Contribution to variability in response to opioids

Opioids are the oldest and most effective agents for the short- and long-term control of severe pain, particularly chronic cancer pain palliation. However, morphine and other opioids display wide variations in pharmacological efficacy and tolerability, and a significant number of patients are unable to achieve adequately controlled pain at doses that do not produce intolerable adverse effects. This article reviews factors that affect the efficacy and tolerability of opioid analgesics and clinical strategies for successful pain mangement.     

Impediments to communication in transition to terminal illness

Viewing themselves in two hypothetical roles—as terminal patients and as family members related to a terminal patient—48 adults were surveyed on their expectations and preferences about how information should be communicated when a terminal illness is first diagnosed. Identifying with the patient role, respondents believed patients should be told the truth immediately and unconditionally. In contrast, respondents indentifying with family members perceived conditions under which the rights of patients should be abridged. In this latter role, male respondents were significantly less likely than males to imagine themselves as able to inform a loved one about a terminal illness. Nevertheless, for both sexes, early childhood experiences communicating about death and dying were found to be a better predictor of the ease with which respondents can imagine communicating with a terminally ill loved one than are current adult attitudes and experiences. Regardless of personal ease in discussing death, however, most respondents thought the physician, not family members or other health care professionals, should decide when and how the terminally ill adult should be informed—a noteworthy finding in light of the fact that 83 percent of all respondents consider physicians poorly equipped for this role.     

Contributions made in 1939 to knowledge in regard to the pancreas

The American Journal of Digestive Diseases -     

Job satisfaction in relation to change to all-RN staffing

BACKGROUND: A university hospital clinic changed from a mixed to only registered nurse staffing, to reduce the staff and to encourage a philosophy of patient centred care. The aim was to maintain the same level of service and quality of care at a lower cost. AIM: The main purpose of the study was to examine job satisfaction in relation to the change from mixed to only registered nurse staffing and reduction in number of staff. METHODS: Data were collected by an established questionnaire measuring job satisfaction. Non-parametric statistics were used to analyse the data. The questionnaire was distributed to 22 nurses on the ward on three occasions, covering a period of 3 years. RESULT: The experience of having time to plan patient care changed during the investigation period, from 'sometimes' to 'most often having time'. Nurses with longer work experience gave more verbal information to patients and perceived less stress. Information about job performance was more important to newcomers on the ward and became less important with time. However, quite a few have had regrets over choice of work and had considered non-caring work, nevertheless the results show no significant changes in overall job satisfaction.     

Tolerance to phencyclidine in pigeons: cross-tolerance to ketamine

In order to determine whether tolerance developed to the behavioral effects of phencyclidine, pigeons were trained to respond under a multiple fixed-ratio 30, fixed-interval 600-sec schedule of food presentation. When rates and patterns of responding reached stability, dose-response curves for phencyclidine (0.1-10 mumol/kg i.m.), ketamine (3-56 mumol/kg i.m.) and pentobarbital (1-75 mumol/kg i.m.) were determined. Phencyclidine, ketamine and pentobarbital all decreased fixed-ratio 30 responding in a dose-related manner and increased fixed-internal 600-sec. responding at immediate doses. At higher doses, pentobarbital decreased responding. High doses of phencyclidine and ketamine suppressed responding in the early portions of the session, but when responding returned, it returned at a high rate. After 35 daily injections of phencyclidine (3 mumol/kg/day i.m.), dose-response curves were redetermined for all three drugs. A tolerance was observed for moderate doses of phencyclidine, and a moderate cross-tolerance was observed to ketamine. No tolerance was observed for the total suppression of responding produced by high doses of phencyclidine and ketamine early in the test sessions. No cross-tolerance to pentobarbital was observed. After 215 days of daily phencyclidine administration, no withdrawal signs were observed upon the discontinuation of daily injections.     

