(中德康復(fù)技術(shù)培訓(xùn)課件)2406康復(fù)技術(shù)培訓(xùn) 神經(jīng)康復(fù)

BDH-ClinicHessischOldendorfProf.Dr.JensD.RollnikMedicalDirectorInstituteforNeurorehabilitationResearch(InFo)歡迎BDH-ClinicHessischOldendorfPSchedule9:30 Welcome-meeting(Prof.Rollnik)歡迎見(jiàn)面會(huì)9:35 LectureonneurologicalrehabilitationinGermany (Prof.Rollnik)講座---神經(jīng)康復(fù)在德國(guó)10:15 TouroftheBDH-ClinicHessischOldendorf(Dr.Lenzand co-workers)參觀BDH-ClinicHessischOldendorf11:30 Questiontime(Dr.Lenz)提問(wèn)環(huán)節(jié)12:00 Lunchtimesnack午餐時(shí)間Schedule9:30 Welcome-meetingBDH-ClinicHess.Oldendorf-non-profitorganisation非營(yíng)利性組織-TeachingHospitalofHannoverMedicalSchool漢諾威醫(yī)學(xué)院教學(xué)醫(yī)院-InstituteforNeurorehabilitationResearch(InFo),MedicalSchoolHannover漢諾威醫(yī)學(xué)院神經(jīng)康復(fù)研究所-KTQ-certified,certifiedStrokeUnit優(yōu)質(zhì)-透明-醫(yī)療服務(wù)合作培訓(xùn)中心，中風(fēng)單元培訓(xùn)中心-113hospitalbeds(incl.25ICU-and39IMC-beds)and140rehabilitationbeds113張臨床床位（包括ICU25張，IMC39張）康復(fù)床位140張-400employees400名員工BDH-ClinicHess.Oldendorf-nonNewICUInvestment: 10.000.000€資產(chǎn)投入：一千萬(wàn)歐元ICU-beds: 25ICU床位：25NewICUInvestment: 10.000.000NewICU全新的ICU病區(qū)NewICU全新的ICU病區(qū)NewICU全新的ICU病區(qū)NewICU全新的ICU病區(qū)Neuroimaging–MRIandCT神經(jīng)影像設(shè)備—核磁及CTNeuroimaging–MRIandCT神經(jīng)影像Thesix-phasemodeloftheFederalRehabilitationCouncil(BAR,1994)聯(lián)邦康復(fù)委員會(huì)六級(jí)模式（聯(lián)邦康復(fù)學(xué)會(huì)，1994）Thesix-phasemodeloftheFedSix-phasemodeloftheGermanFederalRehabilitationCouncil德意志聯(lián)邦康復(fù)委員會(huì)六級(jí)模式資方主體健康保險(xiǎn)公司健康保險(xiǎn)公司健康保險(xiǎn)公司私人保險(xiǎn)公司雇主及私保公司護(hù)理及健康保險(xiǎn)公司聯(lián)邦康復(fù)學(xué)會(huì)分段分段特點(diǎn)急診入院治療早期康復(fù)巴塞爾量表得分六級(jí)模式由德國(guó)聯(lián)邦康復(fù)委員會(huì)確立對(duì)早期康復(fù)影響較大的，急性期，需要密集治療的，包括輔助呼吸病人康復(fù)分級(jí)仍處在需要高度護(hù)理及醫(yī)療處置期的康復(fù)分級(jí)處于大部分獲得深度日常獨(dú)立活動(dòng)能力，剩余康復(fù)以后續(xù)治療為主醫(yī)療專業(yè)康復(fù)達(dá)到2級(jí)，包括門(mén)診隨診長(zhǎng)期維持性看護(hù)，轉(zhuǎn)相關(guān)?？