A patient education MAP: an integrated, collaborative approach for rehabilitation.

Because Roosevelt Warm Springs Institute for Rehabilitation has been faced with decreasing patient lengths of stay, increasing patient acuity, and changes in the nurse staffing mix, nurses wanted to ensure that patients and their families were receiving appropriate education and learning the skills required to provide safe and competent self-care in the home. As a result, they developed a patient education action plan. This multidiscipline action plan (MAP) involved changing from a multidisciplinary to an interdisciplinary approach toward patient and family education. This plan provides a framework that is linked to expected outcomes for education during a patient's stay, reduces the redundancy of patient education by professionals from different disciplines, and increases collaboration. Teaching modules that outline and provide all of the information an educator needs to effectively teach a patient or group of patients make up the basis for the MAP system. This article describes the MAP system and the related continuous quality improvement activities, offers documentation forms, and identifies a structural path.

Yersinia enterocolitica meningitis and septicaemia in a patient with acute lymphoblastic leukaemia.

We report the first case of Yersinia enterocolitica meningitis and septicaemia during induction treatment for acute lymphoblastic leukaemia. The patient was also being treated with recombinant granulocyte colony stimulating factor and hence pursued an unusually mild clinical course.

Prostate biopsy in patients after proctectomy.

Until the discovery of prostate specific antigen as a tool to detect prostate carcinoma, the rectum has always been necessary to allow the best evaluation and biopsy of the prostate, whether by digital examination or transrectal ultrasound. We describe a simple, accurate, computerized tomography-guided method to biopsy the prostate in men who have undergone proctectomy.

Recombinant human erythropoietin therapy in children maintained by haemodialysis.

Six children (aged 3 years 11 months to 15 years 9 months) with end-stage renal failure and anaemia (mean haemoglobin 7.1 g/dl, range 6.3-7.7 g/dl) on thrice-weekly haemodialysis were treated with recombinant human erythropoietin (rHuEPO), given as an intravenous bolus in an escalating dose regime after dialysis. All responded with an increase in reticulocyte count and haemoglobin concentration in a mean time of 11 weeks (range 9-13 weeks) and at a dose of 100 or 150 units/kg thrice weekly. The dose of rHuEPO was then adjusted to maintain the haemoglobin concentration within the lower half of the normal range for the child's age and sex. The mean haemoglobin after 12 weeks treatment was 10.9 g/dl (range 8.5-12.1 g/dl) and after 24 weeks, 10.5 g/dl (range 7.9-13.3 g/dl). Four children had no further need for blood transfusion and are thus no longer at risk of blood-borne infection, iron overload and sensitisation to HLA histocompatibility antigens. Serum ferritin fell in the three patients with evidence of iron overload; the three with low or normal iron stores at the onset of treatment maintained erythropoiesis with oral iron supplementation. HLA antibodies decreased in all patients. The only serious complication encountered was thrombosis of vascular access in one child. No child became seriously hypertensive or developed cerebral symptoms. The benefits of rHuEPO therapy for children with end-stage renal failure are potentially considerable and with careful monitoring, the risks low.

Hepatic parenchymal gas after blunt trauma.

Hepatic parenchymal gas was demonstrated by computed tomography in a boy who had sustained severe blunt trauma to the abdomen 12 hours earlier. There was no clinical evidence of infection. Although previous reports have suggested that hepatic parenchymal gas indicates the presence of infection, such gas may also be a manifestation of severe blunt trauma without infection.

Early venous thrombosis: A scanning electron microscopic study.

The passage of a minimal electric charge was used to initiate thrombosis in rabbit femoral veins, and the events occurring during formation of the thrombus were observed using scanning electron microscopy. Thrombosis began to occur within ten minutes after passage of the charge, upon an apparently unaltered endothelium. The first event was the laying down of a fibrin meshwork and this was shortly followed by the appearance of regularly arranged platelet clumps.

Erythrocyte fluorescence and lead intoxication.

Blood samples from people exposed to inorganic lead were examined by fluorescence microscopy for excess erythrocyte porphyrin. With continued lead absorption, fluorescent erythrocytes appeared in the circulation of workers handling this metal or its compounds, and they progressively increased in number and brilliance. These changes ensued if the blood lead concentration was maintained above 2-42 mumol/l (50 mug/100 ml), and preceded any material fall in the haemoglobin value. At one factory, 62-5% of 81 symptomless workers showed erythrocyte fluorescence attributable to the toxic effects of lead. Excess fluorocytes were found in blood samples from a child with pica and three of her eight siblings. These four were subsequently shown to have slightly increased blood lead concentrations (2-03 to 2-32 mumol/l). Fluorescence microscopy for excess erythrocyte porphyrin is a sensitive method for the detection of chronic lead intoxication. A relatively slight increase in the blood lead is associated with demonstrabel changes in erythrocyte porphyrin content. The procedure requires little blood, and may be performed upon stored samples collected for lead estimation. The results are not readily influenced by contamination, and provide good confirmatory evidence for the absorption of biochemically active lead.

A basophilic micro-organism infecting human red cells.

Clusters and chains of basophilic micro-organisms were found on the red cells of a woman who suffered from malignant melanoma. The infection was clinically silent for at least 7 years. During her last year of life the patient became febrile and anaemic. Her spleen enlarged and the basophilic bodies on her red cells became coarser. The infecting organism is referred to only as a 'basophilic agent', since its relationships to recognized genera are uncertain. Similar epierythrocytic parasites occur in a wide variety of animals. Though these infections are often latent, they profoundly modify host immune responses.

Bone marrow lipofuscin.

Lipofuscins are commonly present in the macrophages of the marrow. In unstained preparations they may be confused with haemosiderin, but they are readily distinguished by fluorescence microscopy. In contrast to the belief that lipofuscins are a manifestation of senility, no age dependence has been demonstrated. Exceptionally large amounts have been found in illnesses accompanied by fever and leucocytosis, in keeping with the concept of their formation from insoluble remains of ingested cell fragments. It is probable that the ;sea-blue histiocytes', described in the literature, are macrophages laden with strikingly uniform granules of lipofuscin.