Lactose feeding during persistent diarrhoea

Lactose intolerance is a recognized complication of some episodes of diarrhoea. Whereas it is of clinical importance in relatively few children with acute diarrhoea it seems to be a more common problem in children presenting with persistent diarrhoea, especially in malnourished children with severe diarrhoea. We describe a recent study which also demonstrated adverse clinical and nutritional consequences in the majority of children with mild but persistent diarrhoea consuming 6 g lactose/kg body weight/d. It is desirable to identify these children who need to reduce their lactose intake in order to limit unnecessary dietary changes which are expensive to implement and/or nutritionally disadvantageous. Admission clinical characteristics were analyzed for their ability to predict clinical outcome in a group of 33 children with persistent diarrhoea taking a lactose-containing diet. The results of tests of stool reducing substances and a lactose breath hydrogen test (LHBT) were analyzed in the same group whose clinical management had been independent of the test results. Eighty-nine percent of children who deteriorated had one of the following characteristics: age <12 months, weight-for-height less than -2 SD below NCHS norms or fever >37°C. Children who unequivocally improved while continuing to take lactose could not be selected without the risk of including children who deteriorated. Neither tests of stool reducing substances nor the LBHT improved the predictive value of simple clinical parameters. Reduction of lactose in the diet of children with persistent diarrhoea who have any of these parameters is recommended, but mixing of milk with cereal or substituting with fermented milk products is preferable to milk withdrawal or dilution with water.     

Diagnostic steps in the evaluation of patients with erectile dysfunction

PURPOSE: The necessity for a thorough diagnostic evaluation for erectile dysfunction has been questioned after the availability of effective oral therapies. We determined the impact of the different diagnostic steps on the management strategy for erectile dysfunction. MATERIALS AND METHODS: The study included all patients who presented at an andrology outpatient clinic during a 4-year period. Baseline evaluation included medical and sexual history, blood tests, physical examination and intracavernous injection test. Patients with normal initial screening were evaluated with specific diagnostic procedures. The results were analyzed to identify the diagnostic potential of each screening step separately. RESULTS: Overall 1,644 patients presented at the clinic during the study period, of whom 368 (22.4%) were excluded from study due to severe psychiatric (5.2%) or cardiovascular (2.7%) disease, or to a history of erectile dysfunction less than 3 months in duration (14.5%). In the remaining 1,276 patients with a mean age plus or minus standard deviation of 56 +/- 14 years, and a mean duration of erectile dysfunction of 4.9 +/- 3.4 years medical history revealed erectile dysfunction associated medical conditions in 57%, blood tests identified previously undiagnosed medical conditions in 6.2%, and physical examination and the intracavernous injection test were diagnostic in 13.9% and 2.6%, respectively. Initial screening was negative in 259 cases (20.3%), in which specific diagnostic procedures identified an underlying vascular pathology in 165 (12.9%) and unfavorable penile geometry in 16 (1.3%). The remaining 78 men (6.1%) had no evidence of organic disease. CONCLUSIONS: Baseline diagnostic evaluation for erectile dysfunction can identify the underlying pathological condition or erectile dysfunction associated risk factors in 80% of patients. Such screening may diagnose reversible causes of erectile dysfunction and also unmask medical conditions that manifest with erectile dysfunction as the first symptom. Specific diagnostic procedures may be limited in patients with primary erectile dysfunction or those without risk factors. Such clinical data support previously published guidelines for erectile dysfunction management.     

兔左室心肌坏死时头胸与常规导联ST段和R波的比较

目的：用头胸导联和常规导联对比观察新西兰兔左室心肌坏死前后心电图ST段抬高和R波幅降低的幅度的差异及意义。方法：用ML2000全同步24导比较心电图仪同步记录新西兰兔左室心肌坏死前后头胸导联和常规导联心电图，对二种心电图的振幅进行比较。结果：左室心肌坏死时，头胸导联R波的振幅减少和ST段的抬高幅度均大于常规导联，以ST段的变化更明显。结论：头胸导联心电图R波降低的幅度、ST段抬高的幅度大于常规导联，在临床上更容易识别和发现。     

酶联免疫吸附测定检测儿童粪便幽门螺杆菌抗原

目的:探讨酶联免疫法检测粪便标本幽门螺杆菌抗原(HpSA)诊断儿童Hp感染的应用价值.方法:采用双抗体夹心酶联免疫吸附测定(ELISA)检测2005年1月至2006年1月门诊、住院的86例患儿怀疑Hp感染的粪便标本,同时与临床试验(快速尿素酶试验、13C-呼气试验)进行比较评价.结果:以快速尿素酶试验、13C-尿素呼气试验联合检测阳性为Hp感染的临床诊断标准,HpSA试验诊断准确率90.7%.粪便抗原试验的敏感度为87.9%,特异度为95.2%,阳性预测值为96.7%,阴性预测值为83.3%.经配对资料x2检验,HpSA检测与联合检测结果差异无统计学意义(x2=0.8,P＞0.05,x0.052=3.84).HpSA试验与13C-尿素呼气试验检测结果差异无统计学意义(x2=0.36,P＞0.05),HpSA试验与快速尿素酶试验检测结果差异有统计学意义(x2=4.92,P＜0.05).结论:粪便标本HpSA试验诊断儿童幽门螺杆菌感染有较高的准确率、敏感度和特异度,为新的简便易行的非侵入性方法.     

