牙科医生对口腔卫生服务体系的评价

目的 :分析牙科医生的日常工作量和牙医对口腔卫生服务的态度评价 ,有助于口腔卫生服务体系的制定和评价。方法 :根据武汉市卫生部门登记在册的牙科医生 ,采用整群抽样的方法随机选择 2 5 0名牙科医生进行开放式问卷调查。结果 :所调查的 2 5 0名样本中 ,5 2 %为女性 ,牙科医生平均工作年限为 11.6年 ,平均使用 0 .8台牙椅 ,每位牙医平均每天看 15个病人。主要工作时间用于充填治疗和拔牙。 93 %的牙医认为中国口腔卫生服务强调治疗而忽视预防保健。结论 :口腔卫生服务应重视口腔预防保健     

多层螺旋CT对食管鱼刺异物的诊断价值

目的 探讨MSCT对食管鱼刺异物的检出率及临床诊断价值.方法 实验组:取3种鱼的鱼刺各30根,分为大、中、小鱼刺3组,3组鱼刺长度分别为(23.36±0.15)、(28.51±0.07)和(30.89±0.10)mm,直径分别为(4.4.9±0.31)、(1.78±0.09)和(0.49±0.07)mm.将鱼刺按照与食管长轴平行、垂直、斜行方式插入食管模型中,MSCT检查采用轴面扫描结合三维重组技术,观察MSCT和X线平片(CR和DR)对鱼刺的显示情况.临床组:回顾性分析20例经内镜或临床手术证实的食管鱼刺异物患者的资料,所有患者均行MSCT平扫,其中11例行X线平片(CR和DR)检查,15例行食管吞钡棉絮检查,17例行内镜检查,观察几种检查方法对鱼刺的显示情况.对不同方法对鱼刺显示情况的比较采用配对卡方检验.结果 实验组:MSCT检出鱼刺90根(100%),X线平片(CR和DR)检出鱼刺60根(66.7%),MSCT对鱼刺的检出率高于X线平片(CR和DR)(X2=28.03,P<0.01).临床组:20例中,MSCT检出鱼刺20例,且清楚显示鱼刺的位置、大小及其与食管壁和邻近组织的关系;X线平片检出鱼刺2例,食管吞钡棉絮检出鱼刺9例,内镜检出鱼刺14例.MSCT对食管鱼刺异物检出率高于X线平片(cR和DR)检查(X2=7.11,P<0.05)及食管吞钡棉絮检查(X2=4.17,P<01 05),与内镜检查差异无统计学意义(X2=1.33,P>0.05).结论 MSCT轴面扫描结合三维重组技术对食管鱼刺异物及其周围并发症的检出率高,可作为食管鱼刺异物的首选检查方法.     

A health comparison of Alabama nurses versus US, UK, and Canadian normative populations

This article is one of a two part series examining the people and environment associated with patient handling. The approach used was that of an occupational injury investigation of a job class, which incorporates defining in the task, environment, tools, and worker health status. Hence, the objective of this portion of the research was to develop a method and use it to compare the physical and mental health of Alabama nurses with known normative populations to determine a baseline of overall health. For this purpose, the validated SF-36© survey was used to collect data on Alabama nurses who had been registered in the state for at least one year. The potential participant pool included 1000 nurses randomly selected from more than 49,000 registered. Physical mailers with a pre-paid return envelope and a follow-up reminder post-card were used. A return rate of 10% was expected based on nursing literature. One hundred and one surveys were returned with 87 being complete. Results confirmed that nursing in the US is a female dominated profession with the survey matching both the Alabama and US national average of 92%. Comparisons of the sample data to general populations yielded significant differences in 3 of the 8 outcome measures: social functioning; physical functioning; bodily pain. In each of these measures, Alabama nurses had a reduced health status compared to at least one comparative population. Additionally, data related to body mass index (BMI) for Alabama nurses were stratified by gender and age. Results indicated 28% had a “healthy” BMI with 37% and 35% of the nurses being “overweight” or “obese”, respectively. Consequently, results suggest Alabama nurses have a reduced health status compared to normative populations and show similar but not identical BMI trends to the general populations for the state of Alabama and the US, which warrants concerns about potential declines in health status among caregivers.

Significance to healthcare

Nurses constitute the largest proportion of the healthcare industry’s workforce. Understanding the perceptions of health status of this employee group is essential to gain further information about possible influences of health on nurses’ ability to continue to perform their jobs.     

