The assessment of cognitive function in the elderly using videoconferencing

People over the age of 65 were recruited from an inner-city old-age psychiatry service. Subjects had a structured interview (the CAMCOG test) by videoconferencing, and also face to face, by an investigator blind to the results of the test in the other mode. Reassessments were carried out within one week of the initial assessment. Eleven subjects were initially enrolled in the study and eight completed both modes. The number of patients in this study is very small but the results suggest that the CAMCOG test can be used reliably over a videoconferencing system without major modification.

The tele-assessment of cognitive state: a review

The telephone is used by all mental health professionals and many of their clients. Despite this, the telephone has been formally evaluated only occasionally. This paper reviews the literature on cognitive testing by telephone and by videoconferencing, and summarizes the different strategies employed to do this task. There remain weaknesses in the use of the telephone for cognitive testing but it could certainly be used more extensively in both clinical work and research, although the choice of test must be made with a clear view of what the assessment is designed to achieve and the limitations of the assessment instrument itself. Assessment by videoconferencing remains at an early stage of development, with much work to be done before it can be routinely employed as a clinical tool. However, videoconferencing shows promise for the future because it allows a much wider range of assessment than the telephone.

SGD: Saccharomyces Genome Database

The Saccharomyces Genome Database (SGD) provides Internet access to the complete Saccharomyces cerevisiae genomic sequence, its genes and their products, the phenotypes of its mutants, and the literature supporting these data. The amount of information and the number of features provided by SGD have increased greatly following the release of the S.cerevisiae genomic sequence, which is currently the only complete sequence of a eukaryotic genome. SGD aids researchers by providing not only basic information, but also tools such as sequence similarity searching that lead to detailed information about features of the genome and relationships between genes. SGD presents information using a variety of user-friendly, dynamically created graphical displays illustrating physical, genetic and sequence feature maps. SGD can be accessed via the World Wide Web at http://genome-www.stanford.edu/Saccharomyces/

Predicting depression in women: the role of past and present vulnerability

BACKGROUND

A prospective study, covering just over a 1-year period, sought to confirm an earlier finding that around 40% of women who experience a severe life event in the presence of two ongoing psychosocial vulnerability factors, (negative close relationships and low self-esteem) will develop a major depressive episode. Distal risk factors were examined to see if they improved prediction.

METHODS

A population sample of 105 mainly working-class mothers with vulnerability and without depression were interviewed three times over a 14-month period to date the occurrence of severe life events and onset of major depression. Degree of vulnerability was assessed at first contact together with distal risk in terms of childhood neglect/abuse and any earlier episodes of depression.

RESULTS

Thirty-seven per cent of these vulnerable women became depressed in the study period. The majority experienced a severe life event, and of these, 48% had onsets. Contrary to expectation, risk was only a little less among those with just one of the two vulnerability factors. Two-thirds of women with an onset had been depressed in previous years. Although this was associated with increased risk, the effect was greatest for those who had experienced an episode before age 20. A relationship between childhood neglect/abuse and onset was entirely accounted for by such early depression.

CONCLUSION

An aetiological model of depression outlined in earlier research was confined with a new factor of teenage depression shown to increase risk of onset.

Follow-up services and the development of a clinical nurse specialist in intensive care

There is little information available regarding quality of life following critical illness. The consequences of a stay in an intensive care unit (ICU) can result in considerable psychological and physical morbidity. At the Homerton Hospital, London, UK an intensive care follow-up outpatient clinic was established to ascertain patients' experiences after discharge from the ICU. This exploratory study examines narrative data collected from 26 patients by means of unstructured client-led interviews. Themes are derived that have implications for staff, patients and relatives. The findings suggest that patients experience a variety of psychological and physical symptoms. Patients experienced vivid dreams, flashbacks, relocation and convalescent stress as well as profound tiredness and weakness. These are consistent with previous research findings. New themes were identified which suggest that mood changes, inability to cope, the need to talk about their ICU experience and indistinct memories of the ICU made recovery at home difficult for both the patients and their families. As a result of these findings, the role of a clinical nurse specialist has developed in order to improve liaison between and within departments, the hospital and the community. Future research will aim to focus on the role of the critical care/community liaison clinical nurse specialist and in improving outcomes through the use of action research.

