Objective To investigate the effectiveness of acupuncture and acupressure as supplements to standard treatment for postoperative vomiting in children undergoing tonsillectomy and/or adenoidectomy. Methods A pragmatic, open, block-randomised controlled trial. The results were analysed according to the intention-to-treat principle. The study was conducted without extra resources in a normal setting at the day-surgery department of Lovisenberg Diakonale Hospital in Oslo. 154 children with an American Society of Anesthesiologists grade 1-2, weighing at least 10 kg, were included. Children with concomitant gastrointestinal diseases, emesis or antiemetic treatment <24 h preoperatively, rash or local infection over the actual acupuncture points were excluded together with patients whose parents' informed consent could not be obtained. The intervention group received acupuncture at pericardium 6 bilaterally, at a depth of approximately 0.7 cm with a median of 21 min during anaesthesia, followed by acupressure wristbands for 24 h and standard treatment. The control group received standard treatment. The primary end point was the occurrence of vomiting or retching during 24 h postoperatively. Results Children in the acustimulation group experienced less retching and vomiting than the control group-46.8% versus 66.2% (p=0.015). The effect of acustimulation was specifi cally pronounced in girls and children aged 1-3 years. Conclusion This trial indicates the effectiveness of acustimulation as an adjunct to standard treatment. The results should encourage and promote the implementation of acustimulation for postoperative vomiting in children undergoing adenoidectomy or tonsillectomy.
The development of wine tourism has been shown to have a possible positive effect for growers in wine producing areas. Examples of areas where studies have demonstrated this effect include Texas and Rioja. It is believed that the English wine producers, for the most part, are not organized to derive the maximum benefit from wine tourism. At present English vineyards are suffering from the general depression in British agriculture and vineyard owners would benefit from any additional income such as that which could be generated by tourist expenditure. A qualitative study conducted by the authors in 2001 and 2002 shows vineyard proprietors' attitudes to wine tourism and identify ways in which they think wine tourism in the UK can be encouraged and organized to the benefit of the wine producers. This paper will present findings of the study and, using secondary data, notably from the Texas Wine Marketing Research Institute, wine tourism practices in the UK will be compared with those in other wine producing regions. Preliminary findings show growing polarization in the UK wine production world between a small number of large producers, selling wine to major supermarkets, airlines and for export, and small life-style proprietors, becoming heavily dependent on cellar door sales. Findings also show a continuing lack of joint vineyard promotional activity whether organized by the producer, by central government, local government or by tourist authorities.
Practice reimbursements increased after EHR implementation, but there was a long-term decrease in the number of patient visits seen in this ambulatory practice context.
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