An audit of long-stay patients in an inner city palliative care centre

An audit was carried out of patients with long admissions to a palliative care centre in central London. The records of patients remaining in the centre for more than 28 days were examined to see whether there were particular features characteristic of long-stay patients which could be identified to improve future admission planning.     

IgE antibodies to D. pteronyssinus in atopic patients.

An aqueous house dust mite extract was separated by SDS-PAGE and transferred to nitrocellulose membranes by Western Blotting. Two major allergens, Der pI and Der pII associated with the mite faeces and body, respectively, were identified on the protein blot. The blot was then probed with atopic sera and the bound antibodies were labelled with 125I anti-IgE and visualized by autoradiography. Using this technique it is shown that serum samples from eczema patients contain a higher proportion of anti-mite body IgE antibodies, whereas those from asthma patients contain a higher proportion of antibodies against the major mite faecal allergen Der pI. Minor mite body allergens are also shown to be important in eczematous patients. The role of mite allergens in atopic conditions is discussed, along with the significance of the findings presented here.     

Focal fits during chlorambucil therapy

An elderly man receiving chlorambucil for chronic lymphatic leukaemia developed focal fits. The onset and frequency were dose related. There was no evidence of metabolic disturbance or of meningeal leukaemia. Although reported in children and well recognized in animals, chlorambucil-induced fits in an adult have not been previously recorded.     

Naturally occurring double-stranded RNA and immune responses. III. Immunogenicity and antigenicity in animals.

Naturally occurring, double-stranded RNA (ds-RNA)) was immunogenic when injected into mice, rats, guinea-pigs, rabbits, dogs and baboons. The response to native material administered intravenously (i.v.) was strongest in rabbits and mice, and weakest in baboons. Mice, guinea-pigs and baboons injected with ds-RNA complexed with methylated BSA emulsified in Freund's complete adjuvant all gave high antibody responses. When ds-RNA was given in aerosol form to mice and guinea-pigs the response was weaker than that following i.v. injection, and baboons did not respond to antigen given as an aerosol. In most species the immune response obtained was predominantly IgM in nature, and there was no evidence for cell-mediated immunity in any species. The only evidence of an adverse reaction associated with repeated administration of ds-RNA was a systemic anaphylactic-type response in a small group of mice given ds-RNA repeatedly in aerosol form and challenged with ds-RNA i.v.     

Hospice at home--a new service for patients with advanced HIV/AIDS: a pilot evaluation of referrals and outcomes.

Between 50 and 70% of patients with a terminal illness indicate a preference to remain at home for as long as possible until their death. Nevertheless, a much smaller percentage actually die at home in England and Wales. A new hospice-at-home service in North London for patients with HIV/AIDS is described in this report. Terminal care for HIV/AIDS patients can be provided at home by a multidisciplinary team which offers 24-hour care.     

Neural mapping of prepulse‐induced startle reflex modulation as indices of sensory information processing in healthy and clinical populations: A systematic review

Startle reflex is modulated when a weaker sensory stimulus (“prepulse”) precedes a startling stimulus (“pulse”). Prepulse Inhibition (PPI) is the attenuation of the startle reflex (prepulse precedes pulse by 30–500 ms), whereas Prepulse Facilitation (PPF) is the enhancement of the startle reflex (prepulse precedes pulse by 500–6000 ms). Here, we critically appraise human studies using functional neuroimaging to establish brain regions associated with PPI and PPF. Of 10 studies, nine studies revealed thalamic, striatal and frontal lobe activation during PPI in healthy groups, and activation deficits in the cortico‐striato‐pallido‐thalamic circuitry in schizophrenia (three studies) and Tourette Syndrome (two studies). One study revealed a shared network for PPI and PPF in frontal regions and cerebellum, with PPF networks recruiting superior medial gyrus and cingulate cortex. The main gaps in the literature are (i) limited PPF research and whether PPI and PPF operate on separate/shared networks, (ii) no data on sex differences in neural underpinnings of PPI and PPF, and (iii) no data on neural underpinnings of PPI and PPF in other clinical disorders.     

Reforming higher specialist training in the United Kingdom--a step along the continuum of medical education

OBJECTIVES: The requirement to align the arrangements for postgraduate training in the United Kingdom with those elsewhere in the European Community provided the opportunity to review and reform our arrangements for higher specialist training. This paper describes the case for change--the strengths and deficiencies of the traditional pattern of postgraduate medical training, demographic influences in the medical workforce and the need for a more structural or planned approach to training. CONCLUSIONS: Over the past 5 years substantial progress has been made: the introduction of new regulatory arrangements and a new higher specialist training grade; the development of a managed and flexible system for delivering training to standards set by the Royal Colleges and which can accommodate the needs of those pursuing academic and research medicine; and the opportunity for trainees' progress to be measured against published curricula. The significant programme of change has been underpinned by careful workforce planning and the publication of comprehensive guidance. Significant reform of higher specialist training has been achieved. This paper also makes the case for a more strategic approach to planning and developing medical education across the continuum, from entry to medical school until retirement, which can guide medical education and improve patient care into the next millennium.     

The incidence of spontaneously occurring antiliver antibodies in New Zealand Black mice

The sera of NZB/BL mice have been found to be active in the complement fixation test against isogeneic liver antigens to a higher titre than the sera of CBA, C57BL and DBA/2 mice. Six sera from NZB mice were fractionated by zone ultracentrifugation in sucrose density gradients and the anti-liver activity was found to sediment with the high molecular weight immunoglobulin. No correlation was found between complement-fixing activity against liver antigens and the presence of globulin on red cells (positive direct Coombs test).