Elderly hospice cancer patients' descriptions of their pain experiences.

A qualitative research design was used to identify and describe the pain experience of elderly hospice patients with cancer. Eleven participants over the age of 65 receiving hospice services from a for-profit hospice in east Texas were interviewed in their homes. On the basis of a constant-comparative method of analysis, participants identified: (a) multiple sites of pain; (b) hierarchy of pain; and (c) strategies used to decrease pain. Participants differentiated "physical" and "psychological" pain, based on the source of pain. Pain was described as a hierarchy of chronic, acute, and psychological pain, with psychological being the worst. Pharmacological and nonpharmacological strategies were used to decrease their "physical" pain, but participants perceived that there was little they could do about their "psychological" pain.     

Effects of naphthalene and benzene on fathead minnows and rainbow trout

Fathead minnows (FHM) and rainbow trout (RBT) were used in flow-through bioassays to determine the acute toxicity of benzene and naphthalene, and to determine the embryo-larval effects of naphthalene on FHM. On an acute basis, naphthalene was more toxic than benzene (naphthalene LC₅₀ values were 1.6 mg/L for RBT and 7.9 mg/L for FHM; benzene LC₅₀ values were 5.3 mg/L for RBT and >15.1 mg/L for FHM). In the embryo-larval test naphthalene significantly (= 0.05) reduced FHM growth at concentrations as low as 0.85 mg/L. The highest concentration producing no effect was 0.45 mg/L naphthalene, which was 5.7% of the FHM 96-hr LC₅₀. Based upon long-term no-effects naphthalene concentration, the best estimate of the maximum acceptable toxicant concentration (MATC) was >0.45 to <0.85 mg/L naphthalene.Work funded under an Interagency Agreement between the U.S. Department of Energy and the U.S. Environmental Protection Agency under Contract No. DE-AS20-79 LC 01761 to the Rocky Mountain Institute of Energy and Environment, University of Wyoming     

Acute pesticide poisoning: a major global health problem

The global problem of acute pesticide poisoning has been confirmed as extensive by a variety of independent estimates. Further, it is also recognized to be a problem confined to the developing countries. Most estimates concerning the extent of acute pesticide poisoning have been based on data from hospital admissions which would include only the more serious cases. The latest estimate by a WHO task group indicates that there may be 1 million serious unintentional poisonings each year and in addition 2 million people hospitalized for suicide attempts with pesticides. This necessarily reflects only a fraction of the real problem. On the basis of a survey of self-reported minor poisoning carried out in the Asian region, it is estimated that there could be as many as 25 million agricultural workers in the developing world suffering an episode of poisoning each year. This article emphasizes the need to control the problem on a collaborative basis by all concerned, including national governments, agrochemical industries, international agencies, scientists and victims.     

Treatment of acute lead intoxication. A quantitative comparison of a number of chelating agents

The efficacy of several chelating agents in alleviating acute lead intoxication has been investigated in male Swiss mice. The relative effectiveness of diethyl-enetriaminepentaacetic acid (DTPA), ethyleneglycolbis-(-amino-ethylether)-N,N-tetraacetic acid (EGTA), cyclohexanediaminetetraacetic acid (CDTA), L-cysteine, N-acetyl-L-cysteine (NAC), ascorbic acid, sodium diethyldithiocarbamate (DDC), 2,3-dimercaptosuccinic acid (DMSA) and sodium 2,3-dimercapto-1-propanesulfonate (DMPS) in reducing lethality of lead was examined. Significant increases in survival were noted with CDTA, ascorbic acid, DMSA, and DMPS. Therapeutic effectiveness (TEF) was determined for these compounds; TEF for ethylenediamine-tetraacetic acid (EDTA) and for 2,3-dimercaptopropanol (BAL) was also determined; CDTA (2.33) and EDTA (1.73) showed the highest values. In subsequent experiments, the effect of the chelating agents on the distribution and excretion of lead was investigated. Lead acetate trihydrate was administered subcutaneously at doses of 37.8 mmol/kg (LD₅₀), and fifteen minutes later, chelators were given intraperitoneally at doses approximately equal to one-fourth of their respective LD₅₀ values. EDTA, DTPA and CDTA were the most effective agents in increasing the urinary excretion of lead, whereas DTPA, CDTA, and DDC increased significantly the fecal excretion of lead. EDTA, DDC, and CDTA were the most effective chelators in reducing the concentration of lead found in various tissues. On the basis of these results, CDTA may be considered as an alternative in the treatment of acute lead poisoning.     

Eczema Herpeticum and Clinical Criteria for Investigating Smallpox

Eczema herpeticum can clinically resemble smallpox. On the basis of the algorithm for rapid evaluation of patients with an acute generalized vesiculopustular rash illness, our patient met criteria for high risk for smallpox. The Tzanck preparation was critical for rapid diagnosis of herpetic infection and exclusion of smallpox.     

