Irrigating ears to remove wax is a time-consuming procedure in UK primary care. In many other countries bulb syringes are used for self-clearance of earwax but evidence of their effectiveness is ...lacking.
To compare the effectiveness of self-treatment bulb syringes with routine care.
Open, randomised, controlled trial.
Seven practices in Hampshire, UK.
Participants were 237 patients attending their GP or practice nurse with symptomatic occluding earwax. A further 128 patients did not want to be part of the randomisation but allowed their data to be analysed. Patients randomised to intervention (n = 118) were given ear drops, a bulb syringe, and instructions on its use. Patients in the control group (n = 119) received ear drops, followed by ear irrigation by the GP or practice nurse. Main outcome measures were symptoms (on a 7-point scale), wax clearance, need for further treatment, and the acceptability of treatment.
Comparing patients using the bulb syringe with those treated with conventional irrigation, the change in mean symptom score was -0.81 and -1.26 respectively (difference -0.45, 95% confidence interval CI = -0.11 to -0.79) and, regarding the proportion requiring no further irrigation, 51% and 69% respectively. Although irrigation was preferred by more patients, most patients using the bulb syringe would use it again (75% versus 100%) and were satisfied with treatment (71% versus 99%).
Advising patients with ears blocked by wax to try bulb syringing before irrigation is effective and acceptable, and could significantly reduce the use of NHS resources.
To determine whether patients read and remembered health promotion messages displayed in waiting rooms, 600 patients in a UK general practice were given a self-complete questionnaire. Two ...notice-boards carried between 1 to 4 topics over four study periods. Three-hundred and twenty-seven (55%) of subjects responded. Twenty-two per cent recalled at least one topic. Increasing the number of topics did not increase the overall impact of the notice-boards. The numbers of patients recalling a topic remained constant, but increasing the number of topics reduced the number remembering each individual topic. Patients aged over 60 years were less likely to recall topics, but waiting time, gender and health professional seen had no effect on results. Very few patients (< 10%) read or took health promotion leaflets. These results suggest that the role of waiting room notice-boards should be reassessed. More modern methods of communication such as electronic notice-boards or videos could be used. However, the waiting room might best function not as an area where a captive audience can be bombarded with health promotion messages, but rather as a place for relaxation before consulting a health professional, making patients more receptive to health advice in the consultation.
Zusammenfassung
Arzneimittel für neuartige Therapien wie Zell- und Gentherapeutika oder Gewebeersatz werden in den europäischen Richtlinien unter dem Begriff „Advanced Therapy Medicinal Products“ ...(ATMPs) zusammengefasst. ATMPs sind in ihrer Zusammensetzung und ihren Eigenschaften hoch komplex und unterliegen sich ständig weiterentwickelnden regulatorischen Rahmenbedingungen. Die vielversprechenden Ergebnisse der Grundlagenforschung wecken hohe Erwartungen an das therapeutische Potenzial dieser Produkte. Es besteht aber das Risiko, dass sie nicht die therapeutischen Effekte zeigen, die anfangs auf Basis theoretischer Überlegungen postuliert wurden. Umso wichtiger ist daher ein effizienter präklinischer und klinischer Entwicklungsplan, um den Übergang vom Labor in die erste klinische Anwendung erfolgreich zu gestalten. Aufgrund der Komplexität der ATMPs sollte dieser Entwicklungsplan frühzeitig mit den Regulierungsbehörden abgestimmt werden, um die Besonderheiten und Herausforderungen des individuellen Produktes zu definieren. Bei der Planung und Durchführung der ersten klinischen Prüfung sind – ebenfalls aufgrund der Eigenschaften der ATMPs – besondere Anforderungen zu beachten, die in diesem Beitrag diskutiert werden.
Estrogen activity was measured in wastewater effluent before and after polishing via soil-aquifer treatment (SAT) using both a (hER-β) competitive binding assay and a transcriptional activation ...(yeast estrogen screen, YES) assay. From the competitive binding assay, the equivalent 17α-ethinylestradiol (EE2) concentration in secondary effluent was 4.7 nM but decreased to 0.22 nM following SAT. The YES assay indicated that the equivalent EE2 concentration in the same effluent sample was below the method-detection limit (<2.5 × 10-3 nM) but increased to 0.68 nM in effluent polished via SAT processes. It was hypothesized that test-dependent differences arose because the competitive binding assay responds positively to both estrogen mimics and anti-estrogens; the YES assay responds to estrogen mimics, but test response is inhibited by anti-estrogens. The hypothesis was supported when organics extracted from wastewater effluent inhibited the YES test response to EE2 (anti-estrogenic effect). A similar extract prepared from SAT-polished effluent augmented the EE2 curve (agonist response). When hydrophobic organics in secondary effluent were fractionated, assay results indicated that several physically distinct anti-estrogens were present in the sample. From this work, it is evident that transcription−activation bioassays alone should not be relied upon to measure estrogenic activity in complex environmental samples because the simultaneous presence of both agonists and antagonist compounds can yield false negatives. Multiple in vitro bioassays, sample fractionation or tests designed to measure anti-estrogenic activity can be used to overcome this problem. It is also clear that there are circumstances under which SAT does not completely remove estrogenic activity during municipal wastewater effluent polishing.
