Quali sono le ragioni delle Missed Care? Risultato di uno studio bilaterale. Ragioni delle Missed Care

BACKGROUND

Evidence of missed nursing care in clinical practice has been well documented; however, fewer studies highlighting why care is missed have been conducted and this prevents effective interventions aimed at minimizing the missed care.

METHODS

A secondary analysis of two cross-sectional study designs was performed to capture the direction and strength of 1,114 Italian and Australian nurses' perceptions about why care was missed in their hospitals. The MISSCARE survey was used to collect data and the specific section aimed at estimating the reasons for missed nursing care was used. Data were analysed using structural equation modelling.

RESULTS

Six significant variables emerged as predictors of why care is missed, and these were: workplace miscommunication; increased work intensity; inadequate physical and human resources for care work; nurses' age; and years of clinical experience.

CONCLUSIONS

Australian and Italian findings contribute to growing international studies as to why nursing care is missed and provides a framework for understanding precipitating factors, such as incomplete workplace communication, unpredictable workflows, staffing and material resources issues might contribute to why care is missed and must thus be addressed/improved.

Environmental health in Australia: overlooked and underrated

Improvements in environmental health have had the most significant impact on health status. In Australia, life expectancy has significantly increased through provision of vaccination, safe food and drinking water, appropriate sewage disposal and other environmental health measures. Yet the profession that is instrumental in delivering environmental health services at the local community level is overlooked. Rarely featuring in mainstream media, the successes of Environmental Health Officers (EHOs) are invisible to the general public. As a consequence, students entering university are unaware of the profession and its significant role in society. This has resulted in there being too few EHOs to meet the current regulatory requirements, much less deal with the emerging environmental health issues arising as a consequence of changing global conditions including climate change. To futureproof Australian society and public health this workforce issue, and the associated oversight of environmental health must be addressed now.

106 Assessment of fecal near infrared reflectance spectroscopy to detect and monitor the reproductive status of endangered Amur and Snow leopard females

Feces from captive and wild carnivores can yield valuable information about an individuals’ physiological and reproductive status, diet, and ecology. Near infrared spectroscopy (NIRS) is a rapid, noninvasive, cost-efficient technique widely used in the agricultural, pharmaceutical, and chemical industries that has gained traction in diagnostic and ecological field applications for herbivore species, such as wild deer, antelope, and giant panda. The aim of this study was to test the transferability of NIRS to measuring reproductive status in feces from 2 endangered carnivore species, the Snow (Panthera uncia) and Amur (Panthera pardus orientalis) leopards. Fecal near infrared spectra analysed with multivariate statistics were used to generate prediction models for estrone-3-glucuronide (E1G) and progesterone (P4). In the E1G NIRS model, fecal samples (n=93) were obtained from 5 female leopards (3 Amur, 2 Snow) at 5 different zoo facilities, whereas for the P4 NIRS model fecal samples (n=51) from only 1 pregnant Amur leopard was available. The hormones were extracted with methanol and quantified by enzyme-linked immunosorbent assays (C. Munroe), where the sample range for E1G was 0.20-2.17 μg/g and the range for P4 was 0.06-61.89 μg/g. The near infrared spectra (350-2500nm) were acquired with an ASD FieldSpec®3 portable spectrometer (Malvern Panalytical, Malvern, UK), and the chemometric analysis was realised using the Unscrambler® X v.10.4 (CAMO Software AS, Oslo, Norway). Hormone reference values were log transformed before chemometric analysis to account for the heterogeneity of variance. Spectral pretreatment of standard normal variate was applied to the truncated wavelength range 700-240 0nm in order to remove interference from the visible region (350-700nm) due to individual diets that can confer colour variants that alter spectral signatures. Initial principal component analysis for the E1G and P4 datasets models showed >95% of the variation was explained by 4 factors, with no separation of principal component analysis scores between species or reproductive status. Quantitative prediction models using partial least-squares regression on selected wavelength ranges yielded a coefficient of determination for E1G and P4 of 0.10-0.04 and 0.35-0.19 for calibrations and validations, respectively. These near infrared models require further mathematical processing and consideration of sample variation due to diet complexity in carnivores in order to accurately assess hormone levels and monitor reproductive cycles in these species. This work was supported by USDA-ARS Biophotonics Initiative grant #58-6402-3-018.

