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Abstract Introduction: Despite sensory enrichment being critical for ensuring the well-being of captive wild animals, smells are not being included in enrichment protocols for birds. For this group, neophobia can be a problem when it comes to implementing new enrichment devices. Objective: To explore how participation in an olfactory enrichment and latency times varies between bird taxonomic groups (Amazona spp. / Ara spp. / Ramphastos spp.). Methods: We exposed 257 birds to a scent enrichment, and we recorded which individuals engaged with it and the time they took to interact with it. Results: We discovered that participation by toucans in the enrichment was higher compared to amazons and macaws. Furthermore, latency time to interact with the enrichment was higher in amazons that in the other species. Our findings could suggest that toucans are neophilic species which could benefit from higher exploration rates. Amazons on the contrary seem to be particularly neophobic, possibly because of their less opportunistic feeding habits compared to toucans and their higher vulnerability to predation compared to macaws. Conclusion: These results point out that toucans would be more inclined to engage in environmental enrichments, while a more natural design using smells inside familiar objects could be a more successful enrichment for psittacids.
Resumen Introducción: A pesar de que el enriquecimiento sensorial es fundamental para garantizar el bienestar de los animales silvestres en cautiverio, los olores no son incluidos de forma rutinaria en los protocolos de enriquecimiento para aves. Además, en el caso de estos animales, la neofobia puede ser un problema a la hora de implementar nuevos dispositivos de enriquecimiento. Objetivo: Explorar cómo varía la participación y la latencia en la interacción con un enriquecimiento olfativo entre grupos taxonómicos de aves (Amazona spp. / Ara spp. / Ramphastos spp.). Métodos: Expusimos a 257 aves a un enriquecimiento olfativo y registramos qué individuos participaron y el tiempo que tardaron en interactuar con él. Resultados: La participación en el enriquecimiento fue mayor en los tucanes en comparación con las amazonas y los guacamayos. Además, el tiempo de latencia para interactuar con el enriquecimiento fue mayor en las amazonas que en las otras especies. Nuestros hallazgos sugieren que los tucanes son especies neofílicas que podrían beneficiarse de tasas de exploración más altas. Por otro lado, las amazonas parecen ser particularmente neofóbicas, posiblemente debido a sus hábitos alimenticios menos oportunistas en comparación con los tucanes y a su mayor vulnerabilidad a la depredación en comparación con los guacamayos. Conclusión: Estos resultados señalan que los tucanes serían más proclives a participar en enriquecimientos ambientales, mientras que un diseño que utilice olores dentro de objetos más naturales o familiares podría ser más exitoso para las psitácidas.
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Animals , Parrots/growth & development , Animal Welfare , Amazona/growth & development , Refugium , Costa RicaABSTRACT
OBJETIVO: Mapear tendências de utilização do Professional quality of life (PROQOL) em bombeiros. MÉTODO: Será aplicada a metodologia do Joanna Briggs Institute (JBI) para revisões de escopo. Seguirá diretrizes do Pre-ferred Reporting Items for Systematic reviews and Meta-Analyses ex-tension for Scoping Reviews(PRISMA-ScR). Realizou-se pesquisa nas plataformas do Open Science Framework (OSF), International Prospective Register of Systematic Reviews (PROSPERO), Cochrane Library, Epistemonikos, e no repositório online de acesso aberto (FIGSHARE), para identificar artigos idênticos, como não foi encontrado considera-se este trabalho original. Serão incluídas nesta revisão as bases: Excerpta Medica dataBASE (EMBASE), SCOPUS, Medical Literature Analysis and Retrieval Systemon Line (PubMed - MEDLINE), Science Direct, PsycInfo da American Psychological Association (APA), Google Scholar, Cumulative Indexto Nursing and Allied Health Literature (CINAHL), bem como, Teses, Dissertações, artigos de sites governamentais e de bombeiros. Dois revisores selecionarão os artigos de maneira independente, não havendo consenso um terceiro revisor decidirá pela inclusão ou exclusão do estudo. O levantamento foi registrado na plataforma OSF website, e será um dos estudos mais abrangentes sobre a utilização dessa escala em Bombeiros.
