The trend in suicide methods in South Korea in 1997–2015

South Korea exhibited the highest crude suicide rate in the world. To better understand this phenomenon, the author analyzed all suicides in South Korea from 1997 to 2015 and charted the trend in suicide methods by gender. Over time, both genders rapidly chose hanging for suicide at the expense of drug/pesticide poisoning. Gassing was hardly used in the beginning, but its recent gain in use is noteworthy. Including undetermined deaths did not change the main results. The author regressed hanging on demographics and found that hanging was particularly chosen by ever-married men of prime working age with a respectable level of education.     

Will accident reports filed in hospitals in Japan be used in the future as evidence in malpractice lawsuits?

A major drawback of submission of so-called incident reports for medical institutions is that such reports may be able to be obtained on request by patients and to be used as evidence in malpractice lawsuits. In Japan, there are no established rules concerning the use of accident reports in medical lawsuits. More debate is needed for voluntary report systems to become established in medical institutions throughout Japan. (Am J Emerg Med 2001;19:597. Copyright © 2001 by W.B. Saunders Company)     

Radiology in 2010 in a NYC Academic Medical Center

A large NYC Academic Medical Center’s Department of Radiology will be used to explore how a large department of radiology meets its missions of①providing excellent patient care;②educating residents/fellows;and ③research.The regulatory environment(state and federal government regulations and payors),its relationship to its hospital and medical school will be discussed.The organization,staffing of radiologists and technologists,equipment,services offered,andfinances of a Radiology Department at a NYC Academic Medical Center will be reviewed.Strategies for meeting the challenges of maintaining quality,expansion of services(teleradiology),shrinking reimbursements,and preparing for the HealthCare Reform Bill will be discussed.     

Xuezhikang capsule in combination with assistive exercise in the treatment of hyperlipidemia in 50cases

Background：Improvingorcorrectingabnormallipidmetabolismisessentialforpreventionandtreatmentofcardiovasculardisease．Tatinedrugscaneffectivelyreduceserumcholesterol，TG，LDL－C，andraiseHDL－C，aswellasdecreaseincidenceandmortal－ityofcardiovasculardiasese．Now，exercisereceivesmoreattentioninreducingbloodlipid．Objective：Toevaluateefficacyandsafetyofxuezhikangcap－suleincombinationwithexerciseintreatmentofhyperlipidemia．Unit：InternalDepartment，SecondPeople＇sHospitalofXinxiang．Su…     

Regulation of κ-opioid receptor signaling in peripheral sensory neurons in vitro and in vivo

There is considerable interest in understanding the regulation of peripheral opioid receptors to avoid central nervous system side effects associated with systemically administered opioid analgesics. Here, we investigated the regulation of the κ-opioid receptor (KOR) on rat primary sensory neurons in vitro and in a rat model of thermal allodynia. Under basal conditions, application of the KOR agonist trans-(1S,2S)-3,4-dichloro-N-methyl-N-[2-(1-pyrrolidinyl)cyclohexyl]benzeneacetamide hydrochloride hydrate (U50488) did not inhibit adenylyl cyclase (AC) activity nor release of calcitonin gene-related peptide (CGRP) in vitro and did not inhibit thermal allodynia in vivo. However, after 15-min pretreatment with bradykinin (BK), U50488 became capable of inhibiting AC activity, CGRP release, and thermal allodynia. Inhibition of AC by 5-hydroxytryptamine 1 or neuropeptide Y(1) receptor agonists and stimulation of extracellular signal-regulated kinase activity by U50488 did not require BK pretreatment. The effect of U50488 in BK-primed tissue was blocked by the KOR antagonist nor-binaltorphimine both in vitro and in vivo. The effect of BK in vitro was blocked by either indomethacin or bisindolylmaleimide, suggesting that an arachidonic acid (AA) metabolite and protein kinase C (PKC) activation mediate BK-induced regulation of the KOR system. Furthermore, the effect of U50488 in BK-treated tissue was blocked by a soluble integrin-blocking peptide (GRGDSP), but not the inactive reverse sequence peptide (GDGRSP), suggesting that, in addition to AA and PKC, RGD-binding integrins participate in the regulation of KOR signaling in response to U50488. Understanding the mechanisms by which peripheral KOR agonist efficacy is regulated may lead to improved pharmacotherapy for the treatment of pain with reduced adverse effects.     

