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Background: A person is said to have a functional limitation when he/she does not have the physical or cognitive ability to independently perform the routine activities of daily living. If recognized at an early stage, these can often be improved greatly, helping them regain their functional abilities and independence. Objective: The objective of the study was to determine the prevalence of functional limitations among older adults in a rural area in south Kerala. Materials and Methods: The cross-sectional study was conducted among older adults residing in the field practice area of a rural health training center of a medical college in south Kerala for 3 months from October 2019 to December 2019. Data were collected by interview of the participants by the investigator. The modified Barthel Index for activities of daily living was used to determine the prevalence of functional limitations. Results: The overall prevalence of functional limitations among older adults in a rural area in south Kerala was 35.9%. The most common functional limitation experienced by the participants was difficulty in climbing stairs. Functional limitation was found to be significantly associated with the age, socioeconomic status, and type of family of the participants. Conclusion: There is an urgent need to focus on the functional limitation among older adults, especially among the oldest old and those in lower socioeconomic status with emphasis on the need to strengthen the health‑care facilities for them, with respect to early identification and management of their functional limitations.
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Object:To explore the clinical effect of periacetabular osteotomy (PAO) in the treatment of developmental dysplasia of hip (DDH).Methods:The clinical data of 305 patients with DDH admitted to Tangshan Second Hospital from January 2012 to June 2018 were analyzed retrospectively. All patients were treated with PAO alone. There were 123 cases of left hip dysplasia, 131 cases of right hip dysplasia and 51 cases of double hip dysplasia (356 hips in total). The patients underwent X-ray examination before and on the second day after operation to compare the acetabular index and the lateral center edge angle (LCEA) and the anterior center edge angle (ACEA) of the acetabulum before and after operation. The ability of daily living and hip joint function were evaluated before and 6 months after operation, and Barthel index and Harris score of hip joint were compared before and after treatment. The measurement data with normal distribution are expressed in xˉ± s, and the paired t test was used for comparison before and after operation. The measurement data of non-normal distribution is expressed by M( Q1, Q3), and the comparison before and after surgery is performed by the rank sum test. Results:On the second day after operation, the LCEA and ACEA of 356 hip joints in 305 patients were greater than those before operation (32.5(20.0,47.5)° vs 8.5(-18.5 23.0)°, 29.0(18.5,52.3)° vs 2.5(-20.8, 24.5)°), while the acetabulum index was lower than that before operation (6.7(-8.4,12.5)° vs 26.8(10.0, 62.3)°), and the differences were statistically significant ( Z values were 51.50, 45.37, 32.22, all P<0.001). After 6 months of follow-up, the Barthel score and Harris score of the hip joint were higher than those before the operation (92.5±1.3) scores vs (65.6±1.5) scores, (96.4±2.5) scores vs (85.1±1.3) scores, and the difference was statistically significant ( t values were 335.56 and 89.70, both P<0.001). Conclusions:PAO can make the acetabulum cover the femoral head well through acetabular transposition, improve the ability of daily living and hip joint function of DDH patients, reduce pain, increase joint range of motion, and correct limb deformities. It is an effective means to treat DDH.
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Objective：We analyzed whether activities of daily living (ADL) had an additive effect on the discharge destination of hospitalized older patients with internal medicine.Methods：Of the 691 patients hospitalized for medical illness aged 65 years or older who received physical therapy during this study period, 186 patients were included in the analysis. The main outcome was the discharge destination. Participants were categorized in the home discharge group and other institution group. The Barthel Index (BI) was used to assess the ADL at the first physical therapy session. Multivariate logistic regression analysis was used to estimate the influence of the BI on determining the discharge destination. The cut-off point of the BI score was evaluated using a receiver operating characteristic curve.Results：During the follow-up period, 17 participants (9.1%) could not be discharged to their homes. Logistic regression analysis showed that the BI influenced discharge destinations (odds ratio：1.54；95% confidence intervals：1.23-1.89). The cut-off point of the BI score for determining home discharge was 72.5 (sensitivity, 0.80；specificity, 0.94；area under the curve, 0.94；positive predictive value：0.99, negative predictive value：0.32).Conclusions：These findings suggest that the BI is a useful predictor for determining the potential destination of hospitalized older patients following discharge. However, the results of this study have limitations such as a low negative predictive value and a limited number of subjects.
