Middle turbinate lateralization: a simple treatment for rhinologic headache

OBJECTIVE: To introduce a minimally invasive method to eliminate the symptoms of contact-point rhinologic cephalgia. STUDY DESIGN: A prospective study of 55 patients with chronic nasal or glabellar pain and endoscopically proven nasal origin. METHODS: All 55 patients in whom endoscopic examination demonstrated a contact point between the middle turbinate and the nasal septum were treated by fracturing the middle turbinate lateralward using a small metal tongue depressor under 10% lidocaine HCL topical anesthesia. RESULTS: Of the treated cohort, 48 (87%) of the patients had complete clinical symptom resolution after one treatment and all had resolution after two treatments. Recurrence occurred in 1 patient. There were no short-term or long-term adverse sequelae. The results persisted at a mean follow-up time of 50 months (range, 6-84 mo). CONCLUSION: Middle turbinate lateralization is safe and effective in eliminating the symptoms of rhinologic cephalgia induced by contact point between the middle turbinate and nasal septum.     

基层医院住院病人对护理工作满意度调查分析

目的 提高患对护理工作的满意度。方法 采用问卷调查法,每卷20项内容,每项内容评价分很满意、较满意、不满意。对470例住院病人进行护理工作综合满意度调查分析。结果 470例患对护理工作很满意率＞90％的项目有入院时护士热情接待,介绍病区环境制度,主动巡视病房与患交谈,帮助病员解决问题,了解患睡眠状况,及时更换床单、病员服,患知道责任护士,对护士技术、病区环境均满意。满意率＜805有护士做到服药到口,向患介绍药物作用及疾病知识、饮食知识、康复指导,80％－90％有患向护士询问疾病知识回答满意,护士治疗中介绍注意问题,护士长常深入病房征求意见。结论 加强护理人员的培训力度,多项激励措施,有效实施健康教育,评价患的满意度等措施。提高了患护理工作满意度。     

Outcomes of a community-based dissemination of the health enhancement program

OBJECTIVES: We previously found in an efficacy trial that a health promotion program prevented functional decline and reduced hospitalizations in community-dwelling older people with chronic conditions. We sought to evaluate the effectiveness of the program in its dissemination phase. DESIGN: Outcome evaluation using a within-group, pretest-posttest design. SETTING: Fourteen senior centers located throughout western Washington. PARTICIPANTS: Three hundred four community-dwelling men and women aged 65 and older. INTERVENTION: A disability-prevention, chronic disease-self-management program. MEASUREMENTS: Participant characteristics, risk factors for disability, change in health and functional status, and healthcare use over 1 year of enrollment; participant satisfaction. RESULTS: Participants were 71% female, had a mean age of 76, and reported three chronic health conditions on average. The percentage of participants found to be depressed decreased (28% at time of enrollment vs 17% at 1-year follow-up, P =.005). The percentage of physically inactive participants decreased (56% vs 38%, P =.001). Physical activity level and exercise readiness improved (Physician-based Assessment and Counseling for Exercise mean score 4.3 vs 5.1, P =.001). At follow-up, 83% rated their health the same as or better than a year ago, compared with 73% at time of enrollment. The proportion with impaired functional status, as measured by bed days and restricted activity days, stayed the same. The proportion hospitalized remained stable (23% at enrollment and follow-up, P = 1.0). CONCLUSIONS: Under real world conditions, the Health Enhancement Program reaches older people at risk of functional decline. Those enrolled for 1 year experience a reduction in disability risk factors, improvement in health status, no decrements in functional status, and no increase in self-reported healthcare use.     

Asthma management efficacy of school nurses in Taiwan

As the key health care providers in school settings, the school nurses' asthma management efficacy is crucial to children's health and their continued participation in school learning activities. This article describes the psychometric testing of the asthma management efficacy scale (AMES) for use with school nurses. A cross-sectional survey design was used to assess the asthma management efficacy of 60 school nurses in Taipei, Taiwan. Factor analysis resulted in four factor domains including asthma medication administration, asthma pattern identification, school management behaviour, and monitoring peak expiratory flow rate which explained 76.4% of the variance in school nurses' asthma management efficacy. The school nurses' experience in performing school asthma management activities was positively correlated to their asthma management efficacy (r=0.33, p<0.05). School nurses who had experience with the inhaled asthma medicines had significantly higher efficacy scores on the medication administration subscale (t=-2.89, p<0.01) than did the school nurses who lacked this experience. School nurses who had experience in using peak expiratory flow meters had significantly higher efficacy scores on the total AMES (t=-1.90, p<0.05) and on the monitoring peak expiratory flow rate subscale (t=-5.37, p<0.001) than the school nurses who lacked this experience. Given the need to have nurses who are well prepared to provide asthma care in school settings, implications for nursing education, practice, and further research are discussed.     

Quantitative assessment of chondrocyte viability after laser mediated reshaping: a novel application of flow cytometry

BACKGROUND AND OBJECTIVES: Lasers can be used to reshape cartilage by accelerating mechanical stress relaxation. In this study, fluorescent differential cell viability staining and flow cytometry were used to determine chondrocyte viability following laser heating. STUDY DESIGN/MATERIALS AND METHODS: Porcine septal cartilages were irradiated with an Nd:YAG laser (lambda = 1.32 microm, 25 W/cm(2)) while surface temperature, stress relaxation, and diffuse reflectance were recorded. Each slab received one, two, or three laser exposures (respective exposure times of 6.7, 7.2, 10 seconds). Irradiated samples were then divided into two groups analyzed immediately and at 5 days following laser exposure. Chondrocytes were isolated following serial enzymatic digestion, and stained using SYTO/DEAD Red (Molecular Probes, Eugene, OR). A flow cytometer was then used to detect differential cell fluorescence; size; granularity; and the number of live cells, dead cells, and post-irradiation debris in each treatment population. RESULTS: Nearly 60% of chondrocytes from reshaped cartilage samples isolated shortly after one irradiation, were viable while non-irradiated controls were 100% viable. Specimens irradiated two or three times demonstrated increasing amounts of cellular debris along with a reduction in chondrocyte viability: 31 and 16% after two and three exposures, respectively. In those samples maintained in culture medium and assayed 5 days after irradiation, viability was reduced by 28-88%, with the least amount of deterioration in untreated and singly irradiated samples. CONCLUSIONS: Functional fluorescent dyes combined with flow cytometric analysis successfully determines the effect of laser irradiation on the viability of reshaped cartilage.     

