Caring for older people in prehospital emergency care: can nurses make a difference?

Aims and objectives. The aim of this paper is to explore older people's experiences in prehospital emergency care, and identify benefits and difficulties associated with developing a nurse‐led ambulance service. Data were collected at sites in Sweden and Norway. Focus group interviews were conducted to enable the collection of data from paramedics, ambulance nurses and nursing students, while individual interviews were utilized to gather data from older people. Background. There is little research on the quality of care older people over 65 years old receive in prehospital emergency care. Older people often present with multiple pathology and diverse needs that nurses are well equipped to deal with, but presently there is no clearly defined role for nurses in prehospital emergency care in the United Kingdom, although other countries such as Sweden and Norway are developing an ambulance nurse role. Conclusions. If the multiple needs of older people were addressed in the prehospital field, a reduction in readmissions and increased functional ability might be achieved. Comprehensive training is required for ambulance staff to enable them to meet such needs. While nurses have a great foundation for this care, additional specialist ambulance training is required alongside a need for education on older people's needs and attitudes to older people. Relevance to clinical practice. The introduction of ambulance nurses will result in role differentiation between paramedics and ambulance nurses, which has the potential for creating role conflict. To ensure a smooth transition appropriate training and education for nurses and paramedics should be provided. The end result is a potentially greatly enhanced ambulance care provision, enabling high quality care to all patients.     

Fetal Aortic Arch Anomalies

Aortic arch anomalies are present in 1% to 2% of the general population and are commonly associated with congenital heart disease, chromosomal defects, and tracheaesophageal compression in postnatal life. The sonographically based detection of aortic arch anomalies lies in the 3‐vessel and trachea view. Although highly sensitive, this view alone does not allow identification of the aortic arch branching pattern, which prevents an accurate diagnosis. The systematic addition of a subclavian artery view as part of a standardized procedure may be useful in the differential diagnosis of these conditions. We describe the sonographic assessment of fetal aortic arch anomalies by combining 2 fetal transverse views: the 3‐vessel and trachea view and the subclavian artery view, which are included in the cardiovascular system sonographic evaluation protocol. We also review the sonographic findings and the clinical implications of fetal aortic arch anomalies.     

全人照护干预对尿流改道后行多周期化疗患者的影响

目的探讨全人照护干预对尿流改道后行多周期化疗患者的生命质量、心理社会适应能力及化疗后并发症的影响。方法将96例尿流改道后行多周期化疗患者分为观察组和对照组各48例,对照组给予常规治疗和护理,观察组在常规治疗护理的基础上实施全人照护,包括专业培训、全程信息建立与维护、全程身心照护,比较两组患者的生命质量、心理社会适应能力及化疗后并发症的差异。结果观察组生命质量、疾病心理社会适应能力均优于对照组(P0.01);化疗后并发症低于对照组(P0.01或P0.05)。结论全人照护干预有利于提高尿流改道后行多周期化疗患者的生命质量及心理社会适应能力,降低化疗后并发症的发生,提高护理满意度。     

Factors affecting β-ODAP content in Lathyrus sativus and their possible physiological mechanisms

A neuroexcitatory non-protein amino acid, β-N-oxalyl-l-α,β-diaminopropionic acid (β-ODAP), present in the seeds of the hardy legume crop grass pea (Lathyrus sativus L.), was considered responsible for human lathyrism. The levels of β-ODAP were reported to vary in different tissues during plant development, and to be affected by a wide range of environmental stresses. In this paper, dynamic changes in β-ODAP level at specific stages of plant development as well as the influences of various environmental factors, including nutrient deficiency, drought, salinity, toxic heavy metals, and Rhizobium symbiosis on β-ODAP levels were analyzed, highlighting the relationship between changes in β-ODAP concentrations and Rhizobium growth. Possible mechanisms underlying β-ODAP accumulation are proposed and future research is suggested.     

