➥新冠肺炎感染患者需要注意譫妄(delirium)的問題。
《刺胳針-精神醫學期刊》(Lancet Psychiatry)最新的一項系統性回顧與統合分析3559包含SARS, MERS, COVID-19的冠狀新病毒感染患者數據指出,COVID-19患者的譫妄在感染的急性期時,有不少的比例:
「在COVID-19的研究中」
一項研究加護病房譫妄的比例約69%;另一統計則顯示82在感染後死亡的患者中,有17位也(21%)出現意識狀態改變的譫妄症狀。
治療出院後,三分之一的COVID-19患者有執行障礙的認知功能問題(dysexecutive syndrome,也是譫妄的症狀)
「這份研究顯示」
罹患新冠肺炎的患者,和其他冠狀病毒(SARS, MERS)感染類似,在恢復後不會產生精神疾病。但醫護人員仍需要注意康復後的患者更長期是否有憂鬱、焦慮、創傷壓力後症、以及罕見神經精神疾病的可能性。(「財團法人國家衛生研究院」林煜軒醫師 摘要整理 ➥http://forum.nhri.org.tw/covid19/virus/j_translate/j1108/ )
✽ 關於譫妄的簡介,也可以參見以下整理的圖表:https://bit.ly/2YGCLk8
📋 Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: a systematic review and meta-analysis with comparison to the COVID-19 pandemic (2020/05/18)+中文摘要轉譯
■ Author:
Jonathan P Rogers, Edward Chesney, Dominic Oliver, et al.
■ Link:
(The Lancet) https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30203-0/fulltext
🔔豐富的學術文獻資料都在【論壇COVID-19學術專區】
■ http://forum.nhri.org.tw/covid19/
#2019COVID19Academic
衛生福利部
疾病管制署 - 1922防疫達人
疾病管制署
國家衛生研究院-論壇
同時也有1部Youtube影片,追蹤數超過3萬的網紅POPA Channel,也在其Youtube影片中提到,這根本就是一宗世紀大騙案!做父母之前,總有過來人跟我們說,BB哭鬧不外乎「食、痾、瞓」,餵飽奶,換完片,抱他一下,自然就不會再哭。但實戰開始,你就發現BB哪有這麼容易「服侍」,有些BB沒病沒痛都會日喊夜喊,哭得父母心煩頭痛,新手父母更可能會質疑自己,是不是自己不懂照顧孩子。 但其實BB無定向歇斯底...
「systematic review中文」的推薦目錄:
systematic review中文 在 Dr. Ray 的急症室迎送生涯 Facebook 的最讚貼文
醫者有社會責任去保障公眾健康,我們認為梁卓偉教授和陳家亮教授作為香港兩所醫學院院長責無旁貸。因此,我們呼籲所有醫護人員參與連署,懇請兩位院長履行社會使命發表聲明保障社會大眾的健康和人身安全。
連署連結: https://forms.gle/teMGNCiZPMYatVbh8
———————————————————————-
《致香港大學李嘉誠醫學院院長、中文大學醫學院院長的公開信》
梁教授、陳教授道鑒:
有鑑於在六月十二日、七月二日及二十一日,香港警察濫用武力以控制群眾。如此行徑實對公眾健康遺害無窮,我們一眾醫療人員對此極為關切。作為香港大學李嘉誠醫學院院長、中文大學醫學院院長,吾等懇請兩位院長細察香港警察控制群眾之手段,以保障公眾健康。
據多家本地及國際媒體報導,香港警察於六月十二日,發射多輪催淚彈、橡膠子彈及布袋彈,以驅散聚集在金鐘的示威者。報導提及,警方向示威者發射至少一百五十枚催淚彈,二十輪布袋彈以及數枚橡膠子彈,造成至少七十二人受傷。從多家媒體直播可見,橡膠子彈更直射一名教師眼球,創傷嚴重,對其視力之損害非同等閒。另外,警方亦曾以數枚催淚彈包抄示威者,堵塞其退路;而當示威者被逼退守至中信大廈,警方竟朝人群中央投以催淚彈,造成數以百計的市民受傷及呼吸困難,生死攸關,不容小覷。此外,警方向一名手無寸鐵的市民,近距離發射橡膠子彈,以致其下腹嚴重受傷,情況慘不忍睹。
據多份醫學期刊綜述──如《刺針》(Lancet)[1] 及英國醫學期刊(BMJ (Open))[2],橡膠子彈乃可致命武器。同時,橡膠子彈不易操控,準確性低,有引致重傷,乃至死亡之風險。多份期刊不約而同指出,橡膠子彈不適宜用於密集人群之管制。
然而,香港警察漠視上述已知風險,仍於七月二日及七月二十一日繼續使用此類武器。在七月二十一日,警察更於鄰近民居之地,向群眾發射多輪催淚彈及橡膠子彈,當中更殃及記者。此等武器之禍害影響深重,不單有損呼吸系統,更會導致燒傷、嚴重鈍物創傷及爆炸性創傷。據媒體報導,武器造成至少十四人受傷;更有市民懼於警方之搜捕行動,而未敢求醫,致使受傷數字難以估算。
人權醫療組織(Physicians for Human Rights)醫生哈爾(Dr Rohini Haar)在接受紐約時報訪問時指出,警方對市民使用不成比例的武力,實有濫用武力之嫌。早在二零一四年,潘冬平教授[3]亦對香港警察使用催淚氣體情況深表關注,擔心催淚氣體損害市民呼吸系統。可見,催淚彈、橡膠子彈及豆袋彈等武器危害不輕,對香港市民公眾健康的損害不容置疑。
