The surgeon's use of the rigid and flexible bronchoscopes in the diagnosis of bronchial carcinoma

The results of a prospective study comparing the rigid and flexible fibreoptic bronchoscopic techniques in the diagnosis and assessment of bronchial carcinoma are reported. One hundred and nine patients underwent fibreoptic bronchoscopy and these were compared with a similar group of 111 patients in whom the rigid bronchoscope was used. Bronchoscopic diagnosis of malignancy was achieved in 73.4% of patients in the fibreoptic group and in 73% using the rigid bronchoscope.     

电子支气管镜不同清洗消毒方法的效果比较

目的:了解多酶清洗剂对电子支气管镜清洗的重要性以及不同采样方法对电子支气管镜清洗、消毒效果的检测情况。方法:将483例诊疗后污染的电子支气管镜随机分为试验组和对照组,分别从内镜表面清洁度、镜身表面附着物、管道堵塞及细菌菌落检测等方面进行评价。结果:应用多酶清洗剂清洗后,内镜表面清洁度、镜身表面附着物、管道堵塞均较单纯用流动水清洗效果好;无论是内腔采样法还是外表采样法,试验组的无菌生长例数都高于对照组;在对照组,通过内腔采样法进行细菌培养的标本,≥20cfu/件的例数要多于外表采样法,而在试验组该差异减小。结论:应用多酶清洗剂可明显提高电子支气管镜清洗、消毒质量;对电子支气管镜的监测,建议采用内腔采样和外表采样相结合的方法进行标本采集。     

An outbreak of Pseudomonas aeruginosa infections following thoracic surgeries occurring via the contamination of bronchoscopes and an automatic endoscope reprocessor

An outbreak of Pseudomonas aeruginosa infections occurred after thoracic surgeries performed between May and June 2003. Clinical data of seven patients were reviewed and the fact was revealed that bronchoscopes were used during endotracheal intubation for one-lung ventilation in most patients. P. aeruginosa was recovered from the sputum of these patients at a very early stage post-operation. Environmental samples from bronchoscopes and an automated endoscope reprocessor (AER) were cultured and P. aeruginosa strains were recovered from all of them. All of these strains were confirmed to be identical by pulsed-field gel electrophoresis (PFGE). Inspection of the sterilization cycles of bronchoscopes revealed inappropriate management of bronchoscopes and a flaw in the AER; once its detergent tank was contaminated, it was not possible to disinfect it. After all the bronchoscopes had been disinfected, and the washing machine had been remodeled, with the washing process confirmed to be appropriate, the outbreak finally ended. This outbreak had two causes, a flaw in the AER and inappropriate disinfection procedures. Outbreaks associated with bronchoscopic examinations have been reported elsewhere. Bronchoscopes are widely used to facilitate endotracheal intubation, especially for one-lung anesthesia. Although they are used for only a short time during anesthetic procedures, we should handle them more carefully.     

颅脑和胸部撞击伤发生机制研究

目的：介绍自制的各种生物撞击机，总结以往颅脑和胸部撞击伤发生机制方面的研究成果，以便为颅脑和胸部撞击伤的防治提供理论依据。方法：应用自行研制的生物撞击机,给犬、兔、大鼠等动物造成不同类型的撞击伤，并进行颅脑和胸部撞击伤发生机制的研究。结果：（1）制成几种生物撞击机和颅脑、胸部撞击伤模型。（2）证实原发颅脑撞击伤的主要原因是外力作用于颅脑后形成的剪切应力所致。（3）继发性颅脑伤是因血管损伤、炎症损伤和兴奋性氨基酸增多致神经元钙离子内流等因素所致。钙通道阻断剂尼莫地平和血管扩张药物伊洛前列素（Iloprost) 均有抗损伤作用。（4）胸部损伤与胸腔内应力传播有关，黏性损伤标准可作为最有效的伤情指数。结论：原发颅脑和胸部撞击伤是由于体内应力传播和应力集中所致。继发性损伤与血管损伤、过度炎症反应和兴奋性氨基酸增多致使神经元钙内流增强有关，相应的拮抗措施有明显的抗损伤作用。     

Burden of cluster headache

The aim was to analyse the socioeconomic burden of cluster headache in patients from a tertiary headache centre. One hundred consecutive patients from the Danish Headache Centre were invited to an interview about the socioeconomic impact of cluster headache. Work absence and use of medical services were compared with a Danish population-based survey. Eighty-five patients participated; 78% reported restrictions in daily living and 13% also outside of cluster periods; 25% reported a major decrease in their ability to participate in social activities, family life and housework. The disease caused lifestyle changes for 96%, most frequently in sleeping habits and avoidance of alcohol. The absence rate among patients was 30%, which was significantly higher than 12% among the general population (P < 0.001). Use of health services due to headache was also higher among the patients (P < 0.001). Cluster headache, although periodic in most cases, has considerable impact on social functions, quality of life and use of healthcare.     