高血压病的中医心理干预

高血压在世界上许多国家都是常见病,有关高血压致病因素的研究表明心理因素可能参与了高血压的形成,文章通过介绍目前中医心理学对高血压病的认识及干预效果,试图从＂心理学本土化运动＂以及＂心理治疗与世界观＂两个视角回答：为什么中医心理学在治疗高血压病具有原创的优势,也更多的为患者所接受,相比西方心理治疗有更好的疗效。     

运用扎根理论方法探索中医复杂干预组成要素的定性研究

目的：探索并建立中医复杂干预的组成要素及要素间相互关系的理论模型。方法：采用社会学定性研究的方法,开展41次参与性观察和7例个体深入访谈以收集资料;使用扎根理论方法设计和分析数据。结果：中医复杂干预组成要素包括处方药物、医嘱、心理干预、医患关系和患者依从性,它们之间相互作用、相互协同可以产生或提高疗效。中医诊断过程和治疗过程存在交叉,体现动态特征。诊断过程具有潜在的治疗作用,中医药物干预作为主要干预发挥治疗作用。中医复杂干预措施的组成要素包含在整个中医干预过程中,可以上升为发现问题、解决问题的过程,通过宏观与微观的途径产生作用,体现整体观指导下的高度个体化辨证论治的原则。结论：中医临床实践是一种复杂的整体性干预,中医疗效的体现是中医诊疗过程中诸多因素共同作用的综合结果。未来需要扩大样本量开展定性研究以增加中医复杂干预组成要素模型的稳定性和普适性,并通过随机对照临床试验验证和探索本扎根理论所获得的各要素与总体疗效的关系。     

The anterior center edge angle in Lequesne’s false profile view: interrater correlation,dependence on pelvic tilt and correlation to anterior acetabular coverage in the sagital plane. A cadaver study

Introduction  Lequesne’s vertical-center-anterior margin (VCA) angle measured on the false profile view of the pelvis aims at quantifying the anterior acetabular coverage of the femoral head. The anterior delimitation of the acetabular roof is often defined on the false profile view but there are no data on its interrater reliability. Additionally, it is not known how pelvic tilt may influence this angle. Finally, the plane in which this angle is measured lies at an angle of 65° to the sagittal plane and we wondered if this angle would be transposable to the anterior acetabular coverage measured in the sagittal plane. Methods  Eight hips from four cadaver pelvises were investigated by means of a total of 72 false profile views, each taken in defined pelvic inclinations at 5° increments ranging from −20° to +20°, and the VCA angle measured by three independent raters. A computed tomography (CT) of each hip was performed in a neutral pelvic tilt position and a sagittal 2D reconstruction calculated in order to measure anterior coverage in the sagittal plane. The interrater reliability of the VCA angles was assessed using the intra-class correlation coefficient (ICC). The dependence of the VCA angle on pelvic tilt was assessed by regression analysis. The Correlation between the VCA angle and anterior coverage in the sagittal plane of the CT was analyzed using a simple linear regression model. Results  The interrater reliability for measurements of the VCA angle was almost perfect (ICC:0.97). Regression analysis showed that each degree of pelvic tilt was accompanied by a change of the VCA angle by a value of 0.63° (P < 0.001). A low correlation between the VCA angle measured in the false profile view and the anterior coverage in the sagittal plane was statistically not significant (r = 0.667, P = 0.06). Conclusions  Lequesne’s VCA angle has an excellent interrater reliability and represents a reliable measure of acetabular dysplasia for comparisons with published data. Lequesne’s VCA angle is influenced by pelvic tilt in a linear manner. Performing the false profile view in a standing position may reduce the clinical relevance of this dependency on pelvic tilt. The correlation of Lequesne’s VCA angle to anterior acetabular coverage in the sagittal plane is low and therefore unsuitable to be transposed into the sagittal plane.     

Clinical evaluation and follow-up outcome of presurgical plan by Dextroscope: a prospective controlled study in patients with skull base tumors

Background

Patient-specific approach design, comprehensive evaluation on perioperative data, and follow-up of postoperative life quality (KPS) were carried out to evaluate the application of VR technology of Dextroscope in procedures of patients with skull base tumors.

