Technology anxiety as a potential mediating factor in response to medical technology

Technology anxiety, defined as a fear of working with medical equipment, was measured via the use of the Technology Response Questionnaire. Nurses (N=414) working on nine types of nursing units at two hospitals participated in the study. Nurses working on psychiatric units were found to be most anxious about working with medical equipment, while nurses working on surgical and adult intensive care units were least anxious. A comparison of the nurses who were highest and lowest on technology anxiety indicated that those who were most anxious about technology were less positive toward computers, felt more stressed by their work, were lower on job satisfaction, less positive toward the physicians they worked with, lower on personality scales of autonomy and adaptability, were less likely to do care planning regularly or to use nursing diagnoses, and tended to be older than less anxious nurses.     

Apparent lack of synergism between heparin and dihydroergotamine in prevention of deep vein thrombosis after elective hip replacement: a randomised double-blind trial reported in conjunction with an overview of previous results.

We report the results of a double-blind, randomised trial of venous thrombosis (VT) prevention in 117 patients having elective hip replacement where low dose heparin alone (5,000 IU sodium heparin given subcutaneously [sc] 8 hourly until the seventh postoperative day) was compared with low dose heparin plus dihydroergotamine (DHE; 0.5 mg, given 8 hourly by sc injection). The trial end point consisted of VT discovered through bilateral ascending venography done routinely on the seventh postoperative day. VT developed in 34% of patients given heparin/DHE (95% confidence interval = 22% - 47%) compared with 24% in those given low dose heparin alone (95% confidence interval = 14% - 37%; p = 0.34), difference = 10% (95% confidence interval = -7% to +26%). Corresponding figures for the incidence of proximal (above-knee) thrombosis were 17% and 14% (95% confidence intervals = 8% - 29% and 6% - 25% respectively). These results are discussed in the context of a detailed overview of published evidence concerning VT prevention with heparin/DHE after hip replacement and we conclude it is unlikely that heparin/DHE is markedly superior to low dose heparin alone in this clinical setting.     

Expression of Helenium virus S coat protein in Escherichia coli, in vitro in rabbit reticulocyte lysate and transgenic tobacco.

The coat protein open reading frame (ORF) sequence of Helenium virus S (HelVS) was cloned and expressed in E. coli, rabbit reticulocyte and transgenic tobacco. In E. coli the size of the protein was identical to that obtained for the coat protein from purified virus particles and less than that predicted for the fusion protein. This may be due to ribosome binding at a potential ribosome binding site present on the viral sequence, approximately 45 nucleotides upstream from the initiating methionine of the coat protein ORF. This region of HelVS, equivalent to the 1.5 kb subgenomic RNA, also produced high levels of protein when transcribed and translated in vitro. When introduced into Nicotiana tabacum by leaf disk transformation via Agrobacterium tumefaciens, high levels of stable coat protein were detected which were identical in molecular weight to that of HelVS coat protein and constituted approximately 0.1-0.5% of the total extracted protein.     

Chemotherapy-induced nausea

The rubric complementary medicine covers a variety of approaches that may seem alike only in their being outside conventional care and training. We have asked experienced practitioners to present their own pieces of this jigsaw, realising that these clinical fragments, when seen together, create excitement but also confusion. Of course, this forum is not intended to be a comprehensive review of relevant complementary treatments, and often the individual apporaches to clinical problems will appear totally unrelated, while their apparent effectiveness stretches the biomedical model and conventional research methodology beyond their capacity. With this in mind, we intend that forthcoming articles and reviews will expand on the therapies themselves, and discuss the evidence supporting them.     

Aortic valve endocarditis in an acutely rejecting orthotopic heart transplant recipient

Infective endocarditis is an infrequent but serious complication in heart transplant recipients. We report successful treatment for this serious complication.     

A single-blind randomised trial comparing adrenaline 1.0% with dipivalyl epinephrine (propine) 0.1% in the treatment of open-angle glaucoma and ocular hypertension.

The results of this single-blind randomised trial comparing adrenaline 1% with dipivalyl epinephrine (Propine) 0.1% confirm that both have a significant effect in lowering the intraocular pressure in patients with open-angle glaucoma and ocular hypertension, but it is generally insufficient to warrant their use as the first line medical treatment of these two conditions. There was no significant difference between the intraocular lowering effect of the two preparations, and 60% of patients receiving Propine and 66% of those receiving adrenaline noted side effects.     

Effect of timolol versus pilocarpine on visual field progression in patients with primary open-angle glaucoma.

BACKGROUND: Relatively few studies have been conducted linking decreasing intraocular pressure (IOP) to preservation of visual field. This investigation was conducted to determine if this link could be made and to compare the long-term effect of two ocular hypotensive agents on preservation of visual field. METHODS: In an observer-masked study, 189 patients with primary open-angle glaucoma received either timolol or pilocarpine by random allocation. The dose of antiglaucoma agent was increased from 0.25% to 0.5% twice daily for timolol or from 2% to 4% four times daily for pilocarpine if the initial IOP response was inadequate. After an on-treatment baseline, visual fields were followed every 4 months for 2 years using the Octopus program 32. RESULTS: Compared with timolol, significantly more patients receiving pilocarpine discontinued use because of inadequate IOP control (P < or = 0.01). By comparing the mean visual field scores, it can be seen that the pilocarpine group had a significantly worse score at all timepoints from month 4 to month 24. The pilocarpine group also had a greater mean number of test loci with decreased sensitivity of 5 or more decibels (dB) at all timepoints. The mean within-patient regression slope for timolol was 0.01 dB/month and for pilocarpine was -0.06 dB/month (P < 0.01). The study has shown that over a 2-year period, patients treated with pilocarpine 2% or 4% four times daily experienced a significantly greater visual field deterioration than that seen in patients receiving either 0.25% or 0.5% timolol twice daily. CONCLUSION: Although these data do not support a link between lowering of IOP and visual field preservation, treatment with timolol was associated with significantly less visual field loss than treatment with pilocarpine.     

Researches on a unilaterally blue-blinded rhesus monkey

Psychophysical measures of hue (wavelength) discrimination and spectral sensitivity were collected over a 3-year-period on a rhesus monkey whose right eye had been exposed to intense blue light 10 years prior and had shown a pronounced loss of blue sensitivity in an increment-threshold, spectral-sensitivity task. Hue discrimination, to a somewhat greater degree than spectral sensitivity, revealed large differences between the normal and blue-exposed eye. The difference limens were in some cases 100 nm for the blue-exposed eye compared to 10-15 nm for the normal eye. The hue-discrimination functions from the blue-exposed eye were similar in form to those from human tritanopes (blue-blind humans), and those from the monkey's normal eye were similar to those from normal humans. Detailed functions, where the variable wavelength was shorter as opposed to longer than the reference wavelength, were shown separately for each of the monkey's eyes; those from the blue-exposed eye were very similar to analogous functions from the one case where they have been shown separately for a human tritanope.