Predicting hospice appropriateness for patients with dementia of the Alzheimer's type.

The appropriateness of admitting individuals to hospice services is determined by assessing the individual's 6-month survival prognosis. Clinical parameters that guide clinicians in assessing prognosis, however, are not well defined in cases of dementia of the Alzheimer's type (DAT) when compared to other illnesses. The Alzheimer's-Hospice Placement Evaluation Scale (AHOPE) was developed to assess the 6-month prognosis of individuals with late-stage DAT. The purposes of this study were to estimate the reliability and predictive validity of AHOPE and to test additional demographic and clinical indicators to determine their added contribution to predicting 6-month survival and hospice appropriateness. Data were collected on 112 long-term care residents with DAT at enrollment and 6 months following enrollment. Initial reliability and predictive validity of AHOPE were supported. Other demographic and clinical indicators were not predictors of 6-month survival. Although additional research is indicated, nurses can use AHOPE to enhance clinical observation and decision making for implementing appropriate care strategies for patients with end-stage DAT and their families.

Measuring patient satisfaction outcomes across provider disciplines.

The purpose of this methodological research was to modify and test an instrument measuring patient satisfaction outcomes with primary care providers who represent different disciplines. The Patient Satisfaction with Health Care Provider Scale (PSHCPS) was adapted from a questionnaire indexing four satisfaction dimensions: Access, Humaneness, Quality, and General Satisfaction (Cherkin, Hart, & Rosenblatt, 1988). Following modification, the PSHCPS was administered to 167 adults with NP or MD providers at a university-based, managed-care setting for the medically indigent. The total scale Cronbach's alpha was .93. Factor analysis supported an unidimensional scale with 18 items loading above .40 and 43% explained variance.

Historic and future health promotion contexts for nursing.

PURPOSE: Health promotion in the United States has been narrowly defined focusing primarily on individual behaviors, risk factors, and lifestyle. This article traces the historic and conceptual roots of health promotion care in the United States and critically examines the direction nurses have taken in health promotion. SCOPE: Health promotion care in Western ideology emphasizes the value of individuals and the importance of personal responsibility for success or failure. CONCLUSIONS: Health promotion nursing interventions, based on the tenets of individual choice and knowledge, restrict the range of interventions. The complex nature of health promotion requires that nurses consider the economic, sociopolitical, and cultural context in which health care takes place. Recommendations are made for an expanded nursing role in health promotion, one that is consistent with nursing's underlying contextual focus and concern with environments.

Different therapeutic approaches and outcome in the treatment of pterygium.

PURPOSE: This study was initiated to investigate the role of different therapeutic modalities in the outcome of the surgical treatment of pterygium. METHODS: The results of treatment of pterygia with a variety of surgical techniques were studied in 56 eyes (49 patients) operated on at Bristol Eye Hospital during a period of five years. The surgical techniques included simple excision; bare sclera; conjunctival autograft; sliding conjunctival flap; lamellar keratoplasty and penetrating keratoplasty. Twelve eyes received additional beta irradiation in a fractionated total dose of 40 Gys. RESULTS: The incidence of recurrence was 23.2% for the 43 treated primary pterygia, and 23% for the 13 recurrent pterygia. All recurrences occurred between 2.5 and 11 months postoperatively. None of the 11 cases where additional beta irradiation was used showed any recurrence or other complication within the study period. In the recurrent pterygia group, the cases treated with a combination of surgical excision and beta irradiation, showed significantly lower recurrence rate (p < 0.001) compared to those cases treated with surgical excision alone. CONCLUSIONS: Beta irradiation as a complement to surgical treatment of pterygium, is successful in treating high risk cases such as reoperations, whereas for the majority of primary pterygia surgical excision alone is adequate. Additionally, follow up of one year will reveal any recurrences.

Randomised trial of effectiveness of second eye cataract surgery.

BACKGROUND: The effectiveness of cataract surgery on one eye is well established, but concerns over health-care expenditure have called into question the value of cataract surgery on the second eye. We examined the effects of second eye surgery in terms of patient perceptions as well as through visual acuity, contrast sensitivity, and stereoacuity tests. METHODS: 208 otherwise healthy patients awaiting second eye cataract surgery were recruited into our randomised trial. At randomisation participants were allocated expedited surgery (planned to take place within 6 weeks) or routine surgery (routine waiting time, 7-12 months). Assessments were made at randomisation and again at review after about 6 months. Eight primary trial outcomes consisted of four questionnaire items and four visual function tests, done with both eyes open. FINDINGS: Traditional clinical tests of success in cataract surgery (visual acuity and contrast sensitivity) showed only slight differences in binocular vision in favour of the expedited-surgery group. There were major benefits for the expedited-surgery group in terms of reported visual symptoms and effects on quality of life. At review, differences in self-reported vision related difficulties between the two groups ranged from 11% (95% CI 4.4-17%, activities) to 30% (19-41%, reading). Stereoacuity was better in the expedited surgery group, the difference between the groups for the proportions with stereoacuity of 3000 s of arc or worse was 58% (47-69%). INTERPRETATION: This trial has shown that there is a clear benefit from second eye cataract surgery.

How effective is undergraduate and postgraduate teaching in ophthalmology?

