Blood or Body Fluid Exposures and HIV Postexposure Prophylaxis Utilization among First Responders

Objectives. To estimate the incidence of first-responder visits to emergency departments (EDs) for blood or body fluid exposures, elucidate any temporal patterns of these visits, and quantify human immunodeficiency virus (HIV) postexposure prophylaxis (PEP) utilization for these exposures. Methods. This was a retrospective study of first responders presenting to Rhode Island EDs for blood or body fluid exposures from 1995 to 2001. Incidence rates for exposures with 95% confidence intervals (CIs) were estimated. Temporal trends for visits were modeled. Factors associated with HIV PEP utilization were identified using logistic regression. Odds ratios (ORs) with 95% CIs were estimated. Results. The average incidence rate of ED visits for blood or body fluid exposures was 23.29 (20.07–26.52) ED visits per 100,000 ambulance runs. The incidence rose between 1995 and 1999 and then decreased. First-responder ED visits were lowest in October and highest in April and were lowest at 7 am and highest at 7 pm. First responders presenting with a percutaneous or blood-to-mucous membrane exposure had a 4.13 (1.82–8.89) greater odds and those exposed to a known HIV-infected source had a 9.03 (1.59–51.26) greater odds of being offered HIV PEP. First responders presenting to a teaching hospital had a 2.21 (1.02–4.77) greater odds of being offered prophylaxis and a 4.20 (1.08–16.32) greater odds of accepting prophylaxis when it was offered. Conclusions. First responders face a risk of blood or body fluid exposure that varies over the course of the day and the year. HIV PEP is more likely to be used if the exposures are percutaneous, or blood-to-mucous membrane, or if the source is known to be HIV-infected. Standardization of protocols across EDs for administering HIV prophylaxis appears to be needed.     

Development and use of a prehospital-oriented ems computer bulletin board service

Objective. To describe a Level 1 trauma center's response to the need for centralized information for EMS providers by implementing a computer bulletin board service (BBS). This service permits rapid retrieval of continuing education and reference information as well as an electronic forum for EMS-related issues. Methods. A desktop computer with a modem supporting 14.4 kbps running Remote Access v2.01 is accessed by both local and toll-free telephone numbers. Users may connect using any personal computer or terminal equipped with a modem as no proprietary formats are used. The service is available 24 hours a day, free of charge, and requires users to register online. Results. The first 41 months of experience has seen 9,592 calls answered by the BBS. 1,372 users, who may be individuals or groups, have registered on the service. Usage occurs in every county in the sponsor's state. In one sample period, 49% of the activity was educationally related, followed by discussion forums (26%). The BBS is used most heavily in the afternoon and evening hours. Conclusions. A prehospital-oriented EMS BBS has seen increasing utilization in its first 41 months of existence. It has rapidly established itself as a statewide mainstay of EMS information while being inexpensive to develop and maintain. It provides focused service to a target audience and is easily accessible. The development of similar local resources elsewhere is encouraged.     

Understanding women's experiences with medical abortion: In-depth interviews with women in two Indian clinics

Abstract

We explored women's perspectives on using medical abortion, including their reasons for selecting the method, their experiences with it and their thoughts regarding demedicalisation of part or all of the process. Sixty-three women from two urban clinics in India were interviewed within four weeks of abortion completion using a semi-structured in-depth interview guide. While women appreciated the non-invasiveness of medical abortion, other factors influencing method selection were family support and distance from the facility. The degree of medicalisation that women wanted or felt was necessary also depended on the way expectations were set by their providers. Confirmation of abortion completion was a source of anxiety for many women and led to unnecessary interventions in a few cases. Ultimately, experiences depended more on women's expectations about the method, and on the level of emotional and logistic support they received rather than on inherent characteristics of the method. These findings emphasise the circumstances under which women make reproductive choices and underscore the need to tailor service delivery to meet women's needs. Women-centred counselling and care that takes into consideration individual circumstances are needed.     

