A local safety standard for invasive procedures for out-patient endonasal procedures performed under local anaesthetic: a template from Newcastle upon Tyne hospitals.

BACKGROUND: In November 2017, a working feasibility analysis commenced of a local anaesthetic endonasal procedures out-patient clinic service at Freeman Hospital, Newcastle upon Tyne. Fundamental to introducing an innovative ambulatory out-patient practice is the development of a novel local safety standard for invasive procedures to support this service. OBJECTIVE: This paper presents the new safety standard developed for this purpose and implemented in our institution. CONCLUSION: Increasingly, there is a shift toward ambulatory services, directed by patient choice, technological advances and the opportunity for cost savings. It is hoped that this local safety standard for invasive procedures will provide a useful template for those considering implementing ambulatory endonasal services, or other novel procedures, within the specialty of ENT.

Measuring the cantilever-position-sensitive detector distance and cantilever curvature for cantilever sensor applications.

Measuring cantilever sensor deflections using an optical beam deflection system is more complicated than often assumed. The direction of the reflected beam is dependent on the surface normal of the cantilever, which in turn is dependent on the state of the cantilever. It is often assumed that the cantilever is both straight and perfectly level before the onset of sensing experiments although this assumption, especially the former, is rarely true. Failure to characterize the initial state of the cantilever can lead to irreproducibility in cantilever sensor measurements. We have developed three new methods for characterizing the initial state of the cantilever. In the first case we show how to define the initial angle of inclination beta of the chip on which the cantilever is attached. This method was tested using an aluminum block with a known angle of inclination. A new method for determining the initial distance L(o) between the cantilever and the position-sensitive detector (PSD) is also presented. This parameter which behaves as an amplification factor of the PSD signal is critical for obtaining precise cantilever sensor data. Lastly, we present a method for determining the initial curvature of the cantilever which often results from depositing the sensing platform on the lever. Experiments conducted using deflected cantilevers showed the model to be accurate. The characterization methods presented in this work are simple to use, easy to implement, and can be incorporated into most cantilever sensor setups.

Defining the cost of educating undergraduate medical students at the University of Virginia.

PURPOSE: To develop a model for calculating the cost of a four-year undergraduate medical education at the University of Virginia School of Medicine (UVA) in 1994-95. METHOD: All data were based on faculty contact hours (FCHs), the primary driver of cost. (An FCH was an hour during which a faculty member was actively teaching.) First- and second-year data were derived from a published curriculum schedule. Third-year data were derived from hours spent in each clerkship and a series of calculations to assess direct teaching time in each clerkship accurately. Fourth-year data were modeled on an artificial but typical program consisting of the required clerkship in neurology, a two-day course in advanced cardiac life support, and seven elective blocks; electives were chosen based on relative overall popularity. The number of full-time-equivalent (FTE) faculty required was calculated. The salary costs of UVA full-time faculty were calculated. Other total direct costs, including the costs of support and administrative services as well as the costs of the educational contributions of housestaff and contract faculty, were calculated. The overall cost, including direct and indirect costs, was calculated. An average of 139 students per year was assumed. RESULTS: The total number of FCHs was just under 100,000. The number of FTE faculty required was 223. UVA faculty salary and fringe benefits totaled $29,400,000. The costs of support and administrative services totaled $4,100,000; the costs of housestaff and contract faculty totaled $2,300,000. The overall educational costs totaled $49,600,000. CONCLUSION: The overall cost of a four-year medical education at UVA was $357,000 per student. Although the process of calculating this cost was complex and, at times, based on assumptions open to debate, the model developed can be applied to any medical education setting.

Diagnosis and treatment of acromegaly.

Acromegaly is a clinical syndrome that most typically is the manifestation of adenomatous hyperplasia of growth hormone-secreting cells in the pituitary gland. Although the primary process is benign, many disfiguring and potentially serious complications can develop. Because of the slow evolution of signs and symptoms, acromegaly can be a diagnostic challenge. Furthermore, many common diseases, such as hypertension, diabetes mellitus and hyperlipidemia, occur secondary to acromegaly but may initially be treated as isolated primary processes. Systematic evaluation should be performed if acromegaly is suspected. The diagnosis is based on clinical observation, hormonal assays and selective radiologic imaging. Acromegaly is most often treated surgically, but radiotherapy and drug therapy can be effective alternatives.

Does pseudoephedrine increase blood pressure in patients with controlled hypertension?

