Evidence-Based Practices to Promote Tobacco Cessation During Pregnancy in a Sample of Romanian General Practitioners.

Changes in confidence in implementing smoking cessation support for pregnant women was assessed among Romanian General Practitioners (GPs) before and after a training program of evidence-based clinical practices to promote quitting. The total number of physicians participating in the study was 69. Before training, 51% of GPs felt somewhat/very confident asking pregnant women about tobacco use, 39% assisted smokers with a quit plan, 38% arranged follow-up for patients. After training, 85-90% found the training informative/very informative on: how to ask patients if they smoke (89%), advising patients to quit (88%), talking about the benefits of quitting (85%), assessing patients readiness to quit (87%), assisting patients in setting a quit date (87%).

[Leptospirosis--epidemic, clinical and diagnostic aspects]. / Leptospiroza--aspecte epidemiologice, clinice si de diagnostic.

Leptospirosis is a major public health problem throughout the world. We studied 22 cases of leptospirosis. They were hospitalised between 1999-2003. Men were more affected than women and those with rural origin prevailed, too. The direct infection was more often found in these cases. These patients presented a large spectrum of signs and symptoms attributable to this spirochetal pathogen. The etiology was dominated by L. pomona, L. canicola, L. wolffi. Leptospirosis presented with 3 syndromes: Weil's syndrome, atypical pneumonia syndrome and aseptic meningitis. The adequate treatment was with penicillin or ampicillin i.v.

Pulmonary complications of feeding tubes: a new technique of insertion and monitoring malposition.

OBJECTIVE: To confirm the value of a new technique that will ensure safe introduction of feeding tubes. DESIGN: Two case reports; an anatomical and physiologic description of deglutition; and a case study. SETTING: A level 2 regional referral centre. PATIENTS: Thirteen anesthetized adult patients and 7 awake subjects, comprising patients scheduled to undergo elective surgery, medical staff and health care volunteers. INTERVENTIONS: Airway sampling for carbon dioxide with capnography in 13 anesthetized adults with the tip of the feeding tube in the pharynx, in the esophagus and in the trachea, and airway sampling for carbon dioxide from the pharynx and esophagus in 7 awake subjects during introduction of the feeding tube. Fluoroscopic monitoring of the position of the tip of the feeding tube during introduction in two patients and two volunteers. MAIN OUTCOME MEASURES: Carbon dioxide levels at the tip of the feeding tube during introduction. RESULTS: In all patients, with the tube either in the trachea or pharynx, a normal capnogram was displayed. When the tube was introduced into the esophagus no capnogram curve was seen, indicating the absence of carbon dioxide. With the subject lying down during introduction, the weighted tube followed the posterior pharyngeal wall to the upper esophageal sphincter. CONCLUSION: Positioning of the patient lying down with the head flexed and capnographic measurement of carbon dioxide levels from the tip of the feeding tube during insertion is a safe, accurate and cost-effective method for the introduction of feeding tubes.