The impact of a client's diagnosis of AIDS on social workers' clinical judgements: an experimental study

This article reports the findings and implications of a study in which the effect of the AIDS diagnosis, alone and in interaction with a client's race, gender and sexual orientation, on social workers' clinical assessments was determined. The study utilized a constructed case history in which all information about the client was held constant except for his or her race (African-American or white), gender, sexual orientation and terminal diagnosis (AIDS or heart condition). Licensed social workers in one state were randomly selected and sent one case history as well as a questionnaire which required them to provide clinical assessments of the hypothetical client as well as information about themselves and their evaluations of their ability to be helpful to the client. Results indicate that respondents believed that a variety of treatment options were necessary if the client they had read about had AIDS. Further, they reported feeling uncomfortable and ill-prepared to work with such a client. The interaction effects of the AIDS diagnosis and the client's race, gender, and sexual orientation also influenced several dependent measures.

From antianginal drugs to myocardial cytoprotective agents

The existing major classes of antianginal drugs improve quality of life in patients with coronary artery disease, but mortality in these patients remains unacceptably high. In order to limit the complications of the disease, it is vital to limit myocyte loss. Potentially, this can be achieved not only by prophylaxis, but also by protection, against ischemia. Any therapy that increases myocardial resistance to ischemia will protect against cell death and prolong the life of the myocyte, and possibly the patient. The mechanisms of cell damage during ischemia, and possible therapeutic interventions, are discussed.

Emergency coronary artery stenting for coronary dissection complicating diagnostic cardiac catheterisation

Dissection of a coronary artery is a recognised and significant complication of diagnostic coronary angiography that often requires emergency coronary artery bypass grafting. A coronary stent was used to treat this complication. This technique has potential advantages in terms of speed of reperfusion and availability in centres performing diagnostic angiography without surgical cover on site.

The vicious circle of ischemic left ventricular dysfunction

Myocardial ischemia tends to be self-propagating, and minor events such as plaque rupture can lead to the catastrophic sequelae of myocardial infarction and death. The biology of the endothelium and the cardiac myocyte is crucial to the development of these vicious circles. The abnormal responses of the endothelial cell in atherosclerosis tend to provoke and propagate ischemia, and because of the limited metabolic reserve of the myocyte, even short periods of ischemia can lead to left ventricular dysfunction and arrhythmias. This article examines the clinical implications of the disordered biology of the endothelial cell and the myocyte that is the basis for ischemic left ventricular dysfunction.

Detection of ambulatory ischaemia is not of practical clinical value in the routine management of patients with stable angina. A long-term follow-up study

It has been reported that medically treated patients with stable angina and positive exercise test for ischaemia have an adverse 1-2 year outlook if they are shown also to have transient, and predominantly silent, ischaemic episodes detected by ambulatory ST segment monitoring during their daily activities: it has been suggested that this investigation could be used to identify patients more likely to benefit from early investigation and treatment. We assessed the long-term (up to 65 months) prognostic significance of transient ischaemic episodes during daily activities in 172 patients routinely attending cardiac outpatients with medically treated stable angina who had undergone exercise testing and 48 h of ambulatory ST segment monitoring between February 1988 and August 1989 for this purpose. A positive exercise test for ischaemia was not a prerequisite for inclusion. One hundred and four patients (60.5%) had a positive exercise test for ischaemia and 72 (42%) had transient ischaemia during daily activities (63 had both tests positive). Over a median 50-month follow-up period 54 patients suffered at least one cardiac event (primary event: cardiac death n = 7; non-fatal myocardial infarction n = 11; unstable angina n = 18; elective CABG/PTCA n = 18). Two further patients suffered non-cardiac death. Cardiac events, either objective (cardiac death or non-fatal myocardial infarction) or subjective (unstable angina or revascularisation) were no more likely to occur in those with transient ischaemia during daily life when compared with those without, at follow-up times up to 65 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Potassium channel openers: clinical applications in ischemic heart disease--overview of clinical efficacy of nicorandil

Nicorandil is a balanced arterial and venodilator that may also possess cardioprotective properties via its activation of ATP-sensitive potassium channels. It has a number of beneficial hemodynamic effects and has been shown to be effective in treating angina with similar efficacy as the currently available antianginal agents. In addition, it may have useful effects in unstable and variant angina. In this review we examine the hemodynamic effects of nicorandil and discuss the currently available data on its clinical efficacy, both in isolation and in comparison with other agents.

The Trent Regional Day Case Commission. An initiative to investigate the constraints to the extension of the use of day surgery

In 1989, Trent Regional Health Authority set up a Commission to enquire into the organization of day case surgery and encourage its use. Improved methods for measuring and comparing day surgical activity were developed using routine data sources. These revealed even greater variation between hospitals and specialties in the amount of day surgery performed than did the usual analyses. Arrangements for day surgery differed considerably between specialties. Few theatres, beds, or surgeons' sessions were dedicated to day surgery, but general surgery and gynaecology used dedicated facilities more than other specialties such as ENT and ophthalmology. The Commission visited each hospital and found that day case facilities, organization and resources were poor in many of them. It was able to make specific recommendations for improvements. Day case surgery increased substantially over the period that the Commission operated, most hospitals reported that it had influenced changes in day surgery and that it had been useful, especially for local managers. Schemes to increase day surgery were funded. Highlights two elements for managing change: the need for good information about a problem, and the need to extend ownership of the issue throughout the organization.

