FEASIBILITY OF CONDUCTING CARDIOVASCULAR OUTCOME RESEARCH IN AUSTRALIAN GENERAL PRACTICE: RESULTS FROM THE ANBP2 PILOT STUDY

1. The present study aimed to determine the feasibility of conducting a 5 year cardiovascular outcome trial of the treatment of 6000 elderly hypertensive patients in Australian general practices. 2. General practitioners (GPs) were invited to participate by mail and personal follow-up. Patient records were reviewed to identify subjects for a blood pressure (BP) screening programme. Blood pressure was measured on three occasions and eligible subjects were included if the average BP was 160 mmHg systolic or 90 mmHg diastolic if systolic BP was 140 mmHg. 3. Seven hundred and forty-one GPs were approached and 89 were enrolled in the study (12% of mail invites and 75% of those receiving a personal contact). In 16 practices where screening was completed, 82 000 records were reviewed to identify 4% patients eligible for screening. Twenty-two per cent of eligible subjects attended screening. Of 1938 subjects screened, 180 (9%) had BP 5=160/90 mmHg. Forty-seven percent of subjects (n = 916) were receiving antihypertensive therapy and 184 (20%) were withdrawn from therapy. One hundred and sixteen (63%) of these subjects had BP return to study entry levels within 6 weeks. Fifty-seven newly diagnosed and 81 previously treated subjects were randomized (7% of the screened population). 4. Based on the high participation rate of GPs, the response rate of patients to attend a BP screening programme and the 7% randomization to screening ratio for entry into the study, the ANBP2 pilot study has demonstrated that it is feasible to recruit subjects from Australian general practices to a cardiovascular outcome trial.     

'This isn't very typical I'm afraid': observing community care complaints procedures

The new complaints procedures which local authority social services departments have been required to introduce represent an important mechanism for managing the change of culture associated with recent community care reforms. They also represent a new genre in mechanisms of redress for welfare recipients. This paper reports the findings of a study which has observed considerable diversity in the ways in which local authorities are interpreting the nature and purposes of the new procedures and, in particular, the functions of review panels established under those procedures. Variations in the composition of panels, in the style of review panel proceedings, in perceptions of the panels' powers, and in the ways that complaints and complainants are constituted are all discussed. Attention is drawn to four competing interpretations of the review panels' role and to the need for these to be clarified and prioritised.     

Occurrence of the t(2;5)(p23;q35) in non-Hodgkin's lymphoma

Primary CD30(Ki-1)-positive anaplastic large-cell lymphoma (ALCL) is considered by some to be a distinct clinicopathologic entity associated with the t(2;5) (p23;q35). However, the specificity of t(2;5) for ALCL has not been carefully studied. Therefore, we performed a detailed analysis of all cases of ALCL with abnormal cytogenetics results in the Nebraska Lymphoma Study Group registry, as well as all other cases of non-Hodgkin's lymphoma with t(2;5) in the registry. We found the t(2;5) in only five of 10 cases of ALCL, four of whom were young patients. However, we also found the t(2;5) in 11 other cases of nonanaplastic lymphoma, including eight children with typical peripheral T-cell lymphomas of various types. The t(2;5) was also found in three older adults with B-cell lymphomas of various types. Thus, the t(2;5) was not specific for CD30+ ALCL. However, t(2;5) may define a clinicopathologic entity in children and young adults characterized by variable morphologies with a T-cell or indeterminate phenotype, CD30-positivity, nodal disease with frequent extranodal involvement, advanced stage, and an excellent response to therapy, including bone marrow transplantation for relapsed disease. The clinical relevance of the t(2;5) in older patients requires further study.     

Needs and needs assessment: their components and definitions with reference to dementia

The concept of need and the practice of needs assessment are both subject to a wide range of interpretations, to the likely detriment of individual assessments and to multidisciplinary working. Clear definition is important for individual assessment, for the development of multidisciplinary tools and in gathering planning information. The concept of need is clarified, firstly by distinguishing between need and the difficulties that engender it, and secondly through a taxonomy of need. These assist clear definitions of both need and needs assessment when linked with a consideration of the current help a person receives and a specification of the type of help required by a person to meet their needs. Such definitions have implications for the role of needs assessment in individual assessment, service evaluation, service management and planning and in the development of multidisciplinary needs assessment tools.     

