Building partnerships with the community: lessons from the Camden Health Improvement Learning Collaborative.

This case study describes the Camden City Health Improvement Learning Collaborative (the Collaborative), a community care network initiative formed in 1993. The organization is composed of representatives from local healthcare providers, public agencies, religious organizations, and neighborhoods. The major goal of this initiative is to improve the health status of the community by involving and empowering residents in the solution of their needs. The Collaborative represents a grassroots strategic model of community inclusion in the formulation of goals and programs to improve community health status. The case study describes the dynamics of the Collaborative by examining the following: historical development; political, institutional, and social context; planning process; organization and structure; and performance evaluation. The article concludes with a discussion of the strategic and operational lessons learned from the Collaborative.

Minimum oxygen requirements during anaesthesia with the Triservice anaesthetic apparatus. A study of drawover anaesthesia in the young adult.

Thirty-six servicemen were anaesthetised using the Triservice anaesthetic apparatus. They were allocated randomly into one of two groups, to breathe spontaneously or to receive artificial ventilation, and into subgroups who were given air alone, or air supplemented with 1 or 4 litres/minute of oxygen. A further 12 subjects were studied subsequently using 0.5 litres/minute of added oxygen. Intra-operative blood gases were compared with those of awake premedicated controls. Artificial ventilation was associated with an unchanged arterial oxygen tension with air alone; in the other subgroups arterial oxygen tension was higher than with spontaneous respiration when related to inspired oxygen fraction (p less than 0.05). Air anaesthesia caused significant hypoxaemia with spontaneous ventilation (p less than 0.05), and 50% of the subjects required assisted ventilation. There was also a significant respiratory acidosis (p less than 0.05). Intermittent positive pressure ventilation is the method of choice for field anaesthesia when oxygen is unavailable. Spontaneous respiration must be supplemented with at least 0.5 litres minute of oxygen.

Anaesthesia during the Falklands campaign. The experience of the Royal Navy.

The work of nine Naval anaesthetists deployed with the Task Force during the Falklands campaign is described. The anaesthetists worked in a field hospital (Ajax Bay), a hospital ship (SS Uganda), a troop ship (SS Camberra), aircraft carriers (HMS Hermes and HMS Invincible) and a Royal Fleet Auxiliary (Tidespring). The problems of staffing and providing the stores for various teams in different locations at short notice are discussed.

Fat embolism in Eisenmenger syndrome.

A case of fat embolism with known Eisenmenger syndrome is described, in whom the right-to-left shunt appeared to protect the patient from further hypoxaemia. The potential value of an intravenous filter to eliminate air in patients with reversed intracardiac shunts is noted.