Severe accidental hypothermia: rewarming strategy using a veno-venous bypass system and a convective air warmer

Objective: To study a rewarming strategy for patients with severe accidental hypothermia using a simple veno-venous bypass in combination with a convective air warmer. Setting: Eighteen beds in a university hospital intensive care unit. Patients: Four adults admitted with a core temperature less than 30 °C. Hypothermia was caused by alcoholic intoxication in three patients and by drug overdose in one patient. Measurements and main results: All patients were rewarmed by a veno-venous bypass and in three cases a convective air warmer was also used. At a bypass flow rate of 100–300 ml/min the mean increase in core temperature was 1.15 °C/h (Range: 1.1–1.2 °C/h). One patient died 2 days after rewarming as a consequence of a reactivated pancreatitis. The other three patients survived without neurological sequelae. Conclusion: This rewarming technique seems safe and effective and allowed the controlled rewarming of our patients who suffered from severe accidental hypothermia Received: 15 September 1998 Final revision received: 4 January 1999 Accepted: 11 February 1999     

Unintentional injuries among older adults in northern Sweden – a one‐year population‐based study

Scand J Caring Sci; 2011; 25; 185–193
Unintentional injuries among older adults in northern Sweden – a one‐year population‐based study Aim: To study the epidemiology of unintentional injuries in a population of 21 000 Swedish older adults (65+) and to compare the injury incidence with similar data collected two decades earlier. Method: This is a retrospective epidemiologic cross‐sectional study based on a 1‐year data set of all the 1753 registered injury events from a well‐defined population. Result: The injury rate per 1000 individuals was three times higher in the 85+ age group than in the 65–74 age group. The rate was also higher in women than in men aged 75 and older. Fractures, especially on lower and upper extremities, were the most common injuries. Falls in residential care facilities caused the most serious injuries. In transport areas, pedestrian falls and bicyclist crashes were much more common than car crashes. Of the 1753 people injured, 42% were treated as inpatients for a total of 11 569 days; 86% of these days were caused by injury events in the home (57%) or in residential care facilities (29%). Our 65+ age group occupied 69% of all hospital bed‐days for trauma in all ages (0–102 years). Conclusion: Over the last two decades, the injury and fracture rate per 1000 individuals has increased by 40–50%, especially in the older age groups. During this time, the nursing strategy for older adults has changed in Sweden. As a result, more people live in their homes nowadays. This increase is distressing especially when we consider the current knowledge of preventive measures. The high number and proportion (>2/3) of inpatient trauma days for these age groups are a heavy burden for the medical sector. These facts call for more effective preventive measures, especially in the home and in residential care facilities, to minimize the negative health effects and the rising health costs.     

住院患者跌倒普防和专科化预防研究及效果

目的 提高住院患者跌倒预防的实效。方法 建立住院患者跌倒评估表、预防措施表、宣教单、警示标识和使用流程，共同组成住院患者跌倒普防方案予以临床运用；在普防的基础上结合专科化预防，使预防更具有针对性和实效。结果 经过3年的临床研究和实效观察，跌倒普防方案运用与运用前对比，大内科跌倒发生率由每万住院日7．92次，下降到3．52次；普防和专科化预防结合运用与仅用普防对比，全院跌倒发生率由每万住院日4．26次，下降到1．90次；且严重伤害率由70％降到20％。结论 跌倒普防是综合性医院预防跌倒的基础工作；结合专科化预防研究和运用使跌倒防范水平更上新台阶；心理因素应成为更高层次的跌倒预防策略。     

根本原因分析行动在糖尿病住院患者卫生间死亡事件中的应用

目的分析找出患者卫生间意外死亡的根本原因。方法运用根本原因分析行动对我院1例患者卫生间意外死亡进行分析,找出根因,采取以下措施:(1)制定了《临床警示系统管理制度》,建立MEWS风险预警评估机制(并成立RRT团队);(2)构建和执行SBAR交接班作业标准;(3)发生紧急抢救事件应急应对程序,并全院进行心肺复苏培训考核;(4)建立全院钥匙规范管理体系;(5)构建全院的卫生间警铃系统。结果该事件发生至今未再次发生此类事件,改善前后心肺复苏考核通过率比较,差异有统计学意义(P=0.00)。RRT小组到达时间为(6.47±0.76)min,全院急救紧急呼叫及应急复苏演练到达时间[(A组为(3.38±0.600)min,B组为(3.72±0.66)min,C组为(2.32±0.43)min)],均在要求的时间内。护士发现患者被卫生间门反锁到打开卫生间的平均时间缩短154 s,差异有统计学意义(P=0.000)。结论根本原因分析行动活动结束后提高了全院急救能力和完善了相关制度,确保患者安全,并将成效在区域医联体医院推广。     

