Nurse triage for house call requests in a Tyneside general practice: patients' views and effect on doctor workload

BACKGROUND: Demand for consultations in primary care has risen recently, necessitating a change in working practices. As part of this process, the possible contribution of practice nurses in the telephone assessment of home visit requests merits attention. AIMS: To survey the views of our patients encountering our nurse triage system for home visit requests, set up in June 1995, and to plot its effect on the routine visiting workload of our doctors and thus their availability at the surgery. METHOD: The outcome of each request was categorized as: doctor to visit (DV), surgery consultation with doctor (SC), nurse advice given and accepted (NA), or call passed to doctor for advice (DA). Frequency data from September 1995 to December 1996 were recovered. Questionnaires for self-completion were sent to all those requesting a routine weekday house call during two four-week periods in 1995 and 1996. RESULTS: Analysable activity data revealed 1764 house call requests, with 41% DV, 18% SC, 24% NA, and 8% DA. In the first survey, 121 questionnaires were sent out and 84 returned (69% response rate) and, in the second, the corresponding figures were 113, 85, and 75%. About 80% of responders reported that they were satisfied with the help received from the nurse. CONCLUSIONS: Nurse triage of house call requests has led to more efficient care for our patients, as we have increased the availability of surgery consultations by reducing the number of house calls made by our general practitioners.     

Combined nicotinic and muscarinic blockade in elderly normal volunteers: cognitive, behavioral, and physiologic responses

1-, 3-, and 6-nitrobenzo[a]pyrene (nitro-BaP) are environmental contaminants that can be metabolized to genotoxic derivatives by either nitroreduction or ring-oxidation. In this study, we examined the types of mutations produced by the primary nitroreduced metabolites, 1-, 3-, and 6-nitroso-BaP (NO-BaP) in the hprt gene of Chinese hamster ovary cells. RNA from 6-thioguanine-resistant mutants was reverse-transcribed to cDNA and the hprt coding sequence was amplified and sequenced. The mutational patterns produced by the three compounds exhibited extensive similarities: 1) base pair substitutions accounted for 67% (28/42) of 1-NO-BaP, 51% (26/51) of 3-NO-BaP, and 50% (11/22) of 6-NO-BaP mutations; 19-36% of the mutations were exon deletions and 14-18% were frameshifts; 2) most (64-84%) of the simple base pair substitutions occurred at G:C, mainly G:C-->T:A and G:C-->C:G transversions; 3) 98% (46/47) of the simple base pair substitutions at G:C had the mutated dG on the non-transcribed strand and 81% (38/47) were located with the mutated dG flanked 3' by at least one purine; and 4) most simple base pair substitutions (48/62, 77%) occurred in exons 2, 3, and 8 of the hprt gene. Although there were no significant differences among the mutation profiles of the NO-BaPs, a significant difference did exist between the mutation pattern produced by 3-NO-BaP and the mutation pattern previously determined for the ring-oxidized product of 3-nitro-BaP metabolism, trans-7,8-dihydroxy-anti-9,10-epoxy-7,8,9, 10-tetrahydro-3-nitrobenzo[a]pyrene. This observation indicates that differences in the structures of closely related adducts can be important enough to have an effect on mutation profiles.     

Amplification refractory mutation system linear extension: a novel, gel-free, enzyme-linked immunoassay method for DNA genotyping

A single synthesis cycle of the amplification refractory mutation system (ARMS) was applied to the analysis of K-ras alleles amplified by polymerase chain reaction and immobilized in streptavidin-coated microtiter plates. The ARMS cycle provided the specificity and molecular switch characteristics of a conventional ARMS assay. This allowed linear extension from an allele-specific primer and the incorporation of digoxigenin-labeled deoxyuridine monophosphate from digoxigenin-11-deoxyuridine triphosphate in the presence of the appropriate K-ras allele. Any digoxigenin-labeled deoxyuridine monophosphate substitution was then demonstrated by enzyme-linked immunoassay with colorimetric endpoint. This method is capable of detecting underrepresented acquired mutations, and this has been shown by the unambiguous detection of specific K-ras mutations in cell line DNA/normal human genomic DNA admixtures. The characterization of K-ras mutations in frozen colorectal tumor samples and histologic material is also described.     

Assessment of weighting methodology for the National Comorbidity Survey

The authors studied weighting adjustments for the National Comorbidity Survey (1990-1992), a large-scale national epidemiologic investigation of the prevalence, risk factors, and consequences of psychiatric morbidity and comorbidity in the United States. Weighting adjustments for differential selection within households, new construction, unit nonresponse, and poststratification were examined separately and in combination. Specific issues addressed included the magnitude of the bias incurred from ignoring the weights, the added variance from weighting and how well this was predicted by simple formulae, and the performance of methods for trimming the weights. Weights had quite modest effects on point estimates of prevalences but resulted in major increases in variance unless trimmed. The weights after trimming and poststratification appeared to work well. It is suggested that the added variance from weighting be carefully monitored in similar surveys. Alternatives to the use of trimming for controlling variance are worth exploring.     

Frequency of fetal cells in sorted subpopulations of nucleated erythroid and CD34+ hematopoietic progenitor cells from maternal peripheral blood

Fetal cells that circulate in maternal peripheral blood (PB) during pregnancy offer a potential source of nucleated fetal material for noninvasive prenatal diagnosis. Fluorescence-activated cell sorting was used to target two populations of fetal cells: nucleated erythroid cells (NECs; CD71/glycophorin-A+ CD45(lo-int) CD34-) and hematopoietic progenitor cells (CD34+ cells; CD34++ CD71/glycophorin-A- CD45(int)). Fetal cells were detected by fluorescence in situ hybridization (FISH) using directly conjugated chromosome X and Y probes in 65% (13 of 20) of the maternal PBs (fetal karyotype 46,XY). The frequency of fetal cells isolated from the NEC and CD34+ fractions was, respectively, 0 to 14 and 0 to 7 cells per 2 x 10(7) previously frozen maternal cells (approximately 20 mL of blood). In nonfrozen samples, the yield and recovery of fetal cells was moderately improved. Culturing the CD34+ sorted fractions in serum-free media with cytokines improved the quality of the FISH preparations and resulted in a slight expansion in detectable fetal cells. The frequency of fetal cells isolated from cultured CD34+ fractions was 0 to 35 and 0 to 93 cells per 2 x 10(7) previously frozen and nonfrozen maternal PB cells, respectively. These results document the isolation, characterization, and enumeration of fetal cells from the maternal periphery that appear to be present in most, but not all, samples analyzed.     

Quenching-rate determination for standard steel tensile specimens

A vertical tube furnace and a four-channel digital storage oscilloscope have been used to determine quench rates for standard tensile specimens of a martensitic stainless steel. The quenching media examined were air, oil and water. Theoretical calculations were made, based on convection heat-transfer approaches, which quantify the heat flow from the specimen surfaces during cooling. Experimental data are in reasonable agreement with predicted values.