Stress Management and Resiliency Training for public school teachers and staff: A novel intervention to enhance resilience and positively impact student interactions

BackgroundBurnout in teachers has been linked to decreased effectiveness as educators, and suboptimal interactions with students. The purpose of this pilot study was to assess the outcomes of a brief Stress Management and Resiliency Training (SMART) program for public school staff.Materials and methodsThis single-arm, prospective trial involved an investigation of the effects of a brief SMART program on participant stress, anxiety, resilience, gratitude, happiness, life satisfaction, and quality of life (QOL).ResultsSignificant improvements were noted in participant anxiety (P < 0.001), stress (P = 0.003), gratitude (P = 0.001), happiness (P < 0.001), life satisfaction (P < 0.001), and QOL (P < 0.001). Most participants reported that the skills learned positively affected interactions with students (77.2%) and coworkers (72.2%).ConclusionsThe SMART program showed promising effectiveness for improving anxiety, stress, gratitude, happiness, life satisfaction and QOL. Given the prevalence and impact of teacher burnout, larger, controlled trials and broader dissemination of the intervention are warranted.     

Ensayo clínico para determinar si el momento de administración del ácido tranexámico en la cirugía de prótesis total de rodilla con torniquete influye en el sangrado perioperatorio

Background and objectivesThe ideal timing of tranexamic acid administration in total knee arthroplasty with tourniquet remains unclear. Our primary objective was to prove if administering it before surgical incision, instead of before releasing the tourniquet, reduces postoperative bleeding. A second objective was to determine whether a second dose reduces post-operative bleeding.Material and methodsA prospective, double-blind clinical trial was performed on 212 patients scheduled for total knee arthroplasty. They were randomised into 4 groups. Tranexamic acid was administered before the surgical incision in “pre-induction groups” (1 and 2), and just before the tourniquet release in “pre-release groups” (3 and 4). Groups 2 and 4 received a second dose 3 hours post-surgery. Main outcome was postoperative bleeding (visible blood loss and calculated total bleeding). Secondary outcomes were haemoglobin variations, complications and transfusion rate.ResultsThe mean calculated total bleeding was 1563 ml (95%CI: 1445 to 1681) in preinduction groups versus 1576 ml (95%CI: 1439 to 1713) in pre-release groups (P = .9); 1579 ml (95%CI: 1452 to 1706) in single-dose groups versus 1559 ml (95%CI: 1431 to 1686) in double-dose groups (P = .82). One patient was transfused. The mean haemoglobin at discharge was 10.4 g/dl (95%CI: 10.2 to 10.7) in singledose groups versus 10.8 (95%CI: 10.6 to 11.1) in double-dose groups (P = .06).ConclusionsThere were no differences in bleeding or transfusion regarding the time of tranexamic acid administration. The second dose had not impact on outcomes.Trial registration: EudraCT 2016-000071-24.     

“Diabetes care at doorsteps”: A customised mobile van for the prevention,screening, detection and management of diabetes in the urban underprivileged populations of Delhi

Diabetes is on the rise in India and recently shown to be increasing in the urban underprivileged. Lack of awareness of the disease, its complications, combined with lack of financial resources among the underprivileged, often results in late detection and more complications in them. To combat this, healthcare delivered at the doorstep through the use of a customised mobile medical van is a potentially attractive option.We used a customized mobile van (included trained personnel, glucose meters, fundus evaluation camera, apparatus for detection of neuropathy and foot circulation and net enabled Skype calling for remote consultation) for educating general population regarding healthy lifestyle and screening, management and intervention in patients with diabetes.The project covered 10 underprivileged areas (n, 2,31,000 people) in Delhi. Total of 24,072 individuals (10.9% of total population) attended 352 awareness sessions. A total 3,12,347 visits (included repeat visits) were carried out for screening, education and management for obesity and diabetes. During screening (n, 16,834), 2933 subjects (18.7%) had high random blood glucose levels (>200 mg/dL) and had a blood pressure averaging 127.1 ± 23.6/81.3 ± 16.6 mm of mercury (n, 16,339). A pre-post intensive lifestyle counselling for 6 months in a subset of 352 diabetic patients (of which 77.8% i.e. n, 274 were overweight/obese) showed a significant lowering in weight (p < 0.001). In addition, 292 frontline workers and 256 paramedical workers were given training regarding lifestyle and diabetes, over 20 sessions.Based on achievements of this project of spreading awareness, screening, and management of diabetes and obesity in the large number of individuals in urban underprivileged colony, we believe this project could be extended to other cities and rural areas of India, and to other developing countries as well.     

