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PubMed2002

[Study on intervention and comparison of rational use of antibiotics on perioperative period of clean incision and clean-defiled incision].

OBJECTIVE: To explore a set of scientific evaluation and intervention methods on perioperatur period which fits for China's situation, and to promote the development of rational drug use. METHODS: Two would tertiary general hospitals were selected and separated in to intervention group and control group. Intervention was carried out and compared at the same period on inpatient surgical cases of thryroidectomy, mastectomy, cholescystectomy, and hysteromyomectomy plus appendix. RESULTS: The average drug costs was decreased from 1 601.27 yuan to 1 489.59 yuan and the average antibiotics use from 740.20 yuan to 352.03 yuan (P < 0.01) in the intervention group pre and post intervention. There was a remarkable improvement on the rationality of antibiotics use in intervention group, from 31.35% to 91.81% (P < 0.01) pre and post intervention, implemented in the hospital. CONCLUSION: It is practicable and effective to implement rational drug use where intervention was carried out, since it plays an active role on promoting safely, effectively and economic antibiotic use in China.

Anti-Bacterial Agents↗
PubMed1992

[Nutritive value of daily food rations reproduced in several regions of Poland. Part VII. Evaluation of cobalt, chromium, nickel and selenium intakes].

On the basis of the data of the Chief Census Bureau, concerning the consumption of more than 80 food products, we reproduced in years 1987 and 1988 in Lublin, Olsztyn, Poznań, Warszawa and Wrocław the food rations characteristic of manual workers' families and of other families with medium incomes. In samples of these diets, chromium, cobalt and nickel were determined by the ASA method, and selenium-spectrophotometrically. Daily intakes were: for cobalt 15-32 micrograms, chromium 65-187 micrograms, nickel 138-316 micrograms and selenium 93-233 micrograms. It was found that the investigated food rations cover the requirements of these elements, and create no risk of their excess in food. The present results indicate that the levels of the investigated elements are mainly related to the kind of food products and to their composition, whereas they depend to a lesser extent on the region in which the food ration has been reproduced.

Chromium↗
PubMed2004

The effect of an educational intervention on improving rational drug use.

OBJECTIVE: To evaluate the effect of an educational intervention on rational drug use amongst Primary Health Care workers in two Local Government Areas (LGAs), Mushin and Ikeja, in Lagos State. METHODS: Mushin was randomly selected as the intervention LGA while Ikeja was selected as the control L.G.A. A structured educational intervention designed to improve prescribing practices was carried in Mushin LGA for four weeks. Drug use indicators were measured before, at two weeks and three months post intervention. RESULTS: At baseline, most of the drug-use indicators in the intervention LGA were significantly worse (p < 0.05) than the control LGA. However, at the two-week evaluation, the educational programme achieved a significant reduction in the average number of drugs in the intervention LGA from 7.3+ 2.8 to 6.3 + 2.3 (p=0.000) compared to the control LGA where there was no significant change (from 4.9+ to 4.8+2.2, p=0.647). There was also a significant increase in the percentage of patients rationally managed from 18% to 30% (p=0.0005) in the intervention LGA unlike the control LGA (from 33% to 31%,p=0.693.). The rate of change in the average number of drugs prescribed was significantly higher in the intervention LGA (+14% )compared to the control LGA (+2%,p=0.0000). The improvements were not sustained at the three-month evaluation, as most of the indicators were similar to values obtained at the baseline. CONCLUSION: The intervention programme significantly improved rational drug use in the short-term period only. Other cost effective and sustainable intervention models for improving prescribing practices should be developed.

Clinical Competence↗
PubMed2004

[The correlation dependence between urinary excretion of vitamin B1, B2, C and entrance some nutrients with ration].

The results of the correlation analysis between parameters of urinary excretion of vitamins B1, B2 and ascorbic acid and the consumption of some nutrients with daily ration are presented. The expressed correlation dependence between consumption of proteins and fats and urinary excretion of riboflavin, and between consumption of proteins and carbohydrates and urinary excretion of ascorbic acid were found out. The strong correlation was found between the level of the majority trace elements in daily ration and urinary excretion of vitamins. The urinary excretion of thiamin, riboflavin and ascorbic acid depends on their quantity consumed with the daily ration.

Diet↗
PubMed2004

Assessing competency competently: toward a rational standard for competency-to-stand-trial assessments.

