Use of a general surgical high dependency unit in a district general hospital: the first 10 years

The chemotherapy regimen of paclitaxel and carboplatin produces an objective response in 30%-60% of patients with non-small-cell lung cancer (NSCLC). In a prospective study, we administered paclitaxel 200 mg/m2 (by 1-3-hr infusion) and carboplatin at an area under the plasma concentration curve (AUC) of 5 (by the Calvert formula) every 3 weeks to 21 patients who had previously received predominantly platinum-based chemotherapy for NSCLC. We observed no objective responses. Patients received a median of 2 cycles before disease progression. Three of 5 patients who had received only single-agent treatment with a relatively inactive agent may have had modest clinical benefit. We conclude that the paclitaxel/carboplatin regimen has minimal activity in previously treated patients with NSCLC.     

An attempt to improve blood pressure control in the French population: information and outcome awareness at the general practitioner level

To improve blood pressure (BP) control in general practice, 3122 general practitioners agreed to participate in a result awareness program. A survey carried out 6 months after participating physicians had been informed of the outcome of treatments they had given showed that blood pressure control (cut-off point: BP < 140/90 mm Hg) had not improved. However, using less stringent criteria, a slight improvement in blood pressure control could be observed. Although this improvement was marginal, results are sufficiently encouraging to warrant another study after a new awareness campaign among the medical population.     

Prolonged sick-leave: the role of general practitioner

The aim was to study why long sick leave benefit cases had taken a long time with special focus on the communication between the general practitioner and the social service department. An explorative study was made of the development and communication in 27 consecutive lengthy sick leave cases that had lasted more than 13 weeks, that were discussed at three audit panels with participation of the social worker/officer in charge, the general practitioner and the representatives from the local hospital. The study took place in Aarhus County in 1994. The results were that many of the same problems were found in various cases, such as insufficient certificates, inappropriate use of benefit certificates, waiting times for examinations, treatment and especially rehabilitation. In the more complicated cases, of which there were many, a coordinating person would have helped matters. The GP's were willing to take on this role. The main reasons for lengthy benefit cases were that the illness was medically complicated and of a long duration.     

Community-based medical systems advancement in a hospital-primary health care centre in Crete, Greece: concepts, methods, and the new role of the general practitioner

Modern health systems research and development emphasize the transition from hospital to primary health care. Importantly, this transition is projected to be coordinated and interactive, as facilitated, e.g., by improved information systems and collaboration between the involved parties, including Universities and health authorities. An ideal combination of this might accordingly be offered by a synthesis of a basic hospital and primary health care center in an area of suitable site, size, and structure. We believe that our institution, Nosokomion Neapolis, in; the moderate-size Cretan township of Neapolis (New-city) offers an interesting model example of this, because of its affiliation with the University of Heraklion and its international and EU-supported project status. In the present report we want to emphasize the elements that are particularly well suited and manageable and in many ways both opportunistic and conscientious "back to the future" instances of a successful Hospital/Primary Health Care integration. Specifically, we think that the advantages in local area epidemiology, prevention, and quality assurance are apparent, and nurture a--rather renewed that new-role of the general practitioner as both a holistic population doctor and a health systems researcher for the year 2,000 and beyond.     

The role of the general practitioner in postnatal care: a survey from Australian general practice

BACKGROUND: Despite the practice of routine postnatal check-ups, many women experience problems in the months after childbirth. General practitioners (GPs) are involved in routine postnatal care, yet little research has been undertaken to explore this role. AIM: To report the views of Australian GPs as to what physical examination and discussion should take place at the routine six week postnatal check-up and to determine the influence of gender on the approach to the check-up. METHOD: Postal survey of 1104 Australian GPs, yielding an eligible sample of 1022. RESULTS: A total of 715/1022 (70%) usable surveys returned. Over 65% of GPs recommend routine examination of the abdomen, blood pressure, perineum, vagina, pelvic floor, and breasts at the six week check-up. Fewer than a half the sample believed that physical problems (urine and bowel symptoms, back problems), sexual issues, relationship and parenting issues should be routinely discussed. After controlling for age, practice location, obstetric practice, and qualifications, the sex of the GP remains an important factor influencing the GP's approach to postnatal care. Female GPs are three times more likely to believe that maternal feelings should be discussed routinely and about twice as likely to believe that infant sleeping/behaviour, maternal sleeping/diet/tiredness, coping with other children, relationship with partner, and household work should form part of the routine discussion with all recent mothers. CONCLUSIONS: Sex of practitioner and older age (60 years or more) are the two most important influences on a GP's approach to postnatal care. This study indicates a need for GPs to shift their focus from routine examination to indicated examination to allow more time to discuss common postnatal problems.     

