Compliance,concordance and the revolving door of care: caring for elderly people with mental health problems

□ The project involved community pharmacists receiving specialised training, becoming integrated into the community mental health teams and providing pharmaceutical care when making joint domiciliary visits with the key workers. □ Community pharmacists, psychiatrists and key workers all wanted the project to develop into a service and had similar views about the general benefits of the study. However, they had contrasting expectations of the project, based on their own perspectives on compliance, concordance and models of care □ The key workers valued the provision of monitored dosage systems for patients with confusion or memory problems. But the pharmacists felt that they were being expected to organise compliance aids; they recognised that it was their role to assess complaince and that other measures could be taken before organising an MDS □ The psychiatrists stated that involuntary non‐compliance with medication, arising from confusion, memory and physical problems, was a major issue and the project had made improvements in this area; they wanted to keep patients in the community and particularly valued reductions in morbidity, relapses and the “revolving door of care”     

The use of Roy's adaptation model applied to a patient with breast cancer

Roy's adaptation model provides a framework for holistic oncology nursing practice. In this article an overview of Roy's model is provided, and the model is applied to a patient with breast cancer for an assessment of behaviour and the stimuli influencing behaviour, and for the planning and evaluation of nursing care. Also, a comprehensive list of nursing diagnoses is categorized according to Roy's four adaptive modes.     

Aneurysm of the Left Main Coronary Artery

Aneurysms of the left main coronary artery are rare; the estimated incidence is < 0.1%. They are usually associated with atherosclerotic coronary artery disease, and are incidental discoveries at the time of cardiac catheterization for the evaluation of cardiac symptoms. This report describes the clinical course of a patient with an isolated left main coronary artery aneurysm and generalized atherosclerosis.     

Atypical systemic sclerosis following exposure to vinyl chloride monomer. A case report and review of the cutaneous aspects of vinyl chloride disease

An unusual case of systemic sclerosis occurring in a patient exposed to the vinyl chloride monomer (VCM) is presented. The dermatological aspects of vinyl chloride disease (VCD) are outlined and the mechanisms of pathogenesis discussed.     

The role of social support and stressors for mothers and infants

This correlational study of mothers and their 6-month-old infants examined the importance of social support and stressors for parenting and infant development. Mothers (n = 79) were primarily White, married, and ranged in socio-economic status from low to high. All data were collected in mothers' homes when infants were 6 months old. Diversity of sources of social support and diversity of father support were positively related to parenting (quality of stimulation in the home). Diversity of sources of social support buffered the negative relationship of maternal fatigue (stressor) to parenting. Parenting was related to social, hearing-speech, locomotor, and general development. Additionally, social support and aggravation (people in the mother's said network who make life difficult) were related to infant development, independent of parenting.     

Characterisation of the solution conformation of a cyclic RGD peptide analogue by NMR spectroscopy allied with a genetic algorithm approach and constrained molecular dynamics

The solution conformation of a cyclic RGD peptide analogue, cyclo-(S,S)-2-merrcaptobenzoate-arginine-glycine-aspartate -2-mercaptoanilide, has been determined via two independent approaches for the searching of conformational space and identification of conformations consistent with NMR and CD spectroscopic data: (i) the use of a binary genetic algorithm and (ii) a molecular dynamics simulation. Inter-proton distances were obtained via analysis of cross-peak volumes from a two-dimensional ROESY NMR spectroscopy experiment at 600 MHz and were used as constraints for the computational calculations. The mercaptoanilide amide proton resonance chemical shift had a very small temperature coefficient, indicating that this proton was hydrogen-bonded. Circular diehroism data showed that, in solution, the torsion angle about the disulfide bond was negative, consistent with one of the distinct conformations around this bond in the 200 ps molecular dynamics simulation. The backbone conformations of the structures resulting from the two different approaches were very similar.     

The thoughts of the late Fred Hollows on the provision of specialist services to rural and remote Australians

ABSTRACT: This paper consists of the late Professor Fred Hollows' responses to questions concerning the provision of specialist services to remote communities. In December 1991, Professor Hollows was invited to meet with a Research Advisory Committee assisting me as I gathered and analysed data concerning the provision of specialist services. Throughout the interview he emphasised three criteria essential for the provision of effective specialist services, namely: credible and competent service providers, regular services, and good liaison and communication with the local community. In addition, he spoke about the role of the specialist in upgrading the skills of general practitioners and the need for medical audits to assess the extent to which local primary care practitioners are able to accurately identify illnesses requiring specialist attention. Finally, Professor Hollows made comment on the importance of empowering local health professionals, specialists and generalists, through skill and knowledge enhancement so that they are able to advocate on behalf of their constituencies.     

Creating supportive environments for health: a case study from Australia in developing national goals and targets for healthy environments

Creating healthy living and working conditions are central goalsin public health which have re-emerged in prominence in thepast decade. The roots of thLs revival of interest can be tracedto include improved under standing of the relationship betweenliving conditions and health, prompting by the World HealthOrganiza non (WHO) through its ‘Health for All’strategy which has drawn attention to underlying causes of inequitiesin health in society, and a more general international concernwith ecologically sustainable development. Australia has respondeduniquely to the challenge of developing a strategy to createsustainable, supportive environments for health through itsNational Health Goals and Targets. These targets, publishedin 1993, include a range of targets for Healthy Environmentswhich were developed from a ‘health’ perspective,but in co-operation with the different sectors of governmentresponsible for action to achieve them. These include housing,transportation, education and employment. Early responses tothe publication of the targets are encouraging, but will requiresustained governmental support to reach fruition. Critical tosuccess in develop ing and implementing the targets will berecognition by government, and particularly the health sector,of the legitimacy of inter-sectoral action for health. Negotiations to resolve potential conflicts in the priorities of differentsectors should ensure that attention is focused on the commonground for practical inter-sectoral action to improve health.The Australian Targets Report identifies a series of concreteactions required to create supportive environments for health.A willingness to account for pro gress in achieving the targetsfor Healthy Environments will be an important measure of thecom mitment of the Australian federal and state governmentsto the health and well-being of their citizens.     

Studies on the transfer of lymph node cells. VIII. The transfer of cells from blood and peritoneal exudates incubated in vitro with antigenic material derived from Shigella paradysenteriae

Leucocytes were obtained from the blood of rabbits, incubated in vitro with soluble antigenic material derived from Shigella paradysenteriae, washed, and transferred to irradiated recipient animals. On the 4th day after cell transfer, agglutinins to Shigella appeared in the sera of the majority of such recipients. The distribution of maximum agglutinin titers was substantially lower in these animals than in recipients of lymph node cells similarly incubated, as reported in earlier studies. Recipients of iodoacetate-treated cells showed no agglutinins. Similar results were obtained with cells of peritoneal exudates obtained 9 days after the intraperitoneal injection of lanolin and light mineral oil. When cells of peritoneal exudates obtained 1 or 2 days after the injection of this irritant were incubated with the antigenic material and transferred to irradiated recipients, agglutinins did not appear in the sera of the latter. Similar results were obtained with cells from peritoneal exudates obtained a few days after the intraperitoneal injection of heavy mineral oil. The preponderant cell types in the suspensions from these two sources were the polymorphonuclear neutrophils and monocytes, respectively.