Patent ductus arteriosus in a cohort of 1338 preterm infants: a collaborative studya

As part of a prospective national survey on morbidity and mortality of all infants born at less than 32 weeks and/or weighing less than 1500 g in the Netherlands we studied the incidence of symptomatic patent ductus arteriosus (PDA) in infants surviving at least 24 hours. In 1252 of the 1338 infants the presence or absence of PDA could be established. The incidence of PDA was 10.7%. Logistic regression analyses revealed that idiopathic respiratory distress syndrome (IRDS) was the most predictive factor, followed in order of importance by septicaemia, birthweight, prolonged rupture of membranes and gestational age. None of the other maternal and perinatal factors showed any association with the occurrence of PDA. Furthermore, bronchopulmonary dysplasia (BPD) and necrotising enterocolitis (NEC) were found to be sequelae of PDA. The combination of IRDS, very pre-term birth and septicaemia should be considered as high risk for the development of PDA.     

Evaluation of a therapeutic concentration of dithranol in the mouse-tail test

A study of dithranol ointment in the mouse-tail test showed that 0.2% dithranol ointment induced a granular layer and orthokeratosis in mouse-tail epidermis. This provides further evidence of the value of the mouse-tail test in evaluating anti-psoriatic activity of topical preparations.     

Silica-associated systemic sclerosis is clinically, serologically and immunologically indistinguishable from idiopathic systemic sclerosis

To determine whether the clinical, immunological and serological features of patients with silica-associated systemic sclerosis are different from patients with the 'idiopathic' form of systemic sclerosis (SS) we studied 22 underground coal miners who were exposed to silica dust (SD), 30 mine workers who later developed silicosis (S) and 17 mine workers exposed to silica dust who subsequently developed a systemic sclerosis-like disease (SA-SS). The patients with SA-SS had features clinically indistinguishable from individual patients with SS. They all had Raynaud's phenomenon, 14 had cutaneous sclerosis identical to that seen in acrosclerosis and three had a generalized cutaneous sclerosis. Sixteen patients had bibasilar pulmonary fibrosis, 10 had necrosis of the fingertip pulps, nine had oesophageal involvement and only one patient had renal involvement. Antinuclear antibodies and circulating immune complexes were detected in three and eight patients with SD, 14 and five patients with S and in 16 and nine patients with SA-SS, respectively. Anti-Scl-70 antibody was detected in eight of the 17 patients with SA-SS. Evidence for in vivo endothelial cell damage, as determined by elevated levels of von Willebrand factor, was found in nine patients with SD, 14 patients with S and in 10 patients with SA-SS. Following incubation of the patient's serum with confluent cultures of human umbilical vein endothelial cells there was only a significant reduction in calcium ionophore-induced release of prostacyclin with the serum from SA-SS patients compared to that with control serum (NC). The mean +/- SEM release of 6-keto-PGF1 alpha (the stable metabolite of prostacyclin expressed as ng/10(4) cells) decreased from 2.90 +/- 0.27 to 2.01 +/- 0.33 (SD), 3.34 +/- 0.42 to 1.76 +/- 0.31 (S), 1.98 +/- 0.12 to 0.64 +/- 0.07 (SA-SS) and 2.28 +/- 0.33 to 1.36 +/- 0.21 (NC) with 1 and 20% serum, respectively. This study demonstrates that immune complex and antinuclear antibody formation and in vivo endothelial cell damage occurs following occupational exposure to silica. The patients who subsequently develop a systemic sclerosis-like disease have clinical, immunological and serological features which are indistinguishable from the idiopathic form of the disease although as a group the SA-SS patients have a higher prevalence of pulmonary involvement and the anti-Scl-70 antibody.     

The hormonal profile of women with acne and polycystic ovaries

Most women with acne are found to have polycystic ovaries on high resolution pelvic ultrasonography, but most of these women do not manifest the other classical clinical characteristics of the polycystic ovary syndrome. We have compared the endocrinological profile of women with acne who were found to have polycystic ovaries with that of women with polycystic ovaries who presented to an endocrine clinic with hirsutes or non-dermatological manifestations of the polycystic-ovary syndrome. The group of women with acne had normal serum hormonal concentrations. Unlike other women with polycystic ovaries, they did not have significantly elevated serum concentrations of luteinizing hormone or testosterone. By clinical and endocrinological criteria, patients with acne who have polycystic ovaries appear to be a distinct sub-population of women with polycystic ovaries.     

Emotions at work: what is the link to patient and staff safety? Implications for nurse managers in the NHS

Aims  This paper sets the discussion of emotions at work within the modern NHS and the current prioritisation of creating a safety culture within the service.
Background  The paper focuses on the work of students, frontline nurses and their managers drawing on recent studies of patient safety in the curriculum, and governance and incentives in the care of patients with complex long term conditions.
Methods  The primary research featured in the paper combined a case study design with focus groups, interviews and observation.
Results  In the patient safety research the importance of physical and emotional safety emerged as a key finding both for users and professionals. In the governance and incentives research, risk emerged as a key concern for managers, frontline workers and users.
Conclusion  The recognition of emotions and the importance of emotional labour at an individual and organizational level managed by emotionally intelligent leaders played an important role in promoting worker and patient safety and reducing workplace risk.
Implications for nurse managers  Nurse managers need to be aware of the emotional complexities of their organizations in order to set up systems to support the emotional wellbeing of professionals and users which in turn ensures safety and reduces risk.     

Treatment of Raynaud's phenomenon by intravenous infusion of prostacyclin (PGI2)

Twenty five patients with Raynaud's phenomenon due to systemic sclerosis were infused with prostacyclin (PGI²). In 88% of the patients there was objective improvement, monitored by thermography or radiometry.