NPF和S-A用于腭咽闭合功能不全的诊断和治疗

目的 探讨鼻咽纤维内窥镜(NPF)和可摘式语音辅助器(S-A)在诊断与治疗腭咽闭合功能不全(VPI)中的运用。方法 应用NPF确定腭咽闭合类型。制作可摘式语音辅助器(S-A)加语音训练改善患者语音障碍。结果 6例患者戴入S-A后，经过训练，5例患者语音清晰度达70％以上。1例达65％。基本正常率达83．3％。结论 S-A对于不宜再次手术治疗的VPI患者是有效的，临床上有一定运用价值。     

毒蛇咬伤的救护思维虚拟仿真教学平台的构建与应用

毒蛇咬伤是临床常见的急危重症,我院构建的“毒蛇咬伤的救护思维——以银环蛇为例”虚拟仿真实验教学平台,运用虚拟仿真技术、软件创造3D情景虚拟毒蛇咬伤患者环境、病情、抢救场景等,融合实践教学中的视觉、听觉、触觉等感官感受,虚实结合以临床思维串联基础护理、急救护理操作技术,实现“教”“学”“做”的三位一体.     

Psychosocial care for seriously injured children and their families: A qualitative study among Emergency Department nurses and physicians

Background

Approximately one in five children who sustain a serious injury develops persistent stress symptoms. Emergency Department nurses and physicians have a pivotal role in psychosocial care for seriously injured children. However, little is known about staff's views on this role.

Objective

Our aim was to investigate Emergency Department staff's views on psychosocial care for seriously injured children.

Methods

We conducted semi-structured interviews with 20 nurses and physicians working in an Australian Paediatric Emergency Department. We used purposive sampling to obtain a variety of views. The interviews were transcribed verbatim and major themes were derived in line with the summative analysis method. We also mapped participants’ strategies for child and family support on the eight principles of Psychological First Aid (PFA).

Results

Five overarching themes emerged: (1) staff find psychosocial issues important but focus on physical care; (2) staff are aware of individual differences but have contrasting views on vulnerability; (3) parents have a central role; (4) staff use a variety of psychosocial strategies to support children, based on instinct and experience but not training; and (5) staff have individually different wishes regarding staff- and self-care. Staff elaborated most on strategies related to the PFA elements ‘contact and engagement’, ‘stabilization’, ‘connection with social supports’ and least on ‘informing about coping’.

Conclusions

The strong notion of individual differences in views suggests a need for training in psychosocial care for injured children and their families. In addition, further research on paediatric traumatic stress and psychosocial care in the ED will help to overcome the current paucity of the literature. Finally, a system of peer support may accommodate wishes regarding staff care.     

Effectiveness of the Mental Health First Aid programme for general nursing students in Hong Kong: A randomised controlled trial

BackgroundInsufficient mental health related knowledge among healthcare professionals and students may lead to higher levels of stigma towards and increased social distance from mentally unwell patients. Moreover, university students enrolled in healthcare programmes are particularly susceptible to stress, depression, anxiety and other mental health problems.ObjectiveThis study evaluated the effectiveness of the Mental Health First Aid (MHFA) Programme for undergraduate general nursing students in improving their mental health literacy, decreasing their social distance from persons with mental health issues, increasing their mental health first-aid intention, and enhancing their confidence in assisting others. The programme was also extended the effectiveness to help students to maintain their own mental wellbeing.MethodsA randomised controlled trial study with a pre-test, post-test, and follow-up research design was conducted. Three hundred and fifty-eight students were recruited. The experimental group comprised 182 students, of whom 168 completed MHFA training and a post-test questionnaire in mid-2017, and 167 students completed a follow-up questionnaire early in 2018. Meanwhile, 175 and 165 of the 176 students in the control group completed the post-test and follow-up questionnaires, respectively.ResultsThe effectiveness of the MHFA programme was supported by the results of repeated measures analysis of variance with Greenhouse-Geisser correction. Significant interaction effects were found in mental health knowledge in recognition of depression (ηp² = 0.17; 95% CI: 0.24, 0.42), recognition of schizophrenia (ηp² = 0.16; 95% CI: 0.33, 0.47), depression social distance (ηp² = 0.20; 95% CI: ?0.41. ?0.22), schizophrenia social distance (ηp² = 0.31; 95% CI: ?0.58, ?0.37), confidence in helping (ηp² = 0.04; 95% CI: 0.11. 0.14), mental first-aid actions (ηp² = 0.08; 95% CI: 1.75, 2.90), and mental wellbeing (ηp² = 0.15; 95% CI: ?0.53, ?0.19).DiscussionMental illnesses present substantial challenges to healthcare professionals worldwide. MHFA training should be promoted locally and integrated within compulsory training and extracurricular activities in curricula developed for healthcare and general university students.ConclusionThis study confirms the benefits of MHFA for general nursing students in developing their professional understanding of and willingness to assist people with mental health problems, and in developing, maintaining, and improving their understanding of their own mental health.     

