FETAL SCALP BLOOD SAMPLING

Fetal scalp blood sampling (FSBS), in conjunction with fetal heart rate monitoring, is a method of fetal surveillance that may avoid cesarean delivery of the healthy fetus or indicate the need for immediate delivery of a compromised fetus. Some researchers have recently begun to question the efficacy of FSBS. In this article, three nurse-midwives discuss FSBS as a tool in assessing fetal well-being during labor and consider whether FSBS is a nurse-midwifery procedure.     

Scholarly productivity: are nurse academics catching up?

The aim of this study was to document the amount of recent change in Australian nurse academics' scholarly productivity and to investigate the influence of demographic factors such as gender, academic rank, qualifications, increase in qualifications, state of residence, university and university size. Scholarly productivity was calculated from an audit of journal articles. The findings of this study indicate that, while there has been a slight increase in scholarly productivity in the last five years, nursing still lags behind other disciplines. Scholarly productivity was found to be positively associated with highest academic qualification, academic rank and promotion. The study indicates the continuing need for senior nurse academics to provide mentoring to colleagues and foster the development of skills associated with scholarly productivity.     

Do frail, disabled, poor, and very old Medicare beneficiaries have higher hospital charges?

To determine whether basing payments on diagnosis related groups (DRGs) results in mispayment for certain classes of patients, we examined the relation between total Medicare charges per hospitalization and eight beneficiary characteristics (including admission from a nursing home, extreme age, Medicaid enrollment, and disability). We controlled for the hospital in which care was given and the DRG to which the discharge was assigned. The largest effects were that average charges were 6.7% higher for beneficiaries who were disabled before the age of 65 years, and 6.2% higher for patients admitted from a nursing home; charges were 1.5% lower for Medicare beneficiaries who were also enrolled in Medicaid, 3.8% higher for those older than 80 years, and 1.3% lower for those older than 85 years compared with those aged from 80 to 84 years. Because these differences are very small compared with the average variation within DRGs, we conclude that using these beneficiary characteristics in the DRG classification system would only slightly improve DRGs. Medicare's DRG-based payments seem to be substantially equitable with regard to these beneficiary characteristics.     

Preconception Care for Improving Perinatal Outcomes: The Time to Act

Maternal and Child Health Journal -     

The relationship of pineal calcification and melatonin secretion to the pathophysiology of tardive dyskinesia and Tourette's syndrome.

Despite current intensive research, the pathophysiology of tardive dyskinesia (TD), a serious neurological side effect of neuroleptic treatment, is poorly understood. Prompted by the observation of an increased incidence and severity of abnormal perioral movements in neuroleptic-treated pinealectomized, as compared to intact rats, we suggested that the pineal gland exerts a protective effect which mitigates against the development of TD and, by inference, that reduced melatonin secretion may be related to the pathophysiology of TD. To investigate this proposition further, we studied the association of TD with pineal calcification (PC) on CT scan in chronic schizophrenic patients. Our findings revealed a significant association between TD and PC and suggest, furthermore, that PC may be a neuroradiological marker of TD. Since PC may reflect diminished secretory activity of the gland, these findings support the hypothesis that the pathophysiology of TD is linked to disturbances of melatonin secretion. The clinical and therapeutic implications of these novel findings are discussed. In the following communication, in which we introduce the hypothesis that disturbances of 5-HT and melatonin secretion are related to the pathophysiology of TD. Subsequently, we present a series of studies which relate to the association of TD with PC. We conclude by presenting the hypothesis that disturbances in melatonin secretion may also be relevant to the pathophysiology of Tourette's syndrome.     

Psychiatric morbidity in Hobart's dependent aged

Psychiatric morbidity in the dependent aged was studied in the elderly population of Hobart's nursing homes and long-stay hospitals. Only patients with home addresses in Hobart and who were admitted for the first time aged 70 years or over were included. Three hundred and twelve persons were interviewed with a standard interview, and an informant was interviewed when appropriate. The medical records were searched for diagnoses and drug treatments. Physical disability was rated on an ad hoc scale. Comparisons were made of the prevalence of dementia, depression and anxiety in different types of unit, and between these and two domiciliary samples, one of which received domiciliary nursing services (n = 100) and the other not (n = 100). The differential use of institutions by men and women, and a possible sex difference in the prevalence of dementia is discussed.     

Ductal adenoma of the breast

Ductal adenoma is a recently described benign tumour of the breast that can be mistaken for carcinoma in both frozen and paraffin sections. Such a case is presented. Fortunately a mastectomy was not performed, but the patient did undergo axillary node dissection. Surgeons and pathologists should familiarize themselves with this lesion so that patients do not have to undergo unnecessary mastectomies and axillary node dissections.     

Cyclophosphamide and etoposide therapy with GM-CSF for VAD-resistant multiple myeloma

Few effective regimens are available for patients with advanced multiple myeloma resistant to or relapsing after both alkylating agents and VAD. We treated 52 patients with advanced and refractory multiple myeloma with the combination of cyclophosphamide (3.0 g/m²) and etoposide (900 mg/m²) followed by GM-CSF at a daily dose of 0.125 mg/m² until recovery of granulocytes. 42% of patients responded with a median time of 19 d for recovery of granulocytes to 0.5 x 10⁹/1 and a 4% mortality rate. Eight responding patients received a second myeloablative treatment supported by either autologous bone marrow (six patients) or blood stem cells (two patients). The median survival time for all patients was 11 months and the median remission time for responding patients was 8 months. The combination of cyclophosphamide and etoposide provided an effective rescue treatment for many patients with advanced multiple myeloma resistant to conventional therapies. This programme also allowed early marrow or blood stem cell collection in support of subsequent myeloablative therapy for selected patients.