Electroencephalographical examination: special reference to the patients consulted from general practitioner

Expression of Proliferating cell nuclear antigen (PCNA) was evaluated in formalin-fixed, paraffin-embedded normal and abnormal cervical squamous epithelia using immunoperoxidase stains and PC10 monoclonal antibody to PCNA. PCNA was exclusively expressed in the parabasal and basal layers of normal ectocervix and a similar pattern was seen in nine of the 11 cases with squamous metaplasia. Examples of cervical dysplasia showed expression in higher layers of cervical epithelium, corresponding to the degree of dysplasia. Increased staining was seen in condylomas and markedly reduced staining with atrophy. The percentage of basal cells that stained increased progressively from atrophic to normal, to condylomatous, to dysplastic epithelia. Proliferative activity can be satisfactorily assessed in formalin-fixed cervical epithelia using PC10 PCNA antibody. This assessment can be of potential diagnostic use in difficult cases.     

The role of the nurse practitioner in a urology service

OBJECTIVE: To evaluate the role of the nurse practitioner in urology and to determine the impact on the work of junior doctors. METHODS: Written criteria were defined before the postholder was appointed and subsequent performance was assessed against these criteria. Training was provided and the quality of work was assessed by direct observation. Senior House Officers (SHOs) were asked whether the post had increased their opportunities to attend theatre, outpatients and post-graduate training sessions and had decreased the number of 'inappropriate' tasks they had to perform. RESULTS: The nurse practitioner accomplished all the tasks that were defined before the appointment. The assessment of patients in pre-admission and haematuria clinics was satisfactory. The continuity of information, care of patients and counselling for patients receiving complex surgery were improved. Sixty-three per cent of all patients seen in the pre-admission clinic and all patients in a haematuria clinic were assessed initially by the nurse practitioner. Because the nurse practitioner was involved in setting up intravenous drug administration and infusions, administrative tasks and in obtaining results from the laboratory, the number of 'inappropriate' tasks performed by the SHOs decreased and they were able to attend more sessions of training and education. CONCLUSIONS: The nurse practitioner in clinical urological practice constitutes an effective use of resources and relieves junior medical staff from other tasks, allowing them to receive a more focused training. In addition, the quality of patient care was thought to be improved in some areas. The framework of a job plan for a nurse practitioner is described.     

Consultation-liaison psychiatry: a psychosomatic service in the general hospital

Consultation psychiatry, an outgrowth of the tenets of psychosomatic medicine that followed the departure from mental-hospital psychiatry to the general-hospital-based psychiatric units, is similar to those consultation services in other specialties available on medical-surgical wards. Its primary aim is to interpret the psychosocial phenomena of health and illness and to redirect the physician from disease- to patient-orientation and to a comprehensive approach. Its functions are diagnostic-therapeutic, instructional and research directed. The psychosomatic orientation is a sine qua non in the understanding of the psychosocial meaning of physical illness, its effect on psychic disability, the psychosocial adjustment of the patient and his family and his ability to adapt to illness and the hospital. An essential feature is the evaluation of the doctor-patient relationship, especially when severe illness requires serious interventions, including the consultation and its reciprocal effect upon the doctor-patient relationship. Liaison activity consists of interpretive-therapeutic mediation between the patient and the therapeutic team when strain endangers their satisfactory cooperation. The therapeutic activity must be short-term and so construed as not to interfere with the primary treatment. The instructional aspect is for the sake of the usual recipients of the service, as well as residents and students. Teaching the interview techniques, especially to students, should demonstrate the holistic approach, comprehensive diagnosis and the need of avoiding orthodox one-sidedness. This paper reviews briefly the scope and role of consultation psychiatry, compares its North American model with its status elsewhere and explores the resistances to it.     

用软件技术提高旋转编码器分辨率的新尝试

应用软件技术对脉冲信号进行倍频处理，并在热轧钢板横切机组的计算机控制联动及定尺剪切精度改造应用中得到了实现．实践证明，该技术是可行、有效的．     

Inorganic arsenic: a need and an opportunity to improve risk assessment

This paper presents views on the current status of (inorganic) arsenic risk assessment in the United States and recommends research needed to set standards for drinking water. The opinions are those of the Arsenic Task Force of the Society for Environmental Geochemistry and Health, which has met periodically since 1991 to study issues related to arsenic risk assessment and has held workshops and international conferences on arsenic. The topic of this paper is made timely by current scientific interest in exposure to and adverse health effects of arsenic in the United States and passage of the Safe Drinking Water Act Amendment of 1996, which has provisions for a research program on arsenic and a schedule mandating the EPA to revise the maximum contaminant level of arsenic in drinking water by the year 2001. Our central premise and recommendations are straightforward: the risk of adverse health effects associated with arsenic in drinking water is unknown for low arsenic concentrations found in the United States, such as at the current interim maximum contaminant level of 50 microg/l and below. Arsenic-related research should be directed at answering that question. New epidemiological studies are needed to provide data for reliable dose-response assessments of arsenic and for skin cancer, bladder cancer, or other endpoints to be used by the EPA for regulation. Further toxicological research, along with the observational data from epidemiology, is needed to determine if the dose-response relationship at low levels is more consistent with the current assumption of low-dose linearity or the existence of a practical threshold. Other recommendations include adding foodborne arsenic to the calculation of total arsenic intake, calculation of total arsenic intake, and encouraging cooperative research within the United States and between the United States and affected countries.     

