Choking

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  • 文章类型: Journal Article
    我们研究了T7-Fz(言语分析运动计划)大脑区域之间的α带相干性是否与运动中的出色表现有关。我们搜索了八个数据库的相关论文:ProQuestCentral,ProQuest心理学期刊,心术,PsycINFO,SPORTDiscus,MEDLINE,Scopus,和WebofScience使用相关关键字(即,脑电图和运动和相干性)。七项研究,共有194人参加,符合我们的纳入标准并入围统计分析.我们比较了受试者内部和受试者之间实验设计的EEG相干性数据。我们的分析显示,当表现更好时,运动员在T7-Fz脑通路中对α带激活的相干性较低(Hedges\'g=-0.54;p=0.03)。理论上,这些结果证实了这样一种观点,即运动员变得更“神经效率”,因为他们大脑的言语和运动区域功能更加独立,即,神经效率假说。因此,能够限制言语干扰的运动员更有可能成功完成体育任务。
    We examined whether the alpha-band coherence between the T7-Fz (verbal analytical-motor planning) brain areas were related to superior performance in sports. We searched for related papers across eight databases: ProQuest Central, ProQuest Psychology Journals, PsycARTICLES, PsycINFO, SPORTDiscus, MEDLINE, Scopus, and Web of Science using relevant keywords (i.e., EEG AND sports AND coherence). Seven studies, with a total of 194 participants, met our inclusion criteria and were shortlisted for statistical analysis. We compared EEG coherence data for both within-subject and between-subject experimental designs. Our analysis revealed that athletes had lower coherence in the T7-Fz brain pathway for alpha- band activation (Hedges\' g = - 0.54; p = 0.03) when performing better. Theoretically, these results corroborate the notion that athletes become more \"neurally efficient\" as the verbal and motor areas of their brains function more independently, i.e., the neural efficiency hypothesis. Accordingly, athletes who can limit verbal interference are more likely to perform a sporting task successfully.
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  • 文章类型: Journal Article
    目的:本研究的目的是确定一线卫生专业人员如何识别和管理非致命性绞窄事件。
    方法:进行叙事综合综合综述。
    方法:在六个电子数据库中进行了全面的数据库搜索(CINAHL,科学大会,发现,Scopus,PubMed和Scholar)产生了49篇潜在合格的全文,在应用排除标准后,减少至10篇文章可纳入.
    方法:根据系统评价和荟萃分析(PRISMA)声明指南的首选报告项目进行综合评价。数据被提取,使用Whittemore和Knafl(2005)框架进行了叙述性综合,以确定一线卫生专业人员如何识别和管理非致命勒死事件。
    结果:研究结果确定了三个主要主题:卫生专业人员总体上未能识别非致命性勒死,未能报告事件,事件发生后未能跟进受害者。围绕非致命勒死的污名和预先确定的信念,以及缺乏关于体征和症状的知识,是文献中的显著特点。
    结论:缺乏培训和对不知道下一步该做什么的恐惧是为勒死受害者提供护理的障碍。未能检测到,管理和支持受害者将通过勒死的长期健康影响继续伤害的循环。早期发现和管理绞窄对预防健康并发症至关重要,特别是当受害者反复接触这种行为时。
    结论:这篇综述似乎是首次探讨卫生专业人员如何识别和管理非致命性绞窄。它确定了对教育和强有力和一致的筛查和出院政策的巨大需求,以协助非致命勒死受害者参加的服务的卫生提供者。
    UNASSIGNED:本综述不包含患者或公众贡献,因为它检查了卫生专业人员识别非致命性绞窄的知识以及临床实践中使用的筛查和评估工具。
    OBJECTIVE: The aim of this study was to determine how front-line health professionals identify and manage nonfatal strangulation events.
    METHODS: Integrative review with narrative synthesis was conducted.
    METHODS: A comprehensive database search was conducted in six electronic databases (CINAHL, Wed of Science, DISCOVER, SCOPUS, PubMed and Scholar) resulting in 49 potentially eligible full texts, reduced to 10 articles for inclusion after exclusion criteria were applied.
