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《Neuro-Chirurgie》2023,69(3):101420
ObjectiveVagus nerve stimulation (VNS) therapy has been used for more than two decades to treat drug resistant epilepsy and depression and most recently received FDA approval for stroke rehabilitation. Expanding indications will renew the interest in the technique and increase the number of surgeons to be trained. The aim of this study was to survey surgeons with substantial expertise on optimal teaching and training approaches.MethodsAnonymous forms comprising 16 questions were sent by e-mail to surgeons with substantial expertise. Statistical analyses were used to compare the answers of the most experienced surgeons (>5 years) with the less experienced ones (<5 years).ResultsFully-completed forms were collected from 57 experts from 20 countries. The placement of the helical coils was deemed to be the most difficult step by 36 (63.2%) experts, and the use of optical magnification during this step was deemed necessary by 39 (68.4%) experts. Vocal cord palsy should be largely avoidable with proper surgical technique according to 44 (77.2%) experts. The teaching tool considered the most useful was mentoring (38, 66.7%). The future of VNS surgery teaching was deemed to be in anatomical workshops (29, 50.9%) and surgical simulation (26, 45.6%). Overall, answers did not vary significantly according to experience.ConclusionsVNS surgery should be mastered by actively participating in dedicated practical training courses and by individual mentoring during actual surgery, which is still the best way to learn. This study highlights the need for a formal training course and possible specific accreditation.  相似文献   
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Lipid nanoparticles (LNPs) are becoming popular as a means of delivering therapeutics, including those based on nucleic acids and mRNA. The mRNA-based coronavirus disease 2019 vaccines are perfect examples to highlight the role played by drug delivery systems in advancing human health. The fundamentals of LNPs for the delivery of nucleic acid- and mRNA-based therapeutics, are well established. Thus, future research on LNPs will focus on addressing the following: expanding the scope of drug delivery to different constituents of the human body, expanding the number of diseases that can be targeted, and studying the change in the pharmacokinetics of LNPs under physiological and pathological conditions. This review article provides an overview of recent advances aimed at expanding the application of LNPs, focusing on the pharmacokinetics and advantages of LNPs. In addition, analytical techniques, library construction and screening, rational design, active targeting, and applicability to gene editing therapy have also been discussed.  相似文献   
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《Australian critical care》2022,35(3):279-285
IntroductionThere is high paediatric morbidity and mortality in northwestern Nigeria, attributable in part to vaccine-preventable illnesses and lack of comprehensive training of medical and nursing staff in the healthcare delivery of paediatric critical care. Pediatric Universal Life-Saving Effort Inc. (PULSE), a New York–based nonprofit organisation with a mission to develop paediatric critical care in resource-limited settings, collaborated with Aminu Kano University Teaching Hospital to decrease the gaps in knowledge and skills of medical and nursing personnel. The joint effort also aims to address and remove barriers to the delivery of paediatric critical care in northwestern Nigeria. The primary objective was to perform a needs assessment for paediatric intensive care resources in northwestern Nigeria, identify barriers to delivering these services, and designate a hub for the development of paediatric critical care educational programs for healthcare professionals.MethodsAn anonymous survey was designed and distributed using SurveyMonkey® online software to medical and nursing staff from nine healthcare institutions in northwestern Nigeria.ResultsAnalysis from 67 responses revealed that care delivered to critically ill paediatric patients was by anaesthesiologists (77%), pediatricians (26%), and adult intensive care specialists (10%). The acquisition of clinical skills was perceived to be an essential need (65%), followed by adequate staffing of critical care units (19%), continuing medical and nursing education (13%), and availability of medical equipment (3%).DiscussionThere is an identified need for paediatric critical care training and resources in northwestern Nigeria.ConclusionThe needs assessment conducted has provided important results that will form the basis for building staff capacity and training programs for paediatric critical care in northwestern Nigeria.  相似文献   
