Precipitants of post-traumatic stress disorder following intensive care: a hypothesis generating study of diversity in care

Objective This prospective observational study was designed to explore the relationships between post-traumatic stress disorder (PTSD), patients' memories of the intensive care unit (ICU) and sedation practices. Design Prospective multi-centre follow-up study out to 3 months after ICU discharge. Setting Two district general hospitals and three teaching hospitals across Europe. Patients and participants Two hundred and thirty-eight recovering, post-ventilated ICU patients. Interventions None. Measurements and results Assessment of patients' memories of ICU was undertaken at 1–2 weeks post ICU discharge. Patients' psychological recovery was assessed by examining the level of PTSD-related symptoms and rate of PTSD by 3 months post ICU. The rate of defined PTSD was 9.2%, ranging from 3.2% to 14.8% in the different study ICUs. Independent of case mix and illness severity, the factors found to be related to the development of PTSD were recall of delusional memories, prolonged sedation, and physical restraint with no sedation. Conclusion The development of PTSD following critical illness is associated with a number of different precipitating factors that are in part related to how patients are cared for within intensive care. This study raises the hypothesis that the impact of care within the ICU has an impact on subsequent psychological morbidity and therefore must be assessed in future studies looking at the way patients are sedated in the ICU and how physical restraint is used.     

老年胆道外科疾病100例围手术期护理

目的:探讨老年胆道外科疾病患者的围手术期护理方法。方法:对100例老年胆道外科疾病患者术前做好全面检查,积极治疗伴随疾病,术后密切观察病情,做好管道护理,重视健康指导。结果:本组治愈97例,病情危重自动放弃治疗2例,死亡1例。结论:术前做好充分准备,积极治疗伴随疾病,术后密切观察病情,做好健康指导,是提高手术安全性和减少并发症的关键。     

清热醒神颗粒治疗脑卒中阳闭证的临床研究

目的 :观察清热醒神颗粒治疗脑卒中阳闭证的临床疗效。方法 :选择符合脑卒中中西医诊断标准及中医证候诊断为阳闭证病人 78例 ,随机分为治疗组 46例和对照组 3 2例。治疗组运用清热醒神颗粒配合醒脑净注射液静脉输注 ,对照组单用醒脑净注射液静脉输注 ,治疗2 1d后采用脑卒中疗效评定标准和Glasgow意识障碍判断标准评价临床疗效及意识障碍改善情况。结果 :治疗组临床疗效及意识障碍改善明显优于对照组 ,有统计学意义 (P <0 .0 5 )。结论 :清热醒神颗粒能明显提高脑卒中阳闭证的治疗效果 ,是治疗脑卒中阳闭证安全有效的药物。     

2011-2017年河北省甲型H1N1流感流行特征分析

目的掌握河北省甲型H1N1流感的流行特征,为流感防控提供科学依据.方法通过中国流感监测信息系统收集河北省2011年4月至2017年3月流感及流感样病例(influenza-likeillness,ILI)监测数据进行统计分析.结果共检测ILI标本77 008份,甲型H1N1流感病毒核酸阳性2 699份,阳性率3.50％.对2 699例甲型H1N1流感病例进一步分析显示:全省11个地市均有该病例检出,男女比例为1.09:1,各年龄组均可发病,检出率最高的是25～59岁组,最低0～4岁组.2011年11月至2017年3月共出现4次流行,具有明显的季节性,且呈单峰性.各年度均有甲型H1N1流感病例检出,甲型H1N1流感分别是2012-2013、2013-2014和2016-2017年度的优势病原.结论河北省甲型N1N1流感流行具有明显的季节性,冬春季流行,近年来感染以5～14岁年龄组为主.     

Acute viral respiratory infections among children in MERS‐endemic Riyadh,Saudi Arabia, 2012–2013

The emergence of the Middle East Respiratory Syndrome (MERS) in Saudi Arabia has intensified focus on Acute Respiratory Infections [ARIs]. This study sought to identify respiratory viruses (RVs) associated with ARIs in children presenting at a tertiary hospital. Children (aged ≤13) presenting with ARI between January 2012 and December 2013 tested for 15 RVs using the Seeplex^R RV15 kit were retrospectively included. Epidemiological data was retrieved from patient records. Of the 2235 children tested, 61.5% were ≤1 year with a male: female ratio of 3:2. Viruses were detected in 1364 (61.02%) children, 233 (10.4%) having dual infections: these viruses include respiratory syncytial virus (RSV) (24%), human rhinovirus (hRV) (19.7%), adenovirus (5.7%), influenza virus (5.3%), and parainfluenzavirus‐3 (4.6%). Children, aged 9–11 months, were most infected (60.9%). Lower respiratory tract infections (55.4%) were significantly more than upper respiratory tract infection (45.3%) (P < 0.001). Seasonal variation of RV was directly and inversely proportional to relative humidity and temperature, respectively, for non MERS coronaviruses (NL63, 229E, and OC43). The study confirms community‐acquired RV associated with ARI in children and suggests modulating roles for abiotic factors in RV epidemiology. However, community‐based studies are needed to elucidate how these factors locally influence RV epidemiology. J. Med. Virol. 89:195–201, 2017 . © 2016 Wiley Periodicals, Inc.

     

Case series of rash associated with influenza B in school children

This case series describes morbilliform and other rash presentations among schoolchildren during a March 2014 outbreak of influenza‐like illness (ILI) in British Columbia, Canada. Multiplex nucleic acid testing of nasopharyngeal specimens and paired serologic investigations identified that influenza B, characterized as B/Massachusetts/02/2012‐like (Yamagata‐lineage), was the only viral aetiology and most likely cause of ILI and rash. An association between influenza B and rash has been described infrequently elsewhere, and not previously in North America. Influenza B should be considered in the differential diagnosis of febrile exanthem. Evaluation of the nature, incidence and contributing agent–host–environment interactions, and immunologic mechanisms to possibly explain influenza‐associated rash is warranted.