The social worker's role in the hospital: seen through the eyes of other healthcare professionals

Social workers in hospitals necessarily work alongside other healthcare professionals, and the perspectives on social work held by doctors and senior nurses are relevant both to their relationship with social workers and to the smooth running of the hospital. An exploratory investigation in the East Anglian Region has produced profiles of perceived social work practice in six different patient-care categories: surgical and orthopaedic, accident and emergency, medicine for the elderly, psychogeriatric medicine, psychiatry and paediatrics. The social worker's functions are recognized as including statutory responsibilities in child protection and mental health, and there are some secondary roles that often reflect a social worker's personal interest or sphere of expertise. The social worker's primary role, however, is deemed to be that of discharge planning - a task which has been given statutory force under the National Health Service (NHS) and Community Care Act 1990. The nurses and doctors interviewed rated the quality of social work practice predominantly by the extent to which the social worker was seen to identify unambiguously with the hospital and its ethos; but they also set great store by the presence and easy accessibility of a social worker, and they preferred regular contact with the same person. They saw the social worker as a key agent within the health care framework, and acknowledged that the social care role and the social worker's link with the community were crucial components of good hospital practice.     

Control of neuronal excitability by corticosteroid hormones.

The rat adrenal hormone corticosterone can cross the blood-brain barrier and bind to two intracellular receptor populations in the brain--the mineralocorticoid and glucocorticoid receptors. Recent studies have revealed that the corticosteroid hormones are able to restore changes in neuronal membrane properties induced by current or neurotransmitters, probably through a genomic action. In general, mineralocorticoid receptors mediate steroid actions that enhance cellular excitability, whereas activated glucocorticoid receptors can suppress temporarily raised neuronal activity. The steroid-mediated control of excitability and the implications for information processing in the brain are reviewed in this article.     

Cognitive Efficiency in Alcoholics and Polysubstance Abusers

Previous studies have found alcoholics to be impaired on tests of cognitive efficiency. However, it is unclear to what extent individuals who abuse drugs in addition to alcohol exhibit similar deficits. To answer this question, 63 healthy control subjects were compared with 40 individuals who abused alcohol only, 24 individuals who abused alcohol and stimulants, 16 individuals who abused alcohol and marijuana, and 41 individuals who abused alcohol and depres-sants/narcotics, or alcohol and two or more other drugs. All subjects were administered tests of Short-term memory, spatial orientation, visual-spatial perception, and problem-solving. Results from the study indicated that control subjects and individuals who abused both alcohol and marijuana performed significantly better than the other groups on most tests. These results were not attributable to differences on measures of affect or chronicity of alcohol consumption.     

Treatment of single brain metastasis: Radiotherapy alone or combined with neurosurgery

Most patients treated for single or multiple brain metastases die from progression of extracranial tumor activity. This makes it uncertain whether the combination of neurosurgery and radiontherapy for treatment of single brain metastasis will lead to better results than less invasive treatment with radiotherapy alone. The effect of neurosurgical excision plus radiotherapy was compared with radiotherapy alone in a prospectively randomized trial with 63 evaluable patients with systemic cancer and a radiological diagnosis of single brain metastasis. Radiotherapy was given to the whole brain by a novel scheme of 2 faractions per day of each 2 Gy for a total of 40 Gy. Before randomization, patients were stratified by site (lung cancer vs nonlung cancer) and status of extracranial disease (progressive vs. stable). Survival as such and functionally independent survival (FIS; defined as world Health Organization performance status ≤ 1 and neurological funcition ≤ 1) were compared between both treatment arms. The combined treatment compared with radiotherapy alone led to a longer survival (p =0.04) and a longer FIS (p=0.06). This was most pronounced in patients with stable extracranial disease (median survival, 12vs 7 mo; median FIS 9 vs 4 Mo). Patients with progressive extracranial cancer had a median overall survival of 5 months and a FIS of 2.5 months irrespective of given treatment. Improvement in functional status occurred more rapidly and for longer periods of time after neurosurgial excision and radiotherapy than after radiotherpy alone. Patients older than 60 years had a hazard ratio of dying of 2.74(p=0.001) compared with younger patients, but in both age groups the combined treatment did better then radiotherapy alone. We coclude that patients with single brain metastasis and stable extracranial tumor activity should be treated with surgical excision and radiotherapy. For patients with progressive extracranial disease during the previous 3 months, radiotherapy alone appears to be sufficient. After treatment of single brain metastasis, parients remain functionally independent until a few months before death.     

