Relationships of processes of care to patient outcomes.

This study examined relationships between process and outcome components of patient care. Relationships were determined between independent process variables--diagnostic approach, therapeutic approach, and patient compliance--and dependent outcome variables--functional status, clinical health status, perception of health and care, and knowledge and understanding of disease and therapy. Criteria for process and outcome dimensions were developed, based on a literature review. Data on 103 patients, followed for a five-month period, were collected by use of patient record audit and beginning- and end-of-study patient interviews. Cross-tabulations and multiple regression analysis were used to determine relationships between independent and dependent variables. Analysis of variance was used to determine difference in provider and patient process dimensions according to patient severity groups. Significant relationships were found between all independent variables and the dependent variables of clinical health status and knowledge and understanding of disease and therapy. Patient compliance level was found to be the most significant process variable.


Relationship of psychological factors in pregnancy to progress in labor.

A prospective study of 32 normal, married primigravidas was conducted to determine the relationship between psychological factors in the third trimester of pregnancy and progress in two defined phases of labor. Data were analyzed for the total group and with five subjects deleted to control partially for the effect of medications. Psychological variables measured in pregnancy had significant correlations with variables measured at the onset of phase two labor. Conflict concerning the acceptance of pregnancy showed the most significant relationships to the phase two labor variables with correlations of .39 with anxiety, .59 with plasma epinephrine, -.70 and -.52 with two adjacent Montevideo units, and .58 with length of labor in phase two (3-10 cm cervical dilation). Other pregnancy variables which significantly correlated with the labor variables were identification of a motherhood role, history of psychological counseling or psychiatric treatment, the trait scale of the State-Trait Anxiety Inventory, and fears related to helplessness, pain, loss of control, and loss of self-esteem. Several psychological variables measured in pregnancy also correlated significantly with length of labor in phase three and type of delivery. The results demonstrate that specific psychological factors in pregnancy are predictive of progress in labor.


Effect of clinical settings on the utilization of nurse practitioners.

In this study, 143 medical and pediatric nurse practitioners in 61 agencies identified problems in role implementation and formulated recommendations for more effective utilization in clinical settings which employ, or plan to employ, nurse practitioners. Physician-intensive settings appeared to utilize nurse practitioners least effectively and more practitioners left such settings, citing inability to implement the role, than did practitioners employed by other types of health agencies. Different kinds of health agencies integrated and implemented the role at different rates.


Investigation of intake-output as a means of assessing body fluid balance.

This study has demonstrated a mean error in I-O figures of 799.50 cc per day when compared with daily weight calculations. There was no statistically significant correlation between the two values. It is suggested that a change be made in nursing practice. If recording of intake-output is to continue as a nursing practice, then it must be coupled with daily weighings and used only in cases where intake must be limited and/or output carefully monitored. Then the two figures, weight loss and gain and fluid balance, loss or gain, must be compared and causes sought for any variances greater than +/- 250 cc.


Complications associated with balloon-tipped, flow-directed catheters.

In summary, the balloon-tipped, flow-directed catheter is used almost universally to obtain important diagnostic information at the bedside with a relatively low risk of serious complications. The flexibility of the catheter and the protection of the catheter tip with the inflated balloon as it passes through the heart chambers have contributed to the low incidence of complications associated with cardiac arrhythmias. Although serious complications are rare, they have been reported to occur. It should always be kept in mind that this technique is an invasive one and can be potentially dangerous. Most of the complications associated with flow-directed catheters can be avoided, however, if they do occur the user should be able to recognize the problem immediately and correct it if possible.


Left subclavian vein puncture for insertion of Swan-Ganz catheters.

A rapid, safe, and reliable method for insertion of Swan-Ganz flow-directed, balloon-tipped catheters using the left subclavian vein is described. Experience with this method in 24 consecutive patients indicates a distinct advantage over the antecubital fossa approach: A venous cutdown is not necessary, the pulmonary artery is readily entered, fluoroscopy is not required, the patient is free to move both arms, and thrombophlebitis and infection occur infrequently. With proper attention to landmarks such as the clavicular tubercle, the procedure may be performed with facility. The major complication, pneumothorax, is minimized if mechanical ventilators are briefly disconnected during the subclavian puncture.


Enhancement of recall of cardiopulmonary resuscitation (CPR): Use of moving-image card to review the dynamics of CPR.

Since victims of cardiac arrest have a more favorable outcome when CPR is immediately applied, it is important to continue to motivate individuals to learn proper technique. It is equally important to ensure that individuals who have learned CPR maintain adequate recall of the procedure. With the intent of enhancing recall of the principles of CPR, a wallet-size plastic card was developed which, when tilted, creates the illusion of movements. Thus, the card enables a viewer to review the dynamic aspects of CPR and reinforces the essential steps of establishing an airway and maintaining breathing and circulation.


Group sessions as a method of reducing anxiety in patients with coronary artery disease.

The purpose of the group sessions in our hospital was to relieve patient anxiety by offering the patients an opportunity to discuss lifestyle changes necessary for adjustment in living with CAD in order to better adapt to the illness. A series of informal group sessions accomplished these purposes admirably. It is the opinion of these authors that nurses educated in group skills should institute group sessions for patients with CAD. The benefits to both the nurse and patient are unlimited.


Role perception of the staff nurse in the intensive care unit.

A group of 201 ICU staff nurses were questioned regarding those activities they perceived as (1) most important, (2) most time-consuming, and (3) most professional. This information was collected to provide a data base for defining the role of the ICU staff nurse and evaluating the implications for nursing administration and staff development. The results indicated that the nurses are doing what they perceive to be important, but not what they perceive to be professional. There were differences in ranking relationships when the basic educational preparation of the nurse was considered as a variable. The results indicate that role perception was more a function of job requirements than a function of educational background. Comparing functional groupings of activities, the nurses ranked direct patient care activities high in time consumption and for importance when compared to nondirect patient care activities, but neither was ranked high for professionalism. This implies a disparity between perception of importance vs. professionalism.


Critical care unit transfer: reducing patient stress through nursing interventions.

Thirty patients hospitalized with acute myocardial infarction were studied by means of comparison of randomized groups to determine the effectiveness of two different nursing interventions on reducing the stress associated with CCU transfer. In order to promote continuity of patient care, one intervention implemented a family centered nursing approach while the other established a staff nurse-patient relationship prior to transfer to the general medical unit. Inferences as to the relationship between each of the nursing interventions and reduction of patient stress during the CCU transfer period were based on a comparison of the mean scores of psychosocial and physiological measures for the experimental and control groups. Six variables were measured. Overall, experimental patients in each group scored lower than control patients for (1-3) patient stress as reported by patient, family, and nurse, (4) cardiovascular complications within 24 hours of transfer, and (5) cardiovascular complications 24 to 72 hours after transfer; no difference was found in (6) physical complaints reported by the patient the evening of transfer.


Attitudes towards mental illness: a comparison of post-basic nursing students with science students.

Two groups of Nigerian university students were compared in terms of their attitudes towards mental illness. Responses on the OMI scale questionnaire items on attitudes towards mental illness were examined. Subjects were 37 registered general nurses from the Faculty of Medicine and 15 science students from the Faculty of Science. Differences between the nurses and science students not attributable to age were observed in Factors A : Authoritarianism, B: Benevolence and D: Social restrictiveness. The nurses scored lower on the above mentioned factors while they scored higher on Interpersonal etiology and Mental hygiene ideology. Also intercorrelation between the five factors was done. Positive correlation was found between Authoritarianism and Social restrictiveness and also between these two factors and Benevolence.


Sudden cardiac death and selective myocardial cell necrosis.

Sudden cardiac death is characterized by ventricular fibrillation. There is evidence that the pathologic lesion associated with sudden cardiac death is selective myocardial cell necrosis. This lesion can be induced experimentally in animals by the administration of catecholamines. A hypothetical association between the effect of catecholamines and ventricular fibrillation has been discussed.


Measurement in nursing education.

The objectives for this paper are fourfold. Evaluation is put into perspective, including measurement and assessment, in relation to the curriculum as a whole. The elements included in the evaluation of educational programmes are outlined. The process of evaluation is related to learning abilities in the cognitive, affective, psychomotor and experiential domains. Finally, some conclusions are made about the process of evaluation.


A sociological approach to the analysis of nursing work.

This paper describes, from a sociological perspective, the work of hospital ward nurses. An analogy is drawn between the work organization of miners at the coal-face and that of nurses in hospital wards. Work roles are considered in order to provide a framework for the analysis of the work of nurses. Multi-skilled and single skilled work roles are described and the concept of a hierarchy of nursing tasks is considered. Problems of observing and analyzing the work of nurses are highlighted with particular reference to the type of environment in which hospital nursing takes place.


Acute problems in the coronary care unit that do not require intervention. II. Atrial fibrillation with optimal heart rates.

Acute onset of atrial fibrillation during the early period of an MI does not require antiarrhythmic therapy if the ventricular response is not excessive and the patient is hemodynamically stable. The use of diuretics and/or unloading agents, determined by the degree of CHF, is the preferred management. Use of digitalis glycosides is potentially hazardous because of the possibility of precipitating A-V block in patients with acute A-V nodal injury.


Reality and expectation of the British National Health Service Consumer.

On the analysis of some 40 000 letters received each year, the author, a medical journalist, has identified nine main categories of queries about health care problems which are not adequately dealt with by the British National Health Services. The problems are concerned with anatomy and physiology, illness, pregnancy and childbirth, contraception, child care, mental health, the old and plastic surgery. By focusing on these unmet needs, a plea is made to rectify the matter.


