A method for studying inhibitory activity in whole urine

Summary A method has been developed for inducing and quantifying calcium oxalate crystallisation in whole human urine. The propensity of a given urine to induce crystal formation was described in two ways: 1) its ability to resist spontaneous nucleation of calcium oxalate crystals was assessed by titrating 20 mls of the urine with increasing quantities of sodium oxalate (0–150 mol) to determine its practical metastable limit. This limit was inversely related to the endogenous calcium concentration. 2) its capacity to inhibit crystal growth was quantified by determining the rate of growth of calcium oxalate crystals precipitated in response to a fixed oxalate load (30 mol) above its metastable limit. The crystals produced were predominantly calcium oxalate dihydrate and were morphologically identical to those occurring naturally in urine. Citrate had no effect on the metastable limits of 3 urines examined, but markedly inhibited crystal growth. Pyrophosphate had a similar effect on crystal growth, and in addition, raised the metastable limit of one of the urine samples.     

Younger Nursing Home Residents: A Scoping Review of Their Lived Experiences,Needs, and Quality of Life

ObjectivesThe percentage of younger nursing home (NH) residents (ages 18–64 years) in some countries such as the United States and Canada has been increasing over the years. In fact, it is generally held that younger NH residents are considerably different from the older residents (age ≥65 years). There is a need to understand who they are, why they resided in NHs, and their quality of life (QoL). The aims of the study were to describe the experiences, needs, and QoL among younger residents living in NHs.DesignScoping review.Settings and Participants(Younger) Residents of NHs.MethodsFive databases (PubMed, CINAHL, PsycINFO, Web of Science, and Scopus) and Google Scholar were used to search for relevant studies. PRISMA diagram was used to guide this scoping review.ResultsThe key findings of the study cover 5 themes: (1) Confinement, (2) Lack of socialization, (3) Lack of privacy, (4) Lack of appropriate settings, and (5) Loss of identity, as well as results of QoL were generated.Conclusions and ImplicationsThis scoping review provides a deeper understanding of the lived experiences, needs, and QoL among younger NH residents. The results provide suggestions for future studies regarding new interventions to optimize the QoL of NH residents.     

A Local COVID-19 Support Platform for Nursing Homes: Feedback and Perspectives

The COVID-19 pandemic has had a major impact on nursing homes (NHs), which were not prepared to manage infections among their at-risk patient populations. In order to comply with the French government's guidelines, we rapidly set up a local support platform (LSP) to help NHs manage their cases of COVID-19. The LSP comprised multidisciplinary decision support, a specialist phone hotline, mobile geriatric medicine teams, and videoconferences on COVID-19.We first quantified the LSP's interventions in 63 local NHs since the start of the first wave of COVID-19 (March 2020): 9 instances of multidisciplinary decision support, 275 calls to the specialist phone hotline, 84 interventions by mobile geriatric medicine teams, and 16 videoconferences. The LSP had been used during and between the first and second waves of the epidemic, and all had evolved to meet the NHs' needs.     

Absence of COVID-19 Disease Among Chronically Ventilated Nursing Home Patients

ObjectiveTo describe the experience of COVID-19 disease among chronically ventilated and nonventilated nursing home patients living in 3 separate nursing homes.DesignObservational study of death, respiratory illness and COVID-19 polymerase chain reaction (PCR) results among residents and staff during nursing home outbreaks in 2020.Setting and Participants93 chronically ventilated nursing home patients and 1151 nonventilated patients living among 3 separate nursing homes on Long Island, New York, as of March 15, 2020. Illness, PCR results, and antibody studies among staff are also reported.MeasurementsData were collected on death rate among chronically ventilated and nonventilated patients between March 15 and May 15, 2020, compared to the same time in 2019; prevalence of PCR positivity among ventilated and nonventilated patients in 2020; reported illness, PCR positivity, and antibody among staff.ResultsTotal numbers of deaths among chronically ventilated nursing home patients during this time frame were similar to the analogous period 1 year earlier (9 of 93 in 2020 vs 8 of 100 in 2019, P = .8), whereas deaths among nonventilated patients were greatly increased (214 of 1151 in 2020 vs 55 of 1189 in 2019, P < .001). No ventilated patient deaths were clinically judged to be COVID-19 related. No clusters of COVID-19 illness could be demonstrated among ventilated patients. Surveillance PCR testing of ventilator patients failed to reveal COVID-19 positivity (none of 84 ventilator patients vs 81 of 971 nonventilator patients, P < .002). Illness and evidence of COVID-19 infection was demonstrated among staff working both in nonventilator and in ventilator units.Conclusions and ImplicationsCOVID-19 infection resulted in illness and death among nonventilated nursing home residents as well as among staff. This was not observed among chronically ventilated patients. The mechanics of chronic ventilation appears to protect chronically ventilated patients from COVID-19 disease.     

