Decubitus prevention in theory and practice--a study structure with the VIPS model

In 1990, the Bureau of Dental Health Services of the New York City Department of Health launched a major initiative to modernize a network of school-based dental clinics located throughout the city. Since 1913, the bureau has provided dental care to public school children; however, the clinics were not properly maintained or upgraded, and were in a state of disrepair and obsolescence. Anticipating that the survival of the program was in question, the school program was converted to a fleet of state-of-the-art portable dental clinics permitting targeting of underserved, high-risk poor and immigrant populations. Demographics had changed dramatically over the years; the program could now situate services where they were needed most, and provide a broader array of care where access was a problem. This paper presents a six-year analysis of the program and builds a strong case to show that a portable delivery system can equal or in many ways surpass the effectiveness and capabilities of a fixed-state approach.     

Confiscation and delivery of patient records

In most cases, a physician faces an investigation by a prosecutor the first time when his office is subject of a search or confiscation. Without warning in advance, the police or the prosecutor usually demands the delivery of patients records with or without a search warrant. This paper demonstrates the legal requirements for a search and offers recommendations about behavior.     

Nursing records for discharge. Report of the nursing history

The quality of care within our health care system depends upon an active and dynamic communication which bridges the different levels of care (primary and hospital) and will permit a continuity of services between the distinct parts. To insure this success, the authors propose an outpatient nursing record that will follow the patient upon his or her discharge. This record, to be called the "Discharged Patient Report", will be directed to other medical professionals so that they can be informed of previous treatments that the patient has received. Included in the report will be items such as; the previous nursing interactions that were used on the patient, how problems were resolved, possible other solutions, and health care information given to the patient. Using the report in this way will give us a great tool to know our patients and better understand how to serve them.     

A microfilm-oriented central archive for patient records in a large patient care installation

The authors report ten cases of normal pressure hydrocephalus treated by ventricular drainage. They pay particular attention to the neuropsychological and psychometric aspects and endeavour to identify the most characteristic nosological features by comparing their own clinical observations with those reported in the literature.     

Guide for efficiency analysis of a patient documentation system: the first step is the formulation of the targets

The microtubule cytoskeleton has lagged nearly a decade behind the actin cytoskeleton with respect to structural information on the basic polymer subunit. This structural inferiority complex has finally been lifted by two recent papers describing the structures of the alpha beta tubulin dimer and FtsZ, a protein similar to tubulin that is essential for cell division in prokaryotes.     

Intravenous immunoglobulin: implications for use in the neurological patient

The efficacy of intravenous immunoglobulin (IVIG) in the treatment of the autoimmune disease, idiopathic thrombocytopenic purpura (ITP), has been well documented in the literature. This has encouraged researchers to examine possible therapeutic uses of IVIG in other immune-mediated disorders. Recent clinical reports have suggested that IVIG may have a role in the treatment of neurological disorders with a possible immunopathogenic etiology. Intravenous immunoglobulin, a blood product which contains immunoglobulin G and a trace amount of immunoglobulin A, is believed to work as an immunomodulating agent. However, its mechanism of action is not well understood. Nurses involved with the administration of IVIG must be well informed about the manufacturing and regulation, proper dose and administration, adverse effects, appropriate assessments and related patient education.     

Adamantinoma of the tibia: MRI documentation

Experience of the Southport Spinal Injuries Centre in reestablishing ventilator dependent patients back in their own homes has confirmed the view that such level of disability need not prevent people from returning to the community and start living again. Convincing the carers in the community and abolishing the traditional boundaries between hospital and community appear to be the fundamental prerequisites. Increased use of advanced assistive technology will enable these disabled people to have more acceptable control of their lives.     

Nursing staff perceptions of the use and reduction in the use of physical restraints

Substance P (SP) is a neuropeptide found in both the central and peripheral nervous system. In the skin, SP-containing neurons stimulate the release of histamine from connective tissue mast cells (MC). SP also can potentiate neoangiogenesis and induce dermal fibrosis. MC-derived histamine has potent vasoactive effects, is angiogenic, and promotes tissue fibroplasia. In addition to histamine, MC contain many other angiogenic factors and a variety of cytokines, growth factors, and proteolytic enzymes implicated in tissue remodeling, and normal as well as tumor-associated neoangiogenesis. Many MC-derived factors, including histamine, can enhance melanoma cell growth directly. MC often concentrate around cutaneous melanomas which also frequently are associated with angiogenesis and peritumoral fibrosis. The precise mediators of these responses have not been well defined. We evaluated by immunohistochemistry cutaneous lesions representing stages of progression of malignant melanoma and its precursor lesions for the expression of SP. SP was expressed in 17/25 (68%) primary invasive malignant melanomas, 2/5 (40%) metastatic melanomas, 6/10 (60%) melanomas in situ, 7/12 (58%) atypical (dysplastic) nevi, and 4/10 (40%) spindle and epithelioid cell (Spitz) nevi, but was not detected in any (0/11, 0%) acquired benign melanocytic nevi (p<0.05). Invasive melanomas were immunolabeled in both the intraepidermal and the dermal components of the lesions. For those atypical and Spitz nevi which expressed SP, most of the immunoreactive melanocytes were located at the dermal-epidermal junction overlying areas of papillary dermal fibrosis. The results show differential expression of SP among cutaneous melanocytic lesions and suggest that the expression of this neuropeptide together with other factors may contribute to some of the host responses associated with these lesions.     