兩大醫學學院一直致力培育杏林菁英,不遺餘力。一眾醫療人員亦謹承《希波克拉底誓詞》之教誨,不論病患身份職要,一直為全人類之福祉著想,嚴守不懈。學院循循善誘,吾等縷心刻骨。誓詞薪火相傳,代代不息;缺少對生命健康之尊重,醫療人員何以自立?故此,我們一眾醫療人員懇請院長,發表聲明,呼籲香港警察:
一、避免濫用催淚彈及任何類型子彈,以免導致人命傷亡及其他不可見之損傷。
二、在使用武力時,必須顧及市民安全,並保持專業克制。
醫療人員一直存仁心,行仁術;保護市民之健康,乃至生命,吾等責無旁貸。院長為學為醫,高風峻節,茍以吾等同心同德,捍衛市民之生命健康,必見杏林春暖。
謹祝
道安
一眾醫療人員謹上
———————————————————————
Dear Professor Leung and Professor Chan,
We are a group of healthcare professionals, some of us being also graduates from the Faculty of Medicine of the University of Hong Kong and the Chinese University of Hong Kong. We are writing to express our gravest concerns over the persistent and serious threats to the health of members of the public posed by weapons deployed in crowd control by the Hong Kong Police Force (HKPF) on 12 June, 2 July and 21 July. We hereby urge the Deans of the sole Faculties of Medicine in Hong Kong to take actions in censuring the HKPF and the Hong Kong Government against the serious health risks in their crowd-control tactics.
On 12 June, as reported by multiple local and international news agencies, the HKPF fired multiple rounds of tear gas, rubber bullets and bean-bag rounds to disperse protesters in Admiralty. Over 150 canisters of tear gas, 20 bean-bag rounds and several rubber bullets have admittedly been directed at protestors which resulted in at least 72 injuries. As evident in the live reports from various media sources, a teacher suffered traumatic ocular injury causing significant vision loss when his eye was hit by a rubber bullet; hundreds of citizens suffered various degrees of injuries and respiratory distress consequential upon the numerous tear gas canisters shot at Citic Tower in Admiralty where protesters were trapped in a life-threatening space filled with tear gas; an unarmed man sustained injury in his lower abdomen when a rubber bullet was directed at him in a short distance.
According to multiple studies and reviews from high impact factor medical journals, in particular the Lancet[1] and BMJ (Open)[2], rubber bullets can be lethal. Their notorious inaccuracy and risk of severe injury and death render them inappropriate and unsafe means of force in crowd control.
