Nursing the immobile: a preliminary study.

Permanent loss of mobility has profound physical and mental consequences for both sufferers and carers, and is a major challenge to the National Health Service. A recent study has shown that 42% of beds in departments of Geriatric Medicine are occupied by people with longstanding immobility. These people are highly dependent on nursing staff for their daily activities and quality of life. The assessment of mobility, as a single parameter of dependency, and the measurement of allocated nursing hours are both rapidly and easily performed on geriatric wards. It is felt that a simple correlation of these two variables might highlight areas where more detailed audit is desirable. This study demonstrates that the more immobile patients on a ward, the less the hours allocated to Registered and Learner grade nurses. Some possible reasons for this are suggested and the effects of this deployment on nursing practice and staff recruitment are discussed. It is felt that provision of appropriate nursing care to the most dependent patients in continuing care areas is essential, and that high levels of trained staff are needed to ensure this.

Does instillation of chlorhexidine into the bladder of catheterized geriatric patients help reduce bacteriuria?

A randomized prospective trial compared the effect on the bacterial flora of the urine of the instillation of chlorhexidine or of normal saline into the bladder of two groups of elderly patients with indwelling urinary catheters. There was no reduction in urinary bacterial count in either group of patients.

The bedfast.

Many geriatric beds are occupied by bedfast patients. Most were immobile from the time of admission and many were admitted from other hospital departments or residential care. More are discharged home than remain in hospital or are transferred to any other institution. Although a small minority of admissions become long-term bedfast inpatients this group require a disproportionate resource commitment. Reduction in the number of bedfast inpatients is more likely to be effected by changes in unit policy than by improvement in clinical practice.

Tuberculous pericarditis. A review of 100 cases.

A retrospective survey of 100 Black patients with presumed tuberculous paricarditis showed that 82 presented with pericardial effusion while 18 had constrictive pericarditis. The mortality rate was 17%. Of the 82 patients with pericardial effusion, 15 developed 'constricting pericarditis' within 4 months; 12 required pericardiectomy. Sixteen patients died of cardiac tamponade; the effusion had been confirmed by a radio-isotope heart pool scan but had not been aspirated. This emphasizes the need for early and repeated pericardial aspiration. The fate of 38 rural patients with pericardial effusion was not known. Of the 18 patients with constrictive pericarditis, 7 underwent pericardiectomy, while 3 refused operation.

Cell-mediated immunity in measles using the leucocyte migration test.

The cell-mediated immune response was investigated in 21 children with acute measles and in 8 healthy children using the intradermal Heaf and leucocyte migration tests. Tuberculin and purified protein derivative were used as antigens. Whereas all the children with measles were anergic in the in vivo test, two groups of children, i.e. 'reactors' and 'non-reactors' could be delinerated with the in vitro test. The mechanisms responsible for the anergy are discussed.

Failure to obtain positive MEM tests in either cell-mediated immune conditions in the guinea-pig or in human cancer.

The macrophage electrophoretic mobility test described by Caspary and Field (1971) and modified by Pritchard et al. (1973) was investigated in various models of cell-mediated immune conditions in the guinea-pig and in cancer in man. No positive results were obtained in 92 guinea-pig experiments. Only 17 of 154 experiments on 74 patients gave definite positives in experiments with human cancer and a few positive results were obtained with normal healthy subjects.

Immunological aspects of hepatocellular carcinoma in the guinea-pig.

Experimental observations were made on hepatic cancer induced with diethylnitrosamine (DEN) in guinea-pigs. Two cancer cell lines have been established in tissue culture and their antigenicity investigated. Tumour antignes were not found on normal liver cells, liver cells damaged wtih carbon tetrachloride and fetal liver cells obtained from fetuses more than 35 days old. The possibility of using immunological techniques to investigate the antigenicity of human cancer is discussed.

Clinical aspects of hepatocellular carcinoma in man.

The clinical and biochemical findings in 207 Black patients with hepatocellular carcinoma are presented. A bruit over the liver was heard in 25% of the patients, a previously underemphasised sign. In 28 of the 30 biopsy-proven cases alpha-fetoprotein levels were elevated. Hepatitis B antigen was found in 41% of the patients.

Comparison of antigenicity of hepatoma cells, normal liver cells, foetal liver cells and chemically damaged liver cells in guinea-pigs immunized with hepatomata using the macrophage migration inhibition test.

The macrophage migration inhibition test has been used to study the immune responses of guinea-pigs immunized with injections of whole cells of both an allogeneic and a syngeneic hepatoma grown as established cell lines in tissue culture.A clear dose-response relationship between tumour cell concentration and migration inhibition was seen in immunized animals and no significant migration inhibition was seen in control animals. There was no cross reaction between the two tumours used. There was no cross reaction between whole isolated normal liver cells and tumour cells, or between foetal liver cells and tumour cells. Whole isolated liver cells from carbon tetrachloride damaged livers caused some degree of migration inhibition in both normal and immunized guinea-pigs but, taking this into account, they did not appear to cross react with hepatoma cells.