Studies with herpes zoster vaccines in immune compromised patients

INTRODUCTION

The active component of the herpes zoster vaccine (ZVL), licensed for people ≥50 years of age, is a live attenuated varicella-zoster virus. ZVL is contraindicated for immune compromised individuals, with limited regard to the degree of immunosuppression. Areas covered: This review evaluates phase I and II and observational studies for ZVL, and published reports of the off-label use of ZVL, for conditions and therapies for which investigators considered the risk-benefit for using ZVL to be favorable. It also discusses exploratory trials of ZVL for additional immune compromising conditions, and summarizes clinical guidelines from many countries and professional societies that are based upon recent investigations. Studies in immune compromised patients of investigational vaccines that do not contain live virus are reviewed. Expert commentary: It is likely that past and ongoing research with ZVL will define immune compromising diseases and/or therapies for which the risk-benefit for using ZVL vaccine is favorable. The main variables to consider in this assessment in immune compromised patients are safety, immunogenicity, protection against herpes zoster, and persistence of protection. Vaccination against herpes zoster prior to suppressing immunity is an important clinical strategy, although efficacy of this approach has not been evaluated in a clinical trial.

116 DEVELOPMENT OF ASSISTED REPRODUCTION TECHNOLOGIES FOR THE ENDANGERED MISSISSIPPI GOPHER FROG (RANA SEVOSA) AND SPERM TRANSFER FOR IN VITRO FERTILIZATION

Species-specific differences in breeding strategies and physiology have limited the application of assisted reproductive technologies (ART) for critically endangered amphibians in captive assurance colonies. In 2006, the Memphis Zoo (MZ) initiated a program to develop ART for the critically endangered Mississippi gopher frog after natural breeding failed. Standard gamete collection and IVF developed by MZ for reproducing endangered toads such as the Wyoming or boreal toad were applied to the gopher frog with little success, especially hormonal therapy for sperm production. Using the leopard frog as a model species for Ranids, we tested the time and dose dependence of a luteinizing hormone releasing hormone analogue (LHRHa) and hCG on sperm quantity and quality. Initial findings from the leopard frog study were critical in designing the study on gopher frogs. Our objectives were to (1) compare 2 different hormones administered intraperitoneal (500 IU hCG vs 15 μg LHRHa) or their combination on spermiation in gopher frogs; (2) develop in vivo oocyte maturation and ovulation protocols using LHRHa (15 μg) and hCG (500 IU); and (3) transfer this technology to another institution as proof of principle. In gopher frogs, 100 and 83% of the males produced sperm in response to the LHRHa and the combination treatment, respectively, whereas only 16% responded to hCG alone. Sperm concentration peaked at 1 h post-administration for all treatments, with the LHRH/hCG cocktail treatment producing the highest concentration of sperm (mean = 4.6 × 106 ± 1.2 × 106 sperm mL–1, n = 6). No differences in motility were observed between treatments (P > 0.05). For females, a series of priming hormones of hCG and LHRHa were given several months before an ovulatory hormone regimen resulting in ovulation by 100% of the females (n = 6), whereas animals not primed failed to ovulate (n = 4). These 3 separate priming and IVF trials conducted between 2008 and 2010 resulted in each female laying ∼2000 eggs, with an average fertilization rate of 76% for inseminated eggs and hundreds of tadpoles produced. These IVF tadpoles represent the first captive reproduction of gopher frogs and highlight how ART can be applied to conservation and genetic management of threatened species. Subsequently, we tested our IVF protocols on gopher frogs at Omaha's Henry Doorly Zoo using fresh (collected on site) and chilled, shipped sperm from MZ. We collected 6169 eggs from 9 hormone-primed females with all animals ovulating. A portion of the total eggs ovulated were inseminated, resulting in 2401 fertilized eggs (38.9% of total eggs collected) across 18 different male–female pairings leading to viable tadpoles. In addition, sperm transferred overnight from the MZ produced 202/441 fertilized eggs (46%). The transfer of this technology and production of endangered amphibians using chilled, shipped sperm from live animals is a conservation milestone that can be applied to other captive breeding programs.

Total parathyroidectomy without autotransplantation for renal hyperparathyroidism

Background

Parathyroidectomy is the standard treatment for renal hyperparathyroidism although controversy exists about the optimal surgical procedure. Total parathyroidectomy without either autotransplantation or thymectomy is one suggested approach. This study reviewed the medium- to long-term results of this procedure.

