院前急救对急性出血性脑卒中患者的影响

目的:分析和探讨院前急救对急性出血性脑卒中患者预后及死亡率的影响。方法:选取急诊科150例急性出血性脑卒中患者,其中107例经院前急救给予心电监护、吸氧、镇静、脱水降颅压等初步处理后送往石景山医院急诊科就诊,43例自行来院(未经任何处理,由家属直接送入医院)。对两组患者进行分析比较。结果:107例患者经过院前急救,预后良好率37.4%,植物生存率9.3%,死亡率5.6%;而其余43例患者预后良好率11.6%,植物生存率32.6%,死亡率23.2%。院前急救在争取院内救治时间、降低病死率和神经系统并发症等方面均具有显著的作用和效果。结论:及时有效的院前救治大大降低了急性出血性脑卒中的植物生存率和病死率,对于进一步提高抢救成功率和预后生存质量起到了至关重要的作用。     

A critical review of the effects of wearable cameras on memory

The rise of “lifelogging” in this era of rapid technological innovation has led to great interest in whether or not such technologies could be used to rehabilitate memory. Despite the growing number of studies using lifelogging, such as with wearable cameras, there is a lack of a theoretical framework to support its effective use. The present review focuses on the use of wearable cameras. We propose that wearable cameras can be particularly effective for memory rehabilitation if they can evoke more than a mere familiarity with previous stimuli, and reinstate previous thoughts, feelings and sensory information: recollection. Considering that, in memory impairment, self-initiated processes to reinstate previous encoding conditions are compromised, we invoke the environmental support hypothesis as a theoretical motivation. Twenty-five research studies were included in this review. We conclude that, despite the general acceptance of the value of wearable cameras as a memory rehabilitation technique, only a small number of studies have focused on recollection. We highlight a set of methodological issues that should be considered for future research, including sample size, control condition used, and critical measures of memory and other domains. We conclude by suggesting that research should focus on the theory-driven measure of efficacy described in this review, so that lifelogging technologies can contribute to memory rehabilitation in a meaningful and effective manner.     

Feasibility,acceptability, and effectiveness of a decision aid versus an informational website to promote clinical trial decision-making among cancer patients: A pilot randomized controlled trial

ObjectiveTo assess intervention feasibility and acceptability, and compare the effectiveness of the CHOICES Decision Aid (DA) versus the National Cancer Institute (NCI) Cancer Clinical Trials (CCT) website to improve knowledge about CCTs and preparedness to make an informed decision.MethodsOncology patients (n = 101) with a scheduled clinic visit were enrolled and randomized. Decision-making variables were collected at two timepoints. Post-intervention scores were examined via paired t-tests and multivariate regression analyses. Predictors of the magnitudes of the change in scores were examined in multivariable regression analyses.ResultsThe interventions were feasible to implement and acceptable to participants. Both interventions increased objective and subjective knowledge, improved clarity of opinions, and reduced decisional conflict (p-values < 0.01). Improvements in the belief that one could find out about CCTs were observed in the CHOICES DA arm (p < 0.001). Multivariable analyses controlling for educational attainment showed no significant differences in the magnitude of change in outcome variables between intervention arms, but did find that improvements in some variables in the NCI arm – but not CHOICES DA arm – were associated with previous educational attainment.ConclusionsInterventions were feasible to implement and acceptable. Improvements in knowledge and decision-making outcomes were observed in both arms, supporting the view that interventions to improve CCT decision making are effective and feasible. Our results suggest that the CHOICES DA may be more effective than an informational website in improving decision-making outcomes regardless of participants’ educational attainment.Practice implicationsCCT resources should support informed decision-making among all cancer survivors, regardless of educational attainment.     

Syringe Administration of Epinephrine by Emergency Medical Technicians for Anaphylaxis

Objective: In recent years, the costs of epinephrine autoinjectors (EAIs) in the United States have risen substantially. King County Emergency Medical Services implemented the “Check and Inject” program to replace EAIs by teaching emergency medical technicians (EMTs) to manually aspirate epinephrine from a single-use 1 mg/mL epinephrine vial using a needle and syringe followed by prehospital intramuscular administration of the correct adult or pediatric dose of epinephrine for anaphylaxis or serious allergic reaction. Treatment was guided by an EMT protocol that required a trigger and symptoms. We sought to determine if the “Check and Inject” program was safely implemented by EMTs treating presumed prehospital anaphylaxis or serious allergic reaction. Methods: We conducted a prospective investigation of all cases treated as part of the “Check and Inject” program from July 2014 through December 2016 in suburban King County, Washington, and January 2016 through December 2016 within the city of Seattle. All cases were prospectively collected using a custom quality improvement data form completed by the first responding EMTs. Two physicians completed a structured review of each EMS medical record to determine if the EMTs followed the Check and Inject protocol and determine if epinephrine was clinically-indicated based on physician review. Results: Of the 411 cases eligible for analysis, EMTs followed the protocol appropriately in 367 (89.3%) cases. In the remaining 44 (10.7%) cases, the EMS incident report form failed to document either a clear inciting allergic trigger or an appropriate symptom from the protocol list. Physician review determined that epinephrine was clinically indicated in 36 of the 44 cases. Among the remaining 8 cases (1.9%) that did not meet protocol criteria and were not clinically-indicated based on physician review, none had a documented adverse reaction to the epinephrine. Conclusion: We observed that EMTs successfully implemented the manual “Check and Inject” program for severe allergic reactions and anaphylaxis in a manner that typically agreed with physician review and without any overt identified safety issues.     

