A pilot study of radiotelemetry for continuous cardiopulmonary monitoring of patients at home

We have conducted a trial of a wireless device for continuous cardiopulmonary monitoring. Its performance, user acceptance and safety were assessed for monitoring in the patient's home. The study included 20 patients: six with chronic obstructive pulmonary disease, six with chronic heart failure, seven with atrial fibrillation and palpitations, and one with a snoring problem. The system recorded the heart rate and respiratory rate, blood pressure, electrocardiogram and body temperature. The results were transmitted automatically to a central monitoring station. The accuracy of the measurements was checked by a comparison system and also by conventional measurements performed by a nurse. The system was acceptable to patients and functioned satisfactorily in the home. An important facet of home telemonitoring may turn out to be its greater reliability in collecting objective data.

Evaluating theories of alcohol-related aggression using observations of young adults in bars

AIMS

The objective of the present study is to evaluate 36 explanations of alcohol-related aggression that have been proposed in the research literature in terms of their relevance to naturally-occurring incidents of aggression involving alcohol.

DESIGN

The study involved content analysis of descriptions of 105 incidents of aggression.

SETTING AND PARTICIPANTS

Bars frequented by young adults.

MEASUREMENTS

Step-by-step descriptions of incidents of aggression reported by researcher-observers based on 93 nights of observation in bars between midnight and 3 a.m.

FINDINGS

Some explanations relating to the effects of alcohol (e.g. focused on the present, reduced anxiety about sanctions or danger, heightened emotionality) and the environment (e.g. generally permissive environment, expectation by patrons that aggression will be tolerated) were found to be relevant to most incidents, while other explanations (e.g. crowding, release of pent-up anger) were directly relevant to only a few or no incidents. Incidents involving male-to-male aggression were more likely than incidents involving both males and females to be attributable to expectations, acceptance of aggression, power concerns, male honor and "macho" values. Principal components analysis identified five groupings of explanations: risk-taking effects of alcohol, cognitive impairment from alcohol, hyperemotional effects of alcohol, "macho" subculture, and permissive environment.

CONCLUSIONS

The findings are consistent with a model of alcohol-related aggression that involves multiple contributing factors including alcohol effects and situational contexts. The greater relevance of certain explanations and the natural groupings of explanations point to directions for future research.

A controlled pilot study in the use of telemedicine in the community on the management of heart failure--a report of the first three months

This is a controlled pilot study of twenty patients to see if heart failure management can be optimised in the community using telemedicine. The study seeks to examine the feasibility, acceptability and reliability of using telemedicine in this context. Heart failure is a common condition. It is an important cause of mortality and morbidity and has large cost implications for the NHS. Most patients are managed in the UK in General Practice based on clinical assessment by the practitioner. Twenty patients with a mean age of 75.1 years and mean New York Heart Association grade of 1.75 were randomised in to two equal groups (telemonitoring and control) and observed for a period of three months. All twenty patients had a Cardiologist assessment and quality of life measurement at the beginning and end of the study. Patients in the telemedicine group had their blood pressure, pulse and weight data collected daily and undertook a weekly video conference with the nurse. Control patients had their blood pressure, weight and pulse measured at six weekly intervals. The study has been extended for a further six months beyond its initial three-month observation period to see if the initial short term benefit in the telemedicine group is maintained.

Results of a pilot program for training bar staff in preventing aggression

One hundred and twenty-one staff from eight bars in Ontario, Canada participated in a three-hour training program that used a peer learning model to teach problem-solving skills regarding the prevention and management of aggressive behavior in bars. Participants showed significant positive changes in knowledge and attitudes regarding effective approaches to preventing aggression. The majority of participants reported that the training made them think about ways they handed problem situations and that they would change the way they handle problems in the future. Participants rated most aspects of the training as very useful, especially the group discussion. The program illustrates the potential for increasing skills and knowledge of bar staff in preventing aggression and associated injury.

