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Mothers' grief following the death of a child.

AIM OF THE STUDY: Research has shown that caring for a dying child is among the hardest and more demanding tasks in nursing, because the staff are forced to manage their heavy work with inadequate skills and experience. This article deals with the findings of a recent study, the purpose of which was to analyse the mother's grief and coping with grief following the death of a child under the age of 7 years. DESIGN: Data were collected from mothers using a survey (n=91) and an interview (n=50). As the topic was very sensitive ethically and emotionally, survey data were collected first and the mothers were asked to give their consent to taking part in an interview. The study employed both quantitative and qualitative methods. The data were analysed using statistical methods and content analysis. However, only the qualitative part of the study is presented in this article. FINDINGS: The findings show that nursing staff had skills to support grieving mothers, but that there were many feelings and experiences of grief that remained unidentified by staff. The staff's ability to meet the mothers' individual needs while the child was in hospital and after the child's death was inadequate. The information received from staff was perceived to be insufficient or offensive to mothers. CONCLUSIONS: The development of basic and further education and of various support measures would enable the staff to better cope with their work. Focusing on interactive skills and meeting the patient's individual needs using reflective practice would improve the quality of care. Communication and collaboration between different occupational groups should be promoted, because mothers were dissatisfied with dissemination of information, and ambiguous responsibilities between different occupational groups hampered the acquisition of information.

Adaptation, Psychological↗

Determinants of negative emotional reactions and causal beliefs about self-injurious behaviour: an experimental study.

BACKGROUND: Caregivers' emotional and cognitive reactions to challenging behaviours have been identified as potential determinants of their reinforcing responses towards such behaviours. However, few studies have explored factors affecting caregivers' emotional and cognitive responses to challenging behaviours. METHODS: Sixty students inexperienced in work with people with challenging behaviours and 60 experienced staff watched one of two carefully matched, acted videotapes depicting self-injury maintained by attention or escape-from-task demands. The participants were also told whether the self-injury depicted typically led to mild or severe consequences for the person filmed. The subjects completed measures of their negative emotional reactions to the self-injury and their behavioural causal beliefs about the behaviour depicted. RESULTS: Analyses of variance revealed that students reported more negative emotional reactions and were less likely to endorse behavioural causal hypotheses. Those who watched the severe self-injury videotape also reported more negative emotional reactions. Two effects of the behavioural function of the depicted self-injury were also found: (1) attention-maintained self-injury was associated with higher levels of endorsement of behavioural causal hypotheses; and (2) severe attention-maintained self-injury led to the strongest negative emotional reactions, but only from students. CONCLUSIONS: The effects of experience and behavioural function on emotional reactions and behavioural causal beliefs need to be explored in more detail in future research. If replicated, the present results have significant implications for theory and practice in the remediation of challenging behaviours and the support of care staff.

Adolescent↗

Examiner fatigue in communication skills objective structured clinical examinations.

CONTEXT: The assessment of undergraduates' communication skills by means of objective structured clinical examinations (OSCEs) is a demanding task for examiners. Tiredness over the course of an examining session may introduce systematic error. In addition, unsystematic error may also be present which changes over the duration of the OSCE session. AIM: To determine the strength of some sources of systematic and unsystematic error in the assessment of communication skills over the duration of an examination schedule. METHODS: Undergraduate first-year medical students completing their initial summative assessment of communication skills (a four-station OSCE) comprised the study population. Students from three cohorts were included (1996-98 intake). In all 3 years the OSCE was carried out identically. All stations lasted 5 minutes with a simulated patient. Students were assessed using an examiner (content expert) and a simulated-patient evaluation tool, the Liverpool Communication Skills Assessment Scale (LCSAS) and the Global Simulated-patient Rating Scale (GSPRS), respectively. Each student was assigned a time slot ranging from 1 to 24, where 1, for example, would denote that the student entered the exam first and 24 indicates the final slot for entry into the examination. The number of students who failed this exam was noted for each of the 24 time slots. A control set of marks from a communication skills written exam was also adopted for exploring a possible link with the time slot. Analysis was conducted using graphical display, covariate analysis and logistic regression. RESULTS: No significant relationship was found between the schedule point that the student entered the OSCE exam and their performance. The reliability of the content expert and simulated-patient assessments was stable throughout the session. CONCLUSION: No evidence could be found that duration of examining in a communication OSCE influenced examiners and the marks they awarded. Checks of this nature are recommended for routine inspection to confirm a lack of bias.

Clinical Competence↗

Comparative proteome analysis of Helicobacter pylori.

