The experiences and perceptions of nursing service managers regarding transformation of health services in selected provincial academic health complexes.

Nursing service managers are challenged with enormous transformations within the new political dispensation in South Africa. The objective of the study was to explore and describe the experiences and perceptions of the nursing service managers regarding transformation of health services in selected Provincial Academic Health Complexes. A qualitative, exploratory, descriptive and phenomenological design was employed utilising focus group interviews and narratives as methods of data collection. After content analysis was performed, results were grouped into management of health service transformation and quality of patient care in relation to the levels of the organisation. The levels in the organisation are individual level, group level, departmental level and organisational level. Positive and negative experiences and perceptions were identified.

Effect of moderate dietary protein restriction on the progression of overt diabetic nephropathy: a 6-mo prospective study.

To assess whether moderate dietary protein restriction can delay the progression of overt diabetic nephropathy, 22 subjects with insulin-dependent diabetes mellitus were randomly assigned to an unrestricted protein diet (> 1.6 g.kg body wt-1.d-1) or a moderately protein-restricted diet (0.8 g.kg body wt-1.d-1) and followed prospectively for six mo. Direct isotope methods were used to assess renal function. Protein intake was assessed by measurement of urinary urea nitrogen. The two groups were well-matched for age, sex, duration of diabetes, glycemic control, blood pressure, and degree of renal insufficiency. Patients consuming the unrestricted protein diet (n = 11) showed a progressive decline in glomerular filtration rate of 1.3 mL.min-1.mo-1 with no change in proteinuria. Patients consuming the moderately protein-restricted diet showed a marked decrease in the degree of proteinuria (2.15-1.13 g/d, P = 0.036) and a stabilization of glomerular filtration rate. This occurred independently of changes in blood pressure or glycemic control. Moderate dietary protein restriction can ameliorate progression of overt diabetic nephropathy.

Radiation regression patterns after cobalt plaque insertion for retinoblastoma.

An analysis of 31 eyes of 30 patients who had been treated with cobalt plaques for retinoblastoma disclosed that a type I radiation regression pattern developed in 15 patients; type II, in one patient, and type III, in five patients. Nine patients had a regression pattern characterized by complete destruction of the tumor, the surrounding choroid, and all of the vessels in the area into which the plaque was inserted. This resulting white scar, corresponding to the sclerae only, was classified as a type IV radiation regression pattern. There was no evidence of tumor recurrence in patients with type IV regression patterns, with an average follow-up of 6.5 years, after receiving cobalt plaque therapy. Twenty-nine of these 30 patients had been unsuccessfully treated with at least one other modality (ie, light coagulation, cryotherapy, external beam radiation, or chemotherapy).

Simultaneous ocular and orbital involvement from metastatic bronchogenic carcinoma.

A 64-year-old man presented with a nonrhegmatogenous retinal detachment, proptosis, and ptosis. Clinical examination, fluorescein angiography, B-scan ultrasonography and computed tomographic (CT) scan confirmed the presence of concomitant intraocular tumor and orbital mass. The CT scan of the chest and a lung biopsy specimen revealed the presence of an unsuspected asymptomatic bronchogenic carcinoma that rapidly developed widespread metastases. Metastasis to the eye from bronchogenic carcinoma may occur simultaneously with orbital metastasis, and this may be associated with rapid progression and growth.