Firearm-related deaths in Brescia (Northern Italy) between 1994 and 2006: A retrospective study

This retrospective study analyzes post-mortem examination data of 164 firearm-related casualties recorded by the Brescia, Italy Institute of Forensic Medicine between the years 1994 and 2006. The following variables were considered: year, month and day of death, gender and age of the victim, manner of death (homicide, suicide, accidental), type of weapon used, anatomical site and number of wounds, scene of death, and, whenever requested by the local District Attorney’s Office, results of the toxicological examinations conducted on the corpses of the deceased.In the County of Brescia, Italy, the 2006 firearm-related mortality rate amounted to 0.84 per 100,000 residents, with an average of 12.6 cases per year. The most common manner of death was suicide (60.4%), followed by homicide (35.9%) and accidental death (3.7%). Most victims were male, with an average age of 47.2 in cases of suicide, 37.9 in cases of homicide, and 47.5 in cases of accidental death. Considering all of the death manners contemplated in this study, the weapon types most frequently resorted to were single-action, short-barrelled guns, followed by multiple-action, long-barrelled ones. In cases of suicide, entry wounds were primarily situated on the head (right temple) and chest (precordium), while in cases of homicide no conclusions could be drawn as to the entry wounds’ predominant location.     

A failed fall prevention study in an acute care setting: Lessons from the swamp

Designing and implementing fall intervention studies in acute care settings presents researchers with a number of challenges. To date, there are no fall prevention interventions that have unequivocal empirical support in these settings. Based on the best available evidence a multistrategy fall prevention program was implemented using a pretest-post-test design over a 12-month period. The results indicated no reduction in the fall rate. Contrary to the expected result, the fall rate increased post the implementation of the multistrategy fall prevention program. To assist other researchers understand the contextual and methodological barriers to conducting fall prevention research in acute care settings, this paper discusses the difficulties experienced in this study.     

少女救助引发的思考

青少年在性健康的认知与需求方面存在着诸多问题,突出表现为相当多的人性观念存有误区。大多数学校、家长及社会,长期未能给予重视或没有能力依据青少年的需求提供必要适宜的帮助与指导。吉林省性学会联合共青团长春市委,依托省生殖保健医院成立了全国首家少女救助中心,经过两年多的运行,已逐渐地扩大与完善,开设了少女专家门诊、少女病房、少女之家等,形成了初具规模的绿色救助通道。中心共接咨询电话8000余条,其中有记录的近5000多例,实际救助意外妊娠案例160余例,免费救助6例,帮助公安机关立案侦查3例。性教育的最终结果是要使青少年学会认识自己、保护自己、完善自己。互联网对青少年的影响不容忽视,要引导在校学生正确使用互联网。旨在能从更大的范围及更深层面,来探索学校对青少年进行性健康教育的有效途径,引导青少年树立起正确的性道德观念,发挥青少年父母、学校、社会、群团组织以及宣传媒介对青少年开展性健康教育的作用。     

南漳县新型农村合作医疗意外伤害补偿分析

意外伤害补偿是新型农村合作医疗补偿中的重要方面。鉴于近年意外伤害补偿基金所占比例的增大及正确区分意外伤害有无责任方存在一定难度,分析了南漳县2007年意外伤害补偿情况,阐述了存在的问题,并提出了相应的对策建议。     

197例儿童意外伤害原因分析

目的 探讨儿童意外伤害的原因。方法 回顾性分析我院1998年3月至2000年10月急诊室就诊的197例儿童意外伤害病例。结果 儿童意外伤害有其身的特殊性，人为因素占有重要地位。结论 儿童意外伤害应以预防为主，采取家庭、学校、社会相结合的预防方法。     

住院老年精神障碍患者跌倒的调查与护理

目的调查住院老年精神障碍患者跌倒的发生情况及其危险因素。方法利用自制跌倒发生情况调查表、跌倒危险因素调查表，对756例住院的老年精神障碍患者进行回顾性调查。结杲（1）老年精神障碍患者在院期间跌倒发生率为18．0％。（2）单因素分析表明，痴呆、合并躯体疾病、首次精神药物使用等9个变量与跌倒有关。（3）多因素分析表明，跌倒的主要危险因素有痴呆、服用抗精神病药物、伴发糖尿病、合并使用降压药等。结论住院老年精神障碍患者跌倒发生率高，护理中应予以重视，并针对性采取防范措施。