A comparative pharmacokinetic study of intravenous and intramuscular midazolam in patients with epilepsy

The pharmacokinetics of midazolam, a water soluble 1,4-benzodiazepine, has been studied in 12 patients (11 male, 1 female; age range 19–57 years) with epilepsy. All patients were taking hepatic enzyme inducing antiepileptic drugs (AEDs) on a regular basis. Midazolam (5 mg) was administered intravenously and 1 week later midazolam was administered intramuscularly, the dose used being dependent on the sedative response to the intravenous dose (10 mg, N = 2; 7 mg, N = 8; 5 mg, N = 2). Serial blood samples were collected at timed intervals for 5–7 h. After intravenous administration initial distribution was rapid with a mean half-life (t¹/2) of 0.06 ± 0.03 h followed by a terminal half-life (t¹/2β or γ) of 1.5 ± 0.3 h. Volume of distribution was 0.62 ± 0.27 1/kg. After intramuscular administration midazolam was rapidly absorbed with peak serum concentrations achieved at 25 ± 23 min. Two patients showed delayed absorption. Mean terminal half-life was 2.8 ± 1.7 h. The absolute bioavailability of intramuscular midazolam was calculated in 11 patients as 87 ± 18%. Sedation was rapid (< 1–2 min) but transient (7–75 min) after intravenous and slower (2–30 min) and for a longer period (20–120 min) after intramuscular administration. Since intravenous administration of AEDs including diazepam is not always feasible in status epilepticus there are obvious advantages in having an effective intramuscular formulation. Our data suggest that midazolam may be such a drug.     

A survey of high-fibre diet-sheets used in the treatment of irritable bowel syndrome in Great Britain

Forty high-fibre diet-sheets used in the treatment of irritable bowel syndrome (IBS) were surveyed. They varied in their design and layout, presentation of information and in the dietary advice they provided. Although some thought had gone into their production, there was room for improvement by the use of published guidelines on instructional text design. Information on the amount of bran and fluid to take, and the degree of emphasis on the importance of consumption of specific fibre-rich foods, was inconsistent. Daily meal plans, where provided, were open to wide interpretation, so that intakes of less than 20 g of dietary fibre per day were possible whilst adhering to the suggested plans.     

Food intake at age 8 3. Distribution and food density by meal

This report describes how nutrient intake was distributed throughout the day, and the nutrient density according to meal, in 78 boys and 63 girls who have been studied from birth. The food intake was calculated from 4 day weighed records using the CSIRONET data bank based on British tables of food composition.
The percentages of total energy from breakfast, lunch, evening meal, and snacks were 20, 26, 31, 23%. There was a very wide range of individual nutrient intake for each meal. The evening meal made the largest contribution to fat and protein intake. Most starch came from lunch (30%) and least from snacks (16%). Snacks contained a large portion of the simple sugars (39%).
Breakfast was an important source of calcium and B vitamins, but with wide ranges of micronutrients occurring for each meal.
This analysis of nutrient density and distribution contributes towards the formulation of practical recommendations about beneficial dietary changes.     

Social epidemiology of mental disorders. A review of Latin-American studies

This paper reviews the literature about the relationships between cultural change and psychopathology produced by Latin American researchers. With the analysis of 22 epidemiological studies, the author shows how culture has been traditionally viewed by social psychiatric research in Latin America as an independent variable associated with the prevalence of mental disorders. Two basic approaches have been analyzed: one of anthropological origin and the other based on sociological explanations. The hypotheses of cultural shock, stress of acculturation and cultural marginalization belong to the first approach, while the second one is manifested by the notions of urban stress, life change, social support and goal-striving stress. Methodological issues were brought about to evaluate the results on the association of cultural processes and psychopathology available in contemporary socio-psychiatric research in Latin America.     