新护士转型冲击现状调查顾璘翌,俞静娴,沈韵

目的 了解新护士转型冲击的现状，探讨影响新护士转型冲击的因素，为降低新护士转型冲击体验，制定针对性的管理措施提供参考。方法 抽取复旦大学附属中山医院新护士72名作为调查对象。采用新护士转型冲击评价量表和一般资料调查表进行问卷调查。结果 接受调查的新护士转型冲击量表总分为（68.74±4.32）分，得分率为52.92%。新护士的性别、籍贯以及科室是影响新护士转型冲击的主要因素（均P＜0.05）。结论 新护士转型冲击处于中等水平，以知识和技能方面压力最大，且受性别、籍贯、科室等多方面的影响，护理管理者应该给予更多关注，帮助新护士应对转型冲击。     

尿液中含有精子对检测结果的影响

目的探讨尿液中含有精子对检测结果的影响。方法用UF-50全自动尿沉渣分析仪、H-500尿液分析仪与显微镜对100例未含精子组尿液标本和含精子组尿液标本进行检测并对结果进行分析。结果含精子组尿液尿蛋白出现假阳性。当尿液中精子数大于或等于60/μL,尿白细胞数(WBC-U)、尿白细胞(WBC-HP)、尿红细胞数(RBC-U)、尿红细胞(RBC-HP)出现假阳性。未含精子组尿液标本与尿液中精子数大于或等于60/μL含精子组尿液标本的WBC-U、WBC-HP比较差异有统计学意义(P<0.05),RBC-U、RBC-HP两者比较差异有显著统计学意义(P<0.01)。结论应杜绝精子混入尿液中,提高尿液的检测质量。     

下颌骨撞击伤对颞下颌关节紊乱病及关节强直发生的影响

目的研究以不同的力量撞击兔下颌角部,观察其对兔颞下颌关节(TMJ)的影响。方法以不同的力量撞击家兔一侧下颌角部,方向平行于双侧下颌角的连线,造成TMJ的间接损伤。结果两种不同的撞击力均可引起双侧TMJ的间接性损伤;其中对侧较实验侧关节结构的改变更为明显;关节盘下腔面与上腔面都受到破坏,且下腔面较上腔面破坏严重。较大撞击力量可引起较明显的关节破坏。结论下颌骨外伤后,应重视TMJ的检查与治疗,防止颞下颌关节紊乱病或关节强直的发生。     

The impact of cancer and chemotherapy: Perceptual similarities and differences between cancer patients, nurses and physicians

BACKGROUND: An essential condition to provide optimal care to cancer patients is a thorough understanding of the worries and needs of these patients. PURPOSE: To assess and compare perceptions about the impact of cancer and chemotherapy of health-care providers and patients. METHODS: Breast cancer survivors (N=80), oncology nurses (N=41) and physicians (N=49) with oncology experience completed a psychophysical scaling method with items tapping both the physical and psychosocial effects of cancer and chemotherapy. RESULTS: The following five issues ranked highest among patients: fear of metastases, fatigue, consciousness of one's own vulnerability, hair loss and nausea. Whereas there was a strong correspondence between the ratings of nurses and physicians, both groups grossly overestimated and underestimated various issues. For example, the effects on relationships with partners and children were greatly overestimated by nurses, while physicians underestimated hair loss the most. CONCLUSIONS: There was a considerable discrepancy on various issues between perceptions of patients and medical professionals. CLINICAL IMPLICATION: The observed lack of correspondence between patients and health-care providers may result in inappropriate provision of attention and health care. Methods have to be developed to assess easily the main needs and worries of individual patients, which is an essential condition to be able to provide optimal care.     

