Incidence of Perthes' disease in Uppsala, Sweden.

The annual incidence of Perthes' disease in Uppsala County, Sweden, was computed for the years 1978-1989 and further analyzed as regards age and sex distribution. The annual incidence was 8.5 per 100,000 in children 0-14 years of age.     

Rising incidence of hip fracture in Uppsala, 1965-1980

The frequency and incidence of hip fracture in persons aged 55 years and older in the county of Uppsala during the years 1965,1970,1975 and 1980 are reported. For every 5-year interval, the number of hip fractures increased by 21-25 per cent. The ratio of women to men changed from 3.8 in 1965 to 3.1 in 1980. Trochanteric fractures were more common during the later years. The ratio of femoral neck fractures to trochanteric fractures decreased from 1.8 to 1.1 between 1965 and 1980. The incidence of hip fracture in the investigated part of the population increased from 43 per 10 000 in 1965 to 65 in 1980. The age-specific incidence increased especially in the group aged 85 years and older, in which fractures of the femoral neck were three times and trochanteric fractures four times more common in 1980 than in 1965. This investigation shows that the incidence of hip fracture has increased, particularly in the higher age groups. If the age-specific incidences continue to rise in the higher age groups, the frequency of hip fractures will be doubled within a 20-year period.     

Rising incidence of hip fracture in Uppsala, 1965-1980

The frequency and incidence of hip fracture in persons aged 55 years and older in the county of Uppsala during the years 1965, 1970, 1975 and 1980 are reported. For every 5-year interval, the number of hip fractures increased by 21-25 per cent. The ratio of women to men changed from 3.8 in 1965 to 3.1 in 1980. Trochanteric fractures were more common during the later years. The ratio of femoral neck fractures to trochanteric fractures decreased from 1.8 to 1.1 between 1965 and 1980. The incidence of hip fracture in the investigated part of the population increased from 43 per 10 000 in 1965 to 65 in 1980. The age-specific incidence increased especially in the group aged 85 years and older, in which fractures of the femoral neck were three times and trochanteric fractures four times more common in 1980 than in 1965. This investigation shows that the incidence of hip fracture has increased, particularly in the higher age groups. If the age-specific incidences continue to rise in the higher age groups, the frequency of hip fractures will be doubled within a 20-year period.     

Neonatal Hip Instability: Incidence, Diagnosis and Treatment at the University Hospital, Uppsala, 1960-1964 and 1970-1974

Neonatal hip instability, its incidence, diagnosis and treatment, has been studied retrospectively for the periods 1960-1964 and 1970-1974. The respective populations for the two periods amounted to 13,065 and 16,274 children all born at the same hospital. During the first period 191 children (14 per mille) were referred from the maternity nard to the orthopaedic department with suspected hip instability; 109 (8.3 per mille) children were considered by the orthopaedic consultant to have unstable hips. During the second period the corresponding figure were 503 (31 per mille) referred to the orthopaedic department and 189 verified as unstable (11.6 per mille). During the first period, 177 children were treated with Frejka pillows for about 3 months, only 14 being left untreated. In seven children the initial treatment was completed with a plaster cast. The results were uniformly good. During the second period, 195 children were treated with a von Rosen-splint for G weeks followed by Frejka pillows for another 6 weeks (seven completed treatment with plaster); in 143 cases Frejka pillows were the sole treatment and 161 had no treatment at all. There was one primary plaster. The treatment resulted in normal hips in all but one girl. In the non-treated group three subluxations were verified after the neonatal period. There were seven “missed” cases (diagnosed after the first month of life) in the first population (0.5 per mille), 15 in the second (0.9 per mille). This difference is not statistically significant. The calculated incidence of dislocations if no treatment had been instituted in the neonatal period is 1.5 per mille in the first population, and 2.5 per milk in the second. The difference is not statistically significant.     

Fixation of femoral neck fractures. Comparison of the Uppsala and von Bahr screws

In a prospective randomized study, a newly developed so-called Uppsala technique for internal fixation of femoral neck fractures was compared with the von Bahr technique. The series consisted of 222 consecutive patients, 167 women and 55 men, with a mean age of 80 years. Half of the patients were randomized to each treatment group. During the first postoperative year, 18 failures occurred in the Uppsala group, compared with 39 in the von Bahr group (P less than 0.01). Of 128 patients without pain at 4 months, 9 developed failures, compared with 29 of the 37 that had pain at this time (P less than 0.001). We conclude that the new technique gives better results during the first postoperative year and that most failures occur among those with pain at 4 months. Follow-up radiography is indicated only in patients with pain at 4 months.     

