The practice of growth monitoring.
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Body Constitution↗
Biomedical subjects
S George
Publications and source records attributed to S George.
Evaluation of nurse triage in a British accident and emergency department.
OBJECTIVE: To compare formal nurse triage with an informal prioritisation process for waiting times and patient satisfaction. SETTING: Accident and emergency department of a district general hospital in the midlands in 1990. DESIGN: Patients attending between 8:00 am and 9:00 pm over six weeks were grouped for analysis according to whether triage was operating at time of presentation and by their degree of urgency as assessed retrospectively by an accident and emergency consultant. PATIENTS: 5954 patients presenting over six weeks. MAIN OUTCOME MEASURES: Time waited between first attendance in the department and obtaining medical attention, and patient satisfaction measured by questionnaire. RESULTS: Complete data on waiting time were collected on 5037 patients (85%). Only 1213 of the 2515 (48%) patients presenting during the triage period were seen by a triage nurse. Patients in the triage group waited longer than those in the no triage group in all four retrospective priority categories, though differences were significant for only the two most urgent categories (difference in median waiting time 10.5 (95% confidence interval 3.5 to 14) min for category 1 and 8.5 (3 to 12) min for category 2). Responses to the patient satisfaction questionnaire were similar in the two groups except for the question relating to anxiety relating to pain. CONCLUSIONS: This study fails to show the benefits claimed for formal nurse triage. Nurse triage may impose additional delay for patient treatment, particularly among patients needing the most urgent attention.
Adolescent↗
Endobronchial interstitial Au-198 implantation in the treatment of recurrent bronchogenic carcinoma.
Nineteen patients with non-small-cell bronchogenic carcinoma, recurrent following initial conventional external beam radiotherapy, were treated with endobronchial implantation of Au-198 seeds. Seventeen patients were symptomatic with primary symptoms of persistent hemoptysis (9), bronchial obstruction (2), or worsening dyspnea (6). Two patients were asymptomatic and implanted for bronchoscopic evidence of tumor recurrence. The dose delivered was described by three dosimetric parameters: 1) the total activity implanted (m Ci); 2) the midbronchial dose point; and 3) the volume of tissue that received greater than 20 Gy. Response was determined based on a system reflecting the primary indication for the implant. Seven of nine (78%) presenting with hemoptysis, four of six (67%) with increasing dyspnea, and one of two with bronchial obstruction responded. The overall median survival was 5.25 months (2.5-10 months 95% confidence interval). There was no clear correlation between any of the dosimetric parameters evaluated and a clinical response to therapy. Technical complications related to the inability to penetrate the scirrhous tumor surface adequately often led to less than optimal dose distribution. Endobronchial Au-198 implantation is associated with a poor calculated dose distribution but is, nonetheless, a relatively simple and comparatively inexpensive technique that often produces a clinical response and can be a useful option in the management of patients with recurrent bronchogenic carcinoma.
Adult↗
Piloting an evaluation of triage.
This paper takes a broad view of the work involved in pilot studies of evaluation research. Drawing on their experience of preparation for a field experiment in a British Accident and Emergency department, which was to evaluate the effectiveness of a nurse triage system, the authors stress the importance of careful observation of the system to be studied, in the environment in which it is to be studied. In addition, the usual evaluations of research instruments which comprise formal pilot studies are included.
Emergency Nursing↗
A novel tissue preservation medium for immunoperoxidase staining of skin biopsies.
The requirement for unfixed tissue is a major drawback in the use of immunohistochemistry for the diagnosis of inflammatory and neoplastic disease. We describe the use of a novel gel transport medium (U.K. Patent No. WO 90/07703, international patent applications pending) to preserve unfixed skin biopsies from allergic contact dermatitis reactions for 1 week prior to frozen section and immunohistochemistry for leucocyte antigens. The medium can be used with biopsies up to 6 mm3 and does not require any alteration in the usual frozen section or immunohistochemical staining procedures. The results show a subjective improvement in both morphology and staining quality. We believe this to be due to improved cutting of the sections and reduced background staining of collagen. This transport medium should be of considerable benefit to the provision of a clinical service, because it allows tissue for immunohistochemical examination to be taken at locations distant from the pathology laboratory.
