Development of a trail running injury screening instrument: A multiple methods approach

ObjectiveTo develop a trail running injury screening instrument (TRISI) for utilisation as clinical decision aid in determining if a trail runner is at an increased risk for injury.DesignMultiple methods approach.MethodsThe study utilised five phases 1) identification of injury risk factors 2) determining the relevance of each identified risk factor in a trail running context, 3) creating the content of the Likert scale points from 0 to 4, 4) rescaling the Likert scale points to determine numerical values for the content of each Likert scale point, and 5) determining a weighted score for each injury risk factor that contributes to the overall combined composite score.ResultsOf the 77 identified injury risk factors, 26 were deemed relevant in trail running. The weighted score for each injury risk factor ranged from 2.21 to 5.53 with the highest calculated score being 5.53. The final TRISI includes risk categories of training, running equipment, demographics, previous injury, behavioural, psychological, nutrition, chronic disease, physiological, and biomechanical factors.ConclusionThe developed TRISI aims to assist the clinician during pre-race injury screening or during a training season to identify meaningful areas to target in designing injury risk management strategies and/or continuous health education.     

外籍模拟患者活动在本科《多元文化与护理》课程教学中的应用

目的提高《多元文化与护理》课程教学效果。方法以33名涉外护理本科生作为研究对象,在《多元文化与护理》课程中增加15学时的外籍模拟患者教学活动,包括文化访谈、情景模拟视频拍摄等。结果教学结束后,护生课程考试成绩为(72.73±7.01)分;跨文化护理自我效能感3个分量表得分显著高于教学前(P0.05,P0.01),护生对增加外籍模拟患者教学活动的认同率为53.3%～83.3%。结论在本科护生《多元文化与护理》课程教学中增加外籍模拟患者活动,可有效保证教学效果,提高护生跨文化护理自信心。     

Non intentional burns in children: Analyzing prevention and acute treatment in a highly developed country

The objective of this study was to evaluate where and when pediatric burn injuries occurred. Furthermore the quality of first aid treatment, ratio of skin grafting and length of hospital stay were evaluated.The patient records of 749 children with acute burns admitted to the University Children’s Hospital of Zurich, Switzerland, were retrospectively reviewed over an 11-year period.Burn injuries in children with an immigrant background were overrepresented in our study population, whereby the proportion of immigrants decreased with rising age.Sixty-five percent of all patients received some form of first aid. Of those 4.5% did not comply with the current guidelines. Furthermore initial assessment of total body surface area (TBSA) by the first line physician was overestimated in 76% of cases.Flame injuries occurred mainly in summertime in outdoor settings and needed significant more often skin grafts than scalds, which mainly occurred indoors and in wintertime. As a result, patients with flame injuries had to stay significantly longer in hospital (flames: 21 days (range: 1–259 days; median: 30; interquartile range (IQR): 30) versus scalds: 7 days (range: 1–130 days; median: 7; IQR: 12); p < 0.001). Furthermore high voltage injuries often resulted in lower-leg amputations (n = 3; 43%).Based on these facts, targets for the improvement of a prevention campaign and the treatment for burned children were named.     

