International survey of peritoneal dialysis training programs.

OBJECTIVE: To survey nurses around the world about current practices for peritoneal dialysis (PD) home training programs. DESIGN: Random sampling of nurses to complete a written survey from the International Society for Peritoneal Dialysis Nursing Liaison Committee. Settings: United States, Canada, South America (Brazil, Columbia), The Netherlands, Hong Kong. METHODS: Surveys and responses were sent by fax whenever possible, or by regular mail, or hand carried, or conducted by telephone. Results were stratified by geographic areas as well as by cumulative responses and were expressed as medians with ranges. Kruskal-Wallis was used to evaluate differences in responses. Associations between variables were tested with Pearson correlation. Univariate regression analysis was used to evaluate the impact of variables on peritonitis rates. Variables with p < 0.10 were included in a multivariate analysis. RESULTS: A total of 317 nurses responded: 88 in the United States, 46 in Canada, 58 in South America, 58 in Hong Kong, and 67 in The Netherlands. This represented 37% of all surveys distributed. Respondents had a median of 12 years' experience in nephrology (range 1-35 years), but only 31% had a formal background in adult education. Nearly half received their guidance to patient training from a nurse colleague, 11% were guided by a corporate colleague, and 8% were simply self-taught. Clinics responding had a median of 30 PD patients (range 1-400) and reported they trained a median of 8 patients per year (range 0-86). Reported peritonitis rates were a median 0.46 per year or 1 episode every 26 months. Peritonitis rates, however, were not known by 53% of respondents. Total training time per patient had a very wide range of hours, from 6 to 96. There was no correlation between training time and peritonitis rates among the study respondents (p = 0.38), nor with any other variables. CONCLUSIONS: There is wide variation in practices for PD patient training programs within countries and around the world. Training time did not appear to be related to peritonitis rates. Randomized trials of training practices are needed to determine which approaches produce the best outcomes for patients.     

Knee arthroscopy and arthrotomy under local anesthesia

We report our experience with knee arthroscopy in local anesthesia in 64 patients with subsequent arthrotomy in 14 of these. The effectiveness of the anesthetic method was evaluated by both the patient and the anesthetic personnel. There was no difference in pain assessment between arthroscopy alone and arthroscopy followed by arthrotomy. Half of the patients had no pain and only one regarded the procedure as very painful. Supplementary analgesia with 0.05 mg fentanyl was given to half of the patients not undergoing arthrotomy and to two thirds of those who had arthrotomy. It was not necessary to abandon any arthroscopic or surgical procedure because of pain. We conclude that local anesthesia is a safe and practical method for diagnostic arthroscopy, arthroscopic surgery, and minor arthrotomy.     

Moment-to-moment dynamics of ADHD behaviour in South African children

Background  

The behaviour of children with Attention-Deficit/Hyperactivity Disorder is characterized by low predictability of responding. Low behavioural predictability is one way of operationalizing intra-individual ADHD-related variability. ADHD-related variability may be caused by inefficient behavioural selection mechanisms linked to reinforcement and extinction, as suggested by the recently published dynamic developmental theory (DDT) of ADHD. DDT argues that ADHD is a basic neurobehavioural disorder, caused by dysfunctioning dopamine systems. For establishing ADHD as a neurobehavioural disorder, findings from studies conducted in Western countries should be replicated in other cultural populations. The present study replicated the study conducted in Norway, with children from the Limpopo province in the Republic of South Africa.     

Serum fructosamine in diabetic pregnancy

Serum fructosamine was measured in 275 blood donors, in 559 subjects with a normal pregnancy, in 32 gestational diabetics being treated with insulin and 69 being treated by diet only, and in 53 pregnant subjects with established diabetes. In none of the pregnant subgroups did the mean fructosamine concentration exceed that of the donor group. The concentration in normal pregnant subjects showed a modest but significant decrease with gestational age and an increase with maternal age. Hyperglycemic non-pregnant subjects (n = 24) had significantly increased serum fructosamine concentrations, and 96% of these subjects exceeded the upper 95% confidence limit for fructosamine in the donor group. A highly significant correlation was demonstrated between serum fructosamine and preprandial plasma glucose in the hyperglycemic subjects. A weak, but significant, correlation was shown for the entire population sample of antenatal patients, while this was non-significant within each of the sub-groups comprising established diabetics and gestational diabetics, respectively.     

