[Enteral nutrition: nasogastric tube or percutaneous endoscopic gastrostomy?]. / Nutrition entérale: sonde nasogastrique ou gastrostomie percutanée endoscopique?

When enteral nutrition is indicated to prevent or to treat a patient with denutrition choosing between a nasogastric tube (NGT) and a percutaneous endoscopic gastrostomy (PEG) is not always an easy decision. In neurological patients with swallowing disturbances or in patients with head and neck tumors, PEG is associated with lower rates of feeding tube dislodgement, while NGT has lower rates or morbidity. A meta-analysis showed that the interruption of nutrition is less frequent with PEG but there is no difference in terms of mortality and aspiration pneumonia between PEG and NGT. The European Society for Clinical Nutrition and Metabolism recommends PEG when enteral nutrition is expected to last more than 3 weeks.

Community surveys: the benefits and sacrifices.

Community-based research is becoming more important, especially with the introduction of the RDP and the changing role of NGOs. Community surveys are a part of this new research approach. This paper enters the debate around the role and importance of surveys. A case study of a community survey done in Mfuleni by the Western Cape Community Partnership Project will be used to illustrate the points made. Key considerations are raised in terms of the potential for the community survey to be useful. These include the role of the survey in providing information and assisting in the process of the development of the project as a whole. In addition the cost effectiveness plus the ethical and political dimensions are considered. In the course of the survey important lessons were learned that could benefit others also doing research of this type. Issues raised include the importance of the presence of specific research skills being part of the team throughout the project, the importance of full negotiation of access, being clear in terms of objectives and the questions to be asked, sampling issues, problems of questions demanding memory recall, community participation and spreading of skills, and the dissemination of results.

Methodological issues in a disablement prevalence study: Mitchells Plain, South Africa.

The Mitchells Plain Disability Survey was undertaken primarily to expand a community-based rehabilitation programme in an underprivileged South African urban community. This descriptive survey used a proportional stratified random cluster sampling strategy (sample size 2424), with stratification by suburb and clusters consisting of 15 adjacent plots. A household screening questionnaire (based on the WHO disability questionnaire), identified people who reported health problems affecting their functional ability, while a second follow-up interview confirmed disablement status and obtained a medical, disablement and demographic profile of the disabled and ascertained their needs. This paper discusses different methodological issues related to the survey design and emphasizes the need for standardization of methods in the disablement field. Sampling issues include sample loss in a multi-staged data collection strategy as well as the non-independence of observations when sampling entire house- holds. The trade-off between studying disability across diagnostic, disablement and age categories, and wide confidence intervals for specific prevalence rates, is discussed. Because of the prohibitive costs validation of disablement status is often omitted in a low-budget project (as this one was), weakening the design of such studies. Even if the 'disabled' are correctly identified, the criteria for identifying respondents determine what type of disablement prevalence will be obtained, Different diagnoses reported on screening yielded different positive predictive values of disability--the most debilitating conditions yielding the highest proportion of disabled people. The quality of the data--evaluated through comparisons of initial and repeat screening interviews, and proxy and self-reporting--is described. There is a need for disability research to continue developing suitable methods for a wide range of purposes. One such is a 'good-enough' survey design which can be implemented rapidly, at relatively low cost, to yield useful results at local level.

Isolation of malignant cells from human bone marrow using a discontinuous Percoll gradient.

A technique for examining relatively large volumes of bone marrow for involvement by malignancy is described. The use of discontinuous Percoll gradients offers no advantage over conventional methods in the diagnosis of hematological malignancy. Its usefulness in detecting infiltration by solid tumor is uncertain. Complete exclusion of malignancy from the fraction containing hematologic stem cells in three patients raises the possibility that this technique is a useful adjunct to other methods of marrow purging before autologous marrow rescue in malignant disease.

The development of a microassay for human committed progenitor cells.

A microassay for human committed progenitor cells (CFU-c) has been developed using 24-well, 16 mm diameter culture dishes. Comparisons were made of simultaneous cultures of 21 samples in both 35 mm and 16 mm culture dishes employing two sources of colony-stimulating factor (CSF). The microassay does not differ significantly from the standard 1 ml 35 mm assay, apart from some enhancement of colony numbers in the 16 mm dish. Other advantages of the microassay are that it is economical with respect to cells, media, and space; and it is possible to increase the number of experiments fivefold which can be performed with the same number of cells.