关节炎患者生活质量的调查与分析

目的 通过调查了解关节炎患者的生活质量现状,分析影响关节炎患者生活质量的因素,以对患者实施有针对性的护理,提高患者生活质量.方法 采用AIMS2量表,通过设置问卷调查了60例关节炎患者,利用率、构成比、均数及标准差、t检验、相关分析等方法进行统计学分析.结果 关节炎患者生活质量较差,类风湿性关节炎和骨性关节炎或退行性关节炎患者的紧张水平、情绪、手和手指功能、手臂功能差异有统计学意义(P<0.05).关节炎患者的年龄与自理能力、家务活动、活动水平、行走和弯腰、手和手指功能、手臂功能、社会活动和工作呈负相关(P<0.05或P<0.01);关节炎患者的学历与自理能力、家务活动、活动水平、行走和弯腰、手和手指功能、手臂功能和社会活动均呈正相关(P<0.05或P<0.01);病程与患者的行走和弯腰呈负相关(P<0.05);疼痛程度与患者的紧张水平、活动水平和工作情况具有显著相关性;用药情况与患者的活动水平、行走和弯腰、手和手指水平、手臂功能和疼痛情况具有显著相关性;患者的整体健康状况与活动水平、行走和弯腰、社会活动具有显著相关性;健康满意度与家务活动、家人和朋友的支持、紧张水平、情绪、活动水平、行走和弯腰、工作呈负相关(P<0.05或P<0.01),与疼痛程度呈正相关(P<0.01).结论 应关注关节炎患者的生活质量,并将其列为骨科护理工作的重点之一.     

Financial Impact of Emergency Department Ultrasound

Objectives: There is limited information on the financial implications of an emergency department ultrasound (ED US) program. The authors sought to perform a fiscal analysis of an integrated ED US program. Methods: A retrospective review of billing data was performed for fiscal year (FY) 2007 for an urban academic ED with an ED US program. The ED had an annual census of 80,000 visits and 1,101 ED trauma activations. The ED is a core teaching site for a 4-year emergency medicine (EM) residency, has 35 faculty members, and has 24-hour availability of all radiology services including formal US. ED US is utilized as part of evaluation of all trauma activations and for ED procedures. As actual billing charges and reimbursement rates are institution-specific and proprietary information, relative value units (RVUs) and reimbursement based on the Centers for Medicare & Medicaid Services (CMS) 2007 fee schedule (adjusted for fixed diagnosis-related group [DRG] payments and bad debt) was used to determine revenue generated from ED US. To estimate potential volume, assumptions were made on improvement in documentation rate for diagnostic scans (current documentation rates based on billed volume versus diagnostic studies in diagnostic image database), with no improvements assumed for procedural ED US. Expenses consist of three components—capital costs, training costs, and ongoing operational costs—and were determined by institutional experience. Training costs were considered sunken expenses by this institution and were thus not included in the original return on investment (ROI) calculation, although for this article a second ROI calculation was done with training cost estimates included. For the purposes of analysis, certain key assumptions were made. We utilized a collection rate of 45% and hospitalization rates (used to adjust for fixed DRG payments) of 33% for all diagnostic scans, 100% for vascular access, and 10% for needle placement. An optimal documentation rate of 95% was used to estimate potential revenue. Results: In FY 2007, 486 limited echo exams of abdomen (current procedural terminology [CPT] 76705) and 480 limited echo cardiac exams were performed (CPT 93308) while there were 78 exams for US-guided vascular access (CPT 76937) and 36 US-guided needle placements when performing paracentesis, thoracentesis, or location of abscess for drainage (CPT 76492). Applying the 2007 CMS fee schedule and above assumptions, the revenue generated was 578 RVUs and $35,541 ($12,934 in professional physician fees and $22,607 in facility fees). Assuming optimal documentation rates for diagnostic ED US scans, ED US could have generated 1,487 RVUs and $94,593 ($33,953 in professional physician fees and $60,640 in facility fees). Program expenses include an initial capital expense (estimated at $120,000 for two US machines) and ongoing operational costs ($68,640 per year to cover image quality assurance review, continuing education, and program maintenance). Based on current revenue, there would be an annual operating loss, and thus an ROI cannot be calculated. However, if potential revenue is achieved, the annual operating income will be $22,846 per year with an ROI of 4.9 years to break even with initial investment. Conclusions: Determining an ROI is a required procedure for any business plan for establishing an ED US program. Our analysis demonstrates that an ED US program that captures charges for trauma and procedural US and achieves the potential billing volume breaks even in less than 5 years, at which point it would generate a positive margin.     

