BACKGROUND & AIMS: BACKGROUND:Somatizing patients have maladaptive and increased rates of medical care utilization. If there were a way of routinely identifying such patients, one that did not require intensive, case-by-case review, they could be targeted for specific interventions to improve their use of medical care. OBJECTIVE:We sought to identify patterns of medical care utilization that would distinguish somatizing and nonsomatizing medical outpatients with acceptable sensitivity and specificity. DESIGN:Subjects completed questionnaires assessing somatization and sociodemographic characteristics. Their medical care utilization was obtained for the 12 months preceding the index visit. We then used multivariable logistic regression and recursive partitioning to identify patients with a provisional diagnosis of somatoform disorder. These exploratory models used various patterns of medical care utilization and sociodemographic characteristics as the independent variables. SUBJECTS:We studied consecutive adults attending 2 primary care practices on randomly chosen days. MEASURES:The provisional diagnosis of a somatoform disorder was assessed with a 15-item self-report questionnaire. The number of primary care visits, specialty visits, mental health visits, emergency visits, and inpatient and outpatient costs were obtained for the 12 months preceding the index visit from our hospital's automated medical records, which also provided a rating of aggregate medical morbidity. Self-reported utilization outside our hospital system was obtained from a subsample of patients. RESULTS:Complete data were obtained on 1440 patients. Somatizing patients had more specialty care than primary care visits, higher outpatient than inpatient costs, and more emergency visits than nonsomatizing patients. A regression model containing 7 measures of utilization and 4 sociodemographic characteristics distinguished somatizing and nonsomatizing patients with a c-statistic = 0.73. Recursive partitioning identified 10 terminal nodes with a very high specificity (99%) but a very low sensitivity (15%). CONCLUSIONS:We identified 7 discrete patterns of medical care utilization that distinguished somatizing and nonsomatizing patients. However, they did so with only modest specificity and sensitivity. This algorithm might be used effectively as the first step in a 2-step screening procedure whose second step would entail more intensive screening or individual, case-by-case review to identify somatizing patients in primary care practice.

背景与目标： 背景：躯体化患者适应不良，医疗利用率更高。如果有一种常规识别此类患者的方法，而无需进行深入的个案检查，则可以针对他们采取特定的干预措施，以改善他们对医疗的使用。
目的：我们试图确定可以利用可接受的敏感性和特异性来区分躯体化和非躯体化门诊患者的医疗利用模式。
设计：受试者完成问卷调查，评估躯体化和社会人口统计学特征。在索引访问之前的12个月中获得了他们的医疗保健利用率。然后，我们使用多变量logistic回归和递归分区来确定患有躯体形式疾病的临时诊断的患者。这些探索性模型使用了各种医疗保健利用模式和社会人口统计学特征作为自变量。
受试者：我们研究了在随机选择的日子里连续参加2种初级保健实践的成年人。
措施：用15个项目的自我报告调查表对躯体形式障碍的临时诊断进行了评估。在索引访问之前的12个月中，从我们医院的自动医疗记录中获得了初级保健就诊，专科就诊，心理健康就诊，急诊就诊以及住院和门诊费用的数量，还提供了总的发病率。我们从患者子样本中获得了我们医院系统外部的自我报告利用率。
结果：获得了1440例患者的完整数据。躯体化患者比初级保健就诊者拥有更多的专科护理，门诊患者比住院费用更高，并且急诊就诊者比非躯体化患者更多。包含7个使用率度量标准和4个社会人口统计学特征的回归模型以c统计量= 0.73区分了躯体化和非躯体化的患者。递归分区确定了10个终端节点，它们的特异性很高（99％），但敏感性很低（15％）。
结论：我们确定了7种离散的医疗服务利用模式，分别区分了躯体化和非躯体化的患者。但是，他们这样做只是出于适度的特异性和敏感性。该算法可以有效地用作两步筛查程序中的第一步，该步骤的第二步将需要进行更深入的筛查或逐案审查，以识别初级保健实践中的躯体化患者。

BACKGROUND & AIMS: :This study aimed to clarify the effectiveness of post-operative oral care, including tooth brushing, denture cleaning and tongue cleaning, after digestive tract surgery. Subjects included 30 elderly patients aged 60-98 years (74.9 +/- 7.8 years) who underwent digestive tract surgery. Subjects were randomly divided into an intervention group and a control group. In the intervention group, the following oral care was provided daily over a 5-min period in the morning starting at baseline (day of surgery) and continued for 5 days: gargling with povidone iodine, tooth brushing, denture cleaning using a special brush and tongue cleaning using a tongue brush. In the control group, the subjects only gargled with povidone iodine. We compared the following variables between the two groups at baseline and 5 days later: the sensation of dry mouth, intra-oral gas concentration, pulmonary sounds, body temperature and bacterial flora. The number of patients with abnormal pulmonary sounds (dry or moist rales) increased from 1 to 2 in the intervention group and from 0 to 4 in the control group (P < 0.05). The average number of bacterial species per subject for the control group was 3.64 +/- 1.34 pre-operatively and 3.50 +/- 1.74 post-operatively, whereas that for the intervention group was 3.08 +/- 0.95 pre-operatively and 2.62 +/- 0.65 post-operatively. In the intervention group, there was a significant decrease in the number of bacterial species (P < 0.05). These findings indicate that post-operative oral care in elderly patients undergoing digestive tract surgery lowers the number of bacterial species found in the oral cavity. This effect, in turn, might improve respiratory function.

