Professional attitudes to specialisation and minor oral surgery in general dental practice

The elucidation of the chemical structure of lpriflavone was carried out by ultraviolet absorption spectrophotometric, infrared spectroscopic, 1H and 13C nuclear magnetic resonance spectroscopic, low and high resolution EI mass spectrometric, thermoanalytical, elemental analytical and X-ray diffraction methods. The results unambigously verify the structure of Ipriflavone.     

Prevalence of gold contact hypersensitivity in the west of Scotland

373 patients attending for routine patch testing were tested with 0.5% and 0.05% gold sodium thiosulfate (GST). 8 (2.1%) patients had a positive patch test, and a further 4 (1.0%) patient reactions which were interpreted as irritant 2 out of 8 patients with a positive patch test to GST suspected gold allergy prior to testing, and both of these patients reported that their eczema resolved if they avoided gold jewellery. This is the lowest prevalence of hypersensitivity to GST reported and suggests that gold contact allergy may not be as widespread as has been recently proposed.     

Second malignancies in cervical cancer patients in the west of Scotland

A recent focus in health care is to develop a seamless transition for patients between the variety of health care agencies with whom they interact. The continuum of care for patients with stroke is complex and many levels of care are required, from acute intervention through to rehabilitation and reintegration into the community. A group of nurses from a variety of agencies in Southwestern Ontario received funding from the Ontario province Wide Nursing Project to effect a desirable change in the way nurses care for the stroke patient. This article describes the Ontario Province Wide Nursing project and the process of and challenges in developing a nursing model for stroke. The development of a nursing model for stroke patients and their families involved conducting nursing, and patient and family focus groups to identify key issues. Thirty-eight nurses participated in the nursing focus groups, and 8 patients and 18 family members participated in the patient and family focus groups. The common themes were the need for improved communication and the need to better prepare patients and families for the many transitions they experience during their recovery from stroke. A Stroke Education Record, which identifies a comprehensive list of potential learning needs of stroke patients and their families, and a Stroke Education and Resource Guide, which provides a reference for nurses, were developed and will be implemented in September 1998. Implementation of the model included a workshop, staff inservices, a self-learning package, and unit displays. Evaluation of the model will include nursing and patient and family focus groups, a chart review, written nursing evaluations, and patient and family telephone interviews.     

Negotiating the role of the practice nurse in general practice

The debate about the role of the practice nurse is not only about practice nursing per se, but raises broader issues about the organization of primary health care. Two related issues emerge as significant: the role of the practice nurse in providing primary health care; and the effective use of the practice nurse resource in the 'new' National Health Service. This paper, by drawing on material from a qualitative study, specifically examines the type of work performed by practice nurses and the factors that influence this. The responses of practice nurses, general practitioners, Family Health Service Authority (FHSA) advisers, community nurse purchasers and managers of community nursing provider units suggest that a consensus on the future development of practice nursing is unlikely. The different stakeholders emphasized different issues, reflecting their own priorities and backgrounds. Practice nurses' accounts of the future, for example, focused on professional issues. General practitioners stressed the importance of role development which met their General Medical Service responsibilities. Purchasing agencies, provider units and FHSAs adopted a wider perspective and were more concerned to develop an effective and integrated primary health care service. The tensions generated by their different interests and perspectives, and the subsequent organizational and policy initiatives that emerge, will provide the context in which the role of practice nurses will be negotiated.     

Acute upper gastrointestinal haemorrhage in west of Scotland: case ascertainment study

OBJECTIVES: To determine the incidence and case fatality of acute upper gastrointestinal haemorrhage in the west of Scotland and to identify associated factors. DESIGN: Case ascertainment study. SETTING: All hospitals treating adults with acute upper gastrointestinal haemorrhage in the west of Scotland. SUBJECTS: 1882 patients aged 15 years and over treated in hospitals for acute upper gastrointestinal haemorrhage during a six month period. MAIN OUTCOME MEASURES: Incidence of acute upper gastrointestinal haemorrhage per 100,000 population per year, and case fatality. RESULTS: The annual incidence was 172 per 100,000 people aged 15 and over. The annual population mortality was 14.0 per 100,000. Both were higher among elderly people, men, and patients resident in areas of greater social deprivation. Overall case fatality was 8.2%. This was higher among those who bled as inpatients after admission for other reasons (42%) and those admitted as tertiary referrals (16%). Factors associated with increased case fatality were age, uraemia, pre-existing malignancy, hepatic failure, hypotension, cardiac failure, and frank haematemesis or a history of syncope at presentation. Social deprivation, sex, and anaemia were not associated with increased case fatality after adjustment for other factors. CONCLUSIONS: The incidence of acute upper gastrointestinal haemorrhage was 67% greater than the highest previously reported incidence in the United Kingdom, which may be partially attributable to the greater social deprivation in the west of Scotland and may be related to the increased prevalence of Helicobacter pylori. Fatality after acute upper gastrointestinal haemorrhage was associated with age, comorbidity, hypotension, and raised blood urea concentrations on admission. Although deprivation was associated with increased incidence, it was not related to the risk of fatality.     

Nephrology in general practice

Hints for the practitioner concerning the management of patients with renal disease are presented. Important facts relating to history, physical, laboratory and radiological findings are stressed and diagnostic assessment is briefly described. Although the general practitioner will refer such patients in most instances to a nephrologist, he should know what kind of further examinations and studies are necessary for correct diagnosis and adequate treatment. The present therapeutic possibilities have greatly improved, but one still disappointing aspect is the treatment of certain forms of glomerulonephritis. The cumulative survival rates in patients undergoing hemodialysis and renal transplantation are assessed and compared with the survival rates in patients suffering from myocardial infarct and carcinoma of the breast, colon and the lung. Essential preventive measures are avoidance of toxic substances like analgesics and consistent antihypertensive therapy even in patients with a renal ailment. The dosage of drugs which are mainly eliminated by the kidneys must be adapted to renal function (serum creatinine or clearance of endogenous creatinine).     

Somatization in general practice

Patients with unexplained physical symptoms are very common in primary care. Some patients attribute these symptoms to physical disease (somatizing patients). Somatization can be a symptom of psychiatric disorder, which is found in 1/4 to 1/3 of the patients in a primary care setting. This form of somatization makes diagnosing difficult and is the main reason why psychiatric disorders are underdiagnosed. Simple techniques for diagnosing and treating somatizing patients are available to general practitioners. However, to improve diagnostic sensitivity and treatment, further teaching and development in primary care settings are necessary.     

Psoriasis in general practice

This report, based on a resource pack for primary care nurses, describes the features of psoriasis and reviews current prevention and treatments. The pack emphasises the important role of nurses in helping people to maintain their confidence and independence in the face of this chronic disease.