OBJECTIVE: To map trends in the use of Professional Quality of Life (PROQOL) in firefighters. METHOD: The methodology of Joanna Briggs Institute (JBI) will be applied for scope reviews. It will follow guidelines from Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-SCR). Research was carried out on the Open Science Framework (OSF), International PROSPECTIVE Register of Systematic Reviews (PROSPERO), Cochrane Library, Epistemonikos, and on the open access online repository (FIGSHARE), to identify identical articles, as this original work was not found. The basis which will be included in this review: Excerpta Medica dataBASE (EMBASE), SCOPUS, Medical Literature Analysis and Retrieval System on Line (PubMed - MEDLINE), Science Direct, PsycInfo da American Psychological Association (APA), Google Scholar, Cumulative Index to Nursing and Allied Health Literature (CINAHL), as well as, Theses, Dissertations, Articles of Government and Fire Sites. Two reviewers will select the articles independently, and without consensus a third reviewer will decide whether to include or exclude the study. The survey was registered on the OSF website platform, and it will be one of the most comprehensive studies on the use of this scale on Firefighters.
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ObjectiveTo improve the response capabilities to disasters and prevent major epidemics， it is of practical use to study the capability evaluation system of the national emergency medical rescue team that combines theoretical training and practical exercises， to enhance the overall quality of the teams. MethodsFirst， a capability assessment system for the national emergency medical rescue team was constructed based on the INSARAG External Classification （IEC） standards of the national emergency medical rescue team. Then， based on the outcome based education （OBE） concept， we conducted innovative research on the curriculum design and exercise programs for team building and member training. Finally， an empirical analysis was conducted on the effectiveness of the evaluation system and training exercises based on the statistical analysis of the comprehensive quality evaluation of the Shanghai national emergency medical rescue team from 2020 to 2023， as well as the empirical analysis of the rescue exercise on the Cruise of spectrum. ResultsBased on the linear regression analysis of each core competency indicators， the five core competencies in the evaluation system， including rescue skills， medical and health knowledge， disaster coping ability， team cooperation ability， and mental resilience training， were positively correlated with the cumulative number of trainings （r=0.71， r=0.76， r=0.81， r=0.84， r=0.96，all P<0.05）， indicating that the training was effective and the course design was reasonable. Empirical cases showed that the three-dimensional rescue drill model had remarkable results in the actual combat application and ability improvement of team members. ConclusionThe training courses and drills designed based on the three-level assessment system are effective in improving the comprehensive capabilities of the national emergency medical rescue team.
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Objective:To construct core medical skill index system for helicopter medical rescue personnel by Delphi expert consensus method.Methods:This study combined literature review and two rounds of Delphi expert correspondence to construct the core skill index system. Total of 22 experts from relevant disciplines were selected purposively to conduct Delphi expert consultation.Results:The effective questionnaire recovery rates of the two rounds of Delphi expert correspondence was 100%; the authority coefficient of experts was 0.87; the Kendall coordination coefficients of the importance of the first and second level indexes were 0.380 and 0.338 in the first round of correspondence, and then 0.415 and 0.357 in the second round. the Kendall coordination coefficients of the feasibility of the second level indexes were 0.347 in the first round of correspondence and 0.354 in the second round. The final core skill index system for helicopter medical rescue personnel includes 4 primary indicators: core medical skill for diseases or trauma in respiratory system, circulatory system, sports system and other system, and 32 secondary indicators.Conclusions:The core medical skill index system for helicopter medical rescue personnel constructed through two rounds of Delphi expert correspondence is scientific and reasonable, which can provide a scientific basis to accurately understand, describe, analyze, and evaluate the competence level of helicopter medical rescue personnel, as well as serve as a content framework for training programs.