背景与目标： ：这项研究旨在阐明消化道手术后口腔护理的有效性，包括刷牙，义齿清洁和舌头清洁。受试者包括接受消化道手术的30位年龄在60-98岁（74.9 /-7.8岁）的老年患者。将受试者随机分为干预组和对照组。在干预组中，每天从基线（手术日）开始，在每天的5分钟内进行以下口腔护理，并持续5天：用聚维酮碘漱口，刷牙，使用专用刷子清洁义齿和使用舌刷清洁舌头。在对照组中，受试者仅含聚维酮碘。我们在基线和5天后比较了两组之间的以下变量：口干的感觉，口内气体浓度，肺音，体温和细菌菌群。在干预组中，肺音异常（干音或湿音）的患者数量从1增加到2，在对照组中从0增加到4（P <0.05）。对照组术前平均细菌种类数为3.64 /-1.34，术后为3.50 /-1.74，而干预组的平均细菌数为术前3.08 /-0.95，术后2.62 /-0.65。操作上。在干预组中，细菌种类的数量显着减少（P <0.05）。这些发现表明，接受消化道手术的老年患者的术后口腔护理降低了在口腔中发现的细菌种类的数量。反过来，这种效果可能会改善呼吸功能。

BACKGROUND & AIMS: BACKGROUND:Despite increasing numbers of morbidly obese patients admitted to acute care facilities for surgery or treatment of nonsurgical conditions, there is little evidence of the problems nurses face in providing care to these patients. Anecdotal evidence suggests that the care of these patients is more demanding than the care of nonobese patients. The objective of this study was to describe nurses' perceptions of the challenges that they face when caring for morbidly obese patients. METHODS:Focus groups of nurses from a tertiary care facility were convened. A trained facilitator posed questions to the group concerning various aspects of care for morbidly obese patients. Comments of respondents were categorized using NVIVO software. RESULTS:Nurses reported concerns about the increased staffing needs required for care of these patients and the particular challenges of the physical care. Concerns also included the availability, placement, and use of specialized equipment. Room size and the absence of some equipment were also problematic. Finally, nurses perceived safety issues, both for themselves and their patients. CONCLUSIONS:Morbidly obese patients in the acute care setting require specialized nursing care in terms of techniques, levels of staffing required, and the use of specialized equipment.

背景与目标： 背景：尽管进入急性护理机构接受外科手术或非手术条件治疗的病态肥胖患者的人数不断增加，但几乎没有证据表明护士在为这些患者提供护理方面面临的问题。轶事证据表明，与非肥胖患者相比，这些患者的护理要求更高。这项研究的目的是描述护士对照顾病态肥胖患者时面临的挑战的看法。
方法：召集三级护理机构的护士重点小组。一位训练有素的主持人向小组提出了有关病态肥胖患者护理各个方面的问题。使用NVIVO软件对受访者的评论进行了分类。
结果：护士报告担心护理这些患者所需的人员增加以及身体护理的特殊挑战。问题还包括专用设备的可用性，放置和使用。房间的大小和缺少一些设备也是有问题的。最后，护士们意识到了自己和病人的安全问题。
结论：急性护理环境中的病态肥胖患者需要在技术，所需人员配备和使用专用设备方面进行专门护理。

BACKGROUND & AIMS: PURPOSE:Making good consumer decisions requires having good information. This study compared long-term-care recommendations among various types of health professionals. DESIGN AND METHODS:We gave randomly varied scenarios to a convenience national sample of 211 professionals from varying disciplines and work locations. For each scenario, we asked the professional to recommend the appropriate forms of long-term care. RESULTS:Although the professional respondents used the full spectrum of options offered to them, some professionals tended to favor the sector they worked in. Advanced practice nurses recommended day care and homemaking more and adult foster care less. Gerontologists used skilled nursing-facility placement more actively and rehabilitation, homemaking, and home health care less actively. Geriatricians and primary care physicians both favored rehabilitation and skilled nursing-facility care and were both less enthusiastic about assisted living, homemaking, and informal care, but the geriatricians favored day care more than did the primary care physicians. Registered nurses were highly supportive of assisted living, adult foster care, homemaking, and home health care, and they opposed skilled nursing-facility care. Social workers were less likely than other participants to endorse rehabilitation and adult foster care. IMPLICATIONS:Because consumer preference should be a major factor in making long-term-care decisions, many consumers need information about what options may best fit their situation. In the absence of empirical data on which types of long-term care work best for whom, consumers have to rely on expert judgment-but that judgment varies. Clients should be aware that an expert's background (as defined by discipline and work situation) may affect his or her recommendations. Each discipline appears to have its own set of experiences and beliefs that may influence recommendations.

