Reflective testing: what do patients think?

INTRODUCTION

Reflective testing refers to the practice of adding on tests by laboratory staff. Little is known about what patients think of this practice.

METHODS

We surveyed patients attending a general practice surgery and patients attending hospital outpatient clinics. We sought their views about the practice of adding on tests and about the information they received from requesting clinicians about their investigations.

RESULTS

In both groups of patients, large majorities favoured an approach in which relevant additional tests are performed without consulting the requesting clinician or patient first. Most patients also felt that the requesting clinicians had provided a satisfactory explanation about what tests were to be performed and why.

CONCLUSION

Most patients are content to let NHS professionals add on relevant tests if this is felt to be in their interest.

Eosinophilia, mast cell hyperplasia and antibody production in rats following an intraperitoneal injection of Ascaris cuticle including in-vitro studies of immune eosinophil granule lysis

A single intraperitoneal injection of Ascaris cuticle caused a local eosinophilia with peak levels at 2 wk after injection. Mast cells reduced in number and size at 1 wk were found in increased numbers at 3 wk. Injection of a collagen-poor fraction of cuticle known as "cuticlin" resulted in a diminished eosinophil and mast cell response compared with injection of whole cuticle. Precipitating antibodies to soluble Ascaris cuticle collagen were detected in the serum and peritoneal fluid from day 5 onward. It is proposed that the eosinophilia and mast cell hyperplasia are the result of immunization of the animal to an antigen present in Ascaris collagen and rendered soluble by the action of mononuclear phagocytes. The eosinophil and mast cell response to Ascaris cuticle mimicked the response in connective tissue to living nematode parasites. It is concluded that the cuticle of nematode parasites may be responsible for eosinophilia and mast cell hyperplasia in the host.

Survival of transfused platelets collected into new formulation plastic packs

Platelet concentrates were prepared in plastic packs of polyvinyl chloride with tri(2-ethylhexyl) trimellitate as plasticizer. They were stored, with gentle shaking, at room temperature for periods up to 7 days before labelling with isotope and reinfusing. In vivo survival studies, platelet counts, pH and electron microscopy indicated that platelet concentrates prepared in the new plastic were superior to those prepared in the standard pack currently in use. Oxygen was found to diffuse through the new pack more rapidly than through the standard pack. A shelflife of up to 1 week at room temperature seems possible for platelet concentrates prepared in the new plastic.

Transcutaneous nerve stimulation for pain relief in labour

Transcutaneous nerve stimulation (TNS) was asessed for use on thirty-five patients in labour. It was of great benefit to 20% of patients and some benefit to a total of 82%. It was especially appreciated by those patients who complained of backache and further studies should be undertaken with the original idea of TNS in mind--stimulating those areas which feel most painful for the patient. If the method could be made more universally available and could be used by patients and midwives alone with the minimum of supervision and explanation, it would be a safe and useful addition to the present methods of pain relief in labour.

Eosinophilia and mast cell hyperplasia induced by parasite phospholipid

Phospholipid preparations from the nematode Ascaris suum or cysts of Echinococcus granulosus (hydatid cysts) induced an eosinophilia when injected into the peritoneal cavity of rats. Peritoneal eosinophilia persisted throughout 21 days of daily injections of Ascaris lipid and was accompanied by blood eosinophilia, mast cell granule lysis and mast cell hyperplasia. The active material consisted of lecithin and lecithin plasmalogen, and in aqueous suspension had a membrane-like appearance. Electron microscopy revealed that the phospholipid was ingested by all types of cells in the peritoneal cavity, including mast cells, and was rapidly broken down by eosinophils. Phagocytosis was found to be complement dependent. The lipid combined with properdin in human serum and stimulated complement breakdown via the alternative complement pathway.

Perceiving the language of films

Children appear to be familiar with the language of film makers or at least to perceive and remember films less well when the rules of this cinematic language are broken. In this experiment a simple action sequence filmed from a static viewpoint was made up into two films of four shots. One film was edited according to the rules of directional continuity specified by Hollywood cinema, that is the four shots were presented so as to preserve the subject's direction of movement across cuts. The other film was edited disregarding these rules. Apart from this difference both films were identical. Children aged seven, nine, and thirteen years watched either of these films and reconstructed the action using pictures representing the four shots. The children who saw the conventional version were better able to reconstruct what they had seen than those who saw the unconventional version.