Cryopreservation↗
Radiation protection of male fertility in mouse and rat by a combination of 5-hydroxy-L-tryptophan and a thiol compound (AET).
Sperm abnormalities and fall in total sperm count following different doses (4 Gy, 5 Gy and 6 Gy) of whole body gamma irradiation (WBGR) were studied in adult male Swiss strain A mice. The protecting ability of a combination of 5-hydroxy-L-tryptophan (5-HTP, 100 mg/kg) and 2-aminoethyl isothiuronium bromide hydrobromide (AET, 20 mg/kg) was also investigated. Pretreatment with a 5-HTP+AET formulation i.p., 30 min before irradiation modified the fall in sperm counts significantly. Exposures to 4 Gy, 5 Gy and 6 Gy WBGR caused marked increase of sperm abnormalities which could be significantly reduced by pretreatment with 5-HTP-AET. WBGR with 4 Gy, 5 Gy and 6 Gy produced a short period of sterility associated with oligospermia but these abnormalities were corrected by pretreatment with 5-HTP+AET. This finding was supported by breeding experiments in pretreated adult male Sprague-Dawley rats which showed delivery of normal offsprings in drug-protected irradiated groups in contrast to irradiated controls.
5-Hydroxytryptophan↗
Hb Rancho Mirage [beta 143(H21)His----Asp]; a variant in the 2,3-DPG binding site showing normal oxygen affinity at physiological pH.
Hb Rancho Mirage was detected in a 17-year-old male in association with a mild anemia. Hemoglobin electrophoresis revealed the variant had a mobility between Hbs A and J on cellulose acetate (pH 8.6) and a mobility like Hb F on citrate agar (pH 6.4). A substitution of His----Asp was found at position 143 in the beta chain, a residue that contributes to the anionic 2,3-DPG binding site in Hb. This variant exhibited normal oxygen affinity at physiologic pH and reduced affinity at alkaline pH. This suggested a subtle shift in the allosteric equilibrium due most likely to the introduction of a negative charge that stabilized the 2,3-DPG pocket. Both homotrophic (heme-heme) and heterotropic (2,3-DPG and protons) effects were reduced; this might be a consequence of an alteration in the carboxyl terminal region of the beta-subunits. Although a His----Asp substitution would be considered to cause reasonable disruption of the 2,3-DPG and C-terminal conformation of the beta- subunits, the properties of Hb Rancho Mirage suggest that, in fact, there appear to be no major perturbation of the critical C-terminal residues.
2,3-Diphosphoglycerate↗
Protection to glycolysis by a combination of 5-hydroxy-L-tryptophan and 2-aminoethylisothiuronium bromide hydrobromide in lethally irradiated rats.
Rate of glycolysis in vivo at different time intervals following 8 Gy [LD100(30)] whole body gamma radiation (WBGR) was evaluated by estimating liver glycogen, blood sugar, serum lactic dehydrogenase (LDH) and blood lactic acid concentration in adult male Sprague Dawley rats. Within 1 hr of radiation exposure, a significant fall in liver glycogen was observed in rats fed food and water ad libitum. The glycogen content increased after 24 hr and had returned to control level on 7th day after radiation exposure. Blood sugar, serum LDH and blood lactate levels increased significantly as compared to non irradiated controls. Pretreatment with 5-hydroxy-L-tryptophan (5-HTP; 100 mg/kg) + 2-aminoethylisothiuronium bromide hydrobromide (AET; 20 mg/kg) ip 30 min before 8 Gy WBGR, modified these values and restored them to normal level on 7th day post-irradiation.
5-Hydroxytryptophan↗
Radioprotection of spleen by a combination of 5-hydroxy-L-tryptophan and 2-aminoethylisothiuronium bromide hydrobromide in lethally irradiated rats.
Radioprotective efficiency of the combination of 5-hydroxy-L-tryptophan (5-HTP, 100 mg/kg) with 2-aminoethylisothiuronium bromide hydrobromide (AET, 20 mg/kg) in protecting splenic tissue following 8 Gy whole-body gamma radiation (WBGR) has been studied in adult male Sprague Dawley rats. Loss in splenic weight, splenic cells and DNA was observed following & Gy WBGR, which was modified significantly in 5-HTP+AET (ip) pretreated group. The study further showed that pre-treatment with this formulation led to an increased superoxide dismutase (SOD) activity and a decrease in lactate/pyruvate ratio in the cytosol fraction of the spleen.