Droit à mourir et suicide assisté : état des lieux et analyse critique

ObjectivesIn the context of the present re-examination of the French bioethical laws by the National Advisory Ethics Committee (“Comité consultatif national d’éthique”: CCNE), a recent survey indicated a request of the public opinion to obtain a medical aid in end of life and a so-called “assisted suicide”. This led psychiatrists to re-consider their role and deontological position which usually led them to consider a request for an assistance in suicide as – a priori – a pathological demand, occurring within a suicidal crisis. The present article intends to: 1) describe the laws and practices of countries which allow medically assisted end of life help procedures; 2) clarify the definitions of “assisted suicide”, “assistance to suicide” and “euthanasia”; 3) consider available epidemiological data and the roles given to doctors and, more specifically psychiatrists, in these procedures; 4) analyse the rationale behind these demands. These considerations should enable French psychiatrists to clarify their position when facing requests for a medical aid in dying.MethodsFour European countries (Switzerland, the Netherlands, Belgium, Luxemburg) and Oregon (the first US state to introduce legislation) were considered, since they accumulated and published a large amount of experiences and data about “assisted suicide” and medical help in dying. In total, 127 articles were selected, mainly from PubMed and Cairn databases, published between 1997 and 2020. These articles deal with legal considerations, epidemiological data, ethical and sociological considerations.ResultsLaws and practices differ notably according to the state/country. In Belgium, the Netherlands and Luxemburg, as in Oregon, the medical help in dying has been de-criminalized, as long as certain legal criteria are met. In Switzerland, where no specific law exists in the penal code, non-governmental associations have benefited from the legal vacuum and organized the practice of “assisted suicide” for “altruistic motives”. In the scientific and legal literature, the terms used to describe and define the medical help in dying upon request differ greatly. In France, the National Advisory Ethics Committee defines euthanasia (“euthanasie”), assisted suicide (“suicide assisté”) and suicide assistance (“assistance au suicide”). Available epidemiological data, whatever the country considered, indicate that requests for a medical aid in dying are expressed mainly by patients aged over 60 years and suffering from cancer. Psychiatric diseases account for only 1% to 3%. Most often, systematic assessment by a psychiatrist is neither requested nor made, when the demand does not occur during a primary psychiatric illness. In the case of an existing primary psychiatric pathology, a psychiatrist assesses the case against formal legal predefined criteria. This latter practice was only recently introduced, after some feedback and after legal actions had been brought to Court. When the underlying motivations of the request are considered, it appears that, even in the absence of an evolving psychiatric condition, several psychological or psychopathological reasons prevail such as spirituality, attachment style, social isolation, despair, depression… which should greatly benefit psychiatric exploration, investigation and expertise.ConclusionIn some countries, the request for medically assisted help in dying has become a legal and social reality. In France, where the public debate is still open, it should be emphasized that a psychiatric assessment and interview should be systematically provided to any person requesting medical assistance to die or commit suicide. It is the commitment of psychiatrists to understand the implicit demands and unexpressed motives underlying this request which have strong links with the unique life-events and emotional experiences of the person. The psychiatrist has a unique role in the contextualization of such a request.     

透明帽辅助下胃镜食道异物取出术的临床效果及安全性观察

目的探讨透明帽辅助下胃镜食道异物取出术的临床效果及安全性。方法按随机数字表法将2018年1月—2019年2月就诊于驻马店市中心医院的94例食管异物者分为对照组与研究组各47例。对照组行常规电子胃镜取物,研究组行透明帽辅助下胃镜食道异物取出术。对比两组取物时间、异物取出成功率、黏膜损伤率、视野清晰度、患者耐受情况及并发症发生情况。结果研究组异物取出时间为(8.29±3.38)min,短于对照组的(15.15±4.68)min,差异有统计学意义;研究组异物取出成功率为97..87%,高于对照组的82.98%,黏膜损伤率为19.15%,低于对照组的38.30%,差异有统计学意义;研究组视野清晰度优于对照组,差异有统计学意义;研究组耐受优良率为82.98%,高于对照组的57.45%,差异有统计学意义;研究组渗血发生率为4.26%,低于对照组的17.02%,差异有统计学意义;两组穿孔发生率对比,差异无统计学意义。结论透明帽辅助下胃镜食道异物取出术视野清晰度较高,可有效缩短取物操作时间,改善患者耐受性,减轻食道黏膜损伤,减少渗血的发生,安全性较高。     

巴彦淖尔市老年与非老年院前急救患者流行病学调查

目的 调查巴彦淖尔市医院院前急救患者流行病学情况，探讨该市老年与非老年院前急救患者的特点。方法 回顾性收集巴彦淖尔市医院2017 年7 月～2018 年7 月资料完整的院前急救患者，根据患者年龄分为老年组（≥60 岁）和非老年组（＜60 岁）。比较两组患者的疾病谱构成及不同病种随时间变化的趋势。结果 共纳入5215例院前急救患者，老年组2349 例，非老年组2866 例。老年组院前急救患者以神经类疾病（11.4%）、创伤类统疾病（9.0%）、心血管疾病（7.3%）、其他包括糖尿病、多器官衰竭（6.6%）为主，非老年组中以创伤类疾病（21.7%）、神经系统（12.0%）、心血管系统（9.2%）、呼吸系统（6.8%）为主。收住重症监护室患者中，老年组疾病中以心血管系统疾病（11.8%）、神经系统疾病（11.6%）、呼吸系统（7.4%）为主，非老年组以创伤类疾病（16.9%）、心血管系统疾病（10.3%）为主。心血管系统在老年组与非老年组峰值不同，在老年中峰值出现在06：00～9：00；非老年在各个时间段分布无明显差异。呼吸系统在老年组与非老年组趋势相似，高峰都在18：00 点以后。结论 老年和非老年患者院前急救的数量在时间、疾病谱的分布上各具特点，创伤类疾病、神经系统、心血管系统疾病分别为巴彦淖尔市医院最常见的院前急救原因，急诊资源有效配置，有效提高诊治能力。     

