Chrome congestive heart failure: Radiofrequency ablation of accessory pathways: implications of accumulated experience and time dedicated to procedures

Previous reports on radiofrequency ablation of accessory pathwayshave shown that the experience of the operator is of crucialimportance in reducing fluoroscopy time and achieving highersuccess rates. However, a detailed analysis of this importantissue has not been previously attempted We analysed 71 consecutive ablation procedures undertaken atSt George's Hospital by the same electrophysiology group andalways with the same first operator. Of all procedures, 66 (916%)were successful, as judged by abolition of accessory pathwayconduction without recurrence within the next 24 h. Failuresincluded two out of 38 left-sided pathway procedures (5·3%),one out of 11 intermediate septal (9·1%) and four outof 22 right-sided pathway procedures (18·2%). These differencewere not statistically significant. Average procedure and screeningtimes for all procedures were 162·9±86·0min and 56·8±48·2 mm respectively, whereasthe median of the number of discharges was 12, ranging fromone to 51. There was no significant difference between pathwaygroups or between concealed and non-concealed pathways in respectto procedure and screening time or number of discharges. Therewas a significant tendency towards decreased procedure and screeningtimes with accwnulating experience and this was similar forall pathway groups. There was also a tendency towards improvedcwnulative success rates with time dedicated to procedures. We conclude that a certain amount of ablation experience isrequired, even by experienced electrophysiologists, before arelatively high success rate without long radiation exposurecan be achieved, regardless of the location or the mode of conductionof the pathway. Success rates increase with procedure time,suggesting that early abandonment of the procedure may resultin higher failure rates in diffcult cases.     

Geriatric care on a ward without nurses

The Multiphasic Environmental Assessment Procedure (MEAP; Moos and Lemke, 1984) was used to assess three long-stay settings within a geriatric hospital, one of which is a non-nursing unit committed to the philosophy of residents viewing the setting as their own home. Findings suggest positive outcomes for residents on the nonnursing unit, and support the view that types of care fostering independence and personal responsibility of elderly residents in their setting may be associated with increased mental functioning and activity. The lack of trained nursing staff had no detrimental effect on any measure of resident life, and some specific caring practices on the unit may be interpreted as having a positive outcome for residents.     

The influence of clinical problems, age and social support on outcomes for elderly persons referred to regional aged care assessment teams

Abstract Background: Aged Care Assessment Teams (ACATs) have been established throughout Australia during the past seven years. Early studies of their effect have concentrated on their impact on the rate of institutionalisation of disabled elderly, the clinical characteristics of referred cases and the relationship between disability and recommended care plan. Aims: The aim of this study was to explore the relationship between age, clinical features and social characteristics of AC AT subjects with outcomes at 12 months after assessment. Methods: The examination of an arbitrary sample of persons referred to ACATs over a year by one generalist geriatrician with follow-up of all cases by the three ACATs associated with the study was carried out. All analyses were performed on raw data presented as categorical variables in the form of contingency tables. Results: The sample included 324 subjects who suffered from 2030 clinical problems with a mean of 6.5 per person aged 75 or over and 5.5 for those under 75. Cardiovascular and neurological disease were the commonest source of problems. Study of accommodation outcome at 12 months, for those subjects who survived this period revealed that, in the older group, over 60% of subjects with neurological disease were resident in nursing homes while the majority of all other groups remained in the community, as did two-thirds of those aged under 75. Admission to a nursing home was independent of social support for older subjects with neurological disease, but it played a significant role in those with cardiopulmonary or musculoskeletal disease. Conclusions: The study demonstrates that for one-year survivors there is an increased likelihood of admission to a nursing home of people aged 75 or over with neurological disease, while those under 75 were more likely to remain at home. The association was independent of whether spouse, family or friends were living with the subject. (Aust NZ J Med 1994; 24: 378–385.)     

孕产妇生殖器尖锐湿疣的30例护理

目的:探讨妊娠合并尖锐湿疣的护理.方法:选择1999年1月～2001年3月30例孕产妇生殖器感染尖锐湿疣进行分析.结果:产妇均痊愈出院,新生儿无1例发生咽部乳头瘤.结论:孕产妇尖锐湿疣对孕妇及新生儿均有重大影响,医护人员应注意消毒隔离,以剖宫产终止妊娠,使新生儿患病率明显下降.     

Mapping the rat somatosensory pathway from the anterior cruciate ligament nerve endings to the cerebrum

The anterior cruciate ligament (ACL) serves as the primary restraint to anterior tibial translation. In addition to this biomechanical function, the ACL appears to have a function in neuromuscular control. This hypothesis was formulated after the discovery of mechanoreceptors within the ACL. The full somatosensory pathway from the ACL to the cerebrum has yet to be elucidated. In order to map this sensory pathway, we conducted a viral trans-synaptic tracing experiment using the neurotropic pseudorabies virus (PRV). The pseudorabies virus was injected into the ACL of rats and allowed to replicate and spread trans-synaptically for 6-7 days. The brain and spinal cord of each sacrificed rat was then removed and processed immunohistochemically to detect the presence of PRV. PRV-immunoreactive neurons were found to be localized in several different regions from the spinal cord to the cerebrum. Four nuclei in the reticular formation of the brain stem demonstrated strong positive labeling: the mesencephalic reticular nucleus, magnocellular reticular nucleus, paragigantocellular reticular nucleus, and gigantocellular reticular nucleus. This finding suggests that the nerve endings of the rat ACL project into the cerebrum and that the reticular formation may play an important role in the afferent pathway of those nerve endings.     

Identifying the special needs of children with Type 1 diabetes in the school setting. An overview of parents' perceptions.

AIMS: The aims of this observational study were to identify the special needs of children with Type 1 diabetes in schools from the parents' point of view and the difficulties experienced with full integration, and to define a series of interventions which may improve the situation. METHODS: Parents of children aged 3-18 years with Type 1 diabetes were eligible. Those who agreed to participate completed a self-reporting questionnaire which determined the effects of the disease on children, parents and school personnel, and addressed aspects including children's integration, glycaemic control, insulin administration, meals, sports, trips and attitudes of teachers and school colleagues to their disease. RESULTS: A total of 499 questionnaires were completed and validated. Median age of children was 11.5 years (95% CI 7.8-15.2). Only 34% of parents believed that teachers could recognize the symptoms of a mild hypoglycaemic episode. Seventeen per cent of parents experienced problems at their schools when they informed staff about their children's disease, 5% were finally not accepted and 8% were forced to change school. In some cases, they had to modify glucose monitoring (9%) and treatment administration (16%) because of a lack of cooperation from the school. CONCLUSIONS: Training sessions on Type 1 diabetes, an increase in the number of nurses, better availability of resources from diabetic associations to schools and improved communication between school personnel and parents were identified as key factors that may improve the full integration of the diabetic child in this setting.     

影响下尿路尿动力学检查准确性的因素及护理措施

笔者通过对270例患者进行尿动力学检查,认为环境、病人的配合程度、检查体位、导管的型号、膀胱灌注情况及护士操作技术、服务态度对尿动力学检查有一定的影响。针对影响因素采取护理措施:积极创造良好的检查环境,加强对患者的宣教与沟通,正确放置体位和选择导管、冲洗液的速度,操作护士熟练的技术和人性化服务,是获得准确检查结果的关键。     

腰大池持续外引流的临床观察与护理

笔者报道72例腰大池持续外引流病人的观察与护理。认为对于腰穿持续外引流的病人，观察脑脊液的性质、量，严密观察病情变化，加强引流管的护理及基础护理，增强营养，是提高治愈率，减少并发症的重要措施。