5-Hydroxytryptophan↗
Differential radioprotection of tissues in C3H/J mice by a combination of 5-hydroxy L-tryptophan with 2-aminoethylisothiuronium bromide hydrobromide.
Differential radioprotection between normal tissues and carcinoma was observed in C3H/J mice treated with a combination of 5-hydroxy L-tryptophan (5-HTP, 100 mg/kg) and 2-aminoethylisothiuronium bromide hydrobromide (AET, 20 mg/kg). Protection to normal tissues was judged by LD50(30) and by radiation induced damage to bone marrow(BM) using clonogenic ability of blood forming stem cells (10 day CFUs) as the criteria. Pretreatment with 5-HTP + AET combination 30 min before whole body gamma radiation (WBGR) enhanced the recoveries of the number of blood forming stem cells in BM of irradiated mice after 0, 7th and 10th day of irradiation. LD50(30) for C3H/J mice was 7.3 Gy and the dose modifying factor (DMF) of 5-HTP + AET combination was 1.76. On the contrary, pretreatment with this combination did not protect the mammary carcinoma transplanted in C3H/J mice, when exposed to 80 Gy soft X-rays.
5-Hydroxytryptophan↗
Resource allocation and underprivilege.
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Health Care Rationing↗
Homeless people and psychiatric care.
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England↗
Measures of dependency: their use in assessing the need for residential care for the elderly.
The overall need for elderly long-stay care cannot be calculated by use of dependency scales currently in use, or from measurements of any other variable currently available. Although the development of an epidemiological tool that will permit accurate needs assessment in this field should be made a research priority, it must be recognized that the final decision on the level of care offered rests with policy-makers, and that any such tool could only assist in the assignment of degrees of priority to those demanding long-stay care.
Activities of Daily Living↗
In vitro effect of ethanol on polyphosphoinositide metabolism in bulk isolated brain cells.
Metabolism of polyphosphoinositide was studied in bulk isolated brain cells. Cells were isolated by a rapid method using mechanical disruption followed by molecular seiving and centrifugation. Incorporation of [32Pi]orthophosphate into phosphatidyl inositol-4-phosphate and phosphatidylinositol-4,5 bis-phosphate was optimum at 30 and 60 min, respectively, in the isolated cells. Breakdown studies showed maximum loss of 32Pi after 60 min. Addition of ethanol at and above 10 mM concentration in vitro significantly decreased the incorporation of 32Pi into both phosphatidylinositol-4-phosphate and phosphatidylinositol-4,5 bis-phosphate by the isolated cells. However, the spontaneous breakdown of polyphosphoinositide was not altered in the presence of ethanol in vitro.
Animals↗
Maintaining professional ethics and discipline in nursing.
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Education, Nursing↗
Candidal oesophagitis in Cushing's syndrome.
Opportunistic infections are known to occur with increased frequency in patients with Cushing's syndrome, particularly those due to ectopic ACTH production. This report highlights the rare situation of a patient with Cushing's disease having candidal oesophagitis as one of the major presenting manifestations.
Adult↗
Information needs in a provider market: a case-study of ENT.
In the light of the White Paper Working for patients, this study addresses two questions: first, whether the current pattern of service use is a valid surrogate for the assessment of the service needs of a population; second, given that information systems which will provide accurate cost per case information are several years from being implemented, what differences might be made to a specialty budget by the adjustment of case costs by use of different case-mix measures. ENT has been chosen as a case study because of its relative 'market potential'. The study addresses the first question by examining the variations in the current level and type of service use across Districts in a Region. The large variation in utilization across Districts, both in total and for different degrees of case complexity, suggests that the current pattern of service use is a poor indicator of need. The second part of the study examines a Unit which has large inflows of complex patients. Adjusting for case-mix, however, produces a comparatively small effect on the overall specialty budget, whether the adjustment is made using the BUPA schedule of surgical procedures or using diagnosis-related groups. In the light of these results, it is suggested that the current emphasis on accurately costing case-mix could be misplaced, and that more resources should be diverted to scrutinizing the appropriateness of service use to health needs and priorities, in line with the aims of the NHS reforms.
Costs and Cost Analysis↗