This article reports on a survey of forensic psychiatrists and psychologists who read two case study vignettes and assessed whether each criminal defendant was competent to stand trial, using three differently worded standards of competency: one that focused on whether the defendant's thinking was rational, a second that focused on whether the defendant's behavior was rational, and a third that did not use the word "rational." The objective was to discover whether forensic examiners would distinguish among the standards (i.e., find the defendant competent under one standard but not under another) or whether they would find the defendant competent under all standards or incompetent under all standards. In responding to both vignettes, more than three-fourths of all respondents either found the defendant competent under all three standards or incompetent under all three standards. In addition, in answering one vignette, the respondents were divided almost equally in deciding whether the defendant was competent to stand trial. These results are analyzed and respondents' comments are discussed. The article concludes with specific proposals to improve competency-to-stand-trial assessments.

Adult↗
PubMedDate not supplied

[Development of a basic ration out of commercial foods for nutrition in ground-based simulation experiments].

Food rations composed of canned products were given the physiological and hygienic evaluation in the context of their fitness for human volunteers in experiments with head-down bedrest in isolation and confinement. As a result, the food rations were proven to contain the desired quantities of nutrients. Evaluation of food fitness for human subjects was made based on the data of clinical-physiological and biochemical investigations. The rations met the energy and anabolic metabolism demands of human subjects during extreme chamber experiments and were favorable to maintaining good level of vital processes.

Commerce↗
PubMed2004

Rationality versus irrationality in Egyptian medicine in the pharaonic and Graeco-Roman periods.

During the Ptolemaic Period (332 BC-31 BC), many Greek medical practitioners settled in Egypt where they established an outstanding medical school and developed a distinctive rational approach to diagnosis and treatment which some scholars have regarded as a significant advance on earlier Egyptian procedures. However, Egyptian medicine itself combined both 'rational' and 'irrational' procedures, and extant ancient sources indicate that 'rationality' was not a new concept. Also, several other medical advances that modern writers have usually attributed to the Greeks can be identified in earlier Egyptian traditions. Nevertheless, the limitations of extant textual and archaeological evidence constrain the scope of studies in this area, and new information is required to carry the debate forward.

Egypt, Ancient↗
PubMedDate not supplied

[Effect of an unbalanced food ration on induction and course of alloxan diabetes in rats].

Wistar rats were kept on a synthetic ration with different percentage of proteins (18, 9 and 50%) for 2 weeks. Then they were given subcutaneous injections of alloxan at a dose of 200 micrograms/kg of body mass. In some animals glycemia was established on the 7th day after the first administration of alloxan, in others--on the 3rd day after repeated administration of alloxan at a dose of 150 micrograms/kg of body mass. The animals were decapitated on the 14th and 30th day after establishing a hyperglycemic condition. Lethality percentage, a degree of glycemia, and at the end of the experiment insulinemia, body mass indices, indices for some organs were evaluated. A ration with an optimum and high content of protein was shown to decrease lethality percentage, reducing risks developing of a hyperglycemic condition, caused by alloxan. A ration with a high content of protein decreased a degree of severity of a diabetic condition, caused by alloxan.

Animals↗
PubMed1991

Rational suicide: how can we respond to a request for help?

For some persons who are facing terminal illness, severe permanent disability, or extreme old age, suicide may seem to be a rational choice. Suicide prevention services, however, do not provide for suicide as a sane, honorable choice in such circumstances. This paper identifies 17 specific considerations a mental-health professional may use to help such a person explore whether suicide would be rational or irrational. These considerations are formulated without antecedent bias towards prevention and without interpreting interest in suicide as evidence of depression or mental illness. Dying, severely disabled, and aged persons considering suicide on what seem to them to be rational grounds may thus trust and consult mental-health professionals about their plans.

Aged↗
PubMedDate not supplied

[The effect of different concentrations of surface-active substances on the size of the circadian rations and on the duration of food passage in Lymnaea stagnalis infected with Echinostoma revolutum parthenitae].

In solutions of the detergent "Kristall" (0.9 and 90 mg.l.-1) there were established statistically reliable differences in the values of day rations and duration of food passing both in infected and free from infection molluscs. In noninfected individuals day rations increase 1.5 to 5 times and the duration of food passing 5 to 7 times. In infected animals the value of day rations decrease and the duration of food passing increases less intensively.

Animals↗
PubMed1989

[Use of sodium acetate in feed rations in ketotic cows].

