Utilization of nursing teams in the collection of blood

The practice of nursing is group oriented. This was recognized in the past, but has only recently gained full acknowledgment by nursing managment. The concept of team assignment for the nursing staff was implemented in the blood program several years ago. The problems of the professional nurse in blood banking are not the same as in an acute or an extended care facility. Team assignments can improve both the delivery of care and the efficiency of the operation in the blood program. This paper describes many of the problems incurred under the system of conventional staffing and will show how these problems can be either eliminated or modified through the use of team assignment. Two centers experienced with permanent team assignments report these conclusions.     

Predictors of Mortality in Alcoholic Women: A Prospective Follow-up Study

An 11-year follow-up of 100 alcoholic women who were systematically interviewed and diagnosed during hospitalization found 31% dead, the majority as a result of alcohol-related causes. There were over 4 times as many deaths in alcoholic women as expected in the general population. The life span of alcoholic women was shortened by over 15 years. Only those women who had abstained during the interval followlng hospitalization had fewer than expected deaths. Five variables correctly predicted survival status for 79% of the subjects (80% of survivors and 77% of those who died): older age at index, onset of alcoholism before age 30, history of frequent benders, primary diagnosis of antisocial personality, and short-term drinking status.     

THE USE OF ULTRASONOGRAPHY IN DETERMINING THE AMOUNT OF EXTRAOCULAR MUSCLE SURGERY IN STRABISMUS

In twenty strabismus patients using ultrasonography a measurement was taken from the apex of the orbit through the centre of rotation of the eye to the front of the eye along the oculomotor axis which is at an angle of approximately 10° to the anteroposterior axis of the eye. From this and from the diameter of the eye average values were derived for the distance from the equator of the medial rectus insertion of 6.27 mm (range 3. 96–8. 92 mm) the lateral rectus insertion 8. 77 mm, the length of the medial rectus 35.32 mm (range 32. 40–40.25 mm) and the lateral rectus 37.82 mm (range 34, 79–42. 75 mm). There are sources of error in these measurements but they are probably not great, though corneal diameter and muscle positions should be checked at operation. In addition a recession/muscle length ratio may be calculated and it is probably wise not to exceed a ratio of 0. 20 for the medial rectus and 0.25 for the lateral rectus with similar resection muscle length ratios suggested. The variability of the distance of the muscle insertions from the equator is greater than the muscle lengths and it seems important not to recess beyond the equator while alteration of muscle length may be less important This suggests maximal recession of the medial rectus may vary from 4 up to almost 9 mm and from 6.5 to almost 11.5 mm for the lateral rectus. The value of making these measurements pre-operatively seems obvious and the considerable variation is the amount of squint surgery is stressed, particularly for muscle recessions.     

A new substrate for the rapid evaluation of enteric microbial overgrowth

The possibility of a new approach to diagnosis of intestinal bacterial overgrowth has been evaluated in laboratory animals. The diagnostic test involves oral administration of an enzyme-labile substrate consisting ofpara-aminobenzoic acid (PABA) conjugated to a bile acid. In the presence of enteric bacteria, PABA is split from the bile acid and is rapidly absorbed and excreted in the urine. The amount of PABA recovered during the 6 hr following the administered dose of the conjugate may be used as an index of bacterial overgrowth in the upper-gastrointestinal tract. The procedure has been shown to be a reliable index of this condition in laboratory animal models.Research was supported by the Graduate School, The Ohio State University.     

Predictors of successful weight loss in an outpatient obesity clinic

Patients attending weight reduction clinics were tested at the beginning of the program to assess a variety of background variables which might influence successful weight loss. These included measures of self-esteem, social acceptance, locus of control, responsiveness to external stimuli, attitudes toward weight loss, and knowledge about nutrition. Success was related to social conformity and desire for social acceptance but not to self esteem or locus of control. Individuals who believed that poor eating habits caused their obesity and those who were less responsive to environmental cues which may trigger feeding, were also more successful.     

Pathogenesis of viral hemorrhagic fever

Single-stranded RNA viruses from four different families cause a syndrome of fever and malaise, 'capillary leak' with loss of plasma volume, and coagulation defects which can lead to bleeding. Although direct cytopathic effects can contribute to disease severity, most features of illness are caused by innate immune responses, as the systemic spread of virus to macrophages and dendritic cells leads to the release of mediators that modify vascular function and have procoagulant activity. The synthesis of tissue factor by infected cells can also trigger coagulation. Failure of adaptive immunity through impaired dendritic cell function and lymphocyte apoptosis can have a crucial role in fatal infection.     

APOE polymorphism, socioeconomic status and cognitive function in mid-life

Objective The aim of this study was to investigate the association of the common apolipoprotein E gene (APOE) variants with cognitive function and cognitive decline in adult mid-life and explore the possibility that APOE genotype mediates the link between socioeconomic status (SES) and cognitive function.Methods Data on cognitive function, as measured by five cognitive tests, together with APOE genotype were obtained in an occupational cohort (the Whitehall II study) of 6,004 participants aged 44–69 years (1997–1999). Cognitive change was examined in 2,717 participants who had cognitive function measured at baseline (1991–1993).Results SES based on civil service employment grade was strongly related to cognitive function. There was no association between APOE genotype and employment grade. In women, participants with APOE-ɛ4 had a lower memory score (p<0.05), but the result was sensitive to data from a small number of individuals. A marginal cross-sectional difference in the semantic fluency score was found (p=0.07), and there was a relative decline at follow-up (p<0.001, net change=−1.19; 95% CI, −1.90 to −0.49) in those with APOE-ɛ4 genotypes.Conclusions APOE-ɛ4 has little influence on cognitive decline in mid-life, whereas SES is a strong determinant, although APOE genotype may emerge as an important factor in cognitive function in later life.     

Inhibition of Bacterial Adherence on the Surface of Stents and Bacterial Growth in Bile by Bismuth Dimercaprol

Bacterial infection and biofilm formation on the surface of biliary stents is believed to be one of the main factors in stent occlusion. This study explored the role of the new reagent, bismuth dimercaprol, in preventing bacterial adherence and bacterial biofilm formation on the surface of biliary stents. Sterile porcine bile preparations, infected separately with Escherichia coli, Klebsiella pneumoniae, Enterobacter, and Enterococcus, were used as the perfusion media in an in vitro perfusion system. The bacterial growth in the media and the bacterial adherence on the surface of stents were tested when different concentrations of bismuth dimercaprol were used in the perfusion media. BisBAL (5 μ M) did not inhibit the growth of any of the tested bacterial species. It did, however, significantly decrease the amount of bacteria adhering to the surface of stents for all bacterial strains except Escherichia coli. Bismuth dimercaprol (20 μ M) significantly inhibited the growth of Escherichia coli, Klebsiella pneumoniae, and Enterobacter and, thereby, significantly decreased the amount of these bacteria adhering to the surface of stents. The unique bactericidal and anitbiofilm activities of bismuth thiols might contribute to delaying the process of biliary stent occlusion if the effective concentrations of bismuth thiols could be delivered to the target sites. The feasibility of this application of bismuth thiols deserves further investigation.