Helicobacter pylori, the causative agent of gastritis, ulcer and stomach carcinoma, infects approximately half of the worlds population. After sequencing the complete genome of two strains, 26695 and J99, we have approached the demanding task of investigating the functional part of the genetic information containing macromolecules, the proteome. The proteins of three strains of H. pylori, 26695 and J99, and a prominent strain used in animal models SS1, were separated by a high-resolution two-dimensional electrophoresis technique with a resolution power of 5000 protein spots. Up to 1800 protein species were separated from H. pylori which had been cultivated for 5 days on agar plates. Using matrix-assisted laser desorption/ionization mass spectrometry (MALDI-MS) peptide mass fingerprinting we have identified 152 proteins, including nine known virulence factors and 28 antigens. The three strains investigated had only a few protein spots in common. We observe that proteins with an amino acid exchange resulting in a net change of only one charge are shifted in the two-dimensional electrophoresis (2-DE) pattern. The expression of 27 predicted conserved hypothetical open reading frames (ORFs) and six unknown ORFs were confirmed. The growth conditions of the bacteria were shown to have an effect on the presence of certain proteins. A preliminary immunoblotting study using human sera revealed that this approach is ideal for identifying proteins of diagnostic or therapeutic value. H. pylori 2-DE patterns with their identified protein species were added to the dynamic 2D-PAGE database (http://www.mpiib-berlin.mpg.de/2D-PAGE/). This basic knowledge of the proteome in the public domain will be an effective instrument for the identification of new virulence or pathogenic factors, and antigens of potentially diagnostic or curative value against H. pylori.

Bacterial Proteins↗

Development of mental attention in gifted and mainstream children: the role of mental capacity, inhibition, and speed of processing.

The study examined performance of 6- to 11-year-old children, from gifted and mainstream academic programs, on measures of mental-attentional capacity, cognitive inhibition, and speed of processing. In comparison with mainstream peers, gifted children scored higher on measures of mental-attentional capacity, responded more quickly on speeded tasks of varying complexity, and were better able to resist interference in tasks requiring effortful inhibition. There was no group difference on a task requiring automatic inhibition. Comparisons between older and younger children yielded similar results. Correlations between inhibition tasks suggest that inhibition is multidimensional in nature, and its application may be affected by task demands. Measures of efficiency of inhibition and speed of processing did not explain age or group differences on a complex intellective measure of mental-attentional capacity.

Association Learning↗

Nurses' experiences of interactions with family members in intensive care units.

The purpose of this study was to describe nurses' experiences of interactions with family members in intensive care units. Ten experienced Registered Nurses were interviewed, and the interview text was qualitatively analysed by its content. Nursing of families was experienced as an essential, necessary and demanding task, and no systematic assessment and intervention with families were talked about. Two categories emerged from nurses' descriptions: inviting and noninviting interactions between nurses and family members. Inviting interactions were considered when family members were seen as important in the nursing care. The nurses used themselves as instruments to create contact and felt confident working with the family members. Thereby the nurses were forced to reflect on their way of caring and received positive responses from family members. In noninviting interactions, medical and technical tasks were considered to be most important and the nurses considered themselves as experts. They expressed having little time for family members and described being afraid of coming too close to them and having problems with creating relationships. Further research, including direct observations of interactions between nurses and family members, is needed.

Adult↗

Sensory and affective dimensions of phasic pain are indistinguishable in the self-report and psychophysiology of normal laboratory subjects.

This study evaluated the discriminant validity of subjects differentially scaling the sensory and affective dimensions of pain. It sought to determine (1) whether subjects can differentially scale sensory and affective aspects of phasic laboratory pain in the absence of task demand bias that fosters apparent differential scaling; (2) whether psychophysiologic responses to painful stimuli can predict pain report (PR); and (3) whether such responses contribute more to affective than to sensory judgments. Fifty-six men and 44 women repeatedly experienced varied painful electrical fingertip stimuli at low, medium, and high intensities. On half of the trial blocks, subjects made sensory judgments; on the remainder they made affective judgments. Response measures included PR, pupil dilation, heart rate, respiration rate, skin conductance response (SCR), and late near field evoked potentials. Subjects did not rate the stimuli differently when making sensory versus affective judgments. The psychophysiologic variables, principally the SCR, accounted for 44% of the variance in the PR. Psychophysiologic response patterns did not differentiate affective and sensory judgment conditions. Noteworthy sources of individual differences included baseline PR levels and the linear effects of SCR on PR.

Journal Article↗

Perceptions and experiences of motherhood, health and the husband's role among Thai women in Australia.