    METHODS: An integrative review was undertaken in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement guidelines. Data were extracted, and a narrative synthesis using Whittemore and Knafl (2005) framework was undertaken to determine how front-line health professionals identify and manage nonfatal strangulation events.
    RESULTS: The findings identified three main themes: an overall failure by health professionals to recognize nonfatal strangulation, a failure to report the event and a failure to follow up on victims after the event. Stigma and predetermined beliefs around nonfatal strangulation, along with a lack of knowledge about signs and symptoms, were the salient features in the literature.
    CONCLUSIONS: Lack of training and fear of not knowing what to do next are barriers to providing care to victims of strangulation. Failure to detect, manage and support victims will continue the cycle of harm through the long-term health effects of strangulation. Early detection and management of strangulation are essential to prevent health complications, particularly when the victims are exposed to such behaviours repeatedly.
    CONCLUSIONS: This review appears to be the first to explore how health professionals identify and manage nonfatal strangulation. It identified the significant need for education and robust and consistent screening and discharge policies to assist health providers of services where victims of nonfatal strangulation attend.
    UNASSIGNED: This review contains no patient or public contribution since it was examining health professionals\' knowledge of identifying nonfatal strangulation and the screening and assessment tools used in clinical practice.
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    文章类型: Journal Article
    窒息和吸入性肺炎是澳大利亚住院患者可预防死亡的主要原因。在维多利亚,在2018-2019年,被转诊至死因裁判官的住院护理患者中,59%的死亡来自吸入性肺炎.2016-2017年,在新南威尔士州,居住在寄宿护理中的残疾人死亡的主要原因是肺部固体和液体引起的肺炎。这种死亡与吞咽问题(吞咽困难)以及患有认知障碍和多种健康问题的人密切相关,包括心理健康问题,风险最大。本评论的重点是验尸官的调查结果将吞咽困难或吸入性肺炎确定为死亡原因或导致死亡的原因。它还包括验尸官的建议摘要,其中强调了应实施的程序,以提高吞咽困难患者的安全性。
    Choking and aspiration pneumonia are a leading cause of preventable death for people in residential care in Australia. In Victoria, in 2018-2019, 59% of deaths of persons in residential care that were referred to the coroner were from aspiration pneumonia. In 2016-2017, in New South Wales, the leading cause of death in people with disability living in residential care was pneumonitis caused by solids and fluids in the lungs. Such deaths are closely linked with swallowing problems (dysphagia) and people with cognitive impairments and multiple health issues, including mental health issues, are most at risk. This commentary focuses on coronial inquests where coroners\' findings have identified dysphagia or aspiration pneumonia as a cause of death or a contributor to a person\'s death. It also includes a summary of the recommendations by coroners which highlight processes that should be implemented to improve the safety of people with dysphagia.
