Simulation model of renal replacement therapy: predicting future demand in England.

BACKGROUND: The demand for renal replacement therapy (RRT) in England has risen steadily, although from a lower base than many other developed countries. Predicting the future demand for RRT and the impact of factors such as the acceptance rate, transplant supply and patient survival, is required in order to inform the planning of such services. METHODS: A discrete event simulation model estimates the future demand for RRT in England in 2010 for a range of scenarios. The model uses current prevalence and current and projected future acceptance rates, survival rates and the transitions between modalities to predict future patient numbers. National population and mortality data, published literature and data from the UK Renal Registry and UK Transplant, are used to estimate unmet need for RRT, the impact of changing demography and incidence of Type 2 diabetes, patient haemodialysis (HD) survival and transplant supply. RESULTS: By 2010 the predicted prevalence will have increased from about 30,000 in 2000 to between 42 and 51,000 (900-1000 p.m.p.), an average annual growth of 4.5-6%. Changing transplant supply has a small effect on overall numbers but changes the proportion of patients with functioning graft by up to 8%. Even with an optimistic increase in transplant supply (11% p.a. for 5 years), numbers on HD will continue to rise substantially, especially in the elderly. The factors most influencing future patient numbers are the acceptance rate and dialysis survival. CONCLUSION: This model predicts a substantial growth in the RRT population to 2010 to a rate approaching 1000 p.m.p., particularly in the elderly and those on HD, with a steady state not being reached for at least 25 years.     

Periodontal conditions among the middle-aged and the elderly in Hong Kong

Abstract The aim of this study was to describe the periodontal conditions in 372 35–44-yr-old and 537 noninstitutionalized 65–74-yr-old Hong Kong Chinese who were examined clinically for loss of attachment, recession, probing depth, calculus, and bleeding after probing. Community Periodontal Index (CPI) data and treatment need indications were compiled from index teeth or their substitutes. The prevalence of loss of attachment varied considerably in both cohorts according to the definition of the threshold (≥6, ≥9, and ≥12 mm, respectively). The mean numbers of teeth with loss of attachment at the ≥6-mm threshold and at higher thresholds were small. In both age cohorts, about one-fifth of subjects had probing depths ≥6-mm, while al the ≥9-mm threshold only 2–3% were so affected. Although recession was an important component of loss of attachment in the younger cohort, in the older cohort the prevalence and extent of recession were greater than for probing depths at thresholds ≥4 mm. All subjects had one or more teeth with calculus, bleeding, or both, most teeth being so affected. Eighty-four of the 537 65–74-yr-old subjects were excluded either because of edentulousness or because extractions indicated for the remaining teeth would have rendered the subjects edentulous. The distribution of subjects according to their highest CPI score was remarkably similar for the two cohorts. No subjects in either age group were assessed as “healthy” (CPI code 0) or had “bleeding only” (code 1) as their highest score. While most subjects scored CPI code 2 or 3 us their highest score, only 17% of the younger and 15% of the older cohort scored Community Periodontal Index of Treatment Needs (CPITN) code 4. Differences in the mean number of sextants affected by CPI codes between the two cohorts were mainly due to a greater number of excluded sextants in the older cohort. CPI findings for 35–44-yr-olds differed little from those reported in 1984.     

浅谈对传染科护士素质的要求与体会

根据笔者在传染科病房工作中的体会,从六个方面针对传染科工作的特殊性和存在的共性分别阐述了传染科护士在工作中如何高标准、严要求自己,如何对病人做到到位的护理,旨在提高传染科病房的整体护理质量,从而把更多的实惠让利于患者。     

DNA probe technology: implications for service planning in Britain

For certain genetic conditions DNA testing identifies carriers and determines the risk status of foetuses, thus helping parents to make more informed prenatal decisions. Data, collected from three genetic centres in England and Wales from August 1986 to July 1990, are used to describe trends in demand for DNA testing, the impact of DNA tests on carrier risk assessment, and the use of DNA tests in relation to pregnancy outcome. Altogether the data include 23,388 subjects and 681 pregnancies in 8738 families divided into five cohorts by year of entry and referral. The most frequent gene disorders referred to the genetic centres are currently being tested or will soon be tested. For these disorders the initial high level of activity has declined and may have reached steady state. Demand for DNA services is high for cystic fibrosis and Duchenne muscular dystrophy, intermediate for Huntington's disease, and low for adult polycystic kidney disease, phenylketonuria and tuberous sclerosis. Based on these findings we suggest that demand for DNA tests will be high in serious, untreatable and slow progressing conditions with early onset; intermediate for conditions affecting intellect and neurological integrity with later onset; and low for treatable, late-onset conditions, or those for which there is evidence of heterogeneity, and variable penetrance. It would be helpful to assess the extent to which this view of demand is confirmed when the new disorders being DNA tested are considered and for the pattern of activity of DNA testing for some types of cancer. Since no DNA centre could offer a fully comprehensive testing service, it is recommended that a structure is created to audit overall activity, assist in policy formulation, and influence supraregional service organisation, in order that the spread of DNA services be planned as effectively as possible. This structure would facilitate monitoring of the evolution of contract specifications agreed by commissioners and providers on a regional basis.     

