Increase in rapid defibrillation programmes after publication of guidelines.

OBJECTIVE: . To monitor the implementation of in-hospital resuscitation strategies including (i) rapid defibrillation programmes, (ii) the use of amiodarone for prolonged ventricular fibrillation, and (iii) uniform data collection on resuscitation, all recommended by international guidelines published in 2000 and by Finnish national resuscitation guidelines published in 2002. DESIGN: In 2004, a questionnaire was sent to the chief anaesthesiologists. The results were compared with those of a previous study performed using similar methods in 2000. SETTING: All public hospitals that provide anaesthetic services in Finland. MAIN OUTCOME MEASURES: Number of hospitals allowing nurses to perform defibrillation without the presence of physician and number of hospitals using amiodarone as primary antiarrhythmic drug in resuscitation and performing uniform data collection. RESULTS: The response rate was 95% (52/55). The proportion of the hospitals with rapid defibrillation programmes on general wards had increased from 15% in 2000 to 67% in 2004, and most (79%) hospitals had obtained automated external defibrillators. Amiodarone was used in 88% of the hospitals. Data collection of resuscitation attempts using definitions provided in the Utstein guidelines was performed only in 22% of the hospitals. CONCLUSIONS: Rapid defibrillation programmes have markedly increased, and the use of amiodarone has been established in Finnish hospitals since the publication of the international and the national resuscitation guidelines.     

Changes in biological test practices after publication of national guidelines for lipid management among patients under statin treatment

BACKGROUND: Guidelines for screening and treatment of dyslipidemia were disseminated in September and October 2000 by the National Agency of Accreditation and of Evaluation in Health (ANAES) and the French Agency of Medical Safety of the Products of Health (AFSSAPS). It was confirmed that the specific biological test was the measurement of LDL Cholestérol. OBJECTIVE: To study changes in biological test practices after diffusion of guidelines among patients on statin therapy, using Health Insurance database on reimbursement of patients living in Ile-de-France region (8,534,623 social insurance contributors). METHODS: Two groups of patients were defined in the database from the codes for medication refunds during one month (March 2000 and March 2002). The first group named "new users" included patients starting statin therapy in March, in order to follow the biological test for screening. The second group named "long term users" included patients who had been treated by statin therapy for one year or more, in order to examine the biological follow-up of treatment. All lipid biological tests were recorded during one year, before March 2000 and March 2002. Changes in medical practices were noted as the percentage of the biological tests for "exploration of a lipidic anomaly" (EAL) with determination of LDL cholesterol. RESULTS: For new users the percentage of patients having had at least one EAL for screening purposes increased by 13.5 (39.9% in 2000 and 53.4% en 2002). For long term users the change was + 21.1 (38.3% in 2000 and 59.4% in 2002) during follow-up. CONCLUSION: An improvement in biological testing practices was noted after diffusion of guidelines.     

Screening for early detection: incidence and findings in rural settlements over eight years

From 1965 to 1972 an annual detection screening program was carried out, as part of the Donolo Hospital Early Detection Clinic, on the over-35-year-old members of a stable agricultural population (kibbutz). The screened individuals were of equal socioeconomic status with excellent medical services. During this period 6859 examinations were carried out. The program covered all the physically accessible sites (no laboratory assistance), and the examinations took place in the medical centers of the settlements. All adults were examined at least once with the overall coverage being 58.7%. There were 103 cancer cases found over the eight year period, both by screening and the ordinary medical care service. This gave an approximate incidence 2.2 malignancies/1000 of all ages and 6.1/1000 adults aged 35 and over. The common cancers were of the skin, breast, and prostate while 70% of all cancers over the eight year period were in sites accessible to a simple clinical screening examination. It is stressed that a screening program should be an integral part of the medical care services round the primary or family physician.     

Preconceptional folic acid utilization in Israel: five years after the guidelines

OBJECTIVE: In Israel, a national survey was conducted in order to assess the efficacy of the ongoing national folic acid (FA) campaign launched in 2000. The Ministry of Health had issued official guidelines in August 2000 recommending daily FA supplementation for all childbearing age women. METHODS: In 2005, structured interviews of pregnant and postpartum women were conducted by the nursing staff of the Maternal Child Health Clinics administered by the Public Health Service. The results of the 2005 survey are compared with similar surveys done in 2002 and 2000 (baseline). RESULTS: In the 2005 survey (n=1860), FA awareness, knowledge, timing knowledge and preconceptional utilization were 90.3%, 80.8%, 74.6% and 34.0%, respectively. Education was significantly associated with compliance: only 13.6% of women with <12 years of education utilized FA preconceptionally versus 48.1% of women with >or=16 years. In the 2002 survey (n=1661), FA awareness, knowledge, and preconceptional utilization were 85%, 77.7% and 30.5%, respectively. In the 2000 survey (n=1719), FA awareness was 54.6%, knowledge was 17.6% and preconceptional utilization was 5.2%. CONCLUSIONS: The national preconceptional FA campaign in Israel has resulted in significant increases in awareness, knowledge and preconceptional utilization.     