2004～2006年深圳市雪卡毒素食物中毒事件分析

目的:了解引起雪卡毒素中毒发生的原因、临床表现、流行病学特征,以更好地预防雪卡毒素中毒事件的发生。方法:统计分析2004～2006年度食物中毒调查报告及深圳市预防疾病控制中心的食物中毒资料。结果:2004～2006年共发生由进食苏眉、东升斑引发的雪卡毒素中毒共7事件,中毒人数96人,无死亡病例,占全市食物中毒总数的8.9%。结论:加强深海鱼类的管理,认识深海珊瑚鱼含有“雪卡”毒素的毒性,建立预防措施。     

做人做事做学问

我毕业从医已经65年了，我常扪心自问，杏林行走60载，是否让每一个经过我诊治的病人感到温暖，是否做到了想病人之所想，急病人之所急。我深感自己做得还很不够，在我60余年的外科生涯中，有差错、有失误，在深夜不能入眠的时候常使我惭愧和不安，也常常思索如何做人、做事和做学问的道理。     

Interindividual differences in beta-receptor density contribute to variability in response to beta-adrenoceptor antagonists

To determine the role of changes in receptor density and the considerable interindividual variability in the response to beta-adrenergic antagonists, we determined the relationship between the beta-blockade produced by propranolol and the beta-adrenergic receptor density (Bmax) in 16 healthy subjects who received 10, 20, 40, and 80 mg propranolol every 8 hours for 1 day at each dosage level. The extent of beta-blockade produced was assessed as the reduction in exercise tachycardia. The extent of beta-blockade correlated with pretreatment lymphocyte Bmax (30 mg/day: r = 0.6290, p less than 0.05; 60 mg/day: r = 0.5279, p less than 0.05; 120 mg/day: r = 0.5888, p less than 0.01; 240 mg/day: r = 0.6783, p less than 0.005). When the extent of beta-blockade was corrected for plasma propranolol concentrations, the correlation was further improved (30 mg/day: r = 0.7636, p less than 0.001; 60 mg/day: r = 0.7218, p less than 0.002; 120 mg/day: r = 0.7814, p less than 0.001; 240 mg/day: r = 0.6899, p less than 0.005). We conclude that the density of beta-adrenergic receptors is one of the principal factors that control beta-receptor response to antagonists in human beings.     

Differences in the susceptibility of platelets to freezing damage in relation to size

Previous studies have shown that cryopreservation of normal platelets induces a reduction in the contents of secretion granules, the generation of thromboxane B2, and aggregability. The present study investigates whether these changes in the total population occur to the same extent in four size-dependent subpopulations with mean platelet volumes of 4.2, 5.7, 8.0, and 11.1 microns 3, obtained by counterflow centrifugation. Cryopreservation reduced the contents of the alpha granule markers and the generation of thromboxane B2 in the platelets from the four fractions to the same extent as in the platelets from the total suspension. Maximal aggregation of the platelets in response to collagen was measured by optical aggregation. The average decrease in light transmission after freezing was 47 +/- 3 percent (SEM) for the platelets in the total population, 40 +/- 3 percent for the largest platelets, and 65 +/- 5 percent for the smallest platelets, which indicates that aggregability was better preserved in the larger platelets than in the smaller cells. It is possible that, in the smallest platelets, a decrease in thromboxane generation of approximately 70 percent becomes rate-limiting for aggregation. Further improvements in the clinical use of freeze-preserved platelets may be sought in the preparation of concentrates with relatively high counts of large platelets.     

Circulatory response to postural change in healthy male subjects in relation to age

The initial heart rate (HR) response evoked by standing up and 70 degrees head-up tilt from the supine resting position, as well as the changes in HR and blood pressure after 1-2 min in the upright position, was analysed in teenage boys (aged 10-15 years) and healthy old men (aged 60-90 years). Standing up induced a characteristic temporary HR increase that lasted 20 s and far exceeded the gradual initial HR rise induced by head-up tilt. The main effect of age on the initial HR transients was a definite diminution of the response. After 1-2 min standing and tilting, young subjects showed a pronounced increase in HR and diastolic pressure with little change in systolic pressure. In contrast, old subjects showed a lesser increase in HR and diastolic pressure and a decrease in systolic pressure. A fall in systolic pressure of greater than 20 mmHg after 1 min of active standing was, however, not observed. It is concluded that the circulatory adjustment to the stress of postural change differs markedly between young and elderly subjects. In healthy old subjects marked postural hypotension appears to be rare.