The diffusion of nandrolone through hydrated human cadaver skin

Effective diffusion constants have been determined for the permeation of nandrolone through whole and stripped human abdominal cadaver skin in vitro. From the values obtained, the diffusion constant for nandrolone in the stratum corneum has been inferred. The experimental approach used yields reproducible results for skin samples taken from a single individual. There is also a surprising degree of uniformity in the values obtained for skin from different individuals.     

Developing Actionable Dietary Guidance Messages: Dietary Fat as a Case Study

Although consumers say they are concerned about nutrition and are aware that eating a healthful diet is important for good health, this knowledge does not always translate into healthful diet behaviors or motivate behavior change. In an effort to better understand consumer attitudes about nutrition and to explore alternatives for communicating dietary advice in language that is meaningful and motivates behavior change, the International Food Information Council (IFIC) conducted qualitative research with consumers (using focus groups) and registered dietitians (using telephone interviews) in 1998 and 1999. Results of the research are presented using dietary fat as a case study. Findings from the IFIC research were reported to the Dietary Guidelines Advisory Committee to assist the Committee in developing meaningful and action-oriented dietary advice related to dietary fat for inclusion in the 2000 Dietary Guidelines for Americans that would be motivating and easy for consumers to implement. The recommendation to moderate fat intake in the new dietary guideline, "Choose a diet that is low in saturated fat and cholesterol and moderate in total fat" is consistent with communication recommendations in the IFIC research. Further, the moderate fat message is empowering because it suggests an achievable dietary regimen and reduces guilt and worry about foods. It allows flexibility to enjoy desired foods and promotes using common sense when it comes to diet. Several issues emerged from the IFIC research that apply to general nutrition communications with consumers, whether it be through national nutrition recommendations or in one-on-one counseling situations: to be effective, messages to consumers about nutrition, and specifically dietary fat, must address sources of discomfort about dietary choices; they must engender a sense of empowerment; and they should motivate both by providing clear information that propels toward taking action and appeals to the need to make personal choices.     

Shaping practice behaviour: novel training methodology

Context — Some studies that have used “pseudo‐patron” methods have provided the basis for criticism of pharmacists' performance and have stigmatised these methods in pharmacy research. Objective — To test and refine the use of pseudo‐patron methodology, with feedback to practitioners, as a means of implementing behaviour change. Method — In the studies reported in this paper practice behaviour was shaped by conducting a workshop and then providing ongoing training in the form of feedback and coaching immediately after a pseudo‐patron visit. The involvement of pseudo‐patrons was negotiated with pharmacists and their staff and embedded within their professional development. Results — An initial study showed that, compared with controls, pseudo‐patron trained pharmacists were significantly more likely to identify off‐label (not in accordance with label specifications) analgesic use (P<0.01) and were more likely to discuss the use of alternatives (P<0.02). The methodology was refined and in a subsequent study pharmacists were even more likely to identify misuse (P<0.001), assess readiness to change (P<0.001) and deliver an appropriate intervention (P<0.001). Conclusions — The results of the studies presented in this paper demonstrate that the inclusion of pseudo‐patron visits in pharmacist training is feasible and that a combination of workshops and performance feedback, including positive and corrective elements, can produce substantial protocol adherence in the natural setting. The use of pseudo‐patron methods as part of a training programme is effective in shaping behaviour of pharmacists and pharmacy assistants.     

The vitamin K debacle and infants with cholestatic liver disease

An 8 year old girl with cystic fibrosis had severe respiratory disease associated with chronic Pseudomonas aeruginosa bronchopulmonary infection. Despite regular courses of intravenous antipseudomonal antibiotics, she continued to deteriorate over 18 months with persistent productive cough, worsening respiratory function, and increasing oxygen dependence. During her 11th admission Streptococcus milleri was isolated from sputum cultures in addition to P aeruginosa. She failed to respond to antipseudomonal antibiotics but improved dramatically with the addition of intravenous benzylpenicillin. Although S milleri is considered a normal mouth commensal and its isolation from sputum of cystic fibrosis patients is of uncertain significance, it was associated with clinically significant infection in this child. S milleri was eradicated with antibiotic treatment and clinical improvement has been maintained.     