院前急救担架员配置及社会化服务方式探索

承担院前急救搬抬服务的担架员是院前急救医疗服务的重要组成部分,因各种各样的原因全国大部分急救单元不配备或少配备担架员,影响了院前急救工作效率。该文以青岛市院前急救为例,通过分析院前急救担架员的配置现状、存在问题及分析,提出合理配备院前急救担架员的必要性,并积极调研其他地市急救中心的做法,探索院前急救担架员社会化服务方式。     

Impact of a decision-aid tool on influenza vaccine coverage among HCW in two French hospitals: A cluster-randomized trial

IntroductionNosocomial outbreaks of seasonal influenza are frequent, and vaccination is largely recommended for healthcare workers (HCWs). Vaccine coverage in French HCWs does not exceed 20%. Decision-aids (DA) are potential useful interventions to increase vaccine coverage (VC). Our aim was to evaluate the impact of a DA on HCWs influenza vaccine coverage.Material and methodsProspective cluster-randomized trial conducted in 83 departments in two public hospitals (a teaching and a non-teaching hospital) during the 2018–2019 flu season.Distribution of the DA and of questionnaire about decisional conflict and knowledge in the departments randomized in the intervention group.ResultsA total number of 3 547 HCWs were concerned by the study (1 953 in the intervention group, 1 594 in the control group). Global VC was 35.6% during the 2018–2019 season, instead of 23.6% in the 2017–2018 season (p < 0.005). During the 2018–2019 season, VC was 31% (95% CI 28.7–33.3) in the control group and 38.7% (95% CI 36.5–40.9) in the intervention group (p < 0.005). Among the 158 HCWs exposed to the DA who answered the survey, 51.3% had no decisional conflict. HCWs without decisional conflict were more prone to get vaccinated before flu season.ConclusionThe use of the DA was associated with a 25% relative increase in VC among HCWs against seasonal influenza. This modest increase remained far from the WHO 75% target, but may have reduced the number of nosocomial. Multi-component interventions are needed to increase VC in HCWs.     

Risk communication in a patient decision aid for radiotherapy in breast cancer: How to deal with uncertainty?

Background and aimPatient decision aids for oncological treatment options, provide information on the effect on recurrence rates and/or survival benefit, and on side-effects and/or burden of different treatment options. However, often uncertainty exists around the probability estimates for recurrence/survival and side-effects which is too relevant to be ignored. Evidence is lacking on the best way to communicate these uncertainties. The aim of this study is to develop a method to incorporate uncertainties in a patient decision aid for breast cancer patients to support their decision on radiotherapy.MethodsFirstly, qualitative interviews were held with patients and health care professionals. Secondly, in the development phase, thinking aloud sessions were organized with four patients and 12 health care professionals, individual and group-wise.ResultsConsensus was reached on a pictograph illustrating the whole range of uncertainty for local recurrence risks, in combination with textual explanation that a more exact personalized risk would be given by their own physician. The pictograph consisted of 100 female icons in a 10 x 10 array. Icons with a stepwise gradient color indicated the uncertainty margin. The prevalence and severity of possible side-effects were explained using verbal labels.ConclusionsWe developed a novel way of visualizing uncertainties in recurrence rates in a patient decision aid. The effect of this way of communicating risk uncertainty is currently being tested in the BRASA study (NCT03375801).     

My patient is injured: identifying foreign bodies with ultrasound

Patients commonly present to the emergency department with a suspected retained foreign body, following penetrating injury. While plain radiography is often the first line in identifying radio-opaque foreign bodies, radiolucent foreign bodies such as wood and plastic can easily be missed. Furthermore, real-time visualization of such a foreign body can assist in its removal. This article evaluates the use of point-of-care ultrasound by emergency physicians in the identification and removal of soft-tissue foreign bodies along with describing the appropriate technique and highlighting the potential pitfalls. An illustrated case example is presented that highlights the benefits of point-of-care ultrasound foreign body detection and guided removal.