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Thirty consecutive patients with endoscopically proven duodenal ulceration who had Helicobacter pylori infection on culture and histology, were treated with tripotassium dicitrato bismuthate (1 tablet q.d.s., 400 mg metronidazole t.d.s. and 500 mg tetracycline t.d.s. for one week, followed by the bismuth salt for a further 3 weeks. All patients were endoscoped at entry and 4 weeks after cessation of treatment, to check for ulcer healing and H. pylori eradication. Two antral biopsies were taken at each endoscopy for histological and microbiological evidence of H. pylori infection. Complete healing of duodenal ulcers was observed in 27/30 patients (90%). Gastritis improved or completely resolved in 26 patients. Eradication of H. pylori was achieved in 27 patients. Of the three patients who failed to heal, two were H. pylori-positive at follow-up and one was H. pylori-negative.

Preliminary evidence suggests that eradication of Helicobacter pylori (H. pylori) may lead to prolonged remission of duodenal ulcer (DU). The aim of this study was to assess the long-term effect of eradication of H. pylori on the natural history of DU. Fifty-one patients with endoscopically proven duodenal ulcers, who were found to have H. pylori infection on histology and culture, and who were successfully eradicated of H. pylori with combination treatment of colloidal bismuth subcitrate and antibiotics, were studied. All patients were endoscoped at entry, 4 wk after cessation of treatment and again at 1 yr or sooner, if symptoms recurred. At each endoscopy, two antral biopsies were taken and assessed histologically and microbiologically for evidence of H. pylori infection. Recurrence of H. pylori infection occurred in 18/51 patients (35.3%) and, of these, 12 patients had evidence of recurrent peptic disease (five DU, seven duodenitis). In contrast, of the 33 who remained negative for H. pylori at 1 yr, none developed evidence of recurrent DU. Overall, DU recurrence occurred in 5/51 patients (11.7%), and occurred only in patients reinfected with H. pylori. This relapse rate compares favorably with patients on maintenance H2-receptor antagonist treatment. These results lend further support to the hypothesis that antral reinfection with H. pylori is associated with relapse of DU.

Objective: To examine the effect of eradication of Helicobacter pylori on symptoms of non-ulcer dyspepsia., Design: Four week prospective study., Setting: One hospital outpatient and endoscopy department., Patients: 90 adults with persistent symptoms typical of non-ulcer dyspepsia but no clinical or endoscopic evidence of other peptic, biliary, pancreatic, or malignant disease; all had histological and microbiological evidence of infection with H pylori. 83 patients completed the treatment regimen., Intervention: Colloidal bismuth subcitrate 120 mg four times a day for four weeks (27 patients); metronidazole 400 mg and amoxycillin 500 mg each three times a day for one week (27); and bismuth subcitrate 120 mg four times a day for four weeks, metronidazole 400 mg three times a day for one week, plus amoxycillin 500 mg three times a day for the first week (29)., Main Outcome Measures: Change in symptom scores determined with questionnaire; histological evidence of gastritis and microbiological evidence of presence of H pylori in biopsy specimens., Results: Overall, H pylori was eradicated in 41 (49%) patients. Although gastritis scores improved significantly in only patients in whom H pylori had been eradicated (from 1.56 to 0.61, p less than 0.01 v from 1.83 to 1.07, p = 0.52) mean symptom scores after treatment were similar in patients in whom H pylori had or had not been eradicated (3.0 v 2.3, NS). Similarly the mean symptom score improved whether or not gastritis improved (2.8 v 3.1 respectively, p = 0.72). The observations were similar for treatment groups analysed individually., Conclusion: Antral infection with the organism does not seem to have an important aetiological role in non-ulcer dyspepsia short term.

Although percutaneous transluminal coronary angioplasty (PTCA) has been found to be an effective alternative to open-heart surgery for patients with coronary artery disease, the procedure itself can be associated with severe anxiety and discomfort for the patient. The authors report the discomfort patients experience during recovery from PTCA and suggest nursing interventions to reduce pain for these patients.