Nursing students' stress during the initial clinical experience

The purpose of this exploratory longitudinal study was to identify nursing students' perceptions of stress in their initial clinical experiences in a hospital setting. Guided by the relational view of stress, a Nursing Student's Stress Scale (NSSS) was developed to include six subscales: adequate knowledge, close supervision, averse sights, causing pain, insufficient resources, and reality conflict. The NSSS was administered three times during the clinical experience to 46 nursing students. Results showed significant differences between the students' preclinical expected stress levels and the actual levels of stress in the clinical setting. Theoretical, methodological, and practical implications of the findings are discussed. Nurse educators are encouraged to acknowledge students' perceptions of stressful situations as a basis for stress reduction intervention. Students must first cope with their own stress in the clinical reality before being expected to deal with patients' stress.     

The use of retinoids in the pediatric patient

Oral retinoids are molecules derived from vitamin A that represent one of the most important steps forward in dermatologic therapeutics in the present century. The treatment of acne, severe psoriasis, and severe disorders of keratinization, prevalent diseases in children and adolescents, have radically changed since the advent of oral retinoids. Like most highly-effective medications, oral retinoids also have important untoward effects. Specialists, and in particular, dermatologists and pediatricians should be prepared to maneuver the delicate balance between therapeutic efficacy and side effects in order to give the pediatric patient the maximum benefit with the lowest possible risk.     

The use of psychostimulants in the pediatric patient

The psychostimulant drugs have a long history of safe and effective usage in the treatment of ADHD. They remain the drugs of first choice in this condition. Children with ADHD should be aggressively treated with at least two different classes of psychostimulants before moving to nonpsychostimulant agents. As long as side effects are not troublesome, higher dosages may be used to adequately control the ADHD symptoms, and such high dosages do not impair learning. No evidence shows long-term effects of psychostimulants on growth. Effective use of the psychostimulants is essential for any clinician involved in the treatment of children with ADHD.     

Natural product source material use in the pharmaceutical industry: the Glaxo experience

Glaxo PLC has had a significant involvement with Natural Product Source Materials for all of its commercial history and, most recently, has pursued this interest by use of such materials as templates for new lead discovery. Through the expertise and facilities in its Natural Products Discovery Department, Glaxo extracts relatively small quantities of plant material (typically 200-250 g dry weight) and cultures microorganisms from environmental samples (typically 10-50 g). Extracts and fermentation broths are screened in order to detect bioactive principles (BPs). If the potency, selectivity and specificity of the BP is acceptable, isolation, purification and structural elucidation follows. It is most unlikely, in our experience, that the BP itself will become a drug; it is much more likely that we shall need to initiate a medicinal chemistry synthesis program in order to try to produce a molecule that has both the essential biological and desirable chemical properties to become a drug development candidate. This synthetic process is often a long one and our confidence that such a process is worth undertaking is greatly improved if the BP is novel. An essential component of any medicinal chemistry strategy is that it allows us to obtain secure intellectual property rights through patents. Acquisition of product claim protection, the strongest form of patent protection, is of great importance. Safety testing and clinical development of the candidate drug can take 7-10 years, and often more, during which patent protection is constantly eroding. Recognizing that acquisition of Natural Products Source Materials is an issue of growing concern, Glaxo Research and Development Ltd. (GRD), in the early part of 1992, implemented a policy for plant supply. This policy was subsequently modified to embrace source materials such as environmental, soil and marine samples from which fungi, micro- and microorganisms may be obtained. As a direct consequence of this policy, Natural Product Source Materials supply agreements are only concluded with national and international organizations who possess the expertise to identify and collect the samples. It is equally important that our suppliers have the authority, which must be provided to GRD in writing, to collect such materials and to provide them to GRD for extraction and screening purposes. Such materials must be from sustainable and accessible sources. We will not seek to collect any endangered species. Though ethnomedical information can be helpful, it is not essential. Plants must be taxonomically classified. We reimburse the supplying institute for their efforts and their expertise, and recognize an obligation to offer a royalty to the institute in the event that drug discovery, with subsequent commercialization, owes its origin, however indirectly, to a material that it provided. In discussions with the institute, we insist that "a fair proportion' (>40%) of that royalty be used for the direct benefit of the people in the collection source area. In this context, GRD recognizes the importance of local training and education.