层面递进法激光腔内剜除高危前列腺增生的治疗体会

目的探讨1 470 nm激光剜除治疗高危前列腺增生的手术技巧及临床效果。 方法回顾分析2018年6月至2018年9月中山大学附属第三医院泌尿外科采用1 470 nm激光治疗共89例高危前列腺增生患者的临床资料，年龄平均（68±3）岁，前列腺体积（57.4±2.6）ml。所有患者均采用"寻找层面，先易后难，剜切结合"的层面递进法思路行激光腔内前列腺剜除术，比较患者术中及术后情况。 结果89例均顺利完成手术，与术前相比，术后3个月患者最大尿流率明显增加，[（6.9±2.1） ml/s vs（19.8±3.6） ml/s]。国际前列腺症状评分显著好转，[（24.6±1.7） vs（8.0±1.2）]。术中无输血、无电切综合征、无直肠和膀胱穿孔病例，无输尿管损伤、大出血、心脑血管意外等严重并发症发生。 结论层面递进法激光剜除技术构想对于高危前列腺增生外科包膜层面的寻找、减少术后并发症有独到优势，且易于掌握，或可为业界同行提供一个新的思路。     

How do people understand their neuropathic pain? A Q-study

Neuropathic pain (NP) is not easy to understand for those with the diagnosis. Even in specialist medical services, explanation may not be given or may not be integrated with patients’ existing beliefs about their conditions. We were curious about how people with NP conceptualised the problem. Web sites relevant to NP were used to recruit 79 people with NP. They were sampled using Q-methodology, which requires sorting according to degree of agreement or disagreement with diverse statements about NP, derived from the widest possible range of sources. The sets of sorted statements are analysed for factors which represent shared constructions. The four factors that we found differed in important ways: (1) identification of nerve damage as cause; (2) the necessity of identifying cause; (3) the acceptability of symptomatic treatment; (4) the existence or not of psychological influences; and (5) the usefulness of psychological treatment. The meaning of these factors was extended by participants’ free comments: certain viewpoints showed associations with their medical and treatment histories and with the interference of pain with daily life. Overall, a biopsychosocial model of pain was only weakly represented, and no integrated model of pain emerged across the four different accounts. There was little reference to NP having been explained when the diagnosis was made. This study highlights the need for more accessible explanations of NP within and outside medical services if people with NP are to use their understanding of NP to help them manage their pain and reduce its impact on their lives.     

Effectiveness of a health belief model intervention using a lay health advisor strategy on mouth self-examination and cancer screening in remote aboriginal communities: A randomized controlled trial

ObjectiveOral cancers caused by chewing betel nuts have a poor prognosis. Using a lay health advisor (LHA) can increase access to health care among underprivileged populations. This study evaluated a health belief model (HBM) intervention using LHAs for oral cancer screening (OCS) and mouth self-examination (MSE) in remote aboriginal communities.MethodsThe participants were randomly assigned to intervention (IG; n = 171) and control groups (CG; n = 176). In the IG, participants received a three-chapter one-on-one teaching course from LHAs, whereas those in the CG received only a leaflet.ResultsThe IG participants were 2.04 times more likely to conduct a monthly MSE than those in the CG (95% confidence interval: 1.31–3.17) and showed significantly higher self-efficacy levels toward OSC and MSE (β = 0.53 and 0.44, effect size = 0.33 and 0.25, respectively) and a lower barrier level for OSC (β = −1.81, effect size = −0.24).ConclusionThe LHA intervention had a significantly positive effect on MSE, strengthening self-efficacy and reducing barriers to OCS among aboriginal populations.Practice ImplicationsThe effectiveness of the clinical treatment of underprivileged group can be improved through early diagnosis, which can be achieved using LHAs to reduce barriers to OSC.     

Perception of Saudi dentists and lay people to altered smile esthetics

Aim

To evaluate and compare the perceptions of Saudi dentists and lay people to altered smile features.

Methods

Thirty-six digital smile photographs with altered features were used. Altered features included the following: crown length, width, gingival level of the lateral incisors, gingival display, midline diastema, and upper midline shift. The photographs were presented to a sample of 30 dentists and 30 lay people with equal gender distribution. Each participant rated each picture with a visual analogue scale, which ranged from 0 (very unattractive) to 100 (very attractive).

Results

Dentists were more critical than lay people when evaluating symmetrical crown length discrepancies. Compared to lay people, Saudi dentists gave lower ratings to a crown length discrepancy of >2 mm (P < 0.001), crown width discrepancy of ⩾2 mm (P < 0.05), change in gingiva to lip distance of ⩾2 mm (P < 0.01), and midline deviation of >1 mm (P < 0.01). There was no significant difference between dentists and lay people towards alterations in the gingival level of the lateral incisors or towards a space between the central incisors. No significant sex difference was seen across the groups.

Conclusion

In this sample, Saudi dentists gave significantly lower attractiveness scores to crown length and crown width discrepancies, midline deviations, and changes in gingiva to lip distance compared to Saudi lay people.     

Education and age affect skill acquisition and retention in lay rescuers after a European Resuscitation Council CPR/AED course

Objectives

To examine whether education and age affect skill acquisition and retention in lay rescuers after a European Resuscitation Council (ERC) CPR/AED course.

Background

Because of the importance of bystander CPR/AED skills in the setting of cardiac arrest, acquisition and retention of resuscitation skills has gained a great amount of interest.

