Biomedical subjects
Publications and source records attributed to P Glover.
The partograph is part of the midwifery tools of practice, used everyday, but rarely questioned. This paper explores the history of the partograph and describes its development from 1954. It examines the components of the partograph and discusses when one should be commenced. The value of the partograph in practice today is questioned.
The transition from undergraduate nursing student to employment as a registered nurse is fraught with difficulties for a neophyte. This qualitative study used interviews and focus groups with graduate nurses from the Flinders University of South Australia in their first year of practice to ascertain their experiences as new graduates. The results reveal an enculturation of graduates not conducive to ongoing learning, consolidation of skills and application to practice. A rushed environment that was unpredictable, together with a lack of support, were recurrent themes from the graduates' perspective. Graduate nurse programs are run by institutions focused on outcomes and expenditure. There is little or no collaboration with the tertiary sector in providing appropriate programs according to graduates' needs. The graduates, as beginning practitioners, focused on not having the time to nurse holistically, an unrealistic workload, and the need for backup and continuous support on an individual basis. The wards, although possibly efficient and effective in providing health care, provided a culture where the graduates felt inadequate, rushed, overworked and unsupported, which is contrary to the aims and objectives of the graduate nurse programs. The nursing profession as a whole needs to develop a culture that is nurturing, enabling, supportive and protective of our young.
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Transport of wheat germ agglutinin-horseradish peroxidase (WGA-HRP) from olfactory sensory neurons to the olfactory bulb as well as odor detection and discrimination were examined in rats in which each nasal epithelium had been irrigated with 0.1-0.5 ml 5% zinc sulfate. After treatment, rats showed few or no deficits in discriminating among odors and in detecting high (1%-0.01%) concentrations of ethyl acetate, but some had deficits in detecting lower concentrations of the odor. In most cases, HRP reaction product filled more than 30% of olfactory bulb glomeruli 2-4 days after treatment with ZnSO4. The behavioral outcomes are in agreement with recent reports of considerable savings in olfaction even after severe reduction of afferent projections to the olfactory bulb. We conclude that, in the rat, intranasal application of ZnSO4, as generally practiced, does not produce anosmia.
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The introduction of the Australian College of Midwives Inc (ACMI) Competency Standards for Midwives in late 1998, has implications for every midwife in Australia. This paper will provide a brief history of the development of nursing and midwifery competencies in Australia, examine what the competencies mean for practice and suggest ways that the competencies can be used for assessment. It is well to remember that the competencies must be considered in context and midwifery legislation and education form a triad for the implementation and use of the competencies.
We report two cases of venous air embolism which occurred in association with infusion of Haemaccel(R) using a pressure bag. As a result of these incidents, we performed a study that showed that up to 45 ml of air can be infused into a patient from a pressurised Haemaccel(R) plastic bottle using a standard administration set. We also demonstrated that the volume of air infused was influenced by the type and size of the pressure bag and the warming of the Haemaccel(R) plastic container.
In 1994, Case Western Reserve University School of Medicine established a Primary Care Track (PCT) with an integrated curriculum as part of The Robert Wood Johnson Foundation's Generalist Physician Initiative. This study compared the performance of the first cohort of students to participate in the PCT third year with that of their classmates and determined student attitudes toward their experiences. The performances of 24 PCT and 81 traditional students on the Medical School Admissions Test (MCAT) and the United States Medical Licensure Examination (USMLE) Step 1 and 2 were compared using analysis of variance. Grades on the six core clerkships were compared using chi-square analysis. Performances of the PCT students and a subset of traditional students on the generalist school's objective structured clinical exam (OSCE) were compared using multivariate analysis. The students reported their perceptions on a questionnaire. The traditional students had significantly higher scores on the physical science section of the MCAT and on the USMLE Step 1, but at the end of year three, their USMLE Step 2 scores did not differ. Grade distributions in the core clerkships did not differ, except in psychiatry, where the PCT students received honors significantly more often. The PCT students had a lower mean score on the internal medicine National Board of Medicine Examiners shelf exam but performed better on the generalist OSCE exam. A majority of PCT students reported that they would choose the integrated third year again and recommend it to others.
