Contrast-media-induced nephrotoxicity: a consensus report

The purpose of this study was, using consensus methodology, to document current understanding of contrast media nephrotoxicity (CMN) and to identify areas where there is disagreement or confusion. To draw up guidelines for avoiding CMN based on the current understanding of the condition established by the survey. One hundred sixty-four statements were mailed to 148 members of the European Society of Urogenital Radiology (ESUR) and to 48 experts in the field of CMN. They were asked about the definition, clinical features, predisposing factors and pathophysiology of CMN and about prophylactic measures. The importance of the statements was rated on a scale from 1 to 10 (1 least important, 10 most important). Fifty-three members (38 %) and 23 experts (48 %) responded. Both groups considered that an increase in serum creatinine that peaks within 3–4 days and a decrease in creatinine clearance are the most important (rating > 7) features of CMN. Enzymuria was not considered important (rating < 6). Pre-existing renal insufficiency, diabetic nephropathy, dehydration, congestive heart failure, concurrent administration of nephrotoxic drugs and the dose and type of contrast media were considered to be risk factors. Reduction in renal perfusion and damage to tubular cells were considered the main factors in the pathophysiology of CMN (rating > 6). Hydration and the use of low osmolar contrast media were thought to minimize the incidence of CMN (rating > 6). The majority of the responders (84.6 % of members and 95.5 % of experts) believe that the incidence of CMN in patients with normal renal function is less than 5 %. Of the members, 62.5 %, and 35.3 % of experts, believe that the incidence of CMN is 20–30 % in the presence of risk factors. There was disagreement about the definition of CMN, the threshold dose of contrast media above which renal complications may develop, the safe period between repeat injections, the relevance of contrast media renal retention shown on CT and whether contrast media have long-term effects on renal function. The survey showed good understanding of CMN among those who answered the questionnaires, although areas of disagreement remain which require further research. Simple guidelines are proposed. Received: 11 February 1999; Accepted: 23 March 1999     

Node Status Algorithm for Load Balancing in Distributed Service Architectures at Paperless Medical Institutions

Service architectures are necessary for providing value-added services in telecommunications networks, including those in medical institutions. Separation of service logic and control from the actual call switching is the main idea of these service architectures, examples include Intelligent Network (IN), Telecommunications Information Network Architectures (TINA), and Open Service Access (OSA). In the Distributed Service Architectures (DSA), instances of the same object type can be placed on different physical nodes. Hence, the network performance can be enhanced by introducing load balancing algorithms to efficiently distribute the traffic between object instances, such that the overall throughput and network performance can be optimised. In this paper, we propose a new load balancing algorithm called “Node Status Algorithm” for DSA infrastructure applicable to electronic-based medical institutions. The simulation results illustrate that this proposed algorithm is able to outperform the benchmark load balancing algorithms—Random Algorithm and Shortest Queue Algorithm, especially under medium and heavily loaded network conditions, which are typical of the increasing bandwidth utilization and processing requirements at paperless hospitals and in the telemedicine environment.     

Jade and the journalists: Media coverage of a young British celebrity dying of cancer

In contemporary western societies, dying usually occurs in old age, out of sight in hospitals and institutions; how then do lay people learn what dying is like? Since the 1970s, one source of information in Anglophone societies has come from individuals who have chosen to publicise their dying of cancer. This article examines the most high profile case of this to date in the UK; in 2009, celebrity Jade Goody publicised in tabloid newspapers and celebrity magazines the final weeks of her dying of cervical cancer. What did she and her media say and write about dying? This article examines the print coverage of her final weeks, and four different voices are identified: those of Goody, of journalists, of her publicist, and of photographers, each representing her dying somewhat differently. Two major themes are discussed: Jade’s struggles to retain autonomy (challenged by her disease and by other people), and the framing of her final weeks not primarily as a typical media cancer story of heroism, but as one of redemption in which she attained social respectability through dying.     

在构建医院PACS时应该注意的一些技术问题

医学图像归档及通信系统（PACS）是医学图像处理领域的研究热点，同时对医院建立放射信息系统、医院信息系统有着十分重要的意义。首先对PACS进行了简单介绍，并详细论述了在构建PACS时，会遇到的各种各样的技术问题，并给出了多种方案及它们的优缺点。最后，对这些问题进行了总结。     

Safety assessment of a novel ingredient for removable chewing gum

Rev7™ is an indigestible gum polymer used for the manufacturing of chewing gum. It allows for the formulation of chewing gum with low adhesion; thus can be readily removed from surfaces such as sidewalks, clothing, carpets and furniture. In a toxicological safety assessment, Rev7™ was found to be non-mutagenic in the AMES assay. The highest concentration tested in a mouse lymphoma thymidine kinase locus gene mutation assay induced a slight but biologically relevant increase in mutations under non-metabolic activation conditions after 24 h. Because of this finding, a mouse micronucleus assay was performed, and the test article was found to be negative for inducing chromosomal damage. A 28-day repeated oral toxicity study resulted in a NOAEL of 80,000 ppm; the highest concentration tested. Rev7™ was found to be free from contaminants such as heavy metals, monomers, and solvents. Lastly, Rev7™ did not demonstrate skin-sensitizing properties in the murine local lymph node assay.     