芐ix-phasemodeloftheGermanXXPhaseB(EarlyRehabilitation)B級(jí)早期康復(fù)-admissiontoneurologicalandneurosurgicalearlyrehabilitationimmediatelyafteracute-carehospitalstay神內(nèi)/外科早期入院，急診處理后立即進(jìn)入康復(fù)-patientssufferfromdisordersofconsciousness意識(shí)障礙病人-patientsneedmechanicalventilationandmonitoringonICUorIMCwardsICU或IMC病房需要機(jī)械通氣及監(jiān)護(hù)的病人-challenge:multiresistantgerms挑戰(zhàn)：多重耐藥性細(xì)菌PhaseB(EarlyRehabilitation)DRG-System:OPS8-552診斷相關(guān)分類系統(tǒng)DRG-System:OPS8-552診斷相關(guān)分類PhaseB–AdmissiondiagnosesB級(jí)入院診斷(Rollnik&Janosch,2010)早期康復(fù)病例的診斷相關(guān)分類，降序或頻率診斷相關(guān)分類比例男/女平均年齡平均住院時(shí)間腦缺血顱腦外傷腦出血蛛網(wǎng)膜下腔出血缺氧性損害腫瘤形成感染,傳染性疾病脊髓損傷，截癱格林巴利綜合癥其他診斷總計(jì)PhaseB–AdmissiondiagnosesPhaseB–OutcomeB級(jí)結(jié)果(RollnikundJanosch,2010)排除類別，降序或頻率排除類別轉(zhuǎn)后續(xù)康復(fù)轉(zhuǎn)院轉(zhuǎn)其他護(hù)理機(jī)構(gòu)常規(guī)轉(zhuǎn)出死亡自動(dòng)轉(zhuǎn)出轉(zhuǎn)臨終關(guān)懷PhaseB–OutcomeB級(jí)結(jié)果(R(Rollnik,2013)PhaseB–OutcomeB級(jí)結(jié)果年齡巴塞爾量表改變(Rollnik,2013)PhaseB–OutcoPhaseB–lengthofstay(LOS)(RollnikundJanosch,2010)病例百分比住院時(shí)間（月）住院時(shí)間（病程）PhaseB–lengthofstay(LOS)PhaseB–LOS病程(RollnikundJanosch,2010)平均住院時(shí)間（天）早期康復(fù)巴塞爾量表得分區(qū)間PhaseB–LOS病程(RollnikundPhaseB–Weaningfrommechanicalventilation取下呼吸機(jī)(Rollniketal.,2010)-Mortality:6.1%死亡-Weaningwassuccessfulafterameanof12.9(12.0)daysofneurologicalearlyrehabilitation早期康復(fù)中，平均12.9±12.0天可以成功取下呼吸機(jī)PhaseB–WeaningfrommechaniPhaseB–Mechanicalventilation機(jī)械通氣(Rollniketal.,2010)Outcome結(jié)果n%1.Succesfulweaning成功取下呼吸機(jī)5668.32.Dischargetoanotherhospital,stillonventilation轉(zhuǎn)院，仍使用呼吸輔助1619.53.Dischargetoalong-termcarefacility,stillonventilation轉(zhuǎn)入長(zhǎng)期看護(hù)，仍呼吸輔助56.14.Death死亡56.1Sum82100PhaseB–Mechanicalventilati-Resultsfromamulticenterstudy(Oehmichenetal.,2012)多中心研究結(jié)果-n=1486,69.8%weanedsuccessfully1486例，69.8%成功取下呼吸機(jī)PhaseB–Mechanicalventilation機(jī)械通氣-ResultsfromamulticenterstPhaseB–Multiresistantgerms多重耐藥細(xì)菌PhaseB–Multiresistantgerms-highprevalenceofESBL-producinggram-negativebacteria:11.8%大腸埃希菌高發(fā)病率，革蘭氏陰性細(xì)菌11.8%-MRSAprevalence:11.4%抗藥性金黃色葡萄球菌發(fā)病率11.4%SUM:Oneoutoffourearlyrehabilitationpatientsiscolonizedwithmultiresistantgermsonadmission!