Current controversies: exercising during pregnancy

The current emphasis on physical fitness has motivated many women to participate in a variety of exercise programs. Increased participation by pregnant women is also occurring in the form of self-directed activities and/or as recommended by physicians in an effort to shorten labor and improve pregnancy outcome. Whether exercise improves or presents a potential hazard to the mother and fetus is a concern. The implications for the "trained" woman as well as the "untrained" exerciser are unclear and need definitive study.     

Hemorrhoidectomy

A simple method of hemorrhoidectomy has been presented, which if properly performed, will be followed by few complications and should give prolonged relief in the usual case. The pre- and postoperative care has been simplified and less disturbance of the patient's general health results.     

Prospective study of atrial natriuretic peptide for the prevention of radiocontrast-induced nephropathy

Radiocontrast-induced nephropathy (RCIN) is a common cause of hospital-acquired acute renal failure and is associated with a high mortality rate. RCIN is potentially preventable, because administration of the radiocontrast agent is predictable, and a high-risk population has been identified. This multicenter, prospective, randomized, double-blind, placebo-controlled trial was performed to evaluate the efficacy of intravenous atrial natriuretic peptide (anaritide, ANP 4-28) to prevent RCIN. Patients with stable chronic renal failure (serum creatinine greater than 1.8 mg/dL or serum creatinine between 1.5 and 1.8 mg/dL with estimated creatinine clearance of < or = 65 mL/min) were assigned to receive either placebo or one of three doses of anaritide (0.01 microg/kg/min, 0.05 microg/kg/min, or 0.1 microg/kg/min) for 30 minutes before and continuing for 30 minutes after radiocontrast administration. All patients were given intravenous 0.45% saline for 12 hours before the radiocontrast procedure and continuing for 12 hours after the last dose of radiocontrast. Both ionic and nonionic radiocontrast agents were administered. RCIN was defined as either an absolute increase of serum creatinine of > or = 0.5 mg/dL or a percent increase of > or = 25% over baseline. Of the 247 patients who completed the study, 50% had diabetes mellitus. There were no statistical differences in baseline serum creatinine, change in serum creatinine, or the incidence of RCIN. The incidence of RCIN was placebo, 19%; anaritide (0.01), 23%; anaritide (0.05), 23%; anaritide (0.1), 25%. Patients with diabetes mellitus had a significantly greater incidence of RCIN: placebo, 26% versus 9%; anaritide (0.01), 33% versus 13%; anaritide (0.05), 26% versus 21%; anaritide (0.1), 39% versus 8% (diabetic v nondiabetic, P < 0.002). There was no effect in the diabetic or nondiabetic groups by anaritide on the incidence of RCIN. Comparison of the highest-risk group of patients, defined as patients with diabetes mellitus and a baseline serum creatinine > or = 1.8 mg/dL, with the lowest-risk group, defined as patients without diabetes mellitus and a baseline serum creatinine of 1.8 mg/dL or less, did not show a beneficial effect of anaritide administration. In conclusion, administration of intravenous anaritide before and during a radiocontrast study did not reduce the incidence of RCIN in patients with preexisting chronic renal failure, with or without diabetes mellitus.     

Excessive weight loss in the athletic adolescent. A diagnostic dilemma

Differentiating anorexia nervosa (AN) from excessive weight loss in the otherwise healthy, athletic adolescent may be difficult. We report the maximal work capacity, hormonal secretory patterns, and psychological assessment of a 14-year-old male runner who induced excessive weight loss and partially recovered. At 17% below previous body weight (28% below ideal weight for height), he had significant resting bradycardia (38 bmp), low maximal heart rate (167 bpm), depressed VO2 max, and prepubertal 24-hour LH and testosterone secretory patterns in the presence of late pubertal genital development. The diagnostic dilemma of excess weight loss due to food aversion in the normal athlete versus anorexia nervosa with running as a symptom was resolved by psychiatric evaluation. A disturbed body image, marked feelings of inadequacy, and depression were discovered, which are findings consistent with AN. Diagnostic criteria of AN and the possible implications of a subnormal maximal heart rate are reviewed.     

Evaluation of a School-Based Train-the-Trainer Intervention Program to Teach First Aid and Risk Reduction Among High School Students

BACKGROUND: Farming is a hazardous occupation posing health risks from agricultural exposures for the farm owner and family members. First Aid for Rural Medical Emergencies (F.A.R.M.E.) was developed to support a train-the-trainer (TTT) program to prepare high school students to teach first aid skills and risk reduction through peer interaction. This study was designed to evaluate the educational effectiveness for first aid skill development and awareness of safety issues and injury prevention impacting agricultural communities. METHODS: Forty-three agricultural science students from a rural high school participated in the study. A quasi-experimental design was used to evaluate knowledge acquisition and anticipatory action among groups: those participating in training and a comparison group with no training. The intervention group included 27 participants trained as first aid peer instructors using the F.A.R.M.E. manual, return demonstration, case scenario facilitation training, and teaching evaluation sessions. The effectiveness of the program was evaluated using triangulated data. Independent t test analyses were conducted on post-test scores to evaluate the knowledge acquisition and anticipatory action scores between groups. Focus group sessions assessed attitudes, experiences, and values held following the intervention of teaching peers. RESULTS: Results indicate that the intervention group scored significantly higher on anticipatory action (t = 2.23, p = .03) but not knowledge acquisition (t = 1.37, p = .18). Focus group data suggest that the TTT format bolstered confidence in teaching, confirmed that teens enjoy learning from teens, and fostered pride in team work. CONCLUSIONS: The F.A.R.M.E. TTT resulted in a theory and evidence-based intervention that can be implemented in a school setting to promote knowledge and skill acquisition of first aid and injury prevention among rural high school students.     