The physiotherapy management of patients undergoing thoracic surgery: a survey of current practice in Australia and New Zealand

Background and Purpose. Physiotherapy is considered an essential component of the management of patients after thoracotomy, yet the type of interventions utilized, and evidence for their efficacy, has not been established. The aim of the present study was to ascertain the current physiotherapy management of patients undergoing thoracotomy and the factors influencing practice among different providers. Method. A purpose‐designed postal questionnaire was distributed to senior physiotherapists in all thoracic surgical units throughout Australia and New Zealand (n = 57). Results. A response rate of 81% was obtained (n = 46). Pre‐operatively, 16 respondents (35%) reported assessing all thoracotomy patients. The majority of respondents (n = 44; 96%) indicated that all patients were seen by physiotherapists after surgery, with 29 respondents (63%) performing prophylactic physiotherapy interventions to prevent post‐operative pulmonary complications. Respondents reported that physiotherapy treatment was usually commenced on day one post‐operatively (n = 37; 80%) with the most commonly used treatment interventions being deep breathing exercises, the active cycle of breathing techniques, cough, forced expiration techniques and sustained maximal inspirations. Most respondents reported that patients first sat out of bed (n = 41; 89%), commenced shoulder range of movement (n = 23; 50%) and walking (n = 32; 70%) on day one post‐operatively. The majority of respondents reported that they offered no post‐operative pulmonary rehabilitation (n = 25; 54%), outpatient follow‐up (n = 43; 94%) or post‐thoracotomy pain management (n = 40; 87%). Respondents indicated that personal experience, literature recommendations and established practice were the factors which most influenced physiotherapy practice. Conclusion. Most patients after thoracotomy receive physiotherapy assessment and/or treatment in the immediate post‐operative period, but only one‐third were routinely seen pre‐operatively and relatively few were reviewed following discharge from hospital. Further studies are required to guide physiotherapists in determining the efficacy of their practices for patients undergoing thoracotomy. Copyright © 2007 John Wiley & Sons, Ltd.     

急诊科护士健康教育认知状况的调查分析

目的 调查急诊护士实施健康教育的认知状况．以期为做好急诊健康教育提供借鉴。方法 采用问卷调查对北京市5所综合性医院106名护理人员进行了调查。结果 护士均能认识到急诊开展健康教育的重要性，但对于健康教育基本知识的认识．以及是否有能力进行健康教育的回答，高职称护士明显优于低职称护士。调查还显示大部分护理人员健康教育知识缺乏，其所具备的知识结构不能满足现行整体护理的要求。结论 应加强护士健康教育基本知识、基本技能的培训，以期提高医疗及服务质量。     

How healthy are our emergency departments?

Objective: To demonstrate a comprehensive workplace health survey is able to identify indicators that contribute to staff workplace welfare. Methods: Analysis of a VicHealth workplace health survey distributed to seven suburban emergency departments. Respondents rated multiple workplace health indicators in terms of perceived importance and perceived performance. A satisfaction rating and performance gap for each indicator was calculated. Results: There was a 64% response rate to 500 surveys. Staff rated a safe environment, professional standards, and staff morale the most important factors for workplace health. They were most satisfied with the flexibility of work arrangements (85.6%) and leadership (79.9%), and were least satisfied with the performance management of staff (68.5%) and job satisfaction and morale (67.2%). The largest gaps between perceived importance and performance were in the provision of safe well‐lit parking, staff morale, and the use of reward and recognition systems. Conclusion: The VicHealth survey was an effective tool in identifying indicators that contribute to staff workplace health. Quantifiable findings allowed interdepartmental comparison and may be useful in focusing on improvements in organizational structure.     

A national survey of community psychiatric nurses and their client care activities in Ireland

Increasingly, people with mental health problems in Ireland and in the UK are receiving mental health services in the community. The aim of this study was to identify the predominant approaches to care used by community psychiatric nurses (CPNs) and the theoretical bases of their practice. One hundred and sixteen questionnaires out of 203 sent to CPNs throughout Ireland were returned, giving a response rate of 57.1%. In addition, 33 home visits by 13 CPNs were observed. The findings showed that over 96% of the sample were in full-time employment; most (71.4%) worked a 9-5 weekday shift; 31% had a postregistration counselling qualification, and about a quarter were based in hospitals. The average caseload size was 61 and the service was predominantly a closed referral one. The main client care activities were: assessment of clients, medication management, health promotion, and client and family support. From the observations, there was no evidence of CPNs practising cognitive, behaviour therapy or family therapies to any great extent. This study provides baseline data for monitoring trends in community mental health nursing in Ireland, and for informing future policy regarding service provision and training of CPNs.