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Objective：We analyzed whether activities of daily living (ADL) had an additive effect on the discharge destination of hospitalized older patients with internal medicine.Methods：Of the 691 patients hospitalized for medical illness aged 65 years or older who received physical therapy during this study period, 186 patients were included in the analysis. The main outcome was the discharge destination. Participants were categorized in the home discharge group and other institution group. The Barthel Index (BI) was used to assess the ADL at the first physical therapy session. Multivariate logistic regression analysis was used to estimate the influence of the BI on determining the discharge destination. The cut-off point of the BI score was evaluated using a receiver operating characteristic curve.Results：During the follow-up period, 17 participants (9.1%) could not be discharged to their homes. Logistic regression analysis showed that the BI influenced discharge destinations (odds ratio：1.54；95% confidence intervals：1.23-1.89). The cut-off point of the BI score for determining home discharge was 72.5 (sensitivity, 0.80；specificity, 0.94；area under the curve, 0.94；positive predictive value：0.99, negative predictive value：0.32).Conclusions：These findings suggest that the BI is a useful predictor for determining the potential destination of hospitalized older patients following discharge. However, the results of this study have limitations such as a low negative predictive value and a limited number of subjects.
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OBJECTIVE@#To observe the clinical effect of cluster acupuncture at scalp points in treating limb spasm after stroke on the basis of conventional exercise therapy.@*METHODS@#A total of 72 patients with limb spasm after stroke were randomly divided into an observation group (36 cases, 5 cases dropped off) and a control group (36 cases, 6 cases dropped off). The control group was treated with exercise therapy. In the observation group, on the basis of the control group, penetrating technique of acupuncture was exerted at Qianding (GV 21) to Baihui (GV 20), Xinhui (GV 22) to Qianding (GV 21), etc. once a day, 5 days a week for 4 weeks. Before and after treatment, the changes of the modified Ashworth scale (MAS), simplified Fugl-Meyer motor assessment (FMA), and modified Barthel index (MBI) scores of the two groups were compared.@*RESULTS@#After treatment, the MAS scores of upper and lower limbs in the two groups were lower than before treatment (P<0.05), and those in the observation group were lower than the control group (P<0.05). After treatment, the scores of FMA and BMI in the two groups were higher than before treatment (P<0.05), and the score of MBI in the observation group was higher than the control group (P<0.05).@*CONCLUSION@#On the basis of conventional exercise therapy, cluster acupuncture at scalp points can reduce the spasm, improve motor function and activities of daily living in patients with limb spasm after stroke.
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Humans , Activities of Daily Living , Acupuncture Points , Acupuncture Therapy/methods , Exercise Therapy , Lower Extremity , Scalp , Spasm , Stroke/therapy , Stroke Rehabilitation , Treatment OutcomeABSTRACT
Introducción: El mundo ha experimentado un proceso de cambio que implica múltiples transiciones, como la demográfica y epidemiológica. En México, la prevalencia de las enfermedades demenciales como el Alzheimer tiene una tendencia al aumento, de ahí que sea necesario estudiar y analizar sus repercusiones en la población. Objetivo: Determinar el grado de dependencia en adultos mayores con enfermedad de Alzheimer en un hospital de segundo nivel en Nayarit, México. Métodos: Estudio descriptivo, corte transversal y enfoque cuantitativo. Se aplicó el índice de Barthel para evaluar las actividades básicas de la vida diaria a 29 cuidadores principales de los pacientes registrados en la base de datos del hospital. Las variables elegidas fueron: sexo, edad, municipio y grado de dependencia. El análisis de los datos se realizó mediante el programa SPSS de IBM versión 20. Resultados: La edad media fue de 79 años; el 62,1 por ciento fueron mujeres y el 37,9 por ciento hombres; el municipio con mayor número de pacientes fue Tepic (44,8 por ciento); con respecto al grado de dependencia, la independencia fue la más frecuente (27,6 por ciento), seguido de dependencia total (24,1 por ciento). Se evidenció correlación entre defunciones y grado de dependencia con un nivel de significancia por debajo de 0,000 (error α). Conclusiones. En Nayarit existe dependencia en los adultos mayores con enfermedad de Alzheimer. Los cuidadores primarios reciben poca o ninguna capacitación para el cuidado de estos pacientes. El subdiagnóstico de esta enfermedad de alguna manera favorece la dependencia, pues no se orienta o no se otorgan las medidas básicas terapéuticas a la familia para el apoyo del enfermo, esto a su vez es de especial interés debido a que existe una correlación estrecha entre defunción y dependencia(AU)