The health of elderly residents in long term care institutions in New Zealand

AIMS

To estimate the morbidity of residents in long term care institutions in Hamilton, New Zealand and examine the prescribing practice within these institutions.

METHODS

One hundred residents were selected at random from the total population of residents in long-term institutions in Hamilton. Residents were examined by a physician to arrive at ICD-9 diagnoses and details were recorded about prescribing practice.

RESULTS

Eighty residents were examined. Of these, 73% had dementia. Forty-five per cent were diagnosed as having heart failure and 44% cerebrovascular disease. The most common previously undiagnosed disorder was postural hypotension (24%). Residents were prescribed an average of 4.5 non-psychotropic medications. Seventy-seven per cent of residents were prescribed three or more medications.

CONCLUSION

Elderly residents in long term care institutions in Hamilton have complex health care needs which offer particular challenges for doctors and other health care workers. Regular health care reviews could lead to more accurate diagnosis and better prescribing practice.

The relationship between alcohol consumption patterns and car, work, sports and home accidents for different age groups

The purpose of this study was to examine the relationship between alcohol consumption patterns and car, work, sports and home accidents for different age groups. A secondary analysis of data from a randomized household survey of 10385 Canadians was conducted. Overall, alcohol consumption patterns were significantly associated with car collisions, work and sports accidents for younger age groups (i.e. 15-24 and 25-34), but this relationship was not significant for the older age groups.

Demographic and substance use factors related to violent and accidental injuries: results from an emergency room study

OBJECTIVE

The primary goal of this study was to identify demographic and substance use factors associated with violent injuries, accidental injuries, and medical conditions or illnesses (non-injured).

METHOD

Data were examined from a sample of 1701 admissions to emergency rooms at two Canadian hospitals. These patients were interviewed and provided urine samples to detect the presence of drug metabolites for alcohol, THC, benzodiazepines, barbiturates, morphine, and codeine.

RESULTS

Those with violent injuries were significantly (P<0.0001) more likely to be male and have lower incomes compared with both the accidental injury and non-injury groups. About 37% of violent injuries occurred at a bar or restaurant, which was significantly more than 3% for accidental injuries and 2% for non-injuries (P<0.00001). The violent injury group was significantly more likely than the other two groups to report feeling the effects of alcohol at the time of the injury and to report negative consequences of alcohol use (P<0.00001). Furthermore, about 42% of those with violent injuries had a blood alcohol level (BAL) over 80 mg% compared to only 4% with accidental injuries (P<0.00001) and 2% of non-injuries (P<0.00001). In terms of drug tests for other substances, the violent injury group was significantly more likely to test positive for benzodiazepines than the accidental injury group (P<0.01) while all between group comparisons for other drugs were not significant.

Occupational risk factors associated with alcohol and drug problems

Ames and Janes provide a theoretical framework that explains alcohol and/or drug problems among workers. Existing studies of occupational risk factors for alcohol and drug problems across multiple occupations and industries provide mixed findings with respect to Ames and Janes' framework. In a preliminary study, the relationships between occupational characteristics and measures of alcohol and drug problems were investigated among a sample of workers from a variety of occupations and industry settings. Some support was found for all of the major elements of Ames and Janes' framework: normative regulation of drinking, quality and organization of work, workplace factors, and drinking subcultures.

Factors associated with fecal shedding of verotoxin-producing Escherichia coli O157 on dairy farms

Fecal samples were collected from 4,361 dairy cows on 91 dairy operations between 26 February and 8 July 1996. Fecal samples were cultured for Escherichia coli O157, and positive isolates were probed for verotoxin-producing genes. A total of 52 (1.2%) fecal samples on 22 (24.2%) operations were positive for verotoxin-producing E. coli O157. Herds in which samples were collected on or after 1 May 1996 were significantly more likely to test positive than herds sampled before that date (odds ratio = 7.7). Herds maintained on farms on which alleyways were flushed with water to remove manure were 8.0 times more likely to have samples test positive for verotoxin-producing E. coli O157 than were herds maintained on farms cleaned by use of other methods of manure removal.