The pathogenesis of bovine virus diarrhoea virus infections

Bovine virus diarrhoea virus (BVDV) disease in cattle ranges from the transient acute infections, which may be inapparent or mild, to mucosal disease which is inevitably fatal. On occasions the acute infections can lead to clinical episodes of diarrhoea and agalactia but as these syndromes cannot be reproduced experimentally, the pathogenesis remains unclear. The immunosuppressive effect of acute BVDV infections can enhance the clinical disease of other pathogens and this may be an important part of the calf respiratory disease complex. Although BVDV antigen has been demonstrated within the lymphoid tissues, for prolonged periods, the evidence for viral latency remains to be proven. Venereal infection is shown to be important in the transfer of virus to the foetus and congenital infections can cause abortions, malformations and the development of persistently viraemic calves. The two biotypes of the virus, non-cytopathogenic and cytopathogenic, are described. Their sequential role in the pathogenesis of mucosal disease arises from the initial foetal infection with the non-cytopathogenic virus and the subsequent production of persistently viraemic calves. These calves may later develop mucosal disease as a result of superinfection with a "homologous" cytopathogenic virus. The possible origin of this biotype by mutation is discussed. Chronic disease is defined as a progressive wasting and usually diarrhoeic condition; it is suggested that this may develop following superinfection of persistently viraemic cattle with a "heterologous" cytopathogenic biotype.     

一例急性非淋巴细胞性白血病的职业病诊断分析

目的探讨职业性苯致白血病的接触时间、潜隐期在职业病诊断中的应用问题。方法依据职业性肿瘤的诊断标准针对急性非淋巴细胞性白血病的诊断过程中职业史采信、接触时间、潜隐期应用等问题进行分析和探讨。结果认为《职业性肿瘤诊断标准》标准中的累计工龄计算、潜隐期的概念存在不适宜性。结论建议对《职业性肿瘤诊断标准》中工龄计算、亚急性苯致白血病诊断标准、潜隐期的概念等内容进行补充和完善。     

Development of an Official Guideline for the Economic Evaluation of Drugs/Medical Devices in Japan

Objectives

In Japan, cost-effectiveness evaluation was implemented on a trial basis from fiscal year 2016. The results will be applied to the future repricing of drugs and medical devices. On the basis of a request from the Central Social Insurance Medical Council (Chuikyo), our research team drafted the official methodological guideline for trial implementation. Here, we report the process of developing and the contents of the official guideline for cost-effectiveness evaluation.

丁苯酞序贯治疗对急性脑梗死患者神经功能及血清同型半胱氨酸和超敏C反应蛋白的影响

目的 探讨在常规治疗基础上联合应用丁苯酞序贯治疗急性脑梗死患者,对其神经功能及血清超敏C反应蛋白和同型半胱氨酸水平的影响.方法 选取2018年6月-2019年3月大连市中心医院收治的58例急性脑梗死患者为研究对象,按随机数字表法分为观察组和对照组各29例.两组均给予阿托伐他汀、阿司匹林等常规治疗,观察组同时给予丁苯酞序贯治疗.比较两组治疗3个月后的神经功能、血清超敏C反应蛋白和同型半胱氨酸水平.结果 治疗3个月后两组神经功能均较治疗前得到改善,且观察组神经功能评分低于对照组,差异有统计学意义(P<0.05).治疗3个月后对照组血清同型半胱氨酸和超敏C反应蛋白水平与治疗前相比无改变,而观察组两项指标均较治疗前降低,两组治疗3个月后两项指标差异有统计学意义(P<0.05).结论 在常规治疗基础上联合丁苯酞序贯治疗急性脑梗死患者,能够有效改善患者的神经功能,而且能够使患者血清超敏C反应蛋白和同型半胱氨酸水平降低.     

Experience with a new "reserve protocol" in advanced and pretreated Hodgkin's disease

Between 1983-1987 16 patients with advanced stage Hodgkin disease, most of whom in an immunsuppressed, immundeficient state, were treated with a new "post-COPP", or "post-ABVD" reserve-protocol. In all cases megavoltage Co radiotherapy and COPP (CVPP) or ABVD polychemotherapy had previously been. Compared with the previously administered polychemotherapy the new 3-component cytostatic agent was well tolerated by the patients. The LEAMP-protocol therapy is therefore recommended in cases of ineffective combined radiochemotherapy (chemoresistance) or intolerance to chemotherapy. In four cases prolonged, complete, in nine cases partial remission was achieved and in more than a half of the patients favourable clinical effects and changes were experienced. In two cases temporary, partial remission was seen. One cases, because of the short period of treatment could not be evaluated. On the basis of the longitudinal observations the results achieved seemed subjectively and objectively favourable. The LEAMP-protocol was found to be well tolerated and satisfactorily effective.     

