Proviewer一次性使用软组织阻隔装置在颅内手术操作有效性及安全性的随机对照临床研究

目的评价Proviewer一次性使用软组织阻隔装置在颅内手术操作过程中的有效性和安全性,为推广应用提供科学依据。方法采用前瞻性随机对照的临床研究方法,以应用Proviewer一次性使用软组织阻隔装置为试验组,以传统脑压板手术为对照,比较两组手术间临床疗效及手术安全性的差异。结果从2011年06月至2011年12月,共有19例患者纳入全分析集(FAS),其中试验组10例,对照组9例。因为年龄违反入选标准而排除2例,故符合方案集(PPS)共有17例,其中试验组9例,对照组8例。纳入安全性分析集的19例,其中试验组10例,对照组9例。以临床效果综合计分作为主要疗效指标。试验组和对照组比较,在FAS和PPS的差异均具有统计学意义(P<0.05),试验组优于对照组。进一步对视野观察计分和主述性观察计分指标进行比较,表现出相同的结果,即在FAS和PPS的差异均具有统计学意义(P<0.05),试验组优于对照组。以不良事件作为安全性评价指标。试验组共出现1人(10.00%),对照组共出现1人(11.11%)。两组不良事件发生率差别无统计学意义(P>0.05)。所有不良事件均与治疗器械无关,且在病人出院前消除。结论Proviewer一次性使用软组织阻隔装置与传统脑压板相比,在颅内手术操作过程中能为手术者提供更好的观察视野、便利的手术操作,减少术中出血量;且未产生与医疗器械有关的不良反应,有较高的临床应用价值,值得临床推广使用。     

Sociodemographic factors associated with the dental health of persons with diabetes in France

This paper describes and compares the oral health status among people with and without diabetes in France, and analyzes the related socioeconomic factors. The study is based on data from the cross‐sectional national health survey conducted in France from 2002 to 2003, which included 19,231 people over 35 years of age, among whom 1,111 reported having diabetes. Data were collected through interviews that inquired about oral health status and use of dental care services, income, educational level, health insurance, place of residence, and birthplace. The prevalence of oral health problems was higher among subjects who had diabetes, compared with those who were nondiabetic (16.4% vs. 13.4%). Dental care utilization during the survey period was reported to be 8.7% among subjects who were diabetic versus 12.9% among those who were nondiabetic. The subjects with diabetes were more likely to have dental problems (OR = 1.47, CI = 1.03–2.08) and wear removable dentures (partial and complete) when their income was lower (OR = 2.17, CI = 1.52–3.10). There were social inequalities in oral health among people with diabetes in France according to income level.     

Mandibular access osteotomy: Gate way to parapharyngeal space – A case report

IntroductionPara pharyngeal tumors often pose a challenge to surgeons for surgical interventions. Maxillofacial access osteotomies offer excellent visualization and permit unhindered surgical manipulation. Access osteotomy allows the surgeon an adequate access of the surgical field to resect the tumor completely and to preserve vital structures. Though numerous techniques exist, selection of the proper technique is the key factor in reestablishing the function and cosmesis. This article describes our experience with mandibular swing approach that has facilitated complete removal of a parapharyngeal space tumor.Case presentation35years old female complained of deviation of tongue to one side and swallowing difficulty. Clinical and radiographic examinations were suggestive of a skull base lesion involving the hypoglossal nerve. After evaluation the tumor was excised through a mandibulotomy approach. Post operatively the patient was relieved completely of the symptoms and without any postoperative sequalae.Clinical discussionAccessibility is the main concern while dealing with skull base lesions. But the success of surgery lies on the selection of right approach. Paramedian mandibular swing approach has its own advantages over various other facial osteotomies. The swinging of the mandible gives advantage of accessing neck and skull base together, which is not possible with other facial osteotomies.ConclusionManagement of skull base tumors involve a multidisciplinary approach. Choosing the right approach is often a major dilemma. Access osteotomies of facial skeleton is a hatchway to the skull base lesions. Of which mandibular swing approach is a good option for skull base tumors because of the ease of surgical technique even in inexperienced hands.     

Access to conception planning information and services for people living with HIV in Ontario,Canada: A community-based research study

