Defecation complaints after hysterectomy because of a benign condition are rare; a prospective study

OBJECTIVE: To determine the frequency of defecation symptoms after hysterectomy. DESIGN: Prospective multicentre study, 3 year follow-up. METHODS: 404 patients from 13 teaching or non-teaching hospitals in The Netherlands, who underwent hysterectomy for benign disease other than symptomatic uterine prolapse or known endometriosis, were asked to complete the defecation distress inventory before and 3 years after surgery. The defecation distress inventory is a validated disease specific quality of life questionnaire for assessment of the presence and experienced inconvenience of defecation symptoms. RESULTS: A response rate of 328/372 (88%) of 404 patients whose address could be recovered after 3 years was found. De novo constipation occurred in 2% of the patients following hysterectomy. Sensation of anal blockage and incomplete defecation occurred in more than 15% of the patients. Defecation symptoms reported before surgery had persisted in about half of the patients at 3 years after hysterectomy. A feeling of incomplete defecation at 3 years after hysterectomy was more common after subtotal hysterectomy than after total or vaginal hysterectomy (adjusted odds ratio: 2.1 (95% CI: 1.1-3.8) and 1.4 (95% CI: 0.7-2.7), respectively). CONCLUSION: Defecation symptoms seldom developed after hysterectomy for benign disease. The type of operation did not play a role.     

Clinical findings and diagnosis of Yersinia enterocolitica infections; a retrospective study in Friesland

The clinical data of 97 patients with Yersinia enterocolitica infection during 1989 were evaluated. The diagnosis was made by positive culture, serology and/or detection of Yersinia antigens in biopsies. The enteric form (enteritis, abdominal syndrome, pseudo-appendicitis, ileitis and colitis) occurred in 66% of all patients, 10 (10%) had an extramesenteric form, 22 had arthritis and 6 had erythema nodosum. The mean age was 33.6 (SD 19.4) years. Abdominal pain was the syndrome most frequently observed (in 55%), followed by diarrhoea in 44% and malaise in 41%. The duration of the disease was shorter than four weeks in 37% and longer than eight weeks in 34%. Serotype 03 was most frequently isolated. The agglutination reaction was positive in 25%, false-positive in 7% and false-negative in 68%; 91% had specific IgA and IgG antibodies against two or more virulence proteins (Yops).     

Nosocomial hepatitis C in a thoracic surgery unit; retrospective findings generating a prospective study

We describe the transmission of hepatitis C virus (HCV) to two patients from a thoracic surgeon who was unaware of his hepatitis C infection. By partial sequencing of the non-structural 5B gene and phylogenetic analysis, the viruses from both patients were found to be closely related to genotype 1a strain from the surgeon. Two further hepatitis C cases were found in relation to the thoracic clinic. Their HCV sequences were related to each other but were of genotype 2b and the source of infection was never revealed. To elucidate the magnitude of the problem, we conducted a prospective study for a period of 17 months in which patients who were about to undergo thoracic surgery were asked to participate. Blood samples were drawn prior to surgery and at least four months later. The postoperative samples were then screened for anti-HCV and, if positive, the initial sample was also analysed. The only two patients (0.4%) identified were confirmed anti-HCV positive before surgery, and none out of 456 evaluable cases seroconverted to anti-HCV during the observation period. Despite the retrospectively identified cases, nosocomial hepatitis C is rare in our thoracic unit. The study points out the risk of transmission of hepatitis C from infected personnel and reiterates the need for universal precautions.     

Facial skin findings are indicators of human immunodeficiency virus infection and acquired immune deficiency syndrome: a retrospective study

Aims

To explore HIV-related facial skin disorders among HIV-positive outpatients and the role in identifying HIV infection and/or AIDS.

Subjects and methods

We retrospectively evaluated records from all HIV-positive patients who initially presented at our Dermatology and Venereology Department (Southwest Hospital, Chongqing, China) between January 2009 and March 2016. We also compared the prevalences of facial skin disorders among HIV-positive and HIV-negative outpatients.