Schmerzkontrolle in der pädiatrischen Onkologie in Deutschland

As part of a nationwide quality improvement programme, our aim is the assessment of the quality of pain control in German paediatric oncology to tailor the intervention to specific needs. Here we report on the results of a questionnaire-based nationwide survey which addressed the head of the department, one supervising physician, one ward physician, one nurse, and one psychologist/social worker in each of the 76 german paediatric oncology departments. 210/380 health care professionals of 60/76 departments responded to the survey. According to 17% of the physicians (41% of the nurses, p = 0.004) there still exists '(very) often' pain despite pain therapy. Procedures are seen as the main causes of pain. According to 58% of the heads of the department and supervising physician (35% of the nurses and ward physicians, p = 0.005), faces scales are regularly used to score pain intensity. In 80% of the departments a written therapy protocol addressing procedure-related, or postoperative pain is lacking. When larger and smaller departments are compared, in former ones the significantly preferred routes for opioid administration are i. v., or oral for slow release preparations (p = 0.01). The i. m. route is exclusively used in smaller departments. In the treatment of neuropathic pain, only 5% of the physicians regard morphine, but 25% of them regard antidepressants and antiepileptics as ineffective. Only 72% of the physicians (39% of the nurses, p = 0.001) are convinced that during opioid-based pain therapy addiction 'seldom/never' developes. Nurses are less satisfied with pain therapy than are physicians, and they feel more frequently that pain therapy '(very) often' starts too late (p <0.005). The questionnaire revealed obvious deficits in both physicians' and nurses' knowledge regarding pain therapy. Deficits were also addressed by the health care professionals themselves.     

Sex Differences in Pain Intensity in Adolescents Suffering From Cancer: Differences in Pain Memories?

Although sex differences have been investigated in chronic pain populations, little is known about sex differences in the pain experience of paediatric oncology patients and also whether their parents rate the pain experience differently for boys and girls. The aim of the present study was to determine if (1) boys and girls with cancer differ in current perception and past recollection of cancer-related pain and (2) if adolescents' and parents' pain ratings differ in relation to the sex of the adolescent. One hundred twelve adolescents with malignant diagnoses (12 to 18 years) and their parents participated in the study. Girls reported higher pain intensity within the last 7 days and 4 weeks despite similar diagnosis, physical status, duration of diagnoses, and main pain causes. When asked for pain intensity that dated back in time, parent and adolescent ratings diverged, with a trend for parents to reporting higher pain intensity in boys and lower pain intensity in girls, particularly for pain in the preceding 7 days. The present study provides preliminary evidence for sex differences in the recalled pain experience of adolescents with malignant diagnoses. Although boys and girls experience present pain similarly and hence should be treated similarly, girls recall higher pain intensity than boys. Future studies should address whether negative memories in girls play a significant role and may have an impact on girls' well-being and pain-related distress. Additionally, psychosocial factors such as gender role expectations may need to be investigated. Parental variables and their impact on parents' pain ratings, especially for ratings of precedent pain, warrants further investigation.PerspectiveGirls with malignant diagnoses differ from boys in their recalled pain intensity ratings, with girls reporting higher pain intensity. Additional pain management strategies referring to the memory of pain may need to be implemented.     

PAC in FACTT: Time to PAC it in?

Citation

Wheeler AP, Bernard GR, Thompson BT, Schoenfeld D, Wiedemann HP, deBoisblanc B, Connors AF, Jr., Hite RD, Harabin AL. Pulmonary-artery versus central venous catheter to guide treatment of acute lung injury. N Engl J Med 2006;354:2213–2224 [1].

Background

The balance between the benefits and the risks of pulmonary artery catheters (PACs) has not been established.