Molecular analysis of a novelSchizosaccharomyces pombe gene containing two RNP consensus-sequence RNA-binding domains

Proteins containing RNP consensus-sequence RNA-binding domains (CS-RBDs) play diverse roles in many aspects of RNA metabolism. Using a PCR strategy, we cloned portions of six newSchizosaccharomyces pombe genes encoding RBD proteins, including a putative homolog of the mammalian splicing factor SAP49. The genomic locus corresponding to a second PCR product, designatedrnp24, was cloned and characterized in detail. Sequence analysis revealed that the Rnp24 protein is highly charged and contains a second RBD with an unusually long Loop-3 sequence. Strains containing a disrupted copy of thernp24 gene display neither loss of viability nor any discernible growth defects under a variety of conditions, suggesting that the function of Rnp24p overlaps with that of another fission yeast protein. Although database searches did not identify proteins that share extensive amino-acid identity with Rnp24p, phylogenetic analysis suggests that its closest relatives are metazoan hnRNP proteins. The lack of an observable phenotype inS. pombe cells lacking Rnp24p is consistent with this classification, since hnRNP proteins in higher cells include several distinct subfamilies with similar sequences and RNA-binding specifities.GenBank Accession Number U24430     

A case of primary hepatic actinomycosis.

Actinomycosis is a chronic suppurative and granulomatous disease characterized histologically by sulfur granules with extensive necrosis, fibrosis and sinus formation. Depending on the site of primary infection, actinomycosis is generally classified as cervicofacial, thoracic and abdominal type. The liver is known to be the primary site of infection in 15% with abdominal actinomycosis. The authors have experienced a case of liver abscess in a 24-year-old male. The sono-guided aspiration biopsy revealed findings of infiltration of neutrophils and characteristics sulfur granules by light microscopy. This case was thought to represent an instance of liver actinomycosis. Although there have been a lot of reports on actinomycosis of the liver in other countries, only 3 cases were reported in Korea.     

Prophylactic epidural administration of fentanyl for the suppression of tourniquet pain

Severe dull pain on the side of tourniquet application and marked rises in blood pressure and heart rate associated with that pain are often observed even under adequate regional analgesia. The purpose of this study was to evaluate the effect of epidural fentanyl on the suppression of tourniquet pain during orthopedic surgical procedures. Forty-five patients undergoing orthopedic surgery of the lower extremities with a tourniquet were maintained by continuous epidural anesthesia with 2% lidocaine through an epidural indwelling polyethylene catheter (L3–4). The patients were randomly allocated to the following three groups: epidural fentanyl (100μg) (epidural group,n=15); intravenous fentanyl (100μg) (intravenous group,n=15); control (no fentanyl) (control group,n=15). The epidural or intravenous fentanyl was administered at the time of the second lidocaine injection. The severity of tourniquet pain based on the patient's level of complaint and the total dose of supplemental analgesics requested in the epidural group were significantly lower than those in the control group. Blood pressure during tourniquet application in the epidural group was more stable than in the other two groups. No severe side-effects were observed in any patient. Prophylactic epidural administration of fentanyl might be useful in the suppression of tourniquet pain.     

Isolation of Vibrio alginolyticus from Wound Infections

Vibrio alginolyticus was isolated from two patients with leg wounds. Both had a history of recent exposure to ocean water.     

The oligomerization of isoprene with modified ziegler catalysts

The oligomerization of isoprene with modified ZIEGLER catalysts was studied. Dimers of isoprene were obtained in 70–90% yield using combined catalysts of diethylaluminum chloride, dimethyl sulfoxide, and a titanium(IV) compound, such as titanium di-(p-toluenesulfonate) dichloride and N-vinylpyrrolidone or alkylene carbonate complexes of titanium tetrachloride. Two isomeric dimers, produced in approximately equal molar ratio, were found as the main product accompanied by small amounts of a third dimer and of trimers. Each dimer was separated by means of preparative gas chromatography and subjected to analyses. The two predominant compounds were identified as 2.4-dimethyl-4-ethenyl-1-cyclohexene and 2.7-dimethyl-1.3.6-octatriene, respectively. Possible mechanisms are discussed in relation to the oligomerization of butadiene on the basis of the product analysis.