Area-wide diabetes care: the Manchester experience with primary health care teams 1991-1997

Diabetes 2000 has evolved over 6 years from a practice-based audit to a cross-sector, multidisciplinary, multi-agency project. Its prime aim is to improve the care of people with diabetes in Manchester. There are 93 out of 111 practices and all four Trusts now involved. The prevalence of diabetes known to the project is 1.46% (among 418,000 people). Eighteen practices have never participated at any level. There are 6088 people on the now outdated DOS database, another 2000-5000 people are thought to be missing. The audit has shown limited improvements in care over the years. Despite only modest quantitative success there is now in place a mechanism for implementing Department of Health recommendations for a good diabetes service, namely, a city-wide register, management and referral guidelines across primary and secondary care, the start of an integrated care programme and, above all, goodwill on behalf of all participating providers.

An audit of anthropometric measurements by medical and physiotherapy staff in patients with ankylosing spondylitis

BACKGROUND

The main treatments for ankylosing spondylitis (AS) are physical (exercise and stretching), and one way of measuring the effectiveness of these therapies is to record spinal movements in a standardized way. Patients are often seen in both medical (rheumatology) and physiotherapy clinics where duplicate information on their progress may be obtained. The purpose of this study was to assess the completeness of data collection for patients attending both medical and physiotherapy clinics.

DESIGN

An audit of data recorded in medical and physiotherapy notes.

SUBJECTS

Patient records identified either from computerized databases (Huddersfield and Bradford) or from a clinic at which only AS patients attended (Leeds). Data from attendances over a defined period were retrieved and recorded on a standard form. All patients thus identified were then cross-matched against those patients attending for physiotherapy during the same period and, where a match occurred, the same data were retrieved from the physiotherapy notes. MINIMUM DATA SET FOR AUDIT: Before data collection started all participants agreed on the minimum data set required for adequate monitoring of patients with AS. The anthropometric measurements included height, chest expansion, cervical rotation, tragus to wall, modified Schober's flexion, extension, lumbar side flexion, intermalleolar abduction, and interfingertip abduction.

RESULTS

Of 182 medical notes screened, 46 patients had not been seen in the defined period, leaving 136 notes to be reviewed. Of these, 52 patients had been seen in physiotherapy in the same period. In general, measurements were infrequently found in medical notes (only chest expansion in 58%, Schober's flexion in 48% and tragus to wall in 47% were measured with any regularity by medical staff). In contrast, corresponding data from physiotherapy notes were more complete (Schober's flexion and lumbar side flexion in 96%, height in 87%, intermalleolar distance in 87% and cervical rotation in 83%).

CONCLUSIONS

Follow-up and monitoring of AS patients in these medical clinics is clearly inadequate. Physiotherapy-led clinics have already been started in one of the study hospitals and the other centres are reviewing their arrangements for AS follow-up, including the possibility of a combined approach to patient management.

An audit of anthropometric measurements by medical and physiotherapy staff in patients with ankylosing spondylitis

BACKGROUND

The main treatments for ankylosing spondylitis (AS) are physical (exercise and stretching), and one way of measuring the effectiveness of these therapies is to record spinal movements in a standardized way. Patients are often seen in both medical (rheumatology) and physiotherapy clinics where duplicate information on their progress may be obtained. The purpose of this study was to assess the completeness of data collection for patients attending both medical and physiotherapy clinics.

DESIGN

An audit of data recorded in medical and physiotherapy notes.

SUBJECTS

Patient records identified either from computerized databases (Huddersfield and Bradford) or from a clinic at which only AS patients attended (Leeds). Data from attendances over a defined period were retrieved and recorded on a standard form. All patients thus identified were then cross-matched against those patients attending for physiotherapy during the same period and, where a match occurred, the same data were retrieved from the physiotherapy notes. MINIMUM DATA SET FOR AUDIT: Before data collection started all participants agreed on the minimum data set required for adequate monitoring of patients with AS. The anthropometric measurements included height, chest expansion, cervical rotation, tragus to wall, modified Schober's flexion, extension, lumbar side flexion, intermalleolar abduction, and interfingertip abduction.

