The presence of resuscitation equipment and influencing factors at General Practitioners’ offices in Denmark: A cross-sectional study

Background

Automated external defibrillators (AEDs) have proven effective when used by GPs. Despite this and the latest guidelines from the European Resuscitation Council, there are no recommendations for Danish GPs regarding proper equipment to treat cardiac arrest. Currently, there are no published data on the distribution of AEDs among GPs in Denmark.

Aim

To assess the prevalence of resuscitation equipment and educated staff among Danish GPs and the parameters influencing the absence of AEDs at GP offices.

Methods

A cross-sectional questionnaire-based survey among the 2030 GPs registered in Denmark. Questions concerned demographics, occurrence of resuscitation equipment and attitude towards acquisition of an AED.

Results

With a response rate >70%, we found that the prevalence of AEDs in GP offices is low (31.7%). Limited financial possibilities and relevant treatment by ambulance personnel were stated as the primary causes for not having an AED. In general, Danish primary care physicians believe that AEDs should be governmentally sponsored. Positive influential factors on the acquisition of an AED were education, number of physicians in the GP office and previous experience of cardiac arrest.

Conclusions

Danish primary care physicians are generally not equipped with AEDs despite the proven effect of AEDs in GP offices. The main reasons for not acquiring an AED are financial considerations and believing that response time by ambulance services and nearby health facilities are the optimal treatment. We recommend better education and information in order to facilitate future acquisition of AEDs among GPs.     

Rotation length and discount rates

When valuing a commercial plantation, forest risk is commonly incorporated in the discount rate. Determination of the most economic rotation length is heavily dependent on the discount rate selected. Commonly the discount rates that are used for economic evaluation and for determining rotation length are the same.

A single-stand simulation model was developed to analyse the rotation length of radiata pine. Two approaches were examined: one building risk and uncertainty into the value of β in the determination of discount rate and the other explicitly building part of the risk into a deterministic analysis.

The analysis shows that explicitly building some of the risk components into the analysis increases the optimum economic rotation length, sometimes considerably.

In the examples presented, the objective rotation length is increased by as much as 10 years, which is considerable in a crop with a common rotation length of about 35 years. The exact increase will depend on what each forest grower deems to be the appropriate assumptions, but the assumptions made in this article are reasonable.

Organisations would need to carry out their own analyses using their own biometric models and economic data, but the conclusion is that longer rotation lengths are implied if at least a part of the risk is considered explicitly rather than simply by adjusting the discount rate. The conclusion is believed to have widespread applicability.     

长程皮下通道脑室外引流技术在重型颅脑损伤术后泛耐药鲍曼不动杆菌颅内感染治疗中的应用研究

目的探讨长程皮下通道脑室外引流(LTEVD)技术在治疗重型颅脑损伤(TBI)术后泛耐药鲍曼不动杆菌(XDR-AB)颅内感染的临床效果。方法回顾性分析2014年1月1日-2018年12月31日中南大学湘雅医院收治的65例TBI开颅术后并发颅内感染患者的临床资料。其中,50例以短程皮下通道脑室外引流(STEVD)技术治疗为STEVD组,15例术后并发XDR-AB性颅内感染行LTEVD技术治疗为LTEVD组。所有患者均进行围手术期规范化管理,依据脑脊液细菌培养药敏结果选择敏感抗生素治疗,XDR-AB者同期予以脑室内多黏菌素给药。结果两组患者一般特征、脑积水发生率、新增感染率及病死率比较,差异均无统计学意义(P>0.05)。STEVD组脑室内置管时间为(10.7±5.3)d,中位数10.0 d。而LTEVD组脑室内留置导管时间为(31.7±9.2)d,中位数32.0 d。两组比较,差异有统计学意义(P <0.05)。结论 LTEVD技术可以安全地延长脑室外引流时间超过1个月,疗效好,适用于难治性颅内感染或颅内外顽固性积液需长时程(>4周)脑脊液引流患者。     

The clinical significance of circulating B cells secreting anti-glycoprotein IIb/IIIa antibody and platelet glycoprotein IIb/IIIa in patients with primary immune thrombocytopenia

Abstract

Objectives

The objective of the study is to evaluate the possible roles of the detection of circulating B cells secreting anti-glycoprotein IIb/IIIa antibody, platelet glycoprotein IIb/IIIa, and anti-glycoprotein IIb/IIIa antibody in the diagnosis of primary immune thrombocytopenia (ITP) patients.

Methods

Circulating B cells secreting anti-glycoprotein IIb/IIIa antibody, platelet glycoprotein IIb/IIIa and anti-glycoprotein IIb/IIIa antibody in 64 patients with ITP, 33 non-ITP patients, and 32 controls were measured with enzyme-linked immunospot assay (ELISPOT), monoclonal antibody immobilization of platelet antigens assay (MAIPA) and flow cytometic analysis (FCM), respectively.

Results

Compared with the controls and non-ITP patients, the frequency of circulating B cells secreting anti-glycoprotein IIb/IIIa antibody was significantly increased, whereas the positive rate of platelet glycoprotein IIb/IIIa was significantly decreased (P < 0.05) in ITP patients, respectively. The sensitivities for the diagnosis of ITP of ELISPOT and FCM were 68.8% and 57.8%, and the specificities of 90.9% and 90.9%, respectively. The sensitivities of ELISPOT and FCM were higher than MAIPA's sensitivity (39.1%) (P < 0.05). However, there was no apparent difference of the sensitivities of ELISPOT and FCM and the specificities of those three detections (MAIPA's specificity was 81.8%) (P > 0.05).