Applications to undergraduate nursing courses.

Education of nurses has in recent years developed in centres of higher education, but with a rapid rise in courses offered concern has been expressed that too few suitable applicants may be available. This study has attempted to ascertain actual demand for the courses available by cross-referencing applications to a sample of courses, and has demonstrated a downward trend of suitable applications over the two years 1975 and 1976. A cautionary approach to establishing new courses or increasing numbers on existing courses may be advisable and further comparable work will be carried out to assess the validity of the trends already found.


An interdisciplinary tool for assessing patients' readiness for discharge in the rehabilitation setting.

This paper describes the setting up of an interdisciplinary tool to assess readiness for discharge of patients from hospital. The rationale behind the tool is discussed and the literature is reviewed for current perspectives of measurement in rehabilitation, the desirability of planning discharges of referrals and the interdisciplinary nature of the health care team. The concept of readiness is also discussed. Finally, the evolution of the tool is described and its use with selected patients in a rehabilitation hospital is demonstrated.


Commitment to nursing.

After a discussion of models of nursing, the author focuses on what nurses are and argues that their perceptions are significantly different from those of medical practitioners. The commitment of nurses is discussed, debated and explored and some values shared between newly qualified nurses and the lay public. Commitment is put into the prespective of 'accountability' and its effects on assessing quality of care and nurse-patient relationships are discussed. The author also argues that in certain circumstances she would contemplate defecting from 'being a nurse', particularly with regards to her personal concern for the mentally disordered. But the message that pervades the paper is that once one is a nurse, one is a nurse forever. Finally researchers are admonished to strive for 'an elucidation of the nature of commitment'.


Patterns of nurse activity.

A major study was undertaken in three acute hospitals of how nursing staff occupied their time on the medical, surgical and orthopaedic wards, the observation technique adopted being systematic activity sampling. In addition all the interactions patients received from nurses were recorded, the categorization scheme for both sets of data being identical. This paper presents the overall results which emerged from the computer analysis of this material. One of the less expected results is the amount of nursing performed which is categorized as Basic.


The inability to transfer classroom learning to clinical nursing practice: a learning problem and its remedial plan.

The inability to transfer classroom knowledge to clinical nursing practice is a common learning problem encountered by many nursing students. Manifestations of this problem may involve both the academic performance and personal development of the students: inability to solve problems in nursing situations; inflexibility and rigidity in the exercise of nursing care; fragmentation of nursing care; and apathy towards clinical practice. Because of the seriousness of this learning problem, a plan must be formulated to rectify it. This plan is developed with major emphasis on the teaching process, the student and the curriculum. One of the important roles of a teacher is to help students understand many widely useful relationships, principles or generalizations. In order to enhance transfer, nursing students must be given ample opportunities to apply the learned principles in a variety of nursing situations. Learning is a self-active process; an ideal transfer demands the students' conscious realization that transfer is possible. Students need to be committed to the belief that particular facts in the classroom study are pertinent in other situations. To promote transfer, the curriculum must be designed in such a way so that it has transfer value in terms of the students' goals and purposes. Furthermore, proper sequence of curricular activities is crucial if transfer of classroom knowledge to clinical practice is to occur.


Criteria to be used in the selection of clinical areas for basic nurse training.

The problem of establishing criteria to be considered when selecting clinical areas for basic nurse training was investigated by the Teaching team from Bexley Hospital Nurse Education Centre, Kent. Establishments involved in training personnel in occupations other than nursing were examined and evaluated in order to see if comparisons could be made. Unfortunately the establishments chosen provided little information in respect of learner placement in nursing. Contributions to the nursing literature in respect of the subject being considered were sparse, but articles by Martin (1976), Roper (1976), Schröck (1973) and Strohmann (1977) were interesting and of considerable value. Whilst the project at Bexley involved examination of the more obvious criteria used in the selection of training areas, considerable attention was paid to the attitudes of clinical nursing personnel towards nurse education and training. Replies to an educational questionnaire devised by the team revealed many significant differences between the attitudes of those nurses involved in basic nurse training in the hospital's wards and departments when compared with those of other teaching and service personnel. A checklist of criteria was ultimately complied and it was suggested that a further comparative study emphasizing the attitude component of this project should be made in 12 months time.


Professionalism in nursing master's graduates.

The past 10 years have seen a shift in the master's level preparation of nurses. The majority of nurses currently seeking advanced preparation choose clinical specialization as the functional area rather than teaching. Such a shift in focus reflects the ever increasing specialization of services associated with an ever-growing complex society. Although the shift in focus of preparation and the concomitant change in curriculum design have been documented, few scientific investigations have been conducted on the graduates from master's programmes. Of those studies that have been conducted, the majority have focused on the differential personal characteristics of graduate nursing students in different types of programmes. The purpose of the present study was to investigate the relationship between a nurse's area of functional preparation in a master's degree programme and the individual's level of professionalism. The independent variable of the study was functional area of preparation in a master's programme. The dependent variables became enrolment in a formal programme of study, subscription to professional journals, attendance at non-formal educational programmes, number of authored publications, membership in professional organizations and employment in prepared area, as these seemed to reflect the criteria of professionalism explicated by Flexner (1915). The data for the study were gleaned from questionnaires sent to the 637 individuals who had graduated from the programme. Of the 395 questionnaires that were returned, only 272 were usable. This number represented 43% of the graduate population. The chi-square test was used to analyse the data. Each of the chi-square values for association between professionalism and graduate specialty was found to be significant. Postgraduates prepared as teachers met Flexner's criteria more often than did postgraduates prepared as clinical specialists.


The British National Health Service 1948-1978: should we start again?

The author concludes that since the British National Health Service is the product of a complex history, it is impossible th start again: however, the removal of three factors and the development of one would greatly improve it. The factors to be removed are: (i) the witch hunt against management, which has become the scapegoat for other ills; (ii) the medical model of health care, which is no longer relevant or practical; (iii) the industrial model, which has forced the NHS into an inappropriate style of management, trade unionism and employment patterns. The factor to be developed is the clinical skill of the nurse; such development requires improved educational opportunities and a clinical career structure.


From staff nurse to head nurse: a trying transition.

The new head nurse is often unprepared for the role transition required by this new position. In this retrospective analysis of their first six months as head nurses, the authors, with a sense of humor, define a transition process consisting of three maturational stages. If nursing administrators and new head nurses anticipate and recognize these stages and their effects on nursing staff and care delivery, some of the resulting problems may be alleviated.


The evolution of a public health nursing performance evaluation tool.

A tool was developed to evaluate the performance of nurses in a large public health department. Nursing staff were involved in the development process and received inservice education in some aspects of performance that would be measured by the tool. The evaluation tool is used to assess performance in four areas: clinical practice, supervision and management, professional growth and research. The authors wish to express their appreciation to the following individuals in the Chicago Department of Health who worked so diligently in the development of the Performance Evaluation Tool and the inservice education program described in this paper: Elizabeth Velten, Lee Gross, JoAnn Macon, Mitchi Oki, Carol Corcoran, Hazel Barclay, Carrie Manley, Evelyn Ribic, Etherlene Palmer, Zettie Richardson. The authors also acknowledge the guidance of Ms. Claudie Leckeisik during the preparation of this manuscript.


Health education for kindergarten children.

A health education program for kindergarten children was jointly planned and conducted by health and education professionals. The program demonstrates an application of an approach based on skill development for health behavior. It is presented as an example of how a school district can take beginning steps in developing a foundation for teaching health skills. A unique activity of the program included medical students as a means of involving health care professionals as part of school health education.


Values education: extending the view.

A number of values education strategies have recently been developed for use in the classroom. The Shaver model described here incorporates a rational decision-making process based on basic moral values. That process involves identifying and clarifying values, value labeling and generalization, examining the possible consequences of value decision, recognizing and resolving value conflict, and forming qualified decisions. It is not, however, necessary to proceed through that exact sequence of steps. For example, values discussion may begin with the teacher helping a students to recognize a value conflict. From that point, the discussion may move the identification and labeling of values. Consequently, there is flexibility in how this model may be used in the classroom. This model is developed on the premise that people who use such a process in making decisions relating to social-ethnical issues enhance their functioning within a democratic society. It is suggested that people who utilize this process in relation to health issues can likewise enhance the effectiveness of their health-related decisions. Hopefully, there will be a yield of postive health behaviors.


Standards for adequate minimum personal health services.

Consideration of adequate minimum standards for health services usually fails to distinguish among the underlying interpretations of the problem--poverty, wastefulness, or harmfulness. Proposed "redistributive" programs, then, must specify what it is that is to be redistributed; the shortages may not be where expected. Government as guarantor of rights may be more effective in health services than as provider of programs. Adequate standards will best be advanced through adequate financial assistance.


Organizational determinants of services, quality and cost of care in hospitals.

Characteristics of hospitals may be useful predictors of the economy, efficiency, and effectiveness of services delivered. But it is difficult to explain the variables of cost and quality among hospitals until differences among patients and outcomes are accounted for. A promising new research approach is explored as a source of information on that most elusive of all measures in service organizations--the outcome experienced by clients.


Displacement of the abomasum in the cow. Incidence, etiological factors and results of treatment.

Fiftynine cases of abomasal displacement were registered during a 10 year period in a veterinary district in Norway with a dairy cow population of approx. 2500. Of these, 88% were left displacements and 12% right displacements. Ten per cent recovered spontaneously without subsequent relapse. Corrective surgery was performed on the remainder, and 92% of these recovered completely. Surgery was, in most cases, performed on the same day as the diagnosis of abomasal displacement was made. The displacements occurred at all times of the year: 86% of cases involved cows in third or subsequent lactation 95% were diagnosed within the period 4--64 days after calving, and 70% of the cows had been treated for other illness with disturbance of digestion during the week immediately prior to the demonstration of the displacement. In a further 25%, ketosis was diagnosed at the same time as the displacement. Etiology and pathogenesis are discussed.