However, despite the known risks of these weapons, the HKPF tenaciously deployed them on citizens on 2 July and 21 July. On 21 July, 55 canisters of tear gas, 5 rubber bullet rounds and 24 sponge bullets were admittedly shot, some without immediate warning, at protestors and even at journalists notwithstanding the numerous residential buildings and citizens in the vicinity. The use of these weapons has left members of the public with at the very least, various types of injuries and further, burns, blunt force trauma and explosive injuries. 14 injuries have by far been reported where others did not present themselves to the hospital in fear of the risk of prosecution.
Dr Rohini Haar of Physicians for Human Rights had in a recent interview told the New York Times that the force used by the HKPF was disproportionate and excessive. In Hong Kong, Professor Ronnie Poon had as early as in 2014 expressed openly his earnest concern over both the short term and long term health risks in the use of tear gas in particular to one’s respiratory system when the HKPF first fired tear gas at Hong Kong citizens [3]. It is indisputable that these named weapons put the health of Hong Kong citizens at serious risks.
Doctors have striven to stand by the Hippocratic oath that they remain members of society, the identity of which comes before their profession, with special obligations to all fellow human beings. The two medical schools in Hong Kong have been established accordingly for the nurture of healthcare professionals to serve the public with benevolent hearts and minds. This is the time to honour our oath that human life should deserve the utmost respect and to maintain by all means such noble traditions of the medical profession.
We, as healthcare professionals, therefore implore the Deans of the only Faculties of Medicine in Hong Kong, in the service of humanity with conscience and dignity, to take the lead in safeguarding the public’s health and to issue a statement to urge the Hong Kong Police Force to:
(1) refrain from using tear gas and bullets in any form on protestors to prevent further bloodshed and severe non-reversible injuries; and
(2) exercise due restraint over the use of force when handling protests and at all times, put the safety of Hong Kong citizens at the highest priority.
Regards,
A group of healthcare professionals
———————————————————
Healthcare professionals have a social responsibility to safeguard the health of members of the public. We believe that, as Deans of the faculties of medicine in Hong Kong, Professor Leung and Professor Chan bear a paramount obligation in this regard. We appeal to all healthcare professionals to join us in this petition to urge the deans to issue a statement to honour their obligation to defend the public from health risks.
—————————————————————
Petition Link: https://forms.gle/teMGNCiZPMYatVbh8
——————————
參考資料/References
