Spondylometaphyseal dysplasia, corner fracture type: a heritable condition associated with coxa vara

The authors present the radiographic features of a previously incompletely delineated bone dysplasia, which they call spondylometaphyseal dysplasia, corner fracture type. This is a dominant heritable condition associated with short stature and developmental coxa vara. The progressive hip deformity usually causes significant disability requiring surgical correction. Developmental coxa vara, simulated corner fractures of long tubular bones, and vertebral body abnormalities result in a diagnostic constellation. Knowledge of these distinctive radiologic features allows accurate diagnosis, which in turn should lead to appropriate genetic counseling and possibly to earlier, more efficacious surgical treatment of the coxa vara.     

Flolan国际随机存活试验(FIRST)

标题　Ｆｌｏｌａｎ国际随机存活试验（ＦＩＲＳＴ）；最后的结果作者　ＣａｌｉｆｆＲＭ，ｅｔａｌ．ＪＡｍＣｏｌｌＣａｒｄｉｏｌ，１９９６，２７：１４１Ａ（英文）　　研究疾病：末期心力衰竭。目的：评估ｅｐｏｐｒｏｓｔｅｎｏｌ（前列环素）对末期心衰患者之病死率和发病率的影响。　　设计：随机对照式。病人资料：４７１例（预定８７５例），平均年龄为（６５±１０）岁，左心室射血分数＜２５％，充血性心衰，ＮＹＨＡⅢ或Ⅳ级，肺毛细血管楔压＞１５ｍｍＨｇ，心功能指数＜２－５Ｌ／ｍｉｎ·ｍ２。随访：１２个月；６个月评估…     

Epidermal Langerhans cells in actinic prurigo: a comparison between lesional and non-lesional skin

Background  Actinic Prurigo (AP) is a chronic pruritic dermatosis of unknown cause affecting sun exposed skin in defined ethnic groups with characteristic MHC alleles. However, the cutaneous dendritic cells have not been assessed.
Objective  To assess in situ the epidermal Langerhans Cell (LC) status in Actinic Prurigo.
Study design  Fresh skin samples from three AP patients were used to evaluate in situ the epidermal LC, comparing lesional and non-lesional sites in each subject.
Setting  AP patients attending the Dermatology Department at the Hospital M. Gea-Gonzalez in Mexico city.
Methods  Lesional and non-lesional skin samples were taken from each subject to prepare both epidermal sheets and conventional tissue sections. Three markers restricted to LC in epidermis (CD1a, ATPase, MHC-II) were used to quantify the LC per area in epidermal sheets.
Results  Compared to non-lesional skin from the same subject, a significant reduction in the number of LC per area of epidermis was found in lesional skin; with any of the three markers evaluated.
Conclusion  The frequency of epidermal LC decreases importantly in lesional skin from AP patients.     

核、膜蛋白的基因能抑制禽类流感病毒及其重组株的繁殖

对人流感病毒A/Udorn/72(H_3N_2)株与禽类流感病毒A/Mallard/NY/78/(H_2N_2)重组后的重组株分析表明,仅含禽类病毒的核蛋白(NP)或膜蛋白(M)的RNA片段的重组株,在松鼠猴的呼吸道繁殖是受限制的。另外。仅有禽类的RNAl和NS基因的重组株(Clone 12)在松鼠猴的气管内的繁殖也明显受限制,而只具有其中一个基因的Clone 9, Clone 2, 则限制就不明显。由此表明,禽类流感病毒的NP和M基因在宿主范围的繁殖限制中起主要作用,而RNAI和SN基因的结合,同样起着繁殖受限制作用。     

The equity debate within the British National Health Service

The equity debate within the British National Health Service This paper begins by identifying the principles of equity and fairness on which the British National Health Service (NHS) was founded in 1948. It then goes on to summarize the viewpoints of those who more recently have argued that equity is an out-moded, Utopian and unachievable concept that should not be applied to the delivery of health care services. A brief review is conducted of the definitions of equity and inequity as these apply to health care. Brief attention is paid to the relationship between equitable distribution of health care and social class. The new contemporary significance of equity for all NHS managers is exposed through a debate concerning the impact of the recently introduced policies for the implementation of a quasi-market in health services in Britain. The inseparable relationship between equity and the rationing of resources is identified as central to the just distribution of health care. The paper presents evidence that the quasi-market solutions to improved economic efficiency and cost-containment are often in direct conflict with the equity doctrine on which the NHS was created. A brief conclusion how equity principles might be restored to health policy is proffered.     

Clinical role activities of nurse teachers in Project 2000 programmes

This paper presents the findings related to the clinical role activities of nurse teachers in Project 2000 programmes Data were collected by a Delphi survey of 25 colleges of nursing that had implemented Project 2000 between September 1989 and April 1991 The findings from the Delphi survey were explored more fully through in-depth interviews with a sample of the respondents The findings identified a very strong commitment of the respondents to a clinical liaison role But they did not perceive their role to be one of teaching students through 'hands on care', they felt this was the role of the qualified staff in the clinical areas The respondents considered it important to maintain their clinical credibility through theoretical updating rather than being able to perform as an expert practitioner     

The use of maternal weight measurements during antenatal care. A national survey of midwifery practice throughout the United Kingdom

The aim of the present study was to examine the use of maternal weight measurements during antenatal care throughout the United Kingdom. A postal questionnaire and follow-up letter were sent to 1500 midwives throughout the United Kingdom, selected at random from the UKCC register. The postal survey achieved a response rate of 44.8% (672/1500 questionnaires), and obtained responses from at least 10 midwives in all but the lowest grade. Respondents were representative of midwives practising throughout the country, in terms of their gender, working hours and grade, although there were fewer midwives in community settings than those in a contemporary representative English sample. The questionnaire obtained information on the background, training and experience of each midwife, together with their attitudes towards antenatal weighing. For those midwives currently involved in antenatal care, additional information was collected on the schedule of antenatal weight measurements, the criteria used to identify ‘abnormal’ weight gain, and the action taken in response to ‘abnormal’ weight gain. 61.8% of the midwives thought that the pattern of maternal weight gain was ‘not important’ in antenatal care, and only 51.5% of those who currently provided antenatal care weighted women at every antenatal visit. However, most midwives (86.1%) cited at least one clinical condition to explain why women are routinely weighed during pregnancy, and over a third of midwives thought that maternal weight gain could detect seven clinical conditions, including obesity, oedema, pre-eclampsia and polyhydramnios. Midwives with more advanced qualifications (degrees and teaching qualifications) and those working in educational or community settings were least likely to believe that weight gain was good at detecting clinical outcomes. Differences in the perceived utility of antenatal weighing influenced whether midwives would act in response to ‘abnormal’ maternal weight gain, and whether they advised women to gain or lose weight during pregnancy. However, the criteria that midwives used for identifying ‘abnormal’ weight gain were variable, and often inappropriate, so that different midwives are unlikely to intervene consistently or to give consistent advice on the basis of maternal weight gain. These differences in practice may lead to extensive and inappropriate variation in antenatal care. Clear guidelines are urgently required to ensure that, if maternal weight measurements are collected during antenatal care, they are collected and used consistently.