Hospital Supervision Research Articles

Further observations on metronidazole (Flagyl).

Unexpected cases of icterus gravidarum in infancy have in many instances been traced to drug absorption from the maternal circulation. After consulting with paediatricians, it was considered advisable to investigate under hospital supervision the effect, if any, of metronidazole (Flagyl) on the foetus and later on the breast-fed infant. In Edinburgh a and baby survey on 96 patients completed in December, 1960 (Scott Gray, 1961), suggested that there was no placental barrier to the drug. The serum concentrations in mother and child were approximately equal at the time of delivery. The drug was well absorbed during labour, and in four cases where gastric lavage had been previously carried out the serum concentrations were higher than in the remaining cases investigated. Serum bilirubin estimations performed on mothers and babies showed no appreciable increase. This paper presents the results of investigations into the secretion of metronidazole in breast milk and the absorption by the breast-fed infant.

Corsage Pin in Stomach

LONG SHARP foreign bodies in the stomach are alarming to patients, their relatives, and their physicians. Of course, they are potentially dangerous but most of them pass through the gastrointestinal tract without difficulty. When lodged in the esophagus they should be removed, usually by esophagoscopy but occasionally, in difficult cases, by thoracotomy. 1-3 Once they have safely reached the stomach gastroscopic removal is more difficult, normal passage of the foreign body is more likely, and the best policy is, usually, watchful waiting under close hospital and x-ray supervision. Such a policy was successfully carried out in the following case, which is reported because of its general interest and for reassurance of physicians in other similar cases. A 15-year-old boy was admitted to the hospital 5½ hours after swallowing a 6.5 cm. (2.5 in.) corsage pin. He had been asymptomatic since the accident and was asymptomatic on admission. Physical examination

A DECADE OF CHANGE

B EFORE 1950, almost all baccalaureate degree programs in nursing open to graduates of hospital schools were specialized in nature. They were designed to prepare nurses either for beginning practice in the public health nursing field, or for administration, teaching, or supervision in hospitals and schools of nursing. Since 1950, the leading college and university schools and departments of nursing have substituted general nursing programs for their specialized baccalaureate degree programs. Advanced preparation in clinical nursing fields and preparation for teaching, supervision, administration, consultation, and research are now offered by universities at masters and higher degree levels. A number of articles have been

Cycloserine treatment of pulmonary tuberculosis in Asian patients

Summary Fourteen Asian patients, 13 with moderately advanced or far advanced pulmonary tuberculosis and 1 with endo-bronchial tuberculosis, in all of whom the strains of tubercle bacilli were either known to be resistant to conventional forms of chemotherapy or were presumed to be so from lack of clinical improvement, were treated with cycloserine. Ten patients showed some benefit. Although the dosage was low and did not exceed 0·75 g. per day in any case, 10 had definite toxic effects in the form of psychotic symptoms, drowsiness, and anorexia. One patient developed congestive cardiac failure. Two others had personality changes which may have been due to the effects of cycloserine. The trial indicates that the toxicity in Asian patients is no less than in the groups previously described and that the drug should only be used under the closest hospital supervision and then only to patients who are unsuitable for established methods of chemotherapy.

The Struggle for Eradication of Tuberculosis

Advances in drug therapy have required changes in public health procedures without discarding the time tested practices of tuberculosis control. Chemotherapy and modern advances in thoracic surgery have resulted in a sharp drop in mortality, declining morbidity, shorter duration of treatment and diminished hospital confinement. No known single or combination of drugs destroys all tubercle bacilli in the body and the outlook for improved therapy must depend upon research laboratories. Our present anti-tuberculosis drug therapy fails in some cases and has no effect on those infected with drug resistant bacilli. Among others with widespread bilateral disease, especially the elderly, active disease cannot be arrested and such persons must be isolated. Prior to the advent of streptomycin, therapy depended largely on bed rest, nutrition and collapse procedures. Treatment was largely in the hands of specialists in pulmonary disease and only a small percentage of patients was under the care of general practitioners. The average physician could not spare the time necessary on a single patient for proper coverage of medical advice and treatment after making a diagnosis of active disease. The case was referred to a sanatorium or to the phthisiologist. Modern drugs have simplified therapy, and physicians who never treated tuberculosis under the old regime, are now taking care of many ambulatory patients. The doctor now specializing only in tuberculosis is a rarity. A result has been that more patients are refusing hospitalization because they or their physician rejects institutional care. Our problem, now is not only with the “good chronic,” with lingering tuberculosis and positive sputum, who is allowed to go about his occupation, meantime spreading the disease, but also with early, and moderately advanced cases under therapy who form an added source of infection. Patients without hospital supervision have been arrested, but more have progressed to advanced stages before being sent to institutions. Widespread practice of ambulatory chemotherapy has resulted in development of drug resistant organisms in a number of cases. The unhospitalized tuberculosis patient is a major health problem, as a source of infection.

