Search

Klebsiella pneumoniae is one of the leading causative organisms in pyogenic liver disease. It can cause disseminated infections, but rarely to bone, and rarely in healthy hosts. We report an unusual case of a distal humerus fracture from osteomyelitis secondary to dissemination in a non-immuno-compromised patient. The patient was surgically managed with external fixation and insertion of anti-biotic beads, in conjunction with medical therapy via culture direct antibiotics. This report highlights the diagnostic approach and treatment options for these atypical cases.

A determination of soil heavy metal (Cu, Mn and Ni) concentrations in Perlis state, Malaysia was performed to define the level of soil pollution. Six soil samples were collected at depth of 0 – 15 cm in industrial, residential and school areas around Perlis. The highest concentration of Mn (57.80 mg/kg) and Ni (2.83 mg/kg) were detected at limestone quarry in Bukit Air, Cu (17.43 mg/kg) in Kampung Wang Ulu. The concentration of Cu, Mn and Ni were well below their soil geochemical background values. The single pollution indices assessment revealed that the soil contamination due to heavy metals in Perlis is insignificant. On the basis of the heavy metal content, the potential health risk assessment for children and adults was calculated for a lifetime of exposure through ingestion, inhalation and dermal contact based on the USEPA model. The exposure assessment found that the exposure pathways of heavy metals to both children and adults are through ingestion. Both Hazard Quotient (HQ) and Hazard Index (HI) values are lower than 1, indicating no health risk. From the result, the HI values indicated that the soil heavy metal contamination could pose more impacts on children as compared to adults.

This paper explores certain questions regarding whether the law concerning relief upon the dissolution of civil partnership and cohabitation should parallel that of marriage. It will be contended that while the principle of compensation does have an important role to play in the aftermath of de facto relationships, there remain reasons not to assimilate cohabitation fully with marriage – and in particular, not to apply the key principle of equal sharing that now informs divorce settlements in many jurisdictions, including England. On the other hand, an argument against assimilating marriage with civil partnership can be grounded in the fact that a civil partnership involves two parties of the same gender. This point generates room to argue that a presumption of equal sharing – to the extent that it rests upon compensatory rationales – may be less powerful in civil partnerships. Nonetheless, that claim can be circumnavigated by the argument for equal sharing as an independent principle – one applicable to civil partnership just as much as to marriage.

The advent of regenerative medicine has brought us the opportunity to regenerate, modify and restore human organs function. Stem cells, a key resource in regenerative medicine, are defined as clonogenic, self-renewing, progenitor cells that can generate into one or more specialized cell types. Stem cells have been classified into three main groups: embryonic stem cells (ESCs), induced pluripotent stem cells (iPSCs) and adult/postnatal stem cells (ASCs). The present review focused the attention on ASCs, which have been identified in many perioral tissues such as dental pulp, periodontal ligament, follicle, gingival, alveolar bone and papilla. Human dental pulp stem cells (hDPSCs) are ectodermal-derived stem cells, originating from migrating neural crest cells and possess mesenchymal stem cell properties. During last decade, hDPSCs have received extensive attention in the field of tissue engineering and regenerative medicine due to their accessibility and ability to differentiate in several cell phenotypes. In this review, we have carefully described the potential of hDPSCs to differentiate into odontoblasts, osteocytes/osteoblasts, adipocytes, chondrocytes and neural cells.

On the occasion of the International Year of Crystallography, it was pertinent to focus on the consumption of sugar crystals and all other forms of fast sugars in view of the primary and secondary prevention of type 2 diabetes mellitus. This study was carried out to determine the extent to which Mauritians with type 2 diabetes engage in diet modification and physical exercise as means of self-management of their disease. A cross-sectional quantitative study was carried out among diabetic patients aged 25 and above, randomly identified. Data were obtained from face-to-face interview with anonymity of respondents and confidentiality of data being respected. The study sample constituted of 266 participants with type 2 diabetes. Findings revealed that less than half of the participants reported engaging in each of the lifestyle behaviours all the time. Statistical analysis showed that there was a significant association between weight control and advice received from a health professional. The majority of the participants engaged in diet modification, but only a minority sustained the diet modification all the time. In an island which has been producing tonnes of sugar for local consumption and for export, it could be expected that temptation for fast sugars prevails.