背景与目标： 目的：做出正确的消费者决定需要掌握良好的信息。这项研究比较了各种类型的卫生专业人员之间的长期护理建议。
设计与方法：我们为来自不同学科和工作地点的211名专业人员提供了随机变化的情景，以方便他们在全国范围内进行抽样。对于每种情况，我们都要求专业人员推荐适当的长期护理形式。
结果：尽管专业受访者使用了提供给他们的所有选择，但一些专业人士倾向于偏爱他们工作的部门。高级执业护士建议日托和家庭护理更多，而成人寄养则更少。老年学家更加积极地使用熟练的护理设施，而康复，家庭装修和家庭保健的活动则较少。老年医生和初级保健医生都偏爱康复和熟练的护理设施护理，对辅助生活，家庭制作和非正式护理的热情都较低，但是老年医生比初级保健医生更喜欢日托。注册护士高度支持辅助生活，成人寄养，家庭护理和家庭保健，并且他们反对熟练的护理设施护理。与其他参与者相比，社会工作者认可康复和成人寄养服务的可能性较小。
含义：由于消费者的偏好应该是做出长期护理决定的主要因素，因此许多消费者需要有关哪种选择最适合其情况的信息。在缺乏关于哪种类型的长期护理最适合谁的经验数据的情况下，消费者必须依靠专家的判断，但这种判断会有所不同。客户应注意，专家的背景（由学科和工作情况所定义）可能会影响其建议。每个学科似乎都有自己的经验和信念，可能会影响建议。

BACKGROUND & AIMS: :A prospective collection of positive antimicrobial cultures was performed over 12 consecutive months in the medical intensive care unit of a cancer hospital. In all, 144 infections and 163 pathogens were documented during 87 of the 528 admissions. Lung, urinary, ENT (ear, nose and throat) infections and bacteraemia were the most frequently documented. Staphylococcus species, Streptococcus species, Escherichia coli, Klebsiella species and Pseudomonas species were the most common pathogens. Gram-positive strains were observed predominantly during monomicrobial bacteraemia (48.9%). Methicillin-resistant Staphylococcus aureus (MRSA) and Staphylococcus epidermidis (MRSE) were found in 58% and 92% of the isolated strains respectively. No particular outbreak was identified. A further prospective study will be necessary to evaluate the impact of the antibiotic use on the selection of resistant strains in our ICU.

背景与目标： ：在癌症医院的医疗重症监护室连续12个月进行了前瞻性抗菌药物阳性培养。在528例入院病例中，总共记录了144例感染和163种病原体。肺，尿，耳鼻喉（耳，鼻，喉）感染和菌血症的记录最频繁。葡萄球菌，链球菌，大肠杆菌，克雷伯菌和假单胞菌是最常见的病原体。革兰氏阳性菌株主要在单微生物菌血症期间观察到（48.9％）。分别在58％和92％的分离菌株中发现了耐甲氧西林的金黄色葡萄球菌（MRSA）和表皮葡萄球菌（MRSE）。没有发现特定的爆发。有必要进行进一步的前瞻性研究，以评估抗生素使用对我们ICU中耐药菌株选择的影响。

BACKGROUND & AIMS: :Spiritual issues arise frequently in the care of dying patients, yet health care professionals may not recognize them, may not believe they have a duty to address these issues, and may not understand how best to respond to their patients' spiritual needs. The case of a patient with a strong religious belief in a miraculous cure of metastatic pancreatic cancer is used to explore how better understanding of this belief and more explicitly spiritual conversation with the patient by his treating team might have provided opportunities for an improved plan of care. This article distinguishes spirituality from religion; describes the salient spiritual needs of patients at the end of life as encompassing questions of meaning, value, and relationship; delineates the role physicians ought to play in ascertaining and responding to those needs; and discusses the particular issue of miracles, arguing that expectations of miraculous cure ought not preclude referral to hospice care.

