The absence of benefit of proteinase inhibition with aprotinin in severe shock in dogs.

A standard canine shock model has been used to assess the role of proteinase inhibition in the treatment of severe shock. Conventional therapy, i.e adequate volume replacement, was ensured in all experiments, while in the treated groups aprotinin (Trasylol) was administered at different stages of the haemorrhage. Despite other reports to the contrary, no benefit was demonstrated in the period of established refractory shock even when proteinase inhibition was commenced at an early stage of haemorrhage. It is concluded that proteinase inhibition cannot be recommended for shock resuscitation.

The thermal properties of a survival bag incorporating metallised plastic sheeting.

Five male subjects were exposed to a cooling environment equivalent to 1082 W/M2. The subjects wore a clothing assembly with insulation properties of 1.55 clo. A casualty bag in corporating metallised plastic sheeting was provided for additional insulation. Deep body temperature fell 1.2 degrees C. and mean skin temperature 2.6 degrees C. over the 2-h period. Metallised plastic sheeting did not prevent heat loss through the clothing assembly, as indicated by the falls in body and skin temperature and an increase in metabolic heat production. From measurements made during the exposure, the calculated insulation value of the complete assembly of 2.93 clo was close to the predicted value of 2.80 clo calculated from the thermal resistance of the assembly layers. It is concluded that the metallised plastic sheeting in this casualty bag did not provide significant additional thermal insulation.

Helicopter passenger survival suit standards in the UK offshore oil industry.

Special protective clothing for helicopter passengers in transit to and from installations in the U.K. offshore oil industry is considered essential. Such clothing is required to increase the survival chances in the unlikely event of a helicopter ditching. This paper discusses the nature of the threat to life in such an event and proposes standards for the specific protective clothing required to meet it. Test criteria are also outlined, to ensure that standards set are maintained.

The thermal protection offered by lightweight survival systems.

The thermal protection offered by lightweight survival systems was evaluated in a mountain environment. When subjects were exposed for 3 h in bags manufactured from polythene, in metallised plastic sheeting, and in a casualty bag incorporating MPS, no significant differences in thermal benefit were found. The protection offered by each system was comparable and the practical experience gained in the field would suggest that the simple polythene bag was superior to the MPS bag when one considers strength, durability, multiplicity of roles, and cheapness. Addition of a fibre pile liner equivalent to 1.5 clo units during exposure in the MPS-lined casualty bag effectively eliminated cold stress and metabolic compensation. Without this liner, the thermal performance of the casualty bag was very similar to the other two lightweight systems.

A review of Scottish telemedicine.

Telemedicine services have been provided from Scotland for many years. Initial activities centred on the provision of health care to workers on the oil installations in the North Sea, to mixed-gas divers supporting the oil industry, and to scientific staff in British Antarctic Territory. Other Scottish research work has contributed to space medicine. The remote location of much of the Scottish population is currently the reason for much telemedicine research. This paper reviews the past quarter of a century of telemedicine in Scotland and identifies the principles that have led to success in some challenging locations. The same principles can be expected to apply when telemedicine services are provided more generally.

The development of a telemedicine laboratory as a medical faculty resource.

A telemedicine facility was established for the Faculty of Medicine of the University of Aberdeen and developed as a laboratory to help ensure a scientific approach to the implementation of telemedicine. Once a service application has been positively evaluated and established then it should be funded and delivered outside the laboratory, thus freeing up time and resources for the evaluation of new areas. Since it would appear that the practice of telemedicine is here to stay, it would also seem reasonable to suggest that an introduction to telemedicine should be included in the medical undergraduate curriculum.

A pilot study in medical education using interactive television.

Medical students in the United Arab Emirates do not receive postmortem teaching. This is because postmortems are not normally carried out, for cultural reasons. In order to address this problem a collaborative project was established between the medical schools of Aberdeen University and the United Arab Emirates University to evaluate the feasibility, acceptability and effectiveness of telepathology teaching. A videoconferencing link was established between the UK and the Middle East using ISDN at a transmission speed of 384 kbit/s. Although some technical problems relating to line continuity were encountered, the results relating to feasibility, acceptability and effectiveness were very positive. Although expensive, this form of teaching may still be cost-effective in relation to the benefits.

