Chapter 12. Conclusion-Looking Ahead

Abstract

Attention is drawn to important themes thought likely to influence the continuing development of group care services for children and young people in the decade ahead. These include a poorly educated workforce, autonomous training, multi-disciplinary approaches, centres of excellence, diversified programs, new trends and issues shaping the future, and group care practice and the law.     

李氏一指禅推拿联合Vocastim-Master吞咽言语诊治仪治疗脑卒中吞咽功能障碍的疗效观察

目的 观察李氏一指禅推拿联合Vocastim-Master吞咽言语诊治仪治疗脑卒中吞咽功能障碍的疗效。方法 将60例脑卒中吞咽功能障碍患者随机分为对照组和观察组,每组30例,实际对照组完成30例,治疗组29例。两组均予以常规内科治疗及常规吞咽功能康复训练,对照组采用Vocastim-Master吞咽言语诊治仪治疗,观察组在对照组治疗的基础上联合李氏一指禅推拿治疗。治疗前和治疗3周后分别采用吞咽功能评分、改良曼恩吞咽能力评估量表（modified Mann assessment of swallowing ability,MMASA）评价吞咽功能,采用临床肺部感染评分（clinical pulmonary infection score,CPIS）评价肺部感染情况,采用改良Barthel指数（modified Barthel index,MBI）评价日常生活活动能力,采用肌骨超声测定舌骨—甲状软骨间距离缩短率（approximation shortening rate,ASR）,并根据治疗前后洼田饮水试验分级变化判定临床疗效。结果 与治疗前比较,治疗后两组患者吞咽功能评分、CPIS、舌骨与甲状软骨之间的最短距离（minimum hyoid-larynx approximation,MIHLA）显著降低（P＜0.05）,MMASA评分、MBI、ASR显著升高（P＜0.05）;观察组吞咽功能评分、CPIS、MIHLA降低程度和MMASA评分、MBI、ASR升高程度显著大于对照组（P＜0.05）。观察组基于洼田饮水试验分级的临床疗效明显优于对照组（P＜0.05）。结论 李氏一指禅推拿联合Vocastim-Master吞咽言语诊治仪治疗能够改善脑卒中的吞咽功能障碍患者吞咽功能,降低肺部感染发生率,提高日常生活活动能力,修复舌骨与甲状软骨相互靠近的机制。     

A fast ultrasound-assisted extraction procedure for trace elements determination in hair samples by ICP-MS for forensic analysis

An ultrasound-assisted extraction method is proposed for the determination of trace elements in hair samples by inductively coupled plasma-mass spectrometry (ICP-MS) for forensic investigation. Prior to analysis, 25 mg of hair samples were accurately weighed into (15 mL) conical tubes. Then, 2 mL of 20% HNO₃ is added to the samples, sonicated at 2 min (50 W, 100% amplitude), and then further diluted to 10 mL with Milli-Q water. Resulted diluted slurries are centrifuged and the analytes are directly determined in the supernatant. Calibrations against aqueous solutions were carried out with rhodium as internal standard. The method was successfully applied for the extraction of Al, As, Ba, Be, Cd, Co, Cr, Cu, Mn, Pb, Tl, U, V and Zn with a method detection limit (3 s, n = 20) of 0.1, 0.4, 0.2, 0.09, 0.08, 0.04, 0.1, 2.9, 1.0, 0.9, 0.04, 0.05, 0.1 and 4.2 ng/g, respectively. Method accuracy is traceable to Certified Reference Materials (CRMs) 85 and 86 human hair from the International Atomic Energy Agency (IAEA). Additional validation data are provided based on the analysis of hair samples from the trace elements intercomparison program operated by the Institut National de Sante’ Publique du Quebec, Canada. The proposed method is very simple and can be applied for forensic purposes with the elimination of sample digestion step prior to analysis. Then, a considerable improvement in the sample throughput is archived with the use of the proposed method.     

海洛因成瘾者美沙酮维持治疗心理矫治综述

对海洛因成瘾者的戒毒需要药物治疗,更需要心理干预与社会支持.美沙酮维持治疗门诊要有效提高维持率,保证维持治疗效果,对受治者进行综合干预是必不可少的.加强在治疗初期对戒毒者的心理干预力度,戒毒者才能长期坚持治疗,达到美沙酮维持治疗效果.     

