1240 throat samples were processed during different seasons in 11 different communities of The Gambia (West Africa). The carriage rate for Haemophilus influenzae type b ranged from 0 to 33%, but often attained 10% or more, higher than that reported from other open communities. The duration of carriage was short (less than 3 months) and H. influenzae b was found in only 10% of the carriers isolated during the previous or the following survey. Children less than 5 years old carried H. influenzae b in their throat significantly more often than children older than 14 years (P less than 0.05). A high carriage rate did not correlate with the wet or dry season. The carriage rate of children in rural areas was similar to that of children in urban areas. Children in day-care centres or nurseries had a surprisingly low carriage rate (2%). The carriage rate of H. influenzae b was compared to the presence of H. influenzae subspecies in a random sample, which revealed that H. influenzae subspecies was found in 90% of the children under 5 years old. Encapsulated strains of H. influenzae were found in 25% of the same sample, two-thirds of which were not type b. All capsule types were represented. No meningitis cases occurred in the survey populations. We conclude that the prevalence of H. influenzae b in open Gambian communities is similar to that in closed communities elsewhere, but that the kinetics are different from those in closed communities, as persistence of infection in Gambian children is short-lived.

Adolescent↗

PubMedDate not supplied

Guidelines and care pathways for genetic diseases: the Scottish collaborative project on tuberous sclerosis.

In Scotland a national audit project has been undertaken to devise evidence-based guidelines for the clinical management of patients with tuberous sclerosis (TS), a dominantly inherited multisystem disorder. In order to facilitate the audit and use of these guidelines a 'Care Pathway' was devised to form the patient records. We describe the process of guideline development for TS and our TS Care Pathway.

Evidence-Based Medicine↗

PubMedDate not supplied

The contribution of DNA mismatch repair gene defects to the burden of gynecological cancer.

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Base Pair Mismatch↗

PubMedDate not supplied

The unintelligible child: a problem for the health care team.

As a result of the rapid growth of applied psycholinguistic research it is necessary to explode some of the myths of normal and abnormal speech development. The following paper is an attempt to clarify the nature of phonological development and disability and to draw general implications for assessment and management of the unintelligible child.

Child, Preschool↗

PubMedDate not supplied

Pre-dialysis serum albumin is a poor indicator of nutritional status in stable chronic haemodialysis patients.

The correlation between pre-dialysis serum albumin and mortality has been linked with malnutrition. We measured pre and post-dialysis albumin in 86 stable haemodialysis patients and compared them with anthropometric measurements and body mass index (BMI). On the basis of pre-dialysis albumin 13% of patients would be classified as high risk, whilst on the basis of post-dialysis albumin only 12% would be classified as high risk. Change in albumin could be predicted by fluid removal during haemodialysis. Pre-dialysis albumin correlated weakly with mid upper arm circumference (MUAC). Post dialysis albumin correlated with MUAC and triceps skin fold thickness (TSF). There was a weak negative correlation between age and post-dialysis albumin. TSF strongly correlated with MUAC and BMI. Pre-dialysis albumin appears to be a poor predictor of nutritional status and does not correlate well with other nutritional parameters. The excess risk of death associated with a low pre-dialysis albumin may be related to fluid overload rather than malnutrition.

Anthropometry↗

PubMedDate not supplied

Quantitation of multistage carcinogenesis in rat liver.

A well characterized model of multistage carcinogenesis is that of hepatocarcinogenesis in the rat. The histopathology as well as the cell and molecular biology of the stages of initiation, promotion, and progression have been elucidated to varying degrees in this system. Putatively single initiated hepatocytes are identified by their expression of the ubiquitous marker of hepatocarcinogenesis, glutathione-S-transferase pi (GSTP). 0.5-1.0 x 10(6) GSTP-positive "initiated" hepatocytes developed within 14 days after initiation with a subcarcinogenic dose of diethylnitrosamine (DEN). Approximately 1% of these cells develop clonally into altered hepatic foci (AHF) in animals administered promoting agents, such as phenobarbital, chronically for 4-8 mo. Hepatocytes within AHF during the stage of promotion exhibit normal diploid karyotypes but various phenotypes depending on the chemical nature of the promoting agent. Continued administration of the promoting agent results in the infrequent development of hepatocellular carcinomas; however, administration of a complete carcinogen or a progressor agent during the stage of promotion results in substantial numbers of hepatic neoplasms. In order to quantitate the development of the stage of progression more accurately, markers selective for this stage have been sought. Transforming growth factor-alpha (TGF-alpha) appears to be such a marker of progression. About 500 TGF-alpha-positive lesions develop spontaneously following initiation and continued promotion, usually within GSTP-positive AHF, but administration of a single dose of a progressor agent such as ethylnitrosourea may increase this number 3-fold or more. Some agents such as gamma radiation and hydroxyurea, when administered as single or a few closely spaced multiple doses, result in no increased number in TGF-alpha-positive lesions but a markedly enhanced increase in their growth rate. By monitoring gene expression using quantitative stereology, the stages of hepatocarcinogenesis can be analyzed and quantified in sufficient detail so that the animal data can be utilized in biomathematical modeling to develop more accurate models for estimation of human cancer risks.

Animals↗

PubMedDate not supplied

Peripheral i.v. cannula dressings: advantages and disadvantages.