Duration experience for bed-confined subjects: a replication and refinement.

This study replicated a 1975 study that tested the theoretical proposition that duration experience is related to the processing of environmental events and that changes in the load and complexity of auditory information will change temporal experience. Duration experience was measured by the productive judgment of a 40-second interval and the retrospective estimate of a 150-minute interval. The sample consisted of 60 men and 60 women, aged 18--35 years, who had no known physical or mental health problems. Subjects rested in bed for two and one-half hours. Each subject received one of four forms of auditory information: decoded heavy, decoded light, coded heavy, and coded light. Three hypotheses were tested: 1) Duration experience will be shorter for decoded light than for coded heavy auditory information. 2) Duration experience will be shorter for subjects in decoded than for subjects in coded auditory information. 3) Duration experience will be shorter for subjects who assign a positive value to the auditory information than for those who assign a negative value. None of the hypotheses was supported by the data. The differences that were demonstrated in the first study did not occur. The major points of diversion in the two studies were the difference in geographic location of the sample, the method of judging a 40-second interval, and payment or nonpayment to the participating subjects.


Relationship between nurse counseling and sexual adjustment after hysterectomy.

The relationship between nurse counseling of hysterectomy patients and sexual adjustment following surgery was the focus of this descriptive study. Of 108 premenopausal women admitted to seven hospitals in California, New Mexico, and Utah who completed a series of questionnaires preoperatively, postoperatively, and eight weeks post-surgery, only 11 percent identified the nurse as the person who supplied the most valuable information. Self-reported sexual adjustment following surgery was significantly (p=.001) related to their presurgical pattern. Almost half the respondents wrote comments urging nurses to initiate discussion about the effect of hysterectomy on sexuality.


Level of activation, body temperature, and interpersonal conflict in family relationships.

The 24-hour variation in physiological and psychological functioning within the individual and interpersonal differences were investigated in relation to the nature of social interaction between individuals. Level of activation, body temperature, and interpersonal conflict were studied in a sample of 16 married couples for a period of six weekdays of routine activity. Homogeneity was a major factor in sample selection. Body temperature was measured every hour during the waking time by electronic thermometer, and level of activation was measured four times a day on alternate forms of a self-report adjective  checklist. Interpersonal conflict, defined as perceived fulfillment of emotional and interaction needs, was measured in the morning and late day. The interpersonal Conflict Scale with established validity was constructed for the study and had two alternate forms of equal reliability. An index of desynchrony between partners for both temperature and activation was calculated for each day of data collection by the following method: The deviation score from the overall six-day mean was determined for each measurement time for each spouse and for each variable. Absolute values of the differences between deviation scores were added to obtain an index of desynchrony in that variable for the day. A daily mean of interpersonal conflict scores for both partners was also calculated. The hypotheses that a desynchrony between partners in body temperature rhythm and in level of activation rhythm would be positively related to conflict were tested by the Pearson product moment correlation. Obtained coefficient; were not significant at the .05 level.


Use of reality orientation with aging confused patients.

Use of reality orientation with elderly confused patients in a nursing home setting was evaluated. Although no significant differences were found in degree of confusion, as measured by the questionnaire developed for this study, between an experimental group who participated in a concentrated three-week reality orientation program and a control group, many effects were positive. Nursing home staff were cooperative and helpful. Families of some of the patients were pleased with improvements in their relatives. Many patients became less confused, more open, and appeared to be more alert.


Ego defensiveness, open-closed mindedness, and nurses' attitude toward culturally different patients.

Three hundred actively employed female registered professional nurses representing four cultural groups (white Anglo-Saxon, black, Jewish, and Hispanic) participated in a study to investigate nurses' attitudes toward culturally different patients. Cattell's 16 Personality Factor Questionnaire and Rokeach's Dogmatism Scale were used to measure the independent variables of ego defensiveness and open-closed mindedness. The Cultural Attitude Scale which was used to measure nurses' attitudes was developed by the investigator. Lower ego defensiveness of the nurses was found to result in more positive attitudes toward Hispanic patients regarding cultural attitudes and beliefs (p = .05). The more open minded the nurse, the more positive were attitudes toward all patients regarding nursing care-patient interaction (p = .01 for the white patient, p = .001 for the Hispanic, Jewish, and black patients) and cultural attitudes and beliefs. The data supported the hypothesis that ego defensiveness and open-closed mindedness predict greater variance in attitudes than one variable alone for all patients regarding nursing care-patient interaction and cultural attitudes and beliefs. Implications for nursing research, education, and practice are discussed.


Cognitive-affective consequences of grading versus nongrading of formative evaluations.

In testing the effect of grading versus nongrading of formative evaluations on cognitive learning and affective behaviors of graduate nursing students the following hypotheses were formulated: The experimental (E) group will learn and demonstrate affective behaviors significantly more than control I (CI) and II (CII) groups. Subjects were 95 graduate nursing students. E group subjects (N = 38) were taught by means of FE, with grades. CI (N = 32) and CII (N = 25) groups were taught by means of lecture-discussion and FE without grades, respectively. The content covered conditions of learning and instruction in nursing. Pre- and posttests provided data on cognitive learning. Affective measures and demographic data were obtained only at the posttest. The hypotheses were tested by means of t test. Fisher's Exact Probability Test and Pearson were done to test distribution and relationships between variables. Results showed that: The E group learned significantly more than the CI group, but the CII group learned significantly more than the E group; all groups learned significantly; there were no significant differences among groups in affective behaviors although CII subjects scored highest. Implications were made for education of patients, students, and staff.


A follow-up study of the reliability and validity of the motor activity rating scale.

This study compared and extended the evaluation of reliability and validity of the Motor Activity Rating Scale (MARS) for observing and symbolically recording body positions, body movements, and intensity of body movements. In contrast to a previously reported study, the movement of relatively inactive individuals was observed. High interrater reliability and statistically significant correlations between MARS movement scores and actometer scores were again observed.


Use of a decision tree to improve accuracy of diagnosis.

Thirty triads of nurses matched for educational background, length of experience, and previous performance were studied to determine if use of a decision tree would improve diagnostic accuracy. One experimental and two control groups were given a written case study and asked to list all possible diagnoses that could cause the change in behavior exhibited by the patient. Experimental group nurses were given a set of decision trees to enable them to use the information systematically to determine if characteristics of each condition were present. Significant improvement in diagnostic accuracy was shown by nurses who used the decision trees.


Nurses' propensity to risk.

Risk taking by 53 nurses and 22 non-nurses was investigated in nursing and nonnursing situations in a laboratory study to assess nurses' propensity to risk and to gain information about how nurses make decisions. Games involving loss and gain of money were used. Subjects received money won from the games, but debts incurred by subjects were canceled. The study indicated that unwillingness to accept risk is not characteristic of all nurses. A nurse's propensity to risk appeared to depend on the situation and on the nurse's educational level. Study findings, though restricted by the mode of investigation, have implications for practice and future research.


[Antibiotic therapy, intestinal microbial pullulation and risk of infection in children].

The effect of antibiotic therapy on the intestinal flora was studied qualitatively and quantitatively in 41 infants. The results have been compared with 27 normal children of the same age and background. Antibiotics were responsible for the suppression of sensitive strains and for their replacement by resistant organisms but above all to a rapid multiplication of the intestinal flora. Colistin and pristinamycin caused these changes when given orally. Ampicillin when given both orally and parenterally but Colistin and the aminoglycosides when given parenterally did not have any effect. Fourteen cases of secondary septicaemia due to resistant organisms were observed but other factors were also important, namely the young age of the patients and intestinal problems (stasis and diarrhoea).


Ricin and modeccin do not inhibit the elongation factor 1-dependent binding of aminoacyl-tRNA to ribosomes.

Ricin and modeccin do not affect the total number of ribosomes to which phenylalanyl-tRNA becomes bound in the EF 1-dependent reaction. Previous inconsistencies resulted from the use of the nitrocellulose-filter technique, which overestimates the number of control ribosomes engaged in the binding reaction if trace amounts of EF 2 contaminate the ribosomal preparations.


A synthetic steroid (R2323) as a once-a-week oral contraceptive.

Five milligrams of the steroid R2323 (13 beta-ethyl-17 alpha-ethynyl-17-hydroxygona-4,9,11-trien-3-one (R2323) were administered orally once weekly to 28 subjects for a total of 138 treatment cycles. No pregnancies occurred. The predominant side effects were irregular vaginal bleeding, headache, weight gain, and acne. Administration of the drug was stopped by the investigator in four patients (14%) because of the onset of headaches. Four patients discontinued the drug for other reasons. In 8 of 26 subjects (31%), endometrial biopsy in the third treatment cycle showed secretory endometrium. This suggests a variable central suppression with the 5-mg dose schedule. Patients were enthusiastic about the once-weekly oral administration. This contraceptive may be useful in a select group of women.


[Differential-diagnostic problems with the brain abscess in axial computerized tomography (author's transl)].

On the base of three autoptically controlled cases with ring-shaped findings in the CT the problem of the differential diagnosis of the brain abscess in axial computerized tomography is discussed. A brain abscess must especially be taken into account when the hyperdense anulus already occurs without enhancement by contrast media. The ring-shaped finding is then caused by the high amount of collagen fibres within the abscess membrane, which has no comparable correlate in other focal processes of the brain.