Introduction: The world has undergone a process of change that involves multiple transitions, such as demographic and epidemiological. In Mexico, the prevalence of dementia diseases such as Alzheimer's has an increasing trend, hence it is necessary to study and to analyze its impact on the population. Objective: To determine the degree of dependence in aged adults with Alzheimer's disease in a second-level hospital in Nayarit, Mexico. Methods: This is a descriptive study with cross-sectional and quantitative approach. The Barthel index was applied to assess the basic activities of daily living to 29 main caregivers of the patients registered in the hospital database. The variables chosen were sex, age, municipality and degree of dependency. Data analysis was performed using the IBM SPSS version 20 program. Results: The mean age was 79 years; 62.1percent were women and 37.9percent men; the municipality with the highest number of patients was Tepic (44.8percent). Regarding the degree of dependence, independence was the most frequent (27.6percent), followed by total dependence (24.1percent). Correlation between deaths and degree of dependence was evidenced with a level of significance below 0.000 (α error). Conclusions: In Nayarit there is dependence in aged adults suffering from Alzheimer's disease. Primary caregivers receive little or no training in caring for these patients. The underdiagnoses of this disease in some way favors dependence, since the family is not guided or the basic therapeutic measures are not given to support the patient, this in turn is of special interest because there is close correlation between deaths and dependency(AU)
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Humans , Male , Female , Aged , Aged, 80 and over , Activities of Daily Living , Alzheimer Disease/epidemiology , Functional Status , Epidemiology, Descriptive , Cross-Sectional Studies , MexicoABSTRACT
Objective:To observe the relationship between extended Barthel index (EBI) values and functional independence measures (FIMs) in quantifying the ability in the activities of daily living (ADL) of stroke survivors.Methods:Eighty-six stroke survivors′ ADL ability was assessed using the FIM and the EBI and the results were compared.Results:The inter-rater reliability (ICC) of the EBI was 0.866 and the Spearman correlation coefficient relating the EBI and FIM results was 0.972. The 4 ADL functional levels of the EBI were strongly correlated with the 8 ADL functional levels of the FIMs ( χ2=187, P≤0.001). The complete dependence and extreme dependence ratings of the FIMs (18-35 points) corresponded to the EBI′s " completely needed" . Severe and moderate dependence (36-71 points) corresponded to a lot of help needed. Mild dependence, conditional independence or very mild dependence (72-107 points) corresponded to some help needed. Basic independence and complete independence (108-126 points) corresponded to self-care. Conclusions:The EBI has high reliability and good validity, and its 4 ADL functional levels correspond well with the FIMs′ 8 ADL function levels. The EBI has good clinical applicability.
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Improving the quality of life of patients with complete spinal cord injuries is an urgent objective of the Chinese Department of Health. For better management of spinal cord injuries, it is necessary to understand the background of the patients. A total of 392 patients aged ≥18 years with traumatic spinal cord injuries (≥1 year of history) were attending the rehabilitation center of the Institutes. A total of 7 (2%) patients reported low quality of life, 200 (51%) patients reported moderate quality of life, 181 (46%) patients reported good quality of life, and 4 (1%) patients reported excellent quality of life. Male patients (P=0.042), patients with college or more education (P=0.039), incomplete spinal cord injuries (P=0.045), paraplegia (P=0.046), and absence of pressure injury (P=0.047) were associated with higher quality of life. A total of 81 (21%) patients were dependent on the caregiver, 85 (22%) patients were highly dependent on the caregiver, 155 (40%) patients were moderately dependent on the caregiver, 60 (15%) patients were mildly dependent on the caregiver, and 11 (2%) patients were independent for activities of daily living. An incomplete spinal cord injury (P=0.045) and paraplegia (P=0.041) were associated with higher independence in activities of daily living of patients. The independence in activities of daily living and quality of life of the Chinese population with complete spinal cord injury and tetraplegia are poor (Level of Evidence: IV; Technical Efficacy Stage: 5).