OBJECTIVE: to discuss the perceptions and experiences of motherhood among Thai immigrant women in Australia. DESIGN: ethnographic interviews and participant observation were used to elicit information. SETTING: Melbourne Metropolitan Area, Victoria, Australia. PARTICIPANTS: 30 Thai women who are now living in Australia. FINDINGS: becoming a mother meant different things to these women. Motherhood had both positive and negative aspects. Women believed that their health became worse as a result of becoming a mother. The contributing causes of their health status were multi-faceted, including their age, the demanding tasks of motherhood, the depletion of their strength and energy from childbirth, and in not following Thai traditional confinement practices. The findings in this paper support previous literature that motherhood has a profound effect on the life of many women. We, however, found that cultural beliefs and practices have an effect on women's perceptions and experience of motherhood. We also found that the 'presence' of the husband when a woman becomes a mother is important. The ethnicity of their husbands also played a significant role in their motherhood role and the ways in which they mothered their children. IMPLICATIONS FOR PRACTICE: understanding the social and cultural environment in which immigrant women try to be a mother is important if we are to provide culturally sensitive assistance and care to women who choose to become a mother in their new homeland.

Adult↗

[Chronic abdominal pains caused by peritoneal tuberculosis - two case reports].

Chronic abdominal pains caused by peritoneal tuberculosis - two case reports. The diagnosis of a peritoneal tuberculosis could be a demanding task for even an experienced Physician, because of the unspecific symptoms. We report on two patients, who as a result of therapy refractory chronic abdominal pains, weight loss and ascites were admitted to our hospital. The excisional biopsy taken from the peritoneum and the omentum major during an exploratory laparotomy resulted in the histopathologic diagnosis of peritoneal tuberculosis being made. Both patients were given tuberculostatic therapy with isoniazid, rifampicin, pyracinamide and streptomycin and both have since recovered. The symptoms, the difficulties encountered in making the diagnosis and the therapy of the peritoneal tuberculosis are discussed using these two case reports.

Adult↗

[Bilateral stress fracture of the medial malleolus].

INTRODUCTION: A stress fracture can be defined as a partial or complete fracture of bone that results from repeated application of stress to the bone. Stress fractures are common injuries in athletes with an incidence of 0.12 - 4.4 %. Running and jumping are the most common sporting activities that have resulted in stress fractures. Stress fractures of the medial malleolus are extremely rare. Diagnosis and therapy are often difficult, result in a delayed begin of therapy and are a demanding task in sports medicine. Both surgical and conservative treatment are possible. METHODS: We present the case of an athlete, who presented stress fractures of both medial malleolus in 21 months. RESULTS: The patient was treated on one side with arthroscopy and an osteosynthesis and with arthroscopy on the other side. Each time the fracture healed without any problems. DISCUSSION: Based on literature and our patient we believe that surgical and conservative treatment are possible options. However surgical procedures seem to bring back the athlete earlier to sporting activities. Surgery should be considered early in the right patients.

Ankle Injuries↗

Clinical implications of cross-system interactions.

In this review, we briefly highlight potential cross-system interactions between swallowing and speech production, using data from recent neuroimaging studies, common clinical impairments, cross-system treatment effects, and developmental considerations as supporting evidence. Our overall hypothesis is that speech and swallowing (and other motor behaviors) are regulated through a shared network of brain regions and other neural processes that are modulated on the basis of specific task demands. We emphasize the clinical utility of viewing speech and swallowing as being closely linked from both a diagnostic and treatment perspective. We stress the importance of continuing research to explore the common and perhaps distinct neural circuitry underlying speech and swallowing and the clinical intervention strategies that attempt to capitalize on potential cross-system therapeutic benefits.

Biomechanical Phenomena↗

[First experiences with the trauma radiologic PACS project at the University of Innsbruck Department of Radiology].

Radiography in an emergency setting is a demanding task, in technical as well as in logistical terms. Rapid acquisition of high quality radiographs under difficult conditions, for example severely injured patients with multi-organ trauma is important. All image data and radiological reports must be transmitted to the trauma surgeon as soon as possible. To meet these needs with the promising means of modern X-ray technology, we decided to implement a completely digital X-ray division inside the new outpatient trauma department. In the setting of an outpatient emergency department digital radiography and PACS cannot be realised without problems. We present our first experience with the installation and 10 month filmless routine in the X-ray division for traumatology outpatients at the university of Innsbruck department of radiology.

Emergencies↗

Iterative fluctuation charge model: a new variable charge molecular dynamics method.

In molecular simulations, calculation of environmentally dependent atomic charges is still a demanding task. Empirical and semiempirical methods have been proposed and applied to a wide range of problems with different success. In this paper, a new scheme based on the concept of electronegativity equalization is presented and its advantages over several other methods are discussed. This method is an extension of the fluctuation charge model [S. W. Rick, S. J. Stuart, and B. J. Berne, J. Chem. Phys. 101, 6141 (1994)]. By allowing multiple electronic iterations at each nuclear step, the condition of electronegativity equalization can be satisfied to a selected precision. Molecular dynamics simulations using this new method, as well as several other methods, are performed on alpha quartz. Analysis of the simulated results shows that it is advantageous to use the iterative fluctuation charge model in several different situations.

