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.     

Percutaneous endoscopic gastrostomy–a user's perspective

Sixteen patients receiving percutaneous endoscopic gastrostomy (PEG) feeding following a period of nasogastric (NG) feeding were investigated to assess acceptance and identify problems by means of a questionnaire. PEG was considered to be superior to NG feeding in terms of tolerance and cosmetic acceptance by 81% and 88% of participants respectively ( P < 0.001). Pain was an infrequent problem. Interruptions to feeding were consideed to be more common with NG feeding by 50% of participants; 38% considered interruptions equally common with both PEG and NG, and 12% considered interruptions more common with PEG feeding ( P = NS). The time for care was equivalent for both methods. Seventy-five percent considered PEG to have made a valuable contribution to enteral feeding. Leakage was however considered to be more frequent in PEG feeding by 81% of participants (compared to 12% who considered leakage to be more common with NG feeding; P < 0.001) and leakage was more frequent at die junctions in the catheter rather than from the stoma. Thirty-one percent of patients with PEG had needed systemic antibiotics for stomal infections. All patients with both PEG and NG feeding needed professional help. Sixty-two percent needed professional help more frequently with PEG than with NG feeding (compared to 19% who considered that the NG tube needed professional help more frequently; P <0.05). We conclude that leakage and infections are major problems in PEG enteral feeding.     

Light and electron microscopic and autoradiographic studies onN-methyl-N-amylnitrosamine-induced rat esophageal carcinogenesis

The purpose of this study was to investigate the histogenesis of experimental tumors in the rat esophagus. Thirty rats received 0.0015% N-methyl-N-amylnitrosamine (MNAN) in the drinking water for 12 weeks. Another 30 rats received tap water. All rats then received tap water until sacrifice. Rats from each group were sacrificed immediately after MNAN administration, four weeks after, and eight weeks after. One hour before sacrifice, [³H]TdR was injected by tail vein to label proliferating cells. The entire esophagus and stomach were removed and processed for light and electron microscopy and autoradiography. The overall frequency of esophageal tumors after MNAN was 83% and did not differ significantly among the three experimental groups. Tumors were primarily papillomas and squamous cell carcinomas and occurred with equal frequency in the upper, middle, and lower thirds of the esophagus. No tumors were found in the squamous-lined forestomach. Electron microscopy revealed abundant tonofilaments, free ribosomes, and mitochondria accompanied by vacuoles. By autoradiography, esophageal epithelial proliferation was markedly stimulated in nontumorous mucosa from all three experimental groups. We conclude that MNAN ingestion for 12 weeks reliably produces papillomas and squamous cell carcinomas throughout the rat esophagus, but not in the squamouslined forestomach, and that MNAN stimulated marked epithelial proliferation which is accompanied by thickening of the epithelium in nontumorus esophageal mucosa.