Can we measure the ankle-brachial index using only a stethoscope? A pilot study

Background. Ankle-brachial index (ABI) is an excellent methodfor the diagnosis of peripheral arterial disease (PAD) whenit is performed with Doppler. However, this device is not alwaysavailable for primary care physicians. The ABI measured withstethoscope is an easy alternative approach, but have not beenproved to be useful. Objective. To assess the accuracy of the ABI measured usinga stethoscope comparatively to that of the current eligiblemethod for the diagnosis of PAD, the Doppler ABI, and describethe characteristics of this new approach. Methods. We conducted a diagnostic study of ABI measured witha stethoscope and a Doppler probe and compared the results.Eighty-eight patients were accessed by both methods. Results. Mean stethoscope ABI, 1.01 ± 0.15, and meanDoppler ABI, 1.03 ± 0.20, (P = 0.047) displayed a goodcorrelation. Measurements of stethoscope ABI diagnostic accuracyin recognizing a Doppler ABI are described. The comparison ofthis data with the current gold standard method results gavea sensitivity of 71.4% [95% confidence interval (CI), 41.9–91.6]and specificity of 91.0% (95% CI, 81.5–96.6), with predictivepositive value of 62.5% (95% CI, 38.6–81.5) and negativepredictive value of 93.8% (95% CI, 85.2–97.6). The studyaccuracy was 87.7%. The area under the ROC curve was 0.895 (95%CI, 0.804–0.986, P < 0.0001). Conclusions. According to our study, the stethoscope ABI isa useful method to detect PAD and it may be suitable for itsscreening in the primary care setting. Keywords. Ankle-brachial index, peripheral arterial disease, stethoscope.     

双波长一元线性回归分光光度法同时测定复方氨基比林注射液中三组分含量

本文依据一组含有不同比例待测和干扰组分的标准混合液的吸收值,采用一元线性回归方法,在选择最佳测定波长对的同时建立标准工作曲线方程,使其更符合实际作品测定时的情况,提高了结果的精度和可靠性,并使计算量和实验工作量得以降低。应用于复方氨基比林注射液中三组分氨基比林、安替比林和巴比妥的同时测定,其平均回收率分别为99.8％,100.4％和99.8％,变异系数分别为0.59,1.48和1.05,结果优于卡尔曼滤波法、偏最小二乘法和目标因子分析法。     

Applying ethics to health care: the role of continuing education

The study of ethics will not provide health care professionals with specific answers to specific ethical dilemmas they as individuals may face. it will not provide specific rules of conduct. The ability to examine ethical dilemmas sets forth practical wisdom that provides guidance when making decisions. The study of ethics helps to define problems and establishes basic principles to be used in solving these problems. It can help health care professionals identify appropriate goals and give them direction in achieving those goals. Health care supervisors have an obligation to provide the educational opportunity that will enable professionals to emerge with a perspective that allows them to take an ethical stand and to support that position with sound, rational thinking. In fulfilling this obligation, individuals working within health care facilities can significantly contribute to their profession and to society.     

Participation of haemato‐oncological patients in medical decision making and their confidence in decisions

ERNST J., WEISSFLOG, G., BRÄHLER E., NIEDERWIESER D., KÖRNER A. & SCHRÖDER C. (2010) European Journal of Cancer Care
Participation of haemato‐oncological patients in medical decision making and their confidence in decisions Increasingly more clinical care and research acknowledge the patients' interest in participating in medical decision making. However, for haematological patients, there are as yet only modest findings. The current study explores patients' perceptions of their role in the medical decision‐making process in a sample of 117 haematological patients. The majority of patients surveyed (63.9%) took a passive role in the medical decision‐making process, which is a significantly greater proportion compared with individuals suffering from solid cancers. Despite passive majority, most of the participants reported a positive evaluation of the decision‐making process. Importantly, patients' evaluations were significantly more negative either if patients were treated as inpatients (vs. outpatients), or if they experienced no control over the decision (vs. collaboration with the doctor, or deciding autonomously). The results and limitations of the study are discussed.     

MEASUREMENT OF ROOT CANAL LENGTH – USE OF AN ELECTROMETRIC DEVICE

The measurement of root canal length is a pre-requisite for successful pulpectomy. The conventional manual and radiographic methods are not very accurate. In the present study, odontometer was used [Group B) to assess its efficacy over the conventional methods (Group A) for recording root canal length. In group A, 36 teeth were treated with pulpectomy while in group B, 51 teeth were managed by the same treatment. It was observed that post operative complications in group B were significantly less (p < 0.05). The odontometer proved to be an excellent device for rapid and accurate measurement of root canal length.KEY WORDS: Pulpectomy, Root canal length, Odontometer