Is water out of vogue? A survey of the drinking habits of 2-7 year olds

OBJECTIVE--To survey the drinking habits of young children with reference to the consumption of plain water, and to estimate the proportion of a child's recommended energy intake contributed by drinks. DESIGN--A prospective survey. SETTING--Health centres, mother and toddler groups, and infant schools in and around Southampton. SUBJECTS--39 preschool and 66 infant schoolchildren. INTERVENTIONS--Parents kept a diary of all drinks consumed by the child over 48 hours. Parents were interviewed with a questionnaire about the drinking habits of their child. MAIN OUTCOME MEASURES--The type of drinks and volume of fluid consumed over 48 hours; the proportion of a child's recommended energy intake consumed through drinks. RESULTS--72.5% of the preschool group and 50% of the infant school group never drank plain water. Squash was by far the most frequently consumed drink. 15% of the preschool group consumed just under 50% of their recommended daily energy intake in drinks. CONCLUSIONS--Young children consume large quantities of squash which constitutes a substantial energy supply. It is possible that they are conditioned at an early age to the sweet taste of drinks that may be no nutritional benefit to them.     

Management of Soft Tissue Defects of the Ankle and Foot

Background

Treatment of soft tissue defect of ankle and foot has always been a challenging problem.

Methods

Thirty patients with soft tissue defects of the ankle and foot who underwent various reconstructive procedures in two tertiary care teaching hospitals were studied.

Results

Most of the defects (33%) were located in and around the ankle. Trauma was the major cause (56.6%). Defects were reconstructed with a variety of local, regional, distant and microvascular free flaps. Distally based superficial sural artery flap was used in majority of the cases (40%). Free tissue transfer using radial artery forearm flap was done in three (10%) complex wounds where other flaps were not found to be suitable. Superficial soft tissue defects on the dorsum of foot were resurfaced with split thickness skin grafts in 3 (10%) cases. Out of 27 flaps used, 26 survived completely. One inferiorly based fasciocutaneous flap developed partial necrosis. There was graft loss in one patient which required regrafting with the stored autograft.

Conclusion

Distally based superficial sural artery flap remains the choice for reconstruction of soft tissue defects of ankle and foot because of its reliable blood supply and easy elevation.Key Words: Soft tissue defects, Ankle and foot reconstruction     

股骨粗隆间骨折手术治疗51例

1 临床资料 2000/2003年应用手术治疗股骨粗隆间骨折51(男32,女19)例,年龄61～85(平均73.6)岁.根据AO Muller分类法[2],分为A1型5例,A2型40例,A3型6例,应用DHS内固定治疗40(A1型5,A2型33,A3型2)例,应用Gamma钉治疗11(A2型7,A3型4)例.患者均于入院后即刻行血常规化验及心电图、肺部X片检查等,即刻手术治疗39例,入院后3～5 d手术治疗12例.根据患者情况选择全麻或连续硬膜外麻醉.均仰卧位、牵引床固定,C型臂X光机引导下闭合复位,复位满意后再行皮肤切口.DHS内固定均采用135°3～4孔动力髋螺钉,2例手术近端加用1枚松质骨螺钉;Gamma钉内固定治疗均采用扩髓型,远端应用1枚锁钉.     

Effectiveness of travel restrictions in the rapid containment of human influenza: a systematic review

Objective

To assess the effectiveness of internal and international travel restrictions in the rapid containment of influenza.

Methods

We conducted a systematic review according to the requirements of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Health-care databases and grey literature were searched and screened for records published before May 2014. Data extraction and assessments of risk of bias were undertaken by two researchers independently. Results were synthesized in a narrative form.

Findings

The overall risk of bias in the 23 included studies was low to moderate. Internal travel restrictions and international border restrictions delayed the spread of influenza epidemics by one week and two months, respectively. International travel restrictions delayed the spread and peak of epidemics by periods varying between a few days and four months. Travel restrictions reduced the incidence of new cases by less than 3%. Impact was reduced when restrictions were implemented more than six weeks after the notification of epidemics or when the level of transmissibility was high. Travel restrictions would have minimal impact in urban centres with dense populations and travel networks. We found no evidence that travel restrictions would contain influenza within a defined geographical area.

Conclusion

Extensive travel restrictions may delay the dissemination of influenza but cannot prevent it. The evidence does not support travel restrictions as an isolated intervention for the rapid containment of influenza. Travel restrictions would make an extremely limited contribution to any policy for rapid containment of influenza at source during the first emergence of a pandemic virus.     