[Optic neuritis in childhood (author's transl)].

The symptoms and signs of twenty-one children under 15 years of age with optic neuritis are presented here. The optic neuritis often was bilateral and accompanied by papilledema. In the acute stage there was however no typical central scotoma in every case. Some children had only peripheral visual field defects. The visual disorder will not improve so much as is general assumed: a slight decrease of visus and visual field defects in static perimetry usually persist. Half of the children developed signs of multiple sclerosis within a few years.


[Has the rate of resistant staphylococci increased recently? (author's transl)].

In clinical material sent to the Clinic for Chemotherapy and the Institute of Hygiene of Vienna University between 1973 and 1978, Staphylococcus aureus was isolated from 0.9-2.3% and 4.2-11.9% respectively. The rate of resistance of the clinic material to oxacillin increased from 0.8 to 16.0%, to cephalothin from 3.3 to 30.5%, to gentamicin from 0.0 to 43.3%, and to erythromycin from 0.8 to 40.2%. In material sent to the Institute of Hygiene the rate of resistance to oxacillin was stable at 13.8%, and to cephalothin remained fairly constant at 2.4%. On the other hand, the rate of resistance to gentamicin increased from 0.5 to 48.5%, and to erythromycin from 19.8 to 56.9%. The reasons for these alarming increases in resistance and the conclusions which should be drawn are discussed.


Methicillin-resistant strains of Staphylococcus aureus: relation between expression of resistance and phagocytosis by polymorphonuclear leukocytes.

Virulent strains of staphylococci are known to resist phagocytic destruction better than avirulent strains. In this context, in vitro elimination by human polymorphonuclear leukocytes of eight methicillin-resistant strains of Staphylococcus aureus of unknown virulence was studied. After incubation for 1, 3, 5, or 24 hr in a modified phagocytic assay, the methicillin-resistant strains survived as well as other virulent but methicillin-sensitive strains of S. aureus. Highly resistant subpopulations were obtained from three parent strains, and a methicillin-sensitive revertant subpopulation from one resistant parent strain. All subpopulations were eliminated to the same extent as were the moderately resistant parent strains. When the phagocytic assay was performed in the presence of 25 microgram of methicillin/ml, only the methicillin-sensitive strains and the sensitive subpopulation derived from one resistant parent strain were eliminated after incubation for 24 hr. These in vitro data are further evidence against the use of methicillin in infections due to these organisms.


Simulated decision-making experience via case analysis.

An effective strategy for developing decision-making skills is presented, using a problem-solving systems model. Through retrospective examination of an actual problem, the systematic, sequential aspects of decision making are illustrated.


A new role for nursing: project director.

A nursing department project director can play a central role in coordinating and directing nursing participation in construction and remodeling and in various departmental projects such as planning and development of new systems and programs. The author tells how she first assumed the project director role for the purpose of facilitating patient care unit construction, expansion and remodeling, and describes additional tasks that can justify the position in the nursing personnel budget.


A study of patient falls from bed.

An analysis of patient falls from bed can help identify high risk patients and can lead to staffing, inservice education, equipment, and environmental adjustments. The method used to investigate falls in this community hospital can be adapted to any other hospital.


Successful educational programming: increasing learner motivation through involvement.

Requiring attendance at staff development activities does not insure that staff members will be motivated to learn or to use the skills and information being taught. Such motivation can be increased by asking a representative sample of prospective learners to help determine program content. This article will discuss the process used to capture learner input in educational program planning.


Making press interviews work for you.

A press interview provides a unique opportunity to promote a positive public image of your institution. A good interview takes preparation, some understanding of what interests the press, and often follow-up. Covering all three areas, this article tells the nurse administrator how to deal effectively with journalists.


Use of microwave radiation in surgery and cancer therapy.

In considering the therapy of cancer, the author has been interested in the internal dielectric heating property of microwaves and applied their capacity of rapid protein coagulation to medical treatment. With the purpose of utilizing this phenomenon for the resection of fragile parenchymatous organs, the experiment was conducted on rabbit livers, which were irradiated with microwaves for about 3 min. The effect of this phenomenon on cancer cells was also observed. Malignant tumors induced in rats were exposed to microwave radiation for 2 min.


A system for studying effects of microwaves on cells in culture.

An improved design of the fluid-filled waveguide-exposure chamber is described for studying effects of microwave radiation on cells in vitro. The system with a micropipette sample holder may be used as a prototype to isolate the apparent nonthermal factor of microwave radiation on cells in culture from those effects resulting from cell temperature rise. This system also allows more precise calibration of incident and absorbed microwave energies. Compared with control, somatic cells of the Chinese hamster exhibited a lower rate of growth and difference in morphology after 2450 MHz microwave radiation for 20 min at a power density of 500 mW/cm2.


Impact of family planning nurse practitioners.

A survey of family planning clinics shows that over half of responding clinics utilize the services of nurse practitioners and delegate to them considerable responsibility for patient care. Reported benefits from the use of family planning nurse practitioners as primary service providers include improved utilization of physician time, wider range of services, greater patient satisfaction, and increased patient volume. Findings indicate that family planning nurse practitioners have become an integral and important part of the family planning delivery system in the United States.


Birth of a comprehensive family-centered maternity program.

The author shares her personal experience in the development of a comprehensive family-centered maternity program. Emphasis is on concepts of continuous evaluation, planning, communication, and changes in attitude. The historical background and methodology are presented to demonstrate the cooperative efforts and responsibilities among nursing, hospital administration, the medical staff, and the consumer to attain their collective goal of a family-centered atmosphere.


Hypertensive disorders of pregnancy.

Preeclampsia/eclampsia, also known as toxemia of pregnancy, remains one of the great triad of obstetric complications. The outlook for the preeclamptic woman and the fetus has improved as a result of increased knowledge of uteroplacental-fetal physiology and of the physiologic deviations involved in preeclampsia, although the  basic cause of preeclampsia remains unknown. Careful screening of women at risk for preeclampsia along with early detection and treatment can help reduce the toll taken in stillbirths, prematurity, and maternal death. Current concepts of pathophysiology are reviewed as is nursing care during the antepartum and intrapartum periods.


Evaluation and need of education programs for community hospital nurses providing neonatal care.

Phase I: Of 204 RN's providing neonatal care in community hospitals in east Georgia and who were examined using a standardized test, those from large hospitals (greater than 1,000 live births/year) performed significantly better than those from medium or small hospitals (P less than .05). Also, there was negative correlation between test scores and years of experience in areas of the hospital other than the nursery and percent of employment time currently spent in areas of the hospital other than the nursery. Phase II: An educational program in neonatal nursing was then provided to 48 RN's by the authors and to 12 RN's by peer-instructors. At the end of the course of instruction a posttest was given. Thirteen RN's who received no formal instruction served as a control group. On the posttest, both experimental groups performed significantly better than the control group (P less than .01), but the group taught by the authors scored significantly higher than the group taught by peers (P less than .05). Educational programs taught by RN's from the community hospital staff are not as effective in regional educational programs as instruction by course by developers.


Purification and properties of a translation inhibitor from wheat germ.

A translation inhibitor from wheat germ has been purified more than 400-fold to apparent homogeneity. The inhibitor is a basic protein with a molecular weight of 30 000. This protein effectively blocks protein synthesis in animal cell-free extracts but does not affect protein synthesis in intact cells. Inhibition occurs at a ribosome to inhibitor molar ratio of 100:1, indicating an enzymic mechanism of action. The wheat germ protein inhibits the translation of endogenous mRNA, exogenous mRNA, and poly(uridylic acid) at a step in polypeptide chain elongation and without breakdown of the polysomes. Neither the aminoacylation reaction nor mRNA degradation is affected by the inhibitor. An interesting feature of the inhibition reaction is that it requires, in addition to the wheat germ inhibitor, both ATP and tRNA. The function of these two compounds in the inhibition is presently unknown since neither the hydrolysis of the beta,gamma-pyrophosphate bond of ATP nor a modification of the tRNA can be demonstrated during the reaction.


Transfer ribonucleic acids from eleven immunoglobulin-secreting mouse plasmacytomas. Constant and variable chromatographic profiles compared with the myeloma protein sequences.

In order to test the concepts that aminoacyl-tRNAs in plasmacytomas may on the one hand modulate the protein synthesized or on the other hand reflect the structure of the synthesized protein, the RPC-5 chromatographic profiles of aminoacyl-tRNAs for all 20 amino acids were studied in tRNA prepared from normal mouse liver and 11 plasmacytomas. The patterns of isoaccepting tRNA were compared with the structure of the myeloma protein being synthesized. The elution profiles of aminoacyl-tRNAs for nine of the amino acids were constant, i.e. they were the same for liver and all plasmacytomas. Significant variability was observed in the profiles of the other 11 families of aminoacyl-tRNAs: asparagine, serine and tryptophan, had peaks of isoaccepting tRNAs found in tumors and not in liver; glutamic acid, histidine and lysine, had different patterns of aminoacyl-tRNAs in plasmacytomas which could be distinguished from the elution profile of liver; and isoleucine, proline, threonine and tyrosine, showed pattern variability in only a few of the tumors. Valyl-tRNA uniquely had one isoacceptor present in liver but absent in the tumors. This variability is thought to be associated with different posttranscriptional modification of the tRNAs rather than regulation of individual tRNA genes in response to particular amino acid sequences in secreted myeloma proteins. Similarily, the lack of correlation of isoacceptors with sequence differences makes the modulation of protein fine structure by tRNA availability unlikely.