Influence of timing in the fructosamine assay

The fructosamine assay, based on the measurement of the reducing activity in serum at alkaline pH, provides an index of protein glycation. The reducing activity is expressed in equivalents of 1-deoxy-1-morpholinofructose (DMF) by direct comparison with the activity either of this synthetic compound or with a secondary protein standard calibrated against DMF. This study reports the influence of assay timing on the apparent serum fructosamine concentration. The kinetics of alkaline reducing activity in serum differed from that in both DMF and a secondary protein standard. When compared with DMF, activity in serum increased but decreased relative to the protein standard as the pre-incubation interval of the assay was shortened. The use of secondary protein standards results in underestimation of serum fructosamine concentrations when the pre-incubation phase of the assay is shorter than that used for the calibration of the secondary standard. Ascorbate exerted an inhibitory effect in fructosamine assays with pre-incubation times exceeding 5 min. The inhibition increased with both the concentration of ascorbate and the duration of the pre-incubation.     

Morphology of the tegument of Schistosoma intercalatum; comparison of three stocks from Cameroon, Zaire and Gabon

The study of the teguments of male Schistosoma intercalatum with SEM shows two different morphological types: a) Type Cameroon (Edea) (consistent with the previous studies by Kuntz et al.). b) Type Za?re (Kisangani) similar to type Gabon (Libreville).     

Altered cAMP Response after Isoprenaline Stimulation of Mononuclear Leucocytes from Insulin-Dependent Diabetic Patients with Hypoglycaemia Unawareness

Abstract: Loss of adrenergic hypoglycaemic symptoms is the most distinctive feature in insulin-dependent diabetes mellitus (IDDM) patients with hypoglycaemia unawareness. Previous reports from in vivo studies show reduced heart rate responsiveness both to adrenergic agonists and antagonists in these patients. This study was carried out to investigate whether the reduced adrenergic sensitivity in IDDM patients with hypoglycaemia unawareness (IDDM-unaware) also could be demonstrated as reduced increase in cAMP production in mononuclear leucocytes induced by isoprenaline stimulation, or reduced inhibition by ICI-118551 (a selective β₂-adrenergic receptor blocker) of isoprenaline induced cAMP production. We found that the slope of the concentration-response curves of isoprenaline/cAMP and the maximal cAMP concentrations obtained after isoprenaline stimulation were reduced in IDDM-unaware compared to control and IDDM patients with normal hypoglycaemia awareness (IDDM-aware). We did not find any significant differences in the response to ICI-118551 between control, IDDM-aware and IDDM-unaware. This study supports the reports of reduced sensitivity of adrenergic agonists as a part of the pathophysiological changes in hypoglycaemia unawareness, but we have not been able to confirm the reports of an association between hypoglycaemia unawareness and reduced effect of adrenergic antagonists.     

Seasonal patterns in the transmission of Schistosoma haematobium, S. mattheei and S. mansoni in the highveld region of Zimbabwe

The pattern of fluctuation in the population size of Bulinus globosus and Biomphalaria pfeifferi, in their infection rates with Schistosoma haematobium/S. mattheei and S. mansoni, respectively, and in the cercarial population size as monitored using hamster immersions, was elucidated in streams in the temperate highveld region of Zimbabwe over a 27-month period during 1982-1984. The results revealed that transmission of S. mansoni was erratic and unpredictable without a clearcut seasonal transmission pattern. In contrast, transmission of S. haematobium and S. mattheei exhibited a marked seasonal pattern, being most intensive during the hot, dry season (September-November) and markedly reduced during the cold, dry season (June-August). During the rainy (December-February) and warm, post-rainy (March-May) seasons transmission was moderate and variable, but occasionally intensive. The results also showed that rodent immersion is to be preferred to measurements of snail population size and snail infection rate in elucidating seasonality of transmission of schistosomiasis.