JUNE 30, 1962 PROGRESSIVE PATIENT CARE MRICTASOUNAL 1829 The principle of progressive patient care was generally accepted, and, far from being detrimental to patient and To-day's Drugs nurse as critics had suggested, it would result in increased efficiency, though not necessarily economy, in nursing care and improvement in patient morale. There was considerable DRUGS IN COMMON USE divergence of opinion over details of organization, as was to be expected, and all groups agreed that pilot schemes Phenylethylacetylurea (Pheneturide) were essential. While an individual hospital might benefit " Benuride " (Bengud). from the experience of others, it must plan its own scheme Chemistry.-This drug differs chemically from the according to its particular needs. One of the most traditional barbiturate, hydantoin, and oxazolidine-2,4-dione important points was to decide precisely what types of ring structure from which most anticonvulsant drugs arc patient were to be nursed in the intensive care unit; derived, being a "straight-chained" analogue of it suggested proportions varied from 2 to 10% of the hospital corresponding hydantoin ring compound. It is considerably population, but it seemed likely that the lower figure would less toxic than the related compound phenylacetylurea ensure that such a unit did not become merely another acute (phenurone), the first compound of this group to be general ward. It would be valuable if individual doctors produced, which also has anticonvulsant properties. It has studied their hospital admissions for six months or more the following chemical formula: with a view to providing some form of classification. H2 N H One medical person-probably of senior registrar status- should have administrative charge of the intensive care unit, I I- C6 H5 with clearly defined powers and responsibility acceptable to o the consultant staff. For small hospitals units dealing with I l C2~HS all specialties worked well, but in hospitals with 400 beds or more separate units for medical, surgical, and other H N C;nO specialties were desirable. There was no general agreement as to whether the sexes should be mixed, but it was thought PHENYLETHYLACETYLUREA unwise to admit small children to adult units. Experimenta- (PHENETURIDE) tion with self care rather than intensive care units might Pheneturide is supplied in compressed tablets each be more important to start with, by releasing nursing staff, containing 200 mg. of the drug. It can also be obtained in though some anxiety was expressed over leaving patients compound tablets (" trinuride ') each of which contain with a minimum of nurses. 200 mg. of pheneturide, 40 mg. of diphenylhydantoin, and Dr. A. BEAUCHAMP summed up by giving the following 15 mg. of phenobarbitone. advice to anyone wishing to initiate progressive patient care: Pharmacology.-Animal experiments have shown that become thoroughly familiar with its concept and practice, pheneturide protects against drug-induced and electrically involve key persons in its institution, orient every member induced convulsions. E. Frommel and his co-workers' of the staff from board of governors or management compared the effects of the drug with those of phenobarbi- committee down to the newest employee, analyse the needs tone, phenytoin, and phenurone, and showed that the index of the hospital and criteria for classification of patients, of protection for pheneturide was very high. arrange for flexibility, and, if you wish, estimate the cost of Toxicity.-Pheneturide exerts a definite anticonvulsant financing such a scheme. effect in a dosage of 28 mg./kg. of body weight, reaching a maximum at 96 mg./kg. Lethal effects appear in animals Ti Humanities only after reaching a dose of 485 mg./kg. The soporific The closing address was given by the Rt. Rev. A. S. effects of pheneturide appear only in the neighbourhood of REEVE, Lord Bishop of Lichfield, who took as his text: the lethal dose. In the usual dosage it induces a slight "People Matter." He said it would be a pity if "this most degree of excitation and it is more rapidly excreted than exciting development " led to a fragmentation of the patient phenobarbitone or diphenylhydantoin. One case of and an emphasis on the economic necessity of getting him aplastic anaemia has been reported in a patient receiving in and and out of hospital as quickly as possible. The first 1,200 mg. daily for 10 months, which is well above the duty of the doctor and nurse was to display kindness and recommended maximum dosage, but no other important sympathy; discipline was necessary, but reasons for doing haematological side-effects have been reported so far. A things must be explained to the patient. Progressive patient slight rise in serum alkaline phosphatase has been reported care could lead to a new team spirit among hospital staff, in some cases, but no evidence of liver damage ensued. which would inevitably and beneficently be passed on to Occasional erythematous skin eruptions have appeared in the patient. patients taking the drug, but no evidence of renal damage and no gum hypertrophy have been described. (Continued from next column) Therapy.-The recommended daily dose of the drug in 37% of the adults were improved, 37% unchanged, and 26% adults is 600-800 mg., and it is suggested that in view of its were worse. The results in the children were poor. R. D. slight stimulant effect a small dose of phenobarbitone is Fine and J. B. Gaylor8 have reported their results with advisable. The makers claim that the results of early trials trinuride in 21 adult epileptic patients; 8 suffering from have shown that the action of the drug is slightly augmented major epilepsy were improved, some considerably so, 2 were when it is combined with diphenylhydantoin, which is why worse, and 2 unchanged. The results were particularly they introduced the combined tablet trinuride. However, gratifying in 9 cases of temporal lobe epilepsy; in 8 of most neurologists prefer not to use combined anticonvulsant these the attacks and associated abnormalities of behaviour tablets as it is important to be able to vary independently were severe, and 6 were substantially improved. While the dosage of individual anticonvulsant drugs which may these results must be confirmed by more extensive clinical be given together in the treatment of epilepsy. If a patient trials of pheneturide, given alone and in combination with already receiving anticonvulsants is to be transferred to other anticonvulsants, the drug appears to be effective and treatment with pheneturide the transition should be effected it may be particularly useful in cases of temporal-lobe slowly over several weeks. The drug is particularly recom- epilepsy. mended for major and temporal lobe epilepsy. Though N.H.S. Basic Price.-Benuride 200 mg., 100 tabs. for the makers claim that it is useful in all varieties of epilepsy 25s. 6d. there are no published data to support its value in petit REFEENCES mal. D. S. Sharpe and colleagues2 administered trinuride to Frommel, E., Radouco-Thomas, C., and Gold, P.. Arch. int. Pharma- codyn., 1953, 92, 368. 27 adults and 5 children, all of whom were certified mental 2 Sharpe, D. S., Dutton, G., and Mirrey, J. R., J. ment. Sci.. 1958. 104. defectives who also suffered from epilepsy, and found that 834. a Fine, R. D., and Gaylor, J. B., S. Afr. med. J., 1961, 35, 85. (Continued at foot of previous column)