The regional drug information service: a factor in health care?

Most regional health authorities throughout the United Kingdom have established drug information units to provide health service staff with a wide range of information about drugs and drug use. The units, which are staffed by drug information pharmacists, provide their service mainly by answering inquiries, although some disseminate information more positively through lectures and bulletins.An analysis of inquiries received by regional information units during 1976 showed that most were submitted by hospital doctors or pharmacists; comparatively few were received from general practitioners. Topics of inquiry included adverse effects of drugs, source of supply and identification, current treatment, dosage, route, precautions, and pharmaceutical problems such as stability or formulation of drug preparations. A more detailed analysis of the inquiries received by the North-western Regional Drug Information Service at Manchester over three years showed that the number of inquiries gradually increased and that more were received from general practitioners after a programme of lectures had been introduced to tell them about the service. The North-western service also received more requests from hospital pharmacists than other units, though many originated from clinicians.The regional drug information units consulted widely with clinical and other specialists in answering questions, but about a quarter of all inquiries were pharmaceutical, relating to stability and incompatibility. A multidisciplinary approach therefore seems necessary to provide a comprehensive and advisory drug information service.     

BACUP--the first two years: evaluation of a national cancer information service.

The cancer information service of the British Association of Cancer United Patients (BACUP) was launched in October 1985 as a national service to patients and their relatives, the public, and health professionals. Information is provided by telephone and letter by seven nurses trained in oncology. In the first two years over 30,000 inquiries were received: 23,527 (80%) were from women; 9445 (32%) were from cancer patients 11,574 (39%) from relatives of patients, and 2869 (10%) from health professionals. Inquiries came from all over the United Kingdom and from all sections of society but users were predominantly middle class, aged between 30 and 49, and living in south east England. Information about specific cancer sites, treatment, and how to cope was most commonly sought. Nearly a third of all inquiries were related to breast cancer. Though the service is used more by particular groups focusing on particular diseases, clearly there is a need for a cancer information service in the UK.     

Inquiry into homicides by psychiatric patients: systematic audit should replace mandatory inquiries.

Inquiries into homicides committed by psychiatric patients are currently mandatory under Department of Health guidance. They are often broadly defined in their terms of reference and almost always address not only the cause of the incident but also professional skill, practice, and culpability. Concurrent pursuit of both purposes is unlikely to maximise "learning from experience." Also, since inquiries can set their own thresholds for culpability, doctors can potentially be judged to a higher standard than would be required by the General Medical Council or negligence law. Lack of strict legal process increases the inherent potential unfairness to doctors. Investigation of cause and culpability should be separated and inquiries restricted to the former. There should also be a standing secretariat for inquiries to set terms of reference and to collate and distribute findings of inquiries. Widespread mandatory systematic audit of professional practice and service efficiency concerning risk assessment and management should largely replace costly ad hoc mandatory inquiries after homicides.     

National Poisons Information Services: report and comment 1980.

The National Poisons Information Services (NPIS) covering the United Kingdom and the Republic of Ireland currently receive over 40,000 telephone inquiries a year. Over the years there has been little change in the proportion of inquiries related to each of the main categories of poisons (drugs, household, chemical, agricultural, animals, and plants). More detailed analysis, however, shows pronounced changes in the inquiries relating to specific types of poisoning, particularly with drugs. By monitoring these trends and assessing the risks of toxicity, the NPIS has an important role in informing the medical profession of the need for preventive measures and for improved methods of treatment. At present, the NPIS cannot make full use of the available data due to inadequate staffing and lack of computer facilities. It is argued that for a modest increase in funding a much more comprehensive service could be provided.     

The National Poisons Information Service and hospital admissions for children--the experience in Wales of the Cardiff Centre.

When inquiries to the Cardiff Centre of the National Poisons Information Service were compared with hospital admissions in the eight health authorities in Wales the findings suggested fewer admissions in the area within which the centre is situated and showed a more extensive use in that area than elsewhere. High inquiry rates were associated with high hospital admission rates when the eight areas were compared. If the service were delegated to area level a more complete community use would result.     

