Cytotoxic activity of cells recovered from the respiratory tracts of chickens inoculated with infectious bronchitis virus

Previously uninoculated control chickens and chickens exposed to infectious bursal disease virus (IBDV) at 1 day of age were intranasally exposed to the M41 strain of infectious bronchitis virus (IBV) at 5 wk of age. Between 7 and 13 days after inoculation with IBV, cells were collected from the respiratory tracts of both groups of chickens and assayed for in vitro cytotoxic activity against a lymphoblastoid LSCC-RP9 target cell line using a 4-hr 51chromium-release assay (CRA). Compared to thymocytes from uninfected chickens, which were used as negative controls in the CRA, respiratory tract cells from both groups consistently displayed significant cytotoxic activity against LSCC-RP9 target cells. This cytotoxic activity, attributed to natural killer cells, was statistically more pronounced (P < 0.05) in IBDV plus IBV-infected chickens than in chickens inoculated with IBV alone.

The use of an enteral expert system in the prescription of enteral formulas in a university hospital

A personal computer-based expert system has been developed for the prescription of enteral formulas based on patient-need characteristics. Two hundred twelve inpatients in a university hospital setting were prospectively evaluated to compare the identity and cost of the enteral formula prescribed by the expert system with the identity and cost of the enteral formula prescribed by the ward team. Two hundred seven patients had complete data to allow analysis. There was a mean cost savings (+/-SD) of $1.18 +/- 7.69/d for each patient using the expert system compared with the MD-prescribed formula (P = 0.023). We project that the use of this program would save $27,564/y in our hospital (an average of 23,360 patient/days of enteral feeding per year). We conclude that the use of an expert system can be cost-effective in the prescription of enteral formulas for hospitalized patients.

Fractured neck of the femur (DRG 210/211): prospective outcome study

BACKGROUND

An ageing population will increase the need for resources to treat patients with a fractured neck of femur (DRG 210/211). Provision of these resources will be helped by a better understanding of current practices.

METHODS

A prospective study of outcome at discharge for 100 consecutive patients with DRG 210/211 was conducted at five Victorian metropolitan teaching hospitals to assess length of stay and the reasons for any variations.

RESULTS

The major influences on timing of discharge were: delayed availability of rehabilitation beds; the timing of referral and assessment by the Geriatric Assessment Team; delay in surgery more than 24 h after admission; and development of postoperative complications.

CONCLUSION

The efficient management of patients with DRG 210/211 requires a strong protocol of treatment and referral strategies with adequate resources.

Astrocytoma and pineoblastoma arising sequentially in the fourth ventricle of the same patient. Case report and molecular analysis

The sequential appearance of two different brain tumors in the same patient without intervening radiation or chemotherapy is a rare event, most often seen in hereditary cancer syndromes. We present one such case of sequential tumors, along with their molecular analysis. A 17-year-old male presented with a pilocytic astrocytoma arising in the fourth ventricle at the pontomedullary junction. Six and one half years later, a pineoblastoma was discovered in the fourth ventricle, rostral to the first tumor site. Both tumors were treated by gross-total surgical resection. Following resection of the pineoblastoma, the patient underwent craniospinal irradiation and systemic chemotherapy. Single-strand conformation polymorphism analysis showed that the patient had neither a germ-line mutation nor a somatic tumor mutation in the p53 tumor suppressor gene. Coupled with the lack of a family history of cancer, these data suggest that these were not manifestations of Li-Fraumeni syndrome, but rather two sporadic tumors which arose via a p53-independent mechanism.

Lipaemia retinalis: a question of chylomicrons?

Lipaemia retinalis is a rarely described condition which occurs in certain types of both primary and secondary hyperlipidaemia. It presents with a striking fundal appearance. We report 7 cases of lipaemia retinalis and ocular manifestations in hyperlipidaemia which presented over a 12 year period to our hospitals. These illustrate the different presentations and stages of the disease, and other fundal abnormalities seen in hyperlipidaemia.

Metabolic complications of total parenteral nutrition: effects of a nutrition support service

BACKGROUND

The effectiveness of Nutrition Support Services in optimizing parenteral nutrition has not been evaluated since the 1980s.

METHODS

We prospectively monitored medical and surgical patients on total parenteral nutrition (TPN) in a university hospital who did not receive Nutrition Support Service recommendations to compare the incidence of metabolic complications in 1979 (group 1, n = 100) with that in 1992 (group 2, n = 106). The Service provided automatic recommendations on a subsequent group of medical service patients (group 3, n = 128) and compared them with the patients in group 2 who were on the medical service (group 2B, n = 29).

RESULTS

Statistically significant changes between 1979 and 1992 included a decline in the incidence of hyperglycemia from 47% to 22% and in hypokalemia from 12% to 3% of surgical patients and an increase in hypomagnesemia from 0% to 23% of surgical patients and from 2% to 14% of medical patients. The incidence of hypophosphatemia remained > 20% in both medical and surgical patients. Within 1992, the addition of automatic recommendations had little impact on metabolic abnormalities and was associated with slightly but insignificantly lower TPN costs (not counting Service personnel costs).

CONCLUSIONS

Factors such as the general integration of parenteral nutrition into tertiary medical care, standard protocols and order forms, automatic Nutrition Support Service consultations in an affiliated hospital, and nutrition curricula may be responsible for the improvements seen since 1979. However, the addition of automatic Service consultation in 1992 had only a marginal effect on metabolic complications and costs of parenteral nutrition.

Supporting patients with healed leg ulcers

There are high financial costs associated with recurrence of venous leg ulcers. Costs can be reduced and quality of life improved by a structured programme of education. Continued contact and support for patients following healing is beneficial for both patients and staff.

Community liaison in dermatology

Links between hospitals and the community result in greater continuity and therefore quality of care. Consistent assessments and treatment are beneficial to both patients and staff. Liaison posts break down the arbitrary barriers between care settings.

The reorganisation of a dermatology department

In one dermatology unit, work patterns were restructured to improve continuity of care. The creation of nursing teams working in both the ward and outpatients' department has meant the effective use of nursing resources and multi-skilling of nursing staff.

Designing a nursing model for dermatology

Nursing models provide a useful framework for care but should be adapted to specific patient groups. Models need to be adaptable to changing perceptions of patient needs and to patient-centred care.

Nurses' perceptions of dermatology

There has been a reduction in the provision of specialist nursing care for dermatology patients. Low-status specialties are at greatest risk of erosion of their services. Lack of understanding results in a specialty being perceived as of low status.

Toledo type brachyolmia

Brachyolmia is a form of spondylodysplasia that has not to the authors' knowledge been described in the UK. It may be a cause of short stature that is currently unrecognised. A case of an 11 year old boy with clinical, radiographic, and eye findings consistent with Toledo type brachyolmia is reported.

Access to medical care in West Virginia: implications for policy

Access to medical care is an important goal of health care reform. In West Virginia, access to care has been defined in terms of insurance coverage and the availability of health care professionals, especially primary care practitioners. In recent years, three surveys have attempted to measure access to care. These surveys show that approximately 200,000 to 230,000 West Virginians needed medical care but were not able to obtain it because they could not afford it. A much larger number, about 540,000 West Virginians, put off or postponed seeking care they felt they needed because they could not afford it.