The efficacy of Dementia Care Mapping as an audit tool: Report of a 3-year British NHS evaluation

Dementia Care Mapping (DCM, Kitwood & Bredin, 1994a) was incorporated into the Quality Assurance Strategy of an urban British Mental Health (NHS) Trust. Its role as an audit of the outcome of the care process in formal dementia care settings was evaluated. DCM was used in two day hospitals, an assessment ward, two respite care units and four continuing care units over three annual evaluation cycles. This equated to approximately 1,614 hours of mapping over the three cycles. The way in which DCM was used is described in detail. The results were generally very positive with improvements in the quality of care practice being demonstrated. Although anxious about the observational nature of DCM, staff viewed it as a positive means of improving quality of care. DCM is seen as being a highly appropriate audit tool to use in NHS formal dementia care settings. Information on the experience of managing a DCM project is shared.     

Evaluation of Lactobacillus Preparation on Enterotoxigenic E. Coli-induced Rabbit Ileal Loop Reactions

A commercially available lactobacillus-containing preparation has been used extensively in the treatment of diarrhea but few laboratory tests have been performed to determine the efficacy of this product. The rabbit ileal loop reaction was used here to determine the effect of the lactobacillus preparation and its ingredients on E. coli enterotoxin-induced loop fluid response. Enterotoxigenic E. coli cells grown overnight in shake cultures were washed and resuspended in saline to the original volume. They were then diluted in TSB suspensions of the lactobacillus preparation or its ingredients and injected into ileal loops. E. coli diluted in TSB served as positive controls. Fluid response was measured after 18 hours and the loop fluid ratio (LFR) (ml./cm.) of the lactobacillus preparations was compared to the positive controls. The positive controls always showed a high loop fluid ratio (> 1.1 ml./cm.) and negative saline controls showed no fluid response. The lactobacillus granules and tablets had low LFR's (0.08 and 0.05, respectively). Ingredients (whey, talc, sugar, evaporated milk, mineral oil) had variable LFR's (0.65, 0.78, 1.39, 1.46 and 1.54, respectively). Individual ingredients used to make this preparation show little antifluid response when used separately but the final product exhibits a significant antienterotoxin response.     

Intracoronary Infusion of Dilute Ethanol for Control of Ventricular Rate in Patients with Atrial Fibrillation

The effects of selective infusion of 25% ethanoi into the AV nodal artery was assessed in 1J putients with atriai fibrillation and uncontrollabiy rapid ventricular response rates. The primary study objective was to achieve permaneni modificafion of AV nodal function and control ventricular rate without drug therapy and mthout causing permanent complete AV block. "Clinical success" was defined as drug-free rate control by either AV nodal modification or the production of complete AV block. Selective catheterization and ethanol infusion into the AV nodal artery could be performed in nine patients. Jntracoronary ethanol infusion acutely caused second- or third-degree AV noda] block in seven palients and an increase in AV nodal refractory period and Wenckebach cycle length in two patients. Acute occlusion of the AV nodal artery or infarction of nontarget myocardium was not observed. During follow-up of 22.2 ± 2.2 months the primary study objective was attained in only four of nine patienfs treated, yielding an efficacy of 44%. However, the "clinical success" rate was 78%. The acute effects of ethanol on AV conduclion did not predict the chronic effects. Selective intracoronary infusion of dilute ethanol lo control the ventricular rate in atrial fibrillation should be considered when rodiofrequency ablation has been unsuccessful. This method of chemical ablation is as effective and probably safer than rapid administration of 96% ethanol.     

Thin Bipolar Leads: A Solution to Problems with Coaxial Bipolar Designs

A new type of bipolar lead has been designed to be thinner and more reliable than the standard coaxial design. The new lead has passed numerous bench tests to ensure its reliability. Improved fatigue performance was shown during comparisons between the new type of coil (bifilar DFT [drawn filled tube]) and previous standard coils (trifilar MP35N). During the initial animal studies no reliability concerns were raised and stable electrode thresholds were measured. If success in the test process of this lead continues, a bipolar lead may soon be marketed with a size and reliability comparable to unipolar leads.     

THE PERFORMANCE OF A SCAVENGING VALVE

A simple, compact and lightweight device for coupling activescavenging systems to shrouded breathing system valves is described.Provided a scavenging minute flow rate greater than the expiredgas volume is available, the unit can handle automatically changesin both variables. Optimal function is achieved with scavengingflows from about twice the discharged gas flow to about 50 litremm^–1 At these flows the valve can accommodate the outflowof gas-driven ventilators where driving gas and circuit gasare discharged through the same port There is no interferencewith expiratory valve function in the event of scavenging failure     

Mucus-secreting ''alveolar-cell'' tumour of the lung: a histochemical comparison of tumours arising within and outside the lung

Five cases of mucus-secreting 'alveolar cell carcinoma' are described, two of primary pulmonary origin and three metastatic from breast or pancreas. Mucin histochemistry demonstrated qualitative and quantitative differences between the mucopolysaccharides produced by these two groups of tumours. Hyaluronic acid production was restricted to the primary lung tumours. Greater quantities of acid sulphomucins were found in the two tumours arising in the lung and more neutral mucins in the three tumours metastatic from extra pulmonary primaries. It is proposed that mucus-secreting alveolar cell carcinomas represent an unusual, and saprophytic relationship between the metastatic cells of well-differentiated adenocarcinomas and the lung. As the malignancy of the tumour cells increases, so the ability to produce specific mucins decreases and, simultaneously, the tumours cease to maintain their alveolar pattern.