Smart wearable body sensors for patient self-assessment and monitoring

Background

Innovations in mobile and electronic healthcare are revolutionizing the involvement of both doctors and patients in the modern healthcare system by extending the capabilities of physiological monitoring devices. Despite significant progress within the monitoring device industry, the widespread integration of this technology into medical practice remains limited. The purpose of this review is to summarize the developments and clinical utility of smart wearable body sensors.

Methods

We reviewed the literature for connected device, sensor, trackers, telemonitoring, wireless technology and real time home tracking devices and their application for clinicians.

Results

Smart wearable sensors are effective and reliable for preventative methods in many different facets of medicine such as, cardiopulmonary, vascular, endocrine, neurological function and rehabilitation medicine. These sensors have also been shown to be accurate and useful for perioperative monitoring and rehabilitation medicine.

Conclusion

Although these devices have been shown to be accurate and have clinical utility, they continue to be underutilized in the healthcare industry. Incorporating smart wearable sensors into routine care of patients could augment physician-patient relationships, increase the autonomy and involvement of patients in regards to their healthcare and will provide for novel remote monitoring techniques which will revolutionize healthcare management and spending.

     

Multifaceted Inpatient Psychiatry Approach to Reducing Readmissions: A Pilot Study

ABSTRACT:  Context: Access to psychiatric services, particularly inpatient psychiatric care, is limited and lacks comprehensiveness in rural areas. Purpose: The purpose of this study was to evaluate the impact on readmission rates of a multifaceted inpatient psychiatry approach (MIPA) offered in a rural hospital. Methods: Readmissions within 30 days of patients who were admitted to an inpatient psychiatric unit using a MIPA model of care (N = 147) were compared to readmissions of a comparison group of patients who were admitted prior to the adoption of the MIPA (N = 37). Case mix differences were adjusted using multiple logistic regression analysis (N = 184). Findings: Patients treated in the MIPA model of care had lower odds of readmission within 30 days (odds ratio 0.14, 95% CI 0.02-0.87, P < .03). Conclusions: Effective inpatient psychiatric care can be provided in rural hospitals.     

Iatrogenic changes at the venotomy site after percutaneous placement of the Greenfield filter

To determine the prevalence of iatrogenic abnormalities associated with percutaneous delivery of Greenfield filters, the authors prospectively evaluated 69 peripheral veins used for filter placement in 68 patients. Of the 69 venotomy sites, 63 were not associated with preexisting thrombosis and were evaluated with compression and Doppler ultrasound within 1 week of placement and over 13-541 days. New thrombosis developed at the puncture site in nine of 63 sites (14.3%), although clinical suspicion of clot was raised in only one patient. Fifty-four sites (85.7%) showed no evidence of acute deep venous thrombosis, even though three patients had signs and symptoms suggestive of thrombosis. During the follow-up, most new thromboses resolved, yielding a 96.3% long-term patency rate. The authors conclude that postplacement increase in symptoms of venous stasis and occlusion may not correlate with placement site thrombosis. New filters should be evaluated for their ability to capture potential pulmonary emboli while maintaining caval patency and for mechanical and biologic stability because placement site complications occur at low rates and resolve in most cases.     

Soluble factors from murine and human tumors induce suppressor cells

A tumor-derived suppressor factor (TDSF) has been isolated from 3 M KCl extracts of a chemically induced fibrosarcoma of C₃H/HeJ mice by preparative isoelectric focusing. Incubation of TDSF with normal spleen cells induces suppressor cells that enhance tumor growth and inhibit DTH to the chemical sensitizer 2,4-dinitro-1-chlorobenzene (DNCB). Similar suppressogenic activity has been detected in extracts of the 10T $\text{1}\text{2}$ fibroblast line, an ultraviolet-induced fibrosarcoma of C₃H/HeN mice, the C57B1/6J Lewis lung carcinoma, and four human colonic adenocarcinomas. TDSF activity was not found in extracts of syngeneic muscle or spleen cells. Chemical characterization of TDSF from the murine fibrosarcoma MCA-F revealed sensitivity to treatment with heat and RNase, partial sensitivity to treatment with trypsin, but resistance to treatment with DNase, pronase, and neuraminidase. TDSF has an apparent molecular weight of greater than 300 kDa by high-performance gel permeation chromatography. Acidic soluble factors isolated from murine and human tumors induce suppressor cells to inhibit cell-mediated immunity in an intact host.