Severe adverse drug reactions (ADR) of Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) in some patients receiving strontium ranelate have been reported, but the risk factors are unclear. We show that HLA-A*33:03 and B*58:01 are significantly associated with patients who developed SJS/TEN; and provide the first evidence that genetic risk factors are involved in strontium ranelate-associated SJS/TEN. In this study, HLA as a genetic risk factor was assessed among osteoporotic patients prescribed with strontium ranelate that developed severe cutaneous adverse drug reactions (SCARs) compared with those who were tolerant. Genomic DNA isolated from peripheral blood mononuclear cells (PBMCs) of patients was HLA typed using sequencing-based typing method to determine their HLA profiles. Osteoporotic patients who are currently on strontium ranelate were enrolled in the study (n = 76). Tolerant controls were defined as patients who received strontium ranelate for a minimum of 3 months (range 3 months to 8 years) with no reports of any cutaneous reactions as these reactions usually occur within the first 12 weeks after starting treatment. Retrospective cases of SJS/TEN were also identified (n = 5). The majority of the accrued samples were of Han Chinese descent: controls (n = 72) and cases (n = 4). All cases and controls were genotyped at four HLA genes, namely HLA-A, HLA-B, HLA-C, and HLA-DRB1. In comparing the samples of Han Chinese descent (72 controls and 4 cases), we found significant associations with HLA-A*33:03 (p = 0.002) and HLA-B*58:01 (p = 0.023). There was no significant association with any HLA-C or HLA-DRB1 alleles. This study reveals that the occurrence of SJS/TEN in Han Chinese patients receiving strontium ranelate is HLA associated. This has important clinical implications for understanding the underlying mechanisms for this ADR as well as evaluating the potential role of genetic pre-screening for osteoporotic patients who may be prescribed strontium ranelate.

Patients with end stage renal failure require dialysis and strict adherence to treatment plans to sustain life. However, non-adherence is a common and serious problem among patients with chronic kidney disease. There is a scarcity of studies in examining the effects of disease management programmes on patients with chronic kidney disease.This paper examines whether the study group receiving the disease management programme have better improvement than the control group, comparing outcomes at baseline (O1), at 7 weeks at the completion of the programme (O2) and at 13 weeks (O3).This is a randomized controlled trial. The outcome measures were non-adherence in diet, fluid, dialysis and medication, quality of life, satisfaction, symptom control, complication control and health service utilisation.There was no significant difference between the control and study group for the baseline measures, except for sleep. Significant differences (p0.05) were found between the control and study group at O2 in the outcome measures of diet degree non-adherence, sleep, symptom, staff encouragement, overall health and satisfaction. Sustained effects at O3 were noted in the outcome measures of continuous ambulatory peritoneal dialysis (CAPD) non-adherence degree, sleep, symptom, and effect of kidney disease.Many studies exploring chronic disease management have neglected the group with end stage renal failure and this study fills this gap. This study has employed an innovative model of skill mix using specialist and general nurses and demonstrated patient improvement in diet non-adherence, CAPD non-adherence, aspects of quality of life and satisfaction with care. Redesigning chronic disease management programmes helps to optimize the use of different levels of skills and resources to bring about positive outcomes.

Title. Can home visits help reduce hospital readmissions? Randomized controlled trial Aim. This paper is a report of a study to determine whether home visits can reduce hospital readmissions. Background. The phenomenon of hospital readmission raises concerns about the quality of care and appropriate use of resources. Home visits after hospital discharge have been introduced to help reduce hospital readmission rates, but the results have not been conclusive. Method. A randomized controlled trial was carried out from 2003 to 2005 . The control group (n = 166) received routine care and the study group (n = 166) received home visits from community nurses within 30 days of hospital discharge. Data were collected at baseline before discharge and 30 days after discharge. Findings. Patients in the study group were statistically significantly more satisfied with their care. There were no statistically significant differences in other outcomes, including readmission rate, ADL score, self-perceived life satisfaction and self-perceived health. Regression analysis revealed that self-perceived life satisfaction, self-perceived health and disease category other than general symptoms were three statistically significant variables predicting hospital readmissions. Conclusion. Preventive home visits were not effective in reducing hospital readmissions, but satisfaction with care was enhanced. Subjective well-being is a key variable that warrants attention in the planning and evaluation of postdischarge home care.

The quality of the educational climate reflects the quality of the curriculum, teaching, and learning considerations and developing student outcomes as practitioners. The purpose of this study is to identify the differences in opinion of year one nursing students based on their perceptions of the elements operating in the educational environment in a nursing school in Singapore using the Singapore version of the Dundee Ready Education Environment Measure (DREEM) inventory. 49 nursing students during the 2006-2007 academic year completed a self-report questionnaire in two semesters. This study clearly demonstrated changes in students' perceptions of the new nursing curriculum and learning climate when adjustments were made to the curriculum involving workloads, positioning of modules, teaching policy and assessment expectations, including curriculum committee development and student representative input.

