Prognostic factors in upper gastrointestinal bleeding

In this study we examined factors of possible prognostic value about outcome in a consecutive series of 2217 patients with hematemesis and melena. Death occurred in 189 (8.5%) patients, and 243 (11%) patients experienced rebleeding. Death was significantly associated with rebleeding, age over 60 years, and the finding of blood in the stomach at endoscopy. Rebleeding was significantly associated with melena, identification of a gastric or duodenal ulcer, endoscopic stigmata of hemorrhage such as blood, clot, and active bleeding, and the finding of shock at admission. However, female gender, previous history of ulceration, or indigestion of ulcerogenic drugs, especially nonsteroidal antiinflammatory drugs, were poor predictors of either death or rebleeding. We conclude that the identification of patients at a high risk could contribute to improved management of patients with gastrointestinal bleeding, including early therapeutic intervention.     

Neuropsychological profile of children with subcortical band heterotopia

Aim  Subcortical band heterotopia (SBH) or 'double cortex' is a malformation of cortical development resulting from impaired neuronal migration. So far, research has focused on the neurological, neuroimaging, and genetic correlates of SBH. More recently, clinical reports and small sample studies have documented neuropsychological dysfunction in patients with this malformation. This study aimed to characterize further the phenotype of patients with SBH by describing the neuropsychological profiles of children.
Method  Seven children (six females) aged 4 to 15 years were assessed for cognitive functioning (intellectual ability, processing speed, attention, working memory) and academic achievement (reading, spelling, arithmetic). Parents completed questionnaires examining their child's social skills and problem behaviours. Magnetic resonance images (MRI) conducted for routine clinical follow-up were coded by a paediatric neurologist. Genetic and seizure history were obtained from medical records.
Results  There was variation in the neurological, neuroimaging, and genetic presentation of children in the sample. Impairments were observed in all areas of neuropsychological functioning examined. Intellectual ability was generally within the 'extremely low' range (full-scale IQ 44–74; performance IQ 45–72; verbal IQ 57–80). Generalized impairments in cognitive skills were typical, with severe impairments (scores greater than 2SD below the test mean) reported in processing speed, working memory, and arithmetic. Impairments in academic, social, and behavioural functioning were less generalized. No clear relationship between neuroimaging and neuropsychological impairments was found.
Interpretation  Children with SBH demonstrate cognitive, academic, social, and behavioural problems, with the greatest difficulties in processing speed and complex cognitive skills.     

Cardiovascular reactivity to a new mental stress test: The maze test

The response to the maze test was studied in 31 subjects on no medication, including seven subjects with mild essential hypertension. Beat-by-beat finger blood pressure (BP) was measured with a Finapres device. Pulse interval from which heart rate (HR) was derived was obtained from the BP signal. A period of 5 min baseline was used to define resting levels of systolic BP and HR using 20-s averaged values for the calculation of the 95% confidence limit of the two variables. The average test duration was 10 min. During this period a series of video-displayed mazes had to be solved with easy mazes preceding difficult ones. No subject had been exposed to the test before. The maximal BP elevation associated with the test was 27 mmHg. The HR response averaged 11 beats/min. Significant elevations were observed for half the test duration. No significant relationship between these two responses was observed and some subjects exhibited isolated systolic BP or HR responses. When indices obtained during this active mental stress were compared to resting values, positive correlations were observed. When the resting standard deviation (SD) of systolic BP was higher the systolic response was greater. A similar relationship was observed for HR. In addition, when the systolic BP level at rest was higher, the systolic BP reactivity index was greater. However, systolic BP or HR at baseline were not predictive of the systolic BP or HR responses. This study demonstrates the applicability of a new test to assess cardiovascular reactivity. The main advantage of non-invasive continuous BP measurement with the Finapres is the ability to provide variability indices in addition to the peak responses.     

