NHS Direct and nurses--opportunity or monotony?

NHS Direct, the 24-hour telephone helpline providing information and advice about health problems, is available throughout England and Wales. It was envisaged as a nurse-led service presenting a new opportunity for the nursing profession. Free text comments from a postal survey of NHS Direct nurses revealed that a large proportion of nurses were happy with working in NHS Direct, and that it presented some nurses with the opportunity of a new and challenging role. However, a minority found the work monotonous and felt that NHS Direct is likely to face the challenge of staff retention.

Using the SF-36 with older adults: a cross-sectional community-based survey.

OBJECTIVES: To assess the practicality and validity of using the 36-item short-form health survey (SF-36) in a community-dwelling population over 65, and to obtain population scores in this age group. DESIGN: Postal survey, using a questionnaire booklet containing the SF-36 and other health-related items, of all those aged 65 or over registered with 12 general practices in Sheffield. Non-respondents received up to two reminders at 3-weekly intervals. SAMPLE: 9897 subjects, aged 65-104 years. MAIN OUTCOME MEASURES: Scores for the eight dimensions of the SF-36 and a modified version of the physical functioning dimension. RESULTS: The SF-36 achieved a response rate of 82% (n=8117) and dimension completion rates of 86.4-97.7%. Internal consistency measured by Cronbach's alpha exceeded 0.80 for all dimensions except social functioning. These results compare favourably with postal surveys of younger adults. We calculated scores for older adults by age and sex. Comparison with data from younger people showed how physical health declines steeply with age, in marked contrast to mental health. CONCLUSIONS: The SF-36 is a practical and valid instrument for use in postal surveys of older people living at home. The population scores provided here may facilitate its use in future surveys of older adults.

Neighbors for a smoke free north side: evaluation of a community organization approach to promoting smoking cessation among African Americans.

OBJECTIVES: This study evaluated a community organization approach that emphasized involvement of audiences in program planning and implementation in promoting nonsmoking among African American residents of low-income neighborhoods. METHODS: The quasi-experimental design involved a 24-month intervention in 3 low-income, predominantly African American neighborhoods in St. Louis. Intervention neighborhoods were compared with comparable, untreated neighborhoods in Kansas City. RESULTS: The program was successful in engaging audience members in its governance and in instigating numerous and diverse neighborhood activities to promote nonsmoking. The prevalence of smoking declined from 34% to 27% in program neighborhoods but only from 34% to 33% in comparison neighborhoods. This difference was apparent within all demographically defined subsamples, indicating that observed changes were consistent and not attributable to confounding by demographic characteristics. CONCLUSIONS: A community organization approach emphasizing local authority for program decisions and involvement of informal networks may have an appreciable impact on smoking among residents of low-income, African American neighborhoods.

Prognostic implications of qualitative assessment of left ventricular function compared to simple routine quantitative echocardiography.

OBJECTIVE: To compare the prognostic value of qualitative estimates of left ventricular function with that of routine simple quantitative indices used in echocardiography. DESIGN: Retrospective follow up study. SETTING: University hospital. PATIENTS: The records of 2,964 patients who had undergone echocardiography and who could be traced on the family health services register were examined; 919 cases were included in the study, and a further 458 were used to validate the statistical models for prognostic assessment. There were 928 exclusions on the basis of referral for or diagnosis of alternative conditions, and 659 because of incomplete collection of the qualitative and quantitative data used in the study. MAIN OUTCOME MEASURE: Survival over the study period. RESULTS: A qualitative "eyeball" estimate of left ventricular function was of prognostic significance (relative risk of poor v good, 2.248; P << 0.001; 95% confidence interval 1.620 to 3.119). None of the quantitative echocardiographic indices was of independent prognostic significance when all variables were tested simultaneously in the regression model. CONCLUSIONS: A qualitative echocardiographic estimate of left ventricular dysfunction is of prognostic value, supporting the view of many cardiologists who use their overall impression of left ventricular function at echocardiography as the basis for treatment decisions.

Articulation of asthma and its care among low-income emergency care recipients.

Low-income minority patients from East St. Louis, Illinois, a depressed midwestern urban city, who had visited acute care settings with asthma symptoms, participated in a focus group. Questions were constructed around the Health Belief Model to characterize participants' experiences in receiving asthma care, their confidence in long-term asthma self-management, barriers they perceived to managing their asthma, and recommendations they would make for improving asthma care in their community. Analysis of comments suggests an appreciable understanding of asthma triggers, limited coping behaviors for asthma symptoms, very limited practice of active asthma management, perception of the health care system as frequently insensitive to their needs or their knowledge of their own care, exchange of well-articulated information regarding how to deal with the system, and an apparent lack of awareness of any potential contribution of patient education or support system.

