The efficacy of tobramycin in the treatment of ulcerative colitis

This paper reports a double-blind placebo-controlled trial of oral tobramycin in acute ulcerative colitis. Eighty-four patients with an acute relapse of ulcerative colitis were randomized to receive oral tobramycin or placebo for 1 week as an adjunct to steroid therapy. At endpoint, 31 of 42 (74%) in the tobramycin group achieved complete symptomatic remission compared with 18 of 42 (43%) in the placebo group (P = 0.008). The tobramycin group achieved better histological scores (P less than 0.05) at endpoint. These findings show that treatment with oral tobramycin improves the short-term outcome of patients with ulcerative colitis in relapse.     

Antigenic diversity of the asexual developmental stages of Eimeria tenella

Total polypeptides from unsporulated and sporulated oocysts, sporozoites and the first two generations of merozoites of Eimeria tenella were fractionated by electrophoresis through polyacrylamide gels. The parasites are complex and the arrays of polypeptides differ for each of the developmental stages indicating that there is stagespecific control of gene expression. In particular, first generation merozoites display a markedly different polypeptide profile to that of either sporozoites or second generation merozoites. Changes in antigenicity during sporulation and the antigenic relationships between the three asexual zoite stages were examined by probing electroblotted polypeptides with a panel of antisera raised in rabbits to purified preparations of each stage. Antigenic cross-reactivity is well maintained throughout sporulation even though the sizes of antibody-reactive polypeptides change. In contrast there is a marked lack of cross-reactive epitopes between sporozoites, first and second generation merozoites.     

Working alongside the general practitioner: a child psychiatric clinic in the general practice setting

A monthly child psychiatric clinic was established in a primary health care centre in order to offer a more accessible service to patients, and to improve liaison with primary health care professionals. Compared with the base child guidance unit, at the health centre there was a better first attendance rate, a much higher proportion of referrals from health professionals especially general practitioners, and an increased proportion of younger children referred. If further follow-up was necessary at the child guidance unit the attendance rate was very good. The service provided, although not reducing the need for a main multidisciplinary base, offered an acceptable and accessible opportunity for children with psychological problems to be assessed and treated, and for the referring professionals to have easy communication with the child psychiatrist.     

A review of chest physiotherapy in neonatal intensive care units in Australia

Clinical techniques and protocols for chest physiotherapy vary greatly from one Neonatal Intensive Care Unit to another. In 1988 a questionnaire designed to investigate differing techniques used was distributed to Neonatal Intensive Care Units (NICU) around Australia. Fourteen of the 15 questionnaires were completed and returned. The results revealed that the methods of chest treatment and the indicators for commencing chest treatment were similar throughout NICU. Both physiotherapists and nursing staff played a role in the performance of chest treatment in all but one unit where it was the responsibility of nursing staff. However, the area in which there was most variability between NICU was the individual treatment protocols employed pre- and postextubation of the neonate. A review of literature over the past 10 years also demonstrates variability in chest physiotherapy. It was concluded that further well-controlled studies with larger sample sizes are needed to validate the use of chest physiotherapy for the neonate, especially in relation to the techniques and specific protocols employed.     

Congenital rubella syndrome in Western Australia

Abstract The birth prevalence of congenital rubella syndrome (CRS) in Western Australia has been around 20 per 10 000 live births with peaks up to 100 per 10 000 in rubella epidemic years. The rate appears to be falling but it is still too soon to know whether the rubella vaccination programme in Western Australia has made a significant impact. The cohorts of young women who would have received the schoolgirl vaccination programme are only now entering the child bearing age groups. Observed falls may be due also to delayed diagnosis particularly of cases of deafness only. The proportion of nonimmune young women who would have been eligible for the programme in one maternity hospital has fallen.
This study needs to be repeated to ascertain whether further epidemics of rubella have resulted in peaks of CRS or whether the vaccination programme has started to have an effect.     

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 Heart Rate Response to Carotid Artery Massage in a Sample of Healthy Elderly People

Carotid artery massage was carried out in a cross-section of 95 healthy elderly subjects (51 men and 44 woman, mean age of 74 years) to assess the heart rate response and associated symptoms. These subjects were drawn from a larger group of randomly selected healthy elderly people living in Southampton. They had no history of myocardial infarction or stroke and were not taking any drugs that might enhance the carotid sinus reflex. A continuous distribution of response to carotid artery massage was seen with a median percent change in RR interval of 11.6% (IQR 22.9%); 66% had a percent change in RR interval of < 20%, 90% had a change of < 50%, and 9.5% a change of > 100%. Carotid sinus hypersensitivity (sinus arrest > 3 s) was found in 4 previously asymptomatic subjects; a prevalence of 4.2% (95% CI 1.2%–10.4%), and this was associated with dizziness in 2 of these 4 subjects. Dizziness also occurred in one other subject who had a change in RR interval of 178%, The definition of an abnormal carotid sinus reflex is arbitrary given the continuous RR interval response to carotid artery massage. In diagnosing carotid sinus syndrome, the RR interval response to carotid artery massage alone is not sufficient, as this maneuver must also reproduce the patient's presenting symptoms.