OBJECTIVE: To assess the effect of guidelines for x ray requests on requests for cervical spine x rays. SETTING: Accident and emergency (A&E) department of tertiary referral centre. METHODS: Guidelines for all x ray requests were introduced in the (A&E) department of the Royal Infirmary of Edinburgh in February 1992. The effect of the guidelines on requests for cervical spine x rays was assessed by retrospective review of all such x rays taken over two 30 d periods, before and after the introduction of the guidelines. Junior staff had been in post for 3 months during both periods assessed. Films were reviewed for quality by a consultant radiologist. RESULTS: Guidelines reduced the number of inappropriate requests significantly; however, 26% of requests were still unnecessary. The standard of radiography improved but 49% of x rays remained inadequate, usually because the C7/T1 level was not demonstrated on the lateral view. The A&E doctors correctly interpretated the radiographs in 95% of examinations. CONCLUSIONS: Guidelines reduce inappropriate x ray requests. Further improvements can be expected with continued education.

Cervical Vertebrae↗

PubMed1995

Auroral signature of comet Shoemaker-Levy 9 in the jovian magnetosphere.

The electrodynamic interaction of the dust and gas comae of comet Shoemaker-Levy 9 with the jovian magnetosphere was unique and different from the atmospheric effects. Early theoretical predictions of auroral-type processes on the comet magnetic field line and advanced modeling of the time-varying morphology of these lines allowed dedicated observations with the Hubble Space Telescope Wide Field Planetary Camera 2 and resulted in the detection of a bright auroral spot. In that respect, this observation of the surface signature of an externally triggered auroral process can be considered as a "magnetospheric active experiment" on Jupiter.

Extraterrestrial Environment↗

PubMed1995

Safelon--a new device to reduce needle-stick injuries during intravenous cannulation.

A prospective evaluation was performed to assess the efficacy and ease of use of a novel self-sheathing intravenous cannula with needle protection device (Safelon). Use of the device did not require significant change to the normal cannulation technique. Blood splashes during insertion and the risk of needle-stick injury were reduced.

Catheterization, Peripheral↗

PubMed1994

Evolution of dioecy: can nuclear-cytoplasmic interactions select for maleness?

A model of evolution of reproductive systems, when sex is determined by both nuclear and cytoplasmic genes, is presented. Such a control of sex is known to facilitate the occurrence of female individuals in hermaphroditic populations, thus leading to gynodioecy. A two-cytotypes two-nuclear loci (two alleles at each nuclear locus) model for gynodioecy has been developed previously. Such gynodioecious systems are usually considered as stable, i.e. not leading to dioecy. In order to find out if the presence of females can select for male individuals when sex determination is nuclear-cytoplasmic, we followed the evolution of alleles responsible for female sterility. These alleles can be at the preceding loci or at a third locus. We show that male individuals can be selected. Dioecy evolves in less restrictive conditions than under nuclear sex determination. The same also holds for trioecy (coexistence of females, hermaphrodites and males). Nuclear-cytoplasmic polymorphism can be maintained in these reproductive systems.

Biological Evolution↗

PubMed1991

Intermittent claudication in Quebec men from 1974-1986: the Quebec Cardiovascular Study.

The incidence and risk factors of intermittent claudication (IC) and its association with coronary heart disease were evaluated in a cohort of 4570 men, aged 35 to 64 in 1973, free of cardiovascular diseases and followed for 12 years. During the follow-up, 188 developed IC, an annual incidence of 41/10,000. The risk of IC increased with age. In comparison to the rest of the cohort, men with IC were older and had a higher prevalence of smoking, elevated blood pressure, and diabetes. Cigarette smoking was the predominant factor, quadrupling the risk of IC compared to those who never smoked, while those who stopped smoking one year before the study had a risk similar to non-smokers. Quintile 5 of systolic blood pressure doubled the risk of IC. Diabetes requiring a pharmacological treatment at entry in the study was significantly more prevalent in men with than in men without IC (7.5% vs 1.5%). There was no significant relationship between IC and serum cholesterol, body weight, or number of years at school. During the follow-up, 84 of the 188 men with IC had a coronary heart disease event, angina being the most frequent manifestation. Furthermore, 11% of men with IC died and in nearly two-thirds of these, death was attributable to coronary heart disease; this was twice the rate observed in the other men. In these Quebec men, IC is a common health problem and is associated with a high rate of coronary heart disease. Since IC is related to modifiable risk factors, primary prevention of these factors appears warrant.

Age Factors↗

PubMed1990

Telematics: a new tool for epidemiological surveillance of diarrhoeal diseases in the Aquitaine sentinel network.

