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Lung cancer screening has come a long way since the early studies with chest X-ray. Advancing technology and progress in the processing of images have enabled low dose CT to be tried and tested, and evidence suggests its use can result in a significant mortality benefit. There are several issues that need refining in order to successfully implement screening in the UK and elsewhere. Some countries have started patchy implementation of screening and there is increased recognition that the appropriate management of pulmonary nodules is crucial to optimise benefits of early detection, while reducing harm caused by inappropriate medical intervention. This review summarises and differentiates the many recent guidelines on pulmonary nodule management, discusses screening activity in other countries and exposes the present barriers to implementation in the UK.

Solitary pulmonary nodule (SPN) is a common clinical problem, and the clinical history is vital in assessing the pre-test probability of malignancy.Previous relevant imaging should be accessed.CT scanning for an SPN should be to a defined protocol, so that any follow-up studies are comparable.Positron emission tomograpy and depreotide scanning both offer non-invasive characterization, which, with improved image registration, could be of use even in nodules than 10 mm in diameter.

Although glucose uptake is increased in chronically hypoperfused, viable myocardium, the dynamic changes in glucose uptake relative to oxygen consumption in "short-term" models of hibernation have not been fully explored.14 anesthetized swine were instrumented with an hydraulic occluder and flow probe on the proximal LAD artery. Blood flow was reduced approximately 30% for 1 hour. Myocardial blood flow and uptake of oxygen, free fatty acids, glucose and lactate were determined in the LAD region at baseline and at 10, 30, and 60 minutes of ischemia. Transmural biopsies for ATP and creatine phosphate (CP) were obtained in the LAD region prior to and at 15 and 45 minutes of ischemia. In 5 animals, glycogen was assayed at baseline and at the end of 60 minutes of ischemia.In the LAD region, myocardial oxygen consumption was reduced from 2.06 +/- 0.16 micromol/min/gram to 1.46 +/- 0.13 micromol/min/gram (P0.05). By 15 minutes of ischemia, transmural creatine phosphate fell from 7.48 +/- 0.76 micromol/g-wet weight at baseline to 6.19 +/- 0.32 micromol/g-wet weight (P0.05) but normalized by 45 minutes of ischemia (7.39 +/- 0.56 micromol/g-wet weight; NS). Between 10 and 60 minutes of constant flow reduction, glucose uptake as a percentage of MVO2 increased from 3 +/- 2% to 10 +/- 2% (P0.05) while lactate uptake increased from -9 +/- 9% to -1 +/- 2% (P0.05). Glycogen decreased from 27.8 +/- 3.7 at baseline to 16.9 +/- 1.2 micromol/g-wet weight at end-ischemia.In this model of short-term hibernation, glucose and lactate uptake increase relative to oxygen consumption during sustained ischemia, and temporally coincide with the recovery of bioenergetics. The findings are consistent with the notion that glycolytically derived ATP is important for the maintainance of energy supply during sustained ischemia.

We reviewed our short- (30 days) and long-term (up to 17 years) experience with surgical revascularization for patients with angiographically documented isolated single-vessel coronary artery disease.Retrospective study of single-vessel coronary artery bypass procedures performed from January 1980 through June 1996. During this time, 100 consecutive patients underwent a single-vessel coronary artery bypass. All patients were men with a mean age of 59+/-9 years (range, 35 to 78 years) and a mean ejection fraction of 56+/-8% (range, 35 to 77%). The vessels bypassed included the left anterior descending in 66 (66%), right coronary artery in 31 (31%), and the obtuse marginal in 3 (3%).Short-term results reveal no deaths and six (6.0%) complications. Long-term follow-up by chart review and telephone survey was available in 87 (87%) patients at a mean of 46.9 months (range, 12 to 151 months). Cumulative freedom from angina and repeated revascularization was 93% and 98% at 1 year and 55% and 81% at 10 years, respectively (Kaplan-Meier).Single-vessel coronary artery bypass for isolated single-vessel disease can be performed with minimal morbidity and no mortality and provides excellent long-term relief of angina.

To evaluate a departmental computer system.a. Direct comparison of the time taken to use a manual system with the time taken to use a computer system for lung function evaluation, loan of equipment and production of correspondence. b. Analysis of the accuracy of data capture before and after the introduction of the computer system. c. Analysis of the comparative running costs of the manual and computer systems.Within a department of respiratory medicine serving a hospital of 1323 beds.a. Time taken to perform functions with the assistance of computerised methods, in comparison to the manual method used alone. b. Accuracy of data capture. c. Relative running costs.a. The computer system (CS) was significantly faster than the manual system (MS) for lung function evaluation (CS = 7.63 min/test, MS = 12.25 min/test), loan of equipment (CS = 0.40 min/loan, MS = 2.07 min/loan), and checking for overdue equipment (CS = 0.49 s/record, MS = 9 s/record). The production of correspondence was slightly slower with the computer (CS = 9.30 min/letter, MS = 8.54 min/letter). b. All outpatient episodes, but only 43 of 65 (66%) of in-patient episodes, were captured. Lung function and managerial report data were accurate using both manual and computerised methods. The manual system for equipment loans was inefficient, and use of the computer resulted in the recovery of 221 nebulisers. c. Development costs for 1988-1990 were high (72,178 pounds). Only 1200 pounds to 1845 pounds per year was recovered directly from staff time saved by the computer but larger savings resulted from changes in work practice (4049-4765 pounds). After 10 years the projected deficit is 10,000 pounds per annum in running costs.In comparison with the manual methods, the computer system has shown significant advantages which provide accurate information, with significant favourable effects on working practices. In evaluating computer systems used in clinical practice it is essential to ensure that the projected work practice benefits are achieved without unacceptable costs in staff time, inaccurate data and high financial outlay.