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There are many medications available to treat spasticity, but the tolerability of medications is the main issue for choosing the best treatment. The objectives of this study were to compare the efficacy and adverse effects of tolperisone compared to baclofen among patients with spasticity associated with spinal cord injury. Patients received baclofen plus physical therapy (BAF+PT, n=135) or tolperisone plus physical therapy (TOL+PT, n=116), or physical therapy alone (PT, n=180). The modified Ashworth scale score, the modified Medical Research Council score, the Barthel Index score, and the Disability Assessment scale score were improved (P<0.05 for all) in all the patients at the end of 6 weeks compared to before interventions. After 6 weeks, the overall coefficient of efficacy of the intervention(s) in the BAF+PT, TOL+PT, and PT groups were 1.15, 0.45, and 0.05, respectively. The patients of the BAF+PT group reported asthenia, drowsiness, and sleepiness and those of the TOL+PT group reported dyspepsia and epigastric pain as adverse effects. When comparing drug interventions to physical therapy alone, both baclofen plus physical therapy and tolperisone plus physical therapy played a significant role in the improvement of daily activities of patients. Nonetheless, baclofen plus physical therapy was tentatively effective. Tolperisone plus physical therapy was slightly effective. In addition, baclofen caused adverse effects related to the sedative manifestation (Level of Evidence: III; Technical Efficacy Stage: 4).
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Humans , Spinal Cord Injuries/complications , Tolperisone , Muscle Relaxants, Central/adverse effects , Baclofen/adverse effects , China , Retrospective StudiesABSTRACT
Objective:To study the reliability and validity of extended Barthel Index (EBI) in the assessment of activities of daily living (ADL) for stroke patients. Methods:From January, 2018 to October 2019, 136 stroke inpatients from the First Affiliated Hospital of Soochow University were conveniently sampled. They were assessed with EBI by rater A twice within 48 hours after admission, with interval above twelve hours; and by rater B within 24 hours. They were also assessed with modified Barthel Index (MBI) and Function Independence Measure (FIM) within 48 hours after admission by rater C. The intraclass correlation coefficient (ICC) of retest and inter-rater of EBI were calculated, as well as the Cronbach's α coefficient, Spearman correlation coefficient between scores of items and total, and Spearman correlation coefficient of EBI to MBI or FIM. The construct validity of EBI was tested with factor analysis. Results:The retest ICC of items was 0.766 to 0.953; the retest ICC of motor and cognitive items was 0.938 and 0.845, respectively; the retest ICC of total was 0.891. The inter-rater ICC of items was 0.728 to 0.976, the inter-rater ICC of motor and cognitive items was 0.948 and 0.717, respectively; the inter-rater ICC of total was 0.866. The Cronbach's α coefficient of EBI was 0.885. The correlation coefficients were above 0.4 in all the items (P < 0.001) to the total, except the item of vision (r = 0.215, P < 0.05). The correlation of items of EBI to MBI was significant (r = 0.648 to 0.958, P < 0.01), as well as those of EBI to FIM (r = 0.722 to 0.976, P < 0.01). Four components were extracted with principal component analysis, accumulated to 72.19% of the variable; after the vision item was removed, three principal components were extracted, accumulated to 69.09% of the variable. The component 1 was mainly about sphincter control and some advanced brain functions (communication and social cognition), component 2 mainly about ADL related to lower extremities, and component 3 mainly about ADL related to upper extremities. Conclusion:EBI is reliable and valid in the assessment of ADL for stroke patients.