An integrated adolescent curriculum on health and development (ADH) was implemented in a pre-service nursing programme in a university.This study examined the efficacy of an ADH curricular framework in improving the competency variables of student nurses in delivering ADH services.The design of the study was quasi-experimental with the systematically designed ADH training curriculum as an intervention. Pre- and post-tests incorporating an experimental group and a control group for a sample of 101 student nurses were used.Reports from 50 student nurses in the experimental group indicated that there was a significant increase from the pre-test to the post-test phase in the total score for the variables in the ADH Competency Checklist (Z=-5.71, p0.001) and its four subscales: the professional development subscale (Z=-5.37, p0.001), the psychosocial and physical well-being subscale (Z=-5.66, p0.001), the health behaviours and lifestyles subscale (Z=-5.07, p0.001), and the identity and reproductive health subscale (Z=-4.86, p0.001). Significant changes were detected in the ADH competency variables for the control group in the post-test phase.The findings reveal that the systematic integration of ADH in the nursing curriculum had the positive impact of increasing the competency of student nurses for the examined variables.

Chinese and Western medicines are both consumed by citizens in Hong Kong. Safe medication practice, however, whether or not it is conducted by Hong Kong citizens, remains unknown. A data collecting tool was developed to explore the consuming patterns of medicines adopted by Hong Kong citizens. It is hoped that by using this tool, baseline information about the ways in which Hong Kong citizens consume their medicines can be explored. It is also hoped that the information will contribute to the educational planning of community-based safe medication practice. The objectives of this paper were thus to report the development of this data collecting tool and to discuss the use of the tool for the promotion of community-based safe medication practice.

Given the limitations of existing health-related quality-of-life (QOL) measures in capturing the end-of-life experience of patients with advanced chronic diseases, an empirically grounded instrument, the quality-of-life concerns in the end of life questionnaire (QOLC-E), was developed. Though it was built on the McGill quality of life questionnaire (MQOL), its sphere is more holistic and culturally specific for the Chinese patients in Hong Kong. One hundred and forty-nine patients with advanced chronic obstructive pulmonary disease (COPD) or metastatic cancer completed the questionnaire. Seven factors (28 items) which emerged from the factor analysis were grouped into four positive (support, value of life, food-related concerns, and healthcare concerns) and four negative (physical discomfort, negative emotions, sense of alienation, and existential distress) subscales. Good internal consistency and concurrent validity were shown. The results also revealed that these two groups of patients had similar QOL concerns. The validity of applying QOLC-E as an outcome measure to evaluate the effectiveness of palliative and psychoexistential interventions has yet to be tested.

A randomized controlled trial was conducted to compare the effectiveness of airflow- and waterflow-cooling blankets for febrile patients in intensive care unit. More patients in the airflow than in the waterflow-cooling blanket group reached the desired temperature of

Nurse managers are under increased stress because of excessive workloads and hospitals' restructuring which is affecting their work tasks. High levels of stress could affect their mental health. Yet, few stress management training programmes are provided for this population. The purpose of this study was to apply stretch-release relaxation and cognitive relaxation training to enhance the mental health for nurse managers. A total of 65 nurse managers in Hong Kong were randomly assigned to stretch-release relaxation (n = 17), cognitive relaxation (n = 18), and a test control group (n = 35). Mental health status was assessed using the Chinese version of State-Trait Anxiety Inventory and the Chinese version of the General Health Questionnaire. Participants were assessed at the pretreatment session, the fourth posttreatment session, and at the 1-month follow-up session. The results revealed both the stretch-release and cognitive relaxation training enhanced mental health in nurse managers in Hong Kong. The application of relaxation training in enhancing mental health status for nurses and health professionals is discussed.

Assessing a combination of cardiovascular disease (CVD)-risk factors may be a practical tool for risk assessment and for finding the high-risk group among local community members. This study examines the association between the number of CVD-risk factors, regardless of any specific combination with the CVD ambit, using data from 1,570 residents in Tsing Yi community (Hong Kong) who registered with the Telehealth System. A quantitative composite CVD Risk Index (CVDRI) with scores ranging from 0 to 6 included rankings for high systolic and diastolic blood pressure, presence of diabetes, body mass index (BMI), smoking, and age. Multivariate logistic regression was used to estimate odds ratios for the prevalence of CVD. Those with a CVDRI of 1, 2, or 3 and above were 1.7 [95% confidence interval (CI) = 1.34-3.99], 5.3 (95% CI = 3.60-7.90), and 10 times (95% CI = 6.41-15.50) more likely to have CVD, respectively, than those with a risk index of 0. Among the CVDRI components, high blood pressure had the greatest influence on CVD risk, followed by presence of diabetes and high BMI. In conclusion, a CVDRI based on existing health data from a Telehealth System was developed and used to identify local community members at risk of CVD. Nurse intervention may achieve greater reduction of CVD morbidity and mortality if multiple risk factors for the high-risk group are addressed at the same time.

