Quality assurance and the myth of rationality

Examines the extent to which quality assurance can be conceived as a rational endeavour, particularly in ethical terms. Examines the Weberian distinction between rationality as values as an "end in themselves" and values conceived in terms of a "means-ends" distinction. While the emergence and existence of quality assurance can be viewed from either of these two perspectives, both entail a number of problems. Suggests that quality assurance, while appearing rational, fails at a crucial point for two reasons. First, while rationality is a relational concept, quality within the health service does not appear to function in such a manner; and second that quality assurance often neglects to evaluate its own activities. Claims that in both instances quality assurance acts more in terms of its functional role than in terms of its rationality.     

Regulation of type I collagen and interstitial collagenase mRNA expression in human dermal fibroblasts by colchicine and D-penicillamine

Sclerosis is a disease process in which idiopathic hardening occurs in the skin and/or internal organs as a result of the accumulation of type I collagen, induced mainly by transforming growth factor-beta. Colchicine and D-penicillamine are widely used for its treatment. Their effects are known to be due to post-translational down-regulation of type I collagen synthesis, with colchicine also up-regulating interstitial collagenase. To determine whether or not they have any pre-translational effect on type I collagen and MMP-1, and also to observe their effects on the action of TGF-beta, cultured neonatal foreskin fibroblasts were treated with colchicine and D-penicillamine, singly and together. The amount of type I collagen and MMP-1 mRNA were quantitated by Northern blot hybridization. Colchicine suppresses the basal level of type I collagen mRNA but minimally stimulates the mRNA expression of MMP-1, whereas D-penicillamine does not have any significant effects on either. Colchicine was also able to significantly suppress the TGF-beta-induced up-regulation of type I collagen mRNA expression.     

Effects of the solvents on bond strength of resin bonded porcelain

Clinical trials of porcelain veneers for chairside colour modifications may require the use of a trial resin with various colours of tints. The bond strength effects of four different solvents used for removal of trial resin from etched porcelain specimens were investigated. Fifty-six porcelain specimens were fabricated, flattened by a metallurgically standard method, etched with hydrofluoric acid and silane treated. The specimens were divided into four groups at random. The trial resin material was cleaned with different solvents prior to bonding of a dual cure resin composite button. After bonding the specimens were stored in water at 37 degrees C for 7 days. Shear bond strength results were as follows: acetone (control) group, 12.9+/-2.9 MPa; ethanol group, 15.1+/-4.6 MPa; methanol group, 11.5+/-2.9 MPa; methylene chloride group, 11.3+/-2.4 MPa. No significant differences were measured (ANOVA, P>0.05). The results indicated that the resin-porcelain bond strengths were not affected by the type of solvent used to remove trial resin. This procedure is recommended for clinical cases when resin composite is used for the try-in of etched porcelain bonded restorations.     

Short-term effects of a new intravascular nitinol stent in canine arteries

RATIONALE AND OBJECTIVES: To evaluate the short-term effects of a new nitinol stent on canine arteries. METHODS: Eighteen nitinol mesh stents were placed in abdominal aortas, common iliac arteries, and renal arteries of six dogs. Angiography was performed to evaluate the patency rates and structural changes of arteries at 1 day, 3 weeks, 4 weeks, and 10 weeks after stent insertion. Gross and light microscopic examinations were performed after angiography. RESULTS: On angiography, the patency rate was 100%, and no thrombosis was observed. All side branches from stented segments were patent. The mean neointimal thickness over and between stent wires was 94 and 167 microns. No difference was found between the aorta and the small vessels. Histologically, the neointima was covered with endothelium and was composed of subintimal fibrosis with mild inflammation. CONCLUSIONS: The new type of nitinol mesh stent showed a high patency rate, with no thrombosis and relatively thin neointimal proliferation.     

A meta-analysis of randomized controlled trials of laparoscopic versus conventional appendectomy

BACKGROUND: Despite many randomized controlled trials, the merits of laparoscopic appendectomy remain unclear. A meta-analysis may provide insights not evident from any individual studies. DATA SOURCES: Systematic literature search yielded 17 trials (1,962 subjects) of true randomized design with usable statistical data comparing laparoscopic and conventional appendectomy in adults. The effect sizes for operating time, hospitalization, postoperative pain, return to normal activity, wound infection, and intra-abdominal abscess were calculated, using the random effects model to allow for heterogeneity. An estimate of the robustness of all positive findings was also calculated. RESULTS: Modest but statistically significant effect sizes were found for four of the six outcome measures. Laparoscopic appendectomy takes 31% longer to perform, but results in less postoperative pain, faster recovery (by 35%), and lower wound infection rates (by 60%). CONCLUSION: Laparoscopic appendectomy offers significant improvement in postoperative outcomes at the cost of a longer operation.     

Children with congenital pulmonary lymphangiectasia: after infancy

OBJECTIVE: The objective of this original report is to describe the characteristic chest imaging findings in children with primary congenital pulmonary lymphangiectasia who survive infancy. CONCLUSION: In children with primary congenital pulmonary lymphangiectasia, increased interstitial markings decrease over time and increased hyperinflation is associated with persistent patchy areas of ground-glass opacity.