There is an abundance of information on the association between stressful life events and illness within the adult population. In contrast, research on this relationship among adolescents is limited. This study evaluated the role of individual differences (gender and race) on the stress-illness relationship within the adolescent population. Participants were 119 adolescents (54 females and 65 males), recruited from two public high schools located in the southeast, who were administered four questionnaires designed to measure levels of stress, anxiety, and illness. Overall, correlational analysis revealed that stress and anxiety were positively correlated with reported illness. However, racial and gender differences did emerge. Although no gender differences were found with regard to the experience of stress, African-American athletes reported a higher frequency of stressful life events than did their Euro-American counterparts. Further, African-American adolescents reported a lower frequency of illness than did the Euro-Americans. Females reported more illnesses than did males. Possible explanations for individual differences in reported stress and illness are discussed.

Relating the concentrations of active antimicrobial at the potential site of infection to MIC, may give some indication of clinical efficacy. Where relatively insusceptible pathogens are involved, site concentrations are likely to be important predictors of efficacy. Unfortunately, there are sources of errors in measurement which make the values obtained imprecise. Despite this, broad trends are beginning to emerge, especially with bronchial biopsy concentrations. In bronchial biopsies, cephalosporins reach approximately 35 to 55% of simultaneous serum concentrations, in whole lung tissue 15 to 50% and in ELF 15 to 35%. The observed site to serum ratios are consistent with the permeability characteristics of cephalosporins and the barriers to movement of drugs into sites of infection. There is evidence that inflammation may alter the barriers to infection and for the cephalosporins site penetration may be higher. Further work is necessary to establish a clear relationship between site concentrations in the lung and clinical efficacy.

This study identified the exciting nature of work for 176 registered nurses employed in urban and rural home health agencies in the southeastern United States. The results revealed that the majority of the home healthcare nurses perceived their work as moderately to highly exciting. Nurses with higher levels of work excitement selected home care because of personal fulfillment, whereas those who were less excited chose home care for schedule flexibility. Both groups, however, cited direct patient contact as a major factor in their decision to practice in the home care setting.

Exposure to hazardous materials and hazardous wastes has become a critical issue. There is now a greater awareness of the potential health risks associated with these substances. Because intravenous nurses encounter hazardous substances on a daily basis, they must adhere to appropriate precautionary measures. Mandatory compliance, however, is not enough. The I.V. nurse needs to understand the rationale for these measures and the basis for the federal and professional regulations regarding the handling of hazardous materials and wastes. This article focuses on the definitions of hazardous substances, the regulations governing these substances, and the principles concerning the handling and disposal of hazardous materials in the practice setting.

Intravenous therapy is one of the admission criteria for the geriatric patient to enter a skilled nursing facility. Because of shortened hospital stays, more and more geriatric patients are placed in this type of nursing home. These facilities are also potential alternatives to hospitalization of the nursing home resident who requires I.V. therapy. Multiple factors, such as the aging population, federal programs for the elderly, and the economic health care climate, have contributed to the emergence of the skilled nursing facility as a practice setting for I.V. therapy. As the acuity of nursing home residents continues to rise, I.V. therapy will become a more frequent treatment modality. Therefore, I.V. nurses must be aware of the impact of provision of this service in the skilled nursing facility setting.

Although adverse reactions to heparin are rare and usually quickly reversible, recent studies have reported a potentially more serious complication occurring in up to 30 percent of patients receiving heparin. This phenomenon, known as heparin-induced thrombocytopenia, is believed to be of two distinct types that differ in etiology, clinical onset, and therapeutic ramifications. The most common type is characterized by a mild, transient drop in the platelet count on the second or third day of heparin therapy that generally reverses itself with continued heparin administration. The second type is believed to be the consequence of an immune mechanism or heparin-dependent antibody and may be life-threatening because of an associated thrombosis known as white clot syndrome. This type occurs on the fourth to eighth day of heparin therapy and is signaled by declining platelet count and/or increasing resistance to heparin therapy and eventual development of a clot composed almost entirely of fibrin and platelet aggregates. Heparin-induced thrombocytopenia is significant in that it is not related to age, sex, blood type, or amount of heparin administered. Because of the absence of known risk factors, all patients receiving heparin should be considered at risk for heparin-induced thrombocytopenia.

Patient classification systems may be used to justify I.V. work load. The merits of such a system include accurate prediction of staffing requirements based on patient care needs, validation of the I.V. nursing team's productivity and cost-effectiveness, prioritization of the I.V. nursing work load, and evaluation of the quality of I.V. nursing care.

Shrinkage of mushrooms during blanching and retorting processes was studied using microwave and boiling water blanching treatments. A microwave blanching treatment of 4 min 40 sec at the high setting in a microwave oven was compared to a 7 min, boiling water, conventional blanching treatment. Data showed that the microwave blanching process was superior with respect to yield, allowing for a significant (p < 0.01) increase in net yield (3.41%) for three trials. Color and sensory analyses of the canned mushrooms showed that the two treatments were not significantly different (p