The grief evaluation measure (GEM): an initial validation study

This article describes the development of the Grief Evaluation Measure (GEM), a new instrument designed to screen for the development of a complicated mourning response in a bereaved adult. The GEM provides a quantitative and qualitative assessment of risk factors, including the mourner's loss and medical history, coping resources before and after the death, and circumstances surrounding the death. It is designed to provide an in-depth evaluation of the bereaved adult's subjective grief experience and associated symptoms. Reliability and validity studies were conducted with two samples of bereaved adults (n = 23 and n = 92, respectively) from various clinical and support settings. Data on the two central sections of the GEM that assess the mourner's grief response and the level of symptomatology are described. Results indicate that the GEM's internal consistency and test-retest reliability are high. The GEM demonstrates good concurrent validity for established measures of bereavement, trauma, and physical and psychiatric symptoms, and good predictive validity for mourner adjustment one year after initial assessment. Plans for future development and an invitation for other researchers to collaborate with research on the GEM are also discussed.

Antifungal constituents of northern prickly ash, Zanthoxylum americanum mill

Leaf, fruit, stem, bark and root of Zanthoxylum americanum were investigated for antifungal activity with 11 strains of fungi representing diverse opportunistic and systemic pathogens, including Candida albicans, Cryptococcus neoformans and Aspergillus fumigatus. All extracts demonstrated a broad spectrum of antifungal activity and inhibited at least eight fungal species in a disk diffusion assay (600 microg/disk). Antifungal activity was light-dependent, with fruit and leaf extracts most active in general. The presence of light-mediated compounds, such as psoralen, 8-methoxypsoralen and imperatorin in extracts of different organs was confirmed by RP-HPLC. A high furanocoumarin content was detected in fruit and leaf and low furanocoumarin levels were found in bark and wood. A high positive correlation was observed between total furanocoumarin content and fungal inhibition zones (r2=0.902, p<0.001). The results provide a phytochemical basis for the very widespread use of Z. americanum in indigenous North American ethnomedical tradition for conditions that may be related to fungal infections.

Assessment of a point-of-care test for paracetamol and salicylate in blood

BACKGROUND

Paracetamol and salicylate are commonly taken in acute overdose. Clinicians have a low threshold for excluding the presence of these two drugs, by ordering laboratory tests in any patient suspected of ingesting an overdose or with an altered mental state.

AIM

To test the effectiveness of a new point of care test that qualitatively detects paracetamol and salicylate in blood and to examine the potential time saved by its use.

DESIGN

Prospective multicentre trial.

METHODS

The new test was compared with laboratory analysis in a routine blood sample taken from patients presenting to emergency departments with suspected overdose.

RESULTS

The test had sensitivities of 98.5% and 88.5%, and specificities of 74.7% and 92%, for paracetamol and salicylate, respectively, at cut-off levels of 25 mg/l and 100 mg/l, respectively The point of care test results were available 2 h before the laboratory result.

DISCUSSION

This point-of-care test could be used to rule out an overdose with either of these two drugs, and could thus lead to earlier clinical decisions for suspected overdose patients. Recommendations have been made following this trial that the cut-off value for paracetamol should be reduced from 25 mg/l to 12.5 mg/l in order to increase its usefulness. To prevent the test being misread, we also suggest that each device should be embossed to remind users that the presence of a line indicates there is no drug present.

Ornithine transcarbamylase deficiency in pregnancy

Women heterozygous for mutations at the ornithine transcarbamylase (OTC) locus may be at risk for hyperammonaemia and its untoward effects including coma and death in the postpartum period. We present the case of a pregnant woman heterozygous for OTC deficiency (McKusick 311250) whose past medical history was significant for two prior pregnancies complicated by postpartum hyperammonaemic coma. In the index pregnancy, increased levels of serum ammonium were noted during labour. Postpartum hyperammonaemia was averted by administration of oral sodium benzoate. Our experience demonstrates that in women at risk, perilous hyperammonaemia can be prevented through appropriate medical management.

The use and nursing management of benzodiazepines in acute, mental health inpatient care: a discussion

The use of medication in acute mental health is common practice however, there is a lack of research into all aspects of pharmacology within inpatient settings. This paper explores the specific use of benzodiazepines and areas of potential mismanagement. A number of priorities for investigation are raised and implications for nursing roles and responsibilities discussed.

Embryonal rhabdomyosarcoma (sarcoma botryoides) of the cervix presenting as a cervical polyp treated with fertility-sparing surgery and adjuvant chemotherapy

BACKGROUND

Embryonal rhabdomyosarcoma (sarcoma botryoides) of the female genital tract is rare in the cervix. It tends to occur in children and young women, and appears to have a better prognosis than sarcoma botryoides of the vagina and uterus.

CASE

We report a case of embryonal rhabdomyosarcoma (sarcoma botryoides) presenting as a cervical polyp in a 19-year-old female. The tumor was composed of rhabdomyoblasts of varying differentiation dispersed within a loose, myxoid stroma, and formed a distinct 'cambium' layer beneath the epithelium. The patient was successfully treated with fertility-sparing surgery and adjuvant chemotherapy.

CONCLUSIONS

Awareness of this uncommon lesion in this site and its clinical implications is important to avoid misdiagnosis. Therapy has recently inclined towards conservative treatment.

Cementless bipolar hemiarthroplasty for displaced femoral neck fractures in the elderly

Controversy exists regarding the use of cementless femoral fixation for hip arthroplasties in elderly patients. This study reviews the clinical and radiographic outcomes of cementless bipolar hemiarthroplasties in patients older than 65 years of age. From 1998 to 2000, 256 cementless bipolar hemiarthroplasties were performed in 248 patients with displaced femoral neck fractures who had a mean age of 77 years. The mean final follow-up was 3.5 years and Harris hip scores averaged 82 points. Two loose femoral stems were revised and the rest of the implants were radiographically stable and demonstrated evidence of bone ingrowth. Six patients had debilitating groin pain necessitating conversion to total hip arthroplasty. Cementless bipolar hemiarthroplasty can be safely performed in elderly patients and can provide predictable clinical and radiographic results.