Demographic diversity,communication and learning behaviour in healthcare groups

An integrative model of group learning was tested in a sample of 40 healthcare groups (434 respondents), and the results show that age diversity reduces the frequency of face‐to‐face communication whereas educational diversity reduces the frequency of virtual communication in healthcare groups. Frequency of communication (both face‐to‐face and virtual), in turn, positively impacts on the emergence of trust and psychological safety, which are essential drivers of learning behaviours in healthcare groups. Additional results show that average educational achievement within groups is conducive for communication frequency (both face‐to‐face and virtual), whereas mean age within groups has a negative association with the use of virtual communication in healthcare groups. Copyright © 2012 John Wiley & Sons, Ltd.     

The effect of oral contraceptives on current wheezing in young women

BackgroundEmerging evidence suggests that sex steroid hormones may influence respiratory symptoms. The existing literature about the role of oral contraceptive pill (OCP) on respiratory disease is scarce and conflicting especially during the adolescent period. In this study, we aimed to investigate the effect of OCPs on current wheezing among adolescents and young adults.MethodsA questionnaire was administered face-to-face to adolescents and young women by a physician. The questionnaire included ISAAC survey-comprised questions on ever wheezing, current wheezing, allergic diseases, smoking history (active or passive), and family history of allergic diseases and questions on OCP usage status. The effect of OCPs on wheezing was evaluated by logistic regression analysis.ResultsA total of 487 subjects aged between 11.3 and 25.6 years participated in the study and 196 (40.2%) reported that they had used OCPs. 7.4% of the participants had physician-diagnosed asthma and 10.3% of them were active smokers. It was detected that OCPs were associated with increased risk for current wheezing (odds ratio, 2.36; 95% CI, 1.25–4.47 adjusted for asthma and current smoker) and this risk was related with the usage during the past year.ConclusionYoung women taking oral contraceptives had a higher rate of current wheezing, suggesting that sex steroids may be of importance for respiratory health.     

Clinical and microbiological efficacy and toxicity of colistin in patients infected with multidrug-resistant gram-negative pathogens

Polymyxins have recently again become important because of multidrug-resistant (MDR) gram-negative pathogens. The aim of this study was to evaluate the clinical and microbiological efficacy and toxicity of different dosages of colistin in patients infected with MDR microorganisms that were sensitive only to colistin. The study was conducted in the 1,200-bed Ankara Numune Training and Research Hospital. Patients with normal renal function who received colistin for 48 h or more were retrospectively evaluated. Clinical response was defined as resolution of fever and clinical and laboratory findings. Microbiological response was defined as bacteriological eradication from the infection site. Nephrotoxicity was defined as at least two consecutive serum creatinine measurements with an increase of 0.5 mg/dl from baseline at least 24 h apart after 2 or more days of colistin therapy. Twenty-four patients were included in the study: total clinical response was obtained in 17 of 24 (70.8 %) patients and microbiological response in 15 of 24 (62.5 %) patients. Patients were grouped according to colistin dosage of 3 × 1 million units (MU) versus 3 × 2 MU. Clinical response rates were 69.2 % and 72.7 %, respectively (p = 0.65). Microbiological response rate was similar (p = 0.62). Nephrotoxicity was revealed in 1 of 13 patients (7.7 %) for the 3 × 1 MU group and 2 of 11 patients (18.2 %) in the 3 × 2 MU group (p = 0.57). The nephrotoxicity rate was greater with higher dosages of colistin, but the difference was not statistically significant. Renal function of patients receiving higher dosages of colistin should be more closely monitored.     

Antithrombin III prevents deleterious effects of remote ischemia-reperfusion injury on healing of colonic anastomoses

