The use of central nervous system manifestations in the early detection of digitalis toxicity.

Cardiac glycosides have been used therapeutically for more than 3000 years. They have been the treatment of choice for congestive heart failure for many decades, and recently their clinical utility has been redefined. Despite increased telemetry and development of a sensitive radioimmune assay of serum digoxin levels and the availability of digoxin immune Fab fragments (Digibind) to treat digitalis-induced life-threatening dysrhythmias, toxicity remains a serious and common problem. A body of literature, old and new, speaks to the clear but potentially unrecognized role that digitalis-induced central nervous system symptoms can play in the early detection and management of digitalis toxicity.

Current perspectives on intravenous administration of digoxin.

Cardiac glycosides were used as early as the first century A.D. The most commonly prescribed compound of this family is digoxin, because of its relatively short half-life. Intravenous digoxin has high utility 1) for instances in which digitalization must be rapidly accomplished; 2) when oral digitalization is not feasible; and/or 3) as augmentation therapy to other medication protocols. Myocardial uptake of I.V. digoxin is rapid and extensive; yet, serum half-life is approximately 34 hours, the same as in oral administration. Intravenous digoxin can be administered in divided doses every 4 to 8 hours, the 24-hour dose not to exceed 1.0 mg for a 155-pound, or 70.0-kg patient. Awareness of risk factors along with state-of-the-art technology can improve ongoing monitoring of the patient receiving I.V. digoxin.

Inflammatory bowel disease: primary health care management of ulcerative colitis and Crohn's disease.

Inflammatory bowel disease encompasses both ulcerative colitis and Crohn's disease, two conditions so alike clinically that they are frequently indistinguishable from one another. Inflammatory bowel disease occurs at a rate of approximately five per 100,000 people. It tends to cluster in families and is seen four to five times more often in Jewish Caucasians than in other Caucasians. The etiology is unknown. Increasing attention is being paid to autoimmune factors, genetic factors and food allergies, and the notion that inflammatory bowel disease has its roots in a psychological disorder continues to pale for want of empirically sound evidence. Disease pattern is one of remission and exacerbation. The aim of therapy is to maintain an optimal lifestyle in remission through an individually tailored protocol of medications. Sulfasalazine remains the medication of choice; corticosteroids have short-term utility in exacerbation; and immunosuppressants, though controversial, are thought to have some steroid-sparing benefits during acute flare-ups. Indications for surgery vary, depending on whether or not a clear differential diagnosis has been made between ulcerative colitis and Crohn's disease. There is no cure for inflammatory bowel disease except for total colectomy in clearly diagnosed ulcerative colitis. Current research endeavors seek a cause or causes for inflammatory bowel disease, but the literature does not solidly support any one possibility above other rival etiologies.

Community college gerontology education.

Occupational therapists have the knowledge and skill in principles of geriatric health care to qualify them to bring occupational therapy perspectives to curriculums in the community colleges. This article gives an account of how one therapist who had specialized training in gerontology and a background in nursing has been using her skills in a community college. An overview of one course entitled, Leisure Program Planning, illustrates the particular relevance of occupational therapy background and the understanding of role and the multiple factors impinging on individual role enactment to teaching about leisure activity and aging.

The impact of antibiotic policy on prescribing in a London teaching hospital. A one-day prevalence survey as an indicator of antibiotic use.

To assess current antibiotic use and the impact on prescribing of hospital antibiotic policy, a prospective one-day prevalence survey of antibiotic use in both in-patients and out-patients was undertaken at St Thomas' Hospital. Of 921 in-patients, 196 (21%) received 269 antibiotic prescriptions on the survey day. Approximately 40% of in-patients received prophylaxis and 60% received treatment. Among 1521 out-patients, 292 (19%) were given a prescription on the survey day and 102 (7%) received an antibiotic prescription. Assessment of in-patient use with reference to the current hospital antibiotic policy was made mainly on microbiological grounds, on choice and dosage of agents. Choice of antibiotic was largely in accord with antibiotic policy, but was considered inappropriate in 12.5% of 81 in-patients given prophylaxis and 2.5% of 120 in-patients given treatment. Dosage of some major agents and timing of surgical prophylaxis was also considered inappropriate in many patients. A simple one-day survey is a useful indicator of antibiotic use in the hospital, and shows where further guidance to prescribers could be provided.

Cephalexin therapy for infections in the elderly and other vulnerable patients.

A multicentre study was carried out in general practice to investigate the efficacy, safety and tolerance of cephalexin in the treatment of infections in 194 patients with an underlying chronic disease or other complications, and in patients over the age of 65 years. For comparison, a group of 145 patients with no such complicating conditions was included in the study. Altogether, 339 patients were treated with doses of 1 g or 2 g cephalexin daily depending on the type and severity of infection. After treatment for 5 days, over 80% of patients were cured or much improved, with no differences between the two groups. Of the 95 patients who received 10-days' treatment, the clinical outcome was considered satisfactory in approximately 80% in both groups. No clinically significant biochemical changes were recorded, no drug interactions with concurrent therapy were reported, and the incidence of side-effects was low.

Cephalexin therapy for infections complicated by age and concurrent diseases. A study in general practice.

A broad spectrum antibiotic, cephalexin, was used to treat 64 patients in whom the problems of age, underlying conditions and multiple drug therapy could adversely affect the outcome of antibiotic treatment. The majority of patients were given the antibiotic for a lower respiratory tract infection. Treatment was successful in 50 patients after 5 days, and in a further 3 after 10 days. In 25 patients another antibiotic had been used unsuccessfully to treat infection: 19 of these patients responded to cephalexin therapy. Minor gastro-intestinal side effects were reported in 4 patients.