临床科室医疗设备使用管理探讨

医疗设备的临床使用是当前医疗设备管理链条上的薄弱环节;为保障医疗安全和医疗质量,本文从制度建设、记录方法、管理员设置和质量考核等方面,阐述强化医疗设备临床使用管理的措施。     

抓好后勤训练等级评定提升卫勤保障能力

后勤训练等级评定工作是提高部队医院卫勤保障能力的重要手段。为了有效发挥后勤训练等级评定工作的重要作用,采取了以下做法:①强化官兵使命意识,推行激励机制,增强官兵通过等级评定的信心;②理顺考评工作的基本思路,细化量化考评标准,科学组织考评工作;③考评内容结合部队实际情况,并严格执行考评标准,积极创新考评手段等。通过上述措施,达到以考促训、以评促建的目的,全面提升医院卫勤保障的能力。     

Wegener's granulomatosis: The ocular manifestations revisited

AIM . To investigate whether the extent of ocular morbidity had de-creased as a result of improved diagnosis, awareness and treatment of Wegener 's granulomatosis (WG). MATERIALS AND METHODS . A retrospective study of all patients with ophthalmic involvement due to WG over an 8-year period. RESULTS . Forty-nine patients were diagnosed to have WG. Of these, 28 had ocular involvement: 21 patients had focal ocular involvement (conjunctivitis, episcleritis, scleritis, keratitis, iritis, retinitis)and 7 had orbital involvement. Permanent visual loss occurred in three patients with orbital involvement, but in no patients with focal ocular disease. Up to 90% of patients had systemic involvement. Three deaths oc- curred among those with ocular involvement. CONCLUSIONS . Patients with WG have a much improved visual prog- nosis as a result of early diagnosis and intervention with systemic im- munosuppression. A combination of assays for ANCA and tissue biop-sies were needed to establish the diagnosis of WG. Treatment with immunosuppressive agents (usually prednisolone and cyclophospha- mide)led to a good response in the majority of cases.     

Efficacy and safety of pulsed intravenous methylprednisolone in early active thyroid eye disease

Introduction: The mainstay of therapy for active inflammatory phase of thyroid eye disease (TED) is immunosuppression. Patients in our centre with early active TED are treated with pulsed intravenous methylprednisolone (IVMP). Two different protocols are offered in our centre: High dose (1g/day for 3 days, monthly for 6 months), or EUGOGO protocol (500 mg weekly for six weeks, followed by 250 mg weekly for the next 6 weeks).

Methods: A prospective cohort study of patients undergoing the two IVMP protocols was performed from January 2009 to May 2015. Main outcome measures were improvement of Clinical Activity Score (CAS) and International Thyroid Eye Disease (ITEDS) – VISA Inflammatory Index.

Results: We had a total of 63 patients. Mean age was 43.1 ± 13.1years, females comprised 49.2% (n = 31), and 31 (49.2%) had a positive smoking history. Following IVMP, 65.0% (n = 41) had good response, 31.7% (n = 20) partial, and 3.3% (n = 2) poor. There were significant differences (p < 0.001) in CAS and ITEDS scores between pre-IVMP and post-IVMP visits, for both protocols. A higher proportion of patients receiving the modified EUGOGO protocol (58.3%) had persistent activity and required additional immunosuppression compared to those who underwent the high dose protocol (33.3%). Mild side effects were experienced by 5 (7.9%) and 3 (4.8%) patients at 3 and 6 months, respectively. There were no severe side effects, cardiovascular events or liver failure.

Conclusion: With adequate screening and follow-up, six repeated cycles of high dose pulsed IVMP is an effective treatment for TED and can significantly reduce the morbidity associated with this debilitating condition. None of the 51 patients from the high dose protocol met with any serious side effects.     

Role of nonalcoholic fatty liver disease in the development of insulin resistance and diabetes

Nonalcoholic fatty liver disease (NAFLD) is a common disease that is usually accompanied by insulin resistance (IR). Whether or how NAFLD and IR are temporally and mechanistically related is controversial. Recent studies focus on their epidemiology, the importance of dietary fat, the role of adipocytokines and the sterol regulatory element-binding protein-1c. NAFLD and IR may progress to severe diseases, such as cirrhosis, diabetes or both, and understanding the pathogenesis of the precursor conditions has preventive and therapeutic implications. This review focuses on the possible relationships between NAFLD and IR and the treatment options available.     

Medical manipulators — a realistic concept?

Summary

Are medical manipulators just wishful thinking by engineers or a real benefit to minimally invasive surgery? Based on an analysis of current practice in minimally invasive surgery, this paper will argue the case for medical manipulators. Three critical components are discussed in detail: the design of the endoscopes and surgical instruments, the man-machine interface and the actual manipulator itself. On the basis of first evaluation results for a virtual prototype of the system, the paper concludes that the first question should be answered with yes.     

社会需求与村级卫生人才队伍功能定位研究

村级卫生人才队伍是村级卫生组织的核心,其功能定位也随着不同时期社会需求的不同而发生变化。文章通过回顾建国以来不同时期的社会需求和村级卫生人才队伍的功能定位,并结合当前形势下出现的新社会需求,探讨当前村级卫生人才队伍的功能定位和能力要求。