Organization and financing of home nursing in the European Union

The aim of this study was to provide an overview of the organization and financing of home nursing in the 15 member states in the European Union Home nursing was defined as the nursing care provided at the patients' home by professional home nursing organizations Data were gathered by means of three complementary research methods desk research, postal questionnaire among identified experts and face-to-face interviews with experts The results showed that there are large differences between the countries in the way home nursing care is financed There seems to be a relation between the way of funding and the organizational structure In member states where the organizations receive a fixed budget, based on the number of inhabitants or the demography of the catchment area, home nursing is mainly provided by one type of organization and is freely accessible for the patients In this situation there is little competition among the organizations, and the catchment areas of the regional organizations do not tend to overlap On the other hand, in countries where organizations are reimbursed according to a fee-for-service principle and a referral of a doctor is required, home nursing is provided by different types of organizations and also by independent nurses It seems that fee-for-service reimbursement stimulates competition between providers and a market-oriented home care In addition, a fee-for-service method of funding also has the consequence that mainly technical nursing procedures and some basic care are reimbursed, this leaves little room for nurses to perform preventive and psychosocial activities or to provide more integrated care     

Bone scan appearances following biopsy of bone and bone marrow

The influence of sternal marrow aspiration, iliac crest marrow aspiration, and iliac crest bone biopsy on bone scan appearances was examined. Eighteen patients were scanned a mean of 9.9 days after sternal marrow aspiration with a Salah needle (diameter 1.2 mm). Only one patient had an abnormality at the biopsy site. Bone scans obtained in 9 patients a mean of 10 days after iliac crest trephine marrow biopsy with a Jamshidi needle (diameter 3.5 mm) showed no abnormality at the biopsy site. In 18 patients with metabolic bone disease who had undergone iliac crest bone biopsy with an 8-mm needle, a scan abnormality due to the biopsy was usually present when the interval between the biopsy and the scan was 5 days to 2 months. Patients who were scanned within 3 days of iliac crest bone biopsy or more than 2 months after biopsy had normal scan appearance at the biopsy site.     

牛骨形态发生蛋白对骨质疏松性椎体骨折愈合过程中局部血管内皮生长因子表达的作用

目的:观察骨质疏松性椎体骨折愈合过程中,局部血管内皮生长因子动态表达,探讨牛骨形态发生蛋白促进SD大鼠骨质疏松性椎体骨折愈合的作用机制。方法:实验于2005-07/2006-07在解放军兰州军区总医院骨研所完成。①牛骨形态发生蛋白的制备:青海小牦牛大腿骨,-4℃条件下,粉碎,按Urist改良方法提取。②选择雌性SPF级8个月龄SD大鼠96只,去除双侧卵巢建立骨质疏松模型。随机分为2组:实验组和对照组,每组48只。③术后3个月行L5椎体开窗建立人工骨折模型,实验组置牛骨形态发生蛋白10mg 纤维蛋白复合体;对照组注入等量无血清培养液。④于手术后3,7,10,14,21,28,56,84d每组麻醉状态处死6只,用苏木精-伊红染色、免疫组织化学及定量聚合酶链反应检测骨折愈合不同时间的标本血管内皮生长因子及血管内皮生长因子mRNA的动态表达,阳性信号为胞浆内棕色颗粒。结果:96只SD大鼠全部进入结果分析。①骨折愈合不同时间组织学观察:实验组术后7d纤维骨痂形成,21d新生骨组织与旧骨组织出现融合,56～84d软骨性骨痂已逐渐被骨性骨痂取代,骨折部位髓腔再通,出现成熟板层骨,骨折基本愈合。对照组术后7d未见典型纤维性骨痂;21d新生骨组织大都游离与孤立存在,术后28d骨小梁仅有少部分连结成网状,56～84d部分骨缺损存在,不见成熟板层骨,大部分髓腔不通,骨折愈合延迟。②骨折不同时间血管内皮生长因子免疫组织化学结果:实验组血管内皮生长因子在7d左右可见有阳性表达的细胞,14d有分泌高峰,对应循环数(CT值)最小,两组比值最大。而对照组未见明显分泌高峰。③实时荧光定量聚合酶链反应检测结果:对照组在造模后1,2,4,6,8周时,椎体内的血管内皮生长因子mRNA的表达量明显低于实验组(P<0.01)。结论:牛骨形态发生蛋白可促进大鼠骨质疏松性椎体骨折部位血管内皮生长因子的动态表达,可在受体骨折部位局部促进骨折生长。     