Impact of new technologies on diabetes care

Technologies for diabetes management, such as continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) systems, have improved remarkably over the last decades. These developments are impacting the capacity to achieve recommended hemoglobin A1c levels and assisting in preventing the development and progression of micro- and macro vascular complications. While improvements in metabolic control and decreases in risk of severe and moderate hypoglycemia have been described with use of these technologies, large epidemiological international studies show that many patients are still unable to meet their glycemic goals, even when these technologies are used. This editorial will review the impact of technology on glycemic control, hypoglycemia and quality of life in children and youth with type 1 diabetes. Technologies reviewed include CSII, CGM systems and sensor-augmented insulin pumps. In addition, the usefulness of advanced functions such as bolus profiles, bolus calculators and threshold-suspend features will be also discussed. Moreover, the current editorial will explore the challenges of using these technologies. Indeed, despite the evidence currently available of the potential benefits of using advanced technologies in diabetes management, many patients still report barriers to using them. Finally this article will highlight the importance of future studies tailored toward overcome these barriers to optimizing glycemic control and avoiding severe hypoglycemia.     

医科院校学生心理危机管理浅探

结合医科院校学生心理危机管理的实践，阐述大学生心理危机的内涵、类型、特征及心理危机管理的特性，并从建立预警系统、增设心理委员、危机处理的专业化及危机干预策略等方面探讨在医科院校加强学生心理危机管理的对策。     

社会支持对企业员工工作倦怠的影响

目的了解企业员工的工作倦怠状况，探讨社会支持对企业员工工作倦怠的影响并提出组织管理建议。方法以社会支持问卷和MBI-GS问卷对588名企业员工进行调查。结果企业员工的工作倦怠程度并不高，但仍存在．且以情绪耗竭的程度教高；社会支持与工作倦怠及共各构面部分呈显着负相关，社会支持对工作倦怠及其各构面具有显着的预测力，结论社会支持对企业员工工作倦怠有一定的影响．应引起管理者的重视。     

肝细胞癌合并胆管癌栓患者术中癌栓的处理

目的 探讨肝细胞癌（HCC）合并胆管癌栓患者术中癌栓的处理方式和术后恢复过程。方法 对1995年1月-2002年12月手术治疗的27例HCC合并胆管癌栓情况进行回顾性总结和分析。结果 只有59．3％（16／27）患者行肝切除、胆管取癌栓及胆管引流术。全组术后并发症发生率为55．6％（15／27），术后30d病死率为22．2％（6／27）。结论 HCC合并胆管癌栓的预后差，早期诊断和外科手术治疗是改善此病预后的关键。     

Intersexualität

Zusammenfassung Intersexualität bezeichnet eine seltene Störung der somatosexuellen Differenzierung mit einer Inzidenz von etwa 2 pro 10.000 Geburten pro Jahr in Deutschland. Dahinter verbergen sich verschiedene Diagnosen einer vermehrten Virilisierung bei 46,XX-Karyotyp oder deutlich verminderter Virilisierung bei 46,XY-Karyotyp. Manchmal werden diese Störungen erst während der Pubertätsentwicklung entdeckt. Dann ist eine rasche Diagnostik zur Prognosestellung notwendig. Bei allen Jugendlichen mit Intersexualität muss das Management während der Pubertät viele Aspekte von der psychosexuellen Begleitung bis hin zur medizinischen Behandlung mit Hormonsubstitution oder Therapie und der Beratung hinsichtlich chirurgischer Maßnahmen enthalten.