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  • 文章类型: Journal Article
    一些机构提出响应式喂养(RF)作为照顾者在养育孩子时的关系标准,从乳房/配方喂养开始。以前的系统评价(SRs)对照顾者的喂养做法(CFP)包括对来自不同文化国家的人群的研究,营养不良率,和收入,而该SR仅比较来自工业化国家的健康儿童(4-24个月)的不同CFP。临床问题是关于不同CFP对几个重要结果的影响,即增长,超重/肥胖,窒息的风险,龋齿,2型糖尿病(DM2),和高血压。文献综述不支持任何婴儿导联断奶或婴儿导联SolidS导论(BLISS)对儿童体重增加的积极影响,对未来的超重/肥胖也没有预防作用。RF-CFP可以在生命的头两年内导致足够的体重增加和较低的超重/肥胖发生率。而限制性风格和强制性风格,CF中的两种非RF,会产生负面影响,有利于多余的体重和较低的体重,分别。窒息风险:成人未能监督儿童的饮食是最重要的风险因素;BLW/BLISS/RF/NRCF与窒息之间没有因果关系。DM2,高血压,和龋齿:不同的CFP不能被认为是在以后生活中发展这些疾病的风险或预防因素。
    Several institutions propose responsive feeding (RF) as the caregivers\' relational standard when nurturing a child, from breast/formula feeding onwards. Previous systematic reviews (SRs) on caregivers\' feeding practices (CFPs) have included studies on populations from countries with different cultures, rates of malnutrition, and incomes, whereas this SR compares different CFPs only in healthy children (4-24 months) from industrialized countries. Clinical questions were about the influence of different CFPs on several important outcomes, namely growth, overweight/obesity, risk of choking, dental caries, type 2 diabetes (DM2), and hypertension. The literature review does not support any Baby Led Weaning\'s or Baby-Led Introduction to SolidS\' (BLISS) positive influence on children\'s weight-length gain, nor their preventive effect on future overweight/obesity. RF-CFPs can result in adequate weight gain and a lower incidence of overweight/obesity during the first two years of life, whereas restrictive styles and coercive styles, two kinds of non-RF in CF, can have a negative effect, favoring excess weight and lower weight, respectively. Choking risk: failure to supervise a child\'s meals by an adult represents the most important risk factor; no cause-effect relation between BLW/BLISS/RF/NRCF and choking could be found. Risks of DM2, hypertension, and caries: different CFPs cannot be considered as a risky or preventive factor for developing these conditions later in life.
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  • 文章类型: Review
    背景:吞咽困难和窒息在患有精神疾病的成年人中非常普遍。然而,考虑到这一人群吞咽困难的个人经历,研究很少。
    目的:了解使患者参与识别的策略的证据基础,餐时困难的评估和治疗。
    方法:这篇综合综述综合了有关精神健康状况患者吞咽困难经历的文献。患者咨询导致根据Prisma指导对五个科学数据库进行系统搜索的共同设计的搜索术语和资格标准。完成了对合格研究的质量评估和反身主题分析。
    结果:31项研究纳入综述。这些包括病例报告,文献综述和横断面研究。证据质量很弱,没有确定干预研究。关于吞咽困难或窒息的个人经历,细节很少。确定的与生物医学观点相关的主题,在没有上下文的情况下呈现的影响因素,和由临床医生领导的决策。
    结论:精神保健指南呼吁关注身体合并症的诊断不足,并提倡患者包容。然而,该人群中的患者声音很少被描述为吞咽困难。进一步的包容性研究表明,探索吞咽困难和窒息的影响,以及对干预措施和结果措施的影响。
    UNASSIGNED: Dysphagia and choking are highly prevalent in adults with mental health conditions. However, there is scant research considering the personal experience of dysphagia for this population.
    UNASSIGNED: To understand the evidence-base for strategies to involve the patient in recognition, assessment and treatment of mealtime difficulties.
    UNASSIGNED: This integrative review synthesised the literature on the experience of dysphagia in patients with mental health conditions. Patient consultation led to co-designed search terms and eligibility criteria for a systematic search of five scientific databases following Prisma guidance. Quality assessment of the eligible studies and reflexive thematic analysis were completed.
    UNASSIGNED: 31 studies were included for review. These included case reports, literature reviews and cross-sectional studies. Quality of evidence was weak and no intervention studies were identified. There was scant detail regarding the personal experience of dysphagia or choking. Themes identified related to biomedical perspectives, influencing factors presented without context, and decision-making led by clinicians.
    UNASSIGNED: Guidance on mental healthcare calls attention to under-diagnosis of physical co-morbidities and advocates patient inclusion. However, the patient voice in this population is rarely described regarding dysphagia. Further inclusive research is indicated to explore the impact of dysphagia and choking, and implications for interventions and outcome measures.
