When to act--the appropriateness of cardiovascular disease intervention

Nearly 13 million people die each year from cardiovascular diseasesand half of these deaths occur in developing countries. Thisarticle reviews the appropriateness of cardiovascular diseaseintervention and focuses on decision-making and the perpetualquestion: When is it more appropriate to act on available evidencerather than to await further evidence? A fundamental and justifiedprinciple in science is trying to falsify all formulated hypotheses.This sceptical or conservative approach can, however, hampersocial development. It is therefore important for the scientistto distinguish between his role as a scientist and as a memberof society. Medical, epidemiological and economic aspects areconsidered together with an assessment of the feasibility ofdifferent intervention strategies. This review, like many others,indicates that population-based interventions combined withan improved high-risk strategy are appropriate from society'spoint of view in spite of the fact that there are several unsettledquestions which call for further research.     

A study to explore the role of a community oncology nurse specialist

Cancer patients are increasingly being cared for in the community. However, the role of the community oncology nurse specialist (CONS) remains a rare appointment in the United Kingdom. There is little research evidence to substantiate the view that this is a worthwhile and effective role. This study aimed to explore the role of one CONS using a qualitative case study approach. The sample consisted of the CONS, seven patients, no relatives and five community nurses. Semi-structured interviews were used to elicit the view of these participants. In addition, documents containing details of the CONS's work to date were reviewed. A number of the CONS's role components were identified by the different respondent groups. Five themes were identified within the data collected: functions of the CONS, communication between the CONS and other health care professionals, structural and organizational factors, characteristics of the service and benefits to patients and their families. Furthermore, all respondent groups were positive about the service offered by the CONS, and felt that the role was valuable. Some negative features were identified and these were concerned with organizational aspects of the service. The findings suggest the need for further research and evaluation in this area.     

The effects of acute exercise on colonie motility

Abstract Changes in colonic motor activity during aerobic exercise were investigated in ten regularly exercising volunteers (five males and five females) aged 27–70 years. Motility was recorded with a catheter containing three solid-state pressure transducers spaced 5 cm apart. The motility catheter was advanced 40–50 cm from the anal verge by flexible sigmoidoscope without anesthesia at least 60 min prior to testing. Manometric recordings were made from the colon during a 1-h pre-exercise rest period, 1 h of jogging at 70–80% maximum heart rate, and 1-h post-exercise rest period. The dominant frequency of contractile activity in the colon shifted from 1–4 cpm during rest, to 4–9 cpm with the onset of exercise. Activity also shifted from sporadic, isolated contractions to regular, propagated contractions in six of ten subjects, five of whom reported a history of runner's diarrhoea. The dominant frequency returned to 1–4 cpm during the post-exercise period. These changes in distal colonie motility may account for the diarrhoea which some subjects experience during intense, acute exercise.     

A Pilot Study: Defibrillation Thresholds in Dogs are Similar with Isoflurane, Halothane, and Pentobarbital

The objective of this pilot study was to determine if three common anesthetic drugs have differing effects on the measurement of defibrillation thresholds (DFT) in dogs. The drugs compared were pentobarbital, isoflurane, and halothane. We used six dogs, which were surgically instrumented, in a chronic study design. Each dog had two internal defibrillation patches placed on its heart, which were used to deliver the defibrillation energy. DFT was determined while each dog was anesthetized under each of the listed drugs in a crossover design. This pilot study suggests that differences in DFT due to the anesthetic drugs is not significant in studies with low numbers of animals (halothane 14.5 ± 1.0, isoflurane 14.2 ± 1.0, pentobarbital 12.8 ± 1.0;P = NS; mean ± SE). Tbe variation in DFT between individual animals is much larger than the difference in DFT due to the drugs.