小結(jié)：四分之一的早期康復(fù)病人入院時(shí)遭遇多重耐藥菌感染PhaseB–Multiresistantgerms多重耐藥細(xì)菌-highprevalenceofESBL-produPhaseB–MRSAandoutcome抗藥性金黃色葡萄球菌及結(jié)果PhaseB–MRSAandoutcome抗藥MRSApositiveMRSAnegativep-value*Age[years]65.8(15.1)67.0(15.8)n.s.Lengthofstay(LOS)–referringhospital[days]32.8(42.9)34.4(260.5)n.s.LOS–neurologicalearlyrehabilitation[days]63.7(37.1)25.8(24.5)<0.001LOS–entireneurologicalrehabilitation[days]75.0(42.5)46.8(47.1)<0.001Numberofco-diagnoses[n]20.5(5.1)13.3(5.5)<0.001BarthelIndex(BI)onadmission[0to100]13.6(9.9)25.6(24.1)<0.001Barthelindexondischarge[0to100]25.5(21.2)47.4(31.0)<0.001EarlyRehabilitationIndex(ERI)onadmission[-325to0]-80.1(59.5)-47.9(47.6)<0.001ERIondischarge[-325to0]-47.3(51.4)-26.0(35.4)<0.001ComaRemissionScale(CRS)[0to24]昏迷量表得分11.0(6.2)14.0(6.8)n.s.GlasgowComaScale(GCS)[3to15]格拉斯哥昏迷量表9.5(3.2)12.0(3.3)<0.001Earlyfunctionalabilities(EFA)–vegetative[4to20]8.6(3.0)12.4(7.0)<0.001EFA–faciooral[4to20]9.2(5.0)15.4(5.3)<0.001EFA–sensorymotor[7to35]14.4(6.9)22.8(8.2)<0.001EFA–cognitive[5to25]13.3(6.4)18.7(5.2)<0.001Totalmaintherapies[min/day]131.6(16.6)140.2(18.7)<0.001(Rollnik,2014)PhaseB–MRSAandoutcome抗藥性金黃色葡萄球菌及結(jié)果抗藥性金黃色葡萄球菌(+)抗藥性金黃色葡萄球菌(-)年齡住院時(shí)間早期康復(fù)時(shí)間全部康復(fù)時(shí)間共同診斷數(shù)巴塞爾量表得分轉(zhuǎn)出時(shí)巴塞爾量表得分入院時(shí)早期康復(fù)指數(shù)得分傳出時(shí)早期康復(fù)指數(shù)得分早期功能評(píng)定—營(yíng)養(yǎng)早期功能評(píng)定—面口早期功能評(píng)定—感覺(jué)，運(yùn)動(dòng)早期功能評(píng)定—認(rèn)知MRSApositiveMRSAnegativep-vaPhaseB–ESBLandoutcome大腸埃希菌及結(jié)果(Rollnik,2015)PhaseB–ESBLandoutcome大腸埃PhaseCC級(jí)-patientsarestilldependentonnursing,buttheydon`tneedICUorIMC患者仍需支持護(hù)理，但不需要ICU或IMC-patientscooperatemoreandmoreactively患者日趨活躍，并合作良好PhaseCC級(jí)PhaseCC級(jí)PhaseCC級(jí)PhaseC–diagnoses診斷(Rollnik,2009)PhaseC–diagnoses診斷(RollniPhaseC–OutcomeC級(jí)結(jié)果(Rollnik,2009)PhaseC–OutcomeC級(jí)結(jié)果(RollPhaseC–OutcomeC級(jí)結(jié)果(Rollnik,2009)PhaseC–OutcomeC級(jí)結(jié)果(RollnPhaseC–LOSC級(jí)病程(Rollnik,2009)PhaseC–LOSC級(jí)病程(Rollnik,MEmbeR-studyonmedical-occupationalrehab

職業(yè)醫(yī)療康復(fù)的研究-DesignoftheMEmbeR-study:研究設(shè)計(jì)Multicenter多中心Multipleindications(neurological,psychiatric,orthopedics,internalmedicine)多學(xué)科參與

Prospective預(yù)期MEmbeR-studyonmedical-occupaMEmbeR:Centers多中心分布MEmbeR:Centers多中心分布MEmbeR:Studysample研究樣本-meanage34.1(9.9)y,113m,83f平均年齡34.1±9.9歲，男113，女83-LOS:148.6(SD=223)days(approx.5months),range10–1080