Superior vena caval thrombosis in a child: An uncommon presentation of idiopathic dilated cardiomyopathy

A nine year old girl who presented with a thrombosis of the right internal jugular vein and superior vena cava was found to be in cardiac failure and to have a dilated cardiomyopathy. After transient improvement she deteriorated and was accepted for cardiac transplantation. Following transplantation her condition has been much improved.     

Subchronic Inhalation Study with Vinyl Fluoride: Effects on Hepatic Cell Proliferation and Urinary Fluoride Excretion

Subchronic Inhalation Study with Vinyl Fluoride: Effects onHepatic Cell Proliferation and Urinary Fluoride Excretion. BOGDANFFY,M. S., KEE, C. R., KELLY, D. P., CARAKOSTAS, M. C, AND SYKES,G. P. (1990). Fundam Appl Toxicol. 15, 394/406. Vinyl fluorideis used widely in the manufacture of fluoropolymers. Based inpart on the structural similarity of vinyl fluoride to the hepatocarcinogensvinyl chloride and vinyl bromide, a TSCA Section 4 test rulemandated the testing of vinyl fluoride for oncogenicity. Thisreport presents the results of a 90-day inhalation study inrats and mice with vinyl fluoride designed to set test concentrationsfor a subsequent oncogenicity study. Groups of 15 male and femalerats and mice were exposed 6 hr per day, 5 days per week forapproximately 90 days to target concentrations of 0, 200, 2000,or 20,000 ppm vinyl fluoride. Clinical chemical, hematological,and urine analyses were performed on rats after 45 and 90 daysof exposure. A hematological evaluation was performed on micefollowing 45 and 90 days of exposure. A complete gross and microscopicevaluation was conducted at the end of the study. After 93 dayson test, groups of five rats and five mice per sex were implantedwith osmotic minipumps containing [3H]thymidine and were exposedfor an additional 5 days to measure cell proliferation in liver,kidney, lung, and nasal cavity tissues. Results of the histopathological,clinical chemical, and hematological evaluations showed no significanteffects of vinyl fluoride exposure at any concentration followingeither 45 or 90 days of exposure. A concentration-related increasein fluoride ion in urine was observed in rats at 45 and 90 daysof exposure. A plateau in urinary fluoride excretion was observedat approximately 2000 ppm, suggesting saturation of vinyl fluoridemetabolism. Vinyl fluoride-related cell proliferation effectswere largely restricted to liver. Hepatic cell proliferationin male and female rats and mice was elevated at all concentrations.The response was similar at concentrations of either 2000 or20,000 ppm and was consistent with concentration-response relationshipsfor other haloethylenes. Taken together, the urinary fluorideexcretion and hepatic cell proliferation data suggest a mechanisticlink between the two effects. On the basis of these findingsand experience with other haloethylenes, concentrations of vinylfluoride to be tested for oncogenicity should be chosen suchthat the full linear range of the concentration-response curveis evaluated. The present study demonstrates through examplethe value of incorporating cell proliferation studies in standardtesting protocols     

Psoriasis-an index of disability

Fifty-Four patients completed a questionnaire to assess functional lifestyle disability caused by psoriasis and a detailed record of the area of psoriasis involvement was taken. The 10 most relevant and independent questions were identified from the original 28 questions and the final questionnaire score, the Psoriasis Disability Index (PDI), was used to quantify reduction in disability before (34. 1±11. 1) and after (22. 3± 10. 9, n=20, P<0. 002) in-patient treatment. The total area of involvement of psoriasis is not a reliable guide to disability. The PDI may be used as a repeatable measure and record of disability caused by psoriasis and may potentially aid psoriasis management decision taking.     

Anaesthesia for Friedreich''s ataxia

A patient with Friedreich's ataxia was anaesthetised on two occasions. The neuromuscular blocking agent was atracurium 0.5 mg/kg on the first occasion and tubocurarine 0.5 mg/kg on the second. The effect of each was monitored using the train-of-four twitch technique. Friedreich's ataxia has been reported to cause a marked sensitivity to non-depolarising muscle relaxants and hyperkalaemia, with resulting cardiac dysrhythmias after suxamethonium. This patient did not demonstrate an abnormal response to either relaxant; the operating conditions were satisfactory and recovery was not delayed. These drugs may be safely used in this condition provided that monitoring is adequate.