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Background: Goals of Rehabilitation after Traumatic Brain Injury (TBI) focus on preventing complications and improving the level of functional independence. The expectation of TBI survivors and family members following rehabilitation are focused on the quality of outcomes such as reintegration into the community, return to work, and maximal functional capacity. Multiple factors may affect recovery after TBI when interacting with the primary condition and predicting the degree of recovery helps in framing realistic goals. The purpose of this study was to analyze the factors influencing the functional outcome in TBI patients at four months post-injury. Methodology: This observational study was carried out in the Neurosurgery outpatient department when TBI patients returned for review at four months post-injury. 50 TBI patients who were able to follow commands participated in this study. Factors like Admission Glasgow coma scale (GCS), Discharge GCS, Length of Hospitalization, Associated fractures of the upper and lower limb, Co-morbid conditions like Diabetes and Hypertension were obtained from the discharge summary of the patient. Caregiver literacy was obtained from the person who took care of the patient completely. Admission CT scan was graded using the Marshall CT classification. Finally, all these factors were compared to the functional status of the patient evaluated using the Barthel Index. Results: Logistic regression was used to predict the factors affecting the functional outcome. Beta value of Caregiver literacy, Discharge GCS, and Co-morbid conditions was .561, .369 and .234, respectively which influences the functional outcome of TBI patients at four months post-injury. Conclusion: The study concludes that caregiver literacy, Discharge GCS, and Co-morbid conditions influence the functional outcome of TBI patients, which emphasizes the need for awareness and education of the caregiver and along with post-discharge rehabilitation program specific exercises addressing the co-morbid conditions would enhance the recovery.
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Introducción: La discapacidad no es una enfermedad, es una condición, comprende las barreras físicas y actitudinales que impiden la participación plena y efectiva en igualdad de condiciones con los demás. Objetivos: Determinar los tipos, grados y etiología de la discapacidad. Materiales y métodos: Estudio descriptivo, observacional, de corte trasversal donde se estudiaron a 68 adultos con discapacidad, de la comunidad de San Juan Nepomuceno, Departamento de Caazapá. Resultados: Se registraron 54% de discapacidad motora, 12% de discapacidad sensorial y, 21% de multidiscapacidad. Según el grado de dependencia, el 32% son independientes, el 32% dependencia moderada y el 24% dependencia grave. El origen de la discapacidad, por enfermedad 47%, de nacimiento 46% y por accidentes 7%. Discusión: En el estudio predomina la discapacidad motora, seguida de la multidiscapacidad, la condición de pobreza vincula el grado de discapacidad, observándose una mayor proporción de dependencia física. El origen que prevalece es la adquirida, muy cercana al de origen congénita y, un tercio de las personas no tienen escolaridad, exacerbando su condición de vulnerabilidad.
Introduction: Disability is not a disease, it is a condition, it includes physical and attitudinal barriers that prevent full and effective participation on equal terms with others. Objectives: Determine the types, degrees and etiology of the disability. Materials and methods: Descriptive, cross-sectional observational study where 68 adults with disabilities of the people of the community of San Juan Nepomuceno, Department of Caazapá were studied. Results: 54% of motor disability, 12% of sensory disability, 21% of multidisability were registered. Depending on the degree of dependence, 32% are independent, 32% moderate dependence and 24% severe dependence. The origin of the disability, due to illness 47%, birth 46% and accidents 7%. Discussion: In the study, motor disability predominates, followed by multidisability, the condition of poverty links the degree of disability, observing a greater proportion of physical dependence. The origin that prevails is that acquired very close to that of congenital origin. Almost a third of people do not have schooling, exacerbating their vulnerability.
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Background: Quality of life (QoL) among stroke survivors is a concern which has not received sufficient attention in India. The objective of the study was to assess the quality of life of stroke survivors in rural population of Chikkaballapur district, Karnataka.Methods: A community based longitudinal study was done amongst the 150 incident stroke cases registered during the period from March 2013 to November 2014 and who survived beyond 28 days. The cases were enrolled and interviewed using a semi-structured questionnaire and were followed up for 6th month period. QoL was assessed at baseline (at 28 days), at 3rd month and 6th Month using Stroke Specific QoL scale (SSQoL) and Barthel index (BI).Results: The mean age of the persons with stroke was 61.3±15 years with a majority being males (69.3%). Baseline median score (IQR) of SSQoL at 28th day was poor i.e. 131 (77-183). Among the 150 cases, 136 (91%) survived until the end of 6th month. The overall QOL gradually improved to 182 (133-213) and 185 (147-213) at 3rd and 6th month respectively and similar improvement was seen individually in physical, psychological and social domains as well and on multivariate logistic regression age <60 years and few disturbed consciousness among the stroke survivors during the 6th month follow up were found to be predictors for improved quality of life.Conclusions: QoL showed significant improvements in all physical, psychological and social domains by the end of the 6th month of follow up.
