Surrounded by ocean,a world apart ... the experience of elder women living alone

The purpose of this phenomenological study was to discover, describe, and understand the lived experience of some of Maine's most isolated elder women, those living alone on islands off the coast. Nine women, age 80 and older, were interviewed. Three dominant themes essential to this rural island lifeway emerged: no one is an island, no one lives alone; securely anchored in safe harbor; and weathering the storms. Results were that these women remain actively engaged in life, feeling valued and connected, safe and secure; they are resourceful, resilient, and determined.     

Determination of respiratory system compliance during pressure support ventilation by small variations of pressure support

In mechanically ventilated patients, measurement of respiratory system compliance (C_rs) is of high clinical interest. Spontaneous breathing activity during pressure support ventilation (PSV) can impede the correct assessment of C_rs and also alter the true C_rs by inducing lung recruitment. We describe a method for determination of C_rs during PSV and assess its accuracy in a study on 20 mechanically ventilated patients. To assess C_rs during pressure support ventilation (C_rs,PSV), we performed repeated changes in pressure support level by ±?2 cmH₂O. C_rs,PSV was calculated from the volume change induced by these changes in pressure support level, taking into account the inspiration time and the expiratory time constant. As reference methods, we used C_rs, measured during volume controlled ventilation (C_rs,VCV). In a post-hoc analysis, we assessed C_rs during the last 20% of the volume-controlled inflation (C_rs,VCV20). Values were compared by linear regression and Bland–Altman methods comparison. Comparing C_rs,PSV to the reference value C_rs,VCV, we found a coefficient of determination (r²) of 0.90, but a relatively high bias of ??7 ml/cm H₂O (95% limits of agreement ??16.7 to +?2.7 ml/cmH₂O). Comparison with C_rs,VCV20 resulted in a negligible bias (??1.3 ml/cmH₂O, 95% limits of agreement ??13.9 to +?11.3) and r² of 0.81. We conclude that the novel method provides an estimate of end-inspiratory C_rs during PSV. Despite its limited accuracy, it might be useful for non-invasive monitoring of C_rs in patients undergoing pressure support ventilation.     

Enhancing learning environments by maximising support to mentors

In June 2000 the role of the clinical education facilitator across the pan-Avon region (south west) emerged in response to the predicted increase in numbers of preregistration nursing students. The role focused on maximising the capacity of placements for students, and developing quality learning environments using innovative and creative methods. The role now encompasses maximising the support given to mentors who are balancing work pressures with students' needs.     

Advanced life support skills undertaken by nurses--UK survey.

Many nurses successfully complete the Resuscitation Council (UK), European Resuscitation Council, advanced life support (ALS) Provider Course. Acquiring ALS provider status is not necessarily a licence to practice and individual hospital policy determines which skills these nurses can then perform without direct medical supervision. This postal survey aimed to determine which ALS skills are utilised by nurse ALS providers working in a variety of clinical areas within acute hospitals in the UK. A questionnaire was sent to the Resuscitation Officer or Nursing Director of all acute hospital groups in the UK. Almost 261 (87%) of the questionnaires were completed and returned. Nurse ALS providers in 99% of coronary care units, 89% of intensive care units, and 88% of accident and emergency departments undertook manual defibrillation. The majority of hospitals ran compulsory in-house training sessions for intravenous cannulation. Laryngeal mask insertion by nurse ALS providers was permitted in 19% of coronary care units and in the wards of 16% of the responding hospitals. Tracheal intubation by nurse ALS providers working in coronary care units, intensive care units and emergency departments was permitted by 11% of the responding hospitals. This survey has demonstrated that many acute hospitals do not permit nurse ALS providers to use a number of the skills taught on the ALS provider course. General ward-based nurse ALS providers, in particular, are restricted in the ALS skills, they are permitted to use. It would be more efficient for nurses to be trained and assessed specifically in skills they are then permitted to use. Having been assessed in a given skill and achieved a nationally recognised standard, nurse ALS providers should be permitted to use it in clinical practice.     

Social support and physical activity engagement by cancer survivors

Less than 20% of adult cancer survivors participate in physical activity and, as a result of such inactivity, cancer survivors are at increased risk for developing chronic diseases. Studies have linked social support as a predictor of physical activity participation in healthy adults. The primary goal of this systematic review is to examine the relationship between social support and physical activity engagement in adult cancer survivors and determine whether additional research is needed in this area. Several databases were searched and articles were systematically extracted according to the inclusion and exclusion criteria. That search yielded 69 articles, 22 of which were identified and included in this review. Fifty percent of the studies showed a significant relationship between social support and physical activity engagement; however, 59% of the participants were breast cancer survivors. The findings suggest that additional research is needed to develop social support strategies that will increase physical activity engagement in adult survivors of cancers other than breast cancer.     

Early prediction of unexplained syncope by support vector machines

The goal of the present study was to develop and evaluate a new method for the prediction of unexplained syncope occurrences. Diagnosis of syncope is currently based on the reproduction of symptoms in combination with hypotension and bradycardia induced by a 45 min 60-70 degrees head-upright tilt test (HUTT). The main drawback of this widely used test concerns its duration that reaches 55 min if the patient does not faint. Our method is a first step in the avoidance of the HUTT. An electrocardiogram and a transthoracic impedance waveform were recorded for 10 min of supine rest of a HUTT in 128 patients with a history of unexplained recurrent syncope. Seven indices were computed on the transthoracic impedance and its first derivative. The prediction quality of every subset of these variables, mixed with age and sex, has been tested by a support vector machine in a retrospective group of 64 patients (100% of sensitivity and 100% of specificity was reached). The best subset obtained has been evaluated prospectively in a group of 64 patients (94% of sensitivity and 79% of specificity was reached). These results compare very favorably with published results for other unexplained syncope detectors.