Journal Article↗

Perceptual and task factors in fluent braille.

Hypotheses that fluent braille depends (i) on coding letters by global outline shape for all task and speed levels, or (ii) on lateral dot-gap density scanning in fast reading for meaning were tested with three groups of fluent braillists who differed in reading speeds. In experiment 1, 90 degrees-rotated (near to far) texts under vertical and horizontal finger orientation were used. Hypothesis (i) was not supported. Finger orientation interacted significantly with Speed and Task. Vertical finger orientation, which disrupts lateral scanning, slowed reading for comprehension more than for letter search, and differentially more for faster readers. Horizontal finger orientation, which instead disrupts the familiar finger-body relation, did not have differential effects. The findings support hypothesis (ii). In experiment 2, normal texts and texts containing a degraded dot in some letters were used. These are felt in searching for individual letter patterns, but would disrupt lateral scanning of expected dot-gap density patterns in reading for meaning. The results supported the predictions from hypothesis (ii), that degraded texts slow reading for meaning significantly more than for letter search, and more in the case of faster readers than for the slowest group. Findings were not consistent with hypothesis (i), which predicts that text degradation affects tasks equally, and affects the slowest rather than the fastest readers. The results suggest that perceptual coding in reading differs with task demands and speed.

Adolescent↗

Misaligned maps lead to predictable errors.

Three experiments were conducted to investigate the ability of subjects to make judgments of direction when using misaligned maps. Two hypotheses were proposed (i) errors would fall into two lawful categories--mirror-image errors and alignment errors; (ii) the effect of map orientation would generalize to a different mode of responding than has been used in previous studies. Support for both hypotheses was obtained. The results are discussed in terms of the mental processes used to align maps to spaces, and the task demands required by different response modes.

Adult↗

The Pulfrich pendulum phenomenon in stereoblind subjects.

The Pulfrich pendulum phenomenon, in which a pendulum swinging in the frontoparallel plane appears to swing in an ellipse when a neutral density filter is placed over one eye of the observer, was investigated in stereoblind subjects. It was found that such subjects can report the presence of the Pulfrich effect although they fail to fuse random-dot stereograms and fail to exhibit interocular transfer of the movement aftereffect. These findings suggest that 'stereoblind' subjects must retain some residual binocular mechanism for depth perception. Three possibilities are considered: (i) the stereoblind may be able to utilise contiguous temporal disparities as a cue for depth in the Pulfrich effect; (ii) they may retain some residual binocularity, sufficient to reveal the Pulfrich effect but not for other more demanding tasks for the binocular mechanisms; and (iii) they may retain some coarse magnocellular pathway disparity mechanism having lost their high-acuity parvocellular disparity system. There is little evidence to support any of these hypotheses, but the third shows promise.

Depth Perception↗

Perceptual organisation and object recognition--POOR is the acronym, rich the notion.

Instead of studying perceptual organisation and object recognition in relative isolation, they can be viewed as two highly related sets of processes performed by the visual system to achieve its goal of acquiring information about the world. Fifteen papers devoted to specific subproblems within this active area of research have been brought together in two successive issues of Perception. Collectively they demonstrate that focusing on the functional interrelationships between perceptual organisation and object recognition will enrich our understanding of each of the subprocesses involved. The editorial provides an overview of the papers together with a discussion on how they relate to one another. If a general message is to be extracted from this set of papers, it is that the reported findings and the speculations offered to explain them suggest that the visual system's processes cannot be characterised in general by simple dichotomies such as analytic versus wholistic, bottom-up versus top-down, local versus global, low-level versus high-level, parallel versus serial, etc. Instead, it appears that a wide variety of mechanisms is available to the visual system. Therefore, a complete understanding of its functioning will require careful examination of the circumstances within which one processing mechanism seems to be selected over another, depending on the available information, the task demands, and perhaps even the observer's individual characteristics.

Humans↗

Task-dependent changes of the psychophysical motion-tuning functions in the course of perceptual learning.

In some cases, perceptual learning is task-specific. However, task-dependent effects of perceptual learning on psychophysical motion-tuning functions have yet to be clarified. In the present study, subjects performed motion detection or discrimination of the same stimulus over the course of four sessions held on separate days. Subjects who performed motion detection showed the most highly improved performance on the trained motion directions. However, after discrimination training, the highest improvement was not observed at the trained directions but shifted away from them. These results can be explained by lateral inhibition. Task demands may differentially modulate excitatory and inhibitory signals to directions in the vicinity of the trained directions.

Adult↗