Methods

A retrospective review was undertaken of patients undergoing total parathyroidectomy between August 2000 and March 2009. The procedure was performed by a single surgeon and median follow-up was 31 (range 1–120) months.

Results

Data were obtained on 115 patients with no re-explorations for bleeding or clinical recurrent laryngeal nerve injuries. The rate of postoperative hypocalcaemia on the day after surgery was 15·7 per cent. Thirty-three patients (28·7 per cent) had an undetectable parathyroid hormone level at the end of follow-up. Fourteen patients (12·2 per cent) developed recurrent hyperparathyroidism with a median parathyroid hormone level of 35·4 (range 5·4–200·0) pmol/l. The reoperation rate was 3·5 per cent. Thymectomy tissue, taken if all four glands could not be identified, revealed no parathyroid glands.

Conclusion

Total parathyroidectomy alone has minimal associated morbidity or mortality, and a good medium- to long-term clinical outcome with a low recurrence rate.

Hierarchies, bureaucracies and professions. The Medicare Review. Part two

This paper is both a personal account and an analysis of the Medicare Review (part 2) that took place in 1985-6, to which I acted as Consultant Adviser. It analyses health policy issues associated with the recent inquiry to consider expanding the Medicare Scheme to include the services of some paramedical occupations. It considers what took place, the history of events leading up to the Review, the complexities of the review process and issues of implementation as well as the wider context. The paper moves from the descriptive to the analytical level to explain and interpret the review process from both a sociological and social policy point of view. The relevance of the Review to public health is twofold: the development and application of a new methodology to evaluate complementary health modalities on one hand, and the role of the Review in promoting both the legitimacy of these occupations, and, from a public policy analysis viewpoint, cost containment, on the other.

Public health, private genes: The social context of genetic biotechnologies

The last decade has seen rapid discoveries in the genetic basis of disease associated with the Human Genome Project (HGP). Understanding the social (including legal, ethical and political) impact of the these findings, however, lags far behind. This paper addresses the social context of biotechnologies arising out of this project as well as the tension between the individual and collective uses of these technologies. The danger is that, in the context of a global trend towards conservatism, the ideology of genetic reductionism is legitimizing the abandonment of collectivist responses to social problems in favour of the promotion of individualist ones. In seeking to pursue health policy objectives of reducing premature morbidity and mortality more traditional public health concerns are in danger of being marginalized.

The professionalisation of midwifery through education or politics?

The midwifery profession is redefining itself, with a national initiative to separate from nursing using several strategies at political, legal, educational and professional levels. These include lobbying for a Midwives' Act, a national approach to co-ordinate the education of student midwives, the introduction by the ACMI of competency based practice, the initiation of various models of practice and a three-year Bachelor of Midwifery. This paper argues that the educational strategy employed by midwifery is similar to that used by nursing. This strategy was overtaken by political and economic reforms within the health care sector. We argue that achieving professional dominance is not achieved simply through education but is fundamentally a political process.

Gendered embodiment and survival for young people with cystic fibrosis

In the context of improvements in both longevity and the quality of life for people with chronic disease, this paper takes as its sense of problem the differential life expectancy for young men as against young women suffering from cystic fibrosis. From a qualitative study of the transition to adulthood for young people with the disease, a theory of gendered embodiment is proposed to explain this differential. The social construction of masculinity and femininity as social practices resulted in the former being more conducive to survival than the latter in this case. There were marked differences between the young women and young men in attitudes to: the meaning of life, death, career and body image; all of which affected adherence to medical regimen.

Welfare reform consequences for children: the Wisconsin experience

BACKGROUND

The Temporary Assistance to Needy Families, enacted under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, is a reality for many working families. As public policies are enacted, unintended consequences for infants/children must be minimized. Child advocates in Wisconsin, leading this nation in reforming Aid to Families with Dependent Children (AFDC), are concerned about supporting eligible infants/children as safety-net programs are unlinked.

OBJECTIVE

This study reviews the enrollment status of 4 linked programs over time in Wisconsin, from January 1995 to August 1998. Eligible infants/children in programs, such as Medicaid/AFDC, Medicaid/Healthy Start, and Food Stamps, were analyzed and compared with enrollment in Special Supplemental Nutrition Program for Women, Infants/children (WIC), a nonlinked program.