Methods

Objective

To assess the safety and efficacy of PAC-guided vs. central venous catheter-guided management in reducing mortality and morbidity in patients with established acute lung injury (ALI).

Design

Randomized, controlled, non-blinded trial.

Setting

36 centers in the United States and 2 in Canada.

Subjects

1000 patients with established acute lung injury of less than 48 hours duration. Subjects were excluded if they already had a PAC in place or had chronic conditions that could independently influence survival, impair weaning, or compromise compliance with the protocol, such as dialysis dependence, severe lung or neuromuscular disease, or terminal illness.

Intervention

Subjects were randomized to hemodynamic management guided by a PAC or a CVC using an explicit management protocol.

Outcomes

Hospital mortality during the first 60 days before discharge home was the primary outcome. Secondary outcomes included ventilator-free days, intensive care unit-free days, organ failure-free days, and adverse events.

Results

The groups had similar baseline characteristics. The rates of death during the first 60 days before discharge home were similar in the PAC and CVC groups (27.4 percent and 26.3 percent, respectively; P = 0.69; absolute difference, 1.1 percent; 95 percent confidence interval, -4.4 to 6.6 percent), as were the mean (+/-SE) numbers of both ventilator-free days (13.2 +/- 0.5 and 13.5 +/- 0.5; P = 0.58) and days not spent in the intensive care unit (12.0 +/- 0.4 and 12.5 +/- 0.5; P = 0.40) to day 28. PAC-guided therapy did not improve these measures for subgroup of patients in shock at the time of enrollment. There were no significant differences between groups in lung or kidney function, rates of hypotension, ventilator settings, or use of dialysis or vasopressors. Approximately 90 percent of protocol instructions were followed in both groups, with a 1 percent rate of crossover from CVC- to PAC-guided therapy. Fluid balance was similar in the two groups, as was the proportion of instructions given for fluid and diuretics. Dobutamine use was uncommon. The PAC group had approximately twice as many catheter-related complications (predominantly arrhythmias), though rates per catheter insertion were similar between groups.

Conclusion

PAC-guided therapy did not improve survival or organ function but was associated with more complications than CVC-guided therapy. These results, when considered with those of previous studies, suggest that the PAC should not be routinely used for the management of acute lung injury. (ClinicalTrials.gov number, {"type":"clinical-trial","attrs":{"text":"NCT00281268","term_id":"NCT00281268"}}NCT00281268.).     

Application of Massage in rehabilitation of moter function in stroke

Massage has become a manipulation of physical therapy in recent years.Massage is based on theory of zang and fu,channel and collateral of traditional Chinese medicine,instructed by pathology,anatomy and diagnosis of western medicine and combined with kinds of massage manipulation all which have make it an important method of nondrug therapy in preventing and treatment of diseases.Massage is also a measure in rehabilitation of motion function of patients with stroke^[1].     

Application of massage in rehabilitation of motor function in stroke

INTRODUCTIONMassagehasbecomeamanipulationofphysicaltherapyinrecentyears.Massageisbasedontheoryofzangandfu,channelandcol-lateraloftraditionalChinesemedicine,instructedbypathology,anatomyanddiagnosisofwesternmedicineandcombinedwithkindsofmassagemanipulationallwhichhavemakeitanimportantmethodofnondrugtherapyinpreventingandtreatmentofdiseases.Massageisalsoameasureinrehabilitationofmotionfunctionofpatientswithstroke犤1犦.EFFECTSOFMASSAGEINREHABILITATIONAnalgesiaThemostobviouseffec…     

Humor in the OR: a stitch in time?

HUMOR SERVES MULTIPLE PURPOSES and provides numerous benefits for health care practitioners and their patients.IN THE PERIOPERATIVE SETTING, humor can be used to establish relationships, relieve anxiety, release anger in a socially acceptable way, avoid or deny painful feelings, and facilitate learning.PERIOPERATIVE NURSES can use a variety of techniques and resources to increase their use of humor, even if they perceive themselves to be humor-impaired. AORN J 87 (July 2008) 67-77. © AORN, Inc, 2008.     