The value of roentgen studies in supination injuries of ankle and foot

In 523 consecutive patients with inversion injuries of ankle and foot, X-ray examination revealed 52 fractures. The majority of these fractures could be treated symptomatically. On the basis of clinical examination as the diagnostic tool for these ankle injuries, the need for radiological assessment was decided. All important fractures were recognized. The patient's ability to bear weight on the injured ankle, the presence of lateral malleolar tenderness and advanced age were important clinical variables. Careful physical examination can lead to a selective radiological assessment of acute ankle injuries. Superfluous X-ray procedures can be eliminated which will greatly reduce costs without detriment to patient care.     

ECG characteristics of acute myocardial ischemia

The authors discussed the efficacy of ECG in distinction of reversible and irreversible myocardial damage. On the basis of continuous ECG monitoring of a patient, suffering from acute ischemic syndrome, it was established, that neither the appearance of R wave reduction nor that of the transient Q wave (besides the widely accepted ST segment elevation) do not signify the fact of transmural myocardial infarction. In conclusion: the classical rules in indication of myocardial rescue therapy should be expanded and ECG monitoring is of crucial importance in indication and evaluation of myocardial rescue therapy in acute myocardial ischemic syndrome.     

突发群体性氯气中毒1 539例临床救治

目的总结突发群体性氯气中毒的诊治体会并探讨其疾病特点与有效应对策略。 方法回顾性总结分析2009年6月至2017年5月,发生的4次突发性化工厂氯气泄漏事故所致的群体性氯气中毒抢救案例,总计1 539例,其中男性746例,女性793例;年龄7 d ～ 90岁,平均(43.8±0.69)岁。根据患者的症状、体征、影像学检查(胸部X线片及胸部CT)及动脉血气分析等实验室检查结果诊断并分级。对重症急性肺水肿患者,在综合治疗基础上,采用20AA复方氨基酸联用维生素B₆及短程山莨菪碱联用地塞米松冲击疗法,病情平稳后结合中药"柴黄参祛毒固本汤"辅助调理治疗。观察总结中毒初期及重症患者疾病进展过程中的临床表现、胸部X线片及胸部CT、实验室检查(血常规、血生化、动脉血气分析)的特点;计算抢救成功率,评价上述创新治疗方法对急性氯气中毒患者的治疗有效性。 结果1 539例急性氯气中毒患者中,1 041例(67.6%)出现轻度刺激反应,394例(25.6%)轻度中毒,79例(5.1%)中度中毒,25例(1.6%)重度中毒。重度氯气中毒患者治疗96 h内,症状开始好转,并逐渐进入恢复期,经2周左右持续治疗基本痊愈。1 539例患者均治愈,无1例死亡;对25例重症急性化学性肺水肿患者进行长期随访,未出现肺纤维化或肿瘤等远期效应。 结论氯气中毒病情发展快,防治肺水肿是治疗的关键。在综合治疗的基础上,采用20AA复方氨基酸联用维生素B₆、短程山莨菪碱联用地塞米松冲击疗法及柴黄参祛毒固本中药方剂有良好疗效。     

Air sampling in the assessment of continuous exposures to acutely-toxic chemicals. Part I--Strategy

This paper describes the conceptual basis for assessing the hazard of continuous exposures to acutely toxic chemicals. It is stressed that the variability of workers' short-term exposures to airborne chemicals must be considered in establishing strategic criteria which define an acceptable (or unacceptable) environment. The argument is developed that the traditional strategy of an absolute ceiling limit is unworkable since any set of exposures can be declared out of compliance if a sufficiently large number of samples is collected. It is proposed that acute-exposure limits be defined instead as air concentrations that can be exceeded by an explicit fraction of the population of exposures. An "exceedance" rate of 5% is suggested provided that exposure limits incorporate appropriate safety factors which are relatively large for potent acute toxins and small for irritants. The implications of this strategy are analyzed with some existing ceiling limits proposed by NIOSH.     