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Objective To investigate the effect of"zero channel"emergency mode on the treatment of patients with severe traumatic brain injury.Methods A total of 147 patients with severe traumatic brain injury admitted to the Second Hospital of Jiaxing from January 2020 to December 2021 were selected as study objects.Sixty-two patients hospitalized in traditional emergency mode from January to December 2020 were included in control group,and 85 patients hospitalized in"zero channel"emergency mode from January to December 2021 were included in observation group.The initiation time of rescue,completion time of CT examination,completion time of blood transfusion,duration of operation,clinical prognosis and complication rate were compared between two groups.Results The initiation time of rescue,completion time of CT examination,completion time of blood transfusion,and duration of operation in observation group were significantly shorter than those in control group(P<0.05).The proportion of good recovery in observation group was significantly higher than that in control group(68.20%vs.38.70%,χ2=12.671,P<0.001).The complication rate of observation group was significantly lower than that of control group(21.18%vs.80.65%,χ2=51.000,P<0.001).Conclusion"Zero channel"emergency mode can effectively shorten the treatment time of patients with severe traumatic brain injury,improve the success rate of rescue,reduce the incidence of complications,worthy of clinical use and promotion.
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Taking into consideration the characteristics and current development status of air medical rescue,an analysis is conducted from the perspective of hospitals to examine the focal points and challenges in establishing the capability of hospital air medical rescue.A capability framework comprising five modules,namely planning system,service model,professional teams,hardware platform,and operational procedures,is proposed.The key tasks for each module are sorted out.Furthermore,the ex-ploration and practical experience of The First Affiliated Hospital of Sun Yat-sen University are shared,with the aim of providing a reference for the construction of hospital air medical rescue capabilities in the modern era.
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Public hospitals play a dominant role in providing medical services.Meanwhile,they are also critical for un-dertaking missions to handle health emergencies.This paper analyzes the necessity,current situation,and existing weaknesses of the health emergency capacity of public hospitals.It also conducts a comparative study of the emergency response mechanisms of foreign medical institutions.This paper aims to explore a well-developed design for health emergency in public hospitals that is suitable for China's medical conditions and to provide a feasible model for promoting high-quality health emergency management.
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Objective To design a key nursing technique training platform for emergency response caregivers of nuclear,chemical and biological rescue.Methods The platform designed with B/S architecture used C# language for developing the server,HTML5 technology for building the user interface and JavaScript language for writing the logic of interaction,which was composed of three functional modules for video classroom,post-test and simulation training.Results The platform deve-loped realized training and assessment of key nursing techniques for nuclear,chemical and biological rescue without the restriction by time,space and teacher,and was of significance for enhancing the training efficacy.Conclusion The platform developed meets the needs of emergency response caregivers for key nursing techniques of nuclear,chemical and biological rescue.[Chinese Medical Equipment Journal,2024,45(1):37-41]
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Los deportes de combate conllevan un alto riesgo de padecer traumatismos dentoalveolares. Este estudio se evaluó la incidencia de traumatismos y lesiones orofaciales relacionadas con los deportes de combate, junto con la evaluación de las actitudes y hábitos de los deportistas respecto al uso de protectores bucales. Este estudio se realizó mediante sistema de encuestas digitales distribuidas en diferentes clubes deportivos donde se practican deportes de combate y no combate. Los deportistas de combate tienen más probabilidad sufrir alguna lesión orofacial que los no deportistas de combate. El sexo masculino y la experiencia son factores predisponentes en la aparición de traumatismos y lesiones orofaciales, siendo las laceraciones de tejidos blandos las más frecuentes. Los deportistas de combate llevan más protectores bucales que los deportistas en general, siendo el protector tipo II el más usado. Los deportistas que no llevan protectores no consideran que sea necesario. En caso de sufrir una avulsión dental, la mayoría de los participantes consideran que es posible reimplantar un diente avulsionado.
Combat sports carry a high risk of suffering dentoalveolar trauma. This study evaluated the incidence of dentoalveolar lesions related to combat sports, together with the evaluation of athletes' attitudes and habits regarding the use of mouth guards. This study was carried out using a digital survey system distributed in different sports clubs where combat and non-combat sports are practiced. Combat athletes are more likely to suffer a dentoalveolar lesion than non-combat athletes. Male sex and experience are predisposing factors in the appearance of dentoalveolar lesions, with soft tissue lacerations being the most frequent. Combat athletes wear more mouth guards than athletes in general, with the type II protector being the most used. Athletes who do not wear protectors do not consider it necessary. In case of suffering a dental avulsion, most of the participants consider that it is possible to reimplant an avulsed tooth.
