Support of vulnerable patients throughout TB treatment in the UK.

Despite well-established treatment regimens, tuberculosis (TB) remains a public health burden; it disproportionately affects poor and marginalized populations who may not have access to social support, including migrants, homeless people and those dependent on drugs or alcohol. There is a clearly demonstrated need for housing and other appropriate social support, as part of a package of integrated clinical and social care. However, TB prevention and control efforts in the UK often do not address the specific vulnerabilities of these groups and it can be a challenge to support the continued TB treatment of these underserved populations.

The value of uterine artery Doppler in the prediction of uteroplacental complications in multiparous women.

Objective: To investigate the value of second-trimester uterine artery Doppler in the prediction of complications resulting from uteroplacental insufficiency in low- and high-risk multiparous women.

Methods: Color flow pulsed Doppler imaging of both uterine arteries at 20 weeks' gestation was performed on 628 multiparous women; 458 of them had no known risk factors and 170 had clinically identifiable high-risk factors at booking. An abnormal result was defined as bilateral notches and a mean resistance index (RI) >/= 0.

How benchmarking can improve patient nutrition.

Benchmarking is a tool that originated in business to enable organisations to compare their services with industry-wide best practice. Early last year the Department of Health published The Essence of Care, a benchmarking toolkit adapted for use in health care. It focuses on eight elements of care that are crucial to patients' experiences.

Intravenous therapy in critically ill adults: developing a clinically and cost-effective approach.

Intravenous therapies are the most common intervention for critically ill adults. Using a systematic approach as described by Droogan and Song (1996), a review of the literature was undertaken to determine whether the frequency of changing intravenous administration sets in critically ill adults with central venous catheters (CVCs) affected the incidence of CVC-related sepsis/systemic inflammatory response syndrome (SIRS)/bacteraemia. Two major randomized controlled trials were included in the review (Maki et al.

Speech and language therapy for adults in Hackney: an assessment of need.

With the development of separate community and the hospital trusts in the London borough of Hackney, at a time of increasing numbers and range of referrals, a number of gaps in service became apparent. The need for community adult speech and language therapy (SLT) in Hackney was identified, based on previous studies and other relevant literature. Comparison with services locally and nationally shows clearly that Hackney, in having virtually no community SLT for adults, is significantly disadvantaged.

Comprehensive analysis of uterine artery flow velocity waveforms for the prediction of pre-eclampsia.

Objectives: To evaluate the performance of velocimetric indices of uterine artery flow velocity waveforms (FVW's) at 20 weeks' gestation, alone or in combination with qualitative analysis, and establish the optimal screening method for the prediction of pre-eclampsia.

Methods: A total of 614 primiparous women had color flow/pulsed Doppler (CFPD) imaging of both uterine arteries at 20 weeks gestation. Receiver operator characteristic (ROC) curves were created for the systolic/end-diastolic (A/B) ratio, resistance index (RI) and systolic/early diastolic (A/C) ratio for placental and non-placental uterine arteries, individually or in combination with the presence of unilateral or bilateral notches.

Correlation between second trimester maternal serum inhibin-A and human chorionic gonadotrophin for the prediction of pre-eclampsia.

We aimed to investigate the relationship between inhibin-A and human chorionic gonadotrophin (hCG) concentrations in the second trimester in the same cohort of women and compare their screening efficiency for the subsequent development of pre-eclampsia. The main outcome measures were pre-eclampsia and pre-eclampsia requiring delivery before 37 weeks.We carried out a retrospective examination of inhibin-A and free beta-hCG levels taken between 15 and 19 weeks of gestation, from 685 women.

A prospective management study of slow-release aspirin in the palliation of uteroplacental insufficiency predicted by uterine artery Doppler at 20 weeks.

Objective: To investigate the effect of low-dose, slow-release aspirin in reducing the incidence and/or severity of pregnancy complications in women identified as high risk of developing problems associated with uteroplacental insufficiency, namely pre-eclampsia or delivering a small-for-gestational age (SGA) baby.

Design: A prospective, randomized management study. One thousand and twenty-two women of mixed parity underwent color flow/pulsed Doppler (CFPD) imaging of the uterine arteries at the time of the 17-23 week (mean 19.

Letters.

SPINAL INJURY AND PRESSURE SORE PREVENTION TREATMENT FOR OVERGRANULATION.

An analysis of CPR decision-making by elderly patients.

Traditionally clinicians have determined their patients' resuscitation status without consultation. This has been condemned as morally indefensible in cases where not for resuscitation (NFR) orders are based on quality of life considerations and when the patient's true wishes are not known. Such instances would encompass most resuscitation decisions in elderly patients.

Year to end budget forecasting: income and expenditure.

The introduction of devolved management structures within the NHS has exposed many clinical staff to the disciplines of financial management. This short article looks at the principles behind the preparation of budgets, the purpose of the income and expenditure account and the tools used to monitor expenditure at directorate and department level within a hospital.

Letters.

PRESSURE SORE PROTOCOL TEA TREE BURN GELS.

Pressure area care and estimating the cost of pressure sores: Critique 3.

The 'silver' book, Pressure Area Care for the City and Hackney Health Authority, produced in 1988, probably takes second place in the development of pressure area care in the UK only to the 'blue book', An Investigation of Geriatric Nursing Problems in Hospital, published in 1962. Although Hibbs's work was intended only as a local service manual, it rapidly generated a much wider demand, with revision and updating in 1992. Hibbs herself says it is now out of date, but it is worth examining the precepts which formed the basis of modern pressure sore prevention.

Letters.

MAGGOTS - A PERSONAL EXPERIENCE ABPI TECHNIQUES VAPOUR-PERMEABLE DRESSINGS PRESSURE SORES AND SPINAL CORD INJURY DANGERS OF TOWEL CLIPS.