脑卒中偏瘫的中西医结合康复医疗

本文概述了对81例脑卒中所致的偏瘫患者施以中西医结合的康复疗法的情况。其中包括心理治疗、针灸、功能锻炼、语言训练、理疗及中药治疗等一系列疗法。总有效率为88.88％。治疗中发现,缺血性脑卒中引起的偏瘫与出血性脑卒中所致的偏瘫康复效果一致。经早期治疗者,康复效果好。故早期中西医结合康复医疗对脑卒中所致的偏瘫的作用是积极的。

Quality of gastric ulcer healing evaluated by endoscopic ultrasonography

AIM: To evaluate the quality of gastric ulcer healing after different antiulcer treatment by endoscopic ultrasonography(EUS).METHODS: The patients were divided into three groups, and received lansoprazole, amoxicillin and clarithromycinfor 1 wk. Then group A took lansoprazole combined with tepreton for 5 wk, group B took lansoprazole and group C took tepreton for 5 wk. Endoscopy and EUS were performed before and 6 wk after medication. RESULTS: There was no significant difference in cumulative healing rate to S stage between the groups (89%, 82%vs83%,P＞0.05). The rate of white scar formation was significantly higher in group A than in groups B and C (67%, 36%, 50%, P＜0.05). The average contraction rates of the width of ulcer crater, length of disrupted muscularis propria layer and hypoechoic area were higher in groupA than in groups B and C (0.792±0.090, 0.660±0.105 vs0.668±0.143, P＜0.05). The hypoechoic area disappeared in four cases of group A, one of group B and two of group C. The percentage of hypoechoic area disappearance was higher in group A than in the other two groups (44%, 9%vs 17%, P＜0.05). Gastric ulcer healing was better ingroup A.CONCLUSION: The combined administration of proton pump inhibitors and mucosal protective agent can improve gastric ulcer healing.

Pay attention to the rehabilitation of cancer patients—Excerpts of the 2013 NCCN Guidelines for Survivorship

For some survivors, the consequences of cancer are minimal; these patients can return to a normal life after the completion of treatment. In fact, a majority of cancer survivors report being in good general health and experience good to excellent quality of life. A recent review suggests that at least 50% of survivors suffer from some late effects of cancer treatment. The most common problems in cancer survivors are depression, pain, and fatigue. The guidelines suggest the following standards for survivorship care:(1) prevention of new and recurrent cancers and other late effects;(2) surveillance for cancer spread, recurrence, or second cancers;(3) assessment of late psychosocial and medical effects;(4) intervention for consequences of cancer and treatment(eg, medical problems, symptoms, psychologic distress, financial and social concerns); and(5) coordination of care between primary care providers and specialists to ensure that all of the survivor's health needs are met. The NCCN Survivorship Panel hopes that these guidelines can help both oncologic and primary health care professionals lessen the burden left on survivors by their cancer experience so they can transition back to a rewarding life.

3种添加配方奶的喂养方式对促进母乳喂养的影响

目的:探讨3种添加配方奶的喂养方式对促进母乳喂养的影响。方法:将出生3天内的300例剖宫产术后有添加配方奶指征的新生儿随机分为3组,观察(100例)新生儿用母乳喂养促进器喂养,对照组1(100例)新生儿用奶瓶喂养,对照组2(100例)新生儿用小勺喂养;比较新生儿产生乳头错觉的情况、产妇母乳充盈的时间、发生产妇奶胀的情况。结果:观察组新生儿产生乳头错觉3例、产妇母乳充盈的时间术后42小时、产妇奶胀4例;对照组1新生儿产生乳头错觉32例、产妇母乳充盈的时间术后66小时,产妇奶胀38例;对照组2新生儿产生乳头错觉84例、产妇母乳充盈的时间术后72小时,产妇奶胀78例。结论:用母乳喂养促进器喂养明显优于用奶瓶喂养及小勺喂养,新生儿产生乳头错觉极低,母乳充盈的时间较短,产奶较快,产妇奶胀的发生率低(P<0.01),可增强产妇母乳喂养的信心,有效地促进母乳喂养的成功。

The elderly problems and countermeasures of exploring rehabilitation medical services

with the rising proportion of our aging population, the prevalence of chronic diseases in the elderly has increased, but most of the elderly body aging, action inconvenience, self-care ability is poor, become the thorny problem for the treatment of chronic diseases.Medical rehabilitation is a effective way to improve the sick old man body health.But with an aging that meet the needs of the elderly health service system in the aspect of construction and rehabilitation medical resources configuration, there are still some problems to be solved. In this article, through analyzing problems existing in the old medical service recovery to further explore its countermeasures.