糖尿病病耻感的不良影响及干预研究进展

了解病耻感给糖尿病病人造成的不良影响及病耻感干预措施的研究进展,为开展糖尿病病耻感的相关研究提供参考。通过查阅国内外的糖尿病病人病耻感的相关文献,总结糖尿病病耻感的不良影响及干预措施的研究现状。病耻感会导致糖尿病病人自我管理难度增大、较低的自我认同感、回避正常的社交活动、就业与升职壁垒等问题。通过国家立法保护、专科门诊与心理咨询室、糖尿病知识科普运动、完善的家庭支持体系、同伴支持平台、树立正确的自我认知等来消除病耻感及其不良影响。     

The Emotional and Psychological Impact on Radiation Therapists of Treating Children

PurposeThe aim of this study was to determine the psychological effects and difficulties that radiation therapists (RTs) experience while treating paediatric patients. This study is intended to provide some information to assist RTs in their occupation and to complement the literature on this topic.MethodsA survey was conducted to capture data on the emotional effects and opinions of RTs at The Ottawa Hospital Regional Cancer Centre (TOHRCC) treating children with cancer. A questionnaire was created specifically for this study standardized to TOHRCC conditions and methods and inspired from the limited literature around this issue. The study converged on the reactions of RTs while children received radiation treatment at TOHRCC and the impact on their emotional state around this component of their practice. The questionnaire was distributed electronically via e-mail to all RTs within the Radiation Therapy Department at TOHRCC.ResultsThis study involved 62 of 104 RTs employed at TOHRCC who completed the survey of 20 questions and submitted their responses. Due to the sample size, statistical correlations and links between variables were limited. The questionnaire was analysed based on the answers given by the RTs on the provided Likert scale for each question. The questionnaire showed that gender and age played no major role in the RTs' ability to cope mentally. Half of the RTs had children themselves; and of these, 66% indicated that having children made it somehow more difficult to cope emotionally with paediatric patients. Seventy-five percent of all RTs indicated that the emotional state of parents or care givers of the affected children played a key role in the anxiety they felt during a child's treatment. Eighty-one percent of RTs stated that treating children caused higher anxiety levels than treating adults. Finally, our survey suggests that time constraints play a large part in the RTs' stress level during treatments.ConclusionOverall, treating children did not cause much more distress than treating adults. Results from this survey were used to create a new tool describing the cognitive stages in children to help RTs treat paediatric patients in the future.     

Do community-based rehabilitation programmes promote the participation of persons with disabilities? A case control study from Mandya District,in India

Abstract

Purpose: In this paper, we measure the effectiveness of Community-Based Rehabilitation (CBR) programmes in promoting the well-being of people with disabilities and removing the barriers to their participation in family and community decision-making processes. Method: To evaluate the impact of the CBR programme, we use data from a large-scale control study in Karnataka, India. Propensity score matching is used to evaluate the impacts on disabled persons after 2, 4 and 7 years of entering the CBR. The theoretical framework for the analysis is based on the CBR guidelines, which are combined with the International Classification of Functionings (ICF), the United Nations Convention on the Rights of People with Disabilities (UN CRPD) and Amartya Sen’s capability approach. Results: CBR has a positive impact on the well-being of persons with disabilities participating in the programme and particularly on their participation within the family and the society at large. Conclusions: CBR programmes have a multidimensional and positive impact on individual and collective capabilities; on individual, agency and social empowerment.

• Implications for Rehabilitation

• Community-Based Rehabilitation (CBR) can make a lasting difference in the life of persons with disabilities.

• CBR improves participation and inclusion of persons with disabilities in the family and in the community.

     

胆红素待测标本受实验室光线照射影响测定结果的探讨

目的 探讨标本在实验室中放置时间过长,受日光和灯光照射,对总胆红素测定结果的影响.方法 将一组标本暴露在实验室日光和灯光下,一组标本避光保存,2 h后测定两组标本的血浆总胆红素值,对比分析两组标本测定结果的平均偏差.结果 受日光灯光照射组的总胆红素值明显下降,两组测定结果对比差异有统计学意义(P<0.01).结论 待测标本较多时,为减少胆红素的自发性氧化和光氧化而使胆红素测定结果偏低,标本采集后应立即测定胆红素,待测标本在上机测定前应置2～8 ℃冰箱中避光保存,防止标本中胆红素的氧化而影响测定结果.     