On a farm where the ration of cows contained 88.0 g of butyric acid, an experimental group of cows (n = 8), producing milk containing 7.9 mg or more acetone per litre, was studied for 14 days for the effect of a 250 g supplement of sodium acetate to the ration (combined with single i.m. administration of vitamins A, D2 and E) on selected metabolism parameters and on milk production. As distinct from the control group of cows (n = 8) from the same farm which produced milk containing 3.9 mg or less acetone per litre and which were fed without sodium acetone supplements, a tendency of increased alkaemia of the organism was suggested in the experimental cows. This tendency manifested itself during the trial in increased pH values, increased base excess (BE) and standard bicarbonate (SB) in the blood, and in an increase in the pH value and net acido basic secretion in urine. A decrease was recorded in the concentration of the acetone + acetacetic acid sum, the same as beta-hydroxybutyric acid in blood and the sum of acetone and acetacetic acid in milk (P less than 0.01). An insignificant increase of the activity of gammaglutamyl transpeptidase (GMT) was recorded in the blood serum of the experimental cows and a significant increase occurred in the content of potassium (up to P less than 0.01) and urea (up to P less than 0.01) in urine. The supplement of sodium acetate to the feed ration did not influence the degree of ketonuria and the finding of urobilinogen in urine.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetates↗
PubMed1986

Rational management following diagnosis of myocardial ischemia.

Assuming one knows that myocardial ischemia is present, rational management will first require a careful history to assess the severity of symptoms, such as angina, the lifestyle of the patient, his/her age, and the availability of resources. When a patient is greater than or equal to 70 years, has little angina, even the demonstration of ischemia will not require early arteriography; pharmacological therapy on a trial basis is the preferred approach. Judging the response to oral nitroglycerine, isosorbide dinitrate, beta blockers and calcium antagonists, (often combined and in modest doses) is good rational management. If symptoms persist despite therapy or when the patient is younger and has symptoms which cannot be alleviated by changes in lifestyle and/or workload, the established ischemia assumes much greater significance and nearly always requires a coronary arteriogram for proper management. Once the coronary arteriogram has been analyzed in terms of severity of flow impairment, correlation with the tests showing the extent of myocardial ischemia must be made, best during exercise. If single vessel disease is found with a local dyskinetic (echo, scintigraphy, or angio) segment, which corresponds to a stenosis of greater than or equal to 70%, particularly when found in the anterior descending artery, balloon dilatation (PTCA) or bypass surgery (CABG) should follow. When tests, such as the ECG, are obtained during an attack of angina, the Chahine classification may be used first. In Class IIa with pure ST-segment elevation significant atherosclerotic lesions are absent in most patients, while local spasm can be shown upon provocation. Here rational management can be limited to calcium antagonists sometimes combined with beta blockers.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic beta-Antagonists↗
PubMed1989

Validity of self-estimated and weighed dietary data for assessment of military rations.

Validity of food intake values, self-estimated by subjects and weighed by researchers, was evaluated during the assessment of a new military ration. As an addition to food intake measured by the two methods, a third set of intake values was generated by combining food intakes from the self-estimated and weighted data. This combined method is proposed as another reference for assessing validity. The new ration, Meal-Ready-to-Eat (MRE), was the sole source of food for an experimental group of 27 soldiers engaged in a 34-day field exercise. A control group of 30 soldiers ate a freshly prepared (A ration) breakfast and dinner and an MRE lunch. Agreement of mean nutrient intake values from self-estimated and weighed data was high among both experimental and control groups (average coefficients of correlation for 16 nutrients, 0.948 and 0.884, respectively). Paired t-tests yielded no significant differences between self-estimated and weighed means for nutrient intake but were significantly different from the means obtained by the combined method (p less than .0001). Mean nutrient intakes determined by both the self-estimated and weighed methods approached 90% of the intakes found by the combined method.

Adult↗
PubMed1979

[Rational therapy of peptic ulcers].

Prerequisites of rational conservative treatment of peptic gastroduodenal ulceration are rational diagnostics(endoscopy, histology, cytology), present state knowledge of peptic ulcer pathogenesis, and knowledge of the drug to be used. Treatment should aim at: pain relief, promotion of ulcer healing, prophylaxis of ulcer relapse including consideration of side-effects and costs of the drug, which should be minimal. At present, rational recommendations can be given only for the treatment of the acute ulcer attack but not as to prophylaxis of recurrences. Patients with uncomplicated peptic ulceration should be treated as outpatients, whereas in case of complications (penetration, perforation, bleeding of ulcers, symptoms of stenosis, dramatic pain, or particularly adverse living conditions at home) patients need hospitalization.

