Introducing nurse telephone triage into primary care

In this article, the authors describe the changes required to introduce a nurse telephone triage system into a large primary care practice in York. 'Whole systems' changes were necessary in that not one element of the primary healthcare team (PHCT) system has remained unaffected. The introduction of nurse triage has changed working practices, professional working relationships and job satisfaction. Far from being just a workload management solution, it has fundamentally altered the way that nurses, doctors and reception staff work together and with patients.     

Comparison of preservative-free and preservative-containing ipratropium bromide

Abstract A double-blind crossover study was performed on 33 children with asthma to compare the effectiveness of nebulized solutions of preservative-containing and preservative-free ipratropium bromide. Both solutions produced bronchodilation. No significant differences were found between the two solutions at any time after nebulization in minimum and maximum changes from baseline value or in the areas under the lung function time curves. The presently formulated preservative-containing ipratropium bromide solution was not shown to be inferior to a preservative-free compound.     

Sick role and the cancer patient

This paper examines the concept of the sick role and its effect on the cancer patient. The hypothesis is put forward that lack of control and the creation of a feeling of helplessness can adversely affect the illness career of the cancer sufferer. Some of the various strategies used by cancer patients as ways of regaining a degree of control and overriding the paternalistic approach of the health care professions are examined and the importance of patient empowerment is emphasized.     

DERMATOLOGY IN AUSTRALIA: A SURVEY OF PRIVATE PRACTICE

A survey has been conducted to assess the pattern of private dermatological practice in Australia. This shows that keraloses and skin cancers occupy one quarter of patient visits while acne and eszema together occupy one third of patient visits. These results can be compared with those of other surveys, and also can guide the cmplasis to be given to different dermatology topics in undergadnate teaching.     

Neurotransmission and neuromodulation in the chemosensory carotid body

The mammalian carotid body is a small chemosensory organ that helps maintain the chemical composition of arterial blood via reflex control of ventilation. Thus, in response to decreased PO2 (hypoxia), increased PCO2 (hypercapnia), or decreased pH (acidity), chemoreceptor glomus or type I cells become stimulated and release neuroactive agents that excite apposed sensory terminals of the carotid sinus nerve. The resulting increase in afferent discharge ultimately leads to corrective changes in ventilation so as to maintain blood gas and pH homeostasis. Recent evidence that the organ can also sense low glucose further emphasizes its role as a polymodal sensor of blood-borne stimuli. The chemoreceptors occur in organized cell clusters that receive sensory innervation from petrosal afferents and are intimately associated with the blood supply. Additionally, synaptic specializations between neighboring receptor cells allow for autocrine and paracrine regulation of the sensory output. Though not without controversy, significant progress has been made in elucidating the various chemotransductive pathways, as well as the neurotransmitter and neuromodulatory mechanisms that translate the receptor potential into an afferent sensory discharge. Progress in the latter has been hampered by the presence of a wide variety of endogenous ligands, and an even broader spectrum of receptor subtypes, that apparently help shape the chemoreceptor output and afferent discharge. This review will highlight recent advances in understanding the role of these neuroactive ligands in carotid body function.