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Biomedical subjects

R Crouch

Publications and source records attributed to R Crouch.

69 records · Page 4Linked to original sources
PubMedDate not supplied

Piloting an A&E and practice nurse educational exchange.

The accident and emergency (A&E) department acts as an interface between primary and secondary care. Traditionally, general practice has been viewed negatively by A&E nurses. This article explores some of the issues surrounding these views. The need to challenge the traditional view of A&E as simply a department within a hospital and replace it by one that identifies A&E within the broader community context is identified. This change in ethos requires nurses who work in the A&E department to challenge their beliefs about the specialty. There is a need to look at the educational preparation of A&E nurses. A pilot educational exchange scheme, developed to explore ways of improving the relationship between A&E nurses and nurses working in general practice, is described.

Clinical Competence↗
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A study of out-of-hours telephone advice from an A&E department.

A prospective analysis of telephone calls to an accident and emergency (A&E) department during weekday evenings/nights and weekends was undertaken over a 3-month period. A telephone consultation record (TCR) proforma was developed to record information about each call for advice. The volume of calls, characteristics of callers and patients, nature of presented problems, and advice given were analysed. An average of 9.3 calls were documented during each weekend 24-hour period, and 3.3 calls during each weekday evening/night. Junior nurses took 93% of calls. Advice was sought for a broad range of problems, of which only 11% were musculoskeletal conditions or injuries. Twenty-six per cent of patients were advised to attend A&E, 35% were given self-care advice, and the remainder were advised to contact or see their GP. There is considerable potential to develop a nurse-provided telephone advice service, but the need for staff training and guidelines has to be addressed.

Adolescent↗
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Demanding times.

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Emergency Nursing↗
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Resuscitation. Nurses' skills in basic life support: a survey.

Cardiopulmonary resuscitation (CPR) skills are fundamental to the function of health professionals, but studies have shown them to be inadequate and outdated. This week, Nursing Standard launches a three-part weekly series on resuscitation. Parts two and three will address the associated ethical issues and measures of outcomes and accountability. The series begins with a survey in a district general hospital which aimed to establish nurses' levels of awareness on the current recommendations for CPR laid down by the Resuscitation Council of the UK. The results show a poor knowledge level and recommendations are offered.

Adult↗
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Development of telephone advice in A&E: establishing the views of staff.

Fifty-eight staff in an inner city accident and emergency department were issued a questionnaire seeking their views on A&E-based telephone advice services and the training they would require to operate one with confidence. A 64 per cent response rate was achieved. The staff agreed that the service in the department needed to be developed, and forwarded a number of suggestions on how this could be achieved. They also highlighted the need for training in skills such as crisis intervention. Their views have helped to shape the development of a decision-support computer software package for the department, backed by a training programme.

Counseling↗
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Telephone triage--how good are the decisions? (Part 2).

This is the second part of a review of the literature about telephone triage and explores the accuracy and reliability of telephone assessment and advice. The authors identify the need to formalise processes of telephone advice and assessment.

Emergency Nursing↗
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Isolation and characterization of an ether glucuronide of zidovudine, a major metabolite in monkeys and humans.

A major metabolite of zidovudine (3'-azido-3'-deoxythymidine, AZT), which previously had not been observed in a variety of experimental animals, was identified in samples of plasma and urine from cynomolgus monkeys and a patient treated with AZT. The urinary recoveries of metabolite from the monkeys and the patient were, respectively, 1.5- and 6.9-fold higher than the recoveries of unchanged drug. The metabolite was purified in gram quantities from the urines of the monkeys and the patient and was identified enzymatically, using beta-glucuronidase and a specific inhibitor of the enzyme, as a glucuronide conjugate of AZT. The metabolite was formed in vitro by incubating AZT with preparations of human liver in the presence of UDP-glucuronic acid. In addition, the metabolite was prepared synthetically and physical characterizations--including microanalysis and UV, IR, NMR and mass spectra--of compound from all three sources were identical and confirmed the metabolite to be the 5'-O-beta-D-glucuronide of AZT.

Animals↗
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Platelet-derived growth factor A-chain synthetic peptide inhibits human glioma xenograft proliferation in nude mice.

The expression of polypeptide growth factors and their receptors by certain malignant human cell lines and the ability to grow these tumors as xenografts in murine hosts provides a useful setting to investigate the efficacy of antitumor agents. Exon 6 of the platelet-derived growth factor A-chain predicts a highly basic region consisting of 18 amino acids. Previously, we demonstrated that a synthetic peptide bearing this sequence interacts with a large population of binding sites at the cell surface and inhibits the binding and mitogenesis stimulated by several polypeptide growth factors (Khachigian et al J Biol Chem 267: 1660-1666, 1992; Khachigian and Chesterman, J Biol Chem 267: 7478-7482, 1992). In this report, we show that the exon 6 peptide can inhibit the mitogenic response of cultured human U-118 malignant glioma cells to normal human serum. When these cells are grown as subcutaneous xenografts in athymic nude mice, repeated intratumoral administration of the peptide results in dose-dependent growth inhibition. Indeed, injection of 0.48 mg of peptide five times a week abrogated growth during the entire course of treatment. Mouse weight or behavior did not differ significantly between control and treatment groups. Moreover, histologic examination of the tumors following treatment did not indicate necrosis. Thus, the exon 6 peptide can inhibit glioma cell proliferation both in culture and in an animal model without apparent side effects.

Amino Acid Sequence↗
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Effect of topical interferon-alpha 2b on corneal haze after excimer laser photorefractive keratectomy in rabbits.

BACKGROUND: Anterior corneal stromal keratocytes are activated by excimer laser photorefractive keratectomy resulting in haze with healing of the ablated area. In some eyes, this causes a visible haze or scar on the cornea, and an unpredictable regression of the myopic correction following refractive ablations. METHODS: Following a 6.00-diopter excimer laser photorefractive keratectomy to both eyes, 16 rabbits were treated for 5 weeks with interferon-alpha 2b drops four times a day to one eye only. Eight of these rabbits were treated with dexamethasone drops four times a day to both eyes. Using a standard grading scale for haze, the corneas were examined and the haze graded weekly. RESULTS: The observed corneal haze was significantly reduced in the treated eyes by the application of topical interferon-alpha 2b drops (p = .004), and topical dexamethasone drops (p < .001). Topical dexamethasone also produced less haze in combination with interferon-alpha 2b than when used alone (p = .035). There was continuing resolution of the corneal haze in those rabbits observed for 7 weeks after the cessation of the drops. Topical interferon-alpha therapy was not toxic to the rabbit eye and was not associated with delayed reepithelialization after the laser procedure. CONCLUSION: Topical interferon-alpha 2b appears to reduce the corneal haze produced by excimer laser photorefractive keratectomy in rabbits.

Administration, Topical↗
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Primary care: nurse-led telephone triage and advice out-of-hours.

In this article the authors report on the evaluation of an out-of-hours telephone triage and advice service in general practice. A computer-based decision support tool was used to guide nurses in the assessment of patients and outcome for calls. Data from the computer system were analysed for all calls over a six-month period. The researchers found that the nurses were able to handle just over half the calls received by giving advice alone. Overall, the service appeared to be remarkably consistent in the decisions taken by nurses, and training and organisational issues to be considered in the future development of the service were identified.

Adolescent↗
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Independence day.

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Humans↗