Analysis of pregnancy-related calls to an occupational hazard hot line.

Since 1980 the Hazard Evaluation System and Information Service has responded to over 11,000 inquiries regarding workplace health hazards. Of 2,424 inquiries in 1986, 593 (24%) concerned hazards to pregnancy. This represents a 17-fold increase since 1981. Most pregnancy-related inquiries were from employees (70%) and health care providers (23%). Referral sources for the employees calls were almost exclusively individual health care providers or institutions that provide health care or health counseling, or both. These data suggest that pregnant employees seek information on their own or from health care providers instead of from employers. Of the inquiries, 80% were for general pregnancy hazard information; 20% involved symptomatic pregnant employees. Most inquiries concerned employment in the services (58%) and manufacturing (26%) sectors. Organic solvents, pesticides, acrylic nail-grooming products, lead, and video display terminals were among the agents about which callers inquired most frequently.     

Beneficial effects on employment and preventive health care: the concept and results of counselling processes from a German project

Since December 1998 a project of working time counselling named "Design of Modern Working Times" is supported by the federal state of North Rhine-Westphalia in Germany and the European Union; AWiS-consult is entrusted to carry out this project. The service offered to all companies, institutions, work committees, and employees interested covers information, assessment of existing working time schedules, development of alternative or new working time schedules, and accompanying implementation processes. Up to June 2001 nearly 300 inquiries were worked on, most of them from industry, service companies, and from the field of care and hospitals. Working time design in this project aims not only at work safety and health care but also at beneficial effects on employment. In a special campaign from May 2000 to May 2001, 61 companies were supported by AWiS-consult, with the result of more than 400 new employees and 16 companies with employment secured, so the combination of preventive health care and beneficial effects on employment by working time design can be assessed as successful.     

Obstetric audit using routinely collected computerised data.

OBJECTIVE--To examine the use of routinely collected computerised data in clinical audit. DESIGN--Retrospective review of all analyses of obstetric practice based on a computerised data system from January 1983 to June 1988. SETTING--Maternity department of the regional referral hospital in Oxford. MAIN OUTCOME MEASURES--Congruence with the principles of clinical audit; that is, comparing clinical practice with previously agreed standards and changing practice to meet these standards if necessary. RESULTS--Over the five and a half years of the study the data formed the basis of 130 special inquiries into different aspects of obstetric practice. Most inquiries seemed to be aimed only at describing current activities and identifying trends. Genuine clinical audit was rare. Simple audits--for example, concerning induction for pregnancy after term--could be supported by the computerised data, but for detailed and wide ranging audits--for example, reducing antenatal clinic visits for low risk multiparas--the data had to be supplemented from other sources. CONCLUSIONS--Routinely collected computerised data enable ongoing clinical audit, but it becomes a reality only when clinicians agree on standards of practice and have a flexible attitude towards change. Even then, genuine clinical audits of obstetric practice demand more detailed and comprehensive data than are generally available on such systems.     

Consequences a long terme de la vasectomie: Revue de la litterature

Since 20 years, many contradictory data have been reported about vasectomy in animals and in humans, as regards its efficacy and safety. We have examined the main experimental and clinical reports, published these last 20 years. In particular experimental conditions, in animals subject to hypercholesterolemic diets, vasectomy would cause negative effects, particularly an increased atheroma risk. But, none of the large epidemiologic inquiries performed until now in several developed and on developing countries, showed an increased vascular and infarction risk in vasectomized males.     

Molecular markers reveal differentiation among isolates of Coccidioides immitis from California, Arizona and Texas

Coccidioides immitis causes coccidioidomycosis, a fungal disease of both immunocompromised and otherwise healthy people; it is capable of causing large epidemics and the disease is often refractory to chemotherapy. To quantify the magnitude of population differentiation and estimate levels of gene flow in C. immitis , multilocus genotypes were scored for 20–25 clinical isolates from each of Bakersfield (California), Tucson (Arizona), and San Antonio (Texas). The molecular markers used were PCR products with polymorphic restriction endonuclease sites, found and characterized in a previous study of the Tucson population. The data show very highly significant differences in allele frequencies between all three populations, and suggest very low levels of migration between populations. One isolate in the San Antonio sample was an outlier, showing the California-specific allele at all four of the loci distinguishing the two populations, and subsequent inquiries indicated that the infection had indeed been acquired in California. Thus, genetic information can be used to infer the geographical origin of a fungal infection.     

