Using attitudes and subjective norms to predict pharmacist counselling behaviors

This field study examines the applicability of the central components of Fishbein and Ajzen's model for the prediction of behavior to the medication counselling activities of community pharmacists. The findings from a sample of 40 pharmacists provide support for the attitudes-subjective norms model. Both the attitude and subjective norm measures are significant predictors of behavior for verbal instruction provided and the length of encounter time. Each of the other behaviors examined--written instruction provided, monitoring activity, and pharmacist approachability--is weakly to moderately influenced by one of the two independent variables.     

Fournier's gangrene: A general surgery problem

Fournier's gangrene is a specific form of synergistic gangrene involving the scrotum and perineum. The disease may follow a variety of clinical conditions or occur without an apparent precipitating cause. It is associated with severe systemic toxicity and a significant mortality rate, and it demands prompt recognition and urgent, aggressive surgical intervention. Its treatment calls on the full armamentarium of the general surgeon. Preoperative resuscitation is often required. Operative debridement can be extensive, involving the buttocks and on occasion the upper thighs and abdominal wall. Postoperative management consists of wound care with eventual grafting or flap rotations. Colostomy may be required. Three cases illustrating the salient features of this disease are presented, together with a review of the literature.     

The grand mal pattern of Gibbs, Gibbs and Lennox.

The "grand mal" pattern of Gibbs, Gibbs and Lennox was observed in records of 14 patients during the past 3 years. It occurs most commonly in those epileptic patients who suffer from primary generalized seizures of more than one seizure type and in whom akinetic attacks are the main clinical problem. In addition, there is usually some degree of intellectual limitations. The EEG features and clinical accompaniments of the discharge were described and since the term "grand mal" discharge is not appropriate, it is suggested that it be replaced by either "generalized repetitive fast discharge", as had been suggested in the European literature, or "beta band seizure pattern".     

Primary appendectomy.

A review of 403 patients undergoing appendectomy in a community hospital led to the following conclusions. Appendectomy with the finding of a normal appendix and no other condition requiring operation was accompanied by a higher complication rate and longer hospitalization than appendectomy for nonperforated diseased appendix. A high frequency of removal of normal appendices did not result in a lower incidence of appendiceal perforation. An increased diagnostic accuracy in the surgical treatment of "acute appendicitis" was not associated with increased incidence of appendiceal perforation. These findings support the thesis that a more discriminate diagnosis of acute appendicitis will lower the incidence of unnecessary appendectomy without increasing the morbidity from unrecognized appendiceal disease.     

Screening and follow up assessment in three cases of auditory neuropathy.

Three children with auditory neuropathy are described. Two were detected via a targeted neonatal hearing screening programme based on auditory brain stem response testing, and one via the routine Health Visitor Distraction Test. Auditory neuropathy is an important but poorly understood disorder which has implications on planning future hearing screening policy and management of hearing impairment.