Critical care dependency tool: monitoring the changes.

The critical care patient dependency system (CCPD) is a factorial patient acuity system developed in 1993 by Ferguson and Harris-Ingall' for use in adult critical care areas. It was developed specifically to help determine Australian nursing cost weights and was utilised to collect data from nine Sydney critical care units from October 1992 until May 1993. The St. George Hospital (SGH) general intensive care unit, one of the nine participating hospitals, continues to use and collect data with the CCPD. This paper describes the instrument and compares data on Australian national diagnosis related groups (ANDRGs), collected during the original study, to ANDRG information on the critical care population 3 and 6 years later. In addition, the paper examines and compares the demographics of the SGH critical care patient population, patient acuity (based upon CCPD patient scores) and intensive care nursing clinical practices collected over a 3 month period in 1996 and again in 1999. Demographic and patient acuity data for SGH in 1993 are unavailable and so comparisons were unable to be made. The findings demonstrate changes in the management of critically ill patients, especially in relation to ventilation management, wound care and invasive monitoring practices; this resulted in shifts to the nursing workload. For this reason, the instrument is useful in providing nurse managers with information about patient dependencies and nursing work.

[A case of Guillain-Barré syndrome associated with SIADH, treated by intravenous gammaglobulins]. / A case of Guillain-Barré syndrome associated with SIADH, treated by intravenous gammaglobulins.

The authors report a case of Guillain-Barré syndrome occurring after a hip replacement associated with hyponatremia due to a syndrome of inappropriate secretion of antidiuretic hormone (SIADH). They describe and review the literature about this syndrome's etiology and its association, relatively rare, with SIADH. The diagnostic reasoning and the therapeutic possibilities are described.

Brain metastases in patients with renal cell carcinoma: prognosis and treatment.

Thirty-four patients with renal cell carcinoma and brain metastases were reviewed to define important prognostic factors and treatment results. The following covariates were analyzed to determine their influence on survival: disease-free interval, serum calcium, number of central nervous system (CNS) metastases, weight loss, performance score, age, radiation therapy, surgery, and surgery plus radiation. The mean survival for all patients was 7.0 months (range, seven days to 32 months). The patients with a good performance score of 0-2 survived significantly longer (mean survival, 10.2 months) than those with a poor performance score of 3-4 (mean survival, 2.8 months; p = 0.0019). Surgery was associated with significantly improved survival (mean survival, 13.8 months versus mean survival, 4.2 months; p = 0.014). However, all the surgical patients were from the good performance score group, suggesting patient selection. Radiation was associated with an improved mean survival of 8.6 months versus 3.2 months. Performance score is a significant prognostic factor. Furthermore, the data support treatment with radiation therapy for patients with multiple CNS metastases and surgery followed by postoperative radiation therapy for patients with single CNS metastases.

Alkaline phosphatase inhibition by a series of pyrido[2,1-b]quinazolines: A possible relationship with cromolyn-like antiallergy activity.

Several known antiallergic agents, including cromolyn sodium and a series of pyrido[2,1-b]quinazolines, inhibit human alkaline phosphatase (ALP), a membranal enzyme associated with calcium uptake in certain tissues. A comparison of ALP and rat passive cutaneous anaphylaxis (PCA) inhibition indicates that PCA inhibition may be associated with drug-ALP interaction, since ALP inhibition potency parallels PCA inhibitory activity. The unpredictability of the PCA test toward clinical efficacy could in part be related to the uncompetitive nature of these inhibitors. The results also suggest that alkaline phosphatase may be a component of membranal calcium channels.