RESULTS

Of 182 medical notes screened, 46 patients had not been seen in the defined period, leaving 136 notes to be reviewed. Of these, 52 patients had been seen in physiotherapy in the same period. In general, measurements were infrequently found in medical notes (only chest expansion in 58%, Schober's flexion in 48% and tragus to wall in 47% were measured with any regularity by medical staff). In contrast, corresponding data from physiotherapy notes were more complete (Schober's flexion and lumbar side flexion in 96%, height in 87%, intermalleolar distance in 87% and cervical rotation in 83%).

CONCLUSIONS

Follow-up and monitoring of AS patients in these medical clinics is clearly inadequate. Physiotherapy-led clinics have already been started in one of the study hospitals and the other centres are reviewing their arrangements for AS follow-up, including the possibility of a combined approach to patient management.

Eicosanoids in periodontal diseases: potential for systemic involvement

The potential application of gingival crevicular fluid (GCF) levels of prostaglandin E2 (PGE2) for predicting periodontal disease severity and reflecting disease activity has been described by several investigators. The potential application of GCF levels of PGE2 for predicting amniotic fluid levels of PGE2, and thereby estimating risk of preterm low birth weight, has not been explored until recently. The fact that intraamniotic levels of many inflammatory mediators, such as prostaglandin E2, increase during pregnancy and peak at delivery suggests that these mechanisms play an important role in normal physiologic parturition. There is increasing evidence to suggest that the presence of a subclinical endogenous Gram-negative infection of periodontal disease may present a systemic challenge sufficient to initiate the onset of premature labor, either as a source of lipopolysaccharide (LPS, endotoxin) and/or through stimulation of secondary inflammatory mediators such as PGE2 and interleukin 1 beta (IL-1 beta). This pilot investigation determines associations among the levels of PGE2 in gingival crevicular fluid, within serum, and within amniotic fluid of 18 women who were undergoing routine amniocentesis during early midtrimester, in an attempt to reveal new baseline data regarding the relationship between periodontal inflammatory mediators and intraamniotic mediators during normal parturition. Full-mouth periodontal examinations were performed and samples of GCF, serum and amniotic fluid were collected from each subject for the quantitative assessment of PGE2 by radioimmunoassay (RIA). Results of a pairwise regression analysis model reveal that PGE2 levels within the GCF are positively associated with intraamniotic PGE2 levels at the P = 0.018 level of significance. Thus, gingival crevicular levels of PGE2 may be used to provide an indirect estimate of the amniotic fluid levels of PGE2.

Comparison of lifestyle and substance use factors related to accidental injuries at work, home and recreational events

The purpose of this study was to examine whether risk factors vary for injuries that occur at work, at home, at recreational events and at multiple settings. Three major types of factors were investigated: lifestyle factors such as sleep, stress and exercise; substance use; and demographic characteristics. Data were obtained from a household survey of 882 Ontario adults. In order to determine whether different factors were related to different kinds of accidental injuries, chi 2 tests were conducted among five injury groups: no injuries; work; home; recreational; and multiple injury episodes (i.e. at least two separate injury episodes in two different settings). The first set of comparisons were conducted between those with zero injuries and each of the aforementioned four injury groups. Those with multiple injury episodes were significantly more likely than those with no injuries to be single, under the age of 30, and have lifestyle problems (i.e. sleep problems, financial problems and a desire for counselling) and substance use/problems (i.e. cigarettes, alcohol, licit and illicit drugs). For comparisons between each of the work, home and recreational injury groups and no injury group, eight factors were significant altogether, but no single factor was significantly related to more than one injury group. Contrasts between all combinations of injury group pairs (i.e. excluding the no injury group) indicated that risk factors for those with multiple injury episodes differed significantly from those with home and recreational injuries for several characteristics. This exploratory study provides some support that risk factors may vary, depending on the injury group.