背景与目标： 精神问题经常出现在垂死患者的护理中，但是医疗保健专业人员可能不认识他们，可能不相信他们有责任解决这些问题，并且可能不了解如何最好地满足患者的精神需求。以强烈信仰宗教信仰的患者奇迹般地治疗转移性胰腺癌的案例为例，探讨了如何更好地理解这一信仰，以及治疗团队与患者进行更明确的精神对话，可能会为改善护理计划提供机会。本文将灵性与宗教区分开来；描述生命终了时患者的主要精神需求，包括意义，价值和关系问题；描述医生在确定和响应这些需求中应发挥的作用；并讨论了奇迹的特殊问题，认为奇迹疗法的期望不应排除转诊临终关怀的可能性。

BACKGROUND & AIMS: INTRODUCTION:Since 2003, Iraq has struggled to build a single national health system administered by the Iraqi Ministry of Health, but politics, lack of leadership, and a cultural bias against treating soldiers in civilian hospitals have hindered access to care for members of Iraq's armed forces who are wounded in combat. METHODS:U.S. surgeons are providing trauma care for Iraqi soldiers in American field hospitals, with more than 80% of hospital bed days occupied by Iraqis. At the same time, Iraqi hospitals have been treating the many civilian casualties of violence, and the Ministry of Health has greatly improved its emergency response and management capabilities over the past year. RESULTS:Ministry of Health hospitals have adequate surgical capabilities and bed capacity to care for both civilian and security forces casualties. Faltering attempts to develop a national health policy that provides comprehensive care for Iraqi Security Forces will jeopardize Iraq's ability to assume responsibilities for the country's national defense, and could delay the withdrawal of Coalition military forces from Iraq. CONCLUSIONS:It is imperative that leadership of the new government of Iraq and the international surgical community strongly endorse the implementation of a single health care system for all Iraqis.

背景与目标： 简介：自2003年以来，伊拉克一直在努力建立由伊拉克卫生部管理的单一国家卫生系统，但是政治，缺乏领导力以及在民用医院中对待士兵的文化偏见阻碍了伊拉克武装部队获得医疗服务在战斗中受伤的部队。
方法：美国外科医生正在美国野战医院为伊拉克士兵提供创伤护理，其中80％以上的病床天都由伊拉克人占用。同时，伊拉克医院一直在治疗许多平民的暴力伤亡，而卫生部在过去一年中大大提高了其应急响应和管理能力。
结果：卫生部的医院具有足够的手术能力和床位能力，可以照顾平民和安全部队的伤亡。制定一项旨在为伊拉克安全部队提供全面护理的国家卫生政策的步履蹒跚的尝试将危及伊拉克承担起负责该国国防的责任的能力，并可能延迟联军从伊拉克撤军。
结论：伊拉克新政府和国际外科界的领导层必须坚决支持为所有伊拉克人实施单一的卫生保健系统。

BACKGROUND & AIMS: INTRODUCTION:To obtain strict glucose regulation, an accurate and feasible bedside glucometry method is essential. We evaluated three different types of point-of-care glucometry in seriously ill intensive care unit (ICU) patients. The study was performed as a single-centre, prospective, observational study in a 12-bed medical ICU of a university hospital. METHODS:Patients with an expected ICU stay of more than 48 hours were included. Because the reference laboratory delivers glucose values after approximately 30 to 60 minutes, which is too slow to use in a glucose regulation protocol and for calibration of the subcutaneous continuous glucose monitoring system (CGMS) (CGMS System Gold), we first validated the ICU-based blood gas/glucose analyser ABL715 (part 1 of the study). Subsequently, part 2 was performed: after inserting (and calibrating) the subcutaneous CGMS, heparinised arterial blood samples were drawn from an arterial line every 6 hours and analysed on both the Precision PCx point-of-care meter using test strips and on the blood gas/glucose analyser ABL715. CGMS glucose data were downloaded after 24 to 72 hours. The results of the paired measurements were analysed as a scatter plot by the method of Bland and Altman and were expressed as a correlation coefficient. RESULTS:Part 1: Four hundred and twenty-four blood samples were drawn from 45 critically ill ICU patients. The ICU-based blood gas/glucose analyser ABL715 provided a good estimate of conventional laboratory glucose assessment: the correlation coefficient was 0.95. In the Clarke error grid, 96.8% of the paired measurements were in the clinically acceptable zones A and B. Part 2: One hundred sixty-five paired samples were drawn from 19 ICU patients. The Precision PCx point-of-care meter showed a correlation coefficient of 0.89. Ninety-eight point seven percent of measurements were within zones A and B. The correlation coefficient for the subcutaneous CGMS System Gold was 0.89. One hundred percent of measurements were within zones A and B. CONCLUSION:The ICU-based blood glucose analyser ABL715 is a rapid and accurate alternative for laboratory glucose determination and can serve as a standard for ICU blood glucose measurements. The Precision PCx is a good alternative, but feasibility may be limited because of the blood sample handling. The subcutaneous CGMS System Gold is promising, but real-time glucose level reporting is necessary before it can be of clinical use in the ICU. When implementing a glucose-insulin algorithm in patient care or research, one should realise that the absolute glucose level may differ systematically among various measuring methods, influencing targeted glucose levels.

