Augmentation of Pap smear screening of high risk aboriginal women. Use of a computerised process tool within the Broome Aboriginal Medical Service.
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Abstract:
The Broome Regional Aboriginal Medical Service (BRAMS) in Broome, Western Australia, conducted a 4 month program to augment the Pap smear screening of Aboriginal women. The emphasis was on those with a past history of abnormal smears, aged greater than 40 years, living in remote communities and very (more than 5 years) overdue.Continuation of existing opportunistic recall processes supplemented by three components: the development of an Aboriginal Health Worker (AHW) run Pap smear clinic; the provision of Aboriginal outstation screening; and active recruitment of targeted women (by AHW staff) using worklists. All components used Healthplanner, a computerised process tool to facilitate targeting and recall.The number of Pap smears taken from the target groups before and after intervention and the proportion screened from the women eligible in each target group at the start of the program.There was statistically significant increase in the coverage of Aboriginal women overall, those over the age of 40 years, and those from remote communities when compared with the same period the previous years. In 4 months, 21-30% of Aboriginal women eligible for Pap smears in these high risk categories including those with past abnormal smears were screened. Over-screening of women did not occur as only 4% of smears taken were from women screened less than 12 months previously. Smears taken by AHW staff were of high quality.Use of a computerised process tool in a remote setting can facilitate selective recruitment of high risk women overdue for Pap smears.Keywords:
Pap smears
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DeğerlendirilmesiÖZET Amaç: Pediatrik Üroloji polikliniğinde takip edilen hastalar için en değerli tetkikler olan idrar analizi ve kültürünün yorumlanması çok önemlidir.Çalışmamızda, ürolojik sorunları olan hastalarda kullanılan antibiyotiklere direncin
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Hintergrund: Als häufigste angeborene Fehlbildung des Gastrointestinaltrakts ist das Meckel-Divertikel (MD) ein wichtiges Krankheitsbild in der Praxis des Viszeralchirurgen. Ziel dieser Arbeit war es, die Sicherheit der Resektion von MD in Bezug auf postoperative Komplikationen zu analysieren. Aufgrund der relativen Seltenheit des MD wird zudem ein Überblick über die Literatur gegeben. Patienten und Methoden: Alle Patienten, bei denen zwischen 1996 und 2010 an der Chirurgischen Klinik I der Charité – Campus Benjamin Franklin ein MD beschrieben wurde, wurden erfasst. Es erfolgte ein Vergleich zwischen symptomatischen und inzidentellen MD in Hinsicht auf Inzidenz, Operationsindikation, intraoperativen Befund, Histologie und früh-postoperatives Outcome. Ergebnisse: Bei 71 von 29 682 Patienten (0,2 %) wurde intraoperativ ein MD festgestellt. Symptomatische MD zeigten sich bei 26 Patienten (37 %). Bei 6 der 7 Patienten mit gastrointestinaler Blutung (GIB) fand sich ursächlich ein symptomatisches MD (p = 0,005). Alle symptomatischen und 30 (67 %) der asymptomatischen MD wurden reseziert. Ektope Magenschleimhaut lag bei Patienten mit symptomatischem MD signifikant häufiger vor (p = 0,001). Patienten mit asymptomatischem MD und Resektion hatten tendenziell seltener postoperative Komplikationen als Patienten mit symptomatischen MD (p = 0,057). Schlussfolgerung: Ektopes Gewebe kommt bei symptomatischen MD signifikant häufiger vor, insbesondere bei blutenden MD. Bei einer GIB unklarer Ursache sollte ein MD in Betracht gezogen werden. Die Resektion inzidentell aufgefundener MD kann empfohlen werden, solange keine Kontraindikationen wie Peritonitis, Lebenszeit beschränkende Tumorerkrankung, Aszites oder Immunsuppression bestehen.
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Abstract Objective To establish the effect after 24 months of a face-to-face and telephone nursing counseling intervention, aimed at controlling cardiovascular risk factors (hypertension, dyslipidemia and overweight) and improving health-related quality of life (HRQoL) in patients of the cardiovascular health program of family health centers of Concepciόn, Chile. Methods Randomized controlled clinical trial with a 24 months post-intervention follow-up. 120 patients with cardiovascular risk factors under the cardiovascular health program were recruited from 6 family health centers and randomized into a control group (60) and an intervention group (60). The intervention group received the regular care in addition to face-to-face and telephone nursing counseling. Baseline measurements were taken and also at the end of the intervention (7 months). Participants returned then after 12 and 24 months for follow-up evaluations. A total of 109 subjects completed the intervention at 7 months and 45 returned at 24 months. During follow-up evaluations both groups continued to receive regular care given in the health centers. The measurements consisted of HRQoL (physical and mental health), systolic blood pressure (SBP) and diastolic blood pressure (DBP), body mass index (BMI), abdominal circumference (AC), total cholesterol (TC), low density lipoproteins (LDL-Chol), high density lipoprotein (HDL-Chol), atherogenicity index (LDL/HDL), cardiovascular risk factor (TC/HDL), 10-year coronary risk. Ethical requirements were considered and statistical analysis was carried out using MANCOVA and d-Cohen repeated measurements. Results The analysis of the effects of the intervention in the 24-month follow-up showed that subjects in the intervention group only maintained significant improvement of AC over time (F=3.18; p=0.03), compared to the control group. Conclusion Although participants in the intervention group only maintained the AC improvement over time, this can be regarded as an indirect indicator of the presence of intra-abdominal fat that makes it possible to predict and classify the risk of cardiovascular disease. Long-term follow-up studies are required to investigate behaviors and mechanisms that contribute to maintaining improvements in this indicator. Additionally, future research should include reinforcement activities, either face-to-face or by telephone, to help maintain the positive results of interventions. Acknowledgement/Funding Universidad de Concepciόn 214.082.049-1.0
Dyslipidemia
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Romatoid artritte kalp tutulumu yuksek siklikta gorulmekte olup yapilan bircok calismada bu hastalarda kardiyovaskuler mortalitenin artmis oldugu ve olumlerin %35-50'sinden kardiyovaskuler hastaliklarin sorumlu oldugu gosterilmistir. Romatoid artrit hastalari normal populasyon ile karsilastirildiginda %0,9 ile %3 oraninda artmis bir mortaliteye sahiptirler. Romatoid artritte bu mortalite artisinin baslica nedeni kardiyovaskuler hastaliklardir. Biz bu derlemede Romatoid artrit’in kardiyovaskuler hastaliklardan ozellikle koroner arter hastaligi ve kalp yetersizligi ile olan iliskisini ozetlemeyi amacladik
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Zusammenfassung Intraartikuläre Osteoidosteome (IAOO) sind mit 10 % aller Osteoidosteome selten. Die atypischen klinischen und radiologischen Befunde führen meist zu einem langen Intervall zwischen Beschwerdebeginn und Diagnosestellung sowie Einleitung einer adäquaten Therapie. Dieser Fallbericht handelt von einer 32-jährigen Patientin, die seit Jahren intermittierende Kniegelenksschmerzen bei tiefer Beugung und selten nachts angibt. Bei IAOO in der Trochlea femoris war eine Radiofrequenzablation (RFA) aufgrund der direkt subchondralen Lage kontraindiziert. Daher erfolgte eine operative Sanierung mittels Knorpel-Knochen-Transplantation.
Osteoid Osteoma
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