Paraneoplastic syndromes: unusual manifestations of malignant disease.

This monograph has attempted to summarize in a general fashion the ever-enlarging spectrum of the paraneoplastic syndromes. Recognition of their presence at times can lead to the earlier diagnosis of an underlying malignancy. In many instances, palliative therapy or correction of the syndrome may produce relief from the multiplicity of symptoms that develop. The syndromes may be readily apparent or subtle in their onset. Some are life threatening. Prompt recognition and institution of therapy are essential in those instances. The paraneoplastic syndromes usually are categorized by organ system, target organ involved or, where possible, by mediating factors. A careful study of these symptom complexes may lead to better methods of detecting cancer, as well as to a better understanding of its etiology and prevention in the human.


An outbreak of infections caused by strains of Staphylococcus aureus resistant to methicillin and aminoglycosides. I. Clinical studies.

In a 22-month period, strains of Staphylococcus aureus resistant to methicillin and multiple aminoglycosides, (designated MARS) were recovered from 108 inpatients with nosocomial infections at a hospital in the midwestern United States. Sixty-six of these patients were staying in a burn unit, and 42 were on other hospital wards. Among the patients with burns, MARS were recovered from the burn wounds of 64%; 32% of the patients with burns had MARS bacteremia. The patients without burns were age-matched with patients with nosocomial infections caused by antibiotic-susceptible strains of S. aureus. Patients from whom MARS were isolated had a longer mean hospital stay (79.6 days vs. 36.9 days; P less than 0.01), developed infection later (26.5 days vs. 13.5 days after admission; P less than 0.01), and had received antibiotic therapy before infection more often (81% vs. 38% of patients; P less than 0.01) than patients in the comparative population. Types of infection and incidences of death and bacteremia were similar in the two groups. Antibiotic-resistant strains of S. aureus may cause serious infections and significant mortality.


An outbreak of infections caused by strains of Staphylococcus aureus resistant to methicillin and aminoglycosides. II. Epidemiologic studies.

Studies to determine the epidemiologic behavior of strains of Staphylococcus aureus resistant to methicillin and aminoglycosides (MARS) were conducted over a period of two and one-half years, during which MARS were isolated from 201 patients at a hospital in the midwestern United States. Most cases of infection or colonization with MARS (156 of 201) occurred in patients with burns. In the burn unit, MARS were recovered from the air, from the hair and hands of personnel, and from inanimate objects. Nasal (72%) and rectal (66%) colonization were common among burned patients with infected or colonized burn wounds but occurred in only six of 74 burn unit personnel. When compared with two control periods, the prophylactic use of antistaphylococcal agents in patients with burns increased markedly at the time the outbreak began. Of the 45 patients without burns from whom MARS were isolated, 42 (93%) were surgical patients. MARS were not demonstrated in the air or environment of patients with infected surgical wounds. None of 334 non-burn unit hospital personnel were found to be carriers of MARS. Four phage types (83A, 6/75/85, 29/52/80, and 92) were recovered during the outbreak. A determinant of antibiotic resistance was probably transmitted among strains of S. aureus.


Arteriovenous malformations of the spinal cord.

Spinal AVM's are not rare, and are diagnosed today with increasing frequency by utilization of moedern neuroradiological techniques. Their relationship to the spinal medulla is related to vascular embryological anatomy, and the only effective treatment is directed at obliteration of the fistula. Males are affected more frequently in the middle years of life. Symptoms may mimic spinal cord tumors and demyelinating disorders. The pathogenesis of symptoms, classification, and methods of diagnosis are reviewed, and the various methods of treatment discussed.


Let's rethink staff development programs.

Staff development programs act as agents of change in the health care organizations in which they operate. This article suggests that certain consultative techniques and strategies be used by staff development personnel as alternatives to traditional instructional techniques, to bring about positive change more effectively


Adapting the patient care conference to primary nursing.

Patient care conferences are a crucial element in the concept of primary nursing. The authors compare and contrast team and primary nursing patient care conferences. Changes in format and approach needed for patient care conferences in the primary nursing system are discussed, and specific behaviors for conducting primary nursing patient care conferences are outlined.


WICHE panel of expert consultants report: implications for nursing leaders.

A Panel of Expert Consultants, convened for WICHE's Analysis and Planning for Improved Distribution of Nursing Personnel and Services Project, projected nursing requirements for 1982 using an analytic model. Their projections and their recommendations for educational preparation, distribution of nursing services, practice, and planning to meet projected needs have important implications for nursing administrators and nursing educators.


Assertiveness issues for nursing administrators and managers.

Nurses in upper- and middle-management positions often struggle with issues related to assertiveness. The author lists some questions that nursing administrators and managers have raised at assertiveness workshops and offers some answers.


Power: a perspective for the nurse administrator.

The nurse administrator is viewed as a manager within an organization. In this light, power becomes a critical component of the administrative position, and the hospital environment is shown to manifest traditional organizational power phenomena. The nature of power is explored and the skills and strategies necessary for the acquisition and use of power are outlined.


[Translocation in ribosomes induced by elongation factor G without cleavage of GTP. Study using a solid phase translation system in columns].

Columns containing ribosomes translating poly(U) covalently bound with cellulose (solid-phase translating system) were used to study translocation in ribosomes. It is shown that the passing of elongation factor G (EF-G) with the non-cleavable analog of GTP (GMP-PCP) through a column containing pre-translocated ribosomes results in the increase of competence for puromycin (i. e. to the transition of pre-translocated peptidyl-tRNA into the post-translocated state) just as in the case of the passing of EF-G with GTP. On the other hand, it is shown that the passing of EF-G with GMP-PCP through a column with pre-translocated ribosomes makes them capable of binding the next aminoacyl-tRNA (i. e. leads to the vacation of the ribosomal A-site). Thus, by means of the two independent tests it is shown that EF-G-promoted translocation in the ribosome can proceed without GTP hydrolysis. On the basis of the data obtained, a controlled step-wise elongation of polypeptide with the participation of EF-G without GTP cleavage has been carried out in the solid-phase column system of translation.


Type A (coronary-prone) behavior and transient blood pressure change.

A study was conducted to delineate further the physiological mechanisms underlying the type A behavior pattern's influence on coronary heart disease. It was suggested that while chronically elevated blood pressure is apparently not associated with overall A--B distinctions (at least not for males), acting in a type A fashion may be accompanied by temporary increases in blood pressure. Changes in the speech characteristics of 33 black inner-city women during the A--B interview and subsequent unstructured dialogue were analyzed at one-minute intervals and correlated with concomitant blood pressure measurements. Differences in the speech characteristics of women classified type A as opposed to B were consistent with recent studies of white males (e.g., type As spoke significantly faster than type Bs). Further, within-subject blood pressure elevations were significantly associated with louder/more explosive, longer speech episodes. Additional research is urged which examines biochemical and physiological changes as a function of type A behavior considered as a transient state as well as a relatively enduring trait.


Institutional sources of articles published in the American Journal of Nursing, Nursing Outlook, and Nursing Research.

To identify institutions in which scholarly productivity in nursing is occurring, all articles appearing in American Journal of Nursing, Nursing Outlook, and Nursing Research from 1963 to 1977 were tabulated according to institutional affiliation of author, geographic location of institution, and highest degree obtained by the author. More than half of the 5,560 articles appeared in AJN, and more than half were written by authors in the Mid-Atlantic and North Central areas by the U.S.A. Fifty-eight percent of the articles were written by nurses with at least a masters degree. There were 32 institutions in which at least 20 articles originated during the 15 years studied. The three top-ranking institutions, according to number of publications, were University of Washington, University of California at San Francisco, and the University of California at Los Angeles. The findings revealed that publications in AJN, NO, and NR originated in a large number of institutions and that there were few institutions in which large numbers of articles originated.


Use of vignettes to elicit responses toward broad concepts.

Use of vignettes in a measuring instrument is a valid and desirable method of elicting responses toward broad concepts. Ambiguities of any type should be given considered attention in the establishing of validity.


Holistic care in a cancer care center.

Emotional moods and subjective evaluations of care received by three groups of terminally ill cancer patients were measured one week after hospital discharge. Patients treated in a newly opened Cancer Care Center, organized to provide holistic care, formed the treatment group (N = 52). Patients treated before the Center opened comprised one comparison group (N = 67), and patients admitted after the Center opened but treated on other units made up the second comparison group (N = 53). Center patients and their relatives evaluated care in significantly more positive terms than patients in either comparison group. Emotional mood was not significantly different across units; however, women reported more positive moods than men.


Children's fears: a review of the literature with implications for nursing research and practice.

Research reports of child's fears were reviewed from a developmental perspective. These studies suggested that as children's fears change with age they become more complex, varied, and realistic. It was concluded that longitudinal studies of children's fears are needed to support or refute the developmental pattern suggested by these studies of distinct age groups at one point in time. It is also suggested that sex, social class, family relationships, and the media be considered in investigations of the development of children's fears. Implications for practice focused on the use of this information in helping parents deal with fears that concern children as they move through childhood.


Predicting student attrition in a baccalaureate curriculum.

A longitudinal study of enrollment data of the Universtiy of Wisconsin--Madison School of Nursing identified several trends in student attrition over a six-year period and formed the basis for the development of a model to predict student attrition. The model proposed to satisfy the need for more precise measures of probable student retention and attrition for counseling and planning purposes in the school's new curriculum. To arrive at a means for predicting student attrition, scores of random samples of continuing and dropout student on achievement, learning style, and psychologial variables obtained during the first three years of the new curriculum were examined using a discriminant analysis technique. A significant differentiation between continuing and dropout students (p less than .000) resulted and allowed a predictive function to be developed. Using a conservative method of identification with student scores transformed by this function, predictions of successful and nonsuccessful students were obtained.


