The vicious circle between physical,psychological, and physiological characteristics of shift work in nurses: a multidimensional approach

Sleep and Breathing - To compare physical, psychological, and physiological adaptations between rotating and morning shift health workers using objective and subjective approaches. Forty nurses...     

Climatological variations in daily hospital admissions for acute coronary syndromes

OBJECTIVE: We examined the association between climatologic parameters and daily admissions for non-fatal acute coronary syndromes (ACS) to emergency units of hospitals in the greater Athens area, from January 2001 to August 2002. METHODS: Daily mean, maximum and minimum temperatures, relative humidity, wind speed, barometric pressure and a thermo-hydrological index (T.H.I.) were measured at the meteorological station of the Laboratory of Climatology of the Geology Department of the University of Athens. In addition, the daily number of admissions for acute myocardial infarction or unstable angina in the five major general hospitals in the greater Athens area was recorded. Generalized additive models (GAM) were applied to regress-time-series of daily numbers of outpatients with acute cardiac events against climatological variations, after controlling for possible confounders and adjustment for over dispersion and serial correlation. RESULTS: Five thousand four hundred fifty-eight Athenians with non-fatal acute cardiac events were admitted to the selected hospitals during the period of the study, 4093 (75%) males and 1365 (25%) females. There was a negative correlation between hospital admissions and mean daily temperature (MDT) with a 1 degrees C decrease in mean air temperature yielding a 5% increase in hospital admissions (P<0.05). This association was stronger in females and the elderly (P<0.01). Relative humidity was positively correlated with hospital admissions (P<0.05). CONCLUSION: Despite the relatively short study period (<2 years), these findings suggest a significant association between cold weather and increased coronary heart disease incidence, especially in the elderly and females.     

Assessment of patient effective radiation dose and associated radiogenic risk from extracorporeal shock-wave lithotripsy

The aim of the present study was to calculate patient effective dose and associated radiogenic risk from fluoroscopy guided extracorporeal shock-wave lithotripsy procedures. Fluoroscopy required during extracorporeal shock-wave lithotripsy was classified in two types identified by beam orientation: antero-posterior and 30 degrees anterior-oblique projected exposures. Duration of each exposure was monitored in 124 patients undergoing extracorporeal shock-wave lithotripsy treatment for ureteral stones. The dose from a kidney-ureter-bladder radiograph and the dose per min of fluoroscopy along antero-posterior and anterior-oblique projections were measured at 13 organs/tissues using an anthropomorphic phantom and thermoluminescence dosimetry. A radio-opaque object was placed in the phantom to simulate an ureteral stone at the proximal and distal ureter. The total effective dose in male and female patients with proximal ureteral stones was 1.71 mSv and 1.82 mSv, respectively. The corresponding values for male and female patients with distal ureteral stones was 0.76 mSv and 1.62 mSv, respectively. In the United States, the theoretical sex-averaged radiogenic excess of fatal cancers was estimated to be 140 per million and 85 per million of patients treated for proximal and distal ureteral stone, respectively. The average radiogenic risk for genetic defect associated to treatments of proximal and distal ureteral stones was found to be 2.5 and 24.4 per million of births, respectively. The radiation risk from a typical fluoroscopy guided extracorporeal shock-wave lithotripsy treatment of ureteral stones is low. Presented data may be used to determine patient effective dose from extracorporeal shock-wave lithotripsy procedures performed in any laboratory.     

Unusual retrograde movement of a safety-pin ingested by an infant

Here we present the first reported case of an ingested open safety-pin in a 7-mo-old boy that migrated from the stomach to the oesophagus. CONCLUSION: This rare complication is probably due to a gastro-oesophageal reflux effect, and for this reason we propose that all infants with safety-pins and other sharp objects in the stomach should be positioned in a semi-upright position.     