中医院校特色英语教学探讨

中医院校的英语教学，其出发点为普通英语，归结点则应抵达中医英语和英译。因而有必要适时将中医英语和英译作为限选课程引入常规的教学模式，以服务于本专业的实践与科研。     

Isolation of enterovirus strains from children with preclinical Type 1 diabetes.

AIMS: To develop methods for isolation of enterovirus strains from subjects with preclinical Type 1 diabetes and evaluate if their presence in stools is associated with beta-cell damage. METHODS: The study subjects were participants of the Finnish Type 1 Diabetes Prediction and Prevention Study (DIPP). The prospectively followed birth cohort comprised 12 children who turned positive for diabetes-associated autoantibodies during the follow-up (case children) and 53 controls matched for date of birth, sex and HLA-DQB1 alleles. Altogether, 878 stool samples were analysed for the presence of enterovirus RNA by RT-PCR followed by virus isolation and partial sequencing of viral genome. Enterovirus antibodies and RNA were simultaneously analysed from serum. RESULTS: Eleven enterovirus infections were diagnosed in case children and 42 infections in control children by the presence of viral RNA in stools. The proportion of children who were repeatedly enterovirus RNA-positive stools was higher among case than control children (42% vs. 11% of children; P=0.02). Combined serum (antibody and RT-PCR) and stool analyses indicated at least one enterovirus infection in 83% of the case children before the appearance of autoantibodies, while only 42% of the control children had infection by the same age (P=0.006). Twelve enterovirus strains were isolated from case children and 38 strains from control children. CONCLUSIONS: This protocol makes it possible to isolate a large number of enterovirus strains from prediabetic subjects. The findings suggest that enterovirus infections may be associated with the beta-cell damaging process.     

Technology--an actor in the ICU: a study in workplace research tradition

Background. The present study focuses on human–machine interaction in an intensive care unit in the West of Sweden. Aims. The aim of the present study was to explore how technology intervenes and challenges the ICU staff's knowing in practice. Theoretical perspective. The study's theoretical starting point draws on workplace research tradition. Workplace studies encompass the interaction between the actors’ situated activities and the technological tools that make their activities possible. Method. Fieldwork or in situ studies of everyday practice in an intensive care unit documented in written field notes constituted the data. Results. The findings show first how technology intervenes in the division of labour when the taken‐for‐granted ‘old’ everyday practice is disrupted when a new machine intervenes in the morning's work; secondly, it reveal how technology challenges practical knowing and thirdly, it shows how technology reformulates practice. Staff members’ awareness of routine problems is often connected to the ability to see, which is always related to cultural/contextual competence. Conclusion. It is concluded that it is not talk alone that helps the caregivers to ‘(dis)solve’ the problems. The ability to see the problems, the work environment and to find the relevant supporting tools for ‘(dis)solving’ the routine problems is also crucial. But it is not possible to say that it is the skillful work of humans that solve problems, nor do we claim it is the tools that do so. Humans and tools are interwoven in the problem‐solving process. Relevance to clinical practice. Routine problems in the intensive care unit are not ‘(dis)solved’ through the cognitive work of individual staff members alone. Problems are also ‘(dis)solved’ jointly with other staff members. Staff members ‘borrow’ the knowing from each other and problems are re‐represented through communication. The knowing has to be distributed among the intensive care unit staff to make the everyday work flexible.     

Healthcare Access and Utilization Among Women 40 and Older at the U.S.-Mexico Border: Predictors of a Routine Check-Up

Mexican Americans are more likely to experience barriers to access and utilization of healthcare services than any other U.S. Hispanic group. In Mexico, where the majority of the population has access to care, the pressing issue is the underutilization of preventive services among adults. This study was conducted to assess access and utilization barriers among a U.S.-Mexico border population. A cross-sectional, population-based survey was conducted during 1999–2000 in a pair of contiguous U.S.-Mexico border communities. Household surveys were administered to U.S. and Mexican women, 40 years of age and older, to assess healthcare access and utilization, participation in chronic disease screenings, orientation toward prevention and personal history of chronic disease. Analysis indicates few statistically significant differences (p < 0.05) among access and utilization variables by country. Mexican participants were more likely to have a regular source of care and to have had a blood sugar test within the past 12 months. U.S. participants more often reported having had a Pap smear and mammogram during the previous year. Factors independently positively associated with having had a routine check-up during the past 12 months included age and having a regular provider or place to go when sick. Only going to the doctor when ill was independently inversely associated with routine check-ups in the past 12 months. Findings suggest that U.S. and Mexican border populations are similar with regard to healthcare access and utilization characteristics. Efforts to increase utilization of preventive health screenings among women are needed at the U.S.-Mexico border.     

Estimating the marginal value of 'better' research output: 'designed' versus 'routine' data in randomised controlled trials

We recently completed a study which demonstrated that the costs of health technology assessment (HTA) by randomised controlled trial (RCT) can be reduced by substituting routine datasets for data designed and collected specifically for a trial. This cost reduction, however, had the effect of reducing the quality of the research output. In the present study we attempted to tease out the values attached to the 'better' information provided by designed data RCTs using a mock grants committee. Two valuation techniques, implied values and willingness to pay, were used. Ex ante valuations were determined by comparing alternative research proposals - a more costly version using designed data and a cheaper version using routine data. Ex post valuations were determined by comparing results of both versions. The exercise was performed on four exemplar studies. Overall, the committee expressed a general lack of trust towards routine data both ex ante and ex post and placed high values on the better information from the designed data studies - particularly information on preferences. This suggests that currently available routine datasets are not perceived to be able to provide efficient alternatives to designed data for RCTs.