GES Extended-Spectrum β-Lactamases in Acinetobacter baumannii Isolates in Belgium

During a PCR-based surveillance study of β-lactam resistance, 125 multidrug-resistant (MDR) Acinetobacter baumannii isolates were obtained from 18 hospitals in Belgium from January 2008 to December 2009. Nine GES-positive A. baumannii isolates were detected at 6 Belgian hospitals. DNA sequencing of the bla_GES genes identified GES-11, GES-12, and a novel variant GES-14, which differs from GES-11 by a single amino acid substitution (Gly170Ser). All index isolates were travel associated and originated from patients transferred from Turkey (n = 2), Egypt (n = 2), and Palestinian territories (Gaza) (n = 2). A nosocomial outbreak involving three additional patients occurred in a burn unit at a single hospital. No clonal relatedness could be established between the 6 index isolates by pulsed-field gel electrophoresis (PFGE) analysis. Three different alleles (the plasmid-located bla_GES-11 and bla_GES-12 and a likely chromosomally located novel variant bla_GES-14) were detected as part of a class 1 integron, also including the aac6′Ib and dfrA7 genes. Restriction analysis of plasmids suggests a common origin for the plasmids bearing bla_GES-11 and bla_GES-12. Cloning of the bla_GES genes in Escherichia coli identified GES-14 as hydrolyzing imipenem, while GES-12 showed the highest specific activity against ceftazidime. This report highlights the emergence of various bla_GES-like genes, especially those conferring carbapenem resistance in A. baumannii and its importation in Western Europe from Middle Eastern countries.Acinetobacter baumannii has been recognized over the last 2 decades as an emerging opportunistic pathogen that is associated mostly with life-threatening infections in highly debilitated patients and nosocomial outbreaks (5, 26, 29). In addition to their ability to survive for long-term periods in adverse environmental conditions, these organisms display numerous intrinsic and acquired antimicrobial mechanisms, such as changes in outer membrane proteins, overexpression of endogenous efflux pumps, chromosomal and plasmid-acquired β-lactamases, aminoglycoside-modifying enzymes, and fluoroquinolone resistance, among others (5). The genetic flexibility and high adaptability of this organism have resulted in the rapid and global emergence over the last few years of multidrug-resistant (MDR) A. baumannii strains resistant to most classes of antimicrobial drugs, including carbapenems (10). Carbapenem resistance in A. baumannii is most often mediated by acquired β-lactamases of class D (OXA-23-like, OXA-40-like, and OXA-58-like) and less frequently by metallo-β-lactamases (MBLs) (24). In addition, the low outer membrane permeability and/or the upregulation of intrinsic efflux systems are also contributory factors toward carbapenem resistance (24). Very recently the Ambler class A of the GES and KPC (carbapenemase) types have also been reported for A. baumannii (14, 25).bla_GES genes are usually carried on integrons found in various species, predominantly Klebsiella pneumoniae, Escherichia coli, and Pseudomonas aeruginosa, and these resistance determinants have been reported in several countries in Europe, Asia, South America, and South Africa (18). Sixteen GES variants differing by one to three amino acid residues have been reported (18) (http://lahey.org/studies/other.asp). GES β-lactamases exhibit extended-spectrum properties, hydrolyzing oxyimino-cephalosporins. However, differences in the substrate spectra have been observed. Variants with either Gly to Asn (GES-2) or Gly to Ser (GES-4, -5, and -6) at Ambler position 170 are of special clinical importance since they exhibit increased carbapenemase activity compared to other GES enzymes (18). In addition GES-4, -5, and -6 also hydrolyze cefoxitin. Also Gly243Ser substitutions as observed with GES-9 expand the hydrolysis spectrum to aztreonam (21). Following the recent report of GES-11 β-lactamase in one A. baumannii isolate in France presenting a Gly243Ala substitution, we describe in this report the emergence of three different variants, including a novel GES variant, GES-14, that were identified during a screening for acquired carbapenemase genes in multidrug-resistant A. baumannii isolates collected from January 2008 to December 2009 from 18 Belgian hospitals.