Antacids↗
PubMed1987

Can rational prescribing be assessed?

The prescribing of a group of young general practitioners was assessed, before and after educational intervention, using five parameters of rational prescribing. The proportion of drugs prescribed by their generic name, and the proportion falling within a basic formulary for general practice increased significantly even though the participating doctors had neither been involved in the compilation of the formulary nor been given a copy of it. Items prescribed bygeneric name rose from 45 to 74% and the proportions of new and repeat items within the formulary rose by 73 to 83% and 68 to 77% respectively. It appears that discussions about rational prescribing lead to similar changes in prescribing as involvement in the compilation of a formulary.The notion of an ;essential drugs list' for general practice is described, and three easily applied measures of rational prescribing are suggested: (1) the proportion of patients not given a prescription, (2) the proportion of drugs written in their generic form and (3) the proportion of drugs falling within a general practice ;essential drugs list'.

Drug Prescriptions↗
PubMed1986

Doctors and rationing: the end of the honor system.

Physicians have traditionally held that to participate in "rationing" or resource allocation would betray their duty to advocate for everything possible for the patient. However, the record of physician behavior belies that, indicating instead that they have always rationed health care and their own time and services. Physician resistance to calls for "rationing" today appears to be based more on the nature of the process and on the fact that this process is being taken out of the hands of physicians. If American medicine does not rethink its own stance and develop not only a stronger resource allocation ethic but also a means of implementing it, it is unlikely that physicians will continue as the guardians of the quality of care and patient service.

Cost Control↗
PubMed1987

Laminitis and decreased milk production in first-lactation cows improperly fed a dairy ration.

First-lactation cows that were improperly fed a grain ration developed chronic, nonsuppurative laminitis, resulting in profound lameness in all 4 limbs, thin body condition, and poor milk production. Results of ration analysis indicated that the cows were receiving 10% to 40% more energy than that recommended by the National Research Council. The following management changes were instituted for first-lactation cows: the absolute amount of concentrate offered was decreased by 10% to 25% (depending on each cow's milk production), the rate of increase in concentrate fed was lessened to achieve maximal intake in 21 days, feed was made available more frequently and in smaller amounts during the day, sequence feeding was implemented, forage was provided before grain when possible, and sodium bicarbonate (1%, on a dry-weight basis) and fat (5%, on a dry-weight basis) were added to the grain mix. These management changes normalized rumen fermentation, and the clinical problems did not develop in the 20 subsequently fresh heifers. Therefore, the ration should be analyzed when first-lactation cows begin developing lameness and poor milk production.

Animal Feed↗
PubMedDate not supplied

[Physiological and hygienic basis for the rational nutrition of female workers in branches of light industry].

The energy expenditures in the nonproductive period in the women-workers of the boot and shoe industry (group I) and the sewing industry (group II) were almost similar: in group I it was on an average 1372 +/- 35.4 kcal, in group II--1384 +/- 27.6 kcal. In the productive period the energy expenditures in the workers of group I fluctuated from 1.56 to 2.09 kcal/min, in those of group II--from 1.78 to 2.27 kcal/min. Summary energy expenditures in the productive period comprised 877 +/- 91.1 kcal (in group I), and 949 +/- 51.1 kcal (in group II). Daily energy expenditures were 2249 +/- 77.1 kcal and 2333 +/- 63.9 kcal, respectively. The energy value of the rations of their actual nutrition insignificantly exceeded their energy expenditures (on an average by 120-150 kcal) due to excessive fat consumption, animal fat, in particular. Their rations were characterized by protein, and, to a lesser extent, carbohydrate deficiency, by imbalanced mineral composition and vitamin A, B1, B2, PP and C deficiency. Microsymptoms of vitamin deficiency (mainly those of vitamin C deficiency) were detected in 64% of the examined subjects, excessive weight was found in 23-26% and obesity in 11-16% of the women. The women working at the modern boot and shoe and sewing industry should be referred to the first category of the work intensity, with respect to the energy requirements and the energy value of the nutrient components of their food rations.

Adolescent↗