THE TREATMENT OF ACUTE AND CHRONIC VAGINAL CANDIDOSIS

Vaginal candidosis is one of the most common infections of the vagina and the first accredited record of the disease appeared in 1849. Over the years the terms ‘candidiasis’ and ‘candidosis’ have been used, but it is generally accepted now that the terms are synonymous, and the term most commonly in use today is ‘candidosis’. Mainly caused by the yeast Candida albicans, the condition is characterised by intense inflammation of the vaginal mucosa and a curdy, off-white discharge; it is often associated with severe vulval itching and possibly burning pain. The severity of symptoms seems to vary greatly from patient to patient and the reason for this is unclear. It is suggested that in some patients there may be an element of hypersensitivity. Vaginal candidosis may occur in children but is most common in adults and only sometimes affects the elderly. The majority of women will suffer at least one attack of vaginal candidosis during their lifetime, and there are several predisposing factors such as diabetes, pregnancy and antibiotics. Some authorities consider the condition more frequent in those taking oral contraceptives or other hormones.     

5km重复低压缺氧对小鼠肝脏及脾脏中微量元素的影响

目的 探讨5km重复低压缺氧对小鼠肝脏及脾脏中微量元素的影响。方法 将小白鼠分为5km重复低压缺氧实验组及地面对照组。实验组每天进行5km重复低压缺氧30min,连续7d后，处死小鼠，取肝脏、脾脏烘干至恒重，采用火焰原子吸收法测定锌、铜、铁。结果 5km重复低压缺氧小鼠肝脏中Cu、Fe含量与对照组比较有显差异(P＜0．05)；脾脏中微量元素Fe的含量与对照组比较有显性差异(P＜0．05)。结论 5km重复低压缺氧，使肝脏中Fe、Cu含量降低，脾脏中Fe含量升高。     

帕罗西汀对抑郁模型大鼠不同脑区环磷酸腺苷反应元件结合蛋白的影响

目的探讨帕罗西汀在不同用药时间对抑郁模型大鼠海马、前额叶皮质环磷酸腺苷反应元件结合蛋白（CREB）磷酸化（p-CREB）及总蛋白（t-CREB）水平的影响。方法成年雄性SpragueDawley大鼠36只，随机分为6组：对照组、抑郁模型组（以下简称模型组）、抑郁模型＋用药1d组（以下简称用药1d组）、抑郁模型＋用药1周组（以下简称用药1周组）、抑郁模型＋用药2周组（以下简称用药2周组）和抑郁模型＋用药4周组（以下简称用药4周组），每组各6只。抑郁模型的制作为强迫大鼠游泳4周，每天1次，每次15min。帕罗西汀的剂量为10m∥kg体质量，灌胃给药，时间分别为1d和1，2，4周，每天1次，于每次游泳前用药。采用Westernblot法检测各组大鼠海马及前额叶皮质的p-CREB和t-CREB水平。结果（1）模型组及用药1d、1周组大鼠海马p-CREB水平明显低于对照组（P〈0．01），用药2，4周组大鼠海马p-CREB水平与对照组的差异无统计学意义（P〉0．05）；模型组及各用药组海马t-CREB水平与对照组的差异无统计学意义（P〉0．05）。（2）模型组及用药1d和1，2周组大鼠前额叶皮质p-CREB水平均明显低于对照组（P〈0．05），用药4周组与对照组的差异无统计学意义（P〉0．05）。模型组及用药1d、1周组大鼠前额叶皮质t-CREB水平与对照组的差异无统计学意义（P〉0．05），用药2，4周组大鼠前额叶皮质t-CREB水平均明显高于对照组（P〈0．05或P〈0．01）。结论慢性强迫游泳导致大鼠海马及前额叶皮质CREB活性降低，长期使用帕罗西汀可逆转此效应，提高抑郁大鼠前额叶皮质的CREB水平。