Changes in life goals as related to success in a nursing leadership role.

Based on questionnaire returns from 50 nurses in leadership positions, this study revealed major differences in the life goals of successful nurses before and after assuming a leadership role. Our reason for success, the study found, was the nurses' ability to develop life goals consistent with their leadership role.


Tracheal suctioning: a tool for evaluation and learning needs assessment.

A 21-item observation tool developed by one of the authors was used to assess learning needs of 30 registered nurses who regularly suction intubated patients. Of the nurses observed, 97 percent had excellent regard for proper equipment utilization and 91 percent for maintenance of sterile environment. These high percentages were responsible for pulling the overall average scores to 65 percent, thus partially disguising the acute need for patient assessment (38 percent), psychological support (57 percent), and procedure (62 percent). Scores for subgroups of nurses--associate degree (group 1), diploma (group II), And baccalaureate (group III)--were 72, 69, and 65, respectively. Of particular concern were low scores in the assessment and psychological support categories. Despite increased emphasis on both of these areas in nursing programs in the last decade, AD graduates received scores of 52 and 57 percent while diploma graduates received scores of 38 and 58 percent and baccalaureate graduates received scores of 26 and 55 percent.


Defining nursing assignment patterns.

A new way of defining nursing assignment patterns, consistent with current work in studies of organizations, is presented. An instrument has been devised which allows direct measurement of the assignment pattern in use on a patient unit. Although current instrumentation requires continued refinement, the instrument has been used successfully on a dozen patients units to characterize the assignment pattern and appears to be both practical and superior to more conventional methods of characterizing assignment patterns which are now in use.


The preoperational child's reaction to immunization.

Forty-four children, aged four to seven, who attended two midwestern metropolitan immunization clinics were studied in an attempt to ascertain their responses to a painful stimulus and to observe correlations between their behavioral responses and their subjective ratings of the experience. The children were screened with three tests--two Piaget tests for the preoperational stage development and the Denver Develoment Screening Test for normal development. The children were observed for verbal, vocal, facial, and motor behavior during diphtheria-pertussis-tetanus or diphtheria-tetanus injections. The children then rated the extent of pain during the injection by responding to two instruments, a modification of Eland's Projective Tool and Hester's Poker Chip Tool. Each behavior category was correlated with the pain rating. Significant positive correlations were found for verbal and vocal behaviors while significant negative correlations were found for facial and motor behaviors.


Vagus nerves and the gastric tissue histamine concentration in pylorus ligated albino rats.

Gastric tissue histamine concentration was determined, 6 and 16 hours after pylorus ligation in vagus intact and vagotomized albino rats and the results were compared with those of respective control animals, sacrificed, 6 and 16 hours after ether anaesthesia alone. The gastric tissue histamine concentration of rats subjected to none of the experimental situations was also determined and taken into comparison. The results show that the stress of pylorus ligation reduced the gastric tissue histamine concentration, the reduction being more with increased duration of stress. On the other hand, subdiaphragmatic vagtomy preserved the histamine concentration of gastric tissue irrespective of the duration to which the animals were exposed following pylorus ligation. It appears that increase in vagal discharges during stress leads to increased liberation of histamine from the gastric wall, thereby, reducing the gastric tissue histamine concentration; the reduction being proportional to the duration of stress and increase in vagal discharges, whereas, in the absence of vagal impulses following subdiaphragmatic vagotomy, the gastric tissue histamine concentration is preserved in spite of the stress to which the animals were exposed.


Comparison of metabolic effect of ammonia and adrenaline infusions in sheep.

Intravenous infusions of ammonium chloride (62.3 mumol.kg-1.min-1) for 30 min caused a significant increase in blood glucose, lactate, pyruvate and free fatty acid (FFA) levels. A similar effect was also observed during infusion of adrenaline. Propanolol--a beta-receptor blocking agent--completely prevented the rise of blood pyruvate and lactate after adrenaline when 8.3 microgram.kg-1.min-1 of propranolol were infused, but not after NH4Cl administration. Lipolytic actions of adrenaline were completely prevented but that of NH4Cl was only significantly diminished by blockade of beta-receptors with propranolol. It was concluded that the influence of ammonium ions on blood lactate and pyruvate and FFA was not entirely mediated by adrenaline.


Effect of hyperammonaemia on blood glucose and plasma insulin levels in sheep.

The effects of continuous intravenous infusions (6 h) of ammonium chloride (5.6; 11.2; and 16.8 mumol.kg-1.min) on plasma glucose and immunoreactive insulin (I.R.I.) levels were studied in three adult sheep. Infusions of 5.6 and 11.2 mumol.kg-1.min elevated ammonia levels in circulating blood from 100 to 150 and 300 microgram.100 ml-1, respectively, but showed no appreciable effect on plasma glucose and I.R.I. concentrations. Infusion of 16.8 mumol.kg-1.min-1 resulted in a blood ammonia concentration of about 400 microgram.100 ml-1 after six hours of infusion. Blood ammonia returned to normal 1 to 2 hours after the end of infusion. Plasma glucose concentration tended to increase slightly from 65 to 75 mg . 100 ml-1 when 16.8 mumol of NH4Cl were infused kg-1.min-1 and remained at the elevated level at least for two additional hours when ammonia infusions were stopped. Plasma I.R.I. tended to decrease from 48 to 38 microunits . ml-1 during the time of the NH4Cl infusion and increased continually to 82 microunits . ml-1 when NH4Cl infusions were stopped. It is concluded from the time courses of plasma glucose and plasma I.R.I. that the effect of ammonia infusion of these parameters cannot entirely be explained by a regulatory release of adrenaline.


Continuous infusion tobramycin combined with carbenicillin for infections in cancer patients.

The cure rate of infections in cancer patients is adversely affected by neutropenia (less than 1,000/mm3). In particular, patients with severe neutropenia (less than 100/mm3) have shown a poor response to antibiotics. To overcome the adverse effects of neutropenia, tobramycin was given by continuous infusion and combined with intermittent carbenicillin. Tobramycin was given to a total daily dose of 300 mg/m2 and carbenicillin was given at a dose of 5 gm every four hours. There were 125 infectious episodes in 116 cancer patients receiving myelosuppressive chemotherapy. The overall cure rate was 70%. Pneumonia was the most common infection and 61% of 59 episodes were cured. Gram-negative bacilli were the most common causative organisms and 69% of these infections were cured. The most common pathogen was Klebsiella pneumoniae and this, together with Escherichia coli and Pseudomonas aeruginosa, accounted for 74% of all gram-negative bacillary infections. Response was not influenced by the initial neutrophil count, with a 62% cure rate for 39 episodes associated with severe neutropenia. However, failure of the neutrophil count to increase during therapy adversely affected response. Azotemia was the major side effect recognized, and it occurred in 11% of episodes. Major azotemia (serum creatinine greater than 2.5 mg/dl or BUN greater than 50 mg/dl) occurred in only 2%. Azotemia was not related to duration of therapy or serum tobramycin concentration. This antibiotic regimen showed both therapeutic efficacy and acceptable renal toxicity for these patients.


Isolation procedure and properties of monomer unit from lysozyme digest of peptidoglycan complex excreted into the medium by penicillin-treated Brevibacterium divaricatum mutant.

1. The peptidoglycan complex excreted in large amounts into the medium by the biotin-requiring mutant Brevibacterium divaricatum NRRL-2311 incubated in the presence of penicillin for 1 h has been investigated. A convenient isolation procedure with high yield for the pure monomeric unit from lysozyme digest of the accumulated polymer is described. 2. It is shown that the released peptidoglycan possesses the linear uncross-linked structure made of repeating disaccharide-pentapeptide unit [GlcNAc-MurNac-Ala-D-Glyn(meso-DAP-D-Ala-D-Ala)] which was isolated by stepwise gel filtration and fractionation of the digestion mixture in 10-mg quantities. Evidence that the minor digestion product of accumulated peptidoglycan possesses the glycan-linked dimer structure is given. Under conditions of beta-elimination, the monomeric unit yielded a lactylpentapeptide which was isolated in pure form by gel filtration. 3. The monomer unit originating from the cultures to which L-[U-14C]glutamic acid was added simultaneously with penicillin incorporated the label exclusively in the peptide chain, whereas that labeled from E11-14C]acetate as the precursor contained radioactivity in both the peptide chain (53%) and N-acetylamino groups (47%) of the glycan portion.


Further experience with the syndromes produced by coca paste smoking.

Cocaine base or white coca paste was smoked heavily by 188 patients who came to four hospitals of Lima, Peru. The length of hospitalization varied from two days to six months. All patients were admitted because coca paste smoking had become a serious problem for their health or for social adjustment. Coca paste was smoked mixed with tobacco or marihuana. The main symptoms were anxiety mingled with euphoria and a rapidly developing compulsion to continue smoking. Frequently the patients developed irritability, illusions, hallucinations. When the use of the drug was heavy and continued for many hours or several days, the patients developed successively four stages of psychological reaction: euphoria, dysphoria, hallucinosis, and acute paranoid psychosis. The main symptoms and signs of all of these phases are discussed.


Comparative activities of ampicillin, epicillin and amoxycillin in vitro and in vivo.