背景与目标： 简介：要获得严格的葡萄糖调节，准确，可行的床旁血糖测定方法必不可少。我们评估了重症重症监护病房（ICU）患者的三种不同的即时护理血糖仪。该研究是在大学医院的12张病床的ICU中进行的单中心，前瞻性，观察性研究。
方法：包括预期ICU超过48小时的患者。由于参考实验室在大约30至60分钟后会提供葡萄糖值，这太慢了，无法用于葡萄糖调节方案以及皮下连续葡萄糖监测系统（CGMS）（CGMS System Gold）的校准，因此我们首先验证了ICU-血气/葡萄糖分析仪ABL715（研究的第1部分）。随后，执行第2部分：插入（并校准）皮下CGMS之后，每6小时从一条动脉管线中抽取肝素化的动脉血样品，并在Precision PCx即时检测仪上使用试纸条和血液进行分析气体/葡萄糖分析仪ABL715。 CGMS葡萄糖数据在24到72小时后下载。配对测量的结果通过Bland和Altman方法作为散点图进行分析，并表示为相关系数。
结果：第1部分：从45名重症ICU患者中抽取了242份血液样本。基于ICU的血气/葡萄糖分析仪ABL715提供了常规实验室葡萄糖评估的良好估计：相关系数为0.95。在Clarke误差网格中，96.8％的配对测量值在临床上可接受的区域A和B中。第2部分：从19位ICU患者中抽取了165个配对样品。 Precision PCx即时护理仪的相关系数为0.89。百分之九十八的测量值在区域A和B内。皮下CGMS系统Gold的相关系数为0.89。百分之一百的测量值在区域A和B内。
结论：基于ICU的血糖分析仪ABL715是一种快速准确的实验室葡萄糖测定方法，可作为ICU血糖测量的标准。 Precision PCx是一个很好的选择，但由于血液样本的处理，可行性可能受到限制。皮下CGMS System Gold前景看好，但在ICU中临床应用之前，必须实时报告葡萄糖水平。在患者护理或研究中实施葡萄糖-胰岛素算法时，应认识到，各种测量方法之间的绝对葡萄糖水平可能会系统地不同，从而影响目标血糖水平。

BACKGROUND & AIMS: BACKGROUND:Surveys of the population are commonly used to obtain information on health status. Increasingly, researchers are linking self-reported health status information to primary care consultation data. However, it is not known how participating in a health-related survey affects consultation behaviour. The objective of this study was to assess whether completion of a health-related questionnaire changes primary care consultation behaviour. METHODS:Participants were 3402 adults aged 50 and over from the general population in North Staffordshire, UK, who completed a health-related postal survey received in April 2003. The survey was predominantly about occurrence and severity of knee pain in the last year. Primary care attendance for the three months following response was compared to three control periods: i) the three months prior to the survey, ii) the same time period in the previous year and iii) the same time period in the following year. Comparisons were made on consultations for any problem, consultations for musculoskeletal disorders and consultations for knee problems. RESULTS:The percentage of subjects consulting for any condition was marginally higher for the three months directly after receipt of the questionnaire but the difference was only statistically significant in comparison to the three months before the survey (64% v. 62%, p = 0.05). There was little difference in consultation prevalence for musculoskeletal problems immediately after the survey compared to the three control periods. There was an increase of 37% in knee disorder consultations for the three months after the survey compared to the three months directly before the survey (p = 0.02). However, consultation prevalence for knee problems was identical for the three months after the survey to the same time periods in the years prior to and following the survey (both p = 0.94). CONCLUSION:The results from this study suggests that questionnaires related to physical health do not affect the standard consulting behaviour of patients, even for the symptom under investigation. This should reassure researchers who wish to link self-reported health status and medical care utilisation and clinicians whose patients are involved in such research.

