Observed Use of Standard Precautions in Chilean Community Clinics

ABSTRACT Objectives: In Chile, little information about the use of standard precautions (SP) among health care workers (HCWs) exists. As part of a larger study to tailor and test an HIV prevention intervention for community HCWs, this study describes the observed frequency with which appropriate SP were used by HCWs in low-income community clinics of Santiago. Also, the availability of supplies is described.
Sample: A total of 52 structured observations with potential contamination with body fluids were done.
Results: HCWs used SP inconsistently, especially neglecting hand washing, surface cleaning, and cleaning of shared materials. Lack of materials contributed in some instances of failure to use SPs, especially wiping surfaces and safe disposal of sharp instruments, as shown by a positive correlation between use of SP and availability of materials. Essential materials were usually available. Although more education should relate to a better understanding of the importance of SP, no difference was found between professionals and paraprofessionals in the use of SP.
Conclusions: It is clear that the initial training, continuing education, and ongoing support for practicing SP are not adequate. Training should be offered to HCWs involved in caring for clients at community clinics to stop the spread of HIV or other infectious diseases in health care settings.     

Urinary albumin excretion rate and puberty in non-diabetic children and adolescents

Slightly elevated urinary albumin excretion rate (microalbuminuria) is a marker of early diabetic nephropathy, but it is unclear if the established definition of microalbuminuria (20–200 μg/min) is correct for children and adolescents. We investigated the albumin excretion rate, albumin/creatinine ratio and urinary albumin concentration in 150 healthy schoolchildren and adolescents to (a) obtain a reference value for albumin excretion rate, (b) relate albumin excretion to pubertal stages and (c) evaluate albumin/creatinine ratio and morning albumin concentration as screening methods for elevatcd albumin excretion rate. Albumin concentration was measured by immunoturbidimetry in timed overnight urine samples. The albumin excretion showed a skewed distribution (geometric mean 3.2 μg/min, 95 percentile 15.1 μg/min). In girls, a peak in the albumin excretion rate was found at the pubertal stage 4 (Tanner) and in boys at stage 5. Albumin/creatinine ratio of 2.5 mg/mmol as a scrccning level for elevatcd albumin cxcrction (15 μg/min) showed a high positivc (0.88) and negative (0.99) predictive value.     

The long-term effectiveness of an HIV prevention intervention for low-income African American women.

The effectiveness of an HIV prevention intervention for low-income African American women between the ages of 20 and 44 years was assessed. The hypothesis was that at 3, 6, and 9 months, treatment intervention women would have significantly greater increase from baseline on self-efficacy, condom use knowledge, protective sexual behavior, prevention community behavior, and perceived HIV vulnerability compared with the control intervention women. Using an interrupted time series design, one of two geographically distinct but demographically similar communities was randomly assigned to the treatment intervention. A total of 280 women participated. Hierarchical linear modeling revealed no differences at pretest for the treatment and control women. Compared with control women, treatment women significantly increased self-efficacy, protective sexual behavior, condom knowledge, and prevention community behavior. A slight decline in protective sexual behavior at 9 months may indicate that a linear pattern of change may not be appropriate to describe sexual behavioral change.     

Second‐look endoscopy with thermal coagulation or injections for peptic ulcer bleeding: A meta‐analysis

Background and Aims: In the management of peptic ulcer bleeding, the benefits of second‐look endoscopic treatment with thermal coagulation or injections in controlling recurrent bleeding is unsure. This study set out to compare efficacy of routine second‐look endoscopy with treatment using either thermal coagulation or injections versus single endoscopy by pooling data from published work. Methods: Full publications in the English‐language published work as well as abstracts in major international conferences were searched over the past 10 years, and six trials fulfilling the search criteria were found. Outcome measurements included: (i) recurrent bleeding; (ii) requirement of surgical intervention; and (iii) mortality. We examined heterogeneity of trials and pooled the effects by meta‐analysis. The quality of studies was graded according to the prospective randomization, methods of patient allocation, the list of exclusion criteria, outcome definitions and the predefined salvage procedures for uncontrolled bleeding. Results: Among 998 patients recruited in these five randomized trials, 119 received routine second‐look endoscopy with thermal coagulation, and 374 received second‐look with endoscopic injection and 505 had single endoscopic therapy. Less recurrent bleeding was reported after thermal coagulation (4.2%) than single endoscopy (15.7%) (relative risk [RR] = 0.29; 95% confidence interval [CI] = 0.11–0.73), but no reduction was reported for the requirement of surgical intervention and all‐cause mortality. Injection therapy did not reduce re‐bleeding (17.6%) when compared to single endoscopy (20.8%; RR = 0.85; 95% CI = 0.63–1.14), requirement for surgery and mortality. Conclusion: Routine second‐look endoscopy with thermal coagulation, but not injection therapy, reduced recurrent peptic ulcer bleeding. There is no proven benefit in reducing surgical intervention and overall mortality.     

活体肝部分移植术后中、长期管理

0　引言　 1989- 0 7全球首例活体肝部分移植术成功以来 ,这一手术先后在 30余个国家和地区开展 ,至 1996 - 0 8全球累计总例数已愈 70 0例 ,我院于 1997- 0 6 - 30在日本京都大学Tanaka Koichi教授的指导下 ,成功地开展了 1例活体肝部分移植术 ,至今患者已健康生存 1.5 a,现就其术后中长期管理结合文献总结如下 :1　临床资料1.1　病例　患者为 10岁女性 ,诊断为先天性弥漫性肝内胆管囊性扩张症、复发性胆管炎、肝硬变症 ,1997- 0 6 - 30在全麻下行活体肝部分移植术 ,供体为患儿 40多岁的父亲 ,手术顺利 ,术后早期临床资料已作过报告 [1 ] …     

Interpeduncular fossa sign: CT criterion of subarachnoid hemorrhage

A retrospective study of 100 cerebral computed tomography scans interpreted as displaying subarachnoid hemorrhage was undertaken to determine the frequency of blood in the interpeduncular fossa as a useful radiographic sign. The results indicate that the interpeduncular fossa sign is second only to blood in the Sylvian fissure-circular sulcus area as a reliable indicator of subarachnoid hemorrhage on CT scans.