病程：平均148.6天，標(biāo)準(zhǔn)差223，（約5個(gè)月）范圍處于10-1080天

r=-0.47(p<0.001)

(Rollniketal.,2014)MEmbeR:Studysample研究樣本(RolMEmbeR:Unfitforwork無(wú)法適應(yīng)工作Before:69.9%,24monthsafterrehabonly5.6%康復(fù)前：69.9%，康復(fù)24個(gè)月后僅5.6%(Rollniketal.,2014)MEmbeR:Unfitforwork無(wú)法適應(yīng)工作MEmbeR:Jobless失業(yè)Before:19.9%,24monthsafterrehab:3.1%康復(fù)前19.9%，24個(gè)月康復(fù)后3.1%(Rollniketal.,2014)MEmbeR:Jobless失業(yè)(RollniketMEmbeR:Returntowork(Rollniketal.,2014)24monthsaftermedicaloccupationalrehabilitation,153/196(78.1%)returnedtowork!職業(yè)醫(yī)療康復(fù)24個(gè)月后，78.1%病人回歸社會(huì)工作生活回歸工作MEmbeR:Returntowork(RollnikSummary-TheFederalRehabilitationCouncilhasestablishedasuccessful6-phasemodelforneurologicalandneurosurgicalpatients.聯(lián)邦康復(fù)委員會(huì)為神內(nèi)/外系統(tǒng)成功推出6級(jí)康復(fù)模式-TheBDH-ClinicoffersinpatientrehabilitationfromphaseA(acute-carehospitaltreatment)toE(medical-occupationalrehab)本中心提供A-E共五級(jí)康復(fù)-Earlyrehabilitationallowsrehabilitationofmechanicallyventilatedandcriticallyillpatients.Weaningissuccesfulinapprox.70%ofcases.早期康復(fù)接受機(jī)械通氣及嚴(yán)重病患70%可以成功轉(zhuǎn)入下一級(jí)別-Theburdenofmultiresistantgerms(MRSA,ESBL)ischallenginginneurologicalearlyrehabilitation(prevalenceonadmission:approx.25%).對(duì)于早期神經(jīng)系統(tǒng)康復(fù)，多重耐藥菌（抗藥性金黃色葡萄球菌、ESBL菌）的壓力是一大挑戰(zhàn)（入院病人約25%）-PatientscolonizedwithMRSAorESBL-producingbacteriahaveaworseoutcome(lowerfunctionalstatusonadmission,highermorbidity).抗藥性金黃色葡萄球菌、ESBL菌感染病人預(yù)后普遍較差，（入院時(shí)功能狀態(tài)較差，高發(fā)病率）-Medical-occupationalrehabilitationhelpspatientstoreturntowork(twoyearsafterrehabapprox.80%returntowork)!職業(yè)醫(yī)療康復(fù)有效幫助患者回歸工作（2年內(nèi)約80%）SummaryContactThankyouforyourattention!謝謝Prof.Dr.med.JensD.RollnikMedicalDirectorBDH-ClinicHessischOldendorfprof.rollnik@bdh-klinik-hessisch-oldendorf.deTel.