Thromboembolism after Beall Valve replacement of the mitral valve.

A series of 76 isolated mitral valve replacements with the Beall valve is reported. A perioperative mortality of 3.5% (3 patients) and a late mortality of 6.8% (5 patients) was obtained. Thromboembolism occurred in 4 patients (5.2%). In a separate study, platelet survival times were determined in 17 patients with Beall valves by using chromium 51–labeled autologous platelets. Six patients had had thromboembolic (TE) episodes; the remaining 11 had not. The normal platelet survival time was > 3.3 days. Patients with TE had shortened platelet survival times (mean 2.8 $pM 0.11 days) which were significantly less (p < 0.01) than those of patients without TE (mean 3.4 $pM 0.13 days). The incidence of TE, which is associated with shortened platelet survival time, is low with Beall mitral valves. Prognostic and therapeutic considerations are discussed.     

Managing diabetes mellitus in patients with advanced cancer: a case note audit and guidelines

Patients with advanced cancer and diabetes mellitus present a challenge to healthcare professionals. To establish how diabetes is currently being managed in these patients, we audited the care of patients who died in Cheltenham General Hospital over the previous 12 months with diagnoses of both diabetes mellitus and cancer. Management and monitoring of the diabetes was variable and there was little record of discussion between healthcare professionals and the patient or family regarding the diabetes. Thirty-two out of 42 patients continued to have blood sugar monitoring up to and including the day they died. We review the literature on this topic and suggest guidelines to help professionals to appropriately manage diabetes in the palliative setting at the end of life.     

The significance of at-risk factors in ultrasound surveillance of developmental dysplasia of the hip. A ten-year prospective study

Of the 34,723 infants born between 1 June 1992 and 31 May 2002, the hips of 2578 with clinical instability or at-risk factors for developmental dysplasia of the hip were imaged by ultrasound. Instability of the hip was present in 77 patients, of whom only 24 (31.2%) had an associated risk factor. From the 'at-risk' groups, the overall risk of type-III dysplasia, instability and irreducibility was 1:15 when family history, 1:27 when breech delivery and 1:33 when foot deformity were considered as risk factors. Of those hips which were ultrasonographically stable, 88 had type-III dysplasia. A national programme of selective ultrasound screening of at-risk factors for the diagnosis of hip dislocation or instability alone cannot be recommended because of its low predictive value (1:88). However, the incidence of type-III dysplasia and hip dislocation or dislocatability in the groups with clinical instability, family history, breech position and possibly postural foot deformity as risk factors could justify a programme of selective ultrasound imaging.     

Settings, systems and organization development: the Healthy Living and Working Model

This paper highlights the importance of understanding management theories to development of the settings approach to health promotion. It then provides an overview of two areas of especial pertinence: organization development and systems thinking. This is followed by the articulation of the Healthy Living and Working Model, which is proposed as a mechanism for applying the principles of the settings approach in practice within organizations. The paper concludes by pointing to future challenges in developing this Model and reiterating that facilitating improvement at the organizational level should be the defining characteristic of the settings approach to health promotion.