Determinants and Consequences of Adolescent Fatherhood: A Longitudinal Study in Ethiopia,India, Peru,and Vietnam

PurposeAdolescent parenthood is a major challenge in low- and middle-income countries (LMICs). However, the vast majority of the evidence has focused on adolescent motherhood. Little is known about adolescent fatherhood in LMICs. The aim of this study was to examine the determinants of early fatherhood and its consequences on a range of outcomes among adolescent males.MethodsThis study used three waves of longitudinal data from the multicountry Young Lives cohort study, specifically following a sample of 1,779 adolescent boys at ages 15, 19, and 22 years in Ethiopia, India, Peru, and Vietnam. Individual fixed effects models were conducted to investigate the sociodemographic determinants of adolescent fatherhood and the consequences of adolescent fatherhood on males' education, health, psychosocial well-being, and time use outcomes.ResultsThe results indicated that lower educational attainment, absence of the adolescent's mother and father from the home, larger household size, and poverty increased the likelihood of becoming an adolescent father by age 22 years. The results revealed that becoming an adolescent father was associated with a higher likelihood of school dropout, being overweight, smoking, greater internalizing problems, and less time spent on leisure activities and more time spent on caregiving responsibilities.ConclusionsHighlighting the experiences of young men as adolescent parents in LMICs, findings underscore the importance of prevention strategies to delay early parenthood for adolescent boys and multicomponent interventions to support young fathers and their unique health, socioeconomic, psychosocial, and behavioral needs.     

口腔修复科进修医师接诊前培训探析

为了提高进修医师的教学质量和医疗水平,我们在2006届进修医师教学工作中加强和细化了进修医师接诊前的培训,取得了良好的效果.实践证明,实施接诊前培训对于提高进修医师的医疗水平和自信心,实施规范化操作,克服诊疗中的盲目性,减少或避免医疗纠纷,进而提高进修医师的教学质量具有重要意义,值得推广和借签.     

Variability in cesarean delivery rates among individual labor and delivery nurses compared to physicians at three attribution time points

ObjectiveTo examine the variability in the cesarean delivery (CD) rates of individual labor and delivery nurses compared with physicians at three attribution time points.Data SourcesMedical record data from nine hospitals in Washington State from January 2016 through September 2018.Study DesignRetrospective, observational cohort design using an aggregated database of birth records.Data Collection/Extraction MethodsChart‐abstracted clinical data from a subset of nulliparous, term, singleton, vertex births attributed at admission, labor management, and delivery to nurses and physicians. Two classification methods were used to categorize nurse‐ and physician‐level CD rates at three attribution time points and the reliability of these methods compared.Principal FindingsThe sample included 12 556 births, 319 nurses, and 126 physicians. Overall, variation in nurse‐level CD rates did not differ significantly across the three attribution time points, and the extent of variation was similar to that observed in physicians. However, agreement between attribution time points varied between 35 percent and 65 percent when classifying individual nurses into the top and bottom deciles. The average reliability of nurse‐level CD rates was 32 percent at admission (IQR 22.0 percent to 38.7 percent), 32.6 percent at labor (IQR 23.1 percent to 40.9 percent), and 29.3 percent (IQR 20.9 percent to 35.8 percent) at delivery. The average reliability of physician‐level CD rates was higher: 54.2 percent (IQR 38.7 percent to 71.4 percent) at admission, 62.5 percent (IQR 49.0 percent to 79.6 percent) at labor management, and 66.1 percent (IQR 53.7 percent to 81.2 percent) at delivery.ConclusionFeedback on nurse‐level CD rates as part of routine clinical quality audits can provide insight into nurse performance in the context of other individual‐level and unit‐level information. To reliably distinguish individual nurse performance, larger sample sizes are needed.     

The concept of distinct but voluminous groups of bipolar and unipolar diseases

Summary One hundred and six affective (76 unipolar and 30 bipolar) and 101 schizoaffective patients (45 unipolar and 56 bipolar) were investigated after a long-term course of illness, evaluating sociodemographic and general data, the long-term course of illness, disability and psychosocial alterations according to WHO/DAS, WHO/PIRS and GAS, as well as several social consequences of the illness (living situation at the end of the observation time, downward occupational drift, downward social drift, premature retirement, achievement of the expected social development). Comparing the 30 bipolar affective and 56 bipolar schizoaffective disorders, no differences were found regarding (a) sociodemographic and general data (i.e. sex distribution, age at onset, education and occupation at onset, stable heterosexual relationship, premorbid personality and social interactions, mental illness in the family, broken home, life events, season of birth and social classes) and (b) relevant patterns of the long-term course. Regarding long-term out-come the only difference found concerned the more favourable outcome of the bipolar affective disorders according to WHO/DAS, while using GAS the difference was not statistically significant. No difference was found either between the two bipolar groups in the social consequences of the illness. The combining of both bipolar groups as bipolar diseases is discussed, as well as the use of the terms bipolar disease, affective subtype and bipolar disease, schizoaffective subtype.     

Nursing home residents' perceptions of relocation

Summary

• ? The lived experience of relocating to a nursing home is explored from the perspective of 19 residents of Australian nursing homes.
• ? The interpretative research methodology is informed by hermeneutic phenomenology.
• ? In-depth interviews were conducted with 19 nursing home residents living in nursing homes in NSW. Interviews were audiotaped, transcribed and analysed to identify emergent themes.
• ? The themes are described and interpreted to provide an understanding of the relocation experience.