+495152781231ContactBDH-ClinicHessischOldendorfProf.Dr.JensD.RollnikMedicalDirectorInstituteforNeurorehabilitationResearch(InFo)歡迎BDH-ClinicHessischOldendorfPSchedule9:30 Welcome-meeting(Prof.Rollnik)歡迎見(jiàn)面會(huì)9:35 LectureonneurologicalrehabilitationinGermany (Prof.Rollnik)講座---神經(jīng)康復(fù)在德國(guó)10:15 TouroftheBDH-ClinicHessischOldendorf(Dr.Lenzand co-workers)參觀BDH-ClinicHessischOldendorf11:30 Questiontime(Dr.Lenz)提問(wèn)環(huán)節(jié)12:00 Lunchtimesnack午餐時(shí)間Schedule9:30 Welcome-meetingBDH-ClinicHess.Oldendorf-non-profitorganisation非營(yíng)利性組織-TeachingHospitalofHannoverMedicalSchool漢諾威醫(yī)學(xué)院教學(xué)醫(yī)院-InstituteforNeurorehabilitationResearch(InFo),MedicalSchoolHannover漢諾威醫(yī)學(xué)院神經(jīng)康復(fù)研究所-KTQ-certified,certifiedStrokeUnit優(yōu)質(zhì)-透明-醫(yī)療服務(wù)合作培訓(xùn)中心，中風(fēng)單元培訓(xùn)中心-113hospitalbeds(incl.25ICU-and39IMC-beds)and140rehabilitationbeds113張臨床床位（包括ICU25張，IMC39張）康復(fù)床位140張-400employees400名員工BDH-ClinicHess.Oldendorf-nonNewICUInvestment: 10.000.000€資產(chǎn)投入：一千萬(wàn)歐元ICU-beds: 25ICU床位：25NewICUInvestment: 10.000.000NewICU全新的ICU病區(qū)NewICU全新的ICU病區(qū)NewICU全新的ICU病區(qū)NewICU全新的ICU病區(qū)Neuroimaging–MRIandCT神經(jīng)影像設(shè)備—核磁及CTNeuroimaging–MRIandCT神經(jīng)影像Thesix-phasemodeloftheFederalRehabilitationCouncil(BAR,1994)聯(lián)邦康復(fù)委員會(huì)六級(jí)模式（聯(lián)邦康復(fù)學(xué)會(huì)，1994）Thesix-phasemodeloftheFedSix-phasemodeloftheGermanFederalRehabilitationCouncil德意志聯(lián)邦康復(fù)委員會(huì)六級(jí)模式資方主體健康保險(xiǎn)公司健康保險(xiǎn)公司健康保險(xiǎn)公司私人保險(xiǎn)公司雇主及私保公司護(hù)理及健康保險(xiǎn)公司聯(lián)邦康復(fù)學(xué)會(huì)分段分段特點(diǎn)急診入院治療早期康復(fù)巴塞爾量表得分六級(jí)模式由德國(guó)聯(lián)邦康復(fù)委員會(huì)確立對(duì)早期康復(fù)影響較大的，急性期，需要密集治療的，包括輔助呼吸病人康復(fù)分級(jí)仍處在需要高度護(hù)理及醫(yī)療處置期的康復(fù)分級(jí)處于大部分獲得深度日常獨(dú)立活動(dòng)能力，剩余康復(fù)以后續(xù)治療為主醫(yī)療專業(yè)康復(fù)達(dá)到2級(jí)，包括門(mén)診隨診長(zhǎng)期維持性看護(hù)，轉(zhuǎn)相關(guān)?？芐ix-phasemodeloftheGermanXXPhaseB(EarlyRehabilitation)B級(jí)早期康復(fù)-admissiontoneurologicalandneurosurgicalearlyrehabilitationimmediatelyafteracute-carehospitalstay神內(nèi)/外科早期入院，急診處理后立即進(jìn)入康復(fù)-patientssufferfromdisordersofconsciousness意識(shí)障礙病人-patientsneedmechanicalventilationandmonitoringonICUorIMCwardsICU或IMC病房需要機(jī)械通氣及監(jiān)護(hù)的病人-challenge:multiresistantgerms挑戰(zhàn)：多重耐藥性細(xì)菌PhaseB(EarlyRehabilitation)DRG-System:OPS8-552診斷相關(guān)分類系統(tǒng)DRG-System:OPS8-552診斷