疗组和对照组,治疗组采取有计划地运动康复指导、营养指导、心理护理、培养自我管理能力等综合康复护理措施,对照组给予一般护理。观察记录患者的心力衰竭症状和体征,NYHA心功能分级,患者6min步行试验测量步行距离(6MWD),运动耐量(METs),超声心动图测定左室射血分数(LVEF)。结果实施综合康复护理措施后,治疗组NYHA分级改善、6min步行距离增加、运动耐量提高及LVEF增加,差异均有统计学意义(P0.05)。结论综合康复护理措施能有效改善老年慢性心衰患者心功能,提高生活质量。     

运动康复在慢性心力衰竭患者中的应用研究

目的探究运动康复治疗在慢性心力衰竭患者中的应用效果。方法选取本院2015年10月～2018年10月期间收治的60例慢性心力衰竭患者为研究对象。根据患者治疗方法的不同分为两组,每组各30例。对照组患者进行单纯药物治疗,研究组患者采取药物治疗+运动康复治疗。对比两组患者治疗后的6 min步行试验距离、左室射血分数与生活质量评分。结果干预后,研究组6 min步行试验距离长于对照组;左室射血分数高于对照组;生活质量评分低于对照组,差异均有统计学意义(P 0.05)。结论运动康复治疗可以改善慢性心力衰竭患者的运动耐量与生活质量,具有极强的临床应用价值,应该在临床中积极推广。     

中药足浴对慢性心力衰竭患者心功能和生活质量的改善作用

目的观察中药足浴对慢性心力衰竭患者心功能和生活质量的改善作用。方法 86例慢性心力衰竭患者随机分为对照组44例和观察组42例,对照组采用慢性心力衰竭常规治疗和护理,观察组在对照组基础上采用中药足浴治疗。观察2组治疗后心功能改善疗效,观察2组治疗前后心率、左室射血分数(LVEF)、血浆脑钠肽(BNP)水平、6 min步行距离(6 min WD)、明尼苏达心衰生活质量调查表评分。结果观察组心功能改善有效率为95.2%(40/42),显著高于对照组的72.7%(32/44)(P0.01)。治疗后,对照组BNP、明尼苏达心衰生活质量评分均较治疗前显著降低(P0.01),6 min WD均较治疗前显著提高(P0.01);观察组LVEF、6 min WD均较治疗前显著提高(P0.01),心率、BNP、明尼苏达心衰生活质量评分均较治疗前显著降低(P0.01);观察组各指标均显著优于对照组(P0.01)。结论中药足浴辅助治疗慢性心功能衰竭可明显改善患者心力衰竭的症状及体征,提高生活质量。     

运动康复管理在老年慢性心力衰竭运动恐惧患者中的应用效果

目的分析运动康复管理在老年慢性心力衰竭运动恐惧患者中的应用效果。方法选择2021年7～11月安徽医科大学第一附属医院心内科收治的老年慢性心力衰竭运动恐惧患者92例为研究对象, 根据护理方案分为观察组 (采用运动康复管理)和对照组(采用常规护理方案)各46例。比较并分析两组给予不同护理方案后患者明尼苏达心衰生活质量量表(Minnesota Living with Heart Failure Questionnaire, MLHFQ)评分、护理前后心功能指标、血清ALB、NT-proBNP水平、6 min步行试验评分、运动恐惧情况及评估运动康复管理的区别。结果观察组患者干预后MLHFQ各领域评分均低于对照组, 差异有统计学意义(P<0.05);观察组心功能指标〔左室收缩末容积(Left Ventricular End-Systolic Volume, LVESD)、左室射血分数(Left Ventricular Ejection Fractions, LVEF)、左心室舒张末期内径(Left Ventricular End-diastolic Dimension, LVEDD)〕的改...     

早期运动干预对重度心力衰竭患者生活质量的影响

目的探讨早期运动干预对重度心力衰竭（心功能Ⅳ级）患者生活质量的影响。方法选择200例重度心力衰竭患者随机分为观察组和对照组（各100例）,在常规药物治疗的基础上分别采用早期运动护理方案（包括心理、行为、运动强度和时间）和常规护理方案。于入院时、3周、6个月后观察患者的血压和静息心率、6min步行距离、生活质量、左心室射血分数等变化情况。结果观察组患者静息心率明显下降,6min步行距离延长,生活质量明显提高,左心室射血分数增加,心功能明显改善,随访期间再次因心衰住院次数和总住院次数等与对照组对比较,P〈0.01,差异有显著意义,而且死亡率并不增加;观察组2例（2%）死于心源性猝死,对照组9例（9%）因肺部感染、心血管事件而心衰,导致死亡。结论早期运动干预对提高重度心力衰竭患者的生活质量和促进心脏功能康复是有效并安全的。     