A Write-Once Publish-Everywhere model was used to create and deliver on-line clinical training and education for undergraduate prosthetics and orthotics students. This project consisted of three phases: developing multimedia learning and teaching tools, integrating these tools into the curriculum (combination of e-Learning and live practical sessions), and evaluating the outcomes. Video-based multimedia contents were captured and integrated with graphic, audio and text into a PowerPoint presentation software format. The web-based content was integrated into the WebCT platform for course management. Questionnaires were used to obtain student feedback on this e-Learning approach. Results were compared within the prosthetics and orthotics (PO) programme, with other Health Sciences programmes, and overall with the University. PO student responses were significantly higher than other groups for career relevance and problem solving. Qualitative feedback indicated that students appreciated the easy access, integrated and interactive approach of the text materials, concise PowerPoint presentation, demonstration video and the on-line case discussion via the WebCT platform. Educators appreciated the ability easily to maintain contents and publish the modules across multiple media without recreating the contents.

prehensive account of tax law would have to be grounded in a deeper analysis of the nature, function, and legitimacy of our taxation system-especially, in normative propositions about the relationship between the state and its citizens, about the distribution of costs and benefits within a society, and about the nature and requirements of social justice. This view has not always been articulated by the courts. Traditionally, judges have often regarded taxation as something to which normative propositions do not attach; as a field in which it was legitimate to pronounce that there is no equity about a tax.' Of course, no lawyer would nowadays claim that the statutory, delegated, and case-law rules that articulate the tax laws can be interpreted and applied without reference to the principles, doctrines, and standards embedded in those rules. Thus the legislative provisions concerning the taxation of income rest, in default of explicit rules, on common-law notions about when gains are rightly attributable to the taxpayer2 and about when those gains have the character of income rather than capital receipts.3 Neither is it appropriate any longer to interpret tax statutes on a purely literal basis without reference to the purpose of the legislation.4 Increasingly, however, the courts here and elsewhere are going further and demonstrating a consciousness that those principles, doctrines, and standards are not mere legal aides to interpretation but include values with a moral

Aim of the study. To test the effects of music intervention on pre-operative anxiety in Chinese males undergoing transurethral resection of the prostate . Rationale. No studies have measured the effects of music intervention in reducing pre-operative anxiety for patients with transurethral resection of the prostate (TURP). Previous studies have examined the effects of music on pre-operative anxiety but have not examined the possible effects of the presence of a carer as an independent variable in pre-operative anxiety levels of patients in addition to the music intervention. The cultural validity of applying a music intervention to the reduction of pre-operative anxiety was also investigated. Design. A quasi-experimental design with three groups: music intervention, nurse presence and control group. Method. Thirty patients having TURP were randomly assigned ( n = 10 each group) to one of the three groups. Pre- and post-test measures of systolic and diastolic blood pressure, heart rate and state anxiety using the Chinese State-Trait Anxiety Inventory (C-STAI) were obtained for the three groups. Results. The findings showed that the music intervention significantly reduced all blood pressure levels for the patients. A reduction in state anxiety level was also found for the music intervention group. No significant reductions in blood pressure, heart rate and state anxiety level were found in the nurse presence and control groups. Conclusion. The results support the cross-cultural validity of using a music intervention in pre-operative anxiety reduction, in this case for TURP patients waiting in the theatre holding area.

Cardiac rehabilitation program which includes exercise training, nutritional advice, psychosocial and risk factors counseling is traditionally applied for myocardial infarction survivor. However, the low participation rate [1] of cardiac rehabilitation has been reported globally. Recently home-based cardiac rehabilitation program is developed as an alternative approach [2][3][4] to overcome the challenges of low referral rate, inaccessibility of program site, and optimize the utilization of the program. Unfortunately, client may not be able to sustain the modified health behavior in their daily life after the completion of the cardiac rehabilitation programme. To date, the internet-based cardiac rehabilitation program has showed significant in improving the cardiovascular risk factors at the end of the cardiac rehabilitation program. [5][6][7][8] However, there are limited studies to review the significant of internet- based interventions of home- based cardiac rehabilitation in sustention of health behavior in long term. This review will fill the knowledge gap of how the internet-based interventions on home-based cardiac rehabilitation program modify the risk behavior for myocardial infarction survivor in the long run.

