An outbreak of urticarial form of swine erysipelas in a medium-scale piggery in Kiambu District, Kenya

The influence which female sexual steroids, especially estrogen, have on the development of cancer has not only been shown epidemiologically, but also by experimental findings. Hormones, in spite of a known marginal increase in the risk of thrombosis and endometrial cancer, play an important role in the preventive cancer medication (oral contraceptives: ovarian and endometrial cancer; chemoprevention: high-risk breast cancer patients). Basically, hormone replacement therapy should be administered to all patients suffering from gynecological malignomas. In the case of patients suffering from breast cancer, the advantages of hormone replacement therapy (e.g., less risk of cardiovascular complications) need to be weighed against the disadvantages.     

Periodontal health status of patients attending Diabetic Clinic at Kenyatta National Hospital, Nairobi, Kenya

In this study, we tested the effectiveness of Rifaximin, a surface antibiotic which is not absorbed when given orally, in the eradication of Helicobacter pylori (HP). The drug was combined in triple therapy either with Amoxicillin and Omeprazole or with Erythromycin-ethylsuccinate and Omeprazole. Twenty-three patients complaining of dyspeptic symptoms and gastric infection due to HP were evaluated. The patients were randomly given one of the following therapeutic protocols: Rifaximin susp. 600 mg/day x 3/day (at least two hours after meals: 10:00 am, 2:00 pm, 9:00 pm), Amoxicillin tab. 1 g x 2/day (at least two hours after meals: 10:00 am, 9:00 pm), Omeprazole tab. 40 mg/day (in the morning before breakfast) (protocol A) and Rifaximin susp. 600 mg/day x 3/day and Erythromycin-ethylsuccinate tab. 600 mg x 3/day (at least two hours after meals: 10:00 am, 2:00 pm, 9:00 pm), Omeprazole tab. 40 mg/day (in the morning before breakfast) (protocol B). Both therapeutic protocols were prescribed for two weeks. At least one month after the end of the treatment the patients were controlled to ascertain eradication of the infection. The follow-up carried out after treatment showed that HP infection was eradicated in 6 of 10 patients in the first group (protocol A) and in 1 of 10 in the second group (protocol B). These patients were HP-negative in all the tests performed: histological, CP-TEST, culture test. The data collected showed a reasonable level of effectiveness of the protocol using the combination Rifaximin-Amoxicillin and Omeprazole. However, they do not differ from the reported data in the literature which show a similar effectiveness of the combination Omeprazole-Amoxicillin at the same doses. Different formulations that makes it possible for the drug to reach these "protected areas" would probably be more effective.     

Hospital catchment areas and surgery in Meru district, Kenya

The surgical treatment of chronic epilepsies is increasing rapidly. A review of 279 surgical specimens of patients with chronic pharmaco-resistant epilepsies from the University of Bonn Medical Centre revealed specific histopathological findings in 89% of all well-preserved specimens. The most frequent focal lesions were low-grade brain tumours such as gangliogliomas, pilocytic astrocytomas and dysembryoplastic neuroepithelial tumours. Other common findings were glioneuronal and vascular malformations and Ammon's horn sclerosis. This suggests that chronic intractable epilepsies are frequently caused by structural alterations.     

Caregivers' expectations of services at Baragwanath Hospital, Soweto and their understanding of the child's disability

Sixty-one caregivers were interviewed before and after their first visit with the child in their care to specialist neurodevelopmental outpatient clinics at Baragwanath Hospital, Soweto. The interview focused on their understanding of the child's disability and their expectations of the service offered at the clinics. Before consultation the majority of caregivers had a fair understanding of the child's functional problems and the short-term complications, but after the consultation levels of understanding decreased significantly. Caregivers left the consultation with a significantly improved understanding of the aetiology of the problem. Understanding of long-term complications did not differ significantly before and after the consultation. These findings may reflect the consultative process, as professionals may be more comfortable discussing aetiology than long-term complications. Caregivers in a state of shock may be unable to absorb all the information given, and translation during consultation may also be a confounding factor. Even though more than half the caregivers had no idea what services the clinics offered prior to the consultation, the majority (81%) indicated they were satisfied with the service after the consultation.     

