Using functional health patterns to predict outcome with seniors

Two powerful forces in Canada's health care system today are the rapidly growing seniors population and the trend toward community care. Recently, five hospitals in southwestern Ontario initiated a program designed to avert the admission of seniors to hospital and provide them with supports at home to maintain their health. Simultaneous research was conducted to assess the impact and effectiveness of the program.

Job satisfaction, propensity to leave and burnout in RNs and RNAs: a multivariate perspective

This investigation used a multivariate approach to examine similarities and differences between the job satisfaction, propensity to leave, and burnout of registered nurses (RNs) (n = 623) and registered nursing assistants (RNAs) (n = 231). At best, both groups were only moderately satisfied with their jobs, and there were no significant differences between the groups on the outcome measures of satisfaction, burnout or propensity to leave. However, RNs with more years of work experience reported highest job satisfaction, lowest levels of burnout, and were less likely to leave their positions. None of these variables were related to the length of time RNAs were employed. When comparative analyses were conducted by unit types, RNs in psychiatric settings were least satisfied with their jobs, more likely to leave their positions, and reported more burnout than did RNs in other settings. Implications of the study for interventions and future research are discussed.

Acute renal failure complicating diabetic ketoacidosis

Two previously healthy children, aged 13 and 14 years, respectively, presented with diabetic ketoacidosis. Both children developed acute renal failure, a rare complication of diabetic ketoacidosis and required dialysis.

Age-related changes in stress experienced by families with a child who has developmental delays

The hypothesis that stress in families increases as a child with developmental delays grows older was evaluated. Mothers with children ranging in age from 2 to 18 years were assigned to a preschool, middle childhood, or adolescent group and asked to complete the Parenting Stress Index (PSI). Results indicated that Child Domain scores were high for all groups, but Parent Domain scores were within normal limits. The middle childhood group was consistently higher in both domains than either the younger or older groups. Degree of handicap was not associated with mothers' stress in the preschool group, but was related to PSI scores for both other groups. Behavior problems were highly correlated with maternal stress for the middle childhood and adolescent groups (data not available for preschool group).

Acute renal failure complicating diabetic ketoacidosis

Two previously healthy children, aged 13 and 14 years, respectively, presented with diabetic ketoacidosis. Both children developed acute renal failure, a rare complication of diabetic ketoacidosis and required dialysis.

Increased factor VIII as an index of vascular injury in cyclosporine nephrotoxicity

Very high plasma concentrations of factor-VIII-related antigen (RAG) (VIII-RAG) were found in renal allograft recipients during periods of nephrotoxicity induced by cyclosporine. In eight recipients, who were investigated at weekly intervals, levels of factor-VIII-RAG fell toward normal as the dose of cyclosporine was reduced. Plasma levels of C-reactive protein, an acute phase reactant protein, were never raised in these recipients. These findings are further evidence that toxic doses of cyclosporine are associated with vascular injury.

A clinical view of analytical goals in clinical biochemistry

The analytical goals inferred desirable by a group of clinicians for the imprecisions of a wide range of analytes have been studied by survey. The goals required have not in general become more stringent in the past decade and are not as demanding as those promulgated by laboratory professionals. Clinical biochemistry laboratories can now attain analytical imprecisions which satisfy the general demands of clinicians except for analyses of calcium and of low levels of glucose. The lack of published data on analytical goals does not allow wide comparison of criteria for performance standards with the results of this study.

Cyclophosphamide in disseminated bronchial carcinoma

Twenty-four patients with advanced, disseminated bronchial carcinoma were treated with monthly intravenous infusions of cyclophosphamide in doses of 2g. or 3g. (1–1.5g./m2). Useful clinical, chest radiographic and subjective improvement occurred in those patients with anaplastic carcinoma and was especially marked in patients with oat-cell carcinoma. Some patients with squamous carcinoma obtained benefit but no improvement occurred in cases of adenocarcinoma. Toxic effects were not marked. Intermittent infusion of cyclophosphamide should be considered for palliation of symptoms in advanced anaplastic bronchial carcin-noma unsuitable for more radical treatment.