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Resumen Antecedentes: El tratamiento de la infección crónica por el virus de la hepatitis C (VHC) con antivirales de acción directa logra tasas de respuesta virológica sostenida superiores a 95 %. Sin embargo, el manejo del fracaso virológico sigue siendo un desafío clínico y la evidencia sobre el retratamiento es limitada, especialmente en poblaciones como los receptores de trasplante hepático (TH). Objetivo: Este estudio evaluó el régimen de sofosbuvir más glecaprevir/pibrentasvir (GLE/PIB) en receptores de TH en quienes falló el régimen basado en inhibidores de la proteína no estructural 5A (NS5A). Material y métodos: Estudio retrospectivo de 111 pacientes trasplantados entre enero de 2018 y diciembre de 2020; 18 pacientes presentaron infección recurrente por VHC posterior al TH, tres de ellos tuvieron antecedentes de al menos un régimen basado en inhibidores de NS5A. Se inició terapia de rescate con sofosbuvir más GLE/PIB durante 12 semanas posterior al TH; se registraron las características basales de los pacientes y sus desenlaces. Resultados: En los tres pacientes se logró obtener una carga viral indetectable de VHC a las 12 semanas de finalizar el tratamiento. No se observaron eventos adversos graves. Conclusión: En nuestra serie, sofosbuvir más GLE/PIB durante 12 semanas demostró ser una terapia de rescate efectiva y segura posterior al TH en pacientes previamente tratados con inhibidores de NS5A.
Abstract Background: Treatment of chronic hepatitis C virus (HCV) infection with direct-acting antivirals achieves a sustained virologic response rates higher than 95%. However, virologic failure remains a clinical challenge, and data on retreatment are limited, especially in special populations such as liver transplant (LT) recipients. Objective: This study evaluated the sofosbuvir plus glecaprevir-pibrentasvir (GLE/PIB) regimen in LT recipients who had failed to a nonstructural protein 5A (NS5A) inhibitor-based regimen. Material and methods: Retrospective study of 111 liver transplant recipients between January 2018 and December 2020; 18 patients presented with HCV recurrent infection after LT, out of whom three had a history of at least one NS5A inhibitor-based regimen. Salvage therapy with sofosbuvir plus GLE/PIB was started for 12 weeks; baseline characteristics and outcomes were recorded. Results: All three patients (100%) achieved an undetectable HCV viral load 12 weeks after treatment completion. No serious adverse events were observed. Conclusion: In our series, sofosbuvir plus GLE/PIB for 12 weeks is an effective and safe salvage therapy after LT in patients previously treated with NS5A inhibitors.
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OBJECTIVE@#In order to solve the problem of inadequate CT screening ability in emergency medical rescue in remote mountainous areas, high-altitude areas, other public health events and sudden natural disasters, a vehicle-mounted mobile CT suitable for emergency medical rescue is studied.@*METHODS@#A vehicle chassis system suitable for long-distance transportation and a cabin system suitable for epidemic prevention and control was designed. A domestic 32-slice CT with small volume, light weight and high stability was selected to design a vehicle-mounted mobile CT suitable for emergency medical rescue.@*RESULTS@#The high-performance vehicle-mounted mobile CT can provide rapid support, and provide large-scale screening, emergency medical rescue, a supplement to daily CT scanning in peacetime and wartime.@*CONCLUSIONS@#The vehicle CT has high stability, fast scanning speed and high social and economic value.