背景与目标： 背景：人口调查通常用于获取有关健康状况的信息。研究人员越来越多地将自我报告的健康状况信息与初级保健咨询数据联系起来。但是，尚不清楚参与健康相关调查如何影响咨询行为。这项研究的目的是评估完成与健康有关的问卷是否会改变初级保健咨询的行为。
方法：参与者为英国北部斯塔福德郡（North Staffordshire）英国普通人群的3402名年龄在50岁以上的成年人，他们于2003年4月完成了一项与健康相关的邮政调查。该调查主要是关于去年膝盖疼痛的发生和严重程度。将响应后三个月的基层医疗出勤率与三个对照期进行比较：i）调查前三个月，ii）上一年的相同时期，iii）下一年的相同时期。对任何问题的咨询，肌肉骨骼疾病的咨询和膝盖问题的咨询进行了比较。
结果：在收到问卷后的三个月中，针对任何情况进行咨询的受试者的百分比略高，但与调查前的三个月相比，差异仅在统计上具有统计学意义（64％对62％，p = 0.05 ）。与三个对照期相比，调查后立即就骨骼肌肉问题进行咨询的患病率差异不大。与调查前三个月相比，调查后三个月的膝关节疾病咨询增加了37％（p = 0.02）。但是，膝关节问题的咨询患病率在调查后的三个月内与调查前后几年中的相同时间段相同（均为p = 0.94）。
结论：这项研究的结果表明，与身体健康相关的问卷不会影响患者的标准咨询行为，即使对于所调查的症状也是如此。这应该使希望将自我报告的健康状况和医疗利用联系起来的研究人员以及患者参与此类研究的临床医生得到保证。

BACKGROUND & AIMS: :Bedside duplex/color Doppler sonography is used for a wide gamut of abnormalities encountered in the neonatal intensive care unit. This article emphasizes the use of bedside sonography for evaluation of infants with necrotizing enterocolitis, infants requiring line placement, and those in whom a diaphragmatic abnormality is suspected. Although the assessment of those infants requires excellent operator skills, learning to do so is a definite benefit to these babies who would otherwise be exposed to ionizing radiation.

背景与目标： ：床旁双工/彩色多普勒超声检查可用于新生儿重症监护病房中遇到的各种异常。本文强调使用床旁超声检查评估坏死性小肠结肠炎婴儿，需要行放置的婴儿以及怀疑有diaphragm肌异常的婴儿。尽管对这些婴儿进行评估需要出色的操作员技能，但学会这样做对这些婴儿而言无疑是有益的，否则这些婴儿将受到电离辐射的照射。

BACKGROUND & AIMS: :In the present pilot study, the feasibility of a site-of-care cervicovaginal self-sampling methodology for HPV-based screening was tested in 346 women residing in underserved rural areas of Northern Greece. These women provided self-collected cervicovaginal sample along with a study questionnaire. Following molecular testing, using the cobas® HPV Test, Roche®, HPV positive women, were referred to colposcopy and upon abnormal findings, to biopsy and treatment. Participation rate was 100%. Regular pap-test examination was reported for 17.1%. Among hrHPV testing, 11.9% were positive and colposcopy/biopsy revealed 2 CIN3 cases. Non-compliance was the most prevalent reason for no previous attendance. Most women reported non-difficulty and non-discomfort in self-sampling (77.6% and 82.4%, respectively). They would choose self-sampling over clinician-sampling (86.2%), and should self-sampling being available, they would test themselves more regularly (92.3%). In conclusion, self-sampling is feasible and well-accepted for HPV-based screening, and could increase population coverage in underserved areas, helping towards successful prevention.

背景与目标： ：在本项初步研究中，对希腊北部农村地区服务不足的346名妇女进行了基于宫颈癌阴道自我采样方法的HPV筛查的可行性的测试。这些妇女提供了自己收集的宫颈阴道样本以及研究问卷。在进行分子测试后，使用cobas®HPV测试，将Roche®，HPV阳性女性进行阴道镜检查，并在发现异常后进行活检和治疗。参与率为100％。定期进行子宫颈抹片检查的报道为17.1％。在hrHPV测试中，有11.9％呈阳性，阴道镜检查/活检显示有2例CIN3病例。不遵守是没有参加会议的最普遍原因。大多数妇女在自我采样中报告没有困难和不舒服（分别为77.6％和82.4％）。他们将选择自采样而不是临床医生采样（86.2％），并且如果可以使用自采样，他们将更定期地进行自我测试（92.3％）。总之，对于基于HPV的筛查，自我抽样是可行的并且被广泛接受，并且可以扩大服务不足地区的人口覆盖率，有助于成功进行预防。

BACKGROUND & AIMS: INTRODUCTION:The aim of this article is to report, from their own perspective, the attitudes and believes towards vaccination, with special emphasis on the influence of sources of information to make the decision to get vaccinated, of health care workers (HCWs), considered as a specific risk group for immunization strategy against A (H1N1) influenza. METHODS:Cross-sectional observational study focused on active health workers in the province of Alicante. Made by face to face questionnaires to a stratified random sample based on occupational categories in hospitals and health care centres. RESULTS:The sources of information differ between subgroups; physicians used journals and/or conferences, nurses obtained information through the Ministry of Health and other nurses, and the remaining workers opted for television and/or the family physician. Of the three studied groups, physicians felt minor concern about the influenza A (H1N1) pandemic (59.4%), had the most confidence in the vaccine (42.3%), were the ones who recommended the vaccine the most (44.4%), who best followed the recommendations to avoid infection (93%), and were the most vaccinated (18.3%). Around three-quarters (75.5%) of the HCWs assessed the provided information as fair, poor or very poor. All HCWs admitted that a social alarm was created. DISCUSSION:The success of future immunization campaigns against influenza in HCWs could increase if information activities were designed to focus on each subgroup of HCWs, by adapting the strategy and improving the quality of information.