急性有机磷农药中毒(AOPP)院前急救50例

目的：评估院前急救中心现场就地治疗，口服有机磷农药急性中毒(AOPP)患者时的第1小时和第一个214小时。方法：①在现场急救时均以chE快速测定盒在第1小时内即刻作出轻、中、重AOPP的诊断，以准确地反映出AOPP时chE活力变化与中毒症状相平行的状态，以指导现场用药；对症继续治疗的第一个24小时内的患者测定chE动态，判断有无反跳出现。②在现场急救时，均做到即刻快速反复洗胃，谨防毒物从胃粘膜排泄入胃后的反复重吸收。③在chE快速测定盒监测chE活力动态变化下给予早期、足量、重复使用复能剂及并用阿托品及其综合症治疗。结果：13例轻度中毒、18例中度中毒者均治愈，19例重度中毒者10例治愈，4例好转，遗留有迟发性神经症，5例死亡。结论：①院前急救中现场抢救经口服中毒的AOPP患者采用chE快速测定盒监测chE活力变化对即刻作出轻、中、重中毒的诊断是可靠的；②快速、反复、彻底洗胃，依据chE活力变化做到早期足量重复使用复能剂，并用阿托品和相关综合治疗，对治疗口服中毒的AOPP患者有较好的疗效。     

脑外伤患者急诊救治与中西医护理体会

目的：探讨脑外伤患者急诊救治及中西医护理措施,为提高此类患者预后及生活质量提供可靠依据,保障患者生命安全。方法：24例脑外伤患者均进行临床急救,并给予中西医护理配合,记录患者护理前后心理焦虑、抑郁变化情况并给予统计学分析。结果：24例脑外伤患者经上述急救及中西医护理后,所有患者均痊愈出院,治疗成功率为100.00%,死亡率0.00%;患者经中西医护理后,其心理焦虑、抑郁情况均较护理前显著改善,且P〈0.05,对比结果具有统计学意义。结论：应用正确急救措施可获得满意急救效果,且患者经中西医护理后心理负面情绪得到显著改善,值得临床推广应用。     

1例肾移植术后患者合并应激性心肌病的急救与护理

总结1例肾移植术后ICU患者合并应激性心肌病的急救与护理经验。护理要点：专注病情变化,落实高效急救措施;快速准确评估,安全平稳转运;加强血流动力学监测,目标导向性液体管理;精准给药,观察药物疗效及不良反应;重视心理疏导与康复训练,做好转科准备和延续性护理。经过精心的治疗与护理,术后第16天,患者转入肾移植普通病房继续专科治疗,术后第38天,康复出院。     

院前急救对中重度急性有机磷农药中毒患者预后的影响研究

目的探讨研究院前急救对中重度急性有机磷农药中毒患者预后的影响。方法收集2009年6月～2011年6月于本院接受诊断和治疗的120例中重度急性有机磷农药中毒患者,随机分为对照组和观察组,每组60例,对照组患者在入院前未给予急救措施,观察组在入院前给予了急救措施,比较两组患者从服毒到开始实施急救所需的时间、并发症的发生率、治愈率、平均住院时间等指标之间的差异。结果观察组从发病到急救所需的时间和并发症的发生率明显低于对照组,治愈率明显高于对照组,观察组所需的住院时间比对照组的住院时间短,两组比较差异有统计学意义（P〈0.05）。结论院前急救可以有效地提高患者的治愈率,减少并发症的发生,缩短患者的住院时间,改善患者的预后。     

Failing to protect humanitarian workers: lessons from Britain and Voluntary Aid Detachments in the Second World War

Abstract

This paper draws on official records of international and British organizations, newspaper reports, and volunteer memoirs to study the failure to protect humanitarian workers in the Second World War. The Second World War saw a significant expansion in the use of air warfare and flying missiles and these technological advances posed a grave threat to civilians and humanitarian workers. In this context, the International Committee of the Red Cross advocated unsuccessfully to restrict air warfare and create safe hospital zones. The British Government grappled with the tension between military and humanitarian objectives in setting its bombardment policy. Ultimately, humanitarian principles were neglected in pursuit of strategic aims, which endangered civilians and left humanitarian workers particularly vulnerable. British Voluntary Aid Detachment nurses experienced more than six-fold greater fatality rates than civil defence workers and the general population. The lessons from failures to protect humanitarian workers in the face of evolutions in warfare remain profoundly relevant.