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OBJECTIVE@#To improve the understanding of the virome and bacterial microbiome in the wildlife rescue station of Poyang Lake, China.@*METHODS@#Ten smear samples were collected in March 2019. Metagenomic sequencing was performed to delineate bacterial and viral diversity. Taxonomic analysis was performed using the Kraken2 and Bracken methods. A maximum-likelihood tree was constructed based on the RNA-dependent RNA polymerase (RdRp) region of picornavirus.@*RESULTS@#We identified 363 bacterial and 6 viral families. A significant difference in microbial and viral abundance was found between samples S01-S09 and S10. In S01-S09, members of Flavobacteriia and Gammaproteobacteria were the most prevalent, while in S10, the most prevalent bacteria class was Actinomycetia. Among S01-S09, members of Myoviridae and Herelleviridae were the most prevalent, while the dominant virus family of S10 was Picornaviridae. The full genome of the pigeon mesivirus-like virus (NC-BM-233) was recovered from S10 and contained an open reading frame of 8,124 nt. It showed the best hit to the pigeon mesivirus 2 polyprotein, with 84.10% amino acid identity. Phylogenetic analysis showed that RdRp clustered into Megrivirus B.@*CONCLUSION@#This study provides an initial assessment of the bacteria and viruses in the cage-smeared samples, broadens our knowledge of viral and bacterial diversity, and is a way to discover potential pathogens in wild birds.
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Animals , Animals, Wild/genetics , Lakes , Phylogeny , Picornaviridae/genetics , Viruses/genetics , China , Metagenomics , Genome, ViralABSTRACT
Objective To collect the data of hospitalized death cases in a provincial grade A tertiary general hospital,analysis the characteristics,changing trends,rescue conditions and related influencing factors of inpatient death cases,and provide a reference for the hospital's death case management and improvement of medical quality.Methods The gender,age,inpatient department,length of hospitalization,cause of death,rescue measures,sequential organ failure assessment(SOFA)score,and the date of death cases in a grade A tertiary general hospital from January 1,2012,to December 31,2022,were collected from the hospital medical record database.The characteristics of death cases were then statistically summarized through data aggregation.Spearman's rank correlation coefficient was used to analyze the relationship between the two research variables,while multivariate Logistic regression analysis was employed to explore the relevant factors affecting the implementation of rescue measures when death events occur in hospitalized patients,and draw the receiver operator characteristic curve(ROC curve)to analyze the relevant factors affecting the implementation of cardiopulmonary resuscitation in the event of death in hospitalized patients.Results ① The in-hospital mortality rate of inpatients in this hospital in the past 10 years was 0.26％,the mortality rate of males was significantly higher than that of females[0.32％(1 959/607 170)vs.0.19％(1 021/549 802),χ2 = 210.615,P<0.01],the mortality rate of hospitalized patients increased with age(r = 0.860,P = 0.037),and elderly patients>65 years old were the main group of hospital deaths;②The top 5 main causes of death among patients in this hospital were tumors,circulatory system diseases,respiratory system diseases,digestive system diseases and the symptoms,signs,clinical and laboratory abnormal findings,and those who died due to these 5 types of diseases accounted for 82.05％(2 445/2 980)of the total number of deaths;③Before the death event,the electrocardiogram(ECG)monitoring rate of inpatients in this hospital was 77.99％,the epinephrine usage rate was 83.46％,the endotracheal intubation rate was 57.55％,the cardiopulmonary resuscitation implementation rate was 44.93％,and the defibrillation rate was 12.85％.The epinephrine usage rate[86.17％(1 688/1 959)vs.78.26％(799/1 021)],the endotracheal intubation rate[59.37％(1 163/1 959)vs.54.06％(552/1 021)]and the cardiopulmonary resuscitation implementation rate[46.30％(907/1 959)vs.42.31％(432/1 021)]of male patients was significantly higher than that of female patients(all P<0.05);the cardiopulmonary resuscitation implementation rate for patients who died over 65 years old was significantly lower than those in other age groups[43.25％(734/1 697)vs.47.16％(605/1 283),P<0.05],before the death of inpatients in the surgical department,the ECG monitoring rate[68.63％(641/934)vs.82.26％(1 679/2 041)],the epinephrine usage rate[75.48％(705/934)vs.87.21％(1 780/2 041)]and the cardiopulmonary resuscitation