Workplaces need to foster teaching and learning interactions so staff collaborate and learn from each other. Internationally, many countries provide support to graduates and experienced staff to foster engagement necessary for learning and quality care. Workplace attributes can differ across countries depending on managerial, contextual, social and policy issues.This study compared workplace attributes of two Australian hospitals with a Singaporean hospital.A representative sample of nurses in two acute care facilities in Australia (n = 203) and a comparable facility in Singapore (n = 154) during 2010 and 2011 responded to a survey requesting demographic data and responses about workplace attributes. Attributes were determined through validated tools that measure staff perception of support when facilitating others learning (Support Instrument for Nurses Facilitating the Learning of Others) and the clinical learning organizational culture (Clinical Learning Organizational Culture Survey).Results indicated Singaporean nurses rated perception of acknowledgement, workload management and teamwork support in facilitating learners in their hospital as significantly better than the Australian cohort despite similar provisions for support and development. There were no significant differences across the two sites in the clinical learning culture.Analysis across three health facilities only provides a snapshot. Targeting more facilities would assist in confirming the extent of reported trends.Findings indicate differences in nurses' perceptions of support when facilitating learners. Further exploration of Singaporean nurses' increased perceptions of support is worthy. Clinical learning organizational culture findings across Australian and Singaporean acute care facilities suggest common attributes within the nursing profession that transcend contextual factors, for example, a strong sense of task accomplishment.Nurses across both countries demonstrate strengths in accomplishing tasks but less so in recognizing nurses' contributions that may also impact nurses' influence in the practice context. As these attributes are common, nursing can collectively lobby and develop policy, thereby strengthening their cause to be recognized.

In Regina v. Inland Revenue Commissioners, ex parte Bishopp and Another, Mr Justice Dyson sitting in the Queens Bench Division held that the High Court should not review informal, unfavourable, pre transaction Revenue tax advice, or the refusal to offer advice, by granting declaratory relief in advance of a transaction. The application for judicial review was made by the accountancy partnerships Price Waterhouse Coopers and Ernst and Young, who had been exploring techniques for minimising their legal liability as partners in respect of unforeseen lawsuits brought against the partnership. The applicants had looked inter alia at Jersey, whose laws are recognised in England, and had asked the English Revenue to provide assurance that a Jersey limited liability partnership is for tax purposes a partnership in the United Kingdom (as opposed to a company). The Revenue refused to provide any such assurance, and the accountancy partnerships applied to the courts for a declaration that United Kingdom partnerships would remain partnerships for the purposes of English tax law in spite of their concurrent status as Jersey limited liability partnerships.

In recent years, women, children, and taxation have been a topical issue. Attention has focussed on the cost of providing public support for unemployed especially single mothers; there are now, for example, one million single mothers who are dependent on State benefits to care for two million children, at an annual cost of some £10 billion. Now, however, the Government has adopted a ‘solution’: to integrate aspects of the tax and benefit regimes in order to encourage unemployed mothers back to work. In the Social Security Act 1998, Parliament recently authorised a cut in the benefits available to single mothers. And in the Tax Credits Bill now before the Commons, a childcare tax credit is proposed to subsidise the costs of child care incurred by working parents. Under the legislation announced by the Chancellor in his 1998 Budget Statement 70 per cent of childcare expenses may be claimed as credit against tax, subject to a means-tested ceiling, provided the sole or both parents (as the case may be) are in employment.

We report an18-year-old girl with a four-year history of a slow-growing labial mass with a sudden increase in size in the last year. Examination revealed a large fleshy 20 cm perineal mass centering on the left labia majora and attached to it by a 1cm pedicle. It was associated with pain, ulceration and discharge. The lesion was excised via diathermy at the base of the stalk. The excised specimen weighed 1.112kg and measured 20.5 x 17 x 5cm. The lesion showed a solid, soft whitish, cut surface. Histology revealed a hypocellular tumour with focally oedematous fibrous stroma in which were scattered large and small blood vessels, mast cells and other chronic inflammatory cells. True myxoid matrix was not observed. The stromal cells had a spindle to stellate morphology. There was no significant cytological atypia, mitotic activity or necrosis. The tumour cells were negative for SMA, desmin, CD34, S100 protein, EMA and PR. The diagnosis was clinically and histologically challenging because various vulvovaginal soft tissue tumours often have overlapping clinicopathological features. However, based on strict histological criteria and the absence of worrisome cytological features, a diagnosis of fi broepithelial stromal polyp was rendered despite the unusual size. A review of the literature shows that whilst vulvovaginal fibroepithelial stromal polyps are well described, giant variants are rare. Awareness of the extraordinary size that can be attained by such polyps can facilitate swift clinical and histological diagnosis.