Results

We identified 827 HIV-positive patients, who included 150 patients who initially presented with 1 of 14 different facial skin disorders. Noninfectious/inflammatory dermatosis was the most common diagnosis (109/150, 72.7 %), and infectious dermatosis was diagnosed in 41 cases (27.3 %). Most facial skin disorders exhibited a higher proportion of HIV-positive patients, compared to HIV-negative patients. Herpes zoster was the most common disorder, and psoriasis and eczema or neurodermatitis were secondary disorders. Some disorders, such as seborrheic dermatitis, exhibited a severe and refractory clinical manifestation. Photosensitive dermatoses were significantly more common among HIV-positive patients, compared to HIV-negative patients (1.9 % vs. 0.0 %). No malignancies were diagnosed.

Conclusions

There is a wide spectrum of facial skin disorders among HIV-positive patients in southwest China, and some of these disorders may provide the first clinical indication of HIV infection and/or AIDS. However, these findings require confirmation using immunological data.

     

早发型重度子痫前期不良结局及其关联因素的回顾性研究

目的探讨早发型重度子痫前期不良结局及其影响因素的关联性。方法回顾性分析2015-2016年吉林大学第一医院收治的早发型重度子痫前期患者699例,分为无不良结局组576例和不良结局组123例;其中母体不良结局47例,胎儿不良结局56例,母体及胎儿同时发生不良结局20例。应用t检验和Logistic回归分析各因素与早发型重度子痫前期不良结局的关联性。结果在所有不良结局中,胎儿宫内窘迫占34.15%。不良结局组中妊娠28周前发生不良结局33例占26.83%,妊娠28~34周90例占73.17%。乳酸脱氢酶和ALT升高是发生不良结局的危险因素,乳酸脱氢酶升高是胎盘早剥发生的危险因素,白蛋白降低和乳酸脱氢酶升高是胎儿窘迫发生的危险因素。结论在早发型重度子痫前期期待治疗的同时重视危险因素的变化、根据化验结果评估患者病情严重程度并适时终止妊娠有助于改善母婴结局。     

The quality of retrospective questions about occupational history--a comparison between survey and census data

The main purpose of the present study was to assess the quality of information about occupational history obtained via retrospective interview questions. This assessment is achieved by linking interview data from the Swedish survey of Living Conditions (ULF) with occupational information about the same individuals obtained from a number of censuses. This has been done for the census years 1960, 1970, 1975 and 1980. In both ULF and the census, occupations have been classified according to the Nordic Occupational Classification (NYK). Both data sources contain errors. There are also differences in definitions and measurement procedures. Still, the survey question on occupational history gives results of good quality in terms of agreement with census data. This is especially the case for coarse levels of the classification scheme (NYK 1-digit level). The agreement is somewhat lower for the comparisons farthest back in time.     

Assessing the quality of clinical teaching: a preliminary study

Medical Education 2010: 44 : 379–386 Objectives Evaluations in the clinical arena are fraught with problems. Current assessments of clinical teaching typically measure attributes of clinical teachers in overly broad terms, are often subjective and often succumb to the halo effect. This is in contradistinction to measurements of lectures, workshops or online educational content, which can more readily be assessed using objective criteria. As a result, clinical evaluations are often insufficient to provide focused feedback, guide faculty development or identify specific areas for clinical teachers to implement change and improvement. The aim of our study was to offset these limitations. Methods We developed a structured, 15‐item objective structured clinical examination (OSCE)‐type checklist of discrete teaching behaviours intended to be: (i) observable; (ii) applicable to multiple disciplines, and (iii) reliably identifiable. Our goal was to test and utilise this checklist as an objective assessment of clinical teaching across a range of in‐patient teaching rounds experiences. During 2007–2008, pairs of external raters on two separate occasions observed nine attending physicians during actual in‐patient paediatrics and internal medicine ward rounds at a large, academic medical centre. Observers documented the extent to which specific teaching behaviours did or did not occur. Results The internal consistency of the 15‐item checklist was good (α = 0.85). A two‐facet, partially nested G study found the generalisability of ratings to be generally acceptable, but inter‐rater reliability varied greatly between occasions and across individual checklist items. Conclusions Despite attempts to identify discrete and observable target behaviours, placing observers on rounds to detect these behaviours may not be as straightforward as it would seem. Clinical teaching may be a more inherently subjective process, based on different teaching styles of faculty staff. However, a set of objective checklist items to be completed by trained observers on teaching rounds holds promise as a potentially viable means of identifying strengths and weaknesses of clinical instruction. Further research is needed to define what constitutes quality clinical teaching, as well as the most reliable method for assessing it.     