PURPOSE: To gain an insight into the adequacy of ophthalmic medical education for doctors in the primary care setting. METHODS: A short forced-choice questionnaire was set to 150 randomly selected primary care practitioners in and around Bristol. Information was collected in relation to undergraduate and postgraduate ophthalmic education, ophthalmic confidence, facilities and understanding. RESULTS: One hundred and thirty-three primary care doctors replied to the questionnaire of whom 35% were fundholders and 47% in training practices. Only 22% of all respondents felt their undergraduate ophthalmic medical education to be adequate. However, 83% of the 86 primary care doctors who had attended postgraduate update courses in ophthalmology felt these to be adequate. Despite the availability of an ophthalmoscope and distance vision chart, only 56% felt confident with the ophthalmoscope and only 61% reported that their distance chart was set up in accord with manufacturer's instructions. Seventy-one per cent of respondents reported having access to dilating agents but only 61% felt confident using them. Understanding of two key ophthalmic terms was also poor. Despite the general satisfaction, attendance of postgraduate update courses did not appear to alter facilities, confidence or understanding. CONCLUSIONS: It is apparent that most primary care doctors view their undergraduate ophthalmic medical education as inadequate and this is reflected in their confidence and understanding. Postgraduate courses, although more favourably received, do not appear to after these findings. We strongly suggest, therefore that general ophthalmic education is aimed at teaching examination techniques and ophthalmological principles suitable for primary care practice.

Managing relapse as a positive opportunity for change.

During the process of lifestyle changes, there is a high incidence of relapse during the first three months. There are frequently negative feelings experienced by both the nurse practitioner and the client. This paper presents information concerning relapses, conceptualizing relapse as a positive experience, and strategies to support clients who encounter relapse in their efforts to maintain positive health habits.

Refining an emergent life-style-change theory through matrix analysis.

Matrix analysis is a methodologic tool used by researchers to systematically enter qualitative data into matrices and to simultaneously perform the complex integrative functions of data analysis and verification of findings. The article focuses on (1) the steps of qualitative data analysis that can be achieved by using matrix analysis, (2) the appropriate conditions for using matrix analysis, (3) the procedure for constructing a matrix, (4) the application of matrix analysis to a research problem that involved refining an emergent theory of the health life-style-change process, and (5) the use of matrix analysis to meet the criteria for trustworthiness of research findings.

Sickle cell disease in North London.

We have examined our experience of sickle cell disease in the London Borough of Haringey over the past 20 years. There are currently (1986) 145 patients on the Haringey Sickle Cell Register and when comparison is made with other centres, admission for painful crises in Hb SS disease is more frequent than in Jamaica, but the acute chest syndrome appears to be less common in the United Kingdom than in Jamaica. Splenomegaly is less frequent in Hb SC patients in this country and there is also a lower incidence of leg ulceration in both Hb SS and Hb SC disease in the United Kingdom than in Jamaica. The incidence of alloimmunization among transfused sickle cell disease individuals in Haringey is 21%, the most frequently encountered antibodies being anti-E and anti-Kell. All pregnant patients with sickle cell disease were managed with regular blood transfusion throughout pregnancy starting at 12 weeks of gestation. There were no fetal or maternal mortalities, although three babies born were 'small for dates' despite uneventful antenatal courses and adequate Hb A levels being achieved in the mother. Examination of the effect of seasonal variation on the incidence of hospital admissions for painful crises reveals no significant clustering of cases in a particular month or season of the year.

Primary proliferative polycythaemia without splenomegaly: a diagnostic problem.

We report three cases of polycythaemia with no evidence of clinical splenomegaly and normal splenic red cell pool on isotope spleen scan. In each case, however, a diagnosis of primary proliferative polycythaemia (PPP) was suggested by in-vitro erythropoietin-independent growth of peripheral blood erythroid colonies. In one of these cases two possible causes of secondary polycythaemia were also identified. The use of investigations such as isotope spleen scanning and erythroid cell culture in helping to establish a diagnosis of PPP is discussed.

Non-Hodgkin's lymphoma: a survey from a district general hospital.

We report a retrospective survey of 167 patients with non-Hodgkin's lymphoma (NHL) seen at a district general hospital between 1 August 1971 and 1 August 1983. Details of their clinical presentation, histology, therapy, response rates and survival are presented. The patient population reported is generally older than that seen at specialist centres and has a greater proportion of tumours with low-grade histology. Whereas specialist centres see a pre-selected population of patients, our data may be from a more representative group and this gives a truer incidence of this disease in the general population. The remission rates and overall survival of our patients are comparable to those achieved at specialist centres. We conclude that it is both feasible and desirable for patients with NHL to be assessed and treated in a district general hospital with a radiotherapy department.

Thalassaemia intermedia in Cyprus: the interaction of alpha and beta thalassaemia.

Restriction endonuclease analysis has been performed on the alpha and beta globin gene clusters of 57 Cypriots homozygous for beta thalassaemia, 30 with the transfusion dependent form of the condition (thalassaemia major) and 27 who are less severely affected (thalassaemia intermedia). There was a significant difference in the incidence of alpha thalassaemia between the two groups: 14/27 of the patients with thalassaemia intermedia also had deletion forms of alpha thalassaemia, while only 4/30 of the patients with thalassaemia major were similarly affected. Thus in Cypriot patients who are homozygous for beta thalassaemia the co-inheritance of alpha thalassaemia is an important factor in determining the clinical course.

Complete recovery of histiocytic medullary reticulosis-like syndrome in a child with acute lymphoblastic leukemia.

A 6-year-old boy with acute lymphoblastic leukemia (ALL) developed a haemophagocytic syndrome resembling histiocytic medullary reticulosis (HMR) but made a complete recovery on supportive treatment. This was subsequently found to have been associated with a parainfluenzal infection. It is suggested that HMR in immunocompromised hosts may represent a reactive process to an opportunistic viral infection and that the use of chemotherapy in these patients may be deleterious.