Pre-implant surgery was carried out in 20 patients with advanced atrophy of the edentulous maxilla, using autogenous bone grafts. Endosseous implants were placed after the initial healing period and these were used to retain removable overdentures. Patients were observed for up to 5 years with 15 of the 105 implants placed being lost and two remaining as sleepers. The resulting implant success rate was 84%. Three patients had to return to conventional dentures while the remaining 17 expressed a high degree of satisfaction with their implant retained prostheses. Pre-implant surgery successfully extends the scope for implant therapy by providing sufficient bone for implant placement. The survival rate of implants in these cases appears promising up to 3 years, although further data is required to confirm the effectiveness of this treatment in the long term. Implant retained overdentures are able to successfully restore both oral function and facial form. The rehabilitation of the atrophic, edentulous maxilla remains difficult and complex, even when using pre-implant surgery and implant retained prostheses.

Everyone agrees that mens rea is relevant to fault. The maxim actus non fit reus nisi mens sit rea has been around for centuries.1 According to foundational principles of the criminal law, it is normally not enough to support a conviction that D perpetrates the actus reus. Neither should it be. Causing harm to another person may be unfortunate, but the moral turpitude associated with a criminal conviction requires some element of fault. And to show that, we need mens rea.

Aim. This study aimed to identify the influenza vaccination rate among community-dwelling older Chinese people in Hong Kong general outpatient clinics and to identify the factors affecting their vaccine uptake. Background. Community-dwelling older Chinese people in Hong Kong underuse influenza vaccination. The first step to increase their vaccination rates is to understand the factors affecting their influenza vaccine uptake. Design. This was a retrospective and descriptive study. Methods. The sample comprised 197 subjects from five general outpatient clinics in the Kowloon East cluster of Hong Kong. A self-report questionnaire was used for data collection via individual face-to-face interviews. Results. Out of 197 subjects, 64·47% reported having received the vaccine within the previous 12 months. The regression model revealed that perceived benefits including ‘vaccination prevents me from catching influenza (OR = 12·18, CI = 3·61–41·07, p

Objective. To examine community nursing services for patients with cardiovascular diseases, chronic respiratory diseases and other general medical conditions, making the transition from hospital to home. Design. The original study design was a randomised controlled trial. This study is a secondary analysis of the hospital records documented by community nurses for the study-group patients. Sample. The sample consisted of 46 subjects, randomly drawn from the main study group of the study. Measurements. The community nursing records were analysed using the Omaha System. Self-reported health status and readmission data were retrieved from the data base of the original study. Results. The three groups of patients experienced problems across the four domains in the Omaha System. Community nursing interventions did not differ greatly by disease groups. The primary purpose of home visits was observation, followed by treatment and procedures and health teaching. The community nurses in the study spent more effort providing health teaching to the respiratory group than to their counterparts. The outcome measures are self-reported health status and hospital readmission rates. For self-reported health status, significant differences were observed in the respiratory and cardiovascular group before and after community nursing services. For hospital readmission rate, no significant difference was found. Conclusions. To improve the well being of chronically ill patients, a comprehensive home intervention programme, emphasising continuous needs of monitoring and case management, is fundamental to producing desired, measurable effects. Relevance to clinical practice. This paper adds the understanding of home-care services provided by community nurses to chronically ill patients. The scope of nursing services emphasises the significance of a positive, patient-centred, caring and appropriate client–practitioner relationship to improve the self-reported health of patients.

Aim. This paper reports a study comparing the outcomes of diabetic patients undergoing either early discharge or routine care. Background. The hospital is not the best place to monitor the glycaemic control of patients with diabetes with no other morbidity or complications. It is an unnatural environment in which diet is planned and the activity level is low. The hospital is also an expensive place in which to treat patients. Methods. This randomized controlled trial was conducted in the medical department of a regional hospital in Hong Kong. A total of 101 patients who needed glycaemic monitoring, but who were otherwise fit for discharge, were recruited. The control group continued to receive routine hospital care. The study group was discharged early and received a follow-up programme which included a weekly or biweekly telephone call from a nurse. Findings. When compared with the control group, the study group had a greater decrease in HbA1c at 24 weeks, although the statistical difference was marginal (7·6 vs. 8·1, P = 0·06), a higher blood monitoring adherence score at both 12 weeks (5·4 vs. 3·6, P

