Nurse-led hypertension referral system in an emergency department for asymptomatic elevated blood pressure.

OBJECTIVES: To determine the characteristics of asymptomatic elevated blood pressure patients in an accident and emergency setting and assess the effect of a nurse-led intervention system. DESIGN: Cross-sectional study. SETTING: Accident and Emergency Department of a regional hospital in Hong Kong. PARTICIPANTS: Patients with blood pressures of 140/90 mm Hg or above recorded twice (at triage and discharge) with no previous history of hypertension. Exclusion criteria were: (1) admission to hospital; (2) known hypertension; (3) referral for hypertension; (4) blood pressure higher than 180/120 mm Hg on rechecking. INTERVENTION: Patients were issued a referral by the discharge nurse to follow-up for blood pressure monitoring in primary care. MAIN OUTCOME MEASURES: Diagnosis of hypertension, follow-up rate, and risk factors of hypertension. RESULTS: Of 245 patients with asymptomatic elevated blood pressure, we were able to contact 222 for follow-up, of whom 136 (61%) claimed to have been followed up for their blood pressure, and 48 (22%) were diagnosed to have hypertension. The nurse time for finding one case was 28 minutes. The projected impact could be large. If this simple nursing guideline is implemented territory-wide, more than 7000 new cases of asymptomatic hypertension might be picked up annually. CONCLUSION: The implementation of a simple nurse-led hypertension referral system is a cost-effective way to screen asymptomatic subjects with elevated blood pressures in the accident and emergency department.

The closed equilibrated biological aquatic system: a 12 months test of an artificial aquatic ecosystem.

The Closed Equilibrated Biological Aquatic System" (C.E.B.A.S.) is finally disposed for long-term multi-generation experiments with aquatic organisms in a space station. Therefore a minimum operation time of three months is required. It is verified in three versions of laboratory prototypes. The third one passed successfully a 12 months mid-term test in 1995/96 thus demonstrating its high biological stability. The third version of the C.E.B.A.S. consists of a 100 l animal tank, two plant cultivators with a volume of 15 l each with independent illuminations, a 3.0 l semibiological "mechanical" filter, a 3.0 l bacteria filter, a heating/cooling device and a dummy filter unit. The live-bearing teleost Xiphophorus helleri is the vertebrate and the pulmonate water snail Biomphalana glabrata the invertebrate experimental animal in the system. The rootless higher water plant Ceratophyllum demersum is the producer organism. Ammonia oxidizing bacteria and other microorganisms settle in the filters. A sample data acquisition is combined with temperature and plant illumination control. Besides of the space aspects the C.E.B.A.S. proved to be an extremely suitable tool to investigate the organism and subcomponent interactions in a well defined terrestrial aquatic closed ecosystem by providing physical, chemical and biological data which allow an approach to a comprehensive system analysis. Moreover the C.E.B.A.S. is the base for the development of innovative combined animal-plant aquaculture systems for human nutrition on earth which could be implemented into bioregenerative life support systems with a higher degree of complexity suitable for lunar or planetary bases.