OBJECTIVE: To review the metabolism and function of potassium and causes and management of hypokalaemia. DATA SOURCES: A review of studies reported from 1966 to 1998 and identified through a MEDLINE search of the English-language literature of hypokalaemia. SUMMARY OF REVIEW: Potassium is predominantly an intracellular ion that contributes to approximately 50% of the intracellular fluid osmolality and is largely responsible for the resting membrane potential. The latter accounts for its influence on the excitability of muscle and nervous tissue. Hypokalaemia is defined as a serum potassium of less than 3.5 mmol/L or plasma potassium less than 3.0 mmol/L and may be asymptomatic. Clinical features associated with hypokalaemia include abnormalities of cardiovascular, neurological and metabolic function and may be treated with oral potassium salts, although tachycardia and muscle weakness are the two life threatening disorders which may require rapid intravenous correction. The potassium salts of chloride, phosphate and acetate are often used, although the choice is often guided by the presence of an associated hypochloraemic alkalosis, non-anion gap acidosis or hypophosphataemia, indicating treatment with potassium chloride, potassium acetate, or potassium phosphate, respectively. The infusion rates of intravenous therapy depends upon the salt used. Potassium chloride is usually infused at a rate up to 40 mmol/h, whereas potassium acetate and potassium monohydrogen or dihydrogen phosphate are usually infused up to 5 mmol/h and 2 mmol/h respectively. CONCLUSIONS: Hypokalaemia can be asymptomatic or it may cause cardiovascular, neurological or skeletal muscle dysfunction. If intravenous potassium therapy is required, then correction with potassium chloride, acetate, or phosphate salts are usually guided by the presence of a metabolic acidosis, alkalosis or hypophosphataemia.
OBJECTIVE: To review the pathophysiology and management of patients with clinical manifestations of fat embolism. DATA SOURCES: A review of studies reported from 1976 to 1998 and identified through a MEDLINE search of the literature on fat embolism and fat embolism syndrome. SUMMARY OF REVIEW: Fat embolism occurs when bony or soft tissue trauma has caused fat to enter the circulation, or in atraumatic disorders where circulating fat particles have coalesced abnormally within the circulation. The fat particles deposit in the pulmonary and systemic circulations, although only 1 - 2% develop a clinical disorder with respiratory, cerebral and dermal manifestations known as the fat embolism syndrome. Rarely, fat embolism produces a fulminant fat embolism syndrome due to mechanical obstruction within the pulmonary circulation causing a severe right heart failure. The fat embolism syndrome is believed to be caused by the toxic effects of free fatty acids liberated at the endothelial layer which cause capillary disruption, perivascular haemorrhage and oedema. The clinical manifestations of respiratory failure, petechiae and a diffuse or focal cerebral disturbance, are characteristic but not pathognomonic of the syndrome. The syndrome is largely self limiting with treatment being symptomatic. Therapy is directed at maintaining respiratory function and largely follows the same principles of management used in patients who have the acute respiratory distress syndrome. Early immobilization of fractures and methods to reduce the intramedullary pressure during total hip arthroplasty have reduced the incidence of operative fat embolisation. Corticosteroids either before or after the development of respiratory or cerebral symptoms have not been shown to be of any benefit. CONCLUSIONS: Fat embolism occurs in many traumatic and atraumatic conditions and is largely asymptomatic. Preventative measures include early immobilization of fractures and methods to reduce intramedullary pressure during surgical manoeuvres. Treatment is largely symptomatic with therapy for respiratory failure similar to that used in management of acute respiratory distress syndrome. Corticosteroids have not been found to be of significant benefit.