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  • 文章类型: Journal Article
    This systematic review draws together evidence from the literature for the pathological, neurological, cognitive, psychological, and behavioural outcomes of non-fatal strangulation in domestic and sexual violence. A systematic search of PubMed, PsycINFO, CINHAL, Proquest, ASSIA, Web of Science, WestLaw, Open Grey, and Ethos was conducted, with no date limits set, to identify eligible studies. Thirty empirical, peer-reviewed studies were found which met the inclusion criteria. Pathological changes included arterial dissection and stroke. Neurological consequences included loss of consciousness, indicating at least mild acquired brain injury, seizures, motor and speech disorders, and paralysis. Psychological outcomes included PTSD, depression, suicidality, and dissociation. Cognitive and behavioural sequelae were described less frequently, but included memory loss, increased aggression, compliance, and lack of help-seeking. However, no studies used formal neuropsychological assessment: the majority were medical case studies or based on self-report. Furthermore, few authors were able to control for possible confounds, including other physical violence and existing psychosocial difficulties. There is therefore a need for further neuropsychological research, focusing on cognitive and behavioural outcomes, using standardized tools, and control groups where possible. This is urgent, given societal normalization of strangulation, and legal systems which often do not reflect the act\'s severity and its consequences.
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  • 文章类型: Journal Article
    在系统评价中总结治疗异物气道阻塞(FBAO)的干预措施的有效性。
    我们搜索了MEDLINE,EMBASE,和Cochrane图书馆从2019年9月30日开始,用于描述干预措施在成人和儿童中治疗FBAO的有效性的研究。我们纳入了随机对照试验,观察性研究和描述获益证据的病例系列(≥5例)。对于伤害/并发症的证据,我们包括病例报告。两名审核员独立评估研究资格,提取的研究数据,并评估偏见的风险。数据汇总在叙事综合中。等级系统用于评估证据的确定性。
    我们收录了69篇出版物,包括三项横断面研究(557例患者);8例病例系列(755例患者),病例报告59例(64例)。其中一篇论文作为案例系列和横断面研究。对于所有干预措施和相关结果,证据的确定性很低。旁观者早期去除FBAO与改善神经系统生存率相关(比值比6.0,95%置信区间1.5至23.4)。确定的证据表明,关键干预措施(背部打击,腹部推力,胸部推力/按压,Magill镊子,手动去除口腔中的障碍物,基于抽吸的气道清除装置)可有效缓解FBAO。我们发现了与背部打击有关的伤害报告,腹部推力,胸部推力/按压,和盲目的手指扫描。
    关键干预措施成功缓解FBAO,但可能与重要的危害有关。FBAO管理指南应平衡干预措施的利弊。
    To summarise in a systematic review the effectiveness of interventions to treat foreign body airway obstructions (FBAO).
    We searched MEDLINE, EMBASE, and the Cochrane library from inception on 30th September 2019 for studies that described the effectiveness of interventions to treat FBAO in adults and children. We included randomised controlled trials, observational studies and case series (≥5 cases) that described evidence of benefit. For evidence of harm/complications, we included case reports. Two reviewers independently assessed study eligibility, extracted study data, and assessed risk of bias. Data are summarised in a narrative synthesis. The GRADE system is used to assess evidence certainty.
    We included 69 publications, comprising three cross-sectional studies (557 patients); eight case series (755 patients), and 59 were case reports (64 patients). One paper was included as a case series and cross-sectional study. For all interventions and associated outcomes, evidence certainty was very low. Early removal of FBAO by bystanders was associated with improved neurological survival (odds ratio 6.0, 95% confidence interval 1.5 to 23.4). Identified evidence showed that key interventions (back blows, abdominal thrusts, chest thrusts/compressions, Magill forceps, manual removal of obstructions from the mouth, suction-based airway clearance devices) are effective in relieving FBAO. We identified reports of harm in relation to back blows, abdominal thrusts, chest thrusts/compressions, and blind finger sweeps.
    Key interventions successfully relieve FBAO, but may be associated with important harms. Guidelines for FBAO management should balance the benefits and harms of interventions.
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  • 文章类型: Journal Article
    Despite an obstructed airway (choking) being a relatively preventable injury, it has a considerable mortality burden globally, with increasing incidence. Given new technologies in choking management, this systematic review aimed to assess current literature on the effectiveness of anti-choking suction devices at relieving obstructions.