Intercontinental postmortem studies using interactive television.

For cultural reasons, medical students in the United Arab Emirates (UAE) are not offered postmortem studies. In a collaborative project between the medical schools of Aberdeen University and the UAE University the feasibility, acceptability and effectiveness of telepathology teaching were evaluated. The transmission of postmortem video images at a quality high enough for teaching purposes was achieved at a data transmission speed of 384 kbit/s. Videoconferencing as a method of presentation was viewed by the students as both interesting and useful. All students participating in the telepathology teaching sessions exceeded the minimum acceptable score of 60% in a multiple-choice examination. Although international videoconferencing at 384 kbit/s is expensive, the costs involved in the telepathology project were small in relation to the educational benefits.

The nurse practitioner: management of minor trauma.

OBJECTIVE: to identify patient groups within Accident and Emergency (A & E) practice where the nurse practitioner, following agreed protocols and treatment regimes, might make a contribution to patient care; and to describe a possible process of preparation required to introduce nurse practitioners into an A & E department. DESIGN: A 14-day study (6-12 January and 24-30 July 1994) in which the case notes of all patients attending the A & E department were analysed. SETTING: The A & E department of Aberdeen Royal Infirmary, UK. PARTICIPANTS: A census of the case notes of 1785 patients. MAIN OUTCOME MEASURES: Demographic and clinical characteristics of new patients, diagnosis, investigations, treatment ordered, numbers of return visits, source of referrals and disposal destinations. RESULTS: On analyses of the workload profile it became apparent that a small number of injury categories, investigations and treatments, accounted for a significant percentage of patient throughput and that 75% of cases attended between 09:00 and 21:00 h. Many cases were of a minor nature, discharged home after minimal treatment and no follow-up. It was thought possible that the assessment and treatment of a significant percentage of patients (30%) could be carried out by suitably trained and experienced nurses working to an agreed protocol. CONCLUSIONS: The paper discusses the concept of the nurse practitioner and seeks to demonstrate a possible role for such a clinical worker using previously agreed protocols devised from a clinical database of patient requirements. Their employment could possibly bring a considerable routine saving in waiting time for patients with minor injuries.

Research based training for the nurse practitioner.

Exploration for oil and gas began in the North Sea in the mid 1960s. Since that time offshore medics have had the authority to diagnose and treat patients within a set of guidelines. As such they are one of the earliest groups of British nurse practitioners. Training for offshore medics in the UK sector of the North Sea is regulated by the Health and Safety Commission. In order to promote training based on research, a study was conducted to examine the pattern of referrals to the Accident and Emergency department of Aberdeen Royal Infirmary from offshore. This was done for a 9 year period. The purpose was to establish a reliable database of the most frequently occurring injury types and affected body parts, and to use this information to modify existing training courses for offshore medics. The total number of injury referrals during the study was 6270. The most common injury type was fracture/suspected fracture (mean = 50% +/- 3.2%) and the most common body part affected was the hand (mean = 37% +/- 3.7%). This paper indicates the changes which were made to an offshore medic training programme as a result of the research. It is suggested that unless such research is undertaken it is not possible to claim that the training of nurse practitioners, in this case offshore medics, is research based and therefore relevant to the needs of the community being served.

Study of mortality risk factors for children under age 5 in Abu Dhabi.

We investigated the association of biological, sociocultural and economic risk factors with child mortality in Abu Dhabi from 1 January-31 December 1997. With McNemar chi-squared test, most selected biological risk factors were statistically associated with child mortality, although maternal age older than 40 years and history of fetal death were not positively correlated with neonate, infant or age under 5 mortality. Among sociocultural and economic risk factors, maternal lack of formal education and low monthly income were significantly associated with child death. Consanguinity was significantly associated with under 5 and infant but not neonatal mortality. Gestation <37 weeks was highly associated with mortality among all ages. Strengthening health care programmes and emphasizing the need to identify high risk groups should be priorities.