BACKGROUND: Antithrombin III is known as the most important natural inhibitor of thrombin activity and has been shown to attenuate local harmful effects of ischemia-reperfusion injury in many organs. In recent animal studies, delaying effect of remote organ ischemia-reperfusion injury on healing of intestinal anastomoses has been demonstrated. In this study, we investigated whether antithrombin III reduces deleterious systemic effects of ischemia-reperfusion injury on healing of colonic anastomoses in rats. METHODS: Anastomosis of the left colon was performed in 24 rats that were divided into three groups: sham operated control (group I, n = 8), 30 minutes of intestinal ischemia-reperfusion by superior mesenteric artery occlusion (group II, n = 8), antithrombin III treated group (250 U/kg before and after the ischemia-reperfusion, group III, n = 8). On postoperative day 6, all animals were sacrificed, and bursting pressure and tissue hydroxyproline content of the anastomoses were assessed and compared. RESULTS: On postoperative day 6 the mean bursting pressures were 149.6 +/- 4.8, 69.8 +/- 13.5, and 121.8 +/- 8.7 mm Hg for groups I, II, and III, respectively (P = 0.000). Mean tissue hydroxyproline concentration values were 389.5 +/- 29.6, 263.1 +/- 10.0, and 376.0 +/- 33.8 microg/mg for groups I, II, III respectively (P = 0.005). CONCLUSIONS: This study showed that, antithrombin III treatment significantly prevented the delaying effect of remote organ ischemia-reperfusion injury on anastomotic healing in the colon. Further clinical studies are needed to clarify whether antithrombin may be a useful therapeutic agent to increase the safety of the anastomosis during particular operations where remote organ ischemia-reperfusion injury takes place.     

Value of duplex Doppler ultrasonography in renal colic

OBJECTIVES: The aim of our study was to determine the value of duplex Doppler ultrasonography (DDU) in the patients' evolution with renal colic. The study of the resistive index (RI), difference of the RI (ARI) associated with a DDU intravesical recording (ureteral jets) were compared with renographic findings in renal colic. PATIENTS AND METHODS: Between October 1998 and January 2001 we studied 377 cases with suspected renal colic by intravenous pyelography (IVP), grey-scale ultrasonography and DDU with determination of the RI, the difference between the RI of ipsilateral and contralateral kidneys (ARI) and the amplitude (maximum length of the intravesical ureteral jet), velocity and frequency of the urine bolus. We considered normal values RI < or = 0.70 and ARI < or = 0.06. VP was used as a referee investigation and the ureteral intravesical jets were determined in standard conditions. All patients came to the hospital between 4 and 12 h after the onset of the renal colic. RESULTS: We found four series of patients: 1, acute (complete) obstructed kidney (IVP nonfunctional) and dilatation at normal grey-scale, with normal contralateral kidney (n = 153). In this series we found RI > 0.70 in 87%, RI > 0.06 in 90% and absent ureteral intravesical jet of the obstructed kidney site in 89%; 2, acute (complete) obstructed kidney (IVP nonfunctional) without abnormalities at normal grey-scale, with normal contralateral kidney (n = 57). In this series we found RI > or = 0.70 in 73.5%, deltaRI > 0.06 in 82.5% of patients, absent or asymmetric ureteral intravesical jet in 80.7% of cases; 3, incomplete obstructed kidney (IVP with various degree of ureterohydronephrosis) with normal contralateral kidney (n = 96). In this series we found RI > or = 0.70 in 58.3% and deltaRI > 0.06 in 64.5% of patients, asymmetric ureteral intravesical jets in 74% of cases; 4, normal both kidneys normal IVP) were found in 71 cases (18.8%). In this series we found RI < 0.70 in 80.2%, deltaRI < or = 0.06 in 89% of cases, normal ureteral intravesical jets in 93% of cases. The mean RI was 0.76 (0.05) in 306 obstructed kidneys, significantly higher than the mean RI of 0.62 (0.05) in 448 normal kidneys (P < 0.001). The ARI in patients with obstruction was significantly higher than in patients with normal both kidneys, at 0.08 (0.05) and -0.001 (0.03), respectively (P < 0.001). The RI was sensitive in 75.5% and specific in 92.5% and ARI was sensitive in 80.7% and specific in 95.7% (versus IVP, considered the referee value). The presence of the intravesical ureteral jets of the renal colic side, associated with the values of RI (RI < or = 0.70) and deltaRI (deltaRI < or = 0.06), was followed by spontaneous passage of the stones in 71% of cases. CONCLUSIONS: Renal DDU and consecutively, intravesical evaluation of ureteral jets could detect acute renal obstruction and, as a functional investigation, could have a predictive value regarding the ureteral stones passage. It could replace the IVP, being a sensitive and highly specific test.