In this age of shorter hospitalization and consumer demand for more indepth knowledge concerning health state, the need for innovative strategies in cardiac education continues to be a challenge to nurses in a cost containment environment. The use of a patient's own cardiac catheterization film as an adjunctive teaching strategy has not been discussed in the literature. Our experience has shown that the use of these films leads to time efficient and highly individualized delivery of patient education which facilitates patient participation in decision making regarding medical therapy. In addition, concepts found within education theory, such as involving the learner in discussion, associating new concepts with past experiences, incorporating as many senses as possible in the learning experience, and providing content that is immediately useful, are easily incorporated when cardiac catheterization films are used. This article will discuss how an innovative non-traditional strategy may complement traditional approaches to cardiac patient education.

Two studies were conducted to examine the effects of music on analogued labor pain using volunteer nulliparous subjects who were randomly assigned to treatment groups (n = 10 per group). Assessments of the treatments were made in a 1-hour session involving twenty 80-second exposures to a laboratory pain stimulus patterned to resemble labor contractions. In the first experiment, it was hypothesized that subjects listening to easy-listening music would report lower pain ratings and cardiovascular responses than subjects listening to rock music, self-selected music, or a dissertation (placebo-attention) and subjects in a no-treatment control group. No significant group effects were found; significant time effects were found for heart rate, systolic and diastolic blood pressure. Subjects spontaneously reported using imagery as a pain reduction technique. In the second study a combination of music and imagery was examined by randomly assigning subjects to one of five groups: self-generated imagery with music (SIM), guided imagery with music (GIM), self-generated imagery without music (SI), guided imagery without music (GI), or no-treatment control. Again, no significant group effects were obtained. Significant time effects were obtained for heart rate, systolic and diastolic blood pressure.

The utility of a cognitive interactionist approach to crisis, specifically that of becoming a lone parent through marital breakdown, was examined. The Lone Parenthood Scales, which provided information about positive and negative appraisals of the event and possible coping strategies, were administered to 101 members of Parents Without Partners. MANCOVA established two separate and systematic relationships between these multiple independent and dependent variables. One pattern of experience which emerged was of adaptive adjustment: positive appraisals of mobilization of personal resources, increased self-esteem and better relationships with the children were associated with coping by resignation to the situation and accepting help from others. The other was of passive self-preoccupation: negative appraisals of more emotional conflict and increased pressure from others were associated with no particular coping strategies but with renunciation of an active, positive approach to problems. Positive appraisals were found to be different for men and women, but the perceived instrumentality of the decision to separate proved to be relevant for negative appraisals.

Many people find music relaxing and therapeutic. Hospital patients are no exception, especially when they get to choose their own.

H.261, a new transition state inhibitor of human renin with an IC50 of 6.9 X 10(-10) M, was given by intravenous infusion to six anaesthetized baboons. The inhibitor was infused first at 0.1 mumol/kg/h for 15 min, then at 1.0 mumol/kg/h for a further 15 min. After a recovery period of 2 h in which the animals received 5% dextrose, they were infused with captopril, 25 mumol/kg/h for 15 min. At both rates of infusion H.261 markedly and significantly reduced the enzymatic action of renin in plasma, the blood concentration of angiotensin I, the plasma concentration of angiotensin II and mean arterial pressure. All changes reverted towards or to control values in the subsequent control period. Captopril also lowered plasma angiotensin II concentration and mean arterial pressure markedly and significantly but, as expected for an inhibitor of the angiotensin I-converting enzyme, plasma active renin concentration and blood angiotensin I concentration increased. The changes of angiotensin II and arterial pressure were similar with captopril and H.261.

The primary value of clinical research is implementation in clinical practice to improve the quality of nursing care: yet application of research in many clinical settings remains difficult. Here are six different opinions from critical care nurses on why it is difficult to implement the research in clinical practice and what can be done to assist in this research application.

In order to understand better the experience of becoming a lone parent after marital breakdown a taxonomy of positive as well as negative appraisals and possible coping strategies was constructed. Experiential structures elicited through multidimensional scaling were used to form the basis of the Lone Parenthood Scales. The Scales, with demonstrated reliabilities and construct validity, were then administered to a sample of lone parents who were found to experience concern over their children's limited family life but relief at their separation and hope of becoming closer to their children. They saw themselves as coping with problems by direct, positive action. Further uses for the Scales were discussed.