Methods

The ERC CPR/AED course format for written and practical evaluation was used. Eighty lay people were trained and evaluated at the end of the course, as well as at one, three, and six months.

Results

Retention of CPR/AED skills improved over time, recording the lowest practical scores at one month after initial training and the lowest written scores at initial training. In practical evaluation scores, when examined longitudinally, age presented a significant adverse effect and higher background education presented a non-significant positive effect. Moreover, regarding written evaluation scores, when examined longitudinally, education presented a significant positive effect while age did not significantly correlate with written scores.

Conclusions

Education and age affected retention of CPR/AED skills in lay rescuers. Also, our results suggest that the ERC CPR/AED course format may be poorly designed to discriminate between participants with different levels of practical and written resuscitation skills and merit a thorough investigation in future studies.     

Beyond the ‘back yard’: Lay knowledge about Aedes aegypti in northern Australia and its implications for policy and practice

Controlling dengue fever in Australia and internationally, relies heavily upon the actions of residents as well as community education and awareness of the risks. Although it has been well established in medical anthropology that the success of health interventions is highly dependent upon a clear grasp of lay knowledge of disease, limited attention has been given to lay understandings of dengue fever and its vectors in the extant literature. We begin addressing this hiatus through an examination of north Queensland residents’ knowledge of the breeding habitats of Aedes aegypti mosquitoes. Building on the insights of earlier social research, we use factor analysis to examine the results of a series of randomly selected telephone surveys and compare responses over time and between cities.Our analysis confirms that many people assume that Ae. aegypti is ubiquitous in the landscape, that it lives and breeds not only around the home, but also in a variety of geographical spaces located beyond the suburban ‘backyard’, and beyond the control of local residents. Lay understandings appear to be placing people at risk from dengue, influencing the mosquito management practices of local residents and acting as a source of resistance to public health messages that focus on individual responsibility. A way forward through the provision of new information that challenges key assumptions is provided in the discussion. We argue that rather than dismissing lay understandings as ignorance, strategies, practices and policy based on a detailed understanding of this knowledge will mean that practitioners are better able to address these assumptions and will likely be more effective at educating the public of the risks posed by dengue.     

A pilot study of Trabajadora de salud,a lay health worker intervention for Latinas/os with traumatic brain injuries and their caregivers

Background

Latinas/os with traumatic brain injuries (TBIs) and their caregivers experience worse outcomes than others.

Primary health care nurses implement and evaluate a community outreach approach to health care in the South African agricultural sector

BACKGROUND: Early detection and effective case management of tuberculosis (TB) among a high-risk group of materially poor farm workers in an area of the Cape Winelands, South Africa, presents special challenges to the health community, where resource constraints lead to service reduction. In order to address this problem, local nurses established a collaborative partnership between permanent farm workers and their families, their employers, selected non-governmental organizations and the public health sector. In consultation with stakeholders, they developed an intervention primarily focusing on having peer selected trained lay health workers (LHWs) on farms, mentored and managed by nurses. PURPOSE: To describe the complex process of implementation and evaluation of the LHW project, and provide a summary of a number of discrete studies evaluating the effectiveness, cost implications, and the perceptions and experiences of key stakeholders of the intervention. METHODS: Quantitative and qualitative research methods conducted within the context of a pragmatic unblinded community cluster randomized control trial were used. Emphasis was placed on an iterative participatory interaction between the researchers and key stakeholders. RESULTS: The intervention contributed to significantly better successful treatment completion rates among adult new smear-positive TB cases. The process implemented proved cost-effective and was pivotal in initiating a community-based social development programme. CONCLUSIONS: The use of peer-selected LHWs within a wider programme of integrated care designed to merge technical biomedical approaches to disease management with more holistic social development activities, appears essential to meet the complex health needs in conjunction with public health of the rural poor.     

User involvement in clinical governance

Objectives  To investigate the involvement of users in clinical governance activities within Primary Care Groups (PCGs) and Trusts (PCTs). Drawing on policy and guidance published since 1997, the paper sets out a framework for how users are involved in this agenda, evaluates practice against this standard and suggests why current practice for user involvement in clinical governance is flawed and why this reflects a flaw in the policy design as much as its implementation.
Design  Qualitative data comprising semi-structured interviews, reviews of documentary evidence and relevant literature.
Setting  Twelve PCGs/PCTs in England purposively selected to provide variation in size, rurality and group or trust status.
Participants  Key stakeholders including Lay Board members ( n =12), Chief Executives (CEs) ( n = 12), Clinical Governance Leads (CG leads) ( n = 14), Mental Health Leads (MH leads) ( n = 9), Board Chairs ( n =2) and one Executive Committee Lead.
Results  Despite an acknowledgement of an organizational commitment to lay involvement, in practice very little has occurred. The role of lay Board members in setting priorities and implementing and monitoring clinical governance remains low. Beyond Board level, involvement of users, patients of GP practices and the general public is patchy and superficial. The PCGs/PCTs continue to rely heavily on Community Health Councils (CHCs) as a conduit or substitute for user involvement; although their abolition is planned, their role to be fulfilled by new organizations called Voices, which will have an expanded remit in addition to replacing CHCs.
Conclusions  Clarity is required about the role of lay members in the committees and subcommittees of PCGs and PCTs. Involvement of the wider public should spring naturally from the questions under consideration, rather than be regarded as an end in itself.