Methods

Eighty-four patients with skull base tumors involved in this research were randomized into 2 groups (test group and control group), each with 42 patients. Before operation, image data such as MR, MRA, or CTA of head were collected and imported into the Dextroscope workstation. The detailed preoperative plans were made in the test group, but no Dextroscope plans in control group. The resection rate of tumors, preoperative evaluation including the duration of operation, total blood loss, the postoperative LOS, the number of cases with cerebrovascular injury complications in operation, and postoperative KPS of patients on discharge and the sixth month follow-up in the 2 groups were recorded and compared.

Results

The total resection rate of tumors was 83.33% in test group and 71.42% in the control group (P > .05). The total resection rate of meningioma was 86.67% in test group and 76.47% in control group. The total resection rates of trigeminal Schwannoma in the 2 groups were all 100% (P > .05). The duration of operation and the postoperative LOS of each patient were 5.25 ± 0.64 hours and 8.50 ± 1.10 days in the test group and 7.36 ± 0.87 hours and 12.50 ± 1.52 days in the control group, respectively (P < .05). Total blood loss of each patient was 456.75 ± 55.76 mL in the test group and 523.85 ± 66.78 mL in the control group (P > 05). There were 3 cases with complications of cerebral vessels injury in the test group and 7 cases in the control group (P < .05). During follow-up, KPS of patients in the test group on discharge (85.75 ± 9.68) was significantly superior to that in the control group (81.66 ± 9.24; P < .05). The KPS of patients on the sixth-month follow-up in the test group was 92.35 ± 9.95, which was significantly superior to that in the control group (85.6 ± 9.34; P < .05). Karnofsky performance scores of patients in the test group improved significantly from discharge to the sixth month after procedure (P < .05), whereas there were adverse results in the test group (P < .05). The 2 cases with CSF leakage were cured completely.

Conclusion

The preoperative plans with VR technology in patients with skull base tumor or CSF leakage operations can help certain the diagnosis, individually locate the position of skull base lesions, and design patient-specific approach, which also facilitate to shorten operation duration and the postoperative LOS, reduce total blood loss and injury of vessels in operation, and improve the postoperative KPS.     

Antidepressant-like effect of magnetic resonance imaging-based stimulation in mice

INTRODUCTION: It has been reported that a novel type of magnetic resonance imaging (MRI) scan called echo planar magnetic resonance spectroscopic imaging (EP-MRSI) may show antidepressant effects. We examined whether the two routine diagnostic protocols of MRI [T1 and echo planar diffusion weighted imaging (EPI-DWI)], have antidepressant-like effects in an animal model of depression. METHODS: The effects of standard EPI-DWI and T1 MRI on immobility, swimming and climbing times in the modified forced swimming test (FST) in mice were examined. After exposure to the first session of modified forced swimming test, we randomly divided the mice into four groups. The first group (T1 MRI group, n=21) received a 15-minute stimulation of T1 sequence. The second group (EPI-DWI MRI group, n=21) received a 15-minute stimulation of EPI-DWI protocol. The third group (sham group, n=21) spent 15 min in a tunnel similar to the MRI gantry in terms of size, temperature and light intensity and received recorded sounds from a normal session of EPI-DWI with similar duration and intensity. The fourth group acted as controls (n=21).The second session of the modified FST was conducted twelve hours later. The mean of immobility, swimming and climbing times in this session were compared to the control group. RESULTS: T1 weighted and EPI-DWI MRI groups showed a reduction in immobility time compared to the control group (P value<0.002, P value<0.017 respectively). This effect is comparable to that seen in the FST after the administration of antidepressant agents. The climbing time in the group subjected to EPI-DWI MRI was longer than the control group (P value<0.035). Previous studies showed similar effects after the administration of antidepressant drugs affecting the catecholamine systems. The swimming time in the T1 MRI group was significantly longer than the control group (P value<0.037). Previous studies showed qualitatively similar effect to that of anti-depressant drugs affecting the serotoninergic systems. The swimming, climbing and immobility times in the sham and control groups showed no significant difference. CONCLUSIONS: Our findings raise the possibility that MRI-based stimulation may have antidepressant-like effects in mice. This is likely to be through different mechanisms in T1 weighted and EPI-DWI protocols. However the possible biological basis of this effect is not yet understood and we would advocate further studies of MRI-based stimulation effects on transmitters in the different organs in the body specially the brain.