Fire-eater's lung.

Acute pneumonitis following aspiration of petroleum products is usually related to accidental poisonings in children. We describe here two cases of hydrocarbon pneumonitis in fire-eaters, caused by accidental aspiration of petroleum during the performance of fire-eating. Both patients had cough, dyspnoea, chest pain and fever. Chest X-rays showed basal lung infiltrates and, 2 weeks later, pneumatocele formations. Reversible bronchial hyperresponsiveness and restrictive ventilatory limitation were demonstrated in one of the patients. The bronchoalveolar lavage specimen showed cytoplasmic vacuolation of the macrophages and neutrophilia. After treatment with antibiotics and corticosteroids the symptoms disappeared and the lung function values returned to normal within 2-3 weeks. Radiological resolution of the pneumatoceles occurred within 2-12 months.     

Reverse inoculum effect in bactericidal activity and other variables affecting killing of group B streptococci by penicillin.

Variables of the effect of penicillin G on the numbers of viable group B streptococci in broth cultures were studied. One-fourth of the MIC was the lowest concentration that reduced the viable count compared with antibiotic-free controls. The rate of killing increased with the concentration of penicillin up to 4 X MIC, but no further. During the first 2 or 3 h, the bactericidal activity was more rapid than later on. The MIC and supraoptimal concentrations of penicillin killed an inoculum of 10(6) organisms more rapidly than an inoculum of 10(4) organisms. The MIC was not inoculum dependent. The reverse inoculum effect was revealed by the killing curves but not by the MBC. There were reproducible differences among strains as to the rate of killing by penicillin; these did not correlate with the rate of multiplication, which also varied among strains. Among the 11 strains tested, there were no tolerant ones.     

Mediastinal tumors: evaluation with suprasternal sonography

Twelve patients with mediastinal masses evaluated by computed tomography (CT) and histologically verified were evaluated sonographically by means of the suprasternal approach. Eleven of 12 mediastinal tumors could be visualized sonographically, mainly as hypoechoic and perivascularly situated masses, and could be located topographically with a fair degree of certainty. Suprasternal sonography is particularly useful in the detection of small, perivascular lymphomas of the supraaortic branches. In patients with problematic CT findings, particularly children and patients with allergies to contrast media, suprasternal sonography can provide important additional information. Moreover, suprasternal sonography can be used to determine the consistency and to monitor the treatment of mediastinal tumors. Finally, the suprasternal approach is suitable for sonographically guided biopsies of mediastinal tumors.     

The importance of accurate dosage of topical agents: a method of estimating involved area and application to calcipotriol treatment failures

Little attention is given to accurate dosage of topical medication which is a potential source of side-effects and treatment failure. There are studies on the dosage for 'sparing' application relevant to topical steroids but not for 'liberal' application. Though calcipotriol is a first line topical treatment for psoriasis, approximately one-third of patients do not respond adequately. The aims of the present study were to define liberal dosage, to develop a method of calculation of area of involved skin and to evaluate the efficacy of calcipotriol in optimized liberal dosages, based on preliminary studies, in calcipotriol treatment failures. Weight/unit area of ointment and cream base, constituting liberal application, was determined in six normal volunteers. The area of psoriatic involvement in 24 calcipotriol non-responders was estimated by a 'fill-up' method and a modified 'hand' method. The results of the two methods were similar (Pearson correlation coefficient 0.68, P < 0.0001) but the 'hand' method proved easier in use and was the preferred method for the rest of the study. The patients applied calcipotriol at their accustomed rates for at least 2 weeks and then at the calculated liberal rates, using cream in the morning and ointment at night, for 4 weeks. The efficacy measures were Psoriasis Area and Severity Index (PASI) (primary measure), a four-point efficacy score and a visual analogue scale. As a result of the preliminary study and the actual amounts used by the patients in the psoriasis treatment study reported below, liberal application has been defined as 50 g/m2 per application for ointment base and 40 g/m2 per application for cream. At this dosage, an average individual would use approximately 100 g of medication/week to treat 10% of the body surface. During the 4-week treatment study, the psoriasis patients used an average of 39 g (SD 17 g)/m2 per application of cream and 52 g (SD 13 g)/m2 per application of ointment. All efficacy measures showed marked improvement (P < 0.0001). The frequency distribution of the PASI reduction defined responsive (70% of patients) and poorly responsive groups (30%), with mean PASI reduction of 60% and 17%, respectively.