PROFESSIONAL NEGLIGENCE

In the last 5 years there has been an extraordinary increase in negligence actions against South Australian ophthalmologists. This paper considers the reasons, in particular those changes in the interpretation of the law which have made doctors vulnerable. Medical practice needs to be modified if doctors, especially surgeons, are to protect themselves, but the appropriate changes may not be in patients' best interests. The law of negligence is said to be on the brink of collapse and the Australian situation offers an interesting contrast to New Zealand's no-fault accident insurance scheme.     

Transhymenal cultures for sexually transmissible organisms

Vaginal swabs were examined for sexually transmissible organisms in 238 girls seen over a 36 month period from July 1989 to June 1992 inclusive. Three groups were seen (age range 1.5-16.1 years), 165 in group 1 in whom there had been a disclosure of sexual abuse, 35 in group 2 where there was a strong suspicion of sexual abuse, and 38 with vulvovaginitis who formed group 3. The isolation of recognised sexually transmitted organisms was low; however, of group 1 19% were colonised with Gardnerella vaginalis compared with 3% of group 2 and 3% of group 3. These figures show significant differences in the proportion of children in each group isolating only from children over the age of 8 years and in five of the six girls with Candida spp there was concern about sexual abuse. Vulvovaginitis in young children was not associated with vaginal candidiasis. The relation of findings to age is discussed and recommendations are made for testing procedures.     

A unique collaborative network for diabetes education

The DCNH is a unique collaborative venture in outpatient diabetes education. We believe it can serve as a model for rapidly developing standardized diabetes education in geographically dispersed communities. The heart of the organization is the educators' meeting, which enables an extensive sharing of ideas and information that benefit all patients in the region. The features crucial to our success have been (1) administrative leadership with a nursing management or educator background, (2) data collection and analysis, (3) local development of an educational curriculum based on ADA standards, and (4) centralized medical and administrative directors who are available to meet individual program needs. However, we are most indebted to the farsighted and strong commitment of our member hospitals to diabetes care in their communities.     

Tumors of the osseous spine: staging with MR imaging versus CT

Twelve patients with tumors involving the osseous spine were evaluated with magnetic resonance (MR) imaging and computed tomography (CT), six with and six without intrathecal injection of contrast material. MR imaging was found to be superior to CT without contrast material and equal to CT with contrast material in delineating the anatomic relationships of the tumors, including bone involvement, spinal canal invasion, paraspinal soft-tissue extension, and vascular involvement. Since MR imaging can provide most of the anatomic information necessary for treatment planning, intrathecal injection of contrast material can be avoided in most instances when evaluating tumor involvement of the osseous spine. However, CT without contrast medium was superior to MR imaging in showing critical cortical bone destruction and calcified tumor matrix.     

Evaluation of central nervous conduction by visual evoked potentials in insulin-dependent diabetic children. metabolic and clinical correlations

Summary Peripheral neuropathy is a well-known complication of diabetes, but few data are available on central lesions. Visual evoked potentials (VEPs) seem a reliable and feasible technique for detecting a conduction delay in the central nervous, system. Seventy-one insulin-dependent type 1 diabetic children (mean age 15±3 years) and 33 controls were investigated for central neuropathy. We used a pattern of reversal stimulation with television display of a checker board pattern (15 min and 30 min check size). The latencies of the positive peak (P100 wave) were significantly lengthened in 17 patients (27%) but no correlation was found between VEPs and age, duration of diabetes, insulin requirement and HbA₁ level. A negative correlation was found between VEPs and peripheral nervous conduction velocity. VEPs measurement seems a simple and reliable technique for detecting early alterations in CNS function in diabetics. Our data suggest that central and peripheral nervous alterations progress simultaneously.     

The effects of nursing education on job effectiveness: An overview of the literature

An overview of the published studies on the effectiveness of a nursing education as it relates to job performance is presented. Selected literature is reviewed and divided into three areas of study: competency, performance, and quality of care. The literature revealed contradictory evidence on the value of baccalaureate nursing education. More important, the review demonstrates a lack of rigorous research in this area. Suggested research directions include the measurement of individual performance rather than the perception of group performance, the development of better instruments, and control of the setting and individual variables that affect job performance. It is recommended that nursing effectiveness be defined in terms of both patient outcomes and nurse performance.