Discussion

ELISPOT and FCM for detecting the circulating B cells secreting anti-glycoprotein IIb/IIIa antibody and the platelet glycoprotein IIb/IIIa were as specific as that of MAIPA for assay of anti-glycoprotein IIb/IIIa antibody, but ELISPOT and FCM had higher sensitivities. So ELISPOT and FCM were sensitive and specific for identifying patients with autoantibody-mediated thrombocytopenia and these should be used as diagnostic tests in clinic.     

Control of soft tissue deformation during robotic needle insertion

Accurate needle insertion into soft, inhomogeneous tissue is of practical interest because of its importance in percutaneous therapies. In procedures that involve multiple needle insertions such as transrectal ultrasound‐guided prostate brachytherapy, it is important to reduce tissue deformation before puncture and during needle insertion. In order to reduce this deformation, we have studied the effect of different trajectories for a 2‐DOF (degrees of freedom) robot performing needle insertion in soft tissue. To obtain an optimum trajectory, we have compared tissue indentation and frictional forces for different trajectories. According to the results of our experiments, infinitesimal force per tissue displacement is a useful parameter for online trajectory update. In addition, the results show that axial rotation can reduce tissue indentation before puncture and frictional forces after puncture. Our proposed position/force controller is shown to provide considerable improvement in performance with regard to minimizing tissue deformation before puncture.     

轮转护士急诊气管插管配合培训的效果评价

目的探讨轮转护士急诊气管插管配合培训的方法及效果。方法便利抽样法选择2010年5月至2012年5月在第二军医大学长海医院急诊科培训的106名护士为研究对象。将气管插管操作分解为7个标准化操作流程,采用人科评估、模拟教学以及临床带教等方式实施培训,比较培训前后轮转护士在应急能力、插管前准备、插管时配合、操作熟练度方面的满意率情况。结果相对于培训前,培训后106名轮转护士在应急能力、插管前准备、插管时配合、操作熟练程度等方面的满意率均有提高,差异均有统计学意义（均P〈O．01）。结论气管插管配合培训提高了轮转护士的实际操作能力和综合应急能力,值得推广。     

外痔剥离联合痔上黏膜环切术治疗环状混合痔患者的护理

目的探讨外痔剥离联合痔上黏膜环切术(procedure for prolapse and hemorrhoids,PPH)治疗环状混合痔患者的护理方法。方法回顾性分析2010年温州市中医院肛肠外科收治的38例环状混合痔患者的临床资料。结果通过综合治疗及护理,38例患者术后疼痛VAS评分3分以上0例,肛门水肿4例,尿潴留1例。结论外痔剥离联合PPH术,采用及早开始镇痛、联合用药综合措施预防和治疗术后疼痛临床疗效明确,值得临床推广。     

Effect of calcium β-hydroxy-β-methylbutyrate (CaHMB) with and without resistance training in men and women 65+ yrs: A randomized,double-blind pilot trial

Background

Evidence suggests CaHMB may impact muscle mass and/or strength in older adults, yet no long-term studies have compared its effectiveness in sedentary and resistance training conditions. The purpose of this study was to evaluate the effects of 24 weeks of CaHMB supplementation and resistance training (3 d wk^− 1) or CaHMB supplementation only in ≥ 65 yr old adults.

Methods

This double-blinded, placebo-controlled, trial occurred in two phases under ad libitum conditions. Phase I consisted of two non-exercise groups: (a) placebo and (b) 3 g CaHMB consumed twice daily. Phase II consisted of two resistance exercise groups: (a) placebo and resistance exercise and (b) 3 g CaHMB consumed twice daily and resistance exercise (RE). Strength and functionality were assessed in both phases with isokinetic leg extension and flexion at 60°·s^− 1 and 180°·s^− 1 (LE60, LF60, LE180, LF180), hand grip strength (HG) and get-up-and-go (GUG). Dual X-Ray Absorptiometry (DXA) was used to measure arm, leg, and total body lean mass (LM) as well as total fat mass (FM). Muscle Quality was measured for arm (MQ_HG = HG/arm LM) and Leg (MQ₆₀ = LE60/leg LM) (MQ₁₈₀ = LE180/leg LM).

Results

At 24 weeks of Phase I, change in LE60 (+ 8.8%) and MQ₁₈₀ (+ 20.8%) for CaHMB was significantly (p < 0.05) greater than that for placebo group. Additionally, only CaHMB showed significant (p < 0.05) improvements in total LM (2.2%), leg LM (2.1%), and LE₁₈₀ (+ 17.3%), though no treatment effect was observed. Phase II demonstrated that RE significantly improved total LM (4.3%), LE60 (22.8%), LE180 (21.4%), HG (9.8%), and GUG (10.2%) with no difference between treatment groups. At week 24, only CaHMB group significantly improved FM (− 3.8%) and MQ_HG (7.3%); however there was no treatment main effect for these variables.

Conclusion

CaHMB improved strength and MQ without RE. Further, RE is an effective intervention for improving all measures of body composition and functionality.