Surface topography of enamel and dentine from primary teeth following infrared Nd-YAG laser irradiation: An in vitro study

Data on the effects of laser radiation on primary teeth are scarce. This study investigates the effects of exposing sound enamel, photo-initiated sound enamel, sound dentine and carious dentine of extracted primary teeth to a pulsed neodymium-yttrium aluminium garnet laser (Nd-YAG, wavelength 1.06 μm, pulse length 15μs). Each type of tissue was exposed to three fiuences. Qualitative and quantitative assessments of the irradiated areas revealed that the most marked changes were produced in carious dentine, followed in ranking order by sound dentine, photo-initiated enamel and sound enamel. Evidence of thermal damage to the hard tissues peripheral to the fibre-optic tip, and considerable inter-sample variation were found. The experimental evidence obtained in this in vitro study does not support the clinical use of pulsed laser at 1.06 μm wavelength for cutting primary enamel and dentine.     

Glutamine and Other Amino Acid Losses During Continuous Venovenous Hemodiafiltration

Abstract: Serum amino grams and daily losses of glutamine (Gin) and other amino acids (AAs) into diafiltrate were measured during the first 5 days of continuous venovenous hemodiafiltration (CVVHDF) in 6 ICU patients with acute renal failure (ARF). Four patients had ARF as a part of multiple organ failure (MOF) of septic origin, and 2 patients had isolated ARF because of primary renal disease. During the study, all the patients received defined total parenteral nutrition (TPN). The mean daily AA losses into dialysate were relatively low (0.61 ± 0.1 g N ) and reached 4.5% of the daily AA substitution. Gln represented 32.7 ± 5.9% of the total AA losses (0.19 ± 0.04 g N ). Serum levels of Gin (p = 0.002) and of most other AAs were significantly lower in the patients than in the control subjects (AA analysis in 16 healthy volunteers). Phenylalanine (Phe) was the only AA that was increased significantly (p < 0.01) in the patients. The mean patient serum concentrations of Phe and tyrosine were significantly higher (p < 0.03) than the correspondent concentrations in dialysate, but the lysine concentration was higher in dialysate (p < 0.03). The serum and dialysate concentrations of other AAs did not differ. Gin in serum decreased significantly (p < 0.03) on the second day of CVVHDF but returned to the baseline levels subsequently. Serum concentrations of Phe increased on the second day of CVVHDF (p < 0.05). Serum concentrations of other AAs remained stable during the whole study. We conclude that Gin losses into dialysate during CVVHDF are relatively low, but CVVHDF itself may induce changes in Gin metabolism and distribution that are reflected by a decrease of serum Gin levels at the institution of this treatment. Therefore, the need for Gin supplementation in ICU patients is even greater in the first days of CVVHDF.     

The potential of an anaesthesiologist–manned ambulance service in a rural/urban district

The use of anaesthesiologists in prehospital emergency care is controversial. We wanted to assess the impact of an anaesthesiologist and a short time interval from acceptance of a mission to take–off at survival rates in a rural/urban emergency medical service. Prospectively registered data for 991 consecutive patients through a 12–month period were retrospectively evaluated by an independent foreign expert. Of all primary missions, 3.3% were considered probably lifesaving from site of injury to receiving hospital. Of these, the lifesaving result in 50% were dependent on both the qualifications of the anaesthesiologist and a short response time. Survival from hospital admission to discharge was 44%. All patients were discharged to their own homes, able to live a fully functional life. The consistent use of anaesthesiologists compared to less qualified personnel and the maintaining of response times below presently required minima doubles the potential for lives saved in services comparable to the one studied.     

Promoting autonomy and independence for older people within nursing practice: a literature review

The principles of promoting autonomy and independence underpin many approaches to improving the quality of nursing care for older people in whatever setting, and are in line with wider developments in health care such as the Patient's Charter. However, these concepts require careful definition if nursing practices which might promote autonomy and independence are to be identified. Although the generalizability of the research-based literature in this field is limited by a focus upon older people in continuing-care settings, a review of the literature found a number of indicators associated with attempts to promote patient autonomy and independence. These were grouped into the following categories: systems of care delivery which promote comprehensive individualized assessment and multidisciplinary care planning; attempts to encourage patients/clients to participate in decisions about their care; patterns of communication which avoid exerting power and control over patients/clients and attempts to modify the environment to promote independence and minimize risk. It is suggested that the review identifies a number of principles for nursing practice which can be applied in a range of care settings in order to promote the autonomy and independence of older people.     