    Ovid MEDLINE, Embase, PubMed, The Cochrane Library, SCOPUS, Web of Science, CINAHL Plus and the English websites of the devices were searched on September 23, 2019. Studies were included if they reported the anti-choking devices\' dislodgment success rate (primary outcome) or associated adverse events (secondary outcome). Articles, conference abstracts or technical reports were included if peer reviewed. Certainty of evidence was assessed in accordance with GRADE.
    Five studies satisfied the inclusion criteria for this review. Two studies (40%) reported findings of a single centre mannequin trial, one (20%) of a single centre cadaveric trial, and two (40%) were case series. Cohen\'s Kappa for the first and second round of screening was 0.904 and 0.674 respectively. Although several devices have been manufactured worldwide, the LifeVac© has been most extensively studied, with a combined dislodgement success rate of 94.3% on first attempt. However, certainty of evidence for the primary outcome was evaluated as very low.
    There are many weaknesses in the available data and few unbiased trials that test the effectiveness of anti-choking suction devices resulting in insufficient evidence to support or discourage their use. Practitioners should continue to adhere to guidelines authored by local resuscitation authorities which align with ILCOR recommendations.
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  • 文章类型: Journal Article
    Non-fatal strangulation (NFS) can be a cause of severe injury. However, the prevalence and rates of injuries from NFS are unknown, as few victims present to medical attention after strangulation. As up to 40% of fatal strangulations have no external signs, and the majority of surviving victims have few or minor injuries, finding those people severely injured remains challenging. The majority of the evidence regarding NFS is largely based on case reports and case series with no robust studies estimating rates of injuries or the best investigation tools. The injuries that are reported make clear that strangulation is a potentially lethal form of injury that should not be ignored in those presenting having been strangled, or in those presenting with neurological symptoms, including strokes, seizures and vascular abnormalities. The safety implications of strangulation are also important as it can be a prelude to homicide. A search of the literature was carried out with the following terms: Nonfatal strangulation (10), Nonfatal strangulation (17), \'Strangulation injuries\' (19), \'Manual strangulation\' (92) - laboratory testing eliminated, and \'choking game\'. The PubMed database was used first, followed by the collections of Monash University and the Strangulation Institute (as some articles were too old to find electronically). This article summarises the injuries that can occur following strangulation and discusses the quality of the evidence thus far.
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  • 文章类型: Journal Article
    OBJECTIVE: To present a novel approach for the emergent, pre-hospital management of life-threatening aerodigestive tract foreign body aspiration using a portable, non-powered, suction-generating device (PNSD), in the context of a literature review of emergent pre-hospital management of patients with foreign body airway obstruction.
    METHODS: The PubMed and MEDLINE databases were comprehensively screened using broad search terms. A literature review of pre-hospital management and resuscitative techniques of foreign body airway obstruction was performed. Further, independent measurements of PNSD pressure generation were obtained. Application of a PNSD in cadaveric and simulation models were reviewed. A comparative analysis between a PNSD and other resuscitative techniques was performed.
    RESULTS: Physiologic data from adult and pediatric human, non-human, and simulation studies show pressure generation ranging from 5.4 to 179 cm H2O using well-established resuscitative maneuvers. Laboratory testing demonstrated that a protypic PNSD demonstrated peak airway pressures of 434.23 ± 12.35 cm H2O. A simulation study of a PNSD demonstrated 94% reliability in retrieving airway foreign body, while a similar cadaveric study demonstrated 98% reliability, with both studies approaching 100% success rate after multiple attempts. Several case reports have also shown successful application of PNSD in the emergent management of airway foreign body in elderly and disabled patients.
    CONCLUSIONS: PNSDs may play an important role in the emergent, non-operative, pre-hospital management of upper aerodigestive tract foreign body aspiration, particularly in settings and populations with high choking risk. Further characterization of effectiveness and safety in larger cadaveric or simulation studies mimicking physiologic conditions is indicated.
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