Quality improvement in action: a falls prevention and management program.

A departmental program for falls prevention and management, initiated in 1987, and arising out of the awareness of the economic, physical, and psychological effects of falls in hospitalized patients, has been described. Given the results outlined, there is no doubt that the efforts applied in the area of falls prevention have been extremely worthwhile in affecting major quality improvements in patient care. The benefits of the falls prevention program include a reduction in the incidence of falls as well as an increased awareness by staff, patients, and families of the importance of monitoring patients at risk for falls.

Concurrent zidovudine-induced myopathy and hepatoxicity in patients treated for human immunodeficiency virus (HIV) infection.

Myopathy and hepatic toxicity are important complications of zidovudine (3'-azido-3'-deoxythymidine therapy) in patients infected with the human immunodeficiency virus (HIV) both may also occur in HIV infection in the absence of zidovudine therapy. We report 2 cases of myopathy caused by zidovudine, occurring within 16 wks of initiation of therapy, and a case of concurrent hepatic and muscle toxicity. In one case, electron microscopy demonstrated characteristic enlarged mitochondria with paracrystalline inclusions. This technique can distinguish the myopathies caused by either HIV or zidovudine. Both zidovudine-induced myopathy and hepatoxicity require discontinuation of the drug if severe.

Nursing burns on special beds. Practical note.

In this paper we discuss the relative merits of the Clinitron Flotation bed and the Mediscus Low Air Loss Bed in the nursing of Burns. Both beds are excellent in preventing Pressure Sores. The particular advantage of the Clinitron is its drying effect on wet burns. This makes it invaluable in a Unit treating burns by exposure, particularly when both anterior and posterior surfaces are burned. Its greatest disadvantage is in maintaining the patient in any position other than horizontal. The Mediscus Bed has no drying effect but comes into its own when the patients are dry or dressed. The tilt mechanism allows easy positioning by the patient or the nurse.

Inflammatory lymphadenoid reactions with dermatofibroma/histiocytoma.

Lymphoid nodules were found associated with 44 of 1,506 dermatofibroma/histiocytoma tumors of the skin. The lymphoid nodules were usually in the adjacent fat. Germinal center formation occurred, and perinodular and perivascular plasmacytosis was frequently associated.

The clinical diagnosis of Reiter's syndrome. Ophthalmic and nonophthalmic aspects.

The histories of 113 patients with Reiter's syndrome were reviewed to obtain information regarding the sequence of the clinical signs and symptoms, laboratory findings, and progression of disease. Rheumatologic manifestations occurred in 98% of the patients, genitourinary manifestations in 74%, ophthalmic manifestations in 58%, and mucocutaneous manifestations in 42%. Four major criteria and six categories of minor criteria for the diagnosis of Reiter's syndrome, based on the frequency and specificity of the various manifestations of the disease, are proposed. The ophthalmic and nonophthalmic features are important to appreciate because the ophthalmologist is frequently at the pivotal point in suggesting or supporting the diagnosis.

Factitial traumatic panniculitis.

We report five cases of factitial panniculitis produced by blunt trauma. Localized forms include Secrétan's syndrome and l'oedeme bleu, which are usually unilateral and involve the hand and forearm, respectively. When the lesions are more generally distributed, the self-induced nature may be less apparent. These patients may have been diagnosed as having Weber-Christian disease, pancreatic fat necrosis, or superficial thrombophlebitis. The microscopic picture of organizing hematoma may be supplemented by the appearance of amorphous polysaccharide masses commingled with iron pigment.

Histochemical analysis of liver cells from short term, aflatoxin-dosed and nondosed Coturnix coturnix japonica. 1. Aflatoxin-sensitive quail.

