ISSN:0894-9115    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Previous studies of physicians have elucidated knowledge gaps and misconceptions about the use of opioids for the treatment of chronic pain. The recent approval of a pain management subspecialty certification for physiatrists will create higher expectations of the field regarding the treatment of chronic pain. Five hundred randomly chosen physiatrists were surveyed with a 50.6% response rate. Ninety-eight percent of respondents treat patients with chronic noncancer pain diagnoses, and 37% occasionally treat patients with cancer-related pain. Seventy percent of respondents underestimated the percentage of patients with cancer-related pain that could experience relief with oral analgesics. Only 17% underestimated the percentage of advanced cancer patients that experience significant pain. Eight percent of respondents incorrectly answered that a patient, regardless of diagnosis, would become addicted to opioids by taking an opioid daily. Only 25% identified the correct definition of addiction. Questions regarding side effects revealed that 10% of respondents incorrectly believed that opioid-induced respiratory depression is common in patients whose oral morphine dose exceeds 100 mg per day. Eighty percent of respondents preferred long-acting preparations, and 92% preferred set dosing schedules for the treatment of chronic pain. Rapidly evolving concepts regarding the implementation of pharmacologic regimens for chronic pain diagnoses require health care professionals who are trained to administer these treatments. Overall, the survey results are encouraging regarding physiatrists' knowledge about the use of opioids to treat patients with chronic pain.

ISSN:0894-9115    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0894-9115    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

We previously reported reliability and validity of our newly developed comorbidity scale (CS) for stroke outcome research based on a retrospective sample. The objectives of this study were to cross-validate the comorbidity scale in a new prospective sample and to investigate longitudinal changes of the comorbidity scale during hospitalization. In a prospective sample of 175 stroke patients admitted to five nonacute rehabilitation hospitals in Japan, we analyzed the frequency and grading of comorbidities and compared the comorbidity scale with demographic data, impairment as assessed with the Stroke Impairment Assessment Set (SIAS), and disability as measured with the Functional Independence Measure (FIMSM). The results were compared with our previous retrospective study. We also studied longitudinal changes by measuring the comorbidity scale on admission, 2 wk later, and at discharge of 67 patients. As a result, the comorbidity scaling was significantly lower in the prospective sample, and it increased at the second measurement and then plateaued. Among the comorbidities, hypertension ranked first, followed by shoulder pain, and diabetes mellitus. Similar to our previous retrospective study, the comorbidity scale correlated positively with age and length of stay and correlated negatively with the SIAS motor item scores and the FIM scores. In conclusion, the present study suggested concurrent and predictive validity of the comorbidity scale in a prospective sample as well and clarified the comorbidity characteristics of stroke inpatients.

ISSN:0894-9115    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Nerve conduction studies continue to be an important tool in the evaluation of peripheral nerve disorders but have come under increased scrutiny because of heightened cost control in health care service delivery. In selected clinical settings, automated nerve conduction studies may be a useful clinical tool replacing conventional testing, but existing instruments are limited and have not generally been accepted into clinical practice. Further advancements in nerve conduction automation may be possible by incorporating expert system approaches into nerve conduction measurement and control algorithms. Using fuzzy logic techniques to duplicate the reasoning strategies of experienced electrodiagnostic clinicians, a software controller was developed to automatically perform sensory nerve conduction studies. The fuzzy logic system successfully performed 88% of 97 sensory studies in a mixed group of normal and patient populations. Sensory nerve action potential latency and amplitude measures obtained with automated testing were the same as determined by clinicians. Failures were related to design limitations of the controller, noise, and artifact. The high negative predictive value and sensitivity of fuzzy logic based testing suggest that its utility is in minimizing the need for unnecessary conventional electrodiagnostic studies in patients with normal nerve function. Fuzzy logic appears to be a useful approach to nerve conduction automation that can model expert reasoning and judgment.

ISSN:0894-9115    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The shoulder plays a very important role during manual wheelchair propulsion. Unfortunately, substantial numbers of manual wheelchair users eventually develop shoulder injury or pain. Recently, studies have begun to investigate the etiology of wheelchair user shoulder injuries. This study compared three coordinate systems used to represent the shoulder during wheelchair propulsion. Our results show statistically significant differences between the three shoulder representations analyzed. Differences are seen for individuals and for the subjects as a group. Based upon our results, the fixed-z model appears preferable over the other representations due to its simplicity, low hardware requirements, and the similarity of the results to the free representation. This article also provides some insight into maximal shoulder joint forces and moments recorded during manual wheelchair propulsion. Future work should include more sophisticated models of the shoulder complex.