面对"突发公共卫生事件"的医疗器械监管

在“非典”疫情蔓延时期,医疗器械发挥了重大作用,但同时也暴露出医疗器械监管的一些问题。本文回顾总结“非典”时期医疗器械监管工作．指出在“非典”后,医疗器械监管更需严格日常监管和力求帮促到位,并提出一些建设性的意见。     

An in vitro investigation for vaginal bioadhesive formulations: bioadhesive properties and swelling states of polymer mixtures

Bioadhesive tablet formulations have been developed for mucosal application. Sixteen different bioadhesive tablet formulations were prepared and evaluated. Their bioadhesion to vaginal mucosa were studied by tensile testing method. The swelling behaviour of the tablets in three different solutions was also investigated. In addition, the effect of the formulations on pH of the medium was followed. The most favorable formulation resulted a mixture of Carbopol 934 and Pectin (2:1). The highest bioadhesive strength, the highest swelling volume and the lowest pH reduction were obtained with this formulation.     

The Effect of Blood Sampling Site and Physicochemical Characteristics of Drugs on Bioavailability After Nasal Administration in the Sheep Model

Purpose. Investigate the effect of blood sampling site and physicochemical characteristics of drugs on the pharmacokinetic (PK) parameters obtained after intravenous and nasal administration in sheep and compare results with computer simulations. Methods. Three drugs, insulin, morphine, and nicotine, were administered nasally and by intravenous (IV) injection to sheep, and serial blood samples collected concurrently from the carotid artery (insulin, morphine) or cephalic vein (nicotine) and jugular vein. Plasma drug concentrations were measured, and pharmacokinetic and statistical analyses performed, to evaluate sampling site differences. Results. After nasal insulin, bioavailabilities calculated from the two blood sampling site data were comparable. In contrast, apparent bioavailabilities following nasal morphine or nicotine were significantly higher when sampling was from the jugular vein. These results were supported by computer simulations. These observations are attributed to the greater effects of noninstantaneous mixing of drugs for jugular vein sampling following nasal dosing, compared to the other sampling sites, which is significant for drugs that are rapidly and well absorbed and that have a high volume of distribution (V_d). Conclusion. The results clearly show that the characteristics of the drug and the blood sampling site can have a significant effect on the pharmacokinetic results obtained after nasal administration in sheep.     

Nasal continuous positive airway pressure and outcomes of preterm infants

OBJECTIVES: To document the effects of changing to a primarily nasal continuous positive airway pressure (CPAP)-based system of respiratory support on respiratory and non-respiratory outcomes in preterm infants. METHODOLOGY: Outcomes in two groups of preterm infants with a birthweight of 1000-1499 g were compared retrospectively over a 5-year period before (period I; n = 57) and after (period II; n = 59) the introduction of a primarily nasal CPAP-based approach to respiratory support, modelled closely on that used at the New York Presbyterian Hospital (Columbia University), formally known as the Columbia-Presbyterian Medical Center, in New York. RESULTS: From period I to period II, there was a decline in the number of infants ventilated (65 vs 14%, respectively) and receiving surfactant (40 vs 12%, respectively) and in the median days of ventilation (6 vs 2, respectively) and oxygen (4 vs 2, respectively). There were decreases in chronic lung disease (CLD) at 28 days (11 vs 0%, respectively), death or CLD at 28 days (16 vs 3%, respectively), the use of pressor support (34 vs 7%, respectively), the incidence of necrotizing enterocolitis (11 vs 0%, respectively), time to reach full oral feeds (17.3 vs 13.2 days, respectively), discharge weight (2569 vs 2314 g, respectively) and average length of stay (61 vs 52.9 days, respectively). There were no differences in neurosonographic or other morbidity outcomes. CONCLUSIONS: A CPAP-based approach to respiratory support of the preterm infant may decrease the invasiveness and duration of respiratory support and may decrease respiratory and some non-respiratory adverse outcomes without an associated increase in neurosonographic or other morbidity outcomes. Further prospective trials are warranted.     

Nasal glioma presenting as capillary haemangioma

We report the case of a 5-month-old female infant with a congenital nasal tumour originally attributed to a capillary haemangioma. Doppler-flow ultrasound imaging revealed a solid mass surrounded by mildly enlarged vessels which had a flow pattern atypical of haemangioma. Histology showed non-malignant gliomatous cells with low proliferative activity. A diagnosis of nasal glioma was thus established and the patient underwent cranial MRT which excluded intracranial communication of the nasal glioma. Nasal gliomas arise from a skull defect, originating from the defective closure of the anterior neuroporus. They represent encephaloceles which have lost their intracranial connection. Nasal gliomas usually present shortly after birth as an intranasal obstruction or, as in our case, as a mostly extranasal tumour. Conclusion Nasal glioma is often misdiagnosed as a capillary haemangioma. It can be distinguished from the latter by Doppler-flow ultrasonography. Magnetic resonance imaging is required to exclude intracranial communication. Received: 4 March 2000 and in revised form: 19 May 2000 / Accepted: 19 May 2000