Evolution of the medical record format during two years' use of an open-format microcomputer charting system.

In 1988, the authors implemented a microcomputer charting system (SmartChart) within a busy dialysis unit and an outpatient dialysis practice, to be used as the primary recording instrument for physicians and nurses. The program defined the organization of the medical record as three types of titles: problems, therapies, and numerics. Each title had a variety of associated data, such as comments, dosages, values and normals. Predefined care plans were created, and keyboard entry was in a completely open format. Over the next two years, the overall format of this medical record proved to be highly effective, and strict problem orientation allowed both nurses and physicians to use the same problem list. A more specific organization of the title lists in the medical record was needed, however. Separate symbols were placed in front of: problem titles related to prior therapies; problems recorded during current therapies; History and Physical (H&P) data; Plans/Orders; and inactive problems. PRN therapies, those therapies related to patient treatments, vital signs, and numeric data recorded during treatments were identified. The basic format of the medical record that evolved has proven suitable for outpatient, inpatient, and specialized treatment centers.

Case management of the anemic patient epoetin alfa: focus on aluminum management.

Aluminum overload can have a detrimental effect on erythropoiesis which, in turn, can blunt the effectiveness of Epoetin alfa. Nurses can be influential in monitoring, assessing, and preventing aluminum overload.

Catalysts for OTC drug communication strategies: perceptions of information source characteristics by the elderly.

The elderly are the prime users of all medication and especially self-medication using Over-the-Counter (OTC) drugs. This group also has the greatest risk from misuse or interaction of multiple medications. To minimize the risk, information about OTC consumption must be provided to the elderly. This research reports on the importance of various information sources to light and heavy users of OTC medications among the elderly and an evaluation of those information sources with respect to perceived expertise, credibility, understandability and relevance. Communication strategies are suggested for reaching this at-risk group.

Effect of xylazine treatment on equine proximal gastrointestinal tract myoelectrical activity.

Five 5 to 6 month old horses were surgically prepared with silver electrodes sutured to the serosa of gastric antrum, duodenum and proximal portions of the jejunum. Normal migrating motility complex (MMC) periodicity was determined during daytime hours in horses that were fed and horses from which food was withheld for 24 hours. Periodicity was defined as time span from the end of one period of regular spike activity (RSA) to the end of the next RSA in the MMC. The periodicity was 120.5 +/- 9.5 (SEM) minutes in horses from which food was withheld, and was 125.7 +/- 20.3 minutes in horses fed hay free choice. Coincident with each duodenal RSA, antral spike activity ceased. Xylazine (0.25 and 0.5 mg/kg), given IV during the period of intermittent spike activity of the MMC to either fed or unfed horses induced, within 2 minutes, a RSA complex in the duodenum that migrated to the proximal portion of the jejunum. This was followed by a period of no spike activity of normal duration, which proceeded on to a period of intermittent spike activity of varying duration to complete the MMC cycle. Pretreatment IV administration of an alpha 2-adrenergic antagonist, tolazoline (1 mg/kg) also provoked a RSA complex, but blocked the xylazine effect. The results indicated that xylazine resets the duodenal MMC in the horse, but does not seriously disrupt proximal gastrointestinal tract motility, and that control of MMC periodicity in this region probably involves more than alpha 2-adrenergic receptors.

Effect of butorphanol on equine antroduodenal motility.

Six healthy six to eight-month-old horses were surgically prepared with Ag bipolar electrodes sutured to the gastric antrum and duodenum. Leads from the electrodes were exteriorised through a stab incision in the flank. During experimental sessions the horses were lightly restrained in stocks and electrode leads were connected to a physiograph to record antroduodenal myoelectrical activity. Intravenous (i.v.) injection of 0.05 mg/kg bodyweight (bwt) of the opioid agonist/antagonist, butorphanol was followed within 2 to 3 mins by a normal appearing period of repetitive spike activity, or phase III, of the migrating motor complex (MMC) on the duodenum. This was followed by a period of no spike activity, or phase I, of the MMC and then resumption of intermittent spike activity, or phase II, of normal duration. Pre-treatment with 15 micrograms/kg bwt of the non-selective opioid antagonist, naloxone, or with 1 mg/kg bwt of the alpha 2-adrenergic antagonist, tolazoline, did not block the myoelectrical response to butorphanol. It was concluded that a dose of butorphanol that has effective analgesic effects in a colicky horse resets the antroduodenal MMC without causing undesirable effects on antroduodenal motility. This particular effect of butorphanol might not be mediated by either a2-adrenergic or opioid receptors, although the latter question needs further investigation.

Boom in private rest homes in Southampton: impact on the elderly in residential care.

A survey in 1986 of 450 elderly people in 51 private rest homes and 206 residents of seven local authority (part III) homes in the Southampton area showed no significant difference in overall dependency between the two populations. Although age and sex distributions of the residents of part III homes had remained the same between 1982 and 1986, the average level of dependency had fallen significantly. Since the provision of places increased because of expansion in the private sector residential care institutions are generally catering for a more independent population.