This study investigated, by questionnaire, the attitudes of geriatricians, speech therapists, dieticians, and nurses towards feeding by percutaneous endoscopic gastrostomy (PEG). The final response rate from a total of 199 questionnaires sent to this group was 75%. According to 95 (64%) of the respondents, the decision to use PEG feeding was reached by a multidisciplinary team approach and commonly involved carers as well as the patients. The quality of life was the single most important factor influencing this decision. PEG feeding was felt to be indicated in non-dysphagia-related malnutrition by 98 (66%) and in dementia with rejection of oral feeding by 69 (47%) of the respondents. It was felt by 39 (55%) of the nurses and by 32 (42%) of the other professionals that patients with dementia in long-term care who are established on nasogastric feeding should be converted to PEG feeding. This raises several ethical and resource issues.
We investigated the quality of diagnostic coding in relation to cerebrovascular disease (CVD) in a computerized clinical information system by comparing the codes on the computer printout, obtained from casemix database on 166 patients with a diagnosis of cerebrovascular disease, with the codes allocated by the investigators after examining the case notes. Overall, the diagnostic coding was incorrect in 44 (26%) cases. These inaccuracies included 9 (5%) patients who did not have CVD and 35 (21%) patients who were incorrectly coded as "acute but ill-defined stroke". The inadequacy of information in discharge letters was the main reason for such discrepancies (21 cases). There is a need for adequate education and training of doctors and coding clerks and for a constant dialogue between them if the deficiencies in coding are to be rectified and the value of hospital information system in the audit, costing and health care planning is to be improved.
A double blind study in 25 patients with ischaemic heart disease and 20 matched healthy controls examined the effect of sulphinpyrazone on the uptake of serotonin by platelets and the basal concentrations of serotonin in platelets. Uptake was measured using tritium labelled serotonin and basal concentrations estimated spectrophotofluorometrically. Serotonin uptake was significantly increased both in the patients with chronic stable angina of effort and in those with a history of myocardial infarction six months or more previously. Sulphinpyrazone reduced serotonin uptake from 94-25 (SE 8-65) to 57-86 (5-37) cpml10t platelets after 24 weeks of treatment in the group with stable angina and from 137-45 (16.26) to 68-08 (8-38) cpm/108 platelets in the myocardial infarction group. Raised basal concentrations in the two groups were also reduced by sulphinpyrazone. Placebo had no effect on serotonin uptake or basal concentrations in either group of patients.The ability of sulphinpyrazone to inhibit uptake and reduce basal concentrations of serotonin in patients with ischaemic heart disease may be yet another mechanism through which this drug exerts its beneficial antiplatelet effect.
IntroductionThe results of the Anturane (sulphinpyrazone) reinfarction trial showed the beneficial effects of this drug in preventing sudden death after myocardial infarction, though its exact mechanism of action was not clear.' Various antiplatelet agents act in different ways-for example, sulphinpyrazone and aspirin inhibit the platelet arachidonic pathway and therefore the synthesis of thromboxane A2 and platelet aggregation,3 whereas dipyridamole increases platelet cyclic adenosine monophosphate concentrations, thus inhibiting platelet calcium activation, leading to inhibition of platelet aggregation and adhesion.3Other mechanisms through which sulphinpyrazone may act are by reducing thrombus formation4 and preventing ultrastructural changes in platelet morphology.' In addition, in vitro studies show that sulphinpyrazone inhibits the release of serotonin by platelets,6 affects platelet survival time,' and reduces platelet aggregation. ' Platelets are the main reservoir of serotonin in man and show definite uptake and efflux of this amine.9 We have reported finding a significant increase in serotonin uptake by platelets from patients
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