Andracantha tunitae (Acanthocephala) in the shag (Phalacrocorax aristotelis) from Shetland, Scotland.

Following the wreck of the oil tanker Braer on the coast of Shetland, Scotland, in January 1993, many shags (Phalacrocorax aristotelis) were killed. Sixty-nine per cent of these birds were found to harbor a sexually mature acanthocephalan (5 +/- 4.3 [SE] worms per infected bird) in their small intestines. The acanthocephalan has been identified as Andracantha tunitae (= Corynosoma tunitae) on the basis of its characteristic fields of trunk spines and their distribution in the region of the genital aperture.

Knowledge and attitudes related to AIDS among African-American women.

We explored knowledge and perceptions related to AIDS prevention among African-American women who reside in a low-income urban community. The results are based on a short survey and discussions of three focus groups, divided according to the respondents' ages. Results of the study indicate that the respondents were less knowledgeable about AIDS than women from a national survey. Respondents also expressed very little trust in condoms and found it difficult to make their sexual partners use them. Issues raised during the focus groups included fear of contracting AIDS as a result of medical care, mistrust and dislike of condoms, difficulties convincing men to use condoms, inability to affect the sexual behavior of their sons and daughters, and a wish to have AIDS prevention programs in the community. Implications for practice are discussed.

Medical clinic referral letters. Do they say what they mean? Do they mean what they say?

Consecutive general practitioner referrals to three general medical clinics were examined prospectively to assess whether the reason for referral was being correctly interpreted by consultants. The resultant data revealed that although this was not always the case, such misunderstandings did not appear to affect subsequent management. Explicit reasons for referral in the referral letter however could improve both the quality and value of out-patient consultations.

Appraisal of the clinical value of serotoninergic drugs.

Principal objectives in obesity management comprise the prevention of weight gain, the promotion of weight loss, and the treatment of obesity-related complications, including diabetes, hypertension, and depression. Serotonin agonists reduce food intake. The resultant weight loss is variable and there appears to be no way of predicting good responders, nor is there evidence that additional weight loss attributable to drug therapy is sustained once treatment is discontinued, although nonpharmacological strategies for preventing weight regain are worthy of exploration. Serotonin agonists are of clinical value if there is a short-term need for weight reduction or if long-term pharmacotherapy can be justified. This implies that sometimes the dangers of the obese state outweigh the potential hazards of drug treatment. Clearly, if the same agent also improves diabetic control, blood pressure, or depression then a longer term usage is more readily justified. The extent to which this may be achieved by the currently available 5-HT agonists is discussed.

The effects of a new beta-adrenoceptor agonist BRL 26830A in refractory obesity.

Beta-adrenoceptor agonists have recently been shown to promote substantial loss of adipose tissue in laboratory animals. One of these BRL, 26830A, increases thermogenesis in human volunteers and has been shown to enhance the rate of weight reduction in patients adhering to a strict reducing regimen. Forty-three post-menopausal or sterilized female subjects suffering from refractory obesity participated in a double-blind placebo-controlled study, the treatment group receiving BRL 26830A 50 mg qid. Two subjects were withdrawn because they developed an unpleasant sensation of tremor and in all, 17 of the 20 who received BRL 26830A mentioned this side effect. There was no change in erect or supine blood pressure or in resting heart rate. There was no significant difference in weight change during the 6-week study. It is concluded that BRL 26830A does not appear to promote weight reduction in subjects unable to adhere strictly to their dietary regime.

Pre-conceptual dietary management for maternal phenylketonuria.

Experience of preconceptual dietary management of maternal hyperphenylalaninaemia is limited. Two Edinburgh mothers with hyperphenylalaninaemia and borderline IQ have received dietary advice to maintain normal plasma Phe concentration both before conception and during pregnancy, in an attempt to prevent foetal abnormality. Satisfactory compliance was only obtained after intensive in-patient instruction and the diets were maintained for long periods prior to conception. Intellectual and psychological factors were very important and the availability of "same day" biochemical reports useful in encouraging the mothers. Both infants have normal Phe concentrations and satisfactory growth and development parameters at present. Further follow-up continues but these cases provide further evidence in favour of the use of preconceptual dietary advice in the management of maternal hyperphenylalaninaemia.

A comparison of the pharmacokinetics of propranolol in obese and normal volunteers.

The pharmacokinetics of intravenous and oral propranolol have been compared in six obese and six normal subjects matched for age and sex. After intravenous administration there was no difference in plasma clearance but the volume of distribution was greater (V = 339 l vs 198 l) and the half-life was longer (t1/2 = 5.0 h vs 3.0 h) in the obese group. No important difference in the rate of oral absorption was observed. A trend towards higher systemic availability in the obese group (35% vs 27%) was not statistically significant.