武警新兵训练伤发生Logistic回归分析

目的 探讨武警新兵训练伤发生原因,为科学施训提供依据.方法 采用整群分层抽样选取样本,用自拟调查问卷在新兵训练3个月结束前进行问卷调查.结果 新兵入伍前是否受伤、睡眠情况与训练伤发生有统计学意义,OR值分别为0.586、1.204.结论 应严格选兵标准,在新训过程中通过各种方式提高新兵的睡眠质量,以期能快速适应高强度的军事训练,提高武警部队的战斗力.     

Auditory–cognitive training improves language performance in prelingually deafened cochlear implant recipients

Objectives

Phonological and working memory skills have been shown to be important for the development of spoken language. Children who use a cochlear implant (CI) show performance deficits relative to normal hearing (NH) children on all constructs: phonological skills, working memory, and spoken language. Given that phonological skills and working memory have been shown to be important for spoken language development in NH children, we hypothesized that training these foundational skills would result in improved spoken language performance in CI-using children.

Design

Nineteen prelingually deafened CI-using children aged 4- to 7-years-old participated. All children had been using their implants for at least one year and were matched on pre-implant hearing thresholds, hearing thresholds at study enrollment, and non-verbal IQ. Children were assessed on expressive vocabulary, listening language, spoken language, and composite language. Ten children received four weeks of training on phonological skills including rhyme, sound blending, and sound discrimination and auditory working memory. The remaining nine children continued with their normal classroom activities for four weeks. Language assessments were repeated following the training/control period.

Results

Children who received combined phonological-working memory training showed significant gains on expressive and composite language scores. Children who did not receive training showed no significant improvements at post-test. On average, trained children had gain scores of 6.35 points on expressive language and gain scores of 6.15 points whereas the untrained children had test–retest gain scores of 2.89 points for expressive language and 2.56 for composite language.

Conclusion

Our results suggest that training to improve the phonological and working memory skills in CI-using children may lead to improved language performance.     

The 70-degree telescope as a teaching tool for cleft palate repair and pharyngoplasty surgery

ObjectiveTo determine the optimum positioning of a 70-degree telescope to provide a maximum view of the palate and posterior pharynx for observers while minimally obstructing the direct view of a surgeon.DesignSimulator testing of clinical protocol.SettingSimulation center of an academic tertiary care children's hospital.InterventionsThe palate and pharynx of an infant airway mannequin was exposed with a Dingman mouthgag. A 4 mm, 70-degree endoscope was secured to the Mayo stand to provide a projected image of the simulated operative procedure. Various positions of the 70-degree telescope were photodocumented by manipulating the angle of the scope, the extension past the lower lip, and the distance of the scope tip away from the midline. Using a 4-point Likert scale, three surgeons rated the randomized photos from both the direct operative view and the projected endoscopic view.ResultsAverage rating for the adequacy of the view for pharyngeal surgery was 2.4/4.0 and for palate surgery was 3.1/4.0 (p = .001). Only 4 of 22 scope positions were rated as minimally obstructive to direct view by all three surgeons. Only 1 position – scope parallel and just lateral to the tongue blade – was rated as minimally obstructive and adequate for both pharyngeal and palatal surgery by all three surgeons.ConclusionsIn training centers, a 70-degree telescope attached to a Mayo stand may be useful for teaching and assessing cleft palate and pharyngoplasty surgery, while providing minimal obstruction to direct view by the surgeon.     

不同训练方法对人工耳蜗植入儿童术后康复效果影响的比较研究

目的：考察3种训练方法对人工耳蜗植入儿童术后康复效果的影响。方法随机选取2～7岁人工耳蜗植入儿童106人,其中34人接受综合感官训练法、36人接受音素辨听训练法、36人接受听觉口语训练法。采用《听障儿童听觉语言能力评估标准及方法》对所有听障儿童进行评估。结果不同训练方法对听障儿童的听觉、语言能力具有显著影响（P〈0.05）。结论综合感官训练法能在一定程度上帮助听障儿童提高语言能力,但听觉能力发展效果不佳;音素辨听训练法可促进听障儿童的细致辨听能力,但语言能力发展有限;听觉口语训练法能使听障儿童的听觉和言语能力得到均衡发展。     

我国飞行护士培养目标的探讨

目的：探讨我国飞行护士培养目标的具体内容,为未来选拔及培训飞行护士提供理论依据。方法采用文献分析法、专家访谈法形成专家咨询问卷,对不同领域的15名专家进行两轮Delphi专家咨询。结果构建了我国飞行护士培养的总体目标和具体目标,其中具体目标包括3个一级指标和22个二级指标。两轮专家咨询的问卷回收率均为100%,专家对一、二级指标的权威系数均在0.87以上,两轮咨询的所有肯德尔协调系数差异均有统计学意义（均P＜0.01）。结论专家的积极性和权威程度高,意见协调性好,所形成的培养目标合理,具有可操作性。     