相關(guān)分類PhaseB–AdmissiondiagnosesB級(jí)入院診斷(Rollnik&Janosch,2010)早期康復(fù)病例的診斷相關(guān)分類，降序或頻率診斷相關(guān)分類比例男/女平均年齡平均住院時(shí)間腦缺血顱腦外傷腦出血蛛網(wǎng)膜下腔出血缺氧性損害腫瘤形成感染,傳染性疾病脊髓損傷，截癱格林巴利綜合癥其他診斷總計(jì)PhaseB–AdmissiondiagnosesPhaseB–OutcomeB級(jí)結(jié)果(RollnikundJanosch,2010)排除類別，降序或頻率排除類別轉(zhuǎn)后續(xù)康復(fù)轉(zhuǎn)院轉(zhuǎn)其他護(hù)理機(jī)構(gòu)常規(guī)轉(zhuǎn)出死亡自動(dòng)轉(zhuǎn)出轉(zhuǎn)臨終關(guān)懷PhaseB–OutcomeB級(jí)結(jié)果(R(Rollnik,2013)PhaseB–OutcomeB級(jí)結(jié)果年齡巴塞爾量表改變(Rollnik,2013)PhaseB–OutcoPhaseB–lengthofstay(LOS)(RollnikundJanosch,2010)病例百分比住院時(shí)間（月）住院時(shí)間（病程）PhaseB–lengthofstay(LOS)PhaseB–LOS病程(RollnikundJanosch,2010)平均住院時(shí)間（天）早期康復(fù)巴塞爾量表得分區(qū)間PhaseB–LOS病程(RollnikundPhaseB–Weaningfrommechanicalventilation取下呼吸機(jī)(Rollniketal.,2010)-Mortality:6.1%死亡-Weaningwassuccessfulafterameanof12.9(12.0)daysofneurologicalearlyrehabilitation早期康復(fù)中，平均12.9±12.0天可以成功取下呼吸機(jī)PhaseB–WeaningfrommechaniPhaseB–Mechanicalventilation機(jī)械通氣(Rollniketal.,2010)Outcome結(jié)果n%1.Succesfulweaning成功取下呼吸機(jī)5668.32.Dischargetoanotherhospital,stillonventilation轉(zhuǎn)院，仍使用呼吸輔助1619.53.Dischargetoalong-termcarefacility,stillonventilation轉(zhuǎn)入長(zhǎng)期看護(hù)，仍呼吸輔助56.14.Death死亡56.1Sum82100PhaseB–Mechanicalventilati-Resultsfromamulticenterstudy(Oehmichenetal.,2012)多中心研究結(jié)果-n=1486,69.8%weanedsuccessfully1486例，69.8%成功取下呼吸機(jī)PhaseB–Mechanicalventilation機(jī)械通氣-ResultsfromamulticenterstPhaseB–Multiresistantgerms多重耐藥細(xì)菌PhaseB–Multiresistantgerms-highprevalenceofESBL-producinggram-negativebacteria:11.8%大腸埃希菌高發(fā)病率，革蘭氏陰性細(xì)菌11.8%-MRSAprevalence:11.4%抗藥性金黃色葡萄球菌發(fā)病率11.4%SUM:Oneoutoffourearlyrehabilitationpatientsiscolonizedwithmultiresistantgermsonadmission!小結(jié)：四分之一的早期康復(fù)病人入院時(shí)遭遇多重耐藥菌感染PhaseB–Multiresistantgerms多重耐藥細(xì)菌-highprevalenceofESBL-produPhaseB–MRSAandoutcome抗藥性金黃色葡萄球菌及結(jié)果PhaseB–MRSAandoutcome抗藥MRSApositiveMRSAnegativep-value*Age[years]65.8(15.1)67.0(15.8)n.s.Lengthofstay(LOS)–referringhospital[days]32.8(42.9)34.4(260.5)n.s.LOS–neurologicalearlyrehabilitation[days]63.7(37.1)25.8(24.5)<0.001LOS–entireneurologicalrehabilitation[days]75.0(42.5)46.8(47