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Managing practice innovations in prison health care services.

Prison health care is undergoing significant organisational change. This article highlights the potential for practice development in this setting, giving two examples of ongoing developments undertaken as part of a programme of research and development in mental health.

Clinical Competence↗
PubMed1991

Possible effect of altered management practices on seroprevalence of bovine leukemia virus in heifers of a dairy herd with history of high prevalence of infection.

A bovine leukemia virus (BLV) control program was instituted at a high-prevalence, purebred Holstein dairy. The specific control program required single use of needles and obstetrical sleeves, disinfection of tattoo equipment before use, dehorning by use of electrical burning devices, replacement of whole milk feeding with high-quality milk replacer, and heat treatment of colostrum before feeding. The effect of the program was estimated by comparing the pre- (1987) and postintervention (1989) prevalences of BLV-agar gel immunodiffusion titers within particular heifer age cohorts (0 to 90, 91 to 180, 181 to 360 days, and 361 days to parturition). Random serologic testing was conducted quarterly within each cohort, but was analyzed on a combined yearly basis. Seroprevalence of BLV decreased in all age cohorts greater than 180 days old, with significant decreases in the 361 days to parturition (P = 0.003) and the combined 181 days to parturition cohorts (P = 0.0004). Prevalence within the latter cohort decreased from 0.44 in 1987 to 0.17 in 1989. These results were obtained without either culling or segregation of BLV-agar gel immunodiffusion-positive cattle.

Animal Husbandry↗
PubMed1991

Practical management of stress-related gastric ulcers.

Stress ulcers develop in patients who have been subjected to abnormally elevated levels of stress, especially stress caused by conditions associated with reduced gastric blood flow, such as major burns, hypovolemia, and sepsis. Since a significant, often fatal, upper gastrointestinal hemorrhage is a common sequela of stress ulcers, prevention of progression of the lesions is a sensible goal. In numerous clinical trials, antacids, H2-antagonists, and sucralfate have demonstrated comparable effectiveness in preventing bleeding and the associated life-threatening sequelae. The choice of the ideal agent depends on individual patient factors, concomitant disease states and drug therapy, administration requirements, nursing availability, potential adverse effects, and expense.

Antacids↗
PubMed1990

Practical management of hyperthyroidism.

There are several causes of hyperthyroidism, and correct diagnosis is essential for management. Graves' disease is most commonly managed with radioactive iodine therapy (131I), antithyroid drugs or surgery. Toxic adenomas (single or multiple) may be treated with 131I or surgery. Most types of thyroiditis are managed expectantly. Pregnant women, children and the elderly deserve special consideration. Follow-up is vital to identify the later development of hypothyroidism.

Antithyroid Agents↗
PubMed1991

[Heparin-induced thrombocytopenia. Practical management of vascular complications].

The authors report 23 cases of heparin-induced thrombocytopenia with vascular complications. The clinical presentation consisted of arterial ischaemia in 16 cases, hemiplegia in 1 case, 4 cases of blue thrombophlebitis, 1 case of bilateral thrombophlebitis, 1 case of pulmonary embolism. The vascular surgeon faced with such emergency complications must be aware of the difficulties of clinical (atypical forms) and laboratory diagnosis (unreliability of platelet aggregability tests). Arterial occlusions are generally accessible to treatment with a Fogarty catheter during an operation performed without the use of heparin. The excessively frequent delay in diagnosis explains the severity of these complications and 2 deaths, 1 case of paraplegia, 4 cases of amputation secondary to arterial occlusion, 4 cases of severe postphlebitis disease, including 2 cases requiring transmetatarsal amputation and one case of pulmonary sequelae after pulmonary embolism were observed in our series of 23 patients. The diagnosis of heparin-induced thrombocytopenia requires immediate discontinuation of heparin therapy. Replacement by low molecular weight heparin is not devoid or risks and can only be considered with a negative platelet aggregability test (in the presence of low molecular weight heparin). As these test can be rarely performed as an emergency procedure, the use of rapid-acting oral anticoagulants appears to be the most reliable solution. The place of platelet antiaggregants and partial interruption of the inferior vena cava is discussed.

Adult↗