Olfactory rehabilitation and olfactory bulb volume changes in patients after total laryngectomy: a prospective randomized study

IntroductionAfter total laryngectomy, decreased olfactory function and olfactory bulb volume shrinkage have been reported to occur due to olfactory deprivation caused by nasal airflow interruption. There is evidence that the olfactory system can be modulated by repeated exposure to odors in a procedure called olfactory training. However, it is not known whether any recovery of the lost olfactory bulb volume is possible by eliminating olfactory deprivation via olfactory rehabilitation long after laryngectomy.ObjectiveThis study examined the recovery of olfactory function and the change in olfactory bulb volume via long-term olfactory rehabilitation after total laryngectomy.MethodsPossible causes of olfactory dysfunction in the study participants were evaluated by collecting detailed anamnesis. As olfactory tests, orthonasal butanol threshold and odor discrimination tests were performed. Three-dimensional olfactory bulb volumes were calculated using manual segmentation on T2-weighted coronal magnetic resonance images. In olfactory rehabilitation, four different odors were applied to all patients orthonasally, using a larynx bypass technique for 30 min per day for 6 months. Olfactory tests were performed before the rehabilitation and after 6 months of rehabilitation, and olfactory bulb volume measurements were performed using magnetic resonance images.ResultsEleven patients diagnosed with advanced laryngeal cancer who underwent total laryngectomy and postoperative radiotherapy with a follow-up of 5–10 years were included in the study. All patients were male, and the mean age was 58.18 ± 4.17 years. In total laryngectomized patients, the olfactory bulb volumes measured on magnetic resonance images were 42.25 ± 12.8 mm³ before and 55.5 ± 11.22 mm³ after rehabilitation, and this increase was highly significant. Olfactory test scores were 2.3 ± 1.27 before and 4.39 ± 0.86 after rehabilitation, and this increase was also highly significant.ConclusionAs a result of the olfactory rehabilitation applied by providing orthonasal air flow, the olfactory function lost after total laryngectomy was improved considerably, and the olfactory bulb volume was significantly increased. The increase in olfactory bulb volume in total laryngectomy patients via olfactory rehabilitation to eliminate olfactory deprivation due to nasal airflow interruption was demonstrated for the first time in this prospective longitudinal study.     

Evaluation of a traditional birth attendant training programme in Bangladesh

Background and context

the 1997 Safe Motherhood Initiative effectively eliminated support for training traditional birth attendants (TBAs) in safe childbirth. Despite this, TBAs are still active in many countries such as Bangladesh, where 88% of deliveries occur at home. Renewed interest in community-based approaches and the urgent need to improve birth care has necessitated a re-examination of how provider training should be conducted and evaluated.

Objective

to demonstrate how a simple evaluation tool can provide a quantitative measure of knowledge acquisition and intended behaviour following a TBA training program.

Design

background data were collected from 45 TBAs attending two separate training sessions conducted by Bangladeshi non-governmental organization (NGO) Gonoshasthaya Kendra (GK). A semi-structured survey was conducted before and after each training session to assess the TBAs’ knowledge and reported practices related to home-based management of childbirth.

Setting

two training sessions conducted in Vatshala and Sreepur in rural Bangladesh.

Participants

45 active TBAs were recruited for this training evaluation.

Findings

there were significant improvements following the training sessions regarding how TBAs reported they would: (a) measure blood loss, (b) handle an apneic newborn, (c) refer women with convulsions and (d) refer women who are bleeding heavily. A greater degree of improvement, and higher scores overall, were observed among TBAs with no prior training and with less birth experience.

Key conclusions and recommendations for practice

as the Safe Motherhood community strives to improve safe childbirth care, the quality of care in pregnancy and childbirth for women who rely on less-skilled providers should not be ignored. These communities need assistance from governments and NGOs to help improve the knowledge and skill levels of the providers upon which they depend. Gonoshasthaya Kendra's extensive efforts to train and involve TBAs, with the aim of improving the quality of care provided to Bangladeshi women, is a good example of how to effectively integrate TBAs into safe motherhood efforts in resource-poor settings. The evaluation methodology described in this paper demonstrates how trainees’ prior experiences and beliefs may affect knowledge acquisition, and highlights the need for more attention to course content and pedagogic style.