Collateral growth between left internal mammary and left anterior descending coronary arteries following coronary artery bypass surgery

A case is described in which new collateral vessels grew between the left internal mammary artery and the left anterior descending coronary artery following coronary artery bypass surgery. Collateralization of the coronary arteries by extra-cardiac arteries has not been previously described following bypass surgery and may have implications for the mechanisms of angiogenesis.

Initial experience of a new linear everting falloposcopy system in comparison with hysterosalpingography

OBJECTIVE

To assess the endolumenal portion of the fallopian tube from ostium to fimbria using a specially designed linear everting catheter and microendoscope. The study compared falloposcopy results with those obtained with hysterosalpingography (HSG) in the same patients and explored the system's ability to classify internal tubal conditions.

DESIGN

A prospective study of a new diagnostic technique, falloposcopy, versus conventional means of evaluating tubal status.

SETTING

A tertiary university infertility center.

PATIENTS

Eighteen infertile patients with a previous history of infertility of at least 2 years duration.

INTERVENTION

Diagnostic falloposcopy was performed on a total of 31 tubes.

RESULTS

Although the results of HSG and falloposcopy were in agreement in 19 cases, falloposcopy findings were at significant variance with HSG in 12 cases (40%). Seventeen of the tubes visualized by falloposcopy were considered to be normal, 10 showed mild disease, and 4 were severely damaged.

CONCLUSION

Falloposcopy using the linear everting catheter is rapid and atraumatic. It provides more complete information concerning tubal status than HSG and as such constitutes an important advance in diagnosis and therapy planning.

Midterm results of renal artery stenting

Percutaneous transluminal angioplasty (PTA) has become the treatment of choice for major renal artery stenosis. Nonetheless, about 10% of renal artery stenoses cannot be properly dilated, and among the patients successfully dilated, 10%-15% had a recurrence. Renal artery stenting was used in 21 patients in cases of insufficient results after PTA: persisting significant stenosis after a primary or several PTAs (15 cases), recurrences (9 cases). Follow-up in all patients was from 12 months to 4 years. Implantation was performed without any problems but the low radioopacity of the stent makes placement difficult in obese patients, particularly for ostial lesions. There was no major complication except occlusion of a segmental branch of the renal artery in 1 case. Radiological controls have shown a preserved patency in all cases except 2, which present restenosis inside the stent by intimal hyperplasia. A significant clinical improvement was obtained in 90% of cases. These results suggest that the endovascular prosthesis represents an important adjunct to renal PTA.

Transcervical access and intra-luminal imaging of the fallopian tube in the non-anaesthetized patient; preliminary results using a new technique for fallopian access

A study was performed to evaluate a new transcervical, Fallopian tube access system for use in falloposcopy procedures without the need for conventional hysteroscopy or uterine distension. Visualization was accomplished by the use of a 0.5 mm falloposcope which was delivered to the Fallopian tube by a new linear everting catheter. The linear everting catheter allows access to the Fallopian tube by means of a flexible, tubular rolling membrane which can safely negotiate the tortuous anatomy from the ostium to the ampulla. Concurrent laparoscopy was performed solely for supervision purposes and not for tubal manipulations in 13 Fallopian tube access procedures in 10 patients. The ostia were visualized in 12 cases and the Fallopian tube was accessed in all 12 without complications. As a precursor for future gamete and embryo transfer procedures, intra-tubal insemination was performed by visualizing the ostia, accessing the Fallopian tubes, and obtaining successful isthmic-ampullary, intra-luminal images.

Effectiveness of a preoperative teaching programme for cataract patients

Shortened hospital stays have necessitated examination of alternative approaches for pre and postoperative teaching. An investigation of one alternative became a study in which a home care preoperative teaching programme for older adults undergoing cataract extractions with lens implants was implemented and evaluated. The findings indicated that the teaching programme was effective and resulted in positive benefits.

Local thrombolysis and thromboaspiration in the treatment of acutely thrombosed arteriovenous hemodialysis fistulas

Sixty-four thrombosed hemodialysis fistulas in 55 patients were treated by local low-dose infusion of urokinase, percutaneous angioplasty, and thromboaspiration. Lysis was initially successful in 38 cases (59%) without any negative side effects. At 1 year, 59% of these fistulas were still functional. When the procedures failed, surgery saved the vascular access in 17 cases. Local fibrinolysis combined with thromboaspiration and angioplasty provides a clinically useful means of access preservation.

Process issues in consultancy

A piece of short term consultancy work in a school for the Mentally Handicapped is described from the perspective of both the consultants and the consultees with particular reference to the process issues involved. Reasons for the high levels of stress, experienced in the exercise are explored by an examination of the contributory factors within the school and the consultancy process itself. As well as a theoretical discussion questions of practical management are considered.