Our patients have not only a "guardian angel" to see that their needs are being met, but also an entire team of "Guardian Angels" to watch over them. I am very proud of our unit and pleased to be able to provide this service to our community. We have been able to accomplish this through teamwork!

Case Management↗

PubMedDate not supplied

Natural history of early diabetic nephropathy: what are the effects of therapeutic intervention? Melbourne Diabetic Nephropathy Study Group.

Several studies have shown that lowering of blood pressure slows the rate of progression of diabetic renal disease. Some placebo-controlled studies have also shown that angiotensin-converting enzyme (ACE) inhibitors decrease or stabilize albuminuria in incipient nephropathy and slow the rate of progression of advanced nephropathy. However, it is not yet clear if prolonged treatment with ACE inhibitors or with other agents exerts a specific renoprotective effect in incipient diabetic nephropathy. It is proposed that such an effect should be independent from changes in systemic blood pressure and should be characterized by amelioration of the rate of rise of albumin excretion rate (AER) and the rate of fall of glomerular filtration rate (GFR) and independence from changes in other parameters known to influence AER (glycemic control, protein intake, sodium intake). In addition, there should be evidence that the potentially reversible effects of therapeutic intervention on AER and GFR are translated to long-term changes in renal function and structure. This paper reviews the evidence on which the concept of renoprotection is based, with particular reference to choice of end points, heterogeneity of study groups, and complexities of the disease process, and relates this evidence to the natural history of nephropathy in type I and type II diabetes. Based on the above, an assessment is made of the comparative effects of ACE inhibitors and other antihypertensive agents on AER and GFR. It is suggested that longitudinal intra-individual analysis of both variables may be necessary in order to determine whether ACE inhibitors exert greater renoprotection than calcium channel blockers or other antihypertensive agents.

Albuminuria↗

PubMedDate not supplied

The non-use of 9-1-1. Private transport of trauma patients to a trauma center.

HYPOTHESIS: Privately transported, major trauma patients made up approximately 4% of the total trauma patients population at a major, regional trauma center which treats over 90% of all major trauma victims in the geographic area. This study was undertaken to evaluate the patient profile of those individuals who did not access 9-1-1 for transport to a trauma center, including their reasons for such non-use. METHODS: Data on all major trauma occurring within Dade County, Florida, were collected by the county trauma registry. RESULTS: In the last six months of 1989, 1,672 patients were entered into the trauma registry. One-thousand-six-hundred-thirteen (1,613) were transported by professional ground or air services, 59 by private vehicle. For those patients transported directly from the Emergency Department to the Operating Room, only 35% of private vehicle patients entered surgery within 90 minutes of presentation compared to 57% of those who gained access to the 9-1-1 system and used emergency medical services (EMS). One-half of those patients who did not use 9-1-1 did not have telephone access. Patient acuity was similar for those transported by private vehicle compared to those transported by basic or advanced life support units. Private vehicle transport often delayed patient triage and assessment. Thus, for a number of lower income patients, 9-1-1 access was difficult. CONCLUSION: Underestimation of the severity of the injury or fear of delay in rescue response were prominent reasons for non-use of 9-1-1. While educational efforts should concentrate on decreasing inappropriate 9-1-1 use for non-emergencies, the causes of underutilization should not be ignored.

Adult↗

PubMedDate not supplied

Multi-dimensional assessment of soccer coaching course effectiveness.

The purpose of this study was to determine the relationship between the aims of course providers and events during the delivery of two soccer coaching accreditation courses. A secondary purpose was to evaluate performance-analysis methods for assessing the course instructor's performance. A case analysis approach was developed to evaluate the courses and the data-gathering process. This research approach was chosen to amalgamate the sources of evidence, providing a multi-dimensional view of course delivery. Data collection methods included simple hand notation and computer logging of events, together with video analysis. The hand notation and video analysis were employed for the first course with the hand notation being replaced with computer event logging for the second course. Questionnaires, focusing on course quality, were administered to participants. Interviews and document analysis provided the researchers with the instructors' main aims and priorities for course delivery. Results of the video analysis suggest a difference between these aims and the events of the courses. Analysis of the questionnaires indicated favourable perceptions of course content and delivery. This evidence is discussed in relation to intent and practice in coach education and the efficiency of employing performance-analysis techniques in logging instructional events.

Accreditation↗

PubMedDate not supplied

Effective resistance to potyvirus infection conferred by expression of antisense RNA in transgenic plants.