中国医疗保险法律体系的发展与改革

医疗保险作为社会保障的重要组成部分,其法律体系建设依然存在立法滞后、层次较低、执法主体不协调、程序不规范和司法救济严重错位等诸多问题。因此,应抓住全面推进依法治国的重要机遇,推动我国医疗保险法律体系的发展与改革。本文在梳理我国医疗保险法律体系发展历程的基础上,提出了立法层次向上集中、加快单项专项立法进程、探索建立个人信用体系和明确并公开司法工作等对策建议,以促进医疗保险法律体系的完善。     

Childhood leukemia: electric and magnetic fields as possible risk factors

Numerous epidemiologic studies have reported associations between measures of power-line electric or magnetic fields (EMFs) and childhood leukemia. The basis for such associations remains unexplained. In children, acute lymphoblastic leukemia represents approximately three-quarters of all U.S. leukemia types. Some risk factors for childhood leukemia have been established, and others are suspected. Pathogenesis, as investigated in animal models, is consistent with the multistep model of acute leukemia development. Studies of carcinogenicity in animals, however, are overwhelmingly negative and do not support the hypothesis that EMF exposure is a significant risk factor for hematopoietic neoplasia. We may fail to observe effects from EMFs because, from a mechanistic perspective, the effects of EMFs on biology are very weak. Cells and organs function despite many sources of chemical "noise" (e.g., stochastic, temperature, concentration, mechanical, and electrical noise), which exceed the induced EMF "signal" by a large factor. However, the inability to detect EMF effects in bioassay systems may be caused by the choice made for "EMF exposure." "Contact currents" or "contact voltages" have been proposed as a novel exposure metric, because their magnitude is related to measured power-line magnetic fields. A contact current occurs when a person touches two conductive surfaces at different voltages. Modeled analyses support contact currents as a plausible metric because of correlations with residential magnetic fields and opportunity for exposure. The possible role of contact currents as an explanatory variable in the reported associations between EMFs and childhood leukemia will need to be clarified by further measurements, biophysical analyses, bioassay studies, and epidemiology.     

Cultural characteristics of "high" and "low" performing hospitals

PURPOSE: To compare and contrast the cultural characteristics of "high" and "low" performing hospitals in the UK National Health Service (NHS). DESIGN/METHODOLOGY/APPROACH: A multiple case study design incorporating a purposeful sample of "low" and "high" performing acute hospital Trusts, as assessed by the star performance rating system. FINDINGS: These case studies suggest that "high" and "low" performing acute hospital organisations may be very different environments in which to work. Although each case possessed its own unique character, significant patternings were observed within cases grouped by performance to suggest considerable cultural divergence. The key points of divergence can be grouped under four main headings: leadership and management orientation; accountability and information systems; human resources policies; and relationships within the local health economy. PRACTICAL IMPLICATIONS: As with any study, interpretation of findings should be tempered with a degree of caution because of methodological considerations. First, there are the limitations of case study which proceeds on the basis of theoretical rather than quantitative generalisation. Second, organisational culture was assessed by exploring the views of middle and senior managers. While one should in no way suggest that such an approach can capture all important cultural characteristics of organisations, it is believed that it may be at least partially justified, given the agenda-setting powers and influence of the senior management team. Finally "star" performance measures are far from a perfect measure of organisational performance. Despite such reservations, the findings indicate that organisational culture is associated in a variety of non-trivial ways with the measured performance of hospital organisations. ORIGINALITY/VALUE: Highlights considerable cultural divergence within UK NHS hospitals.     

我国罕见病“友好型”普惠险评价指标体系构建及应用探索

构建科学客观的罕见病“友好型”普惠险评价指标体系,为普惠险更好地参与罕见病多层次保障提供参考依据。文章以文献研究为基础,综合应用主成分分析法确定评价体系与指标权重,并对我国市面上保障范围不限制罕见病、基因型疾病或遗传性疾病的62款普惠险产品进行指标测算与应用。在保证基金稳定持续运营的基础上,为产品设置合理的既往症条款和责任免除条款;探索建立普惠险特药清单制度或地方性专项保障制度;在目录外住院自费保障的基础上,增加门诊的保障责任。     

留置胃管间断洗胃治疗敌敌畏中毒合并乙醇中毒疗效观察

目的 探讨留置胃管间断洗胃治疗急性重度敌敌畏中毒合并乙醇中毒的临床应用价值.方法 将60例急性重度敌敌畏中毒合并乙醇中毒患者随机分为2组,每组各30人,对照组给予一次性常规洗胃,治疗组在常规洗胃的基础上留置胃管,给予间断洗胃3d,比较2组患者病死率、胆碱酯酶活力上升至正常低限的时间、阿托品及氯磷啶用量、住院天数、上消化道出血发生率情况.结果 2组患者病死率、胆碱酯酶活力上升至正常低限时间、阿托品及氯磷啶用量差异无统计学意义;间断洗胃组住院天数长于对照组,间断洗胃组上消化道出血发生率高于对照组.结论 对于急性重度敌敌畏中毒合并乙醇中毒患者,在常规洗胃基础上留置胃管间断洗胃时,不能减少解毒药物使用和加速患者恢复,且易增加上消化道出血的发生,不宜作为一常规治疗手段.