The antibacterial activities of three aminopenicillins ampicillin, epicillin and amoxycillin were compared in vitro and in vivo. The minimum inhibitory concentrations (MIC) of the three penicillins were very similar and the compounds were active against non-beta-lactamase-producing strains of Escherichia coli, Salmonella and Shigella species, Proteus mirabilis, Haemophilus influenzae and Neisseria gonorrhoeae. Streptococci including Streptococcus faecalis, and non-beta-lactamase-producing staphylococci were also sensitive to the compounds but Pseudomonas aeruginosa, Klebsiella aerogenes, Enterobacter and indole-positive Proteus species were resistant. At concentrations close to MIC value epicillin and ampicillin showed similar bactericidal activity against E. coli and against S. typhi and both compounds caused a slower rate of kill than was seen with amoxycillin. Microscopical observation of the cells exposed to ampicillin and epicillin for 1 h showed the presence of filamentous forms which lysed slowly, whereas cells exposed to amoxycillin for the same period rapidly. Epicillin was similar to or slightly less active than ampicillin against experimental mouse infections, and against the majority of infections both compounds were significantly less effective than amoxycillin by the oral and subcutaneous routes of administration.


The influence of cannabis on glucoregulation.

The effects of the administration of cannabis resin in different doses on haematic glucose levels, on plasmic IRI and on the amount of ammonia in the blood have been studied in dogs which had not been fed or had been fed intravenously with glucose. The results show that such resin leads to an increase in haematic glucose, accompanied by a reduction in plasmic IRI and an increase in ammonia levels. In addition, a decrease is observed in the tolerance of glucose administered intravenously.


Environmental effects on morphine content in opium poppy (Papaver somniferum L.).

Ten cultivars of opium poppy were tested for morphine content during the past five years at the Indian Agricultural Research Institute (IARI), New Delhi. Techniques employed to determine the adaptive potential (Finlay and Wilkinson, 1963; Eberhart and Russel, 1966), relative stability and environmental interaction showed the significant varietal differences when the cultivars' mean square was tested over pooled deviations as the error term. Significant V- X -E (linear) component suggests the existence of genetically conditional differences in the stability of cultivars. Highest morphine content was observed in cultivar H and least in R. Four cultivars exceeded the grand mean. Within the five-year study period three were observed to have given the highest morphine content.


The field of possible structures for the chlorophyll a dimer in photosystem I of green plants delineated by polarized photochemistry.

Photoselection experiments with immobilized photosystem I particles have been done to determine the mutual orientation of pigments in the reaction centre. When these particles are excited and interrogated with linearly polarized light, the flash-induced transient absorption changes (mainly from the chlorophyll a dimer) reveal linear dichroism, which yields information on the mutual orientation between the excited and the interrogated transition moments. The interpretation of the data, however, is ambiguous, (1) for reasons of principles inherent in the photoselection technique when applied to complex systems and (2) because of incomplete knowledge about the relative contribution of x- and of y-polarized transitions of chlorophyll a to absorption or to absorption changes at a given wavelength. We find it impossible to attribute any particular structure to the photooxidizable dimer based on photoselection data alone. Instead we present a field of possible structures, imposing constraints on proposed models for the dimer structure.


Effects of ions and gravity forces on the supramolecular organization and excitation energy distribution in chloroplast membranes.

This study was designed to explore the possible relationship between chloroplast membrane stacking or particle aggregation in stacked membrane regions (or both) and excitation energy distribution between photosystems I and II. To this end we have quantitatively examined the effects of different concentrations of univalent ions on the above-mentioned parameters, using a combination of freeze-fracture and thin-section electron microscopy for structural analysis and chlorophyll fluorescence measurements to assay energy-transfer processes. Membrane stacking was found to saturate at about 150mM-NaCl. Maximal EFs-face particle density and chlorophyll fluorescence occurred at about 100mM-NaCl, although only 50% of the potential EFs-face particles were located in stacked membrane regions at this salt concentration. Centrifugation (30,000 g, 1 h) could significantly increase the amount of stacked membranes at salt concentrations between 20- and 60-mM-NaCl; in contrast, centrifugation had little effect on cation-regulation of chlorophyll fluorescence properties. These and other findings suggest that neither chloroplast membrane stacking nor the aggregation of EF-face particles into stacked regions is directly related to the mechanism of excitation energy distribution between the two photosystems (as measured by chlorophyll fluorescence changes) although both structural and functional changes may be mediated by the same membrane component. It is proposed that the salt-induced stacking of chloroplast membranes and the concomitant aggregation of EF-face particles is mediated by the screening of negative surface charges on the membrane pigment-protein subunits, by the establishment of specific interactions between light-harvesting pigment-protein complexes and by 'entropic ordering' forces.


Fluorescence of light-harvesting chlorophyll a/b-protein complexes: implications for the photosynthetic unit.

To the extent that extracted light-harvesting chlorophyll proteins (LHCPs) retain the chlorophyll configuration which they had in vivo, information on the optical properties of LHCPs is useful for an assessment of the transfer process of the primary excitation energy in photosynthesis. Within this context we report and discuss the implication of three kinds of data on spinach chloroplast LHCP. First, an analysis of the spectroscopic dependence of absorption, polarization and circular dichroism (reported recently by R.L.V.) suggests a model affording the possibility of easy chlorophyll a intercomplex transfer with chlorophyll b groups acting as local antitraps. Second, the ratio of LHCP emission and absorption probabilities obeys the Stepanov relation over a relatively wide range, an observation which suggests rapid Chl b-Chl a excitation equilibration. Finally, an LHCP absolute fluorescence yield as great as 10% has been measured, which provides a possible upper limit for the yield of the antenna fluorescence.


Energy transfer in a model of the photosynthetic unit.

A simple model of the photosynthetic unit has been constructed and used for simulated Förster-type energy migration, fluorescence and intersystem crossing, in order to gain insight into the conditions that influence both the form and the lifetime of the fluorescence decay in vivo. The model consists of a two-dimensional random lattice with one central trap. The simulation was done by means of repetitive Monte Carlo-type computations. The results obtained show that the form of the decay curve changes from exponential to non-exponential, as the chlorophyll concentration (molecules/nm2) is increased. The fluorescence lifetimes (tau 1/e) were also found to decrease substantially with only slight increases inc concentration. At a concentration comparable to that of chlorophyll in the chloroplast, both the form of the fluorescence decay and the lifetime are in fair agreement with experiment in vivo. The reasons for non-exponentially of the decay as well as the properties of energy migration are discussed. Preliminary work involving the dependence of trapping rate on donor concentration is also presented.


Dynamics of excitions created by a single picosecond pulse.

A theoretical analysis of bimolecular annihilation in finite domains is presented. A Pauli master equation is formulated for the case of varying incident delta function excitation sources. Expressions for the quantum fluorescence yield and its time dependence are derived. The relationship between the fluorescence yield and the number of hits per domain depends on two parameters: the rate constant of bimolecular exciton annihilation and the dimension of the domain in which this annihilation occurs. Recent experimental results imply that the exciton diffusion constant (D) is large (D approximately to greater than 10(-3) cm2 S-1) and that the photosystem II domains may contain as many as five photosynthetic units. An analysis of the time decay of the fluorescence indicates that, for a few hits per domain, the decay may be considered as exponential but for many hits it becomes non-exponential. Thus the fluorescence decay depends on the intensity of the excitation source and/or on the dimension of the domains. Conditions which change the effective size of the domain may change the shape of the fluorescence decay. Some biological consequences and experimental applications of this theory are presented.


Chlorophyll orientation and exciton migration in the photosynthetic membrane.

Measurements of the linear dichroism and of the polarization of the fluorescence with oriented chloroplasts have revealed a definite orientation of the pigment molecules with respect to the membrane plane. The Qy transition moments of the chlorophyll a molecules are more closely inclined with respect to this plane for the forms absorbing at longer wavelengths than for those absorbing at shorter wavelengths. The fluorescence depolarization by energy transfer, determined with magnetically-oriented chloroplasts, indicates that the degree of local order increases with wavelength for the different (absorption wavelength) forms of chlorophyll a in vivo. Laser pulses of either picosecond or microsecond duration have been used to probe the emission spectrum, lifetime and quantum yield of fluorescence of chloroplasts at various temperatures. With single picosecond pulses, singlet-singlet annihilations occur within the light-harvesting chlorophyll molecules. In the case of microsecond pulses, triplet excitions act as efficient quenchers of the singlets. By monitoring both the yield of carotenoid triplets and of the fluorescence during and after a laser flash, one can show that the carotenoid triplets account for part of but not all the fluorescence quenching.


Tripartite and bipartite models of the photochemical apparatus of photosynthesis.

Tripartite and bipartite models for the photochemical apparatus of photosynthesis are presented and examined. It is shown that the equations for the yields of fluorescence from the different parts of the photochemical apparatus of the tripartite model transform into the simple equations of the bipartite formulation when the probability for energy transfer from the light-harvesting chlorophyll a/b complex to photosystem II is unity. The nature of the 695 and 735 nm fluorescence bands which appear in the emission spectrum of chloroplasts at low temperature is examined. It is proposed that these bands are due to fluorescence from energy-trapping centres which form in the antenna chlorophyll of photosystem II and photosystem I on cooling to low temperature. Even though these fluorescence emissions can be regarded as low temperature artifacts since they are not present at physiological temperatures, they nevertheless are proportional to the excitation energy in the two photosystems and can be used to monitor energy distribution in the photochemical apparatus. However, the question of their artifactual nature is crucial to the interpretation of fluorescence-lifetime measurements at low temperature.


Picosecond fluorescence from photosynthetic systems in vivo.

