Catherine R. deVries *
Summary
Over the course of approximately 60 years, the field of pediatric urology has evolved as a convergence of pediatric surgery, urology, and plastic surgery to address congenital anomalies of the urinary tract and genitalia in children. Guide-lines for training and certification are narrowing in high-income countries (HICs) at the same time as the fertility rate is declining and the prevalence of complex genitourinary (GU) conditions is decreasing. In low-and middle-income countries (LMICs), health systems for large populations are currently in a state of stress. Here we briefly review the history of pediatric urology as a surgical subspecialty, identify unmet needs especially in LMICs and place the field in the context of a global surgical ecosystem.
Methods
The English language literature on workforce trends in pediatric urology, pediatric surgery and urology was reviewed as well as development of the emerging field of global surgery. Global surgery looks at the social, economic and political context of health systems as well as unmet clinical need. World trends in fertility rates were reviewed to identify regions of workforce surplus and gaps, supply chain needs, infrastructure and systems strengths and weaknesses.
Results
The proliferation of training programs in pediatric surgery and specialties in high-income countries (HICs) coupled with declining birth rates has led to a saturation of specialists and declining surgical case load. In LMICs, while the birth rate has also been declining, surgical specialization has not progressed. In the lowest income countries, especially in sub-Saharan Africa, training in pediatric surgical specialties and urology is rare. The broad workforce that supports surgical care, such as anesthesia, intensivist pediatrics, radiology, laboratory, and nursing face similar challenges. Supply chains for specialized pediatric urological surgery are weak.
Conclusion
There is an evolving maldistribution of pediatric surgical and pediatric urological workforce globally, with too few practitioners in LMICs and too many in HICs. The high cost of specialized equipment limits access to quality care, and the supply chain for consumables and medication is patchy. In LIC’s, basic community-based infrastructure for health including reliable electricity is lacking. Recent experience with Covid and environmental disasters has highlighted that even in HICs surgical resilience can be challenged. This is an opportunity to consider the state of children’s urological care globally and to build resilience by identifying and addressing strengths and gaps.
Ying‑Chu Lin1 , Cheng‑Feng Tsai1,2* and Hsiao‑Ling Huang3*
Abstract
Background The effects of a low concentration of hypochlorous acid (HOCl) mouthwash on salivary bacteria remained unclear. We aimed to evaluate the antibacterial effects of 100 ppm HOCl mouthwash on salivary bacteria, including Staphylococcus aureus (S. aureus), in patients with periodontal disease (PD).
Methods Patients with PD were randomized into mouthwash-only (MW, n=26) and mouthwash with periodon‑tal flosser (MWPF, n=27) groups. Patients without PD were selected for the control group (n=30). S. aureus culture and saliva samples (before and after the intervention) were collected for bacterial DNA extraction. A real-time poly‑ merase chain reaction assay and serial dilutions of S. aureus culture and saliva samples were used to measure the salivary bacteria total count (SBTC) and confirm the antibacterial effects of the mouthwash using S. aureus.
Results No significant difference in demographic data was observed among the three groups. Before the intervention, the baseline SBTC of the MW and MWPF groups was significantly higher than that of the control group. After the mouthwash rinses, the SBTC data significantly changed in the MW and MWPF groups only (by 62.4% and 77.4%, respectively). After the base-2 log-transformation of the SBTC data, a similar trend was observed. Linear regression revealed that baseline SBTC and the MWPF intervention significantly affected SBTC reduction percentage by volume. After incubation with 10% (v/v) of mouthwash, the survival rates of 106 and 107 colony-forming units/mL of S. aureus were 0.51%±0.06% and 1.42%±0.37%, respectively.
Conclusions These study results indicated that 100 ppm HOCl mouthwash treatment could effectively reduce SBTC in patients with PD and the abundance of S. aureus. It provides that the HOCl mouthwash can be an option for individuals to help control SBTC, especially in patients with PD.
Trial registration The study protocol was approved by the Institutional Review Board of Kaohsiung Medical University Hospital (KMUHIRB-F(I)-20200042) on 20/03/2020 and retrospectively registered at ClinicalTrial.gov (NCT05372835) on 13/05/2022.
Keywords Antibacterial ability, Total bacterial count, Hypochlorous acid, Mouthwash, Intervention, Bacterial growth estimation
原创：伤口治疗及造口护理中心
对于每一个人来说、食物中富含营养素的多少，及其自身吸收利用的程度的高低，将决定着他本人的营养状况。目前对一个人营养状况的评价，大体上是根据我国各类人群中每日膳食营养素供给量的标准米衡量的。对符合每日供给量标准的为营养状况良好，超过的为营养过剩，不足的为营养不良。受历史条件的限制，祖国医学认为人的营养状况取决于饮食结构与进食量是否合理，合理的饮食结构能保障营养素的供给，所以营养状态良好的饮食标准应该是下面几点。
接着我们上一次内容，如果压力性损伤一旦发生，我们的家庭护理重点将从预防转成减缓其发展和促进愈合。那么愈合减缓压力性损伤的发展内？
四月已接近尾声，五月已悄悄来临，对于每一位护士来说，五月是不平凡的一月。5.12护士节马上就要来临了，小编作为临床护理工作岗位上的普通一员，心里也是异常激动，无论是院里还是市里都筹备着丰富多彩的节目和各项比赛。应领导号召，小编自己也积极参加各项活动。但无奈分身乏术。在此向大家致歉，没有及时更新内容。让各位读者久等了。再次向大家致歉。今天小编就向大家继续讲解关于压力性损伤的相关内容。
人的一生中，从生命开始到生命结束，是一个不断变化的过程。
伤口世界平台生态圈，以“关爱人间所有伤口患者”为愿景，连接、整合和拓展线上和线下的管理慢性伤口的资源，倡导远程、就近和居家管理慢性伤口，解决伤口专家的碎片化时间的价值创造、诊疗经验的裂变复制、和患者的就近、居家和低成本管理慢性伤口的问题。
2019广东省医疗行业协会伤口管理分会年会
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