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1.
The initial management of bladder outflow obstruction typically related to benign prostatic hyperplasia (BPH) falls to a large extent within the remit of general practice. Referral onwards to secondary care typically arises following the failure to respond to conservative measures or when complications have supervened; the most significant of which is urinary retention. In the hospital setting, anaesthesia, constipation and immobility are the common precipitants. What follows is a practical guide to the management of these situations and provides an overview of the conservative, medical, minimally invasive and surgical treatments available. 相似文献
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Antiplaque agents delivered from toothpastes, gels, or mouthrinses can augment mechanical oral hygiene procedures to control the formation of supragingival plaque and the development of early periodontal disease. Clinically effective antiplaque agents are characterized by a combination of intrinsic antibacterial activity and good oral retention properties. The overall oral retention of an antiplaque agent is determined by the strength and rate of association of the agent with its receptor sites and the accessibility of these sites. The substantivity of an antiplaque agent and its clearance from the oral cavity are determined by the rate of dissociation of the agent from the receptor sites and the salivary composition and flow rate. Positively charged and non-charged organic molecules, metal ions, enzymes, and surface-active agents have all been considered as antiplaque agents. To exert clinical antiplaque activity, an antimicrobial agent must be formulated in a chemically compatible delivery vehicle to give optimal release and uptake to the sites of action in a biologically active form during its time of application. In principle, antiplaque activity may be enhanced by combining antimicrobial agents with broadly similar, but complementary, modes of action. Alternatively, the activity of a single agent may be increased by use of a retention aid to enhance oral substantivity. Substantial evidence exists to demonstrate the validity of the first approach. However, there are few data, as yet, to support the effectiveness of the second. The oral mucosa is the bulk retention site for all clinically proven antiplaque agents. Plaque, the pellicle-coated tooth surface, and saliva are probably all sites of biological action. A detailed understanding of the interactions between agents and the various receptor sites, and of the importance of these receptor sites to biological activity, is generally lacking. 相似文献
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D. Cummins 《ISBT科学丛刊》2007,2(1):249-252
Identification errors remain the most serious and the most common type of error in blood transfusion practice. Adverse events may occur when a patient has similar or identical identifiers to another patient (a ‘doppelgänger’), is doubly registered (a ‘duplicate registration’), or when registration details are derived from two or more separate sources (a ‘hybrid registration’). Such categorization provides a valuable conceptual framework for the development of appropriate risk management strategies. Distinguishing doppelgängers from duplicate registrations is not always easy. A search of the Harefield Hospital Patient Administration System (PAS) database revealed 39 registrations that shared a forename, surname and date of birth with at least one other registration. Thirty‐seven of these cases involved a duplicate registration, one involved a hybrid registration, and one involved a doppelgänger. A national strategic tracing service is available in the UK to help resolve difficult cases. Little attention has been directed at the extent to which risk reduction strategies in this area are in conflict with political and regulatory agendas. Most notable are initiatives that aim to preserve patient confidentiality. The less that is known about an individual, the greater is the risk he will be mistaken for someone who possesses similar identifiers to himself. An important, but largely unexplored, contributor to patient identification errors is innate cognitive bias. The fundamental concept underlying all blood transfusion – unique patient identity – is inherently ambiguous and vulnerable to a range of misperceptions, particularly with regard to the twin themes of coincidence and uniqueness. A major challenge will be to develop approaches in practice and education that are suitably informed by insights gleaned from cognitive and evolutionary psychology. 相似文献
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Prevention of Postinfectious Asthma in Children by Reducing Self-Inoculatory Behavior 总被引:1,自引:0,他引:1
Cortey Donald L.; Gevirtz Richard; Nideffer Robert; Cummins Leo 《Journal of pediatric psychology》1987,12(4):519-531
Recent studies have shown that the spread of infectious nasalsecretions from hand-to-hand or hand-to-object, followed byself-inoculation is an efficient means of viral transmission.The present study was designed to investigate whether self-inoculationbehavior in asthmatic children could be reduced and, if so,whether this reduction would reduce the frequency of infectionand asthma. Sixteen subjects aged 4 to 8, all diagnosed withpostinfectious asthma, were assigned to a treatment (differentialreinforcement of other behavior and contingent education) orplacebo control condition. Results indicate that self-inoculatorybehavior, infection, and asthma were signjficantly reduced.These findings may indicate an important role for behavioralmedicine inpostinfectious asthma. 相似文献
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Background
There is currently an unprecedented expressed need and demand for estimates of maternal mortality in developing countries. This has been stimulated in part by the creation of a Millennium Development Goal that will be judged partly on the basis of reductions in maternal mortality by 2015. 相似文献9.
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Cytomegalovirus Isolation from a Chimpanzee with Acute Demyelinating Disease After Inoculation of Multiple Sclerosis Brain Cells
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Zofia Wroblewska Donald Gilden Mary Devlin Eng-Shang Huang Lucy B. Rorke Takeshi Hamada Toru Furukawa Larry Cummins Seymour Kalter Hilary Koprowski 《Infection and immunity》1979,25(3):1008-1015
A strain of cytomegalovirus (CMV) was isolated during the third subcultivation of explants from the left frontal lobe of a chimpanzee that developed paralysis more than 3 years after intracerebral inoculation at birth with brain cell cultures derived from a patient with multiple sclerosis. Another strain of CMV was also isolated from a lymph node culture taken from the same chimp. The isolates, designated MZM-13 and MZM-14, produced a cytopathic effect characteristic for CMV when inoculated into brain, ganglion, or fibroblast cultures of human or simian origin. Infected cells contained characteristic Cowdry A intranuclear as well as intracytoplasmic inclusion bodies, and 100-nm spherical herpes-like virus particles were detected by electron microscopy in the nucleus and cytoplasm of infected cells. Virus was further identified as CMV with convalescent human anti-CMV serum. Complement-fixing antibody to CMV was present at a titer of 1:32 when the acutely ill chimpanzee was sacrificed. No antibody was detected at birth or at 1 or 2 years of age. A newborn chimpanzee inoculated intracerebrally with MZM-13 developed clinically asymptomatic lesions in the central nervous system characterized by acute and chronic inflammation and degeneration of myelin in cranial and spinal nerve roots. Restriction endonuclease analysis of viral deoxyribonucleic acid isolated from these two viruses indicated that MZM-13 and MZM-14 are identical and are closely related to chimpanzee CMV. No similarity in restriction endonuclease fragment patterns was found between MZM virus and the Towne and Clegg strains of human CMV. 相似文献