Biomedical subjects
Publications and source records attributed to C Powell.
Nine months ago the author became a student on a part-time Bachelor of Nursing Sciences Course. The author shares her experience in order to encourage nurses to consider undertaking this type of study and at the same time persuade course selector that part-time workers with domestic commitments can cope.
Ten new monoclonal antibodies (MAbs) to SIV envelope were produced and characterized. Using a panel of 28 MAbs, 10 antibody binding sites on SIV envelope protein were identified. Seven sites were located in gp120 and three in gp41. Five sites in gp120 and two in gp41 were defined by overlapping peptides. The remaining two sites on gp120 and one on gp41 were distinguished by competition binding assays but could not be defined by overlapping peptides, suggesting that they were discontinuous or conformational epitopes. Five of the 28 MAbs consistently and reliably neutralized the infectivity of SIVmac251. Two of these bound to a peptide (aa171-190) in the V2 region. The remaining three MAbs bound to a conformational epitope on gp120. These two neutralizing epitopes on SIV are analogous to similar epitopes recently described in HIV-1. In contrast, three MAbs binding to the V3 region of SIV failed to neutralize infectivity, suggesting that this region in SIV may by functionally different from the V3 loop in HIV-1.
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OBJECTIVES: To determine what treatment decisions physicians will make when faced with an incompetent elderly patient with life-threatening gastrointestinal bleeding and to identify the factors that affect their decisions. DESIGN: Survey. SETTING: Family practice, medical and geriatrics rounds in academic medical centres and community hospitals in seven countries. PARTICIPANTS: Physicians who regularly cared for incompetent elderly patients. OUTCOME MEASURE: A self-administered questionnaire containing three case vignettes. Each provided the same details on an incompetent elderly patient; however, one gave no information about the wishes of the patient and his family (no directive), the second provided a do-not-resuscitate (DNR) request, and the third included a detailed therapeutic and resuscitative effort chart (DTREC) requesting maximum therapeutic care without admission to the intensive care unit (ICU). The four treatment options were supportive care only, limited therapeutic care, maximum therapeutic care without admission to the ICU and maximum care with admission to the ICU. MAIN RESULTS: Treatment decisions varied and were systematically related to age, level of training and country (p less than 0.001). The older physicians and those in family medicine were less likely than the others to choose aggressive treatment options. Brazilian and US physicians were the most aggressive; Australian physicians were the most conservative. The DNR request resulted in a significant decrease in the number of physicians choosing aggressive options (p less than 0.001). The DTREC resulted in a move toward more aggressive treatment, as outlined in the directive (p less than 0.001). Overall, however, about 40% of the physicians chose a level of care different from what had been requested. Furthermore, over 10% would have tried cardiopulmonary resuscitation despite the DNR request. CONCLUSION: Treatment of incompetent elderly patients with life-threatening illness varies widely within and between countries. Uniform standards should be developed on the basis of societal values and be communicated to physicians.
This is the first reported case in the English literature of malacoplakia of the liver. In common with other cases of malacoplakia, the patient was immunosuppressed secondary to steroid therapy for underlying systemic lupus erythematosus. The patient died 18 months after presentation; at autopsy, the histologic features included those of the late or fibrous stage of malacoplakia.
The behaviour of 18 children with severe malnutrition between the ages of six and 24 months was observed. They were compared with 21 age-matched adequately nourished children in hospital with other diseases, and were given regular developmental assessments with the Griffiths test. On admission to hospital the malnourished children were less active and more apathetic than the controls when alone in their cots, while the controls were more distressed. When given toys, initially the malnourished children explored them less, using fewer play actions and touching fewer toys. These differences were not present on recovery. Initial behaviour did not predict later developmental levels.
Nurses practicing in long-term care facilities were surveyed on the adequacy of their nutrition education, nutrition knowledge, and general attitudes about the diet of elderly residents. While 78% of the 95 responding nurses reported taking a required nutrition course during their training, only 61% indicated the quantity of their nutrition education was sufficient and 66% indicated the quality of their education was sufficient. The mean nutrition knowledge score was 60% correct with 51 subjects scoring at this level or less. Since the nurse is such an important caregiver for the institutionalized elderly it is recommended that more emphasis be placed upon nutrition of the elderly in the nurses' education as well as the provision of more inservice training for practicing nurses utilizing the registered dietitian.
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An isolated mass protruding from the chest wall of the fetus was visualized by ultrasonography. Doppler velocimetry over the mass revealed low-resistance blood flow through cystic areas, implicating a highly vascular lesion. An operative delivery was performed to avoid possible rupture of the mass.
Three separate lots of S. typhi/S. sonnei hybrid (Ty/Shig) live oral vaccine strain 5076-1C were tested for efficacy in human volunteers challenged with virulent S. sonnei. Two lots (2 and 5) protected volunteers, a third lot (8) did not. The three lots were evaluated by immunological tests and electron microscopy. Lots 2 and 5, which protected, contained bacteria that reacted with anti-flagellar serum and had observable attached flagella and pili. Lot 8, which failed to protect, did not react with anti-flagellar serum, and had no observable pili. There was no correlation between vaccine efficacy and the reaction of IgG in patient's sera in western blot analysis. Surface structures on the Ty-Shig hybrid may be important for generating a protective immune response.
A threatened strike by non-professional hospital employees caused a teaching hospital to halve its in-patient numbers. This paper describes this unexpected, involuntary intervention in patient care in the Department of Geriatric Medicine. Fifty-three patients were discharged, 46 patients were transferred for 12 days to another hospital and 29 remained in the department. There was no evidence of important disruption in patient-care nor exacerbation of patient-distress as seen in ratings of patients' social, emotional and physical functioning. It is suggested that important factors in achieving successful unexpected relocation are: selection of patients who are medically stable albeit with significant physical and mental disability; the preparation and participation of patients and staff; and the continuation of patient care by nursing staff familiar to the patients.
Bioelectrical impedance (BIA) and anthropometric measurements were taken of 129 stunted and 32 non-stunted children aged 9-24 months in Kingston, Jamaica. The reliability of BIA in such young children was examined and the relationships between impedance and anthropometry were determined. The stunted children had significantly lower body mass index (BMI) and smaller triceps skinfolds than the non-stunted children, suggesting differences in body composition between the groups. Resistance was significantly higher in the stunted children than the non-stunted children and nutritional group (stunted or non-stunted) contributed significantly to the variance in resistance after controlling for length, weight, mid-upper arm circumference, triceps and subscapular skinfolds, age and sex. This suggests that there were differences in body composition and/or body shape between the groups beyond that measured by the anthropometric indices used. Total body water (TBW) was estimated using an equation for Jamaican children of comparable age. As a percentage of body weight the TBW estimates were the same for the two groups, a finding which is inconsistent with the anthropometric data.
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Physical restraint is commonly used in the management of elderly people in North American hospitals and nursing homes. Between December 1981 and March 1982 the Department of Geriatric Medicine, St. Boniface General Hospital, Winnipeg, changed its practice regarding the use of such restraints. In the fiscal year 1980-81 the rate of application of physical restraints was 52 per 1000 patient-days and the frequency of falls 7 per 1000 patient-days. By 1986-87 the figures were 0.3 and 8.7 per 1000 patient-days respectively; the increase in falls was not clinically significant. During the study period there was a 40% reduction in the use of chemical restraints (psychotropic drugs other than hypnotic and antidepressant agents). Here we record how this change in practice occurred and persisted.
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