Many of the studies reviewing the needs of the dying patient have used specified time points rather than following the patients through the last span of their lifetime, until death. This prospective study, using clinical records and nursing anecdotes, examined the health problems encountered by dying patients receiving home care from referral to home care until death. Thirty-two subjects were recruited in the study. The clinical records were content-analyzed using the Omaha system, and the anecdotes of the nurses were used to illuminate the numerical findings. This study reveals that patients who were discharged home were living in good environmental and social conditions. The physical symptoms were generally well controlled, except for dyspnea. The psychological aspects caused the most concern to patients, families, and healthcare professionals. The severity of the psychological signs and symptoms was moderate at the time of the initial visits, but improved toward the final visits. Understanding the needs of palliative home care patients can facilitate the healthcare team to plan care to support "good dying" of these patients.

IT is said to be a tort for D intentionally to induce C to break C’s contract with P. Where this occurs, P has an action in tort against D, quite apart from P’s action for breach of contract against C. But the rationale for this tort is controversial, and its legitimacy has been doubted by a number of commentators.

The authors of this article consider that the swing-lock partial denture has a useful place in contemporary clinical dental practice and offers many advantages compared with conventional removable partial dentures in terms of retention and stability, especially in the extremely compromised dentitions. Here they describe the concept of the swing-lock removable partial denture, together with the indications, contraindications, technical and clinical considerations.

This article reviews the literature on maxillary implant-supported overdentures.Retrospective studies and clinical reports comprise the majority of publications, with few prospective studies.Maxillary implant-supported overdentures are associated with implant and prosthesis survival rates similar to those of fixed implant prostheses when patients are matched for bone quantity and quality. High failure rates are associated with extreme atrophy, poor bone quality, and the use of short implants, which represent situations in which overdentures are most commonly used.Further research is required to elucidate the most appropriate implant number and distribution as well as the most favorable prosthetic constructions.

Ablative surgery of the oral tissues may result in significant facial deformity, poor oral function, and psychologic detriment. Immediate surgical reconstruction with vascularized free flaps has become increasingly popular, but the oral rehabilitation of these patients with conventional dental prostheses is usually unsuccessful. The results and clinical experiences of treating a group of 17 patients with ablative surgery, immediate reconstruction with free flaps, and restoration with mandibular implant-retained prostheses are presented after follow-up periods of 6 months to 7 years. Most patients expressed a high degree of satisfaction with their prostheses. General principles and guidelines for the provision of this effective treatment modality are discussed.

Recent advancement in computer graphics and networking technologies enable researchers to experiment and build the distributed virtual environment (DVE) system. In general, a DVE system allows many clients to simultaneously explore a virtual world and at the same time, users in this virtual environment can interact with each other and can manipulate the objects in the virtual world. To implement such a system, there are many challenges that researchers have to face so as to build an efficient DVE system that can represent a large virtual world and at the same time, support large number of concurrent users. In this work, we present some of these important issues, such as the necessity to balance the workload among different servers as well as minimizing the inter-server communication. We show that the problem, in general, is NP-complete and we proposed several algorithms so as to find the partitioning policy efficiently.