Liver transplant for giant cell hepatitis with autoimmune haemolytic anaemia

Giant cell hepatitis (CGH) with autoimmune haemolytic anaemia (AHA) is a distinct entity with an aggressive course. Immunosuppression may help early disease. A case is reported of a child with GCH and AHA with early disease recurrence after liver transplantation for end stage liver disease.

General practice referrals to a community team for mental health in the elderly: information and the mode of referral

Referrals by general practitioners to a community health in the elderly team by telephone and letter were compared for the information provided. Significantly less information was available to the team when the referral was by letter, particular in the areas of suicidal tendencies, patient telephone number, and possible informants. The implications of these findings are discussed.

Genetic and physical maps of Saccharomyces cerevisiae

Genetic and physical maps for the 16 chromosomes of Saccharomyces cerevisiae are presented. The genetic map is the result of 40 years of genetic analysis. The physical map was produced from the results of an international systematic sequencing effort. The data for the maps are accessible electronically from the Saccharomyces Genome Database (SGD: http://genome-www.stanford. edu/Saccharomyces/).

Posttranscriptional regulation of T-cell IL-2 production by human pooled immunoglobin

We evaluated the mechanism by which human pooled gamma-globulin for intravenous use (hIVIG) inhibits interleukin-2 (IL-2) production by human T cells. hIVIG reduced by 70-95% the amount of IL-2 in culture supernatants from mitogen-stimulated peripheral blood T cells or Jurkat cells. This reduction was not apparent at the transcriptional level: hIVIG had no effect on the levels of IL-2 mRNA or on the accumulation of firefly luciferase when its gene was linked to the IL-2 promoters. In contrast, hIVIG inhibited IL-2 protein synthesis, and the intracellular IL-2 was not restored by monensin. Our results indicate that the inhibition of IL-2 production by hIVIG occurred post-transcriptionally, and also suggest that secretion was unaffected, and that this effect of hIVIG was specific for IL-2 (and possibly other related cytokines). The data identify a previously uncharacterized regulatory mechanism of IL-2 production and predict that this immunomodulatory effect of hIVIG may be significant for its therapeutic actions in immune-mediated diseases.

Factors affecting the decision of nursing students in Taiwan to be vaccinated against hepatitis B infection

Compliance with Hepatitis B vaccination for nurses has been reported to be low in Taiwan. Therefore, a study of nursing students' view was conducted in Taiwan to discover possible reasons. As complex decision-making was involved in taking the vaccine, a four-level utility decision model underpinned by the Multi-Attribute Utility theory was proposed to ascertain the relative contribution of the specific components of attitude and beliefs to the final decision and experience of being vaccinated against Hepatitis B infection. Results indicated that the 'personal value of Hepatitis B vaccination', in particular for 'concern about the efficacy of the Hepatitis B vaccine', 'fear of pain from repeated injections', 'time' and 'money', were the main determinants in relation to the uptake of the Hepatitis B vaccination. Such results were consistent with earlier findings based on the Health Belief Model. It appears that the greater the experience gained in nursing care the lower the rate of vaccination; the important items under the concept of 'Personal value of Hepatitis B vaccination' varied by 'experience in nursing care'. The overall predictive validity was 67%, based on the utility decision model. When stratified by 'experience in nursing care', the prediction improved, ranging from 89% to 100%. Based on these findings, a specific intervention programme should be provided to change behaviour and improve the vaccination rate.

Planning for the future: advanced nursing practice in critical care

The subject of advanced nursing practice has become a topic of great interest and considerable debate in recent years. It has as a concept, however, been increasingly obscured by the plethora of terms used to denote its particular role and function. The purpose of this paper is to suggest how a consensus may be achieved in terms of role clarification, educational preparation, intellectual skill, level of performance and remuneration. Fundamental elements of the current debate are seen to be the need for advanced nursing practice, how it will be recognized in practice, the parameters of the expanding role and the centrality of the patient rather than professional boundaries in delineating advanced nursing practice for critical care. The debate will no doubt continue. It is not the aim of this paper to reach a definitive understanding, but to provide a platform so that essential elements can be confronted and the development of the role carefully considered.

First European cases of onychomycosis caused by Onychocola canadensis

Onychocola canadensis is a new fungus responsible of onychomycosis only isolated until now from Canada and New Zealand. We present the first European cases of onychomycosis caused by this fungus.