The financial burden of an influenza outbreak in a small rehabilitation centre

We report an influenza outbreak in a 75‐bed rehabilitation centre and present the detailed microeconomic impact that it had during the season 2016/2017. The direct medical, direct non‐medical and indirect costs were calculated. The outbreak included 18 patients with influenza and 8 contact patients, leading to 86 days with isolation precautions. During the outbreak month, 25 (15%) employees were absent from work for 89 days (mean 3.6 days, SD ± 1.8), and during the entire influenza season 33 for 175 (5.3 ± SD 4.6) days, respectively. The economic burden related to the outbreak was 114 373 CHF (106 890 €, 112 131 $).     

Reconstructing Harry: A Genealogical Study of a Colonial Family ‘Inside’ and ‘Outside’ the Grahamstown Asylum, 1888–1918

Recent scholarship has explored the dynamics between families and colonial lunatic asylums in the late nineteenth century, where families actively participated in the processes of custodial care, committal, treatment and release of their relatives. This paper works in this historical field, but with some methodological and theoretical differences. The Foucauldian study is anchored to a single case and family as an illness narrative that moves cross-referentially between bureaucratic state archival material, psychiatric case records, and intergenerational family-storytelling and family photographs. Following headaches and seizures, Harry Walter Wilbraham was medically boarded from his position as Postmaster in the Cape of Good Hope Colony of South Africa with a ‘permanent disease of the brain’, and was committed to the Grahamstown Asylum in 1910, where he died the following year, aged 40 years. In contrast to writings about colonial asylums that usually describe several patient cases and thematic patterns in archival material over time and place, this study’s genealogical lens examines one white settler male patient’s experiences within mental health care in South Africa between 1908 and 1911. The construction of Harry’s ‘case’ interweaves archival sources and reminiscences inside and outside the asylum, and places it within psychiatric discourse of the time, and family dynamics in the years that followed. Thus, this case study maps the constitution of ‘patient’ and ‘family’ in colonial life, c.1888–1918, and considers the calamity, uncertainty, stigma and silences of mental illness.     

血浆置换和托珠单抗治疗六例2019冠状病毒病(COVID-19)重型患者临床分析

目的分析血浆置换和托珠单抗治疗2019冠状病毒病（COVID-19）重型患者的疗效。方法回顾性分析2020年1月25日至2月25日在蚌埠医学院第一附属医院感染应急病区接受治疗的6例COVID-19重型患者的临床资料（3例采用血浆置换治疗，3例采用托珠单抗治疗）。观察血浆置换和托珠单抗治疗对患者体内过度炎症反应的抑制作用。结果血浆置换治疗后，3例患者C反应蛋白和IL-6水平下降明显，淋巴细胞和凝血酶原时间均有改善；托珠单抗治疗后，3例患者炎症水平未见明显下降，淋巴细胞计数和凝血酶原时间也无明显改善。结论COVID-19重型患者采用血浆置换治疗后炎症因子水平明显降低或恢复正常，而托珠单抗治疗患者炎症因子下降不明显。因此对于炎症反应强烈的COVID-19重型患者，血浆置换可能是首选。     

2019冠状病毒病(COVID-19)危重型患者的营养支持治疗

营养支持治疗是2019冠状病毒病（COVID-19）危重型患者治疗过程中不可缺少的一部分。COVID-19危重型患者常处于高炎症、高应激、高分解代谢状态，机体能量消耗显著增加。所有COVID-19危重型患者需早期采用NRS-2002或Nutric评分工具进行营养风险筛查；若存在营养不良的风险，则进一步采用主观整体评估（SGA）或全球领导人营养不良倡议（GLIM）等工具进行营养不良的评估。评估完成之后，结合病情，首先确定患者每日所需的能量、蛋白质、电解质及液体量等，然后再根据患者胃肠道功能受损的程度，选择口服营养补充、肠内营养、肠外营养或两者联合的方式进行营养支持；对于胃肠道功能正常需俯卧位通气或接受体外膜肺氧合治疗的患者，建议首选肠内营养。此外，在患者营养实施过程中需密切监测腹胀、腹泻、反流、静脉炎及肝功能损害等不良反应，及时调整营养方案，保障营养支持的顺利实施。基于COVID-19危重型患者的代谢特点，本文从营养风险筛查和评估、营养治疗目标量、营养干预和治疗、特殊人群的营养支持、营养支持治疗常见的不良反应等方面进行总结和建议，以期充分发挥营养支持治疗的临床作用，为COVID-19危重型患者的个体化营养支持治疗提供参考。     

Risk Assessment: A Reflection on the Principles of Tools to Help Manage Risk of Violence in Mental Health

The proposition that the vast majority of persons experiencing mental illness will never be violent is complicated by the large body of literature demonstrating a heightened risk of violent behaviour in persons suffering from mental disorder. In an era in which resources and individual judgement appear to dictate treatment, the question arises as to why structured clinical judgement is not utilized more in front-line assessment of risk for violence in those with mental and personality disorders? Our review of the literature on mental disorder and violence, risk assessment and risk management led to the contention that front-line mental health professionals can employ structured clinical judgement underpinned by the principles of risk assessment tools, such as the HCR-20. Ongoing resource development, education and availability of expertise should aid the development of more uniform approaches to violence risk management and therapeutic amelioration of the likelihood for violence in persons affected by mental illness.