浅谈如何提高安全评价工作的质量

安全生产是企业持续稳定发展的基本保证．安全评价是企业实现安全生产的重要手段。本文结合安全评价的工作实践,分析了安全评价中存在的主要问题,提出了进一步提高安全评价质量的建议,努力寻求一条使安全评价质量持续改进、不断提高的有效途径。     

Pathways to mental health care among South African adolescents: analysis of referrals to an adolescent psychiatric unit

Assessment forms of 670 adolescents referred over four years to an adolescent psychiatric unit were analyzed to establish how they entered mental health care. The first part of the study examined referral sources; the second established the appropriateness of referral. Adolescents were referred via a number of pathways, of which school sources, psychiatric services, and social agencies were prominent. Interestingly, 60.7% of the referrals were from persons not trained in mental health care. No significant difference in appropriateness of referral was found between trained and nontrained sources. Thus, the unique referral base of adolescents in need of mental health care must be recognized. Although the majority in this study were not mental health care workers, the findings show that their referrals were clinically appropriate. This suggests that by improving the mental health skills of this sector, the provision of psychiatric care to adolescents could be enhanced.     

Patient-caregiver functional unit scale: a new scale to assess the patient-caregiver dyad

BACKGROUND AND OBJECTIVES: This study evaluated the reliability and validity of the Patient-Caregiver Functional Unit Scale (PCFUS), a new instrument to assess the stability or endurance of patient-caregiver dyads. METHODS: Patient-caregiver dyads were recruited from a nursing home (NH) (n = 38), a comprehensive geriatric assessment program (CGA) (n = 20), and an ambulatory medical clinic (controls) (n = 85). Caregivers were eligible if they assisted, or were available to assist, the patient with personal and instrumental activities of daily living, without pay. Data were collected by interviewer-administered questionnaires. Inter-rater and test-retest reliability were evaluated among the CGA sample. Validity was assessed by comparing PCFUS scores among the NH, CGA, and control groups and by correlation of PCFUS scores with other standardized caregiver burden measures. RESULTS: The PCFUS had excellent inter-rater and test-retest reliability. Mean PCFUS scores were significantly lower (ie, less stable patient-caregiver dyad) in NH than CGA and control caregivers. PCFUS scores were significantly associated with Burden Interview, Perceived Stress Scale, and Geriatric Depression Scale scores and risk factors for caregiver stress (eg, patient's cognitive impairment, disruptive behaviors). CONCLUSIONS: The PCFUS is a short, easily administered measure with good reliability and validity and is applicable to clinical and research settings.     

Practice nurses and the effects of the new general practitioner contract in the British NHS: the advent of a professional project? National Health Service

Interposition of a metabolizable linkage has been performed to reduce the hepatic radioactivity levels of radiolabeled antibodies. To estimate the validity of this strategy, a radioiodination reagent (HML) that provides a stable attachment for m-iodohippuric acid with proteins in plasma while facilitating rapid and selective release of the compound after lysosomal proteolysis in the liver was conjugated with a monoclonal antibody (mAb) against osteogenic sarcoma (OST7, IgG1). Radiolabeled OST7 conjugates with a plasma-labile ester bond for releasing m-iodohippuric acid (MIH), plasma-stable amide bonds for releasing radiometabolites of hepatobiliary excretion (MPH), or slow elimination rates from hepatocytes ([111In]EMCS-Bz-EDTA) were prepared with similar conjugation chemistry. The four radiolabeled OST7 conjugates were characterized both in vitro and in vivo. All the radiolabeled OST7 conjugates had similar radiochromatograms on size-exclusion HPLC and similar antigen binding affinities. While MIH-OST7 indicated accelerated clearance of radioactivity from the blood due to the release of m-iodohippurate, the rest of the three radiolabeled OST7 conjugates remained stable in serum incubation studies and had similar radioactivity elimination from the blood in vivo. When injected into normal mice, HML-OST7 demonstrated tissue-to-blood ratios of radioactivity similar to those of MIH-OST7 and significantly lower than those of the other two radiolabeled OST7 conjugates. In biodistribution studies in nude mice, both HML-OST7 and MIH-OST7 exhibited tumor-to-liver or tumor-to-intestine ratios of radioactivity higher than those of [111In]EMCS-Bz-EDTA-OST7 or MPH-OST7, respectively. HML-OST7, MPH-OST7, and [111In]EMCS-Bz-EDTA-OST7 indicated there were no changes in the radioactivity levels in the tumor between 24 and 48 h postinjection, whereas MIH-OST7 significantly decreased the radioactivity levels in the tumor at these time points. HML reduced the radioactivity levels in nontarget tissues without impairing the tumor radioactivity levels delivered by OST7. These findings indicated that the design of a radiolabeled mAb that is stable in plasma and liberates the radiometabolite of rapid urinary excretion constitutes an effective strategy for achieving target-selective radioactivity delivery.