Development of quality of care indicators for Parkinson's disease.

Parkinson's disease (PD) is a major cause of disability. To date, there have been no large-scale efforts to measure the quality of PD care because of a lack of quality indicators for conducting an explicit review of PD care processes. We present a set of quality indicators for PD care. Based on a structured review of the medical literature, 79 potential indicators were drafted. Through a two-round modified Delphi process, an expert panel of seven movement disorders specialists rated each indicator on criteria of validity, feasibility, impact on outcomes, room for improvement, and overall utility. Seventy-one quality indicators met validity and feasibility thresholds. Applying thresholds for impact on outcomes, room for improvement, and overall utility, a subset of 29 indicators was identified, spanning dopaminergic therapy, assessment of functional status, assessment and treatment of depression, coordination of care, and medication use. Multivariable analysis showed that overall utility ratings were driven by validity and impact on outcomes (P < 0.01). An expert panel can reach consensus on a set of highly rated quality indicators for PD care, which can be used to assess quality of PD care and guide the design of quality improvement projects.     

急性左半结肠癌梗阻一期切除吻合治疗39例

目的：探讨左半结肠癌致急性肠梗阻的手术处理方法。方法：回顾分析1995－2001年间39例左半结肠癌致肠梗阻一期切除吻合术的外科临床效果。结果：全组39例病人均采用梗阻近端肠管减压灌洗，并留置盲肠造瘘管术后接负压吸引，术后均一期愈合，未出现吻合口漏。随访2例中，1例存活率58％，3年存活率16％，5年存活率8％。结论：严格掌握手术适应症和基本操作，在病情允许时，对左半结肠癌急性肠梗阻行一期切除吻合手术是可行的。     

Induced abortion in China and the advances of post abortion family planning service

<正>This is a review of current situation of induced abortion and post abortion family planning service in China. Induced abortion is an important issue in reproductive health. This article reviewed the distribution of induced abortion in various time, areas, and population in China, and explored the character, reason, and harm to reproductive health of induced abortion. Furthermore, this article introduces the concept of Quality of Care Program in Family Planning, and discusses how important and necessary it is to introduce Quality of Care Program in Family Planning to China.     

Revisiting the Relationship between Managed Care and Hospital Consolidation

Objective. This paper analyzes whether the rise in managed care during the 1990s caused the increase in hospital concentration.
Data Sources. We assemble data from the American Hospital Association, InterStudy and government censuses from 1990 to 2000.
Study Design. We employ linear regression analyses on long differenced data to estimate the impact of managed care penetration on hospital consolidation. Instrumental variable analogs of these regressions are also analyzed to control for potential endogeneity.
Data Collection. All data are from secondary sources merged at the level of the Health Care Services Area.
Principle Findings. In 1990, the mean population-weighted hospital Herfindahl–Hirschman index (HHI) in a Health Services Area was .19. By 2000, the HHI had risen to .26. Most of this increase in hospital concentration is due to hospital consolidation. Over the same time frame HMO penetration increased three fold. However, our regression analysis strongly implies that the rise of managed care did not cause the hospital consolidation wave. This finding is robust to a number of different specifications.     

BiPAP ViSION 在慢性阻塞性肺疾病Ⅱ型呼吸衰竭的应用和护理

目的 探讨经鼻(面)罩双水平气道内正压通气(BiPAP)ViSION型呼吸机对慢性阻塞性肺疾病(COPD)伴Ⅱ型呼吸衰竭患者疗效及护理特点。方法 应用BiPAP ViSION型呼吸机对21例COPD伴Ⅱ型呼吸衰竭患者采用鼻/面罩连接单向呼气活瓣行双水平气道正压通气,观察其通气前后动脉血气及临床表现变化。结果 通气治疗后19例患者动脉血氧分压(PaO_2)及氧饱和度(SaO_2)明显升高(P<0.01),二氧化碳分压(PaCO_2)显著降低(P<0.05);肺性脑病症状消失,昏迷患者神志转清。2例病情恶化,其中1例改用有创通气后好转,1例拒绝有创通气死亡。结论BiPAP ViSION呼吸机治疗COPD伴Ⅱ型呼吸衰竭的疗效较为肯定,正确的护理对提高其疗效和减少并发症至关重要。