'Jumping through hoops': parents' experiences with seeking respite care for children with special needs

Background   Respite care may act as a means to reduce stress and fatigue in people caring for a dependent who has a disability. Despite this, a variety of barriers may exist to obtaining such services. This study explored caregivers' experiences seeking respite care for their children with special needs within a province in Canada.
Methods   Caregivers were recruited from two agencies providing respite care for children with fetal alcohol spectrum disorders and other mental health and developmental difficulties. In total, 10 caregivers participated in in-depth individual interviews. A constructivist grounded theory approach was employed in the design and analysis of the data.
Results   Caregivers discussed their frustrations with the process of finding and obtaining respite care, a course of action described as 'jumping through hoops'. This construct was composed of subcategories emphasizing the complexity of 'navigating the system', the bidirectional process of 'meeting the requirements' and the challenges of 'getting help'.
Conclusions   The collective experiences of these caregivers point to the need for more flexibility and co-ordination of respite care services for children with special needs.     

解放军医学图书馆电子阅览室的技术特点

从阅览室网络拓扑结构、硬盘保护、网络控制、网址限制及视频点播等几个方面对电子阅览室采用技术的特点逐一做了简要介绍,并以此阐明通过综合管理,使阅览室各计算机能够正常、安全的运行,从而达到既可为读者提供优质服务又可保证系统安全的目的.     

武汉市武昌区精神发育迟滞卫生服务调查

目的 了解武汉市武昌区精神发育迟滞的卫生服务利用和需求以及满意度。方法 对108例一胎精神发育迟滞与正常儿童进行1：1对照入户调查。结果 就诊医院以附属医院和省级医院为主；就诊科别集中在儿科。最需要的服务机构是专科门诊、特殊教育学校。遗传咨询比例约50％。自费比例为37．96％，没有医疗保险。对医院满意度调查中一般57．41％，不满意26．85％，很满意15．74％。结论 有必要对高危人群宣传遗传咨询。要加强专科门诊建设和特殊教育发展规划，并从社会保险、医疗保险和商业保险以及社会救助中重视这一以前忽略的领域。     

基于学习体验的医学生智慧教室使用需求调查

为了更加准确地了解医学生智慧教室的使用需求,为智慧教室管理者在制定智慧教室环境优化策略时提供科学依据,本研究采用问卷调查法,从硬件设施、信息技术、教学法、医学智慧教室特色功能4个维度23项指标展开调查,采用KANO模型分析技术和满意度、重要度象限图对1 074份问卷进行数据分析。发现23项需求指标中,必备属性6项、期望属性7项、魅力属性9项、无差异属性1项。根据KANO模型理论重要度排序,智慧教室管理者应首先改善必备属性相关指标质量,优先提升期望属性相关指标质量,最后满足魅力属性相关指标需求。文章从学校顶层设计、教师和管理者3个层面提出了智慧教室相关政策和建设建议。     

Regulation of growth hormone during exercise by oxygen demand and availability

Summary Five normal men performed seven sets of seven squats at a load equal to 80% of their seven repetition maximum. Plasma growth hormone (GH) and lactate levels increased during and after the completion of the exercise. A significant (r=0.93, P<0.001) linear correlation was found between GH changes and the corresponding oxygen Demand/Availability (D/A) ratio expressed by (where f=[lactate at time x]/[lactate at time 0]). A retrospective examination of previously published data from our laboratory and others also demonstrated the existence of a significant correlation between changes in plasma GH levels and the D/A ratios over a wide variety of exercise; aerobic and anaerobic, continuous and intermittent, weight lifting and cycling, in both fit and unfit subjects under normoxic and hypoxic conditions. It is suggested that the balance between oxygen demand and availability may be an important regulator of GH secretion during exercise. DCIEM No. 87-P-27