BACKGROUND: The use of the decongestant pseudoephedrine has been avoided in hypertensive patients with little evidence to support this caution. The purpose of this study was to determine the effects of therapeutic doses of pseudoephedrine on blood pressure in patients with controlled hypertension. METHODS: Twenty-five patients with controlled hypertension were enrolled in a randomized, placebo-controlled, double-blind crossover trial. This was a 4-week study in which all participants received placebo during the 1st and 3rd weeks. Subjects were randomly assigned to receive pseudoephedrine or placebo during the 2nd week of the study, and to receive the opposite during the 4th week of the study. Blood pressure readings were taken at the beginning and end of each week of the trial, and at a 1-week poststudy follow-up visit. RESULTS: The mean systolic pressure was 133 mm Hg in patients receiving both pseudoephedrine and placebo (P = NS). The mean diastolic pressure was 82 mm Hg in patients receiving pseudoephedrine and 82.5 mm Hg in patients receiving placebo. Mean pulse rates were 76.8 and 75.2 beats per minute in patients given pseudoephedrine and those given placebo, respectively (P = NS). There were no statistically significant or clinically important differences in the mean systolic or mean diastolic blood pressures among the groups during the entire 4-week course of the study. CONCLUSIONS: At standard doses, pseudoephedrine has no significant effect on systolic or diastolic blood pressure in patients with controlled hypertension.

Hypnosis in family medicine.

Hypnosis can be a useful adjunct to other treatment modalities. For example, hypnosis may induce a level of relaxation that allows patients to cooperate more easily with conventional treatment. The often dramatic historical background of hypnosis has led to misconceptions about hypnotic technique and its clinical applications in modern medicine. Hypnosis is useful in the treatment of acute and chronic pain, somatoform and habit disorders, anxiety and depression. Persons who are attempting to stop smoking, patients with bulimia and those with psychogenic impotence may respond to hypnosis.

Laser desorption/Fourier transform mass spectra of glycoalkaloids and steroid glycosides.

Positive- and negative-ion mass spectra of five glycoconjugates were obtained using laser desorption/Fourier transform mass spectrometry. These were the glycoalkaloids alpha-solanine and alpha-tomatine and the steroid glycosides gitoxin, lanatoside A and digitonin. Doping with KCl yielded both potassium- and chloride-attachment ions. Few fragment ions were observed for these species, with the exception of digitonin, although the negative-ion spectra showed relatively more fragmentation than the positive-ion spectra. All major fragments appeared to arise from losses of sugar groups due to cleavages at the glycosidic linkages. This contrasted sharply with the behavior of the malto-oligosaccharides studied in this laboratory.

Laser desorption Fourier transform mass spectra of malto-oligosaccharides.

Laser desorption mass spectra of malto-oligomers, including starch, have been obtained using Fourier transform mass spectrometry. Fragmentations of these oligomers have been examined after doping with metal salts to obtain cation-attachment ions. Doping starch with NaCl, KBr and Ag2O results in analogous cation-attachment oligosaccharide fragment ions for all three metal ions. A distinct and unusual fragmentation pattern is observed for the larger oligomers.

Hemoglobin function in the vertebrates: an evolutionary model.

Comparative data on quaternary structure, cooperativity, Bohr effect and regulation by organic phosphates are reviewed for vertebrate hemoglobins. A phylogeny of hemoglobin function in the vertebrates is deduced. It is proposed that from the monomeric hemoglobin of the common ancestor of vertebrates, a deoxy dimer, as seen in the lamprey, could have originated with a single amino acid substitution. The deoxy dimer has a Bohr effect, cooperativity and a reduced oxygen affinity compared to the monomer. One, or two, additional amino acid substitutions could have resulted in the origin of a tetrameric deoxy hemoglobin which dissociated to dimers on oxygenation. Gene duplication, giving incipient alpha and beta genes, probably preceded the origin of a tetrameric oxyhemoglobin. The origin of an organic phosphate binding site on the tetrameric hemoglobin of an early fish required only one, or two, amino acid substitutions. ATP was the first organic phosphate regulator of hemoglobin function. The binding of ATP by hemoglobin may have caused the original elevation in the concentration of ATP in the red blood cells by relieving end product inhibition of ATP synthesis. The switch from regulation of hemoglobin function by ATP to regulation by DPG may have been a consequence of the curtailment of oxidative phosphorylation in the red blood cell. The basic mechanisms by which ATP and DPG concentrations can respond to strss on the oxygen transport system were present before the origin of an organic phosphate binding site on hemoglobin. A switch from ATP regulation to IP5 regulation occurred in the common ancestor of birds.