A Bromide Paper Camera for Organ Imaging Systems

The new generation of organ imaging systems has created a need for high quality low cost prints for permanent diagnostic records. This need has been met by the development of a large format camera utilizing resin coated bromide paper. Rapid processing using a standard 90 second x-ray film processor gives high quality and fast access to the diagnostic information. The camera described can be constructed in most hospital engineering workshops at low cost.     

Developing an R&D agenda for pharmacy workforce research

□ A consultation exercise was conducted to identify and prioritise the research agenda on the pharmacy workforce □ A two‐ound Delphi technique was employed for the main study □ People from all sectors of the profession were invited to contribute their views on what research should be carried out □ Ninety per cent of respondents agreed that the top priority for research was to “identify the levels, causes and implications of turnover among different cohorts of pharmacists” □ The need to take forward aspects of the proposed programme is now a matter of some urgency for the profession and the National Health Service     

INTRA-BURSAL TETRACYCLINE IN THE TREATMENT OF OLECRANON BURSITIS IN PATIENTS WITH RHEUMATOID ARTHRITIS

We report on the novel usage of intra-bursal tetracycline astreatment of olecranon bursitis in a pilot, open study of sevenpatients with RA. KEY WORDS: Olecranon bursitis, Tetracycline, Rheumatoid arthritis     

A review of factors that influence the use of community pharmacies as a primary health care resource

This review paper provides an analysis of a range of pharmacy practice, health services and sociological literature relevant to understanding how the public in the United Kingdom use and view community pharmacies as a primary health care resource. Papers published between 1980 and 1997 inclusive were identified, based on on-line searches of databases, and hand searches of a published literature index, relevant journals, and bibliographies of published papers. Papers included in the review are those which report findings on any aspect of consumers' views and use of community pharmacies. No attempt is made to evaluate the adequacy of the findings since the level of reporting in most short papers does not allow for this type of evaluation. Instead, the review paper “maps out” what is currently known about pharmacy utilisation. Key variables that have been used to explain pharmacy use, including a number of demographic and organisational factors, are identified, as well as factors associated with need and demand issues. The paper summarises the main empirical findings, and provides a view of where further work could add to a greater understanding of the relationship between the delivery of pharmaceutical services and primary health care. Potential strategies that could positively influence consumer demand for community pharmacy services are discussed.     

Peripheral Nerve Dysfunction in Scleroderma

Peripheral neuropathy in patients with scleroderma is thoughtto be rare. We have undertaken a quantitative assessment ofperipheral nerve function in 29 patients with either limitedcutaneous scleroderma or progressive systematic sclerosis. Tactilethresholds were raised in the fingers in 28 per cent of patientsand in the foot in 50 per cent. Two-point discrimination wasabnormal in 10 patients, thermal thresholds were abnormal infive and vibration thresholds were abnormal in one. Nerve conductionstudies showed abnormalities in six patients, five of whom hadclinical signs of a mild peripheral neuropathy: the mean durationof disease in these six patients was 10 years longer than thatin the remainder of the patients. There was electrophysiologicalevidence of a subclinical carpal tunnel syndrome in two patients.The sympathetic skin response was recorded in 16 patients whohad not been subjected to sympathectomy for Raynaud's phenomenon,and was abnormal in four. These results indicate that peripheralnerve dysfunction in scleroderma, though mild, is not as uncommonas previously thought. The abnormal cutaneous sensory thresholdsmay be partly due to altered viscoelastic properties of theskin, but abnormal responses in the lower limbs to tests oftactile sensitivity, the clinical findings and the disturbancesof nerve conduction argue in favour of an additional neuropathicprocess in some patients. Low grade distal nerve trunk ischaemiamay be responsible.     

A LONGITUDINAL STUDY OF PERIPHERAL BLOOD MONONUCLEAR CELL PROLIFERATTVE RESPONSES TO BACTERIAL ANTIGENS IN REACTTVE ARTHRITIS

Reactive arthritis (ReA) is a sterile inflammatory arthritiswhich usually occurs after an enteric or genitourinary infection.In recent years it has been recognized that synovial fluid mononuclearcells from an affected joint demonstrate marked proliferativeresponses if incubated with preparations of the organism triggeringthe arthritis; peripheral blood mononuclear cell (PBMC) responsesare typically much smaller. One interpretation of this findingis that recognition of the triggering organism is enhanced withinthe joint compared to peripheral blood, but it could also beargued that the PBMC responses are actually depressed duringacute arthritis. We have examined this possibility in a longitudinalstudy of PBMC proliferative responses in patients with ReA.In this study we have demonstrated that PBMC proliferative responsesto the triggering organism were indeed depressed during acuteReA, and showed a significant increase after recovery from thearthritis. These findings also applied to PBMC recognition ofthe recall antigen PPD, and to the response to IL-2. KEY WORDS: T cells, Reactive arthritis     

SMALL JOINT SYNOVTTIS IN RHEUMATOID ARTHRITIS: SHOULD IT BE ASSESSED SEPARATELY?

In the assessment of disease activity in rheumatoid arthritis(RA) small joint synovitis is traditionally included only asa component of active, tender or swollen joint counts. By contrast,in the assessment of disease damage in RA, the X-ray score ofhands and feet represents one of the most common parametersused and is regarded as a major indicator of outcome. Data presentedin this study lead us to hypothesize that the small joints requireseparate assessment in any study of disease activity or outcomein RA: (i) there is clear evidence that small joint synovitisoften occurs in the absence of an abnormal acute phase response(ESR or C-reactive protein) and (ii) measured synovitis is anindividual (PIP) joint has been shown to be reliable and tobe related to subsequent X-ray changes in the same joint. Ourfindings show that, in a study of a treatment of RA, it is quitepossible for disease activity measures to appear controlledwhile inflammation continues in the small joints causing radiologicaldamage. This radiological damage is reflected as an adverseoutcome. Hence the paradox of improving disease activity butnot outcome. We argue that small joint inflammation and damageshould be recognized as one aspect of the RA disease processoffering unique information and as such should be assessed independently. KEY WORDS: Rheumatoid arthritis, Disease activity, Small joint synovitis, X-ray