Changes in the ratio of urinary α1-microglobulin to ulinastatin levels in patients with Alzheimer-type dementia and vascular dementia

Abstract Relationships between urinary levels of α1-microglobulin (α1M) and ulinastatin (UT) in patients with dementia were investigated. There were no significant differences in α1M and UT levels and α1M: UT ratios among three groups: age-matched control subjects, patients with either Alzheimer-type senile dementia (ATD) or vascular dementia (VD). Although a positive correlation was established between α1M and UT levels in these groups, the regression of the demented patients differed significantly from that of controls ( P <0.05). A tendency towards a negative correlation between α1M: UT ratios and the levels of severity or duration of the disease was displayed in the ATD group, whereas a tendency toward a positive correlation between α1M: UT ratios and the levels of severity was observed in the VD group. These results suggest that changes in the relationships between urinary levels of α1M and UT may provide a useful biochemical index for diagnoses of ATD and VD.     

Developing nurse practitioners to develop practice: the experiences of nurses working on a Nursing Development Unit

Aim To elicit nurses' accounts of their involvement with nursing research and their interpretations of the meaning of these projects for their practice.
Background The links between research and practice development in health care are poorly understood and require further exploration in the light of the emerging research and development agenda within the National Health Service.
Methods Semi-structured interviews were conducted with 15 qualified nurses working on a Nursing Development Unit. The interviews were tape recorded, transcribed and analysed thematically.
Findings Data analysis identified two distinct groups—a core group of nurses actively engaged in the research projects and a peripheral group involved in data collection. The characteristics of the core group mirror the characteristics of those involved in non-research-based practice development activities.
Conclusions Engaging in research activities does not always result in the development of practice, however, there appears to be a link between practice development and critical thinking.     

All change: cancer services in transition

The policy and health service background to this discussion are the radical changes in cancer services currently underway in the wake of the Calman-Hine Report and the wider changes ushered in by the NHS and Community Care Act 1990 (UK). Using the changing face of hospice care as the focus, the authors explore some of the potential issues and dilemmas involved in providing supportive care for cancer patients and their families. Three 'themes', or areas of concern, are highlighted: links between services, changing organizational factors, and increasing 'medical imperialism'. Potential benefits and drawbacks of the changing ethos and organizational structures are discussed. Interview data are used as 'triggers' for the presentation of the authors' own reflections on developments in the hospice and cancer services' arenas. The paper draws on interview data collected in the pilot phase of a 3-year study on the psycho-social needs of cancer patients and their informal carers in north-west England. Twenty-nine interviews were conducted with a range of professionals involved in the provision of cancer services in Lancaster and Kendal. In the spirit of 'gathering thoughts' and facilitating debate, a commentary on developments in the hospice sector is offered rather than any firm conclusion.     

Nurse managers don’t get the corner office

Aim To provide an original perspective on the power and status of first-line nurse managers by observing their working environment. Background The role of first-line nurse managers includes clinical, administrative and managerial components, with their responsibilities not always reflected in their level of organizational power. The business literature suggests that an appropriately resourced workspace is not merely functional, it also confers power and status. Method Twenty Australian rural nurse managers’ workspaces were observed, as part of a larger qualitative study that explored their role and organizational power using semi-structured interviews. The observational data consisted of detailed researcher notes that were analysed thematically. Results The nurse managers’ workspaces were suboptimal and did not provide sufficient physical space or resources for the participants’ to manage tasks effectively. These results were considered using Kanter’s theory of organizational power. Implications for nursing management The findings support those reported in the business literature that inadequate physical workspaces are counterproductive in terms of both functionality and organizational power. Suggestions are made regarding the workspace needs of first-line nurse managers, based on a closer alignment between the work environment and their role responsibilities. These findings have implications for decisions regarding organizational support of first-line nurse managers.     

Quality of life for patients with schizophrenia living in the community in Greece

Several quality of life instruments were considered for use in a Greek mental health environment. Subjective Quality of Life Profile was chosen as it was easy to complete and covered the issues raised by patients with schizophrenia through interviews. Confirmatory factor analysis gave credence to the four-dimensional structure identified by the original authors. Patients with schizophrenia were generally satisfied with their quality of life, found the items in the instrument important and were optimistic about expectations for change. Age, gender, education, marital status and years of sickness were not statistically significant in a general linear model with quality of life as the outcome for the 27 core questions. There were some statistically significant results for the three disease-specific questions; positive expectation was correlated positively with education and negatively with years of sickness.     

Organizational commitment, work environment conditions, and life satisfaction among Iranian nurses

Employee commitment to the organization is a crucial issue in today's health-care market. In Iran, few studies have sought to evaluate the factors that contribute to forms of commitment. The aim of this study was to investigate the relationship between nurses' organizational commitment, work environment conditions, and life satisfaction. A cross-sectional design was utilized. Questionnaires were distributed to all the staff nurses who had permanent employment (with at least 2 years of experience in nursing) in the five hospitals affiliated to Birjand Medical Sciences University. Two hundred and fifty participants returned completed questionnaires. Most were female and married. The correlation of the total scores of nurses' affective organizational commitment and work environment conditions indicated a significant and positive relationship. Also, a statistically significant relationship was found between affective organizational commitment and life satisfaction. The implementation of a comprehensive program to improve the work conditions and life satisfaction of nurses could enhance their organizational commitment.     

The measurement of psychotic acuity by nursing staff

Accurate evaluation of patients' psychotic state is essential to decrease psychotic symptoms and protect the patient and others. The aim of this paper is to conduct a literature review in order to access the utility, reliability and validity of current rating scales that are purported to measure psychotic acuity of inpatient population. A search of a number of electronic databases was undertaken to retrieve potential articles that focus on the measurement of acute psychosis. We identified some conceptual and theoretical problems when using a scale that is monitoring the progress of discharge and assesses the outcome of treatments. The findings revealed a difficulty in finding a commonly agreed definition of acute psychosis and a problem of obtaining frequent measures, and the frequency of measurement and fluctuation in psychosis. The most dominant scales in assessing psychosis were reviewed: the Global Assessment of Functioning Scale, the Brief Psychiatric Rating Scale and the Positive and Negative Symptom Scale. Several issues related to the scales' inter-rater reliability and construct validity remain unexplored. None of these scales addressed the conceptual and theoretical problems that we identified. A new scale that will measure acuity of symptoms in inpatient settings needs to be created.