Conservation of structure and subunit interactions in yeast homologues of splicing factor 3b (SF3b) subunits

Human SAP 49, a subunit of the multimeric splicing factor 3b (SF3b), contains two RNA recognition motifs (RRMs) and binds another SF3b subunit called SAP 145, whose yeast homologue is CUS1. Here we show that the predicted yeast open reading frame YOR319w (HSH49) encodes an essential yeast splicing factor. Using bacterially expressed proteins, we find that yeast HSH49 binds CUS1. Mutations that alter putative RNA-binding residues of either HSH49 RRM are lethal in vivo, but do not prevent binding to CUS1 in vitro, suggesting that the predicted RNA-binding surfaces of HSH49 are not required for interaction with CUS1. In vivo interaction tests show that HSH49 and CUS1 associate primarily through the N-terminal RRM of HSH49. Recombinant HSH49 protein has a general RNA-binding activity that does not require CUS1. The parallels in structure and interaction between two SF3b subunits from yeast implies that the mechanism of SF3b action is highly conserved.

The absence of the transcription activator TFE3 impairs activation of B cells in vivo

TFE3 is a ubiquitously expressed member of the TFE3/mi family of basic helix loop helix zipper transcription factors. TFE3 binds to muE3 sites located in the immunoglobulin heavy-chain (IgH) intronic enhancer, heavy-chain variable region promoters, the Ig kappa intronic enhancer, and regulatory sites in other genes. To understand the role of TFE3 in Ig expression and lymphoid development, we used embryonic stem (ES) cell-mediated gene targeting and RAG2-/- blastocyst complementation to generate mice which lack TFE3 in their B and T lymphocytes. TFE3- ES cells fully reconstitute the B- and T-cell compartments, giving rise to normal patterns of IgM+ B220+ B cells and CD4+ and CD8+ T cells. However, TFE3- B cells show several defects consistent with poor B-cell activation. Serum IgM levels are reduced twofold and IgG and IgA isotypes are reduced three- to sixfold in the TFE3- chimeras even though in vitro, the TFE3- splenocytes secrete normal levels of all isotypes in response to lipopolysaccharide activation. Peripheral TFE3- B cells also show reduced surface expression of CD23 and CD24 (heat-stable antigen).

Introduction of high-alcohol beer in Ontario: preliminary observations on its use by underage drinkers

Preliminary data are reported on the use of high-alcohol beer by underage drinkers in Ontario. Students in grades 11 and 12 with a valid driver's licence completed a questionnaire between January and May, 1994 (i.e., between three and seven months after the introduction of high-alcohol beer). About one-half of students who had drunk alcohol within the previous four weeks reported consuming high-alcohol beer within that period. In this group, males were much more likely to report high-alcohol beer consumption in the previous month. Both male and female high-alcohol beer consumers drank alcohol more frequently, got drunk more frequently, and drank five or more drinks on the same occasion more frequently than non-consumers. One reason for trying high-alcohol beer, "wanted a higher alcohol content", was endorsed by more than one-third of high-alcohol beer consumers. Our data suggest that the users of high-alcohol beer among this underage drinking sample tend to be heavier drinkers and more likely to experience alcohol-related problems.

Chest tube removal after cardiac surgery

Prompt remove of chest tubes by RNs has allowed earlier and more aggressive ambulation of our patients and, along with other interventions, has decreased length of stay by 1.5 days while improving quality of care. Proper education, both didactic and clinical, is the key component in preparing RNs to safely and effectively perform this procedure.

Chest tube removal after cardiac surgery

Prompt remove of chest tubes by RNs has allowed earlier and more aggressive ambulation of our patients and, along with other interventions, has decreased length of stay by 1.5 days while improving quality of care. Proper education, both didactic and clinical, is the key component in preparing RNs to safely and effectively perform this procedure.