Teamworking in nursing homes Wicke, Dorothy; Coppin, Richard; Payne, Sheila
Journal of advanced nursing,
January 2004, Letnik:
45, Številka:
2
Journal Article
Recenzirano
Background. Nursing homes have an important role in the care of frail older people, but concerns have been raised about the quality of care. High standards of care appear to be facilitated when ...nurses work in effective teams. Greater understanding of teamworking in nursing homes could have implications for training and policy‐making.
Aim. The aim of the study was to explore the experiences and perceptions of teamworking with qualified nurses working in nursing homes.
Method. This was a small, exploratory focus group study. The sample was 12 qualified nurses working in nursing homes in the south of England. Transcriptions of the focus groups were coded by the research team and agreement was achieved by discussion.
Findings. Teams described were constructed in ‘vertical’, hierarchical terms rather than as ‘flat’, collaborative structures. The achievement of good teamworking was hindered by inadequate communication, particularly as many staff worked part‐time and on shifts. Management was perceived as remote, and lines of authority were ambiguous and unfocused.
Conclusions. This group of nurses were aware of the difficulties of working in a hierarchical, profit‐making culture. Individually, they tried to provide good quality care for patients and aspired to teamworking, but seldom succeeded to their satisfaction. There may be considerable potential to improve the working lives of staff and quality of patient care by effective teamworking. However, significant barriers, particularly concerning organizational culture, need to be overcome.
Studies have shown that in comparison to rapid occlusion of a vessel, gradual occlusion produces less severe tissue ischemia due to a more effective development of collateral circulation. As other ...studies have shown that collateral circulation can be enhanced by stimulation of the endogenous renin-angiotensin II system, it was hypothesized that this system is involved in the mechanism of protection against ischemia that obtains during gradual vascular occlusion. To test this hypothesis, mortality rates were evaluated in gerbils subjected to gradual vascular occlusion by means of progressive carotid ligation while simultaneously infused with inhibitors of the renin-angiotensin II cascade--enalaprilat or saralasin. Groups of animals with either abrupt or progressive carotid ligation infused with saline served as controls. Results showed that (1) in saline-infused animals, there was a significant decrease in the mortality rate of progressive-ligated animals when compared to abrupt-ligated animals, and (2) administration of either enalaprilat or saralasin to progressive-ligated animals resulted in mortality rates that were indistinguishable from those of saline-infused abrupt-ligated animals. These results suggest that the endogenous renin-angiotensin system is indeed involved in an adaptive mechanism that occurs during progressive ligation of the carotid artery, and more specifically, that the relatively benign effect of progressive carotid ligation may be due to the action of angiotensin II to stimulate the development of collateral circulation and reduce the severity of focal brain ischemia.
A search for single top production (e(+)e(-) --> t (c) over bar) via flavour changing neutral currents (FCNC) was performed using the data taken by the DELPHI detector at LEP2. The data analyzed have ...been accumulated at center-of-mass energies ranging from 189 to 208 GeV. Limits at 95% confidence level were obtained on the anomalous coupling parameters kappa(gamma) and kappa(Z). (C) 2004 Published by Elsevier B.V.
Novel therapies, e.g., cell and gene therapy or tissue engineering, are summarized in the European Union as advanced therapy medicinal products (ATMPs). In terms of composition and product ...properties, ATMPs are highly complex, and given their multiple potential actions they are subject to continuously developing regulatory requirements. Due to promising basic research findings, there are high expectations by the society toward the therapeutic potential of ATMPs. It is of utmost importance to develop a scientifically sound preclinical and clinical development plan before entering into the first clinical trial. Due to the complex features of ATMPs, this development plan should be discussed early with the regulatory authorities to define the specifics and challenges of each individual product. For planning as well as operational realization of the initial clinical trial involving ATMPs, specific requirements that need to be addressed are discussed in this paper.
The management of symptomatic ear wax is a frequent demand on general practice, but is under-researched. Since an earlier survey of GPs in Scotland, there has been an increase in the number of ...practice nurses (PNs) in the UK and there seems to have been a trend away from traditional metal syringes towards electronic ear irrigators. As part of a project to improve ear wax management, we decided to survey a sample of GPs and PNs to explore current pathways of care. (Original abstract)
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