Nicotine effects on exercise performance and physiological responses in nicotine‐naïve individuals: a systematic review

The purpose of this systematic review was to evaluate the effects of smokeless forms of nicotine on physiological responses and exercise performance. Methodology and reporting were based on the PRISMA statement. The intervention was defined as any product containing nicotine that did not require smoking. Searches were conducted across two electronic databases with supplementary approaches utilized. Studies were selected following set inclusion and exclusion criteria and checked by two independent authors. A modified PEDro scale was utilized to rate study quality with studies averaging 9·3/13. Six studies assessed exercise performance with endurance‐based parameters reported as significantly improved with nicotine in one study, while anaerobic parameters were unaffected or decreased compared to placebo except in one study which reported enhanced leg extensor torque but no effect on countermovement jump or Wingate anaerobic capacity. Sixteen of 28 studies investigating physiological responses reported that nicotine significantly increased heart rate compared to placebo or control. Blood pressure and blood flow were also reported as significantly increased in multiple studies. While there is strong evidence of nicotine‐induced changes in physiological function that would benefit physical performance, beneficial effects have only been reported on leg extensor torque and endurance performance by one study each. Subsequently, there is need for more research with strong methodological quality to definitively evaluate nicotine's potential as an ergogenic aid.     

The effects of merit-based financial aid on drinking in college

We study the effect of state-level merit aid programs (such as Georgia's HOPE scholarship) on alcohol consumption among college students. Such programs have the potential to affect drinking through a combination of channels – such as raising students’ disposable income and increasing the incentive to maintain a high GPA – that could theoretically raise or lower alcohol use. We find that the presence of a merit-aid program in one's state generally leads to an overall increase in (heavy) drinking. This effect is concentrated among men, students with lower parental education, older students, and students with high college GPA's. Our findings are robust to several alternative empirical specifications including event-study analyses by year of program adoption. Furthermore, no difference in high-school drinking is observed for students attending college in states with merit-aid programs.     

床头型急救车在病区急救准备中的效果观察

目的 观察自主创新研制的一款床头型急救车在急救准备中的使用效果。方法 选择泗洪县中医院呼吸内科、神经内科、胸外科、神经外科共30名护士为操作对象,采用模拟抢救考核的方式,要求她们分别采用传统的常规方法（常规法）和床头型急救车方法（改进法）完成急救准备,纪录两种方法的急救准备时间、物品准备齐全率及物品摆放合理性,并进行对比分析。结果 按常规方法,急救准备耗时（260.0±49.6）s,物品准备齐全率46.7%;使用床头型急救车方法,急救准备耗时（159.2±13.9）s,物品准备齐全率93.3%,两组比较差异均有统计学差异（P<0.01）。使用床头型急救车方法的物品摆放更为整齐、合理。结论 床头型急救车在抢救患者时可以减少抢救准备用时,提高物品准备齐全率,使物品摆放更规范安全,值得临床推广使用。     

在西非创建埃博拉治疗中心的实践

作者参加援利比里亚医疗队,认真了解埃博拉出血热诊疗中心（ETU）建设的整个过程,对其设计理念、工作流程、运营管理等方面有一些体会：按照WHO标准将ETU设置为“三区两通道”,同时参照国内传染病医院的建设标准,在满足各项医疗基本要求的同时,为患者提供良好就医条件,为医护人员创造卫生、安全、便捷的工作环境,做到功能合理、流程科学;结合西非当地气候特点,建成在利比里亚全国18个ETU惟一采用板房材料的治疗中心,设有接诊区、留观病区、治疗病区、卫生防疫组,配套的配电站、信息房、库房等;信息化程度高,也是惟一有全方位视频监控的ETU,采用军卫一号系统开展日常诊疗工作。     

Out‐of‐hospital emergency care providers' work and challenges in a changing care environment

Acutely ill patients are often treated on site instead of being transported to hospital, so wide‐ranging professional competence is required from staff. The aim of this study was to describe and produce new information about out‐of‐hospital emergency care providers' competence, skills and willingness to engage in self‐development activities, and to uncover challenges experienced by care providers in the midst of changing work practices. A quantitative questionnaire was sent to out‐of‐hospital emergency care providers (N = 142, response rate 53%) of one Finnish hospital district. Data were analysed using spss for Windows 22 software. Almost all respondents found their work interesting and their ability to work independently sufficient. The majority found the work meaningful. Almost 20% felt that work was dominated by constant rush, and 40%, more than half of 25‐year‐olds but <10% of over 45‐years‐olds, found the work physically straining. The majority indicated that they had a sufficient theoretical–practical basis to perform their regular duties, and more than one‐third felt that they had sufficient skills to deal with multiple patient or disaster situations. Over 20% stated that they were unsure about performing new or infrequent procedures. A number of factors experienced as challenging were revealed. The results provide a basis for improving care providers' initial and further training.