背景与目标： 简介：本文的目的是从他们自己的角度报告对疫苗接种的态度和信念，并特别强调信息源对决定是否接种疫苗的医护人员（HCW）的影响，作为针对A（H1N1）流感的免疫策略的特定风险人群。
方法：横断面观察研究的重点是阿利坎特省的在职卫生工作者。通过面对面的问卷调查，根据医院和保健中心的职业类别对分层的随机样本进行调查。
结果：亚组之间的信息来源不同；医生使用期刊和/或会议，护士通过卫生部和其他护士获得信息，其余工人选择电视和/或家庭医生。在这三个研究组中，医生对甲型流感（H1N1）大流行的担忧不大（59.4％），对疫苗最有信心（42.3％），是推荐疫苗最多的人（44.4％），最好遵循建议避免感染的建议（93％），并且接种疫苗最多（18.3％）。大约四分之三（75.5％）的医护工作者认为所提供的信息是公平的，差的或非常差的。所有医护人员都承认创建了社交警报。
讨论：如果旨在通过调整策略和提高信息质量而将信息活动设计为针对医护人员的每个亚组，那么将来针对医护人员的流感免疫运动的成功率可能会增加。

BACKGROUND & AIMS: OBJECTIVES:To describe the prevalence of oral diseases and their impact on oral-health-related quality of life in people with severe mental illness undertaking community-based psychiatric care. METHODS:A survey was conducted at eight outpatient psychiatric care clinics in Tower Hamlets, London, UK. One hundred and twelve consecutive patients with mental illness were invited to participate in this study. They were clinically examined and asked to complete the oral health impact profile (OHIP) questionnaire. RESULTS:The response rate was 79% (n = 89); 57 (64%) males and 58 persons over 45 years of age (65%) participated in this survey. Overall OHIP score was 25.4 (95% CI 23.3, 27.4), 70 (78%) were smokers and 45 (51%) had been to the dentist in the last two years. Forty-seven (53%) respondents had caries in at least one tooth, 60 (67%) had 21 teeth and more, and 14 (16%) used dentures. Advanced periodontal treatment was indicated in 42 (55%) of patients and 52.8% (n = 47) patients reported current pain. CONCLUSION:Overall, this survey found that oral health has a great impact on patients with severe mental illness being treated in the community setting and their oral health is poorer than the national adult general population. Future research should consider the causes that relate to the poorer oral health in this population and potential health promotion mechanisms in this population to encourage an upstream approach to health.

背景与目标： 目的：描述在进行基于社区的精神病治疗的重度精神疾病患者中口腔疾病的流行及其对口腔健康相关生活质量的影响。
方法：在英国伦敦塔哈姆雷特市的八家门诊精神病诊所进行了一项调查。连续邀请112名精神疾病患者参加这项研究。对他们进行了临床检查，并要求他们填写口腔健康影响概况（OHIP）问卷。
结果：回应率为79％（n = 89）；男性（57％）（64％）和58岁以上的58人（65％）参加了这项调查。 OHIP总体得分为25.4（95％CI 23.3、27.4），吸烟者70（78％）和最近两年去牙医的45（51％）。 47名（53％）的被调查者的至少一颗牙齿上有龋齿； 60（67％）的人有21颗及以上的牙齿，以及14颗（16％）的假牙。 42名（55％）患者表示进行了牙周治疗，目前有疼痛的患者占52.8％（n = 47）。
结论：总体而言，该调查发现，口腔健康对在社区环境中接受治疗的严重精神疾病患者有很大影响，并且其口腔健康状况比全国成年人口人群差。未来的研究应考虑与该人群口腔健康较差的原因以及该人群中潜在的健康促进机制，以鼓励采用上游健康方法。

BACKGROUND & AIMS: :Transforming small independent practices to patient-centered medical homes is widely believed to be a critical step in reforming the US health care system. Our team has conducted research on improving primary care practices for more than fifteen years. We have found four characteristics of small primary care practices that seriously inhibit their ability to make the transformation to this new care model. We found that small practices were extremely physician-centric, lacked meaningful communication among physicians, were dominated by authoritarian leadership behavior, and were underserved by midlevel clinicians who had been cast into unimaginative roles. Our analysis suggests that in addition to payment reform, a shift in the mind-set of primary care physicians is needed. Unless primary care physicians can adopt new mental models and think in new ways about themselves and their practices, it will be very difficult for them and their practices to create innovative care teams, become learning organizations, and act as good citizens within the health care neighborhood.