The Diagnostic Value of Radial and Carotid Intima Thickness Measured by High-Resolution Ultrasound for Ischemic Stroke

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Brief report on a systematic review of youth violence prevention through media campaigns: Does the limited yield of strong evidence imply methodological challenges or absence of effect?

BackgroundWe present a brief report on a systematic review which identified, assessed and synthesized the existing evidence of the effectiveness of media campaigns in reducing youth violence.MethodsSearch strategies made use of terms for youth, violence and a range of terms relating to the intervention. An array of academic databases and websites were searched.ResultsAlthough media campaigns to reduce violence are widespread, only six studies met the inclusion criteria. There is little strong evidence to support a direct link between media campaigns and a reduction in youth violence. Several studies measure proxies for violence such as empathy or opinions related to violence, but the link between these measures and violence perpetration is unclear. Nonetheless, some evidence suggests that a targeted and context-specific campaign, especially when combined with other measures, can reduce violence. However, such campaigns are less cost-effective to replicate over large populations than generalised campaigns.ConclusionsIt is unclear whether the paucity of evidence represents a null effect or methodological challenges with evaluating media campaigns. Future studies need to be carefully planned to accommodate for methodological difficulties as well as to identify the specific elements of campaigns that work, especially in lower and middle income countries.     

慢性化脓性中耳炎患者手术前后生活质量调查及其影响因素分析

【目的】探讨慢性化脓性中耳炎（Chronic suppurative otitis media ,CSOM ）患者手术前后生活质量及其影响因素。【方法】选取2010年5月至2015年5月于本院行手术治疗的CSOM患者216例,采用慢性化脓性中耳炎生活质量量表（CSOM‐QOL）及视觉模拟量表（VAS）评价其手术前后生活质量及分析其影响因素。【结果】与手术前相比,患者手术后生活质量总评分、躯体表现、情感异常、医学资源利用、日常活动受限制评分明显较高;患者手术后平均VAS评分显著低于手术前;手术前患者中,年轻、生活在城市、累及双耳、鼓膜穿孔的患者生活质量总评分较低（ P ＜00．5）;手术后患者中,累及双耳、鼓膜穿孔的患者生活质量总评分较高（P ＜00．5）。患者手术前年龄、生活环境、累及耳别、中耳炎类型与生活质量有相关性（P ＜00．5）;手术后累及耳别、中耳炎类型与生活质量有相关性（ P ＜00．5）。【结论】CSOM 患者经手术治疗后生活质量明显改善,累及双耳及病情较严重的患者术后生活质量改善更加明显,可根据生活质量评价选择合适的治疗手段。     

肺动脉MSCT成像碘对比剂剂量优化的实验研究

目的探讨MSCT肺动脉血管成像(MSCTPA)降低碘对比剂剂量的可行性。方法将A-1.50mL/kg、B-1.25mL/kg、C-1.00mL/kg三种不同剂量碘对比剂以1.5mL/s注射速率随机对3只家犬进行8次,共24次MSCTPA。根据原始图像以及容积重现(VR)、最大密度投影(MIP)及多平面重建(MPR)分别对犬肺动脉边缘清晰程度、分支显示情况及肺静脉充盈程度进行评分。结果三者的评价一致性极佳,Kappa值分别为0.84、0.87、0.81。组间评分两两比较差异均无统计学意义。结论降低碘对比剂剂量,可得到良好犬肺动脉CTA图像,为临床优化碘对比剂使用,减少毒副作用提供实验依据。     

A course for nurses to handle difficult communication situations. A randomized controlled trial of impact on self-efficacy and performance

Objective

To evaluate the impact of a communication skills course for nurses on how to handle difficult communication situations in their daily work.

Methods

A 7-h course was developed using a construct of “Awareness, Feelings, Listen, Solve” (AFLS). A pedagogy of experiential, learner-centered learning was adopted. The course evaluation used a randomized controlled design with pre- and post-measures of self-efficacy and performance.

Results

Forty-one nurses volunteered and thirty-three nurses completed all assigned parts of the study. On self-assessment, there was significant improvement for self-efficacy (F = 24.43, p < 0.001), but not for emotional awareness. On performance, there was no significant improvement between intervention and control groups (F = 3.46, p = 0.073).

Conclusion

A short course for nurses on handling difficult communication situations achieved significant improvements in self-efficacy but not in performance.

Practice implications

Teaching communication skills in community-based settings is important for the safety and effectiveness of patient care. Sponsoring organizations should weigh trade-offs between feasibility and achievement of measurable improvements in performance. One possible approach is to focus on specific communication skills rather than a full suite of skills.