上颌埋伏尖牙位置和角度的研究

目的探讨上颌埋伏尖牙与正常未萌尖牙的角度及位置是否存在差别。方法选取50颗上颌埋伏尖牙患者为实验组,以相应年龄组具有正常未萌尖牙的患者为对照组,测量曲面平展片,以腭平面为参考平面测量其角度,以侧切牙为基准测量其位置。结果上颌埋伏尖牙的平均角度为42．14°±13．43°,明显小于正常未萌尖牙;位置明显偏于侧切牙近中。结论测量未萌上颌尖牙的角度和位置有助于预测埋伏牙的发生。     

New paradigms in the recognition and acute treatment of migraine

It would be ideal if clinical decisions regarding acute migraine treatment could be made on the basis of three parameters: a critical appraisal of available scientific evidence, clinical experience (including knowledge of the individual patient and his/her attack characteristics), and, of course, patient preferences. Patients are likely to prefer agents that offer rapid relief, pain-free status within 2 hours, no recurrence or need for rescue medication, extended time to recurrence (if present), consistency of therapeutic effect over multiple attacks, oral administration. good tolerability, safety, and minimal drug interactions. Fortunately, a number of specific therapies now are available which place these objectives within the patient's reach. Ongoing barriers to optimal migraine care include underrecognition, underconsultation, undertreatment, restrictions imposed by insurance companies, and exaggerated concerns regarding the safety of the triptans. Overcoming these barriers is likely to prove a more important contribution to patient care than endeavoring to establish the relative merits of one triptan over another. We have described in detail a number of strategies for improving recognition and treatment of migraine. Many headache specialists now believe that recurrent episodes of disabling headache, with a stable pattern over years, should be viewed as migraine until proven otherwise. In the end, this may represent the most useful paradigm in the primary care setting, where time is of the essence. Studies to validate this approach are needed. Acute treatment intervention that is based on scientific evidence, clinical experience, and patients' needs and desires will provide better outcomes than those presently obtained. Preliminary evidence favors early intervention with oral triptans, and randomized, prospective, double-blind, placebo-controlled studies, ideally employing a crossover design, are required to confirm this. The US Consortium's evidence-based guidelines, the National Headache Foundation's standards of care, and the Canadian guidelines have applied the standards of scientific inquiry to the field of headache management and "translation" of these guidelines into practical instruments for clinicians through vehicles such as the Primary Care Network's Patient-Centered Strategies for Effective Management of Migraine should raise the general standard of care for patients with migraine. Last, but far from least, initiatives undertaken by the World Health Organization (WHO) will add credibility to the many layfolk and professionals who have struggled to present headache as a disabling disorder worthy of scientific investigation and aggressive medical management. The WHO states: "These common complaints impose a significant health burden ... Despite this, both the public and the majority of healthcare professionals tend to perceive headache as a minor or trivial complaint. As a result, the physical, emotional, social and economic burdens of headache are poorly acknowledged in comparison with those of other, less prevalent, neurologic disorders." Migraine is finally out of the closet.     

Assessing the Psychological Impact of Daily Bowel Preparation on Prostate Patients Who Receive Radiation Therapy

PurposeEvidence has shown that the prostate moves depending on filling of the rectum and, to a lesser extent, the bladder; many radiation therapy departments have adopted standardized bladder filling/rectal emptying protocols for radiotherapy treatment. Daily treatments may be delayed until appropriate volumes are attained; the resultant psychological impact of these delays on patients is unknown. The purpose of this study was to determine levels of anxiety, depression, distress, and bother related to bowel preparation for prostate cancer patients undergoing radiation therapy treatment.MethodsA prospective cohort analysis of prostate cancer patients undergoing external beam radiation therapy was completed. Patients were assigned to one of three groups; Group A was standard of care, Group B was standard of care plus increased educational information regarding bowel preparation, Group C was standard of care plus increased educational information regarding bowel preparation plus an anti-flatulent medication. Hospital Anxiety and Depression Scale, Distress Thermometer, and a Bowel Status Bother survey were completed by participants at the start of theircourse of radiation treatment, mid-way through, and at the end. Analysis of variance testing was completed to determine differences in mean scores between the three groups.ResultsMean age of patients (N = 30) was 66 years; 50% of the participants had a university education; 80% were married. Anxiety levels decreased over time in all groups (P = .039) with no difference between groups (P = 0.447). Depression levels across time for each group remained low (P = .577). Overall distress levels associated with bowel preparation were low among each group, and no significant differences were reported (P = .978). All groups reported high rates of quality of life.ConclusionsFindings from this study indicate that collectively across three groups and over time, there were low levels of anxiety, depression, and distress from bowel preparation. Amount, timing, quality, and approach to educational information are important factors to ensure patients feel prepared for their radiation therapy treatments.