Approximately 660 nt including the carboxy-terminal portion of the bean yellow mosaic potyvirus (BYMV) coat protein gene, complete 3' noncoding sequence and a short poly(A) tract were introduced to produce antisense RNA in transgenic Nicotiana benthamiana. Original (R0) transformants were selfed, and homozygous second generation (R2) populations challenged with infected sap, purified virus, or viral RNA. One transgenic line of 10 examined was extremely resistant to infection by mechanical inoculation of 100 micrograms/ml BYMV or 50 micrograms/ml BYMV RNA (the highest concentrations tested); no virus could be detected in inoculated leaves of this line. Nine other lines were systemically infected when inoculated with BYMV or BYMV RNA, with initial symptoms indistinguishable from those in nontransgenic plants. One of these lines subsequently developed reduced symptoms and then symptomless, virus-free leaves (complete recovery from BYMV infection), while other lines produced leaves with reduced symptoms and reduced virus titer compared to the controls (partial recovery). No transgenic lines had resistance to infection, nor recovery from symptom expression, following inoculation with pepper mottle or turnip mosaic potyviruses. Antisense RNA from 3' regulatory regions can confer multiple degrees of resistance to potyviruses, including extreme resistanc to infection, presumably by interference in virus replication.

Base Sequence↗

PubMedDate not supplied

Burn patient registries in the United States: a survey.

The Committee on Organization and Delivery of Burn Care of the American Burn Association conducted a survey among burn care facilities to determine the extent of interest in development and maintenance of computerized patient registries. Initial questionnaires were mailed to 178 burn care facilities. Responses were obtained from 112 (62.9%). Eighty-seven (77%) of the responders indicated that they have some form of registry. Thirty-five of these registries were in the form of handwritten logbooks, while 43 were personal computers with a wide variety of hardware and software. Uses of these registries include patient census and reports (64% of responders), clinical research (62%), patient care (61%), and, less common, quality assurance and education. Twenty-five facilities stated that they do not maintain a registry, but 22 (88%) of them indicated interest in developing one. It seems unlikely that a single system could be designed to fill the needs of all facilities, nor is it likely that existing registries can be "networked" successfully. This is due not only to the diversity of data in the existing registries, but also to the important differences in the way basic terminology is used in different facilities. For burn care facilities interested in developing their own registry, a selected list of successful representative registries is provided.

Burn Units↗

PubMedDate not supplied

The occurrence of acquired immunodeficiency syndrome and unsuspected human immunodeficiency virus in burn patients.

Although the risk of nosocomial transmission of human immunodeficiency virus remains low, burn center personnel may be at greater risk. Approximately 10% of burn patients admitted to an urban center were found to be positive to the human immunodeficiency virus, consistent with other findings of increased prevalence in trauma patients. "Universal" precautions adequate for other health care settings may not be sufficient in the burn center. Knowledge of a patient's human immunodeficiency virus status has important treatment implications.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

Burn nurse retention. Elements of success.

With the national nursing shortage most acute in the critical care area, greater emphasis on effective recruitment and nurse retention is vital. Despite the high-stress environment of a busy burn center, nursing turnover can be reduced to acceptable levels. The greatest "satisfiers" are centered around nursing issues such as schedule flexibility, nurse/patient ratio, and the center's reputation and standards. Salary and the physical plant environment were of little importance in comparison.

Attitude of Health Personnel↗

PubMedDate not supplied

The value of isokinetic exercise and testing in burn rehabilitation and determination of back-to-work status.

Determination of work capability may require assessment of function at speeds consistent with the patient's workday requirements. Standard isotonic physical therapy techniques do not adequately test strength, power, and endurance. Isokinetic training and testing improve both outcome and assessment.

Adult↗

PubMedDate not supplied

Coordinated strategies in burn prevention programs: a case study.

Smoke alarm giveaway programs can be successful, as demonstrated by the experience of the extensive 1982 Baltimore Fire Department project. In the absence of municipal government commitment for such an intensive campaign, a community program that involves many sectors can also be successful. It may, in fact, reach elements of the high-risk population who do not traditionally participate in smoke detector programs, such as renters. A decrease in "extra-alarm" fires and fire deaths can be achieved with multifaceted programs. In Dade County, with a growing population of approximately 1.7 million people that includes large migrant and illegal alien populations, fire-related deaths decreased from 26 in 1985 and 27 in 1986 to 17 in 1987. In the city of Miami, the county's inner core, fire-related deaths decreased by half from 1985 to 1987, in spite of an increase in high-risk population groups and substandard housing. Thus through extensive networking, the integrated efforts of a cross-section of the community can result in a successful safety campaign that has little overhead or political constraints. Designed as multifaceted, ongoing community-based programs, such efforts can, over time and through "persistent learning," lead to desired changes in behavior.

Accident Prevention↗