DESIGN

A cross-sectional analysis of monthly enrollment for infants/children was subdivided into 3 periods: prewelfare reform or AFDC (January 1, 1995 to December 31, 1995), the welfare reform pilot or Pay For Performance (January 1, 1996 to August 31, 1997), and welfare reform better known as Wisconsin Works (W-2), (September 1, 1998 to August 31, 1998), periods 1, 2, and 3, respectively.

PARTICIPANTS

Infants/children in Wisconsin from birth to 18 years of age enrolled in W-2 and/or other safety-net programs were monitored: AFDC or W-2, WIC, Food Stamps, Medicaid/AFDC, and Medicaid/Healthy Start.

RESULTS

The average number of infants/children removed from AFDC and Medicaid/AFDC during periods l and 2 were -1210 increasing to -3128 per month, respectively, almost tripling the rates of decline during the pilot period (see ). By the end of this study, >100 000 (111 198) infants/children were removed from AFDC/W-2 enrollment and 51 559 fewer infants/children benefited from Medicaid. This rate of decline slowed during period 3, averaging -687 per month, while W-2 enrollment continued to decline significantly at a rate of -2692 per month. In contrast, Medicaid/Healthy Start enrollment, targeted to infants/children <6 years of age, increased significantly over all periods by +332, +1327, and +266, respectively. Food Stamps enrollment also declined throughout all 3 consecutive periods, -603, -2462, and -1450, respectively. However, enrollment in the WIC program did not decline significantly to the same degree as other certification-linked programs with AFDC or W-2, as indicated by the consecutive slopes of -60, -111, and -183, respectively.

CONCLUSION

Wisconsin infants/children were rapidly removed from welfare rolls in unprecedented numbers during the periods January 1995 and August 1998. Comparisons of periods before W-2 implementation and 1 year after implementation support the fact that certification-linked programs, such as Medicaid and Food Stamps, were sufficiently aligned to AFDC/W-2 to significantly impact infants/children enrollment. Historically, WIC certification in Wisconsin has not been linked to AFDC, and infants/children traditionally eligible for Medicaid and Food Stamps are also eligible for WIC. Yet, contrary to the AFDC-linked safety-net programs, declines in WIC enrollment were not statistically significant during all study periods. Statewide and local interventions within Wisconsin, such as outreach activities, targeted to Medicaid/Healthy Start and more recently Title XXI (State Children Health Insurance Program), slowed the reductions of Medicaid enrollment for Wisconsin infants/children. These findings support that altering safety-net programs can result in unintended consequences if not carefully transitioned as demonstrated in Wisconsin welfare reform.

Factors impacting on shared care working relationships between practice nurses and general practitioners: a literature review

Practice nurses have worked in general practice for many years yet little is known or published in Australia about their work. Recent health care reforms in Australia, particularly the establishment of the Divisions of General Practice and various best-practice innovations linked to the National GP Strategy have seen an increase in the role of practice nurses. Despite this GPs in Australia are cautious about the role of practice nurses. Much of this caution arises from reform in general practice in Britain particularly the establishment of fund-holding for general practice. This article reviews the literature on practice nurses in Britain and Australia within the framework of the health reforms in general practice in both countries.

The role of the practice nurse. An exploratory study

AIM

There is little research on the role of the practice nurse in Australia. However, there is some evidence that practice nurses are no longer primarily receptionists, but rather function as nurses. This article reports on a small qualitative study that set out to identify areas of effective shared care between general practitioners and practice nurses.

METHOD

Semistructured interviews were conducted with general practitioners and practice nurses in eight general practices. A general practitioner who did not employ a practice nurse and a general practitioner and two nurse practitioners at a Community Health Centre were also interviewed.

RESULTS

It was found that general practitioners and practice nurses have established effective working relationships that enhance patient care. Shared care was not found, except to some extent in the area of wound care.

CONCLUSION

Most GPs and practice nurses interviewed believed that the current funding model, requiring GPs to sight all patients before a fee can be claimed, restricts the potential use of practice nurses' expertise, for example with patients returning for routine blood tests or blood pressure monitoring, or wound dressing. A change to the current model would have implications for the education and accreditation of practice nurses.