Decreased mortality, decreased risk of vertical HIV transmission, and many people living with HIV (PLWHIV) being of reproductive age have led many PLWHIV to consider pregnancy. However, scarce data exist regarding the conception planning resources required and available for PLWHIV to have safe and healthy pregnancies. This study aimed to identify gaps between the need for, knowledge of, and access to conception planning information and services among PLWHIV in Ontario, Canada. PLWHIV from three large and two small urban sites in Ontario were recruited (n?=?63). Participants completed a cross-sectional survey assessing demographics, expectations and plans for conception, and knowledge about and access to existing conception information and services for PLWHIV. Univariate correlations and ranked analyses were used to assess the associations between the need for, knowledge of, and access to conception planning resources with various demographic variables. Participants’ median age was 40 years (interquartile range = 33–45) with 52% being female, 73% identified as heterosexual, and 27% as lesbian, gay, bisexual, queer, transgender, two-spirited, or other. Univariable analysis indicated that male PLWHIV and those from small urban areas were less likely to expect children in the future and less likely to speak to healthcare providers about conception planning. Although 63% of all participants intended to conceive and 44% had a plan for conception in the near future, only 30% had spoken to a healthcare provider about pregnancy and only 30% had some knowledge about conception planning and assisted reproductive services for safer conception for PLWHIV. Knowledge of and access to resources on conception planning for PLWHIV varied by sexual orientation and geographic location in Ontario. Our results show a gap between the need for conception information and knowledge of and access to adequate information and resources among PLWHIV in Ontario, which may impact the psychosocial well-being of PLWHIV and their children.     

Retrospective analysis of physical therapy utilization by the specificity of the diagnosis and order written on the referral

Background: Arguments against reimbursement for direct access to physical therapy (PT) are that a physician examination is necessary to diagnose and that there is a potential for increased cost. Objective: To determine what percentage of PT referrals had a specific diagnosis and treatment orders. Additionally, specific and non-specific diagnoses and treatment orders were compared in regards to PT units billed, average visits per referral, and average cost per referral. Methods: The charts of 1,000 patients treated in outpatient PT underwent a retrospective chart review. Interferential statistics were used to determine if there was a statistically significant difference between specific and non-specific diagnoses and treatment orders in regard to PT units billed, average visits per referral, and average cost per referral. Results: Twenty-nine percent of all referring diagnoses were non-specific in nature and 58% contained treatment orders that were non-specific. Charts with a specific diagnosis had a statistically significant higher utilization as compared to non-specific diagnoses (p ≤ 0.001). Patients with a specific treatment order also displayed a statistically significant larger average in billed units, average visits per referral, and average reimbursement per referral than those without a specific treatment order (p ≤ 0.0001). Conclusion: Our findings suggest that a physician diagnosis and referral may not be required to direct care for patients seeking PT services. Third-party payers that require a physician referral for PT services may be delaying access to healthcare and increasing costs.     

Intensive Referral of Veterans to Mutual-Help Groups: A Mixed-Methods Implementation Evaluation

Community-based support group participation protects against substance use disorder (SUD) relapse, but referrals during treatment are inconsistently delivered and may not acknowledge barriers facing rural patients. This formative evaluation of a rural intensive referral intervention (RAIR) to community-based support groups for Veterans seeking SUD treatment surveyed patients (n = 145) and surveyed and interviewed treatment staff (n = 28). Patients and staff did not differ significantly on quantitative ratings of the helpfulness of, or satisfaction with, seven RAIR components, but staff did not deliver the intervention consistently or as designed, citing two themes: lack of commitment and lack of resources.     

The relationship between perceived role and appropriate use of peripherally inserted central catheters: A survey of vascular access nurses in the United States

BackgroundThe presence and proliferation of vascular access nursing in hospital settings has been identified as a potential contributor to growing demand, and possible overuse, of peripherally inserted central catheters (PICCs).ObjectiveWe examined vascular access nurses’ perceived role related to use of PICCs and the association with appropriateness of PICC use in hospitals.DesignA web-based survey was administered to members of two vascular access professional organizations.ParticipantsOf 2762 potentially eligible respondents who accessed the link, 1698 (61%) completed the survey. This sample was further restricted to vascular access nurses who worked in a U.S. hospital (n = 1147).MethodsRespondents were categorized based on perceived role: 1) an operator who inserts PICCs; 2) a consultant whose views are not valued by the care team (unvalued consultant); 3) a consultant whose views are valued by the care team (valued consultant). Facility and respondent characteristics, reported practices, leadership support and relationships with other providers were compared across groups using chi-squared tests and analysis of variance. Multivariable logistic regression was used to assess the association between perceived role and reported percentage of PICCs placed for inappropriate reasons.ResultsAmong the 1147 respondents, 210 (18%) viewed themselves as operators, 683 (59%) as valued consultants, 236 (21%) as unvalued consultants, and 18 (2%) could not be categorized. A significantly higher percentage (93%) of valued consultants reported that vascular access nurses placed the majority of PICCs at their facility, compared to operators (83%) or unvalued consultants (76%) (p < 0.001). After adjustment, compared with operators, valued consultants were significantly more likely to report that <10% of PICCs at their facility were inserted for inappropriate reasons (OR 1.7, p = 0.002); the finding was reversed for unvalued consultants (OR 0.69, p = 0.06).ConclusionsVascular access nurses and their perceived role as part of the healthcare team are associated with PICC use in hospitals. Strong inter-professional collaboration and respect may help ensure more appropriate use of PICCs.