implementation rate[31.16％(291/934)vs.51.34％(1 048/2 041)]were significantly lower than those in other department(all P<0.05).Patients who died from tumors had the lowest implementation rate of rescue measures when the death event occurred.Except for tumor patients,the ECG monitoring rate[68.33％(233/341)vs.93.07％(1 356/1 457)],the epinephrine usage rate[86.22％(294/341)vs.95.47％(1 391/1 457)],the endotracheal intubation rate[60.12％(205/341)vs.71.31％(1 039/1 457)],the cardiopulmonary resuscitation rate[40.18％(137/341)vs.55.66％(811/1 457)]and the defibrillation rate[7.92％(27/341)vs.19.42％(283/1 457)]of patients who died due to digestive system diseases were significantly lower than those who died due to circulatory diseases,respiratory diseases,and symptoms,signs,clinical and laboratory abnormalities(all P<0.05);④Multivariate Logistic regression analysis showed that urban household registration and SOFA score≥14 points before death were independent factors influencing the likelihood of cardiopulmonary resuscitation being performed in patients with severe death[odds ratio(OR)and 95％confidence interval(95％ CI)were 6.731(1.891-23.958)and 10.023(3.169-31.704),P values are 0.003 and<0.001 respectively];⑤ROC curve analysis shows that urban household registration,SOFA score≥14 points before death and their combination had a certain predictive value for cardiopulmonary resuscitation in hospitalized patients with digestive diseases(all P<0.05),and the combined value was higher,the area under ROC curve(AUC)= 0.840,95％ CI was 0.742-0.934.sensitivity was 82.76％,specificity was 75.51％,positive predictive value was 78.18％,and negative predictive value was 73.91％.Conclusions Hospitals should specifically strengthen the medical quality management of inpatient death cases,enhance the early warning system for high-risk patients,and consistently standardize the rescue measures and procedures for inpatients.Additionally,hospitals should prioritize the care of elderly and male patients with circulatory and respiratory-related critical illnesses,they should also strive to improve their ability to identify and treat critically ill surgical patients,as well as enhance their expertise in managing severe digestive system diseases.
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Objective To analyze the influencing factors of disaster resilience in medical rescue workers,to construct a prediction model for the low-level risk of disaster resilience in medical rescue workers,and to verify the predictive effect of the model.Methods Using the convenience sampling method and the snowball method,1 037 medical rescue workers who participated in disaster rescue in 18 provinces(autonomous regions and municipalities)were selected as the participants from May to July 2022.Online questionnaire surveys were conducted using general information questionnaires,disaster resilience measuring tools for healthcare rescuers,the Mindful Attention Awareness Scale,the Simple Coping Style Questionnaire and the Depression-Anxiety-Stress Scale.Univariate and multivariate logistic regression analyses were used to determine the independent influencing factors for the low level of disaster resilience of medical rescue workers.A risk prediction model was constructed,and a nomogram chart was drawn.The model's effectiveness was evaluated using the receiver operating characteristic curve(ROC)and calibration curve.The Bootstrap method was applied for internal validation.Results The logistic regression analysis showed that per capita monthly income of households,whether to participate in on-site disaster rescue,positive coping,mindfulness level,and adequacy of rescue supplies were independent influencing factors for the disaster resilience of medical rescue workers(P＜0.05).The predictive formula for the low-level risk of disaster resilience in medical rescue workers was established as follows:Logit(P)=8.741-0.381 x per capita monthly income of households-0.891 x whether to participate in on-site disaster rescue-2.544 x positive coping-0.020 x mindfulness level-0.222 x adequacy of rescue supplies.The area under the ROC curve was 0.823,and the optimal critical value was 0.353.The sensitivity and specificity were 79.12％and 71.43％,respectively.The Hosmer-Lemeshow test showed that x2=12.250(P=0.140),and the predicted curve fitted well with the ideal curve.The external validation showed that the sensitivity and specificity of the model were 75.00％and 66.39％,respectively,and the overall accuracy was 69.95％.Conclusion The prediction model in this study has sound predictive effects and can provide references and guidance for managers to select,recruit,and train medical rescue workers.