School-based/school-linked health centers expanding points of access

Health providers and leaders in urban Milwaukee collectively acted to expand school-based health services to children attending Milwaukee Public Schools (MPS). This School-Based/School-Linked Health Centers' (SB/SLHCs) Collaboration was initiated to increase points of access for children, primarily to working-poor families, through mobilizing community resources among local leaders and statewide health systems. Systematic steps such as needs assessment, sharing data, seeking funds and prioritization of school-based sites facilitated the establishment of more than 30 additional SB/SLHCs. This has resulted in approximate 700% increase in school-based health care and health promotion services. This collaboration illustrates how communities and health care systems can effectively advocate and impact local services to benefit a population having high social risk factors. As welfare reform efforts evolve, SB/SLHCs have significantly advanced access to mainstream health services through effective local collaborations.

Media violence

American media are the most violent in the world, and American society is now paying a high price in terms of real life violence. Research has confirmed that mass media violence contributes to aggressive behavior, fear, and desensitization of violence. Television, movies, music videos, computer/video games are pervasive media and represent important influences on children and adolescents. Portraying rewards and punishments and showing the consequences of violence are probably the two most essential contextual factors for viewers as they interpret the meaning of what they are viewing on television. Public health efforts have emphasized public education, media literacy campaign for children and parents, and an increased use of technology to prevent access to certain harmful medial materials.

The prostatic imperative and the social relations of medical technology

A sociological approach to medical technology assessment is outlined in this paper, first in general and then with specific reference to controversies surrounding the use of prostate-specific antigen (PSA) testing to population screening for prostate cancer.

Managing the doctor-nurse game: a nursing and social science analysis

In the struggle to achieve professional status and develop a body of knowledge, nursing has embraced a number of 'sciences' and 'disciplines'. These have included sociology and feminist perspectives. This paper explores the difficulties of drawing on these disciplines independently of everyday nursing practice. Using a case study approach, we illustrate the way in which some nurses draw on sociological and feminist 'definitions of the situation' in the 'doctor-nurse game', while others draw directly on nursing practice. The nursing practice in this case is concerned with pain management. We conclude that 'shared care' requires a collaboration with medicine that draws on nursing practice to demonstrate an integrated nursing knowledge in a way that acknowledges, challenges and asserts issues of power and status.

Health technology assessment in Australia: the role of AHTAC. Australian Health Technology Advisory Committee

This paper outlines and discusses the field of medical technology assessment and the role of the Australian Health Technology Advisory Committee (AHTAC) in that process. Developments in medical technologies have altered the way in which health care is practised and delivered. The policy task is a complex one; attempting to balance the need for cost containment whilst at the same time ensuring that the processes of innovation into Australia, and diffusion occur in a manner which maximises the benefit and minimises any harm to the Australian community.

Childhood immunizations: position on the enhanced inactivated poliovirus vaccine and live attenuated oral poliovirus vaccine dilemma

Recent review of the polio vaccines (live attenuated oral poliovirus vaccine [OPV] and enhanced inactivated poliovirus vaccine [eIPV]) for children has generated much debate between infectious disease experts and public health officials. Poliomyelitis was a common medical condition in the 1940s and 1950s, and the success of OPV in eradicating poliomyelitis from the United States and even the Western hemisphere cannot be disputed. However, the adverse condition of vaccine-associated paralytic poliomyelitis (VAPP) has been reported in eight to nine cases per year as a result of exclusively using OPV in the United States. The dilemma has been how to continue the elimination of wild-type poliovirus paralytic poliomyelitis in the United States and worldwide while minimizing the occurrence of VAPP. Clinical trials have supported that eIPV and OPV provide similar protection for humoral immunity. However, OPV provides superior gastrointestinal immunity, which is a public health benefit for vulnerable populations. Recommendations among experts have concluded that the sequential eIPV/OPV is the preferred schedule, with eIPV only or OPV only as alternative equally acceptable schedules. Therefore, factors such as cost, compliance, and access to health care must be considered by parents and providers when selecting a polio vaccine regimen, especially among underserved populations.

Chiropractic and the politics of health care

Musculoskeletal disorders remain a common disability suffered by Australians, but the question of who should treat them remains a contentious issue as the first centenary of the original chiropractic adjustment approaches. This paper, part of a longitudinal study of the role of chiropractic in the Australian health system, analyses this ongoing debate. Recent events are analysed here in this commentary on the politics of health care in this field. These include meta-analysis to evaluate the effectiveness of spinal manipulation for the treatment of lower back pain, recent legal action in the United States, and the recent epistle against Australian chiropractors published by the Australian Medical Association.

