Use of bisphosphonates for the treatment of metastatic bone pain. A survey of palliative physicians in the UK.

A postal survey of palliative physicians in the UK conducted in 1999 demonstrated widespread use of bisphosphonates for treatment of bone metastases from a variety of tumour types. In the absence of clear guidelines, however, there was found to be wide variation in treatment regimes, and opinions about efficacy varied greatly between respondents. Pamidronate was the most popular choice of drug, but a number of respondents chose to use clodronate, often on the basis of cost saving. A high level of uncertainty about how to monitor side-effects and efficacy was revealed. As well as acute treatment of severe pain, a significant number of respondents reported treating patients prophylactically, and the majority thought that their use of bisphosphonates would increase over the next 2 years. The potential financial consequences of this are considered.

What do hospices do? A survey of hospices in the United Kingdom and Republic of Ireland.

OBJECTIVE: To obtain baseline information about hospice clinical activity. DESIGN: Survey of hospices by postal questionnaire and telephone interview. SETTING: 98 Hospices in the United Kingdom and Republic of Ireland of 111 that had a named matron or senior nurse, including 17 funded by NHS and 81 independent units. PARTICIPANTS: Hospice matrons or nursing sisters in charge, to whom the questionnaire was addressed. RESULTS: Median age of hospices was 7 years, and those built during the past seven years had a median of 12 inpatient beds. All NHS hospices had some input from a medical consultant whereas 12 (15%) of independent units did not. 72 Hospices had home care teams and 12 of 20 of these randomly contacted by telephone provided 24 hour cover. The median number of whole time equivalent nurses was four, but 6 (30%) of teams did not include a doctor. Wide variations were found in discharge rates (range 1-76%) and throughput (1.7-31.8 patients/bed/year). In units with a full time consultant or medical director throughput was greater and more patients had palliative surgery and became organ donors than in units without (45/48 v 38/50 and 45/48 v 25/50, respectively). With the exception of pulmonary function tests and insertion of nasogastric tubes and indwelling epidural catheters, tests and procedures were used by over 90% of hospices, although sometimes the patient had to be transferred elsewhere. CONCLUSIONS: Respondents from units with a full time consultant or medical director were more likely to choose a "technical" description of their unit, such as "a pain relief centre" than those without, who favoured non-technical descriptions. These differences are likely to increase with the appointment of more fully trained consultants in palliative medicine.

Screening for ischaemic heart disease risk factors at a health fair: low attendance by those at highest risk.

Among people attending a heart disease screening project at a Health Fair in Sheffield, only 22 of 425 (5.2%) lived in areas with more than 25% of the population belonging to social classes IV or V. The incidence of heart disease is known to be particularly high in these areas, where 15.1% of the total population live. By analysis of the attendance rates from districts other than those immediately adjacent to the site of the Health Fair, we found that the strength of this inverse correlation increased, suggesting that the problems of access are probably greater for people living in deprived areas than for others.

The Marie Curie/St Luke's Relative Support Scheme: a home care service for relatives of the terminally ill.

A hospice-based scheme for the support of relatives of dying patients is described. The majority of carers were females and almost a third of them elderly. Most patients were suffering from malignancy. Relatives reported a high level of satisfaction with the help they received from the scheme, but late referral was a common source of dissatisfaction. A large proportion of patients subsequently died at home but it is suggested that the intervention of the relative support scheme was not the only contributory factor. The perceptions of nurses working for the scheme and the susceptibility of volunteers to stress are highlighted.

Is the Jarman score better than social class at assessing the need for prevention and primary care?

This paper reports an analysis by small areas of various measures of disease and the use of cervical smear services in the city of Sheffield. The correlation of these with social class and the Jarman underprivileged area score were compared. Wide variations in mortality rates between electoral wards in Sheffield were demonstrated, particularly for deaths from diseases with a large preventable component. Social class correlated more strongly with all-cause mortality (r = 0.69) and preventable mortality (r = 0.91) than did the Jarman score. There was no significant correlation between routine cervical smear rate and either social class or the Jarman score among women under the age of 35 years. Among older women, however, there was a high degree of correlation with fewest smears being taken in the most deprived wards. Social class was more strongly correlated with the invasive cervical cancer rate in electoral wards than was the Jarman score, and was thus a better indicator of the need for cervical screening. However, the Jarman score showed a greater degree of (negative) correlation with the uptake of cervical screening than did social class with disproportionately fewer smears being taken by general practitioners in areas of highest need. Social class may be better than the Jarman score as an indicator of both ill-health and the need for preventive health services in Sheffield. Information is routinely collected decenially on social class and needs little further computation, unlike the Jarman score. Furthermore, much is already known about the relationships between social class and both ill-health and the need for preventive services.

Synthesis and evaluation of potential radioligands for the progesterone receptor.

Several steroidal analogues were synthesized as potential gamma-emitting radioligands for the progesterone receptor. Each of these compounds was tested as an inhibitor of the specific binding of [3H]-17 alpha,21-dimethyl-19-nor-4,9-pregnadiene-3,20-dione (R5020) to the progesterone receptor in rabbit uterine cytosol. R5020 is a well-known progestin with high affinity for the receptor. Of the compounds synthesized, aromatic N-substituted C-17 steroidal carboxamides inhibited the binding only poorly. Three compounds, 16 alpha-iodo-4-estren-17 beta-ol-3-one, 17 alpha-[2(E)-iodovinyl]-4-estren-17 beta-ol-3-one, and 17 alpha-[2(Z)-iodovinyl]-4-estren-17 beta-ol-3-one were excellent competitors, each having a Ki less than or equal to that of the natural progestin, progesterone. Since similar iodinated analogues of estrogens have been shown to be extremely stable both in vivo and in vitro, these compounds are potentially useful ligands for the progesterone receptor.

Human insulin from recombinant DNA technology.

Human insulin produced by recombinant DNA technology is the first commercial health care product derived from this technology. Work on this product was initiated before there were federal guidelines for large-scale recombinant DNA work or commercial development of recombinant DNA products. The steps taken to facilitate acceptance of large-scale work and proof of the identity and safety of such a product are described. While basic studies in recombinant DNA technology will continue to have a profound impact on research in the life sciences, commercial applications may well be controlled by economic conditions and the availability of investment capital.

Authenticity and purity of human insulin (recombinant DNA).

A summary of the exhaustive analyses of human insulin (recombinant DNA) shows chemical, structural, and biologic equivalence to pancreatic human insulin. The high degree of purity accounts for its lack of pyrogenicity and immunogenic contamination. Human insulin from both the proinsulin and chain combination methods is essentially identical. The role of proinsulin as an alternate route to human insulin, and as a new treatment for diabetes when used alone or in combination with human insulin or connecting peptide, warrants further investigation.

Immunocompetence in the lowest metazoan phylum: transplantation immunity in sponges.

Isografts of Callyspongia diffusa fuse compatibly, but allografts are invariably incompatible. Extensive polymorphism of cell-surface histocompatibility markers is evident. The histocompatibility barriers range from strong to weak depending on the interclonal combination, but early rejection with conspicous cytotoxic sequelae is typical. Reaction times of first-set, second-set, and third-party grafts indicate highly discriminating transplantation immunity with a specific memory component.