OBSERVATION ON THE THERAPEUTIC EFFECT OF ACU-MOXIBUSTION OF DIFFERENT ACUPOINT GROUPS IN STROKE PATIENTS IN CONVALESCENCE STAGE

Objective: To observe and compare clinical therapeutic effect of acupuncture and moxibustion at different acupoint groups in stroke patients in the convalescence stage. Methods: Sixty stroke patients were evenly randomized into yin-meridian group and yang-meridian group. On the basis of the treatment with Chinese and Western medicines, these stroke patients of two groups were treated mainly by acupuncture of acupoints of yin meridians such as Jiquan (极泉HT 1), Tongli (通里HT 5), Neiguan (内关PC 6), etc., and those of yang meridians as Jianyu (NFDA1 LI 15), Quchi (曲池 LI 11), Shousanli (手三里LI 10), etc. respectively. After 30 days’ treatment, the therapeutic effect was evaluated by using American National Institutes of Health Stroke Scale (NIHSS), Hamilton Depression (HAMD) Rating Scale, Mini-Mental State Examination (MMSE), Barthel Index and Activities of Daily Living (ADL) Scale. Results: Following treatment, the therapeutic effect of yin-meridian group was significantly superior to that of yang-meridian group in improving stroke patients’ neurological deficits [Level B: 50% (15/30) vs 20% (6/30)] and ADL [Level Ⅱ: 40% (12/30) vs 13.3% (4/30)]. No significant difference was found between two groups in the neurological impairment domains. Conclusion: Acu-moxibustion of acupoints of yin meridians is superior to acupoints of yang meridians in improving stroke patients’ neurological impairment and daily living activities.

Quality-Oriented Climate and Service Quality Among Healthcare Providers： Evidence From a Rehabilitation Center in Italy

The importance of quality in service provision is widely recognized in health service research. However, a limited number of studies have investigated antecedents of quality in healthcare service provision. This article tries to shed further light on this under-researched field. Specifically, the aim of this study is to verify the relationship between the quality-oriented climate and service quality as perceived by employees. The study was conducted in a private non-profit Rehabilitation Centre in Italy using a questionnaire administered to all healthcare workers. The questions focused on perceptions of quality-oriented climate （priorization of quality care, social cooperation, and exchange）, four different connotations of the quality in healthcare provision （provision of high quality service, adequacy of time spent with patients, freedom in clinical decisions, and continuing relationships with patients）, as well as on respondents＇ background. Of the 248 healthcare workers, 183 completed the questionnaire. Hierarchical regression analysis was used to study the relationship between quality-oriented climate and outcome variables （quality in healthcare provision）. The results suggest that a quality-oriented climate does explain service quality in Healthcare settings： When an organization has implemented a quality-oriented climate, the service care provided by healtheare workers can determine an increase for three of the four investigated aspects of quality service provision （quality of care, freedom to make clinical decisions to meet patients＇ needs, and continuing relationships with patients）. The paper demonstrates that the offer of quality services involves in a different way the various healthcare professionals and/or management staff. This research provides interesting findings for healthcare manager in Health Service settings regarding the management of a quality-oriented process of service provision.

Application regularity of medicinal and dietary substances for patients during COVID-19 rehabilitation

