Use of a patient completed iPad questionnaire to improve pre-operative assessment.

Developments in healthcare technology could improve patient care and reduce healthcare costs. There is a need to facilitate communication and increase efficiency in surgical pre-assessment clinics. This study aimed to develop an iPad application to deliver an electronic patient questionnaire, and to evaluate its use in the pre-assessment environment. Software was developed, MyOp, for a standard iPad that mirrored the paper-based pre-assessment system, with features designed for ease of patient use and remote data transfer. A case-control study was conducted, comparing use of MyOp with paper-based practice, to evaluate feasibility and patient preference. Patients were offered the use of MyOp or paper-based system. Outcomes measured included time to complete iPad questionnaire, consultation duration, and a patient preference questionnaire. MyOp cost £3500 to develop. 104 individuals participated in the study, 53 MyOp and 51 controls. MyOp reduced the median consultation duration by 5.00 min. A reduction was seen in all subgroups except those aged over 70 or urology patients. Patients preferred to complete the form independently, using a touchpad or computer but expressed concerns about data security. Use of an electronic patient questionnaire reduces consultation time delivering greater efficiency of pre-assessment nurse time. Preconceived ideas about the use of technology in older age groups are likely inaccurate and less of a barrier than previously thought. Electronic pre-assessments could be used routinely to reduce demands on healthcare facilities, improve patient care, and triage patients prior to clinic attendance.

Metabolic fate of 14C-camostat mesylate in man, rat and dog after intravenous administration.

1. The metabolic fate of N,N-dimethylcarbamoylmethyl 4-(4-guanidino[14C]benzoyloxy)phenylacetate methanesulphonate (14C-camostat mesylate) was investigated after i.v. administration to man (12-h infusion), and to rat and dog (bolus injection). 2. Renal excretion (mainly in 24 h) accounted for at least 80% dose in all three species, and the only two important metabolites were identified as 4-(4-guanidinobenzoyloxy)phenylacetic acid (GBPA) and 4-guanidinobenzoic acid (GBA). 3. Parent drug was not detected in human plasma either during or after infusion of 14C-camostat mesylate owing to rapid hydrolysis of the side-chain ester group (t1/2 < 1 min). Steady-state levels of both GBPA and GBA in plasma were apparently attained by the end of the infusion period. Mean terminal half-life, systemic clearance and apparent volume of distribution at steady-state of GBPA in man were 1.0 h, 6.4 ml/min per kg and 0.38 l/kg, respectively, and the corresponding values for GBA were 2.4 h, 4.7 ml/min per kg and 1.01/kg respectively. 4. Radioactivity was rapidly distributed to most tissues after bolus i.v. doses of 14C-camostat mesylate to rats and dogs, with highest levels being associated with the liver and kidney, the two main organs of drug elimination. Concentrations in the pancreas, a possible site for drug action, were generally lower than those in plasma.

Percutaneous absorption of co-administered N-methyl-2-[14C]pyrrolidinone and 2-[14C]pyrrolidinone in the rat.

The percutaneous absorption has been investigated in rats of a mixture (3:2, w/w) of N-methyl-2-pyrrolidinone (NMP) and 2-pyrrolidinone (2-P), a combination intended for use as a vehicle in the formulation of an antimycotic drug to enhance skin penetration on dermal application, following co-administration of the two 14C-radiolabelled compounds by the dermal and oral routes. Radioactivity was excreted predominantly in the urine after either route of administration, and comparison of the respective excretion profiles indicated that about three-quarters of the applied dose was absorbed through the skin. Plasma concentrations of each parent compound, as determined by radio-HPLC, reached peak values at 2 hr after oral dosing, and remained relatively uniform during 1-6 hr after application to the skin, suggesting constant percutaneous absorption during this period. NMP appeared to be absorbed through the skin more extensively and at a slightly faster rate than 2-P; total percutaneous absorption tended to be more extensive in female than in male rats. Together, these two 14C-compounds accounted for most of the plasma radioactivity up to 6-8 hr post-administration. However, by 12 hr (when plasma levels were relatively low), most of the radioactivity was associated with unknown polar metabolites. In view of the extensive percutaneous absorption and little first-pass metabolism of the two pyrrolidinones, the oral route was considered to represent a valid alternative to the dermal route for the assessment of the systemic toxicity of the two compounds.

Inhibition of external pancreatic secretion by intracolonic and intraileal infusions in the cat.

1. Infusions of oleic acid into the colon or the distal part of the ileum in anaesthetized cats inhibits secretion of water and amylase by the pancreas, stimulated by secretin and pancreozymin. Intraileal infusions of other non-water-soluble substances or hypertonic solutions can also inhibit the pancreas. 2. As inhibition can be produced after extrinsic denervation of the pancreas and gut, it must in part be humorally mediated. 3. Pentagastrin-stimulated gastric secretion of acid and pepsin is also inhibited by the intraileal infusions, but the inhibition of acid secretion is less than that of pancreatic secretion. 4. It is suggested that the physiological counterpart of the inhibitory effects induced by the infusion of non-physiological solutions into the colon or ileum is an inhibition of pancreatic secretion brought about by the cessation of intestinal absorption, which marks the completion of the post-prandial digestive process.

Pancreotone, an inhibitor of pancreatic secretion in extracts of ileal and colonic mucosa.

1. Pancreotone is a polypeptide material obtained from ileal and colonic mucosa by extraction with alcohol and subsequent precipitation by bile salts. 2. In anaesthetized cats in inhibits the actions of secretin on the pancreas, and of pancreozymin on the pancreas and gall-bladder. 3. Pancreotone has a less powerful inhibitory action on pentagastrin-stimulated gastric secretion. 4. The actions of pancreotone resemble the inhibitory effects on the pancreas and stomach of intraileal and intracolonic infusions of oleic acid and other substances in cats with the vagal and splanchnic nerves cut. Pancreotone may be the humoral mediator of these inhibitory effects. 5. A possible relationship between the actions of pancreotone and somatostatin on the stomach, and of pancreotone and pancreatic polypeptide on the pancreas, is discussed.

An indirect sympathomimetic effect of burimamide on kitten isolated atria.

1. Burimamide (34-1080 muM) caused a concentration-dependent increase in the force and frequency of contraction of kitten isolated atria. 2. Metiamide (467 muM) had no stimulant action on kitten atria and did not modify the effects of burimamide. 3. The atrial stimulation produced by burimamide was reduced by (-)propranolol (34-68 nM) and by cocaine (3 muM). 4. The atrial stimulant effect of burimamide was prevented by pretreatment of kittens with reserpine (1 mg/kg, 24 h before the experiment). 5. It is concluded that burimamide causes atrial stimulation by releasing catecholamines.

Mites in the environment of cases of Norwegian scabies.

Three cases of Norwegian Scabies diagnosed in Glasgow hospitals within 1 year each caused wide-spread outbreaks of papular eruptions amongst the patients and staff, followed later by a few cases of classical scabies. Symptoms and timing suggested that these infections were caused by immature mites derived by personal contact and possibly by contact with infected cuticular fragments which were abundant in the environment of the three patients. To control a ward epidemic, isolation of the Norwegian scabietic should be followed by environmental and then by personal disinfestation.