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Gene-edited mice are the most ideal laboratory animals for studying human gene functions, exploring disease mechanisms, and developing new drugs. Strain resulting from low fertility, aging, illness, etc. can cause irreversible losses to scientific research, so strain rescues of genetically engineering mice require different measures accordingly. Meanwhile, cost control is another key point when a specific technology is applied. First of all, when the only remaining gene-edited mouse in reproductive age suddenly dies, the dead male mouse can be rescued by in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), while the female mouse can be saved by ovarian transplantation, etc. Secondly, due to aging or diseases, mice can be saved through IVF-embryo transfer (ET) and unilateral epididymal tail assisted reproduction. Thirdly, round sperm injection (ROSI) and ovarian transplantation can be used to save endangered mice before sexual maturity with poor life status. This paper reviews rescue techniques of common endangered mice and their applications, which provides a reference for relevant practitioners to better maintain gene-edited mouse strains.
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Objective:The regional emergency system needs to maintain normal operation in disasters and sudden public health events, ensuring the timely treatment of critically ill patients, and also bearing the responsibility of ensuring various large-scale sports events. This article explores the practice of the "three-dimensional closed-loop" emergency system in the guarantee of the Hangzhou Asian Games in Wenzhou.Methods:After analyzing and integrating existing medical resources, the First Hospital Affiliated to Wenzhou Medical University conducted a two-year medical emergency exercise in a simulated urban road and natural water environment, and improved and optimized the weak links in the medical security system.Results:The hospital established a "three-dimensional closed-loop" emergency system and completed the medical support tasks for the Asian Games. The "three-dimensional closed-loop" emergency rescue system adopted a three-dimensional management team that combined a decentralized organizational structure and a professional medical team, and also has a land-air-sea emergency rescue team. By combining manpower and information technology, the system could provide "4R" medical services: real-time perception of medical emergencies in venues, rapid assessment of the patient's condition, rapid transfer of patients and rapid deployment of medical forces within the hospital. In addition, closed-loop management of the hospital's diagnosis and treatment process improved patients' satisfaction during the treatment process.Conclusions:The the "three-dimensional closed-loop" emergency system provided a strong guarantee for the successful holding of the Hangzhou Asian Games in Wenzhou and also accumulates experience for future urban emergency rescue.
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Autologous tissue reconstruction accounts for a certain proportion in immediate or delayed breast reconstruction. Deep infra-epigastric perforator free flap has its significant advantages, gradually being widely promoted and applied in China. The success rate of DIEP surgery is generally over 95%. However, vessel crisis and flap necrosis are inevitable. Before surgery, personnel and equipment should be prepared and patients should be thoroughly evaluated. During the surgical process, it is necessary to follow certain programmed and standardized procedures. Meticulous manipulations through entire operation are the key to reduce the risk of vessel crisis. Standard of procedure for flap monitoring during and after surgery should be established, and strictly implemented. If vessel crisis occurs, timely and orderly organization, exploration, and rescue should be carried out. The surgical team should do their best to identify problems, and rescue the flap as much as possible. Ensuring the overall safety and reducing interference with subsequent adjuvant treatment for patients should be considered. Based on the author’s long-term and extensive clinical work experience, this paper shares and discusses the strategies and methods of monitoring and rescue of free flap in breast reconstruction.
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Objective:Severe trauma events are emergent, with low incidence and unpredictable. Current guideline does not provide precise recommendations on how the trauma centers should arrange the number of beds in trauma intensive care units while making rational use of medical resources. We analyzed the trauma intensive care unit bed requirement in the branch campus of our hospital to propose a reasonable assessment.Methods:Patients with severe trauma sent to the Intensive Care Unit of Peking University People's Hospital from January 2022 to June 2022 were collected. The daily number of patients received intensive care was counted. The bed requirement of the intensive care unit covering 99% of clinical needs was calculated based on the probability distribution function.Results:From January 2022 to June 2022, 103 patients with severe trauma [74 males and 29 females, aged (51.47±16.06) years, ranging 16 to 87 years] were included in the study. Among the 103 patients, 57 were injured in traffic accidents, 26 fell from a high altitude, 12 fell, 4 were hit by heavy objects, and 4 were stabbed. TISS ranged from 16 to 50. The range of the daily bed requirement in the intensive care unit was 0–10, which was consistent with the Poisson distribution. According to the probability distribution function, nine trauma intensive care beds could meet 99.19% of clinical needs.Conclusions:In severe traumatic events, patients need to be transferred to intensive care unit as soon as possible. For our branch campus, nine trauma intensive care beds can cover more than 99% of clinical needs. It follows that, in accordance with the basic requirements of trauma center construction, hospitals with trauma centers need at least 9 beds in intensive care units. However, traumatic events cannot be predicted; thus, the bed requirement needs to be regularly evaluated.