[1] Mahajna, A., Aboud, N., Harbaji, I., Agbaria, A., Lankovsky, Z., Michaelson, M., . . . Krausz, M. M. (2002). Blunt and penetrating injuries caused by rubber bullets during the Israeli-Arab conflict in October, 2000: A retrospective study. The Lancet, 359(9320), 1795-1800. doi:10.1016/s0140-6736(02)08708-1
[2] Haar, R. J., Iacopino, V., Ranadive, N., Dandu, M., & Weiser, S. D. (2017, December 01). Death, injury and disability from kinetic impact projectiles in crowd-control settings: A systematic review
[3] Professor Ronnie Poon Facebook: https://www.facebook.com/138599119760/posts/10152753050039761?s=1014598371&sfns=mo
—————————————————————
systematic review中文 在 Dr 文科生 Facebook 的最讚貼文
【Home Leave休養】
話說呢排多得各位讀者和記者們的愛戴令文科生呢個page愈來愈多人睇。
但當post的exposure多咗,就免不了會有comment。一直以來文科生都有收過不少的inbox或comment,當中都有些幾難聽同令人幾無奈。
當你打擊緊一些靠偽科學去做生意的人的時候,就容易引來反擊。放棄直線抽擊,淨係寫醫院小故事的念頭曾經在我腦海中閃過。
直線抽不單止可能引起好大迴響,我又要做research,睇Cochrane的meta-analysis/systematic review, 寫背景資料,公共衛生教育,再用淺白的文字和類比去解釋。每寫一篇文都要花上好幾個小時(我打中文真係好慢)。課餘時間我盡量利用踏車的時間去寫,每次我都盡量做足功課,盡量避免有可能誤導到讀者。
但係,即使我花這麼多時間同心力去寫,仍然遇到不少人反映我寫得不好或知識不夠
“睇佢上次同個中醫爭論就知佢仲有排學”
“淨係識抽素人父母水,不如好好讀醫啦”
“成日寫埋d直線抽擊,同人口舌之爭,邊有醫生會咁嫁,仲話學人做仁醫”
“佢寫d嘢好flawed喎,同d偽科學有咩分別”
“你無讀過自然療法同順勢療法,憑咩評論人地”
“你文科出身讀醫,邊夠班呀”
“我唔會想遇到你係我既醫生囉”
“條友博出名呃like”
其實我完全唔介意讀者評論我的文章,但比意見的同時可不可以盡量constructive同elaborate少少。我自問一直以來都會盡量verify facts and quote reputable的reference,所以你唔話我聽到底邊到”唔夠班”, 寫既嘢邊到”好flawed, 好偽科學”, 我係唔會知我篇文邊到出現問題。
一直以來我好努力的每幾日寫一篇文,每篇文都有基本醫學概念和背景資料,係因為我係醫院實在見太多誤信另類療法的病人受到不必要的苦難。然後這班推廣另類療法的人卻大義凜然地繼續推廣,出書,開Facebook group去誤導病人或家屬。
本以為可以透過持續的公共衛生教育去阻止偽科學的發展,但最近無力感愈來愈重,好多嘢想做,好多醫療知識想推廣。但係到底花咁多時間寫直線抽擊系列,有無讀者係真心學到一些醫療知識,理解點解一直以來醫學界都反對另類療法的原因?
適逢下星期開始放假,我會回港遊玩一下,休養一下疲累的身心,花多點時間在家人和朋友身上。在休養的期間我會反思一下這個page的定位和文筆,係咪應該shift返個focus去醫院小故事。希望回來的時候會是個更成熟的文科生。
以下開放給讀者們feedback
我會好好睇大家的意見 (please be constructive)
systematic review中文 在 POPA Channel Youtube 的最佳貼文
這根本就是一宗世紀大騙案!做父母之前,總有過來人跟我們說,BB哭鬧不外乎「食、痾、瞓」,餵飽奶,換完片,抱他一下,自然就不會再哭。但實戰開始,你就發現BB哪有這麼容易「服侍」,有些BB沒病沒痛都會日喊夜喊,哭得父母心煩頭痛,新手父母更可能會質疑自己,是不是自己不懂照顧孩子。
但其實BB無定向歇斯底里地哭三個小時以上,是有學名的,醫學界稱之為「colic」,中文譯作「腸絞痛」,亦是坊間一般所指的「肚風」或「百日哭」。很多人以為這是跟嬰兒飲奶時,肚子入風有關,但原來這個是誤解。「腸絞痛」的真正成因,至今在學術界依然是一個謎。
科學家試過從心理、生理等不同角度去探究,始終都未能有一個完滿的答案。無證據證明腸絞痛跟嬰兒腸胃發育或者腹部健康有直接關係,跟父母育兒技巧亦似乎無關。不過,我們仍然嘗試綜合相關資料,希望有這個煩惱和擔心的父母可以對嬰兒的無故哭鬧有更多了解。
參考資料
Roberts, Donna M., Ostapchuk, Michael, & O'Brien, James G. (2004). Infantile colic. American Family Physician, 70(4), 735-40.
Johnson, J., Cocker, K., & Chang, E. (2015). Infantile colic: Recognition and treatment. 92(7), 577-82.
Anabrees, J., Indrio, F., Paes, B., & Alfaleh, K. (2013). Probiotics for infantile colic: A systematic review. BMC Pediatrics, 13(1), 186.
Ockwell-Smith, S. (2016, March 22). Worried your baby is suffering from colic? This revelation will BLOW your mind. Retrieved from EXPRESS
Batlivala, S. (2017). Colic: An Evolutionary Selective Pressure for Good Parents? Clinical Pediatrics, 56(8), 705-706.
systematic review中文 在 Systematic Review & Meta-Analysis (I) 系統性回顧及統合分析 的推薦與評價
... <看更多>