Postoperative analgesics in South African Clawed frogs (Xenopus laevis) after surgical harvest of oocytes

Heightened awareness for the welfare of earlier-evolved laboratory species has prompted increasing inquiries by institutional animal care committees, investigators, and laboratory animal veterinarians regarding the need for post-surgical analgesics in laboratory Xenopus. Basic research into the mechanisms and regulation of pain in Rana pipiens has demonstrated the clinical potential of opioid, alpha2-adrenergic, and non-opioid analgesic agents in amphibians. However, clinical studies using objectively established indices of amphibian pain, or pharmacological studies in either Rana pipiens or laboratory Xenopus have not been conducted. As discussed above, comparison of limited lethality data suggests that the safety index for these agents is quite narrow in Rana pipiens. Analgesic use in laboratory Xenopus has the added risk of drowning due to over sedation. Drug doses extrapolated from such studies and intended to provide pain relief in Xenopus should therefore be considered very carefully. An additional concern for laboratory Xenopus is that the effects of these agents on amphibian oogenesis, oocyte quality, and embryogenesis are unknown. As the numbers of laboratory Xenopus used in basic and biomedical research continues to increase, clinical studies that address all of these issues cannot come too soon.     

In vivo therapeutic applications of cell spheroids

Spheroids are increasingly being employed to answer a wide range of clinical and biomedical inquiries ranging from pharmacology to disease pathophysiology, with the ultimate goal of using spheroids for tissue engineering and regeneration. When compared to traditional two-dimensional cell culture, spheroids have the advantage of better replicating the 3D extracellular microenvironment and its associated growth factors and signaling cascades. As knowledge about the preparation and maintenance of spheroids has improved, there has been a plethora of translational experiments investigating in vivo implantation of spheroids into various animal models studying tissue regeneration.We review methods for spheroid delivery and how they have been utilized in tissue engineering experiments. We break down efforts in this field by organ systems, discussing applications of spheroids to various animal models of disease processes and their potential clinical implications. These breakthroughs have been made possible by advancements in spheroid formation, in vivo delivery and assessment. There is unexplored potential and room for further research and development in spheroid-based tissue engineering approaches. Regenerative medicine and other clinical applications ensure this exciting area of research remains relevant for patient care.     

Evaluation of a primary care adult mental health service: Year 2

Aims This study aimed to examine the effectiveness of a primary care adult mental health service operating within a stepped care model of service delivery.Methods Supervised by a principal psychologist manager, psychology graduate practitioners provided one-to-one brief cognitive behavioural therapy (CBT) to service users. The Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) was used to assess service user treatment outcomes. Satisfaction questionnaires were administered to service users and referring general practitioners (GPs).Results A total of 43 individuals attended for an initial appointment, of whom 19 (44.2%) completed brief CBT treatment. Of the 13 service users who were in the clinical range pre-treatment, 11 (84.6%) achieved clinical and reliably significant improvement. Of the six service users who were in the non-clinical range pre-treatment, three (50%) achieved reliably significant improvement. Both service users and GPs indicated high levels of satisfaction with the service, although service accessibility was highlighted as needing improvement.Conclusion The service was effective in treating mild to moderate mental health problems in primary care. Stricter adherence to a stepped care model through the provision of low-intensity, high-throughput interventions would be desirable for future service provision.     