Cases in Hospital Supervision

Cases in Hospital Supervision

Cases in Hospital Supervision

Cases in Hospital Supervision

Rauwolfia serpentina in hypertensive vascular disease.

1. Rauwolfia serpentina (Raudixin Squibb) was administered for periods of 2 weeks or more to 10 ambulatory patients with uncomplicated hypertensive vascular disease, 10 bed patients with the accelerated phase of this disorder, and to 4 hospital patients in varying stages of the disease, the last group being studied in detail while on a constant fluid and dietary regimen. 2. Significant depressor effects and bradycardia were observed in the majority of the ambulatory patients; some degree of relaxation was noted in those who were emotionally tense; but little or no effects were evident in those with the accelerated phase or those under hospital supervision. 3. Temporary sodium retention was apparent in 2 hospital patients with nephrosclerosis, but otherwise Raudixin appeared to have no direct hemodynamic, circulatory or metabolic action.

Public Health in Turkey

THE Asiatic Review of October contains an interesting article by Bay Nuzhet Baba on the public health effort and social assistance in Turkey. The central authority in charge of health and social assistance is the Ministry of Health arid Social Assistance. Free treatment of the sick, campaigns against epidemics and diseases, especially malaria, trachoma, typhoid fever and dysentery, all fall within the sphere of activity of the Ministry. To the Ministry also are entrusted the supervision of maternity homes, hospitals and sanatoria. In order to emphasize the importance of medical examination of school children, dental care, vaccination against small-pox, inoculations, etc., the Ministry has drawn up regulations whereby municipalities are obliged to provide such services free of charge. Museums have been established and exhibitions arranged to propagate hygienic principles, and posters and pamphlets are distributed to the villages and displayed in public places.

Torulosis of the Central Nervous System

In March, 1939. there was admitted under my care at the St. Pancras Hospital Mental Observation Unit a case of torulosis of the nervous system. This is a very rare disease in this country and the present case is only the third recorded in British medical history (Greenfieldet al., 1938; Smith and Crawford, 1930), and the first one to have come under mental hospital supervision. Although such a rarity here, torulosis is more common in the United States, and cases have been reported from nearly every part of the world.

A preliminary report of a study of records of the Maternity Center Association of New York

This study, therefore, demonstrates that, on the score of all essential indices, prenatal care, as conducted by the Maternity Center Association, produces effective results. The mortality of the mothers was reduced to about a third of the mortality occurring in the same area among women not receiving the intensive care offered by the Maternity Center. Stillbirths were 42 per cent lower than in the rest of the district and infant deaths in the first month of life were reduced 32 per cent as compared with the control group in the same area.But it is only too true that in spite of the gains, the irreducible minimum has not yet been reached in the mortality of mothers, in the diminution of stillbirths or in the deaths of babies under one month. There are still too many misfortunes to mothers and babies under the present régine. A combination of such a service as the Maternity Center Association gives with a well-controlled Medical Delivery Service preferably under a hospital's supervision, would more than likely eliminate many of these misfortunes.For the country as a whole, the results already achieved in the Maternity Center experiment reported in this study, have very definite implications. If the same type of service could be rendered universally and the same results obtained, 10,000 of the 16,500 women who die annually could be saved; many stillbirths could be prevented and some 30,000 babies that annually now die, under one month, would be living. The need of the future is obviously to put into operation the machinery which has been demonstrated over these years to be effective.

Principles and Practice of Supervision: A Course of Study in Supervision in Hospitals and Schools of Nursing

Principles and Practice of Supervision: A Course of Study in Supervision in Hospitals and Schools of Nursing

A PRACTICAL DANGER IN THE USE OF INSULIN BY THE PATIENT AT HOME

When insulin was first introduced as a therapeutic measure in the management of diabetes mellitus, it was deemed advisable that its administration be begun with the patient under hospital supervision. That this was and still is a wise and just precaution, should evoke no controversy. We are dealing with a powerful agent, and employing it to combat a condition that varies widely with each individual, thereby precluding the possibility of anything like a fixed dosage. With each case a law unto itself, it is essential that, through careful and painstaking analysis, the degree and severity of the disease be determined, and, by a study of its reaction and behavior to an adjusted diet and insulin, a safe dosage of the latter arrived at. This was found to be practical only in a well instituted hospital. Particularly was this so if, in addition, it was anticipated that insulin therapy might be