背景与目标： ：人们普遍认为，将小规模的独立实践转变为以患者为中心的医疗之家，是改革美国医疗保健体系的关键步骤。我们的团队针对改善初级保健实践进行了十五年的研究。我们发现小型初级保健实践的四个特征严重阻碍了他们向这种新的保健模式转变的能力。我们发现，小规模的实践非常以医师为中心，在医师之间缺乏有意义的沟通，被专制的领导行为所主导，并且被中庸的临床医师所忽视。我们的分析表明，除了支付改革之外，还需要改变基层医疗医生的思维方式。除非初级保健医师可以采用新的心理模式并以新的方式思考自己及其行为，否则他们及其实践将很难建立创新的护理团队，成为学习型组织并在医疗保健邻里中扮演好公民的角色。 。

BACKGROUND & AIMS: OBJECTIVE:Provoked deep venous thrombosis (DVT) is precipitated by a specific event. This paper compares the characteristics of provoked DVT in patients with transient risk (TR) factors and patients with continuous risk (CR) factors. METHODS:A retrospective review of records of all consecutive patients diagnosed with DVT between January 2013 and August 2014 was performed. Patients with provoked DVT were included in the TR group if the provoking event resolved in 2 weeks and they did not have ongoing risk of thrombosis. Patients in the CR group had a provoked DVT with ongoing risk of thrombosis due to individual factors deemed to be ongoing risks of thrombosis, such as cancer, hypercoagulable disorder, and prolonged immobilization. Demographics, risk factors, association with pulmonary embolism (PE) and its severity, risk of recurrent venous thromboembolism (VTE), and mortality were compared between the two groups. RESULTS:A total of 838 patients were diagnosed with DVT, and 50.7% (425) were provoked. There were 127 (29.9%) patients with TR and 298 (70.1%) with CR. TR patients were younger (60.4 ± 16.3 vs 65.9 ± 16.0; P = .001). TR was more likely to be provoked by surgery (70.9% vs 55.4%; P = .003), whereas CR was more likely to be provoked by immobilization (21.5% vs 12.6%; P = .032). CR patients were affected by cancer (48.7%) and hypercoagulable disorders (4.4%). TR patients were more likely to have calf DVTs (36.2% vs 26.2%; P = .047). There was a trend toward lower association with PE on presentation in TR (17.3% vs 21.1%; P = .072), but that did not reach statistical significance. However, TR factors were more likely to be associated with low-risk PE compared with CR factors (30.2% vs 54.6%; P = .040). After mean follow-up of 7.2 months, CR had higher risk of recurrent VTE (14.0% vs 6.8%; P = .045) and mortality (23.5% vs 7.1%; P < .0001). CONCLUSIONS:Provoked DVT with CR factors affects older patients and is associated with high recurrence of VTE and mortality compared with provoked DVT with TR factors.

背景与目标： 目的：诱发深静脉血栓形成（DVT）是由特定事件引起的。本文比较了短暂风险（TR）因子和持续风险（CR）因子引起的DVT的特征。
方法：回顾性分析2013年1月至2014年8月间所有诊断为DVT的连续患者的病历。如果挑衅事件在2周内解决并且他们没有持续的血栓形成风险，则将挑衅性DVT的患者纳入TR组。 CR组的患者患有诱发性DVT，具有持续血栓形成的风险，这是由于个别因素被认为是持续血栓形成的风险，例如癌症，高凝性疾病和长时间固定。比较了两组的人口统计学，危险因素，与肺栓塞（PE）的关联及其严重性，复发性静脉血栓栓塞（VTE）的风险和死亡率。
结果：总共诊断为DVT的838例患者，引起了50.7％（425）的挑衅。有127名（29.9％）的TR患者和298名（70.1％）的CR患者。 TR患者较年轻（60.4±16.3 vs 65.9±16.0; P = .001）。 TR更有可能由手术引起（70.9％vs 55.4％; P = .003），而CR更有可能由固定引起（21.5％vs 12.6％; P = .032）。 CR患者受癌症（48.7％）和高凝性疾病（4.4％）的影响。 TR患者更有可能患有小腿深静脉血栓（36.2％vs 26.2％; P = .047）。在TR中出现与PE的关联性较低的趋势（17.3％对21.1％; P = .072），但这没有统计学意义。然而，与CR因子相比，TR因子更可能与低风险PE相关（30.2％vs 54.6％; P = .040）。平均随访7.2个月后，CR复发VTE（14.0％vs 6.8％; P = .045）和死亡率（23.5％vs 7.1％; P <.0001）的风险更高。
结论：诱发性DVT伴CR因素影响老年患者，与诱发性DVT伴TR因素相比，其VTE复发率和死亡率高。