ISSN:0894-9115    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Personal cooling systems are used to alleviate symptoms of multiple sclerosis and to prevent increased core temperature during daily activities. The objective of this study was to determine the thermal and physiologic responses of patients with multiple sclerosis to short-term maximal head and neck cooling. A Life Support Systems, Inc. Mark VII portable cooling system and a liquid cooling helmet were used to cool the head and neck regions of 24 female and 26 male patients with multiple sclerosis in this study. The subjects, seated in an upright position at normal room temperature (∼22°C), were cooled for 30 min by the liquid cooling garment, which was operated at its maximum cooling capacity. Oral, right, and left ear temperatures and cooling system parameters were logged manually every 5 min. Forearm, calf, chest, and rectal temperatures, heart rate, and respiration rate were recorded continuously on a U.F.I., Inc. Biolog ambulatory monitor. This protocol was performed during the winter and summer to investigate the seasonal differences in the way patients with multiple sclerosis respond to head and neck cooling. No significant differences were found between the male and female subject group's mean rectal or oral temperature responses during any phase of the experiment. The mean oral temperature decreased significantly (P< 0.05) for both groups ∼0.3°C after 30 min of cooling and continued to decrease further (∼0.1-0.2°C) for a period of ∼15 min after removal of the cooling helmet. The mean rectal temperatures decreased significantly (P< 0.05) in both male and female subjects in the winter studies (∼0.2-0.3°C) and for the male subjects during the summer test (∼0.2°C). However, the rectal temperature of the female subjects did not change significantly during any phase of the summer test. These data indicate that head and neck cooling may, in general, be used to reduce the oral and body temperatures of both male and female patients with multiple sclerosis by the approximate amount needed for symptomatic relief as shown by other researchers. However, thermal response of patients with multiple sclerosis may be affected by gender and seasonal factors, which should be considered in the use of liquid cooling therapy.

ISSN:0894-9115    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

A significant reduction in bone mineral density occurs in stroke patients on the hemiplegic side, correlating with the degree of paralysis and vitamin D deficiency due to malnutrition, sunlight deprivation, and immobilization-induced hypercalcemia, and increases the risk of hip fracture. We evaluated the effect of ipriflavone and 1α-hydroxyvitamin D3 [1α(OH)D3; vitamin D3] administration on bone mineral density preservation as compared with untreated controls. In a randomized and prospective study of 103 patients with hemiplegia after stroke (the mean duration of illness was 4.8 yr), 68 (34 patients in each group) were given 600 mg ipriflavone or 1 μg vitamin D3 daily for 12 mo, whereas the remaining 35 patients received no drug. Bone mineral density on the hemiplegic side decreased by 1.4% in the ipriflavone group, 3.8% in the vitamin D3 group, and 5.4% in the control group (P< .0001, ipriflavonevvitamin D3 and control). At baseline, all three groups of patients showed a 25-hydroxyvitamin D insufficiency, increased serum ionized calcium, and low levels of 1, 25-dihydroxyvitamin D, suggesting immobilization-induced hypercalcemia and inhibition of renal synthesis of 1, 25-dihydroxyvitamin D. After treatment, the serum 1, 25-dihydroxyvitamin D level increased by 139.9% in the ipriflavone group and by 26.9% in the vitamin D3 group. Significant decreases in the serum ionized calcium and pyridinoline cross-linked carboxyterminal telopeptide of type I collagen, and increases in parathyroid hormone and bone Gla protein were observed in the ipriflavone group, whereas no changes occurred in the other two groups. One patient in the untreated group suffered a hip fracture, compared with none in the ipriflavone and vitamin D3 groups. These results suggest that ipriflavone is more efficacious than vitamin D3 in the prevention of decreased bone mineral density in hemiplegic stroke patients because it decreases serum calcium levels through inhibition of bone resorption and cause a subsequent increase in 1, 25-dihydroxyvitamin D concentration.

ISSN:0894-9115    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Respiratory complications, such as pneumonia and atelectasis, are major causes of mortality and inhibit rehabilitation programs in spinal cord injury. Tetraplegic patients cannot cough enough to clear their sputum because of expiratory muscle weakness, mainly of the abdominal muscles. However, tetraplegics are still able to activate some muscles during coughing. Some tetraplegics, even though they cannot contract the abdominal muscles, can cough effectively. It was supposed that some accessory expiratory muscles were activated during coughing in tetraplegics. We, therefore, studied the peak expiratory flow rate, expiratory muscle strength, and the activities of the pectoralis major and latissimus dorsi muscles in 11 complete tetraplegics. Peak expiratory flow rate was measured by spirometry. Expiratory muscles strength was assessed by maximal expiratory mouth pressure; muscle activity was assessed by means of the root mean square voltage obtained by surface electromyography. The results showed that peak expiratory flow rate, maximal expiratory mouth pressure, and root mean square of these two muscles were correlated with neurological level. Peak expiratory flow rate was correlated with peak expiratory flow rate. Peak expiratory flow rate was correlated with the root mean square voltage of the pectoralis major and latissimus dorsi muscles. It was supposed that these two muscles were activated as accessory expiratory muscles and play an important role in expiratory function in tetraplegic patients.

ISSN:0894-9115    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0894-9115    

出版商:OVID    

年代:1999

数据来源: OVID