脑卒中后吞咽障碍的针灸康复思路探析

针刺治疗结合康复训练对促进脑卒中后吞咽障碍患者吞咽功能的恢复、改善生命质量具有重要意义.中医辨证辨经相结合,吞咽功能及时筛查与系统评估相结合,整体察病,对脑卒中后吞咽障碍患者的全面评估及康复治疗有重要的指导意义.可根据吞咽分期五期模式分期论治:认知期阴阳失调,窍闭神匿,治神为本,取之督脉;口腔准备期和口腔期清窍失养,气...     

基于Brunnstrom理论探讨脑卒中后肩手综合征的中西医结合诊疗策略

肩手综合征（shoulder-hand syndrome,SHS）是脑卒中后常见的以肩手肿胀、疼痛为主要特征的并发症,早期诊断和治疗对患者功能恢复具有积极意义。将现代康复理念与中医基础理论相结合,基于Brunnstrom理论探讨SHS不同时期的多学科综合治疗策略具有重要意义。BrunnstromⅠ期促进患者运动能力的建立,Brunnstrom Ⅱ~Ⅲ期平衡肌群间肌张力,Brunnstrom Ⅳ~Ⅵ期纠正异常运动模式、强化运动协调性。     

Compulsory mental health care in Norway: The treatment criterion

The Norwegian government has chosen to retain a treatment criterion in the Mental Health Care Act despite the opposition of several user organizations. From a critical user perspective, the only reason for using coercion to require mental health treatment is that the individuals are in a state where they are an immediate danger to themselves and/or their surroundings. This articles aims, first, to provide an overview of research studies concerning the benefits or harmfulness of involuntary treatment after coerced admission and, second, to evaluate studies that try to compare involuntary with voluntary treatment. A systematic overview of studies of compulsory mental health care with regard to treatment criteria, coercion in mental health, and involuntary admission published over the last decade was examined in detail, along with a secondary manual search of references cited in identified publications. Few studies have been conducted on the effect of compulsory mental health care, and the results have been contradictory. More randomized studies are needed to document the kinds of effects that the use of compulsory treatment has on treatment results. Another issue that needs further examination is whether the use of coercion should be transferred to legal bodies with an adjudicatory process.     

Violent behavior and the factors associated with the decision to report it: a retrospective study

An ample volume of research evidence supports the conclusion that severe mental illness is correlated with violent behavior. While episodes of violent behavior are included in medical notes, not all episodes of violent behavior are officially reported to the police, even when they are actual crimes. We conducted a retrospective study on the already existing clinical files of four public psychiatric outpatient facilities, based in Southern Italy, in order to assess how many cases of violent behavior are actually reported and which variables are more frequently connected with the decision to report. The data shows that the episodes known to the health services, in number and seriousness, vastly outnumber the complaints actually made towards their patients.     

手术并发症发生因素与医疗过错鉴定

医疗损害案件中因手术并发症而导致的占了很大的比重。发生手术并发症的发生原因可归结为医疗与患者两个方面。医疗方面的因素主要包括手术人员的责任心不强、医学基础知识欠缺、医疗技术生疏、诊断失误、术后护理及管理缺陷等;患者方面的因素主要有自身解剖变异、个体体质差异等。手术并发症产生的原因大多是可以被认知的,在此基础上判断产生手术并发症的医疗行为是否有过错时不能一概而论,应遵循一定的标准。建议按照医学理论和实际操作能力划分为两个标准,预见义务采用＂医学水平＂标准;防范义务采用＂医疗水平＂标准。通过两个＂标准＂来综合考量手术并发症才是科学的。     

基于营救目的实施的逼供行为之法律效果——以欧洲人权法院Gfgen v.Germany案判决为例

在欧洲人权法院看来,基于营救目的实施的逼供行为违反《欧洲人权公约》第3条,应当排除被告人于审前程序作出的所有认罪口供。在被告人于庭审时重新作出认罪口供的情况下,欧洲人权法院认为,以不人道待遇获取的认罪口供洐生的实物证据可以不排除。内国法院使用这样的实物证据用于检验该认罪口供的真实性并未侵犯被告人不自证己罪的权利和公平审判的权利。