A sentinel health information system using telematics and a network of general practitioners was set up in Aquitaine in south western France in 1986. Among the health problems under surveillance was acute diarrhoea. Data for each patient who fulfilled the usual case definition for acute diarrhoea were reported by general practitioners using home terminals (Minitels) connected to a central computer by telephone. Over one year 2234 cases of diarrhoea were reported, the incidence varying from 0.8 to 1.5 cases per doctor per week. Seasonal variations in incidence were observed, with peaks in the winter and in the summer. Only 379 (17%) episodes of diarrhoea were classified as severe, and these patients consulted their general practitioners earlier than patients whose diarrhoea was less severe. Foreign travel was rarely found in the patients' histories, but clusters of cases were found in communities (4.6%) and in families (22.3%). The advantages of this system were easy reporting and immediate feedback, but it was difficult to extrapolate the data, and the system was inadequate for intervening in outbreaks of diarrhoeal disease. Our knowledge of diarrhoeal diseases in south west France improved.

Acute Disease↗

PubMed1990

[Short-stay hospitalization of elderly persons: first step toward institutionalization?].

One month outcome after hospitalization was studied in 1695 persons aged 75 and over, living in the community and admitted to acute care medical units: only 9.6% of them were then institutionalized. Returning home requires a high level of independence for feeding, mental status and continence. The level of dependence of institutionalized patients was particularly high for dressing or bathing, technical care, mental status and security. A multivariate analysis showed that the only independent predictors of institutionalization were: sex, living alone, mental status and hospital type. The role played by physical disability must be counterbalanced by the effective physical assistance, brought to the elderly by institutional or informal home care after hospitalization. These results allow early identification of persons at high risk of institutionalization.

Activities of Daily Living↗

PubMed1989

Epidemiological surveillance of suicides and attempted suicides in Aquitaine, south-west France, using an original computer network of sentinel general practitioners.

To improve the epidemiological study of suicide and attempted suicides in Aquitaine, France, we developed a comprehensive surveillance system based on the input of Sentinel General Practitioners (SGPs). From October 1986 to May 1988, for each case of suicide or attempted suicide, the SGPs reported epidemiological data to our system through a computer network of personal home terminals (Minitels). Data included age, sex, method and result of attempt and antecedents. In an analysis of the relationship between the suicidal method, antecedents and results of suicidal act, the principal findings were a high rate of antecedents of suicide attempts by drug overdoses, hangings and drownings; and no antecedents for attempts by the use of firearms. This may show that the increasing accessibility of firearms is making it more likely that impulsive suicide attempts will be lethal.

Adult↗

PubMed1988

HIV monitoring via general practice.

Explore the source record for details and available documents.

Acquired Immunodeficiency Syndrome↗

PubMed1988

Predictors of non-bedridden survival in dementia.

The present study examined non-bedridden survival in 105 patients diagnosed as demented (Alzheimer's disease, multi-infarct dementia, mixed dementia) in a neurological ward. Follow-up observations were made. During the first year, the cumulative mortality rate was 69% compared to a rate of 44% in the second year. The initial disability stage, as assessed by the Dementia Disability Scale, was found to be the only significant predictor of non-bedridden survival. The type of dementia, age, type of diagnosis, and post-hospitalization placement in an institution have not been found to be significant predictors of this evolution.

Adult↗

PubMed1988

[Epidemiological surveillance: experience in Aquitaine from a network of sentinel physicians].

Explore the source record for details and available documents.

Adolescent↗

PubMed1987

Age differences in the consistency of cardiovascular response patterns in healthy women.

To determine if response consistency is higher in older women, twenty young adult (mean = 20 years) and twenty-two elderly (mean = 82 years) women participated in a 20-min stress protocol including serial subtraction, anxiety and anger imagery tasks. All subjects were healthy and free of diagnosed cardiovascular disease. Heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) responses to the tasks were assessed. To allow comparisons of the effects of stress on different cardiovascular parameters, all baseline-stress change scores were converted to z-scores. Forty-two 3(parameter)X3(stressor) matrices of z-scores, one for each subject, were created. Intraclass correlations computed using these matrices revealed greater consistency of response hierarchies (e.g., DBP greater than SBP greater than HR) among elderly subjects. Possible mechanisms for this effect are discussed.

Adolescent↗

PubMedDate not supplied

Ethics in professional nursing practice.

With expanded roles in nursing comes increased responsibility, often without clear authority. Understanding professional ethics and their practical application is essential to professional practice. The authors review the concept of ethics and discuss examples for application of ethical judgment from OGN nursing practice.

Ethics, Nursing↗

PubMedDate not supplied

Telematics and sentinel health information system with general practitioners in Aquitaine, southwest France.

A sentinel health information system using a telematics system to collect epidemiological data from a network of general practitioners (GPs) making up 5% of the GP population was set up in October 1986 in Aquitaine, France. In the first year, four topics were under surveillance. The GPs reported data for each case diagnosed by filling out a questionnaire displayed on their home terminal (Minitel), which transmitted the data by standard telephone lines to a central minicomputer located in the Bordeaux University Medical Centre. Regular feedback was provided to the participating GPs, public health officials and the Bordeaux Medical School. A detailed report of GP participation is presented, the reliability of our findings is discussed in terms of the motivational factors of participants, and the usefulness of the system is evaluated both for immediate teaching implications and for future research possibilities.

Computer Communication Networks↗