Anatomical urinary stress incontinence in women with rheumatoid arthritis: its frequency and coping strategies

OBJECTIVE

The objectives of this study were to develop a valid screening tool for anatomical urinary stress incontinence (AUSI), to use it to determine the frequency of AUSI in women with RA, and to identify the cognitive, behavioral, and psychological coping strategies used by these women to deal with incontinence.

METHODS

A screening tool concerning AUSI was validated by comparing self-reported incidences of AUSI with clinical evaluation. Questionnaires regarding presence of AUSI and cognitive, behavioral, and psychological coping strategies were sent to 750 women clinically diagnosed with RA.

RESULTS

Of the 262 respondents (35% response rate), 21% had characteristics of AUSI, a rate similar to general population studies. Coping strategies varied depending on whether the women were at home or away from home and whether the women were alone or with others.

CONCLUSIONS

There is a need for women with incontinence and the health care workers who serve them to be educated about AUSI and its treatments.

Nurses and independent fee-for-service practice: a critical view

A contemporary development in nursing in Australia is the move to independent private practice. This move is made in support of autonomy for the individual nurse practitioner and in the interests of improved patient care. This paper examines this development using the literature as data and critical theory as the framework of analysis. Critical theory argues that much human knowledge is bound by 'ideological' interests in either the technical or interpretative. Emancipatory knowledge attempts to peel off the various ideological layers in search of truth. Using work to examine the 'technical interest' and professionalism to examine the 'interpretative interest', it is argued that in the contemporary Australian health care system the nurse's claim to autonomy through independent practice calls for continuing debate and reflection.

Chiropractic in Australia

This paper analyzes the emergence of professional chiropractic in Australia. Drawing on the concept of legitimation, it aims to provide a sociological analysis of the evolution of chiropractic.

Occupational stress and RANs

This paper explores nurses' self-reported stress during a time of policy changes in the Northern Territory Health Department. It is argued that current research tends to associate nurses' stress with their personality or type of work, offering a psychological or occupational explanation. Little consideration is given to the complex structural subordination and ambivalence remote area nurses experience on Aboriginal settlements vis a vis their immediate superiors and clients. It is proposed that the nurses' self-reported stress can be partly accounted for by their marginal position between these two groups. The sociological concept of marginality can explain this.

Efficacy of concomitant early summer treatment with fenbendazole and clorsulon against Fasciola hepatica and gastrointestinal nematodes in calves in Louisiana

The efficacy, safety, and compatibility of fenbendazole (FBZ) and clorsulon (CLN) were tested after oral administration of label recommended and of higher (5x) dosage rates to calves naturally infected with gastrointestinal nematodes and Fasciola hepatica. Results for 42 calves allotted to 4 treatment groups indicated a similar efficacy against mature F hepatica by FBZ (5 mg/kg of body weight) and CLN (7 mg/kg) in a combined oral suspension, compared with CLN (7 mg/kg) alone (100 vs 99% reduction). A lesser efficacy was observed against immature flukes (88.6 and 84.9% reduction, respectively). Calves given 25 mg of FBZ/kg and 35 mg of CLN/kg had nearly complete reduction of both mature (99.6%) and immature flukes (99.1%). Fasciola egg counts were reduced by greater than 99.5% in all treated groups. Against Ostertagia ostertagi, the percentage of efficacy of the combined FBZ (5 mg/kg) and CLN (7 mg/kg) treatment was 94.3% against adults and 81.3% against inhibited larvae. Efficacy against all other nematodes was 100%, except against Cooperia spp adults (98.3%) and immature Oesaphagostomum radiatum (88.0%). At 5 x dosage rates for FBZ and CLN, percentage of removal of adults and inhibited larvae of O ostertagi was 99.3 and 99.0%, respectively, and 99 to 100% for other nematodes. Results indicate that FBZ and CLN are compatible when mixed together and administered as an oral suspension to cattle and that the efficacy is similar to that of the drugs individually. On the basis of further results, we suggest that summer treatment may be superior in preventive value for gastrointestinal nematodes and F hepatica, compared with spring treatment, because of seasonal infection dynamics of the major cattle parasites in Louisiana.