Objective This study focused on the application regularity of medicinal and dietary sub-stances(MDS)of traditional Chinese medicine(TCM)diet therapy during rehabilitation,in order to help patients with Corona Virus Disease 2019(COVID-19)reduce sequelae and improve their life quality.Methods The official websites of the national and provincial health committees,the website of the National Administration of Traditional Chinese Medicine,the China BioMedical Literature Database(CBM),China National Knowledge Infrastructure(CNKI),China Science and Technology Journal Database(VIP),and Wanfang Database were used to search the keywords,such as“coronavirus”“novel coronavirus pneumonia”“COVID-19”“protocol”“guideline”“consensus”and“rehabilitation period”.The search time was from the establishment of databases to July 31,2022.The prevention and control protocols of various provinces and cities were manually supplemented and screened out.The information on the frequency,property,flavor,meridian tropism,and efficacy of MDS was collected for association rule analysis through the Apriori algorithm.Hierarchical cluster analysis was performed using the Euclidean distance and longest distance.Results A total of 18 protocols were screened out,including 56 lists of TCM diet therapy,and 47 kinds of MDS with a frequency of 132 times during the rehabilitation of COVID-19.Among them,six lists of diet therapy were collected from national websites,26 from local government websites,and 24 from social and academic institution websites.The intended population can be divided into seven categories including normal recovery,lung-spleen Qi deficiency,deficiency of both Qi and Yin,spleen-stomach weakness,deficiency of Yang Qi,kidney Qi deficiency,and blood deficiency.Shanyao(Dioscoreae Rhizoma)and Lianzi(Nelumbinis Semen),followed by Dazao(Jujubae Fructus)were used most commonly in MDS,with mainly flat property,sweet flavor,and spleen and lung meridians in meridian tropism.Besides,deficiency-tonifying drugs were commonly used in MDS.Through association rule analysis,12 groups of association MDS pairs were obtained.The pair of Yiyiren(Coicis Semen)and Chenpi(Citri Reticulatae Pericarpium)had the highest Lift value,and Yiyiren(Coicis Semen)was used most frequently in the MDS category for eliminating pathogenic factors.The results of complex network analysis showed that the core MDS were Yiyiren(Coicis Semen),Shanyao(Dioscoreae Rhizoma),Huangqi(Astragali Radix),Fuling(Poria),and Dazao(Jujubae Fructus).Three core categories were classified by cluster analysis,including the category of strengthening spleen,nourishing kidney,and grasping Qi,the category of removing phlegm,abating panting,and regulating Qi,and the category of strengthening the middle-energizer and reinforcing Qi.Conclusion Based on the TCM theory,most patients during the rehabilitation of COVID-19 are in a state of lingering pathogens due to deficient vital Qi.TCM diet therapy is based on the principle of“giving both reinforcing and reducing treatment”,and the MDS combinations focus on both reinforcing the health Qi and eliminating pathogenic factors.The diet therapy mainly uses the MDS with flat property and sweet flavor,which belongs to deficiency-tonifying drugs,adding suitable MDS of pathogen-eliminating drugs according to different situations.The ultimate goal is to promote lung inflammation absorption,improve pulmonary fibrosis,increase immunity,reduce the occurrence of sequelae,and improve life quality.

Epidemiological data on acupuncture and physical and rehabilitation medicine in the European Union

OBJETIVE: To know the prevalence of acupuncturists within physical and rehabilitation medicine specialists in Europe and their characteristics,as well as to analyze the pathologies treated and therapeutic techniques used.METHODS: This is a cross-sectional descriptive study based on a structured and closed questionnaire. The study was carried out from October 2011 to May 2014.RESULTS: A total of 115 specialists from 19 countries completed the questionnaire. The mean characteristics of the physical and rehabilitation medicine(PRM) specialists who are also acupuncturists in Europe were: women(62.6 %); mean age of47.91 years old; 4.20 years of physical and rehabilitation medicine school and 2.00 years of acupuncture training; 15.03 years of mean time of clinical practice as physical and rehabilitation medicine specialists and 10.42 years of experience as acupuncturists; 35.65 % had a doctorate(Ph D) degree,obtained at a mean age of 33.55 years old; working in a public hospital(80%); treating mainly neurological conditions(48.1%) and using mainly techniques such as kinesiotherapy(11.81%),orthosis(10.40%) and electrotherapy(9.92%). Acupuncture was applied by 32.2% of the participants mainly in musculoskeletal conditions(27.38%). A mean number of more than 20 patients a day were treated by47.04% of the specialists,being 41.8% of the patients(adults and children). Significant differences were found between the variables,acupuncture and gender(Pearson's correlation Index = 0.007).However,no differences were observed in relation to acupuncture and age,doctorate degree,years of clinical practice and workplace(all with P values >0.05).CONCLUSION: In the European area,physical and rehabilitation medicine specialists who are also acupuncturists are mainly female,middle-aged,with15 years of professional experience,Ph D holders,working in public hospitals,treating mainly neurological conditions with kinesiotherapy and acupuncture,and treating over 20 patients a day(adults and children) during a 7 h shift. Further epidemiological studies on PRM to provide more information regarding the real situation of this medical specialty and the possibility to open to Chinese traditional medicine techniques such as acupuncture are necessary.