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Objective:To explore the effect and value of the active learning mode based on mind mapping in the teaching of medical service support for major disasters.Methods:A total of 90 undergraduate students of 2016 Clinical Medicine of Naval Medical University were randomly selected as research objects, and they were randomly divided into observation group and control group. The 45 students in the control group used the traditional teaching mode, and the 45 students in the observation group used the mind mapping-based active learning mode for major disaster rescue and medical survice. The teaching time of the two groups was 12 h. The theoretical examination of knowledge and practical skills of the two groups of students were compared after teaching, and the students' satisfaction with the application of mind mapping-based teaching model in the teaching of medical service support for major disaster rescue was investigated. EmpowerStats and R softwares were used for t test and Chi-square test. Results:There were 24 males and 21 females in the observation group, with an average age of (21.40±0.69) years old. There were 22 males and 23 females, with an average age of (21.71±0.55) years old. The theoretical performance of the observation group (91.38±4.37) was significantly higher than that of the control group (84.91±3.98) ( P<0.001), and the practical skill performance of the observation group (92.98±3.24) was significantly higher than that of the control group (87.38±3.80) ( P<0.001). At the same time, the students' satisfaction with teaching effect in the observation group was 82.2% (37/45), which was significantly higher than that in the control group (37.8%, 17/45). Conclusion:The active learning mode based on mind mapping focuses on cultivating students' independent learning, interactive exploration and clinical thinking ability, and has a broad application prospect in the teaching of medical service support for major disasters.
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Objective:To summarize the management experience of helicopter medical transport in patients with critical heart disease, so as to provide reference for transport of patients with critical heart disease under the background of major natural disasters.Methods:The clinical and transport data of 36 critically ill cardiac patients in Fuwai Central China Cardiovascular Hospital from 16:30 on July 21 to 19:30 on July 22, 2021 due to historically rare heavy rainstorms were collected. All 36 critically ill cardiac patients were transported by helicopter. The safe transportation was implemented under the measures of quickly forming a transport leadership and coordination group, clarifying responsibilities and division of labor, doing a good job in the pretreatment of the patient's condition, pipeline assessment and mechanical circulation support (MCS) equipment, simulating and practicing the transfer process, improving the safety of the transfer implementation process, and effectively handing over with the target hospital. The gender, age, disease type, MCS, transport and outcome of patients were collected.Results:Thirty-six patients with cardiac critical illness were from adult extracardiac intensive care unit (ICU), adult cardiac care unit (CCU), children's CCU, comprehensive ICU and department of neurology. There were 24 males and 12 females; age (50.93±20.86) years old. There were 12 patients using respirator, 7 patients needing MCS, 2 of whom needed both extracorporeal membrane oxygenation (ECMO) and intra-aortic balloon pump (IABP), and 7 patients with post-cardiac surgery. The total distance of transportation of 36 patients was 1 638.4 km, the transit time was 10.5 hours, one way flight time of helicopter was about 8 minutes, and the average transport time per patient was about 17.5 minutes. The vital signs of 36 patients during transport were basically stable, without complications, and all of them reached the target hospital safely.Conclusion:Under the seamless connection of the rapid establishment of the transfer leadership coordination group, assessment of the patient's condition and pretreatment, the simulation of the transfer process, and the effective handover with the receiving hospital, the use of helicopter for medical transport for critically ill heart patients is feasible and safe, which can buy valuable time for saving patients' lives and further treatment.