The neuromuscular blocking effects and the reversibility of cisatracurium 0.1 or 0.15 mg.kg-1 were compared with those of atracurium 0.5 mg.kg-1 during anaesthesia with propofol, nitrous oxide and isoflurane. Neuromuscular block was monitored using train-of-four stimulation while recording the mechanomyographic response of the adductor pollicis muscle. The block was either allowed to recover spontaneously or was antagonised with neostigmine 50 micrograms.kg-1 at 10% or 25% recovery of the first twitch of the train-of-four. The median times to maximum block were 2.7, 2.2 and 1.5 min following cisatracurium 0.1 and 0.15 mg.kg-1 and atracurium 0.5 mg.kg-1, respectively. After cisatracurium 0.1 mg.kg-1 had been given, the median time to recovery of the train-of-four ratio to 0.8 ('adequate recovery') was 74 min during spontaneous recovery, 48 min after reversal with neostigmine when the first twitch of the train-of-four had returned to 10% of control and 50 min after reversal when the first twitch of the train-of-four had returned to 25% of control. These times for cisatracurium 0.15 mg.kg-1 and atracurium 0.5 mg.kg-1 were 90, 66 and 57 min and 75, 56 and 54 min, respectively. Administration of neostigmine significantly shortened the time to adequate recovery for both drugs but there were no significant differences in the case of either neuromuscular blocking drug between the groups of patients given neostigmine at 10 or 25% recovery of the first twitch of the train-of-four.
A perceived difficulty in grading clinical practice has meant that over the past two decades, educators in nursing have focused on non-graded results for clinical practicum. However, students expect rewards for achievement. Hospitals and universities require a means of differentiating levels of performance for employment and further study. This exploratory study uses quantitative and qualitative methods to evaluate a tool for grading clinical competence. The aims of the study were to determine the distribution of clinical grades, compare the clinical grades with the cumulative theoretical grades and compare the clinicians' and students' perceptions of competence. Study findings show that students and clinicians rated clinical performance well above the expected level. These grades for clinical performance exceeded comparative results in theoretical work for the practicum topic. In addition, content analysis of the qualitative data indicates that clinicians may have difficulty in using the ANCI Competencies to rate a student's performance for registration as a nurse.
As midwives we have developed excellent skills in abdominal palpation. However assessment and physical examination of the woman and her family requires more than this. We need to develop a full repertoire of assessment skills that we can use, as midwives, to work in collaboration and partnership with women to provide the best care possible within the bounds of our practice settings. It is time to reflect on our competence in this area of practice and decide whether we have "art" in the heart of our midwifery practice.
Crucial issues related to the transition from university student to registered nurse are addressed, through a review of the literature. The considerable literature in this area indicates three distinct approaches in examining this question: there are personal and professional deficits which the new graduate must make up, the formal content of the university curriculum is deficient and must be replaced, the socio-political and professional contexts of practice constrains beginning practice. Each of these approaches is examined here in the expectation that uncovering these issues will encourage employers and educators to work together to resolve some of the current conflicts and difficulties inherent in the transition from university student to registered nurse. Various models of transition in current use are then explored, since support for the graduate is paramount for provision of a cost effective and efficient nursing service in a rapidly changing health service environment.
The specialist medical packaging sector is in a period of change. Product innovations, new manufacturing methods, and increasingly stringent demands are the features of today. Aside from the evolving requirements of medical device manufacturers, the driving forces for change are prompted by new packaging legislation, environmental pressures, and, above all, the need to maximize cost effectiveness. The adoption of new production processes and products looks set to increase.
We have designed and constructed a quiet gradient set with restricted access for the combined purposes of evaluating the principles of active acoustic screening, recently introduced by Mansfield, Glover, and Bowtell, and for EPI studies of the head at 3.0 T. The design utilizes the return paths of the conductors in a closed arc loop arrangement to eliminate net Lorentz forces thereby attenuating acoustic noise especially at low frequency. This design should significantly reduce the dangers to patients of high noise levels, especially in high field magnetic resonance imaging systems.