Incidence of hip fractures in the elderly: Uppsala County 1980-1987

The age-, sex-, and fracture-type-specific annual incidence of hip fracture in patients over 55 years of age in Uppsala County were computed for the years 1980 to 1987. The number of fractures increased by less than 2 percent annually. The increase was mainly due to age changes in the population. The overall increase in specific incidence rates was approximately 1 percent; and most age, sex, and fracture-type groups demonstrated an unaltered incidence. Cervical fractures in women 55 to 64 and 75 to 84 years of age decreased in specific incidence.     

我院护理病区独立运行模式的效果与反思

目的探讨新型护理病区运行模式的效果,并进行反思。方法护理病区运行模式是将护理单元与医生组分开,工作自主安排、经济独立核算、行政管理按三级学科运行的管理模式;其具体实施措施包括合理配置人力资源,充分利用现有设备资源,经济独立核算,责、权、利三位一体,建立和谐的新型伙伴式医护关系,加强业务学习,提高专业素质等。结果施行护理病区独立运行模式后,床位使用率提高,医疗成本降低,护理人员积极性显著提高。结论护理病区独立运行模式是一种能获得较大社会效益和经济效益的管理模式,但要具体情况具体分析,充分认识其中存在的问题。     

Incidence of hip fractures in the elderly. Uppsala County 1980-1987

The age-, sex-, and fracture-type-specific annual incidence of hip fracture in patients over 55 years of age in Uppsala County were computed for the years 1980 to 1987. The number of fractures increased by less than 2 percent annually. The increase was mainly due to age changes in the population. The overall increase in specific incidence rates was approximately 1 percent; and most age, sex, and fracture-type groups demonstrated an unaltered incidence. Cervical fractures in women 55 to 64 and 75 to 84 years of age decreased in specific incidence.     

The enlightenment kidney-nephrology in and about the eighteenth century

The intellectual movement of inquiry by direct observation and inductive reasoning to acquire new knowledge matured in the Enlightenment. In medicine, personal observation as the prime mover of investigation began in anatomy, and gradually extended into studies of function, site of disease, and composition of body fluids. This led to the generation of new information on renal structure, function, and urine composition in health and to some extent in disease. Studies on the dissected, injected, and teased kidneys have left us with many of the eponymous renal structures described by Eustachio, Bellini, Malpighi, and Ferrein. Subsequent studies by Haller of the renal circulation and scrutiny of the separation of serous fluid from blood in the renal cortical glandular components established the beginnings of renal physiology. The movement to integrate chemistry into medicine championed by Boerhaave, which launched studies of urine composition in diabetes, urolithiasis, and gout led to the exploration of a chemical basis of other diseases. Albuminous precipitate in the urine of a dropsical case was described by Cotugno, but its association with kidney disease went unappreciated. Most of the new information on the kidney was communicated to and discussed in the increasing number of new scientific societies that were being formed, and transmitted to the eager members of the learned bourgeoisie of the period in the Encyclopédie of Diderot and d'Alembert.     

The aetiology and epidemiology of clavicular fractures. A prospective study during a two-year period in Uppsala, Sweden

In a prospective study, the age- and gender-specific incidence and features of clavicular fractures were studied during 1989 and 1990. The population at risk consisted of about 200,000 individuals aged 15 or above in the county of Uppsala, Sweden. There were 187 clavicular fractures in 185 patients corresponding to an annual incidence of 50/100,000 (males 71/100,000, women 30/100,000). Males were significantly younger and sustained comminuted fractures more often than women. The fracture incidence decreased with age in both genders, although the reduction was significant only in men. Bicycle accidents most frequently caused clavicular fractures in both genders, whereas sports activities were significantly more common in men. Right and left clavicles were almost as frequently fractured, and a direct fall on the shoulder was the most frequent mechanism of injury for both genders. There was no difference between genders in the anatomical location with about three of four fractures occurring through the middle part and one of four through the acromial part of the clavicle. Ninety-five percent healed uneventfully, while non-union developed in 5% - evenly distributed between the middle part of the clavicle and the acromial part.     

新加坡中央医院人性化护理举措及启示

介绍新加坡中央医院人性化护理举措,包括花园式的就医环境、清晰明了的指引标识、无缝隙衔接的入院流程、人性化的护理用具、精准的护理管理流程、全面铺开的信息管理、自动化的检验标本传输、人性化的护士在职教育,提出应借鉴其人性化护理服务理念,从细节出发,改善患者就医环境;立足现有条件,加大硬件设施配置;改革现有护理教育模式。     

现代外科理念更新给予我们的启示

近20年来,现代外科学取得了明显的进步。特别是损伤控制外科、体外生命支持系统、微创外科、加速康复外科等新理念的提出,使得外科学发生了巨大的革新和进展。在一些新的领域中有许多经验值得我们总结,同时也有很多地方需要继续发展与研究。不管是损伤控制外科中的分阶段处理,体外生命支持系统中的器官联合支持,还是微创外科的机器人手术都体现着“损伤最小化”这一核心理念。这不但是外科学的发展方向,也是医学的发展方向。