Unicornuate uterus and uterus didelphys indications and techniques for surgical reconstruction: a review

Unicornuate uterus and uterus didelphys consist of miscellaneous congenital malformations of the female genital system. These anomalies can cause many gynecological and obstetrical complications including infertility, ectopic pregnancy, recurrent abortions and preterm deliveries. Laparoscopy and hysteroscopy are two helpful operative procedures in establishing an accurate diagnosis and treating effectively. A case of a patient with unicornuate uterus and longitudinal vaginal septum, who presented at our hospital suffering from infertility, is reported.     

Assessment of sperm chromatin condensation and ploidy status using flow cytometry correlates to fertilization,embryo quality and pregnancy following in vitro fertilization

Purpose  

Sperm flow cytometry (SFC) was used to evaluate the association of sperm chromatin condensation and ploidy with fertilization, embryo development, pregnancy and abortion rates following IVF.     

Acute Tc-99m DMSA scan for identifying dilating vesicoureteral reflux in children: a meta-analysis

Controversy exists regarding the type and/or sequence of imaging studies needed during the first febrile urinary tract infection (UTI) in young children. Several investigators have claimed that because acute-phase Tc-99m dimercaptosuccinic acid (DMSA) renal-scan results are abnormal in the presence of dilating vesicoureteral reflux, a normal DMSA-scan result makes voiding cystourethrography (VCUG) unnecessary in the primary examination of infants with UTI. To evaluate the accuracy of acute-phase DMSA scanning in identifying dilating (grades III through V) vesicoureteral reflux documented by VCUG in children with a first febrile UTI, we performed a meta-analysis of the accuracy of diagnostic tests as reported from relevant studies identified through the PubMed and Scopus databases. Patient-based and renal unit-based analyses were performed. Overall, 13 cohort studies were identified. Nine studies involved patients younger than 2 years, 3 involved children aged 16 years or younger, and 1 involved exclusively neonates. Girls constituted 22% to 85% of the involved children. Pooled (95% confidence intervals) sensitivity and specificity rates of DMSA scanning were 79% and 53%, respectively, for the patient-based analysis (8 studies) and 60% and 65% for the renal unit-based analysis (5 studies). The respective areas under the hierarchical summary receiver operating curves were 0.71 and 0.67. Marked statistical heterogeneity was observed in both analyses, as indicated by I(2) test values of 91% and 87%, respectively. Acute-phase DMSA renal scanning cannot be recommended as replacement for VCUG in the evaluation of young children with a first febrile UTI.     

Determining population based mortality risk in the Department of Veterans Affairs

We develop a patient level hierarchical regression model using administrative claims data to assess mortality outcomes for a national VA population. This model, which complements more traditional process driven performance measures, includes demographic variables and disease specific measures of risk classified by Diagnostic Cost Groups (DCGs). Results indicate some ability to discriminate survivors and non-survivors with an area under the Receiver Operating Characteristic Curve (C-statistic) of .86. Observed to expected mortality ranges from .86 to 1.12 across predicted mortality deciles while Risk Standardized Mortality Rates (RSMRs) range from .76 to 1.29 across 145 VA hospitals. Further research is necessary to understand mortality variation which persists even after adjusting for case mix differences. Future work is also necessary to examine the role of personal behaviors on patient outcomes and the potential impact on population survival rates from changes in treatment policy and infrastructure investment.     

Duodenal duplication. Is ultrasound appearance enough to confirm the diagnosis?

A case of duodenal duplication is reported. It is a rare anomaly and is commonly discovered during infancy. Symptoms of partial obstruction dominate the clinical picture. Abdominal ultrasound (US) seems to be the best method to confirm the diagnosis especially when the two-layer pattern is present. In our case the radiological evaluation apart from US comprised plain film of the abdomen, upper gastrointestinal series and CT scan. The diagnosis of duodenal duplication made by US examination as well as by gastrointestinal series and CT scan was confirmed surgically. We consider that when at US the sign of two-layer pattern is present there is no need for further radiological evaluation for alimentary tract duplication.