Although aflatoxicosis in Coturnix coturnix japonica has been described, the histochemical localization of liver chemicals and the occurrence of ingested aflatoxins within blood, feces, and liver have not been described. Six to 8-week-old quail, which were intubated with a carrier with or without .3 mg mixed aflatoxins (AFB1, AFB2, AFG1, AFG2)/kg body weight were sacrificed within .25 to 5 days of intubation. Deparaffinized sections of livers were stained for lipids, nucleic acids, polysaccharides, and proteins. Other livers and excrement were homogenized and filtered homogenates as well as blood partitioned against chloroform. The aqueous phase was treated with pepsin and then partitioned, but the organic phase was analyzed directly. Organic phases of .25 to 5 day blood, feces, and liver lacked aflatoxins. Pepsin digesta of blood from males and females dosed 6 hr appeared to contain aflatoxicol (disappeared by 24 hr) and an unknown fluorescent compound, respectively. Whereas an unidentified fluorescent compound was observed within excrement of males dosed 6 hr, female excrement contained a fluorescent compound with an AFB1 Rf (disappeared by 24 hr). Although the liver of males dosed 6 hr had three fluorescent compounds (Rfs for AFB1 and AFB2a), only one was seen within dosed females. Ultra violet absorption spectra of presumed AFB2a and aflatoxicol failed to yield their reported absorption maxima. Livers from dosed quail exhibited bile duct proliferation, cellular necrosis, vacuolization, congestion, fatty changes and mild hepatitis. Sinusoidal membranes were thickened and contained abundant periodic acid-Schiff's (PAS)-positive substances. Although livers of nondosed quail abounded with regularly shaped and uniformly distributed, Sudan IV-positive droplets, livers of dosed quail accommodated few, irregularly-shaped and positioned droplets. Hepatocyte nuclei and nucleoli of dosed quail displayed marked affinities for the Feulgen reagent and toluidine blue O, respectively. Lobules of dosed quail possessed concentrations of cells in which their entire cytoplasm was PAS positive. Treatment of sections with alpha-amylase reduced staining suggesting the presence of glycogen. Ninhydrin-positive substances were distributed throughout the liver in both DQ and non DQ with no apparent difference in intensities between the two livers. Generally the DQ showed mild hepatitis due to aflatoxicosis and the toxin altered liver histochemistry for the major classes of cellular chemicals.

Comparison of three studies of aircraft noise and psychiatric hospital admissions conducted in the same area.

Two earlier studies conducted in the vicinity of London (Heathrow) Airport compared the rate of admissions to a psychiatric hospital from areas exposed to different levels of aircraft noise. Their methods and results were not identical. A third study, reported here, examined standardized rates of admission to the same hospital for a longer period and for a larger area divided into 4 bands of aircraft noise. Statistically significant trends of decreasing admission with increasing noise levels were found. Comparisons between the investigations show how the contradictory results are related to the methods used and the accuracy of the data, and that caution should be exercised in formulating conclusions from exploratory research.

The effect of aircraft noise on the mental health of a community sample: a pilot study.

Results of the investigation of a sample of size N = 200, half of whom live in the vicinity of a main airport, are reported. Three health indicators were examined: (1) annoyance reactions measured with a scale which did not include symptoms; (2) a symptom score, obtained with a screening instrument which identifies possible psychiatric cases; and (3) confirmed psychiatric cases identified with a traditional diagnosis after an interview by a psychiatrist. Noise was undoubtedly associated with annoyance. An association between noise and psychiatric measures was only present in a subgroup of respondents of high education. There was a marked association between annoyance and psychiatric measures. An attempt was made to clarify the nature of this relationship. Hypersensitivity to noise was associated with a high frequency of psychiatric symptoms and should be considered among the high risk factors for psychiatric illness.

The nature of the toxic reaction of influenza virus towards lung tissue.

The inoculation of large doses of unadapted influenza virus intranasally into mice results in the production of severe lung lesions. This toxic effect is a result of the entry of virus particles into the lung cells followed by uncoating of the virus ribonucleic acid.The toxic property of the virus is destroyed by procedures which destroy or modify the nucleic acid such as exposure to monochromatic UV light of wavelength 2537 A, or treatment with hydroxylamine or Bayer A139. Reagents acting on amino groups are particularly effective as they react with the nucleic acid and probably also interfere with penetration of virus into the cell.Toxicity is also destroyed by mercurials which probably prevent uncoating of the nucleic acid by union with disulphide bonds, and by oxidizing agents such as iodine, permanganate, osmic acid and hydrogen peroxide under condition which suggest possible action on some constituent of the virus containing methionine.The toxic effect produced by the inoculation of large doses of unadapted virus intranasally in mice is associated with the occurrence of an incomplete growth cycle in which there is full production of RNP antigen but no production of haemagglutinin or infective virus.