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Objectives: The aim of this study was to investigate the relationship between preoperative 10m gait speed and ADL disability in patients undergoing cardiovascular surgery. Methods: There were 131 patients who underwent scheduled cardiovascular surgery and pre and postoperative ADL evaluation from June 2014 to December 2017 in our hospital. A total of 19 patients, including 13 whose Barthel Index (BI) was lower than before surgery at discharge and 6 who had a long-term hospital stay of 6 weeks or more after surgery, was defined as the ADL disability group. The other 119 patients were defined as the control group. We retrospectively compared the two groups and searched for predictors of postoperative ADL disability. Results and Conclusions: An independent predictor of postoperative ADL disability was identified: more than 7.04seconds for walking 10m.
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Objective To explore the influence of family-integrated transition care on the daily living ability of discharged patients with stroke.Methods Seventy-eight patients with stroke who were admitted to Renmin Hospital of Wuhan University from May 2016 to October 2017 were selected by convenience sampling and were divided into a control group and a family-integrated transition care group (hereinafter referred to as transition care group).The patients in the control group received routine neurological health education,while those in the transition care group received a family-integrated transition care intervention in addition to routine neurological health education.The family-integrated transition care included team building,skills training for family members,family-integrated guidance for discharged patients,and regular visits.The scores of the modified Barthel index were compared between the two groups of patients at discharge,three months after intervention,and six months after intervention.Results Among the 71 patients that were finally included,35 cases were included in the control group,of which 17 cases were men (49％),18 cases were women (51％),and their mean age was (70.1±3.7) years;the transition care group comprised 36 cases,of which 18 cases were men (50％),18 cases were women (50％),and their mean age was (69.8±4.5) years.The baseline scores of the control group and transition care group on the day of discharge were (49.1 ± 7.5) and (49.7 ± 7.9),respectively,with no significant difference (P＞0.05).In terms of time effects,the scores of the patients in the two groups had statistically significantly improved at six months after discharge (P＜0.05).In the group comparison,the scores of the patients in the transition care group after the intervention were significantly higher compared to the scores of those in the control group (P＜0.05).In terms of time and inter-group effects,there was an interaction (P＜0.05),and therefore,the influence of time effects was excluded and the same timepoint was compared between the two groups.The scores at three months (63.9±8.8) and six months (76.9± 10.1) in the transition care group were higher than those in the control group (58.1 ±8.1 and 66.0 ±9.3,respectively).The difference was statistically significant (P ＜ 0.05).Conclusion Family-integrated transition care can effectively improve daily living ability and isworthy of promoting.