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In this letter to the editor, we would like to show in our hospital how our nurse team manage formation during coronavirus disease 2019 pandemic.  相似文献   
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目的 评价沉浸式虚拟现实(immersive virtual reality,IVR)认知训练对主观认知下降(subjective cognitive decline,SCD)、轻度认知障碍(mild cognitive impairment,MCI)、阿尔茨海默病(Alzheimer’s disease,AD)患者认知功能、日常生活活动能力和负性情绪的影响。方法 计算机检索Pubmed、Embase、CINAHL、PsycINFO等11个中英文数据库和临床试验注册平台,检索时限为从建库至2021年4月27日。纳入IVR认知训练对SCD、MCI、AD患者认知功能等的干预效果的随机对照试验和类实验性研究。由2名研究者独立进行文献筛选、资料提取、文献质量评价后,采用RevMan 5.4进行Meta分析。结果 共纳入8篇文献,包括406例患者。Meta分析结果显示,IVR认知训练有助于改善MCI或AD患者的总体认知功能[SMD=0.37,95%CI(0.15,0.60),P=0.001],短期记忆[SMD=0.62,95%CI(0.19,1.04),P=0.005],日常生活活动能力[SMD=0.84,95%CI(0.57,1.11),P<0.001],但在执行功能[SMD=-0.24,95%CI(-0.56, 0.08),P=0.140],长期记忆[SMD=0.00,95%CI(-0.42,0.41),P=0.990]方面差异无统计学意义,在负性情绪方面的干预效果尚不明确。此外,目前尚缺乏IVR认知训练对SCD人群的干预研究。结论 IVR认知训练有助于改善MCI或AD患者的认知功能和日常生活活动能力。受纳入研究数量的限制及干预任务有一定的异质性,上述结论尚待更多大样本研究进行验证。此外,IVR认知训练在SCD人群中的干预效果尚待探索。  相似文献   
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目的 调查5省基层卫生技术人员医防融合相关培训状况以及相关知识能力的需求状况,为完善我国基层医防融合建设,提高基层卫生服务机构防病治病能力提供参考建议。方法 对五个省15个区县的乡镇卫生院和社区卫生服务中心(站)的卫生技术人员进行分层抽样问卷调查,对调查数据进行描述并对各种医防融合相关知识能力需求进行单因素χ2检验和多因素logistic分析。结果 76.0%的基层卫生技术人员近一年参加过培训,乡镇卫生院卫生技术人员培训参与率(73.2%)低于社区卫生服务中心(站)(84.3%)(χ2= 83.812,P<0.001),不同特征基层卫生技术人员培训参与率不同(P<0.01)。各类培训参与率均低于相关知识技能的需求率,公共卫生相关知识技能的需求率最高。χ2检验和多因素logistic分析显示不同特征基层卫生技术人员对各类知识技能的需求率不同:相对于社区卫生服务中心(站),乡镇卫生院人员对传染病防控技能(OR = 0.756,95%CI:0.666~0.858)和一般病与常见病诊疗技能(OR = 0.860,95%CI:0.762~0.971)的需求程度更高;临床医疗岗位人员对传染病防控技能及一般病与常见病诊疗技能、的需求程度更高(P<0.001);年轻人员对慢病管理与病因监测技能的需求更高(OR = 0.937,95%CI:0.885~0.992);公共卫生岗位人员(OR = 1.346,95%CI:1.114~1.626)和专职管理岗位人员(OR = 2.334,95%CI:1.707~3.191)对信息化技能的需求程度更高。结论 应以需求为导向,加强基层卫生技术人员的培训强度,提升培训内容和知识技能需求的匹配程度,建立完善医防交叉培训机制和医防能力兼备的复合型人才培养供给体系。  相似文献   
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《Pain Management Nursing》2022,23(4):504-516
BackgroundIn 2020, the COVID-19 virus sparked a crisis constituting a nationwide public health emergency that rapidly altered the provision of healthcare services for all Americans. Infectious disease mitigation led to widespread lockdowns of perceived nonessential services, programs, and non-emergent healthcare interventions. This lockdown exacerbated the public health dyad of uncontrolled pain and the opioid epidemic, which was already in a crisis state. Current literature supports the management of uncontrolled pain with a biopsychosocial approach, empowering patients to explore self-care to enhance activities of daily living. Pain Coping Skills Training (PCST) delivers real-life strategies that improve quality of life and strengthen self-efficacy. Self-efficacy has been identified as a patient outcome measure that demonstrates improved patient-perceived function and quality of life despite pain intensity. Studies have shown that nurse practitioners (APRN) are well-positioned to provide PCST to chronic pain sufferers.MethodsA pretest-posttest design was utilized for this project to enhance pain self- efficacy through an APRN-led community-based intervention.InterventionCommunity-dwelling adults treated in a specialty pain management practice were self-selected to participate in a 6-week telehealth delivered PCST Program. This APRN delivered program presented basic pain education and a broad range of evidence-based nonpharmacologic pain management self-care tools. The primary outcome was improved Pain Self-efficacy measured with the pain self-efficacy questionnaire (PSEQ), with secondary outcomes of improved perceived pain intensity and function measured with the pain, enjoyment, and general activity (PEG) scale tracked weekly.ResultsBaseline PSEQ and weekly PEG scores were obtained and compared to scores after the program. Collateral data points included confidence in using complementary and alternative nonpharmacologic interventions, satisfaction with the program, and a qualitative patient statement regarding pre-and post-intervention participation.ConclusionsThis project concluded that a Nurse Practitioner delivered PCST program via telehealth technology could provide community-dwelling adults with an intervention that improves pain self-efficacy, enhances self-reported PEG measures, and meets the social distancing requirements that continue to impact patients during the COVID-19 pandemic.  相似文献   
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