There are many peripheral intravenous cannula dressings being used throughout the country. This article is a review of these dressings and looks at those used in the authors' trust as well as other products on the market. The article gives an overview of the advantages and disadvantages of the different dressings, including costs, that allow medical and nursing staff to make an informed choice about the type of dressing they use. The authors felt, given all the evidence, the traditional method of using gauze, tape or mefix was no longer acceptable practice.

Bandages↗

PubMedDate not supplied

A practical guide to venepuncture and management of complications.

For years many nurses have felt that if they had the ability to perform skills such as venepuncture they would be able to provide a more holistic and efficient service. The culture in which nurses and doctors have traditionally worked has often made it difficult for nurses to become competent at such skills. However, the boundaries of medical and nursing roles have started to change and a culture of shared roles is emerging which has many benefits for patients, medical staff and nursing staff. This article provides a practical guide to venepuncture. It highlights the structure of a vein and the veins that are suitable for venepuncture. It also addresses the prevention and management of potential complications.

Catheterization, Peripheral↗

PubMedDate not supplied

Solving the Orem mystery: an educational strategy.

Three years ago Orem's Self-Care Deficit Theory was introduced in five pilot units at the Toronto General Hospital. To augment the existing implementation program and to introduce the basic concepts of the theory to staff from nonproject units, the clinical nurse specialist group developed a multimedia exhibit showing the theory in action. The theory was interpreted within the framework of the nursing process. A case study approach was developed so that a global perspective of the actual application of the model could be readily visualized. This article describes the activities involved in producing a self-learning educational presentation that can be put to a variety of uses, such as orientation of new staff and a review for current project unit staff, and that can also be revised and augmented as use of the theory becomes more sophisticated.

Education, Nursing, Continuing↗

PubMedDate not supplied

Drugs in feeds.

Explore the source record for details and available documents.

Animal Feed↗

PubMedDate not supplied

Perioperative antimicrobial prophylaxis in middle Tennessee, 1989-1990.

The patterns of use of perioperative antimicrobial prophylaxis were assessed in a randomly selected sample of short-stay hospitals in middle Tennessee. Overall, 438 procedures (48%) were associated with antimicrobial prophylaxis. Prophylaxis was more common in hospitals with more than 400 beds than in smaller hospitals. Moreover, prophylactic antibiotics were given more often for procedures with a proven indication for prophylaxis than for those without a proven indication (60% vs. 41%, P less than .05); this relationship remained constant regardless of hospital size (common odds ratio, 2.09). However, prophylaxis for procedures with a proven indication was more likely to be given in teaching hospitals than in nonteaching hospitals (odds ratios, 5.41 vs. 1.94). The duration of prophylaxis was less than 2 days for 89% of procedures. A wide variety of agents were used. This study suggests that while improvements have been made over the past decade in decisions about the duration of prophylaxis, considerable variation remains in the selection of the procedures in which such treatment is administered and of the antimicrobial agents used.

Anti-Infective Agents↗

PubMedDate not supplied

Albumin kinetics and oedema following reconstructive arterial surgery of the lower limb.

Of 26 patients who had either femoro-popliteal or aorto-iliac bypass surgery pitting oedema occurred in the reconstructed limb during the post-operative period in 13. Eleven of 13 patients (84.6%) who had a femoro-popliteal bypass developed oedema compared to 2 of 13 (15.4%) who had aorto-iliac operations (P less than 0.001 chi squared). There was a significant reduction in the serum concentration of total protein and the albumin fraction after operation in both groups of patients (P less than 0.01). The concentration of protein and albumin remained lower than the pre-operative values until the end of the study period but the mean values did not at any stage fall below the lower limit of the normal range. Albumin labelled with I125 was used to investigate changes in the albumin content of the reconstructed limbs. Following femoro-popliteal bypass there was a three fold increase in I125 albumin compared to the non-operated limbs and this persisted to the end of the study period (P less than 0.001). After aorto-iliac surgery there was only a small transient accumulation of I125 albumin in the legs compared to the pre-operative value (P less than 0.02). In both groups of patients large accumulations of albumin were associated with the presence of pitting oedema. It was concluded that altered albumin kinetics play an important part in the development of post-reconstruction oedema. The possible mechanisms involved are discussed together with the practical implications of the results.

Adult↗

PubMedDate not supplied

Patency of the primary pedal arch, blood flow through a femoro-tibial graft, and the role of a distal arteriovenous shunt.

In a series of 30 femoro-tibial grafts for limb salvage, blood flow through the graft was compared to patency of the primary pedal arch. Where the primary pedal arch was occluded mean flow was 83 +/- 44 ml/min compared to 152 +/- 51 mls/min when the pedal arch was complete (p less than 0.01). In order to increase blood flow through the graft in patients with an occluded pedal arch, an arteriovenous shunt was constructed at the distal tibial anastomosis. Following this procedure mean flow increased to 236 +/- 92 mls/min (p less than 0.001). The cumulative patency rate in patients who required an arteriovenous shunt was 65% at 6 months, compared to 68% in patients with a complete pedal arch in whom an arteriovenous shunt was not thought necessary. The results show that an arteriovenous shunt may be of value when blood flow through a femoro-tibial graft is limited by occlusive disease in the primary pedal arch.

Aged↗