成本核算在医院经营管理中的作用

由于医院成本意识淡薄,成本管理弱化,卫生资源利用效率不高,只有加强成本管理实行成本核算,才能有效地促使医院以较少的成本投入,取得较好的医疗服务效果,达到社会效益和经济效益的最佳结合,走优质、高效、低耗的可持续发展之路.     

Determinants of Economic Cost Related to Low Back Pain among Nurses at a University Hospital

Little is known of the genetic factors that may contribute to the development of chronic idiopathic thrombocytopenic purpura (cITP). We have previously shown that a developmentally regulated Vh gene (Humhv3005) is absent in 10/41 (24%) of patients with systemic lupus erythematosus while it is absent in only 7/88 (8%) of normal controls. This finding suggests that a homozygous deletion of an Ig variable (V) gene may alter the immune system and thus predispose the host to an autoimmune disorder. We have analyzed the same gene in 44 patients with cITP and found that Humhv3005 and like genes were absent in a higher percentage of patients (14 of 44, 31.8%) than they were absent in either normals (7/88, 8%, p = 0.002) or thrombocytopenic patients without cITP (6/53, 11.3%, p = 0.042); the hv3005 deletion frequency in the latter group did not differ from that in normals (P = 0.74). These data suggest that deletions of Humhv3005 and/or highly homologous Vh genes may predispose individuals to the development of cITP, and may contribute toward production of pathogenic antiplatelet antibodies.     

成本核算在医院管理中的应用和发展

通过成本核算在医院管理中的应用,总结医院开展成本核算的意义,分析开展成本核算过程中遇到的难点,寻找解决难点的方法,从而更好地发挥成本分析评价和成本控制的职能,达到降低医疗服务成本和医院运营成本的目的,构建低成本经营优势.     

Maxillofacial trauma at RAF War Hospital, Wroughton

The following article is a historic look at maxillofacial trauma at the Royal Air Force War Hospital at Wroughton from D-Day to VE Day. The article describes the pattern of injury and the management of personnel injured on the Continent and evacuated to Wroughton by air ambulance.     

Use by visitors of the services of the Queen Elizabeth Hospital, Barbados, W.I

The successful excision of genitourinary malignancies extending to the inferior vena cava relies heavily on accurate preoperative imaging. For the majority of these patients magnetic resonance imaging, inferior venacavography, abdominal ultrasound or abdominal computerized tomography will reliably predict the extent of inferior vena caval involvement by tumor. However, occasionally the results of these studies will conflict or be called into question intraoperatively. We report on 8 patients considered to be at risk for inferior vena caval involvement by tumor and for whom intraoperative ultrasound was obtained to clarify the presence or extent of thrombus. Five patients had renal cell carcinoma and 3 had adrenal carcinoma. In all patients concern as to the extent or presence of tumor was based on either inconclusive preoperative studies or unexpected intraoperative findings. In each case intraoperative ultrasound clearly visualized the inferior vena cava and established the presence or extent of tumor invasion. In 4 patients venacavotomy was avoided as a consequence of these findings. Intraoperative ultrasound is a useful tool that can accurately assess the inferior vena cava for possible tumor invasion, especially when the presence or extent of tumor involvement is not definitively established preoperatively.     

The changing nature of conflict and famine vulnerability: the case of livestock raiding in Turkana District, Kenya

The context of famine in Turkana has changed in recent years as the role played by livestock raiding in contributing to famine has increased. External responses to famine in Turkana have largely been drought driven, for example, food assistance and livestock restocking programmers, which have failed to meet the real needs of herders. The role of armed conflict in the form of raiding has been overlooked as a common feature of societies facing famine and food insecurity. The traditional livelihood-enhancing functions of livestock raiding are contrasted with the more predatory forms common today. The direct impact of raiding on livelihood security can be devastating, while the threat of raids and measures taken to cope with this uncertainty undermine herders' livelihood strategies. Self-imposed restrictions on mobility negatively affect the vegetation of both grazed and ungrazed pastures and restrict the available survival strategies. Predatory raiding leads to a collapse in the moral economy. Some implications of this for relief and development policy are considered, including approaches to conflict resolution.     

