Design should help use of patients' data

Checklists and other tools help doctors to use published evidence in clinical practice. Two other important sources of evidence, however, are the patient and his or her medical record. This series aims to advance the practice of evidence-based medicine by helping in redesign of medical records, drawing on insights from psychology, information design, and medical informatics; and by promoting changes analogous to those occurring in the medical literature. The four papers look at: the uses of medical records and importance of organising them so doctors can use the data they contain; different methods doctors use to search for data and how design of records can help or hinder these approaches; how we interpret data once found, and how record formatting assists this process; and the issues raised by computerisation of records.     

Pharmacological properties of homomeric and heteromeric GluR1o and GluR3o receptors

Homomeric and heteromeric alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionate (AMPA) receptor subunits GluR1o and GluR3o were expressed in Spodoptera frugiperda (Sf9) insect cells. Membranes containing the recombinant receptors showed a doublet of bands of the expected size (99-109 kDa) after western immunoblotting which was shifted to a single band upon deglycosylation. In (R,S)-[3H]AMPA binding experiments, high expression was seen (Bmax = 0.8-3.8 pmol/mg protein) along with high affinity binding to a single site (Kd, nM+/-S.D.): GluR1o, 32.5+/-2.7; GluR3o, 23.7+/-2.4; GluR1o + GluR3o, 18.1+/-2.9. The pharmacological profiles of these receptors resembled that of native rat brain AMPA receptors: AMPA analogues > L-glutamate > quinoxaline-2,3-diones > kainate. In the Xenopus oocyte expression system we had previously shown that the agonist (R,S)-2-amino-3-(3-carboxy-5-methyl-4-isoxazolyl)propionate (ACPA) exhibited an 11-fold selectivity for GluR3o vs. GluR1o. In this study, it was found that ACPA has 3-fold higher affinity at homomeric GluR3o and heteromeric receptors than at homomeric GluR1o, suggesting that its efficacy and/or desensitisation properties are different at GluR1o vs. GluR3o.     

Fecal bile acids and neutral sterols in patients with familial polyposis

Fecal neutral steroids and bile acids were measured in patients with familial polyposis, family controls who are immediate relatives of patients, and controls other than relatives. All subjects were consuming a mixed Western diet at the time of collection of stool specimens. Although the total fecal neutral sterol concentrations were not different between the groups, the patients with familial polyposis excreted a high amount of cholesterol and low levels of coprostanol and coprostanone compared with other groups. Patients with familial polyposis excreted levels of total bile acids in their feces comparable to those excreted by controls; lithocholic acid excretion was decreased in patients with familial polyposis. These findings suggest that analysis of stools for cholesterol and its metabolites be useful in screening the siblings of polyposis families for latent disease.     

Fetal heart rate patterns preceding death in utero

Four cases of intrauterine fetal demise in term infants are presented. From these cases and other published reports, a sequence of fetal heart rate changes preceding intrapartum death is presented. Late or variable decelerations, if unrelieved or uncorrected, lead to baseline heart rate changes of tachycardia and loss of variability reflecting loss of fetal reserve and fetal distress. This is followed by an unstable heart rate, a sinusoidal pattern, or a rapidly changing fetal heart rate. The final event is a profound bradycardia just prior to fetal demise.     

Planning and operational studies in the integrated use of desalination. Case studies for Cyprus and Jersey

Two case studies are described relating to the integrated use of desalination with conventional water resources.The first study describes work undertaken at the request of the Government of Cyprus to advise on the potential role of desalination in the long-term development of the island's water resources. Special features of the study are the strong influence of irrigation demands and the need to devise plans which are flexible against an only partially defined future.The second study relates to the 1.5 mgd MSF plant operated by the Jersey New Water Works Company (Jersey. Channel Islands) where the objective is to maintain overall supply reliability at minimum cost. The plant is operated in conjunction with an unusually complex system of surface water resources which present special difficulties in the optimization of control rules for the desalination plant.     

Fortification of common salt with iron: effect of chemical additives on stability and bioavailability

Fortification of salt with iron has been suggested as a practical method of iron supplementation. In an effort to identify a suitable method for fortifying salt with iron two approaches were investigated. In one the possibility of fortifying salt with ferrous sulfate and a stabilizing agent was tried. Of the several stabilizing agents studied orthophosphoric acid was found to be the most promising one. Salt fortified with ferrous sulfate and orthophosphoric acid was found to keep well on storage without color development. Bioavailability of iron from this fortified salt, although satisfactory at the beginning, deteriorated on storage. An alternative approach in which salt was fortified with ferric orthophosphate, a stable iron compound and an absorption promoter like sodium acid sulfate was found to be more satisfactory. Salt fortified with ferric orthophosphate (3,500 ppm) and sodium acid sulfate (5,000 ppm) kept well without any color development for several months. The bioavailability of iron from this formula was comparable to that from ferrous sulfate and bioavailability did not decrease even after storage for 4-5 months. This fortified salt was also acceptable. This formula offers a practical solution to fortification of salt with iron.     

Ultrasonography of renal sinus lipomatosis

Gray scale B-scans in renal sinus lipomatosis show a variety of features which must be differentiated from clinically significant pathological processes. Normal kidneys show dense homogeneous central echoes. In renal sinus lipomatosis, however, the central echoes are divided and become more sparse (Type I), interspersed with small relatively echo-free areas (Type II), or outline a single relatively echo-free area resembling a mass (Type III). In contrast to similar features in hydronephrosis or multiple cysts, the relatively echo-free areas in lipomatosis are ill-defined and do present several weak internal echoes.