Substitution of beclomethasone aerosol for oral prednisolone in the treatment of chronic asthma

In a double-blind study 10 patients with chronic asthma received beclomethasone dipropionate 400 mug daily in a Freon propellant from a pressurized dispenser, and 10 patients received the Freon propellant alone. At the start of the trial each patient was receiving long-term maintenance treatment with oral prednisolone in a dose of 7.5 to 15 mg daily. The daily dose of prednisolone was reduced by 1 mg every four weeks and the patient's progress followed by regular clinical assessment and studies of pituitary-adrenal function. The trial was continued until the dose of prednisolone was reduced to zero or until asthmatic symptoms increased to an unacceptable level.In the 10 patients who received beclomethasone the mean maintenance dose of oral prednisolone was reduced by 5.6 mg/day but in only two cases could this drug be withdrawn completely. In the placebo group the mean reduction in dose was only 1.3 mg, thus there was a significant difference between the two groups (P <0.01). Studies of pituitary-adrenal function showed that a normal adrenal response to tetracosactrin stimulation returned only in the two patients from whom prednisolone was withdrawn.Hence the addition of beclomethasone dipropionate by inhalation to systemic corticosteroid therapy allows useful reductions to be made in the oral maintenance doses of corticosteroid. Reductions must be made with caution since there is wide individual variation in response to beclomethasone and in only a minority of patients can oral treatment by completely withdrawn.

Prednisolone and mustine in prevention of tumour swelling during pulmonary irradiation

Ventilatory function declines during the early stages of irradiation for bronchial carcinoma. This decline is potentially dangerous if the tumour narrows the trachea or both main bronchi. The protective effect of preliminary treatment with prednisolone or mustine before irradiation was studied in 88 patients by serial estimations of forced expiratory volume and forced vital capacity. Twenty-three patients received prednisolone by mouth, 24 had mustine intravenously, and 41 had no preliminary treatment. Both prednisolone and mustine prevented a significant decline in ventilatory function due to tumour swelling, prednisolone being marginally superior. It is concluded that all patients at risk should be treated with oral prednisolone, 20 mg daily, for one day before and two days after the first fraction of irradiation.

Bronchodilator effect of oral salbutamol in asthmatics treated with corticosteroids

In a double-blind trial the effect on ventilatory function of oral salbutamol (in two different doses) and a placebo were studied in 12 patients with chronic asthma receiving regular maintenance treatment with prednisolone. Salbutamol in a dose of 4 mg four times daily, given for a period of four weeks, produced a sustained and statistically significant increase in peak expiratory flow rate over the pretreatment recordings. This effect was not observed with a lower dose of salbutamol (2 mg four times daily) or with a placebo. Salbutamol in the higher dose would seem to be an effective and safe oral bronchodilator that can be recommended for the treatment of mild or moderate asthma. The duration of treatment in this study was, however, limited to four weeks, and it is not known whether effective bronchodilatation would be maintained if the drug were given for longer periods.

Ampicillin hypersensitivity in lymphatic leukaemia

Skin rashes developed during ampicillin therapy in 10 of 12 patients with lymphatic leukaemia. This apparent susceptibility to ampicillin is similar to that previously described in patients with infectious mononucleosis. It is postulated that patients with lymphatic leukaemia and infectious mononucleosis have an alteration in immune response due to abnormal lymphocytic function. It is suggested that, in these patients with bacterial infection, initial antibiotic treatment should not include ampicillin.

Constrictive pericarditis following Coxsackie virus infection

Infection with Coxsackie B₂ virus is described in a 49-year-old farmer in whom myopericarditis and pneumonitis was followed over a period of 10 months by constrictive pericarditis.

The differentiation between restrictive cardiomyopathy and constrictive pericarditis was not achieved without exploratory thoracotomy. The adherent pericardium was successfully excised with complete relief.

The literature is reviewed and it is suggested that the development of constriction following Coxsackie pericarditis must be considered at subsequent examinations of the patient.

Ventilatory function in pregancy

In this investigation 60 pregnant patients underwent serial estimation of forced vital capacity (FVC) and forced expiratory volume (FEV1) throughout pregnancy and after delivery. No significant change occurred in the group mean figures of these measurements of ventilatory function. When patients were divided into those who were non-smokers and those who smoked more than 10 cigarettes daily it appeared that both FVC and FEV1 during the last 8 weeks of pregnancy were slightly reduced in the smokers.

Previous studies on the effects of pregnancy upon ventilatory function are reviewed. In this report individual patients had greater variation in both amount and direction of serial recordings than was shown by control subjects. This individual variation may have been responsible for the conflict in some earlier reports which studied smaller numbers of patients.

It is suggested that the maintenance of FEV1 and FVC during pregnancy in spite of increasing uterine size and increasing blood volume is the result of hormonal action upon the brain stem, chest wall and lung.

Twin Tubal Pregnancy

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Gravid Uterus ruptured through the Scar of a Cæsarean Section

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