Florida's bicycle helmet law and a bicycle safety educational program: did they help?

INTRODUCTION: This research studied the effectiveness of Florida's mandatory helmet law for children and a community bicycle safety campaign promoting helmet use. Children's use of helmets before and after the law's enactment and the type and extent of head injuries sustained in bicycle crashes were evaluated. METHODS: The trauma and medical records from Broward General Medical Center's Pediatric Referral Trauma Center provided demographic data, injury severity scores, and information on the type and extent of head injuries sustained. Data were compared using independent sample t tests and Pearson chi(2) statistics with.05 as the significance level. RESULTS: Each group consisted of 72 children, predominantly 7- to 12-year-old boys. Known helmet use rose from 5.6% to 20.8%, with children aged 10 to 12 years having the greatest increase in helmet use (27%). Helmet use rose in urban and suburban areas. Changes in the type and extent of head injuries were mixed. Injury severity scores were higher for nonhelmeted children in the after-law group. DISCUSSION: Although helmet use increased, especially among the 7- to 12-year-olds targeted during the bicycle safety campaigns, bicycle helmet use remains too low, and nonhelmeted children continue to have a higher risk for serious injuries. Community bicycle safety programs that promote helmet use remain an important adjunct to mandatory helmet use laws.     

Reflection: nursing’s practice and education panacea?

Reflection: nursing’s practice and education panacea? Nurses are now directed to ‘reflect effectively and practice reflectively’. When there is scant evidence to support the use of reflection, why does the United Kingdom Central Council, English National Board for Nursing Midwifery and Health Visiting and institutes of nurse education insist that nurses, at all levels of experience, reflect? Before developing the debate in relation to the robustness or otherwise of the concept of ‘reflection’ and its application to practice, a discussion as to what constitutes nursing knowledge, followed by an examination of the main theories related to adult learning, is presented. The paper develops to encompass a critical examination of both theoretical and applied perspectives on reflection. Conceptual issues and assumptions related to reflection are explored. Key areas considered are whether the practice of reflection facilitates the improvement of one’s knowledge, helps to generate theory and results in one becoming a more critical practitioner with resulting benefits for patients. It will be argued that reflective theory and practice has not yet been adequately tested and that there is a pressing need for evidence to demonstrate irrefutably the effectiveness of reflection on nursing practice, particularly with respect to patient outcomes.     

Being a Mentor: What’s in It for Me?

The benefits of mentorship for the protégé are well established and include increased career satisfaction, advancement, and income. Mentors can derive satisfaction from personal and professional networks within their institutions and specialties. However, the advantages of being a mentor are underreported in the medical literature. The purpose of this review is to investigate the effect of the mentoring relationship on the mentors and institutions in disciplines that have studied it widely and to draw parallels to academic medicine. Literature in the fields of business, organizational psychology, and kindergarten through high school (K-12) education describe benefits of serving as a mentor to the individual, organization, and discipline. Potential mentors are intensely self-motivated and derive satisfaction from developing junior colleagues and improving their institutions. Business mentors take pride in junior colleagues' achievements and enjoy improved recognition by superiors, favorable perception within the organization, increased job satisfaction, accelerated promotion rates, higher salaries, development of managerial skills, and improved technical expertise. Organizations enjoy worker longevity from both members of the partnership and benefit from the formation of networks. In the K-12 education model, master teachers who train novices are more likely to remain in the classroom or advance to an administrative role. Application of the principles from these disciplines to academic medicine is likely to produce similarly positive outcomes of personal satisfaction, collaboration, and academic and institutional advancement.     

Earplugs and eye masks: do they improve critical care patients’ sleep?

Disturbed sleep and sleep deprivation is common in patients in critical care settings. Noise and inappropriate use of light/dark cycles are two of the causes of sleep interruptions. The purpose of the study was to evaluate eye masks and earplugs to help control patients' exposure to noise and light within the critical care environment. An intervention study using a two group post-test quasi-experimental design of high dependency patients within a cardiothoracic critical care unit was undertaken by a group of critical care nurses. Sleep assessment rating scales and open-ended questions were used to obtain patients' reported experiences of their sleep. Patients self-selected into either an intervention or non-intervention group. Sixty-four patients consented to take part in the study, 34 patients tried the interventions earplugs and eye masks and many found they improved sleep. However, noise was still a factor preventing sleep for both groups of patients. Mixed reports were found with the interventions from very comfortable to very uncomfortable. At a cost of 2.50 pounds sterling/patient, earplugs and eye masks were a relatively cheap intervention with notable improvements for some critically ill patients. Further research is required with a larger sample size, plus an examination of both earplugs and eye masks separately. Offering patient's earplugs and eye masks to improve sleep should be considered as a matter of routine nursing practice, this should include time to show patients how to use and try them out for comfort.     