论医院药学服务的有效开展

目的探讨对药学服务的性质,明确药学服务的涵义,促进我国医院药学服务工作的有效开展。方法对与药学服务密切相关的各学科分别加以分析。结果在我国目前特定的条件下,医院药学服务工作能否有效开展并不单单取决于临床药师,而是更多地取决于医院管理层对医院药学服务的认识程度和重视程度,取决于医院开展药学服务的管理体制和管理机制。结论多学科支撑性是医院药学服务的基本特性,这一性质决定了医院药学服务的有效开展需要多种技术人才的通力协作。     

优质服务对结肠癌手术患者早期康复治疗的效果及满意度调查

目的:探讨优质护理服务对结肠癌患者术后恢复的临床效果,为提高临床护理质量提供参考。方法:选取2011年4月-2013年9月在我院胃肠外科接受手术治疗并住院观察的患者76例,随机分为优质服务组和常规护理组,每组38例。优质服务组患者接受心理护理、饮食管理及健康教育等优质护理服务,而常规护理组则接受基本的护理方法。比较两组患者术后的临床疗效,并对护理服务的满意度进行问卷调查。结果:优质护理服务组患者术后拔管时间、排气时间、下床活动时间及住院时间均显著优于常规护理组,且并发症的发生率较低,差异具有统计学意义(P0.05)。优质护理服务组患者对心理护理、饮食管理、健康教育、护患沟通、服务态度及专业技能的满意度评分明显高于常规护理组,差异具有统计学意义(P0.05)。结论:优质护理对结肠癌患者术后的早期康复治疗具有良好的效果,充分满足患者的合理需求,提高了护理质量及患者满意度,值得推广采用。     

A Psychiatric Emergency Service: A Preliminary Report

An emergency service for psychiatric patients was organized in a general hospital owing to the increasing need for such a service. Its main functions have been to screen cases, to offer short-term treatment, and to provide immediate consultation facilities to general practitioners and clinical experience to students, interns and residents.Of 133 patients, 40% were diagnosed as psychotic and 35% as neurotic. The commonest presenting symptoms were anxiety and depression. Approximately 40% were treated by the staff of the emergency service, 40% were sent back to the general practitioner for treatment, and 20% were transferred to a mental hospital.It is concluded that this type of service can provide immediate and effective consultation and treatment for psychiatric emergencies, and is a very useful teaching facility, especially for students and physicians not intending to specialize in psychiatry.     

Deaths of two hospital inpatients poisoned by pilocarpine.

Two inpatients of one hospital ward died. Pilocarpine poisoning was suspected and subsequently confirmed by analysis of urine. The circumstantial evidence strongly suggested that the food given to the patients in the ward had been adulterated. Police inquiries failed to elicit any further information, and open verdicts were returned at the inquest. Precautions taken subsequently to prevent a similar event--sealing food containers and trolleys--entailed a capital cost of 43,000 pounds. In addition, food stores were kept locked and tighter control kept on drugs stored in ward pharmacies.     

Mobile Macromolecules in Plant Development

Plant cells transmit developmental signals and distribute nutrients via dynamic intercellular channels termed plasmodesmata (PD). Multidisciplinary inquiries have provided evidence that plasmodesmatal regulation is critical to fundamental plant functions, such as development, host–pathogen interactions, and systemic RNA silencing. This review focuses on macromolecules that transport cell-to-cell through PD and describes their implications on plant development.     

Glutamate synthase in developing pea cotyledons: Occurrence of NADH-dependent and ferredoxin-dependent enzymes

NADH-dependent and ferredoxin-dependent glutamate synthasesfrom developing pea cotyledons were separated by gel filtrationon a Sephadex G-200 column. The substrate requirements, molecularweights and effect of some inhibitors on both glutamate synthaseenzymes were investigated. ¹ Department of Agricultural Chemistry, Kyoto University, Kyoto606, Japan. ² To whom inquiries should be addressed. (Received August 9, 1979; )     

构建医患和谐：大型医院图书馆的医学信息服务的“三个面向”

针对临床医疗引发的医患矛盾,从医学信息服务角度提出了以面向医院管理层、临床医务人员和患者的医学信息服务来化解矛盾,阐述了大型医院图书馆以医学信息服务为纽带,构建医患和谐的工作要点。