QUALITY OF CARE,QUALITY OF LIFE AND THE RELATIONSHIP BETWEEN THEM IN LONG-TERM CARE INSTITUTIONS FOR THE ELDERLY

A stratified randomly selected sample of 28 of all elderly long-term care institutions in the Southampton district was studied including private and local authority residential homes, private nursing homes and NHS geriatric and psychogeriatric wards. The manager was interviewed with a 57-item quality of care questionnaire modified from the methodology of Willcockset al. (1987) covering aspects of regime and environment. To assess quality of life, 10% of residents were randomly selected for a series of structured quality of life interviews and Barthel Index determination. A life-history approach was used to build rapport and increase the authenticity of resident responses. Systematic significant differences in quality of care and quality of life were found between sectors. The correlation coefficients between quality of care and morale and between quality of care and dependency were significant (r=0.526,p<0.01;r=0.508,p<0.01 respectively) although the correlation between morale and dependency (r=0.155,p=0.2) was insignificant. High-quality care may be more difficult to provide in facilities for more disabled residents. This may affect their morale but the relationship between morale and dependency is complex.     

T helper-2 Type of Interleukins with De Novo Germinal Center Formation in the Spleen During Murine Pregnancy

PROBLEM: Murine pregnancy is characterized by transient thymic atrophy and splenomegaly. Although some reports on the thymus are available, little is known about the role of the spleen. In the present study, sequential changes in the spleen have been evaluated during murine syngeneic pregnancy. METHOD OF STUDY: Formation of germinal centers (GCs), immunoglobulin positive (Ig⁺) cells and interleukin (IL)-2, IL-4, and IL-6 were immunolocalized in the spleen during pregnancy and compared with a control group of virgin mice. RESULTS: Initiation of T-cell dependent B-cell response with the induction of peanut agglutinin (PNA⁺⁾ GCs correlated with decrease in IL-2 and maintenance of IL-4 and IL-6 on day-1 pregnancy followed by an increase in Ig⁺ cells. CONCLUSION: The immune response observed in the syngeneically pregnant mother is not directed to paternal major histocompatibility complex antigens. Present studies demonstrate for the first time the role of the spleen in initiating a T-cell dependent B-cell response with a shift of systemic immune response from T helper 1 to T helper 2 type.     

Diazepam in the Treatment of Dyspnoea in the 'Pink Puffer' Syndrome

Diazepam, in moderate doses, has been used in a placebo controlled,single blind study to treat dyspnoea in four patients severelydisabled from chronic airflow obstruction. The subjects hadthe ‘pink puffer syndrome’, usually associated withemphysema and were not hypercapnoeic nor severely hypoxic atrest. With diazepam, they experienced a striking reduction indyspnoea, and an improvement in effort tolerance; in additionthe slope of the ventilation/CO₂, response curve was rduced.There were no changes in resting blood gases. Psychiatric examinationat the end of the study did not reveal prominent anxiety, althoughthree patients were depressed. The use of diazepam to treatdyspnoea in this syndrome is safe in the absence of any acuteinfection.     

Family and population studies of HLA and coeliac disease in the West of Ireland

Tissue typing (HLA-A, -B and -DR) was carried out on 92 patients with coeliac disease (CD) and on a further 71 first degree relatives of 13 of these patients. Results of antigen frequencies in unrelated patients and segregation analysis in families shows that HLA-DR3 but not HLA-DR7 is positively associated with CD. Haplotype and sib-pair data from these coeliac families suggest that with all of them, genetic susceptibility to CD lies in the HLA region of the sixth chromosome. In families where the coeliac proband has HLA-DR3, the relative risk to siblings who also have this antigen is increased 35 times.     

High tracheal bifurcation

A case study is reported, outlining abnormal tracheobronchial anatomy in an adult male presented for thoractomy. The anesthetic technique is described. Ureteric catheters were used as introducers for the selective intubation of each main bronchus. The problems encountered postoperatively are also discussed.     

A Comparison of Normal Red Cell ATP Levels as Measured by the Firefly System and the Hexokinase System

Widely divergent normal red cell ATP levels have been reported by investigators using different methods. In order to clarify the cause of thesediscrepancies and to establish correct normal values for red cell ATP, the firefly technic for measuring ATP levels was compared with other methods. TheATP content of TCA filtrates of red cells was the same when determined bythe firefly method as by the hexokinase-linked technic. Relatively low concentrations of protein were found to stimulate light output when lyophilyzedfirefly extract, but not freshly prepared firefly extract, was used. Thus, falsely,high values were obtained when red cell extracts were examined, unless protein was also added to the standard. Storage of heparinized blood for as littleas 1 hour resulted in a substantial decrease in red cell ATP levels. The losswith ACD blood was less, and could be obviated entirely by using an ACDsolution with a pH adjusted to between 3.5 and 4.0. Removing the buffy coator washing cells in saline resulted in no further loss of red cell ATP. Extraction of washed red cells with TCA resulted in an average loss of 4.6 per cent ofATP, while extraction of whole blood with TCA resulted in a 14 per cent lossof ATP. In contrast, perchloric acid extraction resulted in no ATP loss. If ATPdeterminations are carried out using the firefly method, protein should beadded to the standard. If red cells must be stored for any period of time priorto extraction of ATP, an ACD solution with a pH of 3.5 to 4.0 should be used.If extracts of red cells are made, perchloric acid appears significantly superiorto trichloroacetic acid.

Submitted on January 10, 1967 Accepted on March 1, 1967