人脂肪干细胞体外培养特性及成脂成软骨分化

目的:观察人脂肪组织间充质干细胞体外分离培养及成脂、成软骨诱导分化的生物学性状,探讨其作为软骨组织工程种子细胞的可行性。方法:实验于2006-08/2007-03在吉林大学中日联谊医院前列腺疾病防治研究中心完成主要工作。实验方法:①人脂肪组织来源于健康成年女性腹部吸脂术,酶消化法分离出脂肪间充质干细胞,接种于含体积分数为0.10胎牛血清的高糖DMEM培养基进行原代培养。②取第3代脂肪间充质干细胞,采用细胞计数法测定细胞生长曲线,流式细胞仪测定CD13、CD34抗原的表达,免疫荧光法测定CD34抗原的表达。③取第3代脂肪间充质干细胞,用含体积分数为0.10胎牛血清、0.5mmol/LIBMX、1μmol/L地塞米松、10μmol/L胰岛素的成脂诱导培养基和含体积分数为0.01胎牛血清、10μg/L转化生长因子β1、50nmol/L抗坏血酸、6.25mg/L胰岛素的成软骨诱导培养基分别诱导分化。④每天用倒置显微镜观察细胞形态及增殖变化,油红"O"、AB-PSA染色和Ⅱ型胶原免疫细胞化学染色检测成脂、成软骨分化情况。结果:①体外培养的脂肪间充质干细胞呈扁平的长梭形,细胞形态均一,传代稳定。间质细胞相关标志CD13和干细胞相关标志CD34表达阳性。②定向诱导后表现出脂肪细胞和软骨细胞特性。经成脂诱导,细胞内出现空泡,油红"O"染色呈红色;经成软骨染色,AB-PSA染色呈紫红色,Ⅱ型胶原免疫细胞化学染色胞浆呈棕黄色。结论:脂肪干细胞能向软骨细胞方向诱导分化,可作为软骨组织工程种子细胞。     

Comparative efficacy of chloroquine and sulphadoxine--pyrimethamine in pregnant women and children: a meta-analysis

OBJECTIVE: To compare the efficacy of chloroquine and sulphadoxine-pyremethamine against Plasmodium falciparum infection in pregnant women and in children from the same endemic areas of Africa, with the aim of determining the level of correspondence in efficacy determinations in these two risk groups. METHODS: Meta-analysis of nine published and unpublished in vivo antimalarial efficacy studies in pregnant women and in children across five African countries. RESULTS: Pregnant women (all gravidae) were more likely to be sensitive than children to both chloroquine (odds ratio: 2.07; 95% confidence interval: 1.5, 2.9) and sulphadoxine-pyrimethamine (odds ratio: 2.66; 95% confidence interval: 11.1, 6.7). Pregnant women demonstrated an almost uniform increased sensitivity for peripheral parasite clearance at day 14 compared with children. This finding was consistent across a wide range of drug sensitivities. Primigravidae at day 14 showed lower clearance to antimalarial drugs than multigravidae (P<0.05). There was no significant difference between parasite clearance in primigravidae and in children. CONCLUSION: The greater drug sensitivity in pregnant women probably indicates differences in host susceptibility rather than parasite resistance. Parasite sensitivity patterns in children may be a suitable guide to antimalarial policy in pregnant women.     

Diagnosis of Rett syndrome: can a radiograph help?

Rett syndrome (RS), a neurodevelopmental disorder almost exclusively affecting girls, is associated with severe intellectual and motor disability. In the absence of biological markers, diagnosis is determined by a set of clinical criteria. In a previous study in Scotland, shortening of the fourth metatarsal was reported clinically in 20% of classical RS cases aged 5 years or older. The Australian Rett Syndrome Study database has facilitated a population-based radiological study of the hands and feet of girls with RS. Straight radiographs of hands and feet were available from 94 cases, representing 70.1% of the known RS population in Australia. Control radiographs were matched for age, sex, and laterality. Relative shortening of the fourth metacarpal/metatarsal was assessed using the sign method. A short ulna (negative ulna variance) was defined as the distal articular surface of the ulna being at least 5mm proximal to the distal articular surface of the radius. A positive metacarpal sign was twice as common in verified cases of RS than in controls in the right but not the left hand. A short ulna was more common in subjects with RS than in controls. A short fourth metatarsal was also more common among subjects with RS. More than half (56.6%) the girls with RS over the age of 4 years had a negative ulnar variance in either wrist or a metatarsal sign in either foot. These findings will assist with the diagnosis of RS and may help direct research towards the location of the molecular defect.