.1)<0.001Numberofco-diagnoses[n]20.5(5.1)13.3(5.5)<0.001BarthelIndex(BI)onadmission[0to100]13.6(9.9)25.6(24.1)<0.001Barthelindexondischarge[0to100]25.5(21.2)47.4(31.0)<0.001EarlyRehabilitationIndex(ERI)onadmission[-325to0]-80.1(59.5)-47.9(47.6)<0.001ERIondischarge[-325to0]-47.3(51.4)-26.0(35.4)<0.001ComaRemissionScale(CRS)[0to24]昏迷量表得分11.0(6.2)14.0(6.8)n.s.GlasgowComaScale(GCS)[3to15]格拉斯哥昏迷量表9.5(3.2)12.0(3.3)<0.001Earlyfunctionalabilities(EFA)–vegetative[4to20]8.6(3.0)12.4(7.0)<0.001EFA–faciooral[4to20]9.2(5.0)15.4(5.3)<0.001EFA–sensorymotor[7to35]14.4(6.9)22.8(8.2)<0.001EFA–cognitive[5to25]13.3(6.4)18.7(5.2)<0.001Totalmaintherapies[min/day]131.6(16.6)140.2(18.7)<0.001(Rollnik,2014)PhaseB–MRSAandoutcome抗藥性金黃色葡萄球菌及結(jié)果抗藥性金黃色葡萄球菌(+)抗藥性金黃色葡萄球菌(-)年齡住院時(shí)間早期康復(fù)時(shí)間全部康復(fù)時(shí)間共同診斷數(shù)巴塞爾量表得分轉(zhuǎn)出時(shí)巴塞爾量表得分入院時(shí)早期康復(fù)指數(shù)得分傳出時(shí)早期康復(fù)指數(shù)得分早期功能評(píng)定—營(yíng)養(yǎng)早期功能評(píng)定—面口早期功能評(píng)定—感覺(jué)，運(yùn)動(dòng)早期功能評(píng)定—認(rèn)知MRSApositiveMRSAnegativep-vaPhaseB–ESBLandoutcome大腸埃希菌及結(jié)果(Rollnik,2015)PhaseB–ESBLandoutcome大腸埃PhaseCC級(jí)-patientsarestilldependentonnursing,buttheydon`tneedICUorIMC患者仍需支持護(hù)理，但不需要ICU或IMC-patientscooperatemoreandmoreactively患者日趨活躍，并合作良好PhaseCC級(jí)PhaseCC級(jí)PhaseCC級(jí)PhaseC–diagnoses診斷(Rollnik,2009)PhaseC–diagnoses診斷(RollniPhaseC–OutcomeC級(jí)結(jié)果(Rollnik,2009)PhaseC–OutcomeC級(jí)結(jié)果(RollPhaseC–OutcomeC級(jí)結(jié)果(Rollnik,2009)PhaseC–OutcomeC級(jí)結(jié)果(RollnPhaseC–LOSC級(jí)病程(Rollnik,2009)PhaseC–LOSC級(jí)病程(Rollnik,MEmbeR-studyonmedical-occupationalrehab

職業(yè)醫(yī)療康復(fù)的研究-DesignoftheMEmbeR-study:研究設(shè)計(jì)Multicenter多中心Multipleindications(neurological,psychiatric,orthopedics,internalmedicine)多學(xué)科參與

Prospective預(yù)期MEmbeR-studyonmedical-occupaMEmbeR:Centers多中心分布MEmbeR:Centers多中心分布MEmbeR:Studysample研究樣本-meanage34.1(9.9)y,113m,83f平均年齡34.1±9.9歲，男113，女83-LOS:148.6(SD=223)days(approx.5months),range10–1080

病程：平均148.6天，標(biāo)準(zhǔn)差223，（約5個(gè)月）范圍處于10-1080天

r=-0.47(p<0.001)

(Rollniketal.,2014)MEmbeR:Studysample研究樣本(RolMEmbeR:Unfitforwork無(wú)法適應(yīng)工作Before:69.9%,24month