运动康复护理在慢性心力衰竭患者中的应用效果

目的探讨慢性心力衰竭患者运动康复护理的可行性和效果。方法将77例慢性心力衰竭患者采用随机数字表法分研究组和对照组,研究组40例根据病情除了一般常规护理外,进行运动康复护理,对照组37例采取常规护理,两组均进行健康教育和患者自我管理的培训,并将两组进行比较。结果两组试验前一般情况和心功能指标相当,差异无统计学意义（P〉0．05）,两组试验后心功能指标均有进步,但是通过运动康复护理心衰患者的心衰症状和生活质量明显改善,康复护理后心脏射血分数为（50．5±7．2）％,而对照组护理后心脏射血分数为（35．5±5．2）％,康复护理后明显高于对照组,差异具有统计学意义（t=2．45,P〈0．05）,康复护理组和对照组治疗后心率分别为（76．5±6．8）次／min和（88．6±7．3）次／min,心率都有下降,但是康复护理组明显低于对照组,差异具有统计学意义（t=2．14,P〈0．05）。康复护理组和对照组治疗后6min步行距离分别为（451．4±35．5）m和（350．8±31．5）in,较观察前有增加,而康复护理组较对照组明显增加,差异具有统计学意义（t=13．17,P〈0．叭）。结论慢性心功能衰竭患者适时进行运动康复护理可降低慢性心衰患者的心率,提高心脏射血分数,提高6rain步行距离,也就是表明能改善慢性心衰患者心功能和生活质量。     

风湿性心脏病伴心力衰竭患者的护理

选取160例风湿性心脏病患者,随机分成护理组和对照组,对护理组患者进行专业的干预护理,对照组患者按常规方法康复,跟踪记录6个月,比较两组患者的死亡率、生存率、左心室射血分数及10min步行距离。护理组患者的生存率、左心室射血分数及10min步行距离均高于对照组,死亡率低于对照组。对风湿性心脏病伴心力衰竭(心衰)患者进行合理的干预护理能够改善临床治疗效果。     

6min步行训练在慢性心力衰竭儿童康复护理中的应用

[目的]探讨6min步行运动训练在慢性心力衰竭患儿康复护理中的应用。[方法]选取收治的92例慢性心力衰竭竭患儿,采用随机数字表法分为对照组46例与观察组46例,对照组患儿接受常规药物治疗,观察组患儿在对照组基础上实施6min步行运动康复训练,观察比较两组患儿治疗前后心功能、血脑钠肽(BNP),心率、左室射血分数(LVEF)及6 min步行距离等各项指标。[结果]治疗后6个月。观察组患儿心率低于对照组,而LVEF指标高于对照组(P0.05)。观察组患儿治疗后六分钟步行距离长于对照组(P0.05)。[结论]临床中对慢性心力衰竭竭患儿在常规治疗基础上采用6min步行运动康复训练进行治疗,可有效提高患儿预后。     

运动7步法对慢性心力衰竭患者运动耐力及生活质量的影响

目的 探讨运动7步法康复运动对慢性心力衰竭患者运动耐力及生活质量的影响.方法 选择60例慢性心力衰竭患者,按随机数字表法随机分为实验组和对照组,各30例,在常规慢性心力衰竭药物治疗和护理基础上,实验组实施运动7步法康复运动,分别于入选时和运动16周后对两组患者左室射血分数（LVEF）、血浆BNP测定、血乳酸和6min步行距离和生活质量（MHL评分）进行测定.结果 入组时两组患者LVEF、血浆BNP、血乳酸和6 min步行距离、MHL评分比较差异均无统计学意义（P＞0.05）;运动16周后实验组患者LVEF（44.52±4.5）％,血浆BNP（402.6±112.4） ng/L,血乳酸（4.97±0.50） mmol/L,6 min步行距离（482.52±50.34）m,MHL（39.3±10.8）分,均优于对照组,差异有统计学意义（t值分别为2.21,3.32,2.41,5.05,7.52;P ＜0.05）;与运动前比较差异均有统计学意义（P＜0.05）;运动前后对照组LVEF、血浆BNP、血乳酸和6min步行距离、MHL评分组内比较差异均无统计学意义（P＞0.05）.结论 运动7步法康复运动能显著地增加慢性心力衰竭患者运动耐力,改善其生活质量.     

运动康复护理应用于慢性心力衰竭病人的效果评价

[目的]探讨运动康复护理应用于慢性心力衰竭病人的效果。[方法]根据随机数字表法将2016年2月—2017年12月收治的102例慢性心力衰竭病人分为观察组和对照组各51例,对照组给予常规护理干预,观察组在常规护理干预基础上给予运动康复护理干预。比较两组病人干预前后心率(HR)、左室射血分数(LVEF)、6 min步行距离水平,干预前后采用焦虑自评量表(SAS)、抑郁自评量表(SDS)和健康调查简表(SF-36)对病人的心理状况、生活质量进行评估。[结果]观察组干预后HR低于对照组,LVEF、6 min步行距离高于对照组(均P0.05)。观察组干预后SAS、SDS评分低于对照组(均P0.05)。观察组干预后各项生活质量评分均明显高于对照组(均P0.05)。[结论]运动康复护理能有效改善慢性心力衰竭病人的心功能与运动耐力,同时消除心理不良情绪,提高其生活质量。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.