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Objective To explore the effect of recombinant human tissue plasminogen activator(rt-PA) intravenous thrombolytic therapy combined with antiplatelet therapy on the recurrence of cardio cerebral vascular adverse events in patients with mild acute ischemic stroke (AIS).Methods From December 2015 to December 2017,74 patients with mild AIS treated in Shaoxing Central Hospital were selected in the research.According to the random number table method,the patients were divided into two groups,with 37 cases in each group.The control group received rt-PA intravenous thrombolysis,and the combined group was treated with antiplatelet therapy on the basis of the control group.The serum creatinine(SCr),alanine transaminase(ALT) and platelet count(PLT) were compared before and after treatment in the two groups,and the scores of the Barthel index scale and the modified Rankin scale were compared between the two groups.The incidence of cardiovascular adverse events in 3 months of the two groups was also recorded.Results There were no statistically significant differences in liver and kidney function indicators between the two groups before and after treatment (t =0.30,0.27,0.20,0.77,0.03,0.64,all P ＞ 0.05).Before treatment,the Barthel index scale scores in the combined group and control group[(74.97 ±4.74)points,(61.95 ± 4.24) points] were significantly increased,and the increasing degree in the combined group was more significant than that in the control group(t =12.45,P ＜ 0.05).The modified Rankin scale scores in the combined group and control group[(1.16 ± 0.37) points,(2.05 ± 0.45) points] were significantly decreased compared with those before treatment,and the reduction degree of the combined group was more significant than that in the control group(t =9.29,P ＜ 0.05).The total incidence rate of bleeding events,cardiovascular events,cerebrovascular events and death events in the combined group(5.41％) was significantly lower than that of the control group(27.03％) (x2 =4.87,P ＜ 0.05).Conclusion rt-PA intravenous thrombolytic therapy combined with antiplatelet therapy can effectively improve the nerve function and daily activity of patients with mild AIS.It can also effectively reduce the incidence of cardiovascular and cerebrovascular adverse events,and thus help to improve the prognosis and improve the quality of life.Therefore,it has good clinical application value.
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Objective To observe the therapeutic efficacy of eight nape needle therapy in treating mild cognitive impairment (MCI) after cerebral stroke. Method By following a randomized controlled trial design, 200 eligible patients were randomized into an eight nape needle group and a medication group by the random number table, with 100 cases in each group. The patients all received basic medications, while the eight nape needle group was additionally intervened by acupuncture at the eight nape acupoints including Fengchi (GB20), Fengfu (GV16), Dazhui (GV14) and Xiangsihua points (Extra), and the medication group additionally received oral administration of nimodipine. The intervention lasted eight weeks, followed by a three-month follow-up. Before and after treatment, the two groups of patients were evaluated by Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA) and Barthel Index (BI). Result Respectively at four-week and eight-week treatment and the follow-up, the scores of MMSE, MoCA and BI showed improvements compared with the corresponding baseline (P<0.01, P<0.05);compared with the medication group, the eight nape needle group was superior to the medication group comparing the MMSE score at each time point after treatment (P<0.01, P<0.05); there were no significant differences in the MoCA and BI scores between the two groups at four-week treatment (P>0.05), but the differences were significant at eight-week treatment and the follow-up (P<0.01). Conclusion Eight nape needle therapy can effectively improve the cognitive function in patients with MCI after cerebral stroke.
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Objective To observe the effect of bloodletting at Jing-well points on the recovery of cognitive function and prognosis in patients with post-stroke cognitive impairment. Method One hundred patients with post-stroke cognitive impairment were enrolled and divided by the random number table into two groups, with 51 cases in the observation group and 49 cases in the control group. The control group was intervened by conventional treatment, while the observation group was additionally given bloodletting at Jing-well points. The two groups were observed and compared in terms of Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Barthel Index (BI), and the plasma cortisol level before and after treatment. The therapeutic efficacy and occurrence rate of adverse reactions of the two groups were also compared. Result After treatment, the MMSE, MoCA and BI scores all increased in the two groups, but the scores of MMSE, MoCA and BI in the observation group were higher than those in the control group (P<0.05). The total effective rate was 94.1％ in the observation group, higher than 71.4％ in the control group (P<0.05). The plasma cortisol level dropped after treatment in both groups (P<0.05), and the level in the observation group was lower than that in the control group (P<0.05). The occurrence rate of adverse reactions was 7.8％ in the observation group, lower than 22.4％ in the control group (P<0.05). Conclusion Bloodletting at Jing-well points as assistant can effectively improve the mental state, cognitive function and activities of daily living, and to some extent reduce the happening of adverse reactions in the treatment of post-stroke cognitive impairment.
