Hand-held computers in clinical audit: a comparison with established paper and pencil methods

The performance of hand-held computer terminals was compared with that of paper and pencil data collection methods. The study was carried out on two wards, with a comparative study in the medical audit unit at Rampton Hospital, one of three special hospitals managed by the Special Hospitals Service Authority. These were analysed, focusing on time factors, error rates, ease of use and financial implications. Findings showed that the electronic system saved time, reduced staffing costs and errors and had unit-wide potential. The electronic data collection contributed to a cost-effective and flexible data-processing system for use in auditing.     

A retrospective review of basilic and cephalic vein-based fistulas

This study compares outcomes of basilic and cephalic vein fistulas for hemodialysis. A retrospective review of arteriovenous fistulas in a university hospital system was performed using charts and hemodialysis records. Patency and demographic data were assessed with life table analysis. One hundred fifty-six patients (88 males; 68 females) underwent creation of 172 autogenous fistulas (mean age 61 years; mean follow-up 78 weeks). There were 101 basilic vein transpositions and 71 cephalic vein fistulas. Primary patency did not differ significantly, while assisted primary patency was significantly better for basilic vein fistulas at one year (73% versus 53%: P = 0.024). Secondary patency was significantly better for basilic fistulas through three years (58% versus 52%; P = 0.027). Primary failure (thrombosis before access or failed maturation) was significantly higher for cephalic than basilic fistulas (28% versus 13%; P = 0.01). Maturation time, usage time and complications were not significantly significant. Thirty-three (33%) basilic vein-based fistulas and 12 (17%) cephalic vein fistulas required revision during follow-up. Basilic vein-based fistulas perform as well as or better than cephalic vein-based fistulas in terms of patency, maturation time, and usage time and complication rates, though requiring more re-interventions.     

Comparison of organophosphorus pesticide metabolite levels in single and multiple daily urine samples collected from preschool children in Washington State

A total organophosphorus pesticide exposure study was conducted in Washington State in 1998 in a sample population of 13 children aged 2.5-5.5 years. The children were roughly split between rural and suburban populations and had been previously identified as having potentially elevated organophosphorus pesticide exposures. One component of the study was urine collection and analysis. Urine samples were collected from each subject up to four times in 24 h in two different seasons. Samples were collected at specific time points: before bed, first morning void, after lunch, and before dinner. Urine samples were analyzed initially for the six nonspecific dialkylphosphate (DAP) metabolites and subsequently for eight specific metabolites including malathion dicarboxylic acid (MDA), 3,5,6-trichloro-2-pyridinol (TCPy), and paranitrophenol (PNP). Relatively large percentages of the urine samples contained quantifiable amounts of two of the nonspecific DAP metabolites (DMTP-97%; DETP-67%), and three of the specific metabolites (MDA (71%), TCPy (79%), and PNP (96%)). A percent deviation analysis was employed to determine which of the spot sample time points was the best predictor of the estimated volume-weighted daily average. Of the four spot samples collected, first morning void samples were consistently found to be the best predictors of weighted-average daily metabolite concentration. This finding also held when the data were creatinine-adjusted. The results of this analysis suggest that if spot sampling is to be conducted as part of a biological monitoring study, first morning void samples should be preferentially collected.     

Effects of gender on intracellular [Ca2+] in rat cardiac myocytes

The present study investigated the effects of gender on intracellular [Ca2+] ([Ca2+]i) in freshly isolated rat cardiac myocytes. Changes in [Ca2+]i in response to varied extracellular [Ca2+], different stimulus frequencies and addition of caffeine and isoprenaline were monitored using fura-2 in both male and female cardiac myocytes. Increasing extracellular [Ca2+] and stimulus frequency resulted in significant increases in peak [Ca2+] and the amplitude of the Ca2+ transient in both male and female cardiac myocytes. However, as extracellular [Ca2+] was raised, peak [Ca2+] and the amplitude of the Ca2+ transient increased significantly more in male than female cardiac myocytes. In addition a significant difference between male and female cells at each stimulus frequency was apparent. The time course of decay of the Ca2+ transient was significantly slower in female cardiac myocytes when compared with male cardiac myocytes, along with significantly slowed times to peak shortening and 50% relaxation, and a reduced extent of shortening. There was no significant difference in the amplitude of caffeine-induced [Ca2+]i responses between male and female cells, however, [Ca2+]i increased more readily in male cells than in female cells when isoprenaline was added. The data demonstrate that, under a variety of conditions, intracellular [Ca2+] rises to higher levels in cardiac myocytes from male as compared to female rats.     

High school football injuries: evaluation

An epidemiologic survey of the literature on high school football injuries revealed methodologic problems. These numerator-denominator inconsistencies and other confounding factors are discussed. The authors suggest a more reliable system of reporting these parameters to further reduce the risk of high school football injuries.