Smoking urges and relapse among lung cancer patients: findings from a preliminary retrospective study

BACKGROUND: As part of a prospective study of relapse to smoking among previously resected lung cancer patients, we conducted a retrospective survey to examine factors that may contribute to relapse. METHODS: Patients who had smoked within 3 months before surgery completed measures assessing demographic characteristics, smoking urges, depression, social support, and psychological reactance. RESULTS: Of 43 participants, 19 had relapsed at some point since surgery and 13 were currently smoking. Patients were at relatively low risk of relapse immediately following hospitalization, but at greater risk beginning 2 months later. Younger age and lower educational level predicted current smoking and shorter time to relapse. Craving to smoke was measured as: Appetitive urge (anticipation of pleasure) and Aversive urge (avoidance of negative affect). Both were greater among current smokers. Aversive urge was significantly correlated with depression. Those high on both psychological reactance and Directive social support had heightened Appetitive urges. CONCLUSION: Among lung cancer patients, relapse to smoking may be delayed several months but remains a problem. Appetitive and Aversive motivational pathways and associated urges appear useful in organizing study of the role of psychosocial factors such as depression and social support in relapse to smoking in this group.     

Lung function and clinical findings in a cross-sectional study of arc welders

Summary An epidemiological, cross-sectional study was conducted in order to assess non-neoplasic effects on the lung due to chronic exposure to arc welding fumes and gases. The study involved 346 arc welders and 214 control workers from a factory producing industrial vehicles. These workers (welders and controls) had never been exposed to asbestos. Respiratory impairments were evaluated by using a standardized questionnaire, a clinical examination, chest radiophotography and several lung function tests (spirometry, bronchial challenge test to acetylcholine, CO transfer tests according to the breath-holding and the steady-state methods, N₂ washout test). The only significant differences between the welders overall compared to the controls were a slightly higher bronchial hyper-reactivity to acetylcholine and a lower lung diffusing capacity for CO in the welders. However, non-specific, radiologic abnormalities (reticulation, micronodulation) and obstructive signs were more frequent in the most exposed welders (welding inside tanks) than in welders working in well ventilated workplaces. The nature of the metal welded (mild-steel, stainless steel, aluminium) did not seem to have an influence on respiratory impairments. In the mild-steel welders, respiratory symptoms (dyspnoea, recurrent bronchitis) and obstructive signs were more frequent in the welders using a manual process than in the welders involved with the semi-automatic process (MIG). For all the workers (welders and controls), smoking had a markedly adverse effect on respiratory symptoms and lung function. Moreover, smoking seemed to interact with welding since CO lung transfer was more impaired in smoking welders than in smoking controls.     

Predictors of re-employment and quality of life in NHS staff one year after early retirement because of ill health; a national prospective study

Aims: To measure changes in health related quality of life and employment status of NHS staff one year after early retirement because of ill health, and to identify predictors of re-employment.     

The Dutch Pediatric Surveillance System; a quality focused instrument for prevention and research

The Dutch Paediatric Surveillance System was initiated by the Dutch Paediatric Society and is housed within the TNO Prevention and Health office. The purpose of the surveillance system is (a) to gain insight on a population level into the prevalence of rare and new diseases in youths (0-18 year), and (b) to promote scientific research addressing the background, nature and prognosis, as well as the treatment and prevention, of these diseases. A monthly report card is sent to all clinically active paediatricians with maximally 10 diseases under surveillance. The response rate is approximately 90%. The information from the registration can lead to primary or secondary prevention (prevention of the disease or of its complications, respectively). The system provides information for the amelioration of quality of care and for health management and, at the same time, acts as an instrument for scientific research.