Picosecond time-resolved fluorescence emission from the pigments of intact photosynthetic systems and isolated pigment-protein fractions has been used to probe the mechanism of energy transfer and the organization of the pigments. The fluorescence kinetics of chlorophyll and the phycobilins of the red alga, Porphyridium cruentum, are governed by time-dependent kinetics, but the observed time dependence of the chlorophyll a fluorescence decay from dark-adapted Chlorella pyrenoidosa and spinach sub-chloroplast fractions is still open to conjecture. In contrast to the green plants containing only chlorophyll and carotenoids, Porphyridium shows distinct emission bands for each the pigments in the transfer sequence. The rate of energy transfer in vivo has the empirical form: dS/dt = -1/2S At-1/2, where S is the excited-state population of the donor pigment and A is the overall rate of energy transfer to the acceptor pigment. The kinetic analysis can describe closely the observed fluorescence risetimes and lifetimes of the photosynthetic pigments of Porphyridium. The extremely rapid rates of energy transfer, determined by this treatment, imply that exciton migration within each pigment bed of the phycobilisome is less extensive than in the chlorophyll-antenna systems. Changes in the fluorescence yield and decay kinetics of chlorophyll a and allophycocyanin in vivo can be induced at high excitation intensities by exciton-exciton annihilation.


Energy transfer and its dependence on membrane properties.

With isolated chloroplasts variations in the degree of energy transfer between light-harvesting chlorophyll-protein complexes can be induced by changing the cation content of the suspending medium. The changes can be observed by measuring chlorophyll-fluorescence yields and lifetimes and are probably brought about by conformatial changes in the thylakoid membrane. Detailed studies of the properties of cation-induced changes in chlorophyll fluorescence indicated that the alterations in pigment organization are due to variations in the density of positive charges immediately adjacent to the surface of the thylakoid membrane, being in qualitative agreement with predictions based on the Gouy-Chapman theory of diffuse double layers. Possible mechanisms for the membrane structural changes controlling energy transfer are given.


Quenching of chlorophyll fluorescence and photochemical activity of chloroplasts at low temperature.

Fluorescence kinetics and emission spectra of pea and spinach chloroplasts were studied between 294 and 4.2 K. In the presence of MgCl2 the fluorescence-induction curves were sigmoidal between 294 and 180 K but they lost their inflection points at lower temperature. In the absence as well as in the presence of Mg2+ ions, analysis of the kinetics of the area over the induction curve revealed two different components, indicating the existence of two different types of reaction centres at all temperatures. The 'rate constants' for these centres were nearly independent of temperature between 294 and 200 K, but showed a sharp decrease on further cooling. Emission spectra at low temperature showed the previously observed bands at 685, 695 and 735 nm. All three bands showed a considerable increase on cooling between 180 and 4.2 K, but with different temperature-dependence. The amplitude of the 695 band became constant below about 50 K, whereas the 685 emission increased markedly in this region. The relative proportion of the socalled variable fluorescence was almost the same at 685 and 695 nm, both at 80 and at 5 K. The data are discussed in terms of changes of energy-transfer rates on cooling.


Transfer and trapping of excitation energy in photosystem II.

The fluorescence yield of chlorophyll a of system II in spinach chloroplasts as a function of the fraction q- of reaction centres in the weakly trapping state PQ-, with reduced acceptor Q-, and reduced primary donor chlorophyll, P, of the reaction centre, is described by the function phi = a/(1 - pq-), a and p being constants (Van Gorkom et al. 1978); P was estimated to be 0.74. By special treatment and additions it was ascertained that the donor complex (S-states, see below) was in the reduced state. Three models of pigment systems have been considered: separate units; units with a boundary limiting energy transfer; and the matrix or pigment bed model, which was found to describe the experimental data. The following supplementary assumptions were made: ktf greater than kt greater than k't greater than 0. The rate constant ktf is that for electronic excitation transfer from a chlorophyll a molecule (or reaction-centre chlorophyll) to the surrounding chlorophyll molecules; kt and k't are rate constants for trapping at the reaction centres in the state PQ and PQ-, respectively. From this model and additional data such as fluorescence yield in vivo and in vitro, kt was estimated to be 4 X 10(11) S-1 and k't = 7.1 X 10(10) S-1; ktf greater than 10(12) S-1. In dark-adapted Chlorella, a series of curves respresenting changes in fluorescence yield as a function of time in a succession of six 16 microseconds xenon flashes spaced at 3 s crossed at one point. It is concluded from this and other observations that in the states S2 and S3 (with two or three oxidizing equivalents in the donor complex of system II) a certain fraction of the reaction centres occurs in a special conformational state. In this state electron transfer and, possibly, energy transfer to P+ are appreciably decreased.


Properties of chlorophyll on plasticized polyethylene particles.

There are several reasons for suspecting that there is a specific interaction between chlorophyll and galactolipids in the chloroplast. The model system described is intended to detect association of chlorophyll with polar lipids and other surfactants at a hydrocarbon-water interface. It consists of chlorophyll and other lipids or surfactants absorbed to the surface of polyethylene particles, which have been swelled with undecane to allow the lipophilic parts of these molecules to be anchored firmly in the hydrocarbon substrate. The absorption spectrum of adsorbed chlorophyll is usually modified by the presence of surfactant, and usually in the direction of decreased order of aggregation. Spectra in the presence of glycolipids in particular seem peculiar to the surfactant. The particles are strongly fluorescent, at room temperature as well as at 77K, and emission bands from aggregated chlorophyll species are observed along with fluorescence of monomeric chlorophyll.


Chlorophyll-protein complexes of brown algae: P700 reaction centre and light-harvesting complexes.

Thylakoid membranes from several brown algae have been fragmented with the non-ionic detergent, Triton X-100. Three intrinsic chlorophyll-protein complexes with different pigment compositions have been isolated by sucrose density gradient centrifugation. Brown algae contain the photosystem 1 reaction-centre complex, a P700-chlorophyll a-protein which has similar spectroscopic and chemical properties to those of higher plants. This complex represents about 10--20% of the total chlorophyll in all species; the Acrocarpia paniculata complex has a chlorophyll/P700 ratio of 38. Two main light-harvesting complexes have also been isolated, which have properties unique to brown algae. The heavier of these, an orange fraction, is a fucoxanthin-chlorophyll a/c-protein; this complex contains most of the fucoxanthin and has only chlorophyll c2. The other, a green fraction, is a chlorophyll a/c-protein enriched in violaxanthin. Neither of these complexes possesses detectable photosystem 1 or photosystem 2 activities. Both of these complexes efficiently transfer light energy to chlorophyll a, indicating that the molecular arrangement of their pigments is similar to that in vivo. Differential extraction of thylakoid membranes indicates that the P700-chlorophyll a-protein is the complex most firmly embedded in the membrane, but the fucoxanthin-chlorophyll a/c-protein is the least firmly bound. We suggest that the fucoxanthin complex is the most variable component of the photosynthetic unit of brown algal chloroplasts.


Culture in vitro as a means of analysing the effect of maternal diabetes on embryonic development in rats.

Rodents have been used by many investigators for studies of the effects that maternal diabetes during pregnancy may have on developing fetuses. In Wistar rats, the induction of mild chronic diabetes at the onset of pregnancy by alloxan or streptozotocin results in abnormalities of the nervous system and the heart, recognized in embryos at 11--13 days' gestation. Thus, early organogenesis is evidently affected in these embryos. With a method which enables rat embryos to be cultured in vitro in serum for the period of their early organogenesis, the growth and differentiation of embryos from normal and from diabetic rats can be observed in some detail. It is also possible to compare the effects of normal and of diabetic maternal serum on their development. The results reported here show that embryos from diabetic animals are more likely to be retarded or abnormal than those from non-diabetic animals when cultured in identical serum. The development of both types of embryo is more successful in diabetic than in non-diabetic serum, however, possibly because of the higher glucose content of diabetic serum. Cultures of fetal organs may also be used as test systems for the effects of diabetic maternal serum. Sacral vertebrae, some of which fail to ossify in fetuses from daibetic rats, are now being grown in media containing diabetic serum. It is planned to test the effects of insulin on these cultures.


Congenital anomalies and the diabetic and prediabetic pregnancy.

Congenital anomalies are two to four times more frequent in the offspring of diabetic mothers than in those of non-diabetic mothers, and represent an increasingly important cause of perinatal mortality. These anomalies involve multiple organ systems more often than those found in the children of non-diabetic mothers. The excess of anomalies associated with maternal diabetes occurs in many organ systems. Anomalies are no more frequent in the offspring of diabetic fathers and pre-diabetic mothers than among those of non-diabetics, suggesting that non-genetic factors are the important determinants. Anomalies are most frequent in the offspring of mothers who have developed diabetes at an early age, many of whom have diabetes of long duration, are insulin-treated, and may have vascular complications. The relative importance of each of these factors in the pathogenesis of anomalies is unknown, but present evidence is consistent with a hypothesis that anomalies are the result of metabolic disturbances in the intrauterine environment during the first trimester of pregnancy. Whether or not their incidence can be reduced by optimum metabolic control of maternal diabetes during this period is unknown.


The influence of preconceptional glucose values on the outcome of pregnancy.

A relationship between maternal diabetes and fetal malformations has been recognized for a long time, but there has been considerable difference of opinion about the size of the risk. Several defects of the pelvis and lower limbs appear to be relatively common in offspring of diabetic mothers. In experimental studies a dose relationship has been shown between some drugs (insulin-Trypan blue) and lower limb malformations. Three patients are discribed with congenital malformations with diabetes or prediabetes during pregnancy. Is the caudal regression syndrome a part of a larger syndrome caused by a disturbance of glucose homeostasis?