Respect for privacy and the case of Mr K.
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Biomedical subjects
Publications and source records attributed to P Gough.
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This article reviews the current situation in nurse prescribing. The authors chart the development of policy and legislation, and try to explain some of the delays that have hindered the implementation of nurse prescribing. They argue that legislative change and some enlightened and lateral thinking about the capabilities and competence of nurses is required.
BACKGROUND: The association between current use of oral contraceptives and increased risk of venous thromboembolism (VTE) has been firmly established. Although data-sheets for hormone replacement therapy (HRT) carry similar warnings as regards VTE, evidence of an association is inconclusive. We carried out a hospital-based case-control study to investigate whether current use of HRT is associated with VTE. METHODS: We screened all women aged 45-64 years admitted to hospitals in the area of the Oxford Regional Health Authority with a suspected diagnosis of VTE between February, 1993, and December, 1994. We recruited 81 cases of idiopathic VTE and 146 hospital controls with disorders of eyes, skin, ears, respiratory and alimentary tracts, kidneys, bones, and joints, and trauma; controls were matched to cases for age-group and date and district of admission. To increase the study power, an additional 22 cases of idiopathic VTE and 32 hospital controls admitted before February, 1993, were recruited retrospectively. Participants were questioned about medical and gynaecological history, use of oral contraceptives and HRT, use of other drugs within the previous 3 months, and lifestyle and socioeconomic characteristics. Detailed diagnostic data were extracted from the notes of eligible cases. Matched analyses, adjusted for body-mass Index, socioeconomic group, and history of varicose veins, were undertaken by conditional logistic regression. FINDINGS: 44 (42.7%) cases and 44 (24.7%) controls were current users of HRT. The adjusted odds ratio for VTE in current users of HRT compared with non-users (never-users and past users combined) was 3.5 (95% CI 1.8-7.0; p < 0.001). No association was found with past use, and risk appeared to be highest among short-term current users (adjusted likelihood ratio test of trend in odds ratios across different durations of current use, p = 0.011). INTERPRETATION: Current HRT use is associated with risk of VTE. The increased risk may be concentrated in new users. The number of extra cases appears to be only about one in 5000 users per year. These findings need to be weighed against the probable benefits of long-term treatment, including reductions in risks of osteoporotic fracture and coronary heart disease, and the probable modest increase in risk of breast cancer.
Pippa Gough argues that practitioners should exercise their professional accountability and competence to the full in order better to meet the needs and serve the interests of their patients and clients--and to establish nursing's rightful place at the centre of the health care world.
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The Bacillus subtilis hemAXCDBL operon encodes enzymes for the synthesis of 5-aminolaevuline acid via the C5 pathway (hemA and hemL) and uroporphyrinogen III (hemB, hemC and hemD). B. subtilis HemA protein (molecular mass 50 kDa) was overexpressed in hemA mutant of both Escherichia coli and B. subtilis. A mutant B. subtilis HemA protein with a Cys to Tyr change at position 105 was also overexpressed. Both wild-type and mutant HemA proteins migrated as oligomers (molecular mass greater than or equal to 230 kDa) on gel-filtration columns. All column fractions containing wild-type HemA protein had glutamyl-tRNA reductase activity. No glutamyl-tRNA reductase activity was found with the mutant HemA protein. It is concluded that the B. subtilis hemA gene product is identical to, or part of, the glutamyl-tRNA reductase of the C5 pathway.
This paper aims to place the current changes impacting on nurse education into the wider context of massive organisational and managerial upheaval, at present affecting the entire welfare state. This innovation and structural change is, however, merely an echo of deeper societal processes and the influence of the technological revolution on the private industrial sector and market economy. Within this frame of reference the implications of current reforms for the future organisational form, and management, of colleges of nursing are considered. Concerns are also expressed as to the tenuous control of the professional curriculum.
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An investigation of the cord blood from full term twin infants revealed an additional haemoglobin F component due to an abnormal alpha chain. The father of the twins, whose blood picture was normal, was shown to have normal alpha and beta polypeptide chains together with variant alpha and beta polypeptide chains. Electrophoresis showed that he had four major haemoglobin components. Separation of the haemoglobin fractions by column chromatography, globin preparation, chain separation, tryptic and chymotryptic digestion and peptide map preparation led to the identification of haemaglobin A, haemoglobin Strumica (alpha2 112His leads to Arg beta2), haemoglobin D Beograd (alpha2beta2 121 Glu leads to Val) and a hybrid haemoglobin Strumica D/Beograd (alpha2 112His leads to Argbeta2 121Glu leads to Val).
Haemoglobin Lepore is a haemoglobin variant associated with a thalassaemia-like disorder. It has been only rarely detected in Anglo-Saxons and its occurrrence in an Australian family of British and stock is reported for the first time. The appearances of the blood film resemble those seen in various hypochromic anaemias, inclusing thalassaemia traits, and on this account it is of clinical importance to recognize it in order to avoid unnecessary investigation and treatment. The chemical structure of nine examples of haemoglobin Lepore has been confirmed by peptide mapping and amino acid analysis, and the genetic mechanisms postulated for the production of haemoglobin Lepore are discussed.
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