The active components of effective training in obstetric emergencies

Confidential enquiries into poor perinatal outcomes have identified deficiencies in team working as a common factor and have recommended team training in the management of obstetric emergencies. Isolated aviation-based team training programmes have not been associated with improved perinatal outcomes when applied to labour ward settings, whereas obstetric-specific training interventions with integrated teamwork have been associated with clinical improvements. This commentary reviews obstetric emergency training programmes from hospitals that have demonstrated improved outcomes to determine the active components of effective training. The common features identified were: institution-level incentives to train; multi-professional training of all staff in their units; teamwork training integrated with clinical teaching and use of high fidelity simulation models. Local training also appeared to facilitate self-directed infrastructural change.     

Western Australian cigarette smokers have fewer small lung nodules than North Americans on CT screening for lung cancer

To determine the prevalence of small lung nodules on low‐dose helical computed tomography (CT) in a Western Australian cohort of asymptomatic long‐term cigarette smokers and to compare this with a large, similarly derived cohort of North Americans from the Mayo Clinic Lung Cancer Screening Trial. Forty‐nine asymptomatic long‐term cigarette smokers of minimum age 50 years underwent a low‐dose 64‐slice helical CT of the lungs. Images were viewed on a soft copy reporting station with thin section axial and coronal images, maximum intensity projection images, and advanced image manipulation tools. The prevalence of all nodules was 39%, significantly lower than the Mayo Clinic cohort prevalence of 51% (P < 0.01, Fisher's exact test), despite the use of more advanced imaging technology and image manipulation designed to increase the sensitivity for nodules. The prevalence of small nodules in asymptomatic long‐term cigarette smokers in Western Australia is high, though significantly less than that found in a large study in North America. The authors postulate this is due to the relatively low rates of mycobacterium tuberculosis and soil‐derived fungal pulmonary infections in Western Australia, as well as a lower degree of urban air pollution.     

Betriebliche Gesundheitsförderung

Back pain is the most frequent reason for absence from work in all industrialized contries, about 70% of their populations experiencing back pain at least once in their lives. Very often, there is no satisfactory explanation for patients' pain; there is therefore no cause-directed therapy, and in some cases not even a symptomatic treatment is possible. BASF Ludwigshafen has a long tradition of preventive programs for nipping back pain in the bud. Seminars directed at behavioral changes and physical training programs are offered to the employees; projects designed to improve ergonomic conditions at the workplace or to reduce psychological strain factors are conducted at the company's various sites. Since 1996, many activities have been organized by the company's own Health Promotion Center. The BASF back pain project in 1993–1995 showed that both absence rates and symptoms of the employees can be significantly reduced by a complex intervention program. In this paper we present our experiences with these in-house programs directed to reducing back pain at the workplace.     

雷公藤三萜酸C的分离与结构鉴定

雷公藤总甙系雷公藤(Tripterygium wilfordii Hook.f)去皮根心经提取后得到的有效组分,它具有很强的抗炎免疫抑制作用。作者从雷公藤总甙中分离出5个三萜类化合物T_1,T_2,T_3,T_6,T_(28)。本文报道T_(28)化合物的分子结构,其他待另文发表。T_(28)是一个新的乌     

Collagenous Colitis

A middle-aged female with chronic, watery diarrhea was diagnosed after extensive evaluation as having collagenous colitis. The clinical, histological, and pathological findings of our case and those previously reported are reviewed. The diagnostic importance of total colonoscopy with biopsy in a normal-appearing colon in a patient with chronic, undiagnosed, watery diarrhea is discussed.