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Objective@#To discuss the role of enhanced recovery after surgery (ERAS) in patients with colorectal carcinoma after natural orifce specimen extraction surgery (NOSES).@*Methods@#From March 2017 to May 2018, 86 patients diagnosed with colorectal carcinoma and received NOSES at Tangshan Gongren Hospital were randomized to the control group and the observation group. Doctors utilized traditional interventions in the control group. In the observation group were orally administered with electrolyte solution for 12 hours before surgery, without gastrointestinal decompression tube routinely. Patients were fasting for 6 hours before surgery, 2 hours of water inhalation, and oral administration of 10% glucose 3 hours before surgery. During surgery, patients received intraoperative warming and controlled infusion volume. After operation, no drainage tube was placed, and multi-mode analgesia was used. The patient was given a fluid diet on the first day after surgery, and gradually transitioned to a normal diet. The intraoperative blood loss, number of lymph node dissection, operation time, hospitalization time, hospitalization expenses, first drinking time after surgery, diet time, exhaust time, time to get out of bed, pre-and post-operative self-rating anxiety scale (SAS) and self-rating depression scale (SDS) score, postoperative Barthel index and complication were compared between the two groups.@*Results@#The intraoperative blood loss, number of lymph node dissection, and operation time were almost the same between the two groups (all P>0.05). The hospitalization time (6.8±1.2 d versus 8.5±1.5 d) and expenses (58±10 thousand Yuan versus 69±12 thousand Yuan) were significantly reduced in The first drinking time after surgery(1.31±0.35 d versus 2.28±0.24 d), diet time(1.8±0.4 d versus 3.0±0.4 d), exhaust time(2.4±0.5 d versus 2.9±0.6 d), and time to get out of bed (12.0±2.4 d versus 16.8±2.5 d) were all earlier in the observation group (all P<0.05). The SAS and SDS score before the operation were similar between the two groups (all P>0.05), while post-operative SAS (57±7 versus 69±8) and SDS (57±4 versus 62±9) score were significantly decreased in the observation group (all P<0.05). The incidence rates of complication after surgery was 7.0%(3/43) in the observation group, which was significantly lower than the control group (27.9%, 12/43, P=0.011).@*Conclusion@#The combination of NOSES and EARS could reduce stress response, complications, recovery time and expense after surgery, while improving the quality of life in these patients.
ABSTRACT
Objective: To evaluate the effect of early preoperative mobilization on the rehabilitation of the elderly patients with hip fractures after operation. Methods: The clinical data of 16 elderly patients with hip fractures between February 2017 and April 2018 who met the selection criteria was retrospectively analyzed. There were 8 males and 8 females, with an average age of 80.3 years (range, 69-90 years). There were 8 cases of intertrochanteric fracture and 8 cases of femoral neck fracture. The preoperative American Society of Anesthesiologists (ASA) scored 2.94±0.43. There were 3 cases of cardiovascular and cerebrovascular diseases, 6 cases of essential hypertension, 5 cases of respiratory diseases, 3 cases of diabetes, and 2 cases of other system diseases. The time from injury to admission was 4 hours to 14 days with an average of 39.5 hours. On the day of admission or on the first day after admission, the patient started to exercise on the floor underwent analgesia treatment. And the patients were treated with closed reduction (9 cases) or artificial hip arthroplasty (7 cases). The time from admission to operation was 4 to 25 days, with an average of 7.4 days. At the time of admission, after the first ground movement before operation, on the second day after operation, and at last follow-up, the Barthel Index was used to assess the patients' self-care ability, and Barthel effectiveness (BE) was calculated. The complications were observed and recorded during follow-up. Results: All 16 patients underwent operation successfully. The hospital stay was 8 to 24 days, with an average of 14.1 days. All patients were followed up 2.5-16.0 months with an average of 6.5 months. One patient developed postoperative pulmonary infection; the remaining patients had no surgical-related complications. No patient died during the follow-up. The Barthel Index scored 30.63±5.56 at admission, 53.13±9.50 after the first ground movement before operation, 60.63±6.09 on the second day after operation, and 96.25±4.84 at last follow-up. There were significant differences in Barthel Index scores between different time points ( P<0.05). The BE was 0.23±0.06 after the first ground movement before operation, 0.30±0.04 on the second day after operation, and 0.66±0.06 at last follow-up. There were significant differences in BE between different time points ( P<0.05). Conclusion: For elderly patients with hip fractures who have long waiting time before operation, early preoperative mobilization has a positive impact on patients' activities of daily living.