The attitudes and attributions of student nurses: do they alter according to a person’s diagnosis or sexuality and what is the effect of nurse training?

The threat of an AIDS (acquired immune deficiency syndrome) epidemic in the early 1980s saw the emergence of strong negative attitudes from both the public and health care professionals alike. Certain 'high risk' groups in society, who were considered as susceptible to the disease, homosexuals and intravenous drug users in particular, became the victims of prejudice and discrimination. More recent research has indicated a possible shift to a more positive orientation, although the findings are far from conclusive. In this current study, the Prejudicial Evaluation and Social Interaction Scale (PESIS) was administered to four separate cohorts of student nurses approximately a year apart in training (n = 192). Each cohort was divided into four groups, each one completing the PESIS after reading a version of a vignette that described either a person with AIDS or leukaemia, and who was either homosexual or heterosexual. The design therefore allowed for within-group and between-group comparisons. Overall the results showed that the student nurses held positive attitudes although they reported a significantly greater prejudice towards AIDS. No significant differences were found for sexual orientation. Additionally significantly greater levels of blame and responsibility were associated with the person with AIDS, but again there was no effect for sexual orientation. The findings suggest that a slightly more negative attitude continues to be associated with a diagnosis of AIDS but no longer with homosexuality. No effect across cohorts was noted either, student nurses being as positive at the beginning of training as at the end. Some of the limitations of PESIS and the difficulties of attitude assessment in general are discussed and future areas of research are identified.     

Adiposopathy and bariatric surgery: is ‘sick fat’ a surgical disease?

Objective: To review how bariatric surgery in obese patients may effectively treat adiposopathy (pathogenic adipose tissue or ‘sick fat’), and to provide clinicians a rationale as to why bariatric surgery is a potential treatment option for overweight patients with type 2 diabetes, hypertension, and dyslipidaemia. Methods: A group of clinicians, researchers, and surgeons, all with a background in treating obesity and the adverse metabolic consequences of excessive body fat, reviewed the medical literature regarding the improvement in metabolic disease with bariatric surgery. Results: Bariatric surgery improves metabolic disease through multiple, likely interrelated mechanisms including: (i) initial acute fasting and diminished caloric intake inherent with many gastrointestinal surgical procedures; (ii) favourable alterations in gastrointestinal endocrine and immune responses, especially with bariatric surgeries that reroute nutrient gastrointestinal delivery such as gastric bypass procedures; and (iii) a decrease in adipose tissue mass. Regarding adipose tissue mass, during positive caloric balance, impaired adipogenesis (resulting in limitations in adipocyte number or size) and visceral adiposity are anatomic manifestations of pathogenic adipose tissue (adiposopathy). This may cause adverse adipose tissue endocrine and immune responses that lead to metabolic disease. A decrease in adipocyte size and decrease in visceral adiposity, as often occurs with bariatric surgery, may effectively improve adiposopathy, and thus effectively treat metabolic disease. It is the relationship between bariatric surgery and its effects upon pathogenic adipose tissue that is the focus of this discussion. Conclusions: In selective obese patients with metabolic disease who are refractory to medical management, adiposopathy is a surgical disease.     

Chimney grafts: is there a need and will they work?

Endovascular repair has become the primary treatment option for abdominal aortic aneurysms over the past decade. The favorable results as well as technical evolution have led endovascular repair to include fenestrated and branched technology for complex juxtarenal, suprarenal, and thoracoabdominal aneurysms. These grafts are, however, extensively customized and patient tailored at present precluding their use in emergency situations. Certain aspect of aneurysm anatomy also limits them. The chimney technique uses standard, off-the-shelf endovascular devices that extend the use of standard aortic stent grafts for aneurysms without suitable proximal landing zones particularly in acute situations. Early results are promising and warrant a continued development of the technique until such time that dedicated devices are available for the treatment of these complex aneurysms.     

Nursing-sensitive safety and quality outcomes: the taming of a wicked problem?

There are tremendous opportunities associated with the increasing interest in outcomes that are sensitive to the effects of nursing. However, the challenges in realizing these opportunities are significant, and can be characterized as “wicked". Taming these challenges requires that we manage highly interdependent processes and techniques, including health information technologies.     

Does a fish need a bicycle? Animals and evolution in the age of biotechnology

Animals, in the age of biotechnology, are the subjects of a myriad of scientific procedures, interventions, and modifications. They are created, altered, and experimented upon--often with highly beneficial outcomes for humans in terms of knowledge gained and applied, yet not without concern also for the effects upon the experimental subjects themselves: consideration of the use of animals in research remains an intensely debated topic. Concerns for animal welfare in scientific research have, however, been primarily directed at harm to and suffering of animal subjects and their prevention. Little attention has been paid to the benefits research might potentially produce for animals themselves and the interests that some animals may therefore have in the furtherance of particular avenues of science.