自发性气胸的诊断与治疗

气胸系指各种原因引起气体在壁层胸膜与脏层胸膜之间积聚，造成肺萎陷，从而产生一系列临床表现，是肺科的常见病。它的发病率近年呈上升趋势，需要及时诊断和处理，否则将引起肺功能损害，甚至危及生命。     

自发性气胸的诊断与治疗

气胸系指各种原因引起气体在壁层胸膜与脏层胸膜之间积聚,造成肺萎陷,从而产生一系列临床表现,是肺科的常见病.它的发病率近年呈上升趋势,需要及时诊断和处理,否则将引起肺功能损害,甚至危及生命.     

Parents' view of parent-child relationship eight years after neonatal intensive care.

Eight years after neonatal intensive care, parents of 597 survivors indicated whether the initial illness and separation had had a long-term effect on their parent-child relationships. Forty percent felt there was an effect on the parent-child relationship, sixty percent did not. Neonatal, medical and social conditions, and the child's outcome (i.e., disabled or not) were variables analyzed to determine differences between the two groups of parents. Parents who felt an effect from the initial illness and separation had children who required supplemental oxygen significantly longer and were from significantly higher socioeconomic and education levels. Length of stay in neonatal intensive care and outcome were among the not significant variables.     

反复发作的自发性气胸的诊治

自发性气胸指无创伤性原因也并非出于诊断治疗目的,因肺大疱或胸膜下微小疱破裂,空气进入胸膜腔所致,是呼吸系统常见急症。自发性气胸分为特发性及继发性两类:特发性气胸指经常规胸部X线检查未发现病变者发生的气胸,多见于瘦高体型的男性青壮年;继发性气胸是在其他肺部疾病基础上形成的大疱破裂或直接损伤胸膜所致。继发性和特发性气胸的复发率相似,不同文献报道从39%～4 7% [1,2 ] 。大多数的复发发生在初次气胸后的第一个月。有研究对14 2名自发性气胸患者进行Cox回归分析显示肺纤维化,年龄大于6 0岁,和较高的身高/体质量比是复发的独立…     

胸腔镜治疗自发性气胸的疗效与术后肺部感染的相关性分析

目的分析胸腔镜手术治疗自发性气胸的疗效与术后发生肺部感染的相关性,探究其临床适用性。方法选择2012年6月-2014年3月接受治疗的140例自发性气胸患者作为研究对象,随机分为研究组和对照组各70例,对照组患者采用常规开胸手术进行治疗,研究组患者采用胸腔镜手术进行治疗,观察两组患者手术的临床疗效及并发症发生率。结果研究组患者的住院时间、手术时间、术中出血量、恢复时间、切口大小均显著优于对照组,两组比较,差异有统计学意义(P<0.05);研究组患者的疼痛程度、二次手术、气胸复发例数均显著优于对照组,两组比较,差异有统计学意义(P<0.05);研究组患者肺部感染等总并发症发生率显著低于对照组,治疗总有效率94.3%,显著高于对照组78.6%,两组比较差异均有统计学意义(P<0.05)。结论胸腔镜手术治疗自发性气胸的临床疗效显著,预后效果良好,复发率低,并发症少,适合临床长期推广应用。     

Antibody titres in women six to eight years after the administration of RA2713 and Cendehill rubella vaccines.

Titres of haemagglutination-inhibiting antibody have been measured repeatedly in young women during a period of 6-8 years after the administration of RA27/3 and Cendehill attenuated rubella vaccines. Mean antibody titres were initially 217 after RA27/3 and 159 after Cendehill, but the difference diminished after the first year. Antibody titres were subsequently well maintained in both groups and did not reveal any need for regular revaccination. Mean titres in the Cendehill group were partly maintained by symptomless reinfection which was commoner after Cendehill than after RA27/3. Significant falls in titre were equally common after both vaccines, but low titres of 30 or less were more frequent in subjects who had received Cendehill. Mean neutralizing antibody titres were initially 15.4 after RA27/3 vaccine and 9 after Cendehill. Titres remained higher after RA27/3 for 3 years, but the difference then diminished and became insignificant during the fifth year. Revaccination of women with low antibody titres produced significant increases in 69% of subjects when standard RA27/3 vaccine was used; a special preparation of RA27/3 of higher potency produced a similar number of rises (70%) but elicited higher titres and might occasionally be useful for revaccinating women who are likely to come into contact with rubella. Challenge with RA27/3 vaccine produced weaker responses in women who had experienced natural infection than in those whose antibody was vaccine-induced. Rises in antibody titre after revaccination consisted mainly of IgG, but traces of IgM antibody were detected in one vaccinee who had recently experienced natural reinfection and in 1 woman with naturally acquired antibody who had been challenged with high titre RA27/3 vaccine.