Analysis of Akinsanya's model of bionursing

A critical analysis of Akinsanya's theory of bionursing is presented This innovative model, designed to direct nursing education in the biological sciences, explores the link between nursing and these sciences and attempts to disassociate nursing from the dominance of the biomedical model The underlying assumptions of the model and its main concepts are examined in the light of current beliefs about professional nursing practice and education Links between the concepts in the model are explored The utility of the bionursing model for nursing education and practice is examined and some hypotheses for empirical testing of the model are suggested     

Scatolia: psychosis to protest

This paper presents the case of a female patient in a special hospital who engaged in faecal smearing whilst in seclusion, A management investigation followed a complaint by a Nurse Manager regarding the reluctance of staff to clean the room whilst the patient remained disturbed. The investigation team adopted a triangulated method of interviews, literature review, survey and case presentations to study the issues involved.
The results presented here suggest the emergence of similar issues from both the interview commentary and the tabulated data from the survey. There apppears an intricate and complex dilemma facing those managing situations involving scatolic behaviour. There are issues of concern from diverse organizational settings that overlap between those persons who engage in scatolia who may be deemed mentally impaired, psychiatrically disordered, or protest behaviour.     

Suicide in Northern Ireland: a comparison of two quinquennia (1982–1986 and 1987–1991)

This study compares government records of death by suicide, in Northern Ireland, during two quinquennia in the decade 1982–1991. Specifically these quinquennia are 1982–1986 l 1987–1991. During the latter quinquennium there was an increse m rate for males in most age groups, except the 45–54 and the over 65 years age groups. However, females had an increased rate in the 15–24 and 35–54 years age groups, but have a decreased rate in the other age groups. There has been a decrease in the rate of suicides by poisoning with solids and liquids for both sexes. However, male suicide rates by more violent methods have increased substantially during the latter quinquennium. Three cohorts of males, those in the 15–24, 25–34, and 55–64 age groups, have shown substantial increases during the latter quinquennium. Suggestions for psychiatric intervention strategies are made.     

OCULAR CHANGES IN PATIENTS INFECTED WITH THE FILARIAL NEMATODE ONCHOCERCA VOLVULUS IN SOUTHWESTERN SUDAN

Ophthalmological examination of 417 patients with onchocerciasis in southwestern Sudan, a woodland savannah region, showed that ocular disease is a major health problem in these patients. Visual acuity was severely impaired in approximately 6% of patients and was reduced to finger counting in some individuals as young as 16 years. Pathological changes seen in the cornea ranged from punctate opacification to more severe sclerosing keratitis; the punctate lesions were more common in juveniles than adults. These punctate lesions were often associated with degenerating microfilariae, and a hypothetical sequence of their development is presented. Posterior segment lesions varied from mild focal retinal pigment changes, visible as dots, to widespread chorioretinal atrophy. Optic atrophy and vascular sheathing were also seen and were found exclusively in adults. These ocular changes are consistent with the findings of workers in other endemic areas who attributed them to onchocerciasis. Additional changes seen in this study included dispersal of pigment in the anterior chamber, iritis with seclusion of the pupil, and cataracts. These findings are discussed in the light of current knowledge of the pathogenesis of the disease and the need for further research into its immunopathology.     

Occupational stress profiles of senior police managers: Cross-cultural study of officers from Berlin and northern Ireland

Senior police officers from Berlin and Northern Ireland have in common the task of policing divided communities and cohabiting with a military presence, and as such were expected to share similar profiles of job-related stressors and exhibit equivalent coping strategies. While some similarities were found, the study reports some interesting differences, with German officers emerging as more stressed and using a greater variety of coping strategies than those from Northern Ireland. Differences are discussed in terms of dimensions of duration and expectedness of threat.     

Managing to care: the importance of using existing information to guide service provision for informal carers

All managerial deciions are taken on the basis of the information. It is important that managers use appropriate information to base their decisions upon about service provision to ensure erhcient use or resources. This basic premise serves as a framework for examining how quantitative and qualitative information can be of help to nurse managers in taking these decisions in the context of developing services for informal carers. The current emphasis on surveys as a means of assessing client need is questioned, and it is suggested that a wealth of evidence, relating to the experience of carers, already exists. Examples of accounts which express the needs of informal carers are presented and their utility, in terms of highlighting the carers' perspective, is discussed to reinforce the importance of utilizing this information. The paper concludes that nurse managers can use these sources as a basis for decision-making in the area of service provision and this may result in a more effective use of resources through a needs-based approach.