The most common genetic alteration identified to date in bladder cancer is loss of heterozygosity (LOH) of chromosome 9, suggesting the presence of possible tumor suppressor genes on this chromosome. We attempted to map the location of these genes by analyzing 69 primary transitional cell carcinomas of the bladder with a panel of microsatellite markers for LOH on chromosome 9. Monosomy 9 (defined by LOH of all informative markers analyzed on 9p and 9q) was detected in 26 of 69 (38%) tumors, and 22 of 69 (32%) tumors showed subchromosomal deletions. Twelve tumors (17%) demonstrated partial LOH of chromosome 9 and indicated two distinct regions of LOH. Eight tumors showed distal allelic loss of 9q with a minimal region of common deletion flanked proximally by marker GSN on 9q33. Six tumors showed proximal allelic loss of 9p and 9q with a minimal area of common deletion flanked by markers D9S970 on 9p12 and D9S283 on 9q21. Two tumors showed loss of both the distal region of 9q and the proximal region of 9p and 9q, which were separated by a possible 6-44 cM of retained genetic material. The proximal minimal area of common deletion excluded 9q22.3-q31 to where two putative tumor suppressor genes, the nevoid basal cell carcinoma syndrome and multiple self-healing squamous epithelioma (ESS1) genes, have been mapped. The growth arrest-specific gene (GAS1), a candidate tumor suppressor gene, was included within the proximal minimal region. We evaluated the GAS1 gene for its potential role in bladder cancer using single-strand conformational polymorphism to screen for mutations in GAS1 in 10 bladder cancer cell lines and 14 primary bladder tumors. A polymorphism at codon 88 was noted in one primary bladder tumor, but no other abnormalities were found, suggesting that another potential tumor suppressor gene important to bladder cancer resides in these minimally deleted regions. Because the nevoid basal cell carcinoma syndrome gene has long been speculated to be a putative tumor suppressor gene in bladder cancer and this gene has recently been characterized as the human homologue of the Drosophila patched gene (PTC), 20 primary bladder tumors with chromosome 9q LOH were screened for mutations in PTC using single-strand conformational polymorphism and heteroduplex analysis. No alterations were found in any of the samples analyzed. Furthermore, 4 of 37 noninvasive papillary (Ta) tumors demonstrated loss of all 9q markers with retention of 9p, whereas no Ta tumor showed loss of 9p with retention of all 9q markers, suggesting that LOH of 9q is the earlier event in bladder tumorigenesis. In summary, our results indicate two tumor suppressor loci associated with proximal chromosome 9p to q and distal chromosome 9q that may be important in bladder cancer. GAS1 and PTC do not seem to be frequently mutated in bladder cancer.

Complications of upper gastrointestinal endoscopy are uncommon. Approximately one complication occurs with every 1000 procedures. The mortality rate is estimated to be between 0.5 and 3 per 10,000 cases. Cardiopulmonary events comprise 50% of all major complications, and most of these events result from the medications used for conscious sedation. Diagnosis, treatment, and prevention of common complications are discussed; rare complications are mentioned.

The maintenance requirements of a group of 58 patients, treated with the IMZ osseointegrated implant system and mandibular overdentures were investigated. Prostheses were retained by either bar and clip or separate stud attachments. The patients were followed up regularly for periods of between one and six years. The median number of maintenance procedures required per patient per year varied between 1-5. Detailed examination of the data revealed that a wide range of maintenance procedures was required, including replacement prostheses in 46% of cases. There were some differences related to the retentive elements used for the prostheses.

This paper presents the treatment results and experiences gained from a retrospective study of patients treated with the IMZ osseo-integrated implant system and mandibular overdentures. Patients experiencing problems wearing conventional dentures were assessed by the implant team and 65 cases were treated with 154 endosseous implants placed in the edentulous mandible. Two to four implants were placed in each case and in addition some patients have had augmentation of the mandible with hydroxyapatite. The definitive mandibular prostheses were supported by both implants and the residual ridges. A variety of retention systems were utilised, which included different types of bar and clip, stud attachments, and magnets. The patients have been followed up regularly and evaluated after periods of between one and six years. Six implants have failed over this time resulting in a success rate of over 96%. Most patients expressed a high degree of satisfaction with their new overdentures. There was, however, a considerable burden of maintenance care required for the patient group examined. The findings demonstrate that implant retained overdentures offer a highly effective means of oral rehabilitation for the atrophic mandible, restoring both oral function and facial form.

The design of metabolically stable, conformationally constrained peptidomimetics is an increasingly used approach in developing orally active drug candidates in pharmaceutical research. In this paper we present conformational energy calculations on model compounds containing 1-aminocyclopropane carboxylic acid (ACC) and its derivatives using molecular mechanics methods. The low energy models adopt conformations characteristic of a variety of regular structures such as the alpha-helix, gamma-turn and three- and fourfold helices. The energetically most favored models adopt either the left- or right-handed 2.2(7) helical conformation or the gamma-turn. These results are qualitatively consistent with the crystal structures of peptide analogs containing ACC and have potential implications for the design of peptidomimetics where the conformational features characteristic of a specific type of gamma-turn are desired.

The sealing ability of four restorative materials, placed in root surface cavities, was assessed by a range of standard in vitro microleakage tests. The rank order of the severity of microleakage associated with the four materials varied with the different tests. Although differences between the performance of unlined amalgam, two different dentine-bonded composites and a glass-ionomer restorative material were detected, most were not statistically significant. None of the materials tested completely eliminated microleakage and so even those materials reported to be adhesive to dentine cannot be considered ideal in the restoration of root surface cavities.

A case of a rare extra-osseous ameloblastoma is presented. It meets identical histological criteria as intra-osseous ameloblastoma, but its clinical presentation and behaviour are very different. It is non-invasive and may be locally excised without recurrence.