Cost of comprehensive pharmaceutical services in a 45-bed rural hospital

The financial impact of a comprehensive pharmacy program on patient charges and hospital operating costs in a 45-bed community hospital was studied. Data were collected retrospectively for the fiscal year prior to initiating pharmacy services (FY73), the fiscal year during program development (FY74) and the fiscal year following full operations (FY75). The total cost of pharmacy services increased 75% from FY73 to FY75, with the largest dollar increase being in pharmacy salaries. Large increases among other cost items also were noted. The average total cost for pharmacy services increased from $3.28 per patient day in FY73 to $6.04 in FY75 (84%). Total hospital cost per patient day increased by approximately $35 from FY73 to FY75 (5%). The pharmaceutical services fee per dose of medication administered did not change from FY73 to FY75. Patient charges per day for medications and pharmaceutical services increased $0.55 (9.8%) from FY73 to FY75. There was a 55% reduction in the number of items carried in pharmacy inventory from FY73 to FY74 following the initiation of a formulary and a unit dose drug distribution system.     

Cost sharing and the use of ambulatory mental health services.

Used preliminary data from the Rand Corporation's Health Insurance Study to examine expenditures for ambulatory mental health services (MHSs) based on a sample of 4,444 families (at initial enrollment) of the nonelderly, noninstitutionalized civilian population. Selected findings reveal that reducing the level of cost sharing increases the demand for MHSs; the response to cost sharing is roughly the same for ambulatory medical and MHSs. Small deductibles, followed by free care, do not deter the use of ambulatory MHSs. (32 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hospital at home or acute hospital care? A cost minimisation analysis

OBJECTIVE: To compare, from the viewpoints of the NHS and social services and of patients, the costs associated with early discharge to a hospital at home scheme and those associated with continued care in an acute hospital. DESIGN: Cost minimisation analysis. SETTING: Acute hospital wards and the community in the north of Bristol (population about 224 000). SUBJECTS: 241 hospitalised but medically stable elderly patients who fulfilled the criteria for early discharge to a hospital at home scheme and who consented to participate. MAIN OUTCOME MEASURES: Costs to the NHS, social services, and patients over the 3 months after randomisation. RESULTS: The mean cost for hospital at home patients over the 3 months was 2516 pounds, whereas that for hospital patients was 3292 pounds. Under all the assumptions used in the sensitivity analysis, the cost of hospital at home care was less than that of hospital care. Only when hospital costs were assumed to be less than 50% of those used in the initial analysis was the difference equivocal. CONCLUSIONS: The hospital at home scheme is less costly than care in the acute hospital. These results may be generalisable to schemes of similar size and scope, operating in a similar context of rising acute admissions.     

Infertility profile at King Edward VIII Hospital, Durban, South Africa

Interventional MRI is one of the most recent developments of clinical MR imaging. Because of the development of open MR systems and very compact high-field systems, a number of interventional procedures are already possible today under MR control and will be tested in experimental and clinical investigations. The currently commercially available systems differ with respect to their static magnetic field strength, their gradient systems and patient access. In addition, there are differences concerning their space requirements and costs. All systems have components facilitating interventional procedures. In this article we discuss the advantages and shortcomings of these commercially available systems and look at future developments in interventional MR equipment.     

Coaching services: A look at coaches, clients, and practices.

Coaching is growing rapidly as a way to help individuals improve their professional and/or personal success. Although similar services have been offered for some time, coaching is becoming more widely available and is being offered by a more diverse set of professionals. This research was undertaken to learn more about coaches from varying academic backgrounds, and how they may differ in their approach to their craft. In the study, 2,231 coaches participated by completing a web-based survey examining coaching practices. A general discussion and conclusions are included. (PsycINFO Database Record (c) 2010 APA, all rights reserved)