Technological innovation and the labour process in health care

The process of technological innovation in health care is explored in this paper using labour process theory. Taking the specific case study of diagnostic imaging technology it argues for the utility of labour process theory for analysing the professional labour process as a means of delineating the social contexts in which technological innovation provides a means of empowering workers.

Chlamydia and the adolescent girl. The enzyme immunoassay as a screening tool

To evaluate the enzyme immunoassay for Chlamydia detection in a population of sexually active urban adolescent girls, 100 endocervical screens using both immunoassay and tissue cell culture were performed. Prevalence of Chlamydia trachomatis was 35%, with more than two thirds of infected adolescents being asymptomatic. When compared with cell culture, the immunoassay was determined to have a sensitivity of 74%, a specificity of 98%, and positive and negative predictive values of 96% and 88%, respectively. Adolescents with false-negative immunoassay test results were more likely to lack evidence of cervical inflammation on examination and have lower-titer infections than their peers with positive results. When the immunoassay was matched against culture for test of cure after therapy, a 10% false-positive rate was found. We conclude that the immunoassay is a useful screening technique for detection of Chlamydia in high-risk adolescent populations; however, its limitations with respect to decreased sensitivity in asymptomatic girls and poor positive predictive value in the context of tests of cure must be appreciated.

A disinfectant delivery system for control of micro-organisms in urine collection bags

We developed a formaldehyde delivery system for urine collection bags and evaluated its effectiveness in suppressing the growth of bacteria in simulated human urine. The system was composed of paraformaldehyde in a polymeric carrier. We determined that inoculation of small numbers of Escherichia coli and Pseudomonas aeruginosa in urinary bags with a continuous flow of synthetic urine (40-80 ml h-1) quickly gives rise to high levels of contamination. This single tablet delivery system, however, proved bacteriostatic or bactericidal for both organisms over the 10-day lifespan. The formaldehyde concentration in the synthetic urine was c. 90 micrograms ml-1 or more during tests.

Ultraviolet light stability of composite resins

The ultraviolet light color stability of seven commercial composite resins was evaluated after 1, 8, and 15 days of exposure. Color differences between exposed and unexposed specimens stored for identical time periods were determined. Samples exposed to ultraviolet light showed large changes in Munsell Hue and Chroma, with smaller but significant changes in Value. Unexposed samples showed small changes in the Munsell components in some cases opposite those observed for the exposed samples. Statistical analysis showed that although significant color changes were observed, brands of composite resins could not be distinguished by length of storage in the dark. Time of exposure was a significant variable at 24 hours and 8 days. At 15 days a number of composite resins did not undergo additional significant color change. Scanning electron microscope showed a significant roughening of the surface of exposed composites with resin breakdown and exposure of the composite filler.

Iatrogenic risks and financial costs of hospitalizing febrile infants

We identified, by diagnostic categories, the iatrogenic and financial costs that arise from hospitalizing febrile infants 60 days of age or younger. Thirty-seven (19.5%) of all admissions resulted in 48 separate complications. Twenty-nine (60.4%) of these complications were preventable, and six complications (12.5%) occurred in infants who probably did not require hospitalization for therapy. Twenty-four (50%) of all complications resulted from intravenous therapy. In addition to the complications, 26 diagnostic misadventures were identified. The average length of hospitalization for all infants was 7.0 days, with a range of two to 28 days. The average cost of hospitalization in 1979-80 dollars was $2,130 per infant, with a range from $6,345 for those infants with bacterial meningitis to $1,480 for those infants with aseptic meningitis. On the average, 25.6% of the bill was for diagnostic studies and 8.3% for physician fees.

Hospitalization v outpatient treatment of young, febrile infants

Our medical center has an unwritten policy of admitting all febrile infants younger than 2 months of age. We studied this practice during a three-year period to determine what proportion of the febrile infants who came to the outpatient department were admitted. The characteristics of the infants who were not admitted were compared with those who were. The timing of and the infant's status at a subsequent visit for those not admitted were also identified. One hundred six (35%) of 303 encounters with young, febrile infants did not result in admissions. An infant was more likely to be admitted if he was male, younger than 30 days of age, and febrile (greater than 38.5 degrees C). None of the infants who were followed up as outpatients suffered morbidity that could be directly related to their not having been hospitalized.