Fibrosing alveolitis: CT-pathologic correlation

Computed tomography (CT) was performed within 10 days of open lung biopsy in nine patients with fibrosing alveolitis. One-centimeter collimation contiguous scans through the chest were obtained in all patients. Additional 1.5-mm collimation scans were obtained in the area in which lung biopsy was later performed in six patients. In seven patients, CT demonstrated patchy involvement of the lung parenchyma, areas with a reticular pattern being intermingled with areas of normal lung. The reticular pattern was associated with cystic spaces 2-4 mm in diameter and was more severe in the lung periphery. Histologically, the reticular pattern corresponded to areas of irregular fibrosis. One patient had diffuse honeycombing (2-20-mm cysts), and one had honeycombing only in the lung periphery. In all patients, CT clearly defined the architectural changes seen on open lung biopsy. These changes were much better seen on the 1.5-mm than on the 10-mm collimation scans. CT may be helpful in determining the pattern and distribution of lung involvement in patients with fibrosing alveolitis and in guiding the surgeon to the most appropriate area(s) for biopsy.     

The changing academic role of the nurse teacher in the United Kingdom

This paper presents findings from a national study conducted over a 3-year period (1991–94) which examined the changing role of the nurse teacher The study used multiple methods to collect data from a wide variety of respondents (nurse teachers, midwife teachers, clinical nurses, health service managers and higher education lecturers) This paper presents the findings relating to the development of the nurse teacher's academic role following the introduction of Project 2000 The issues presented and discussed include specialization within the nurse teacher's role, the nature of this specialization and the development of academic credibility and scholarship The implications of these changes in terms of the development of nursing as an academic subject area and the opportunity to contribute to the establishment of research based practice are explored     

A pilot scheme for an integrated falls prevention service

The National Service Framework for the Older Person (Department of Health 2001) set standards for reducing the number of falls and serious injury. One way this might be achieved is through provision of a Specialist Falls Service. This paper describes a 3 year pilot project to introduce an Integrated Falls Service using money obtained from the local Health Authority Health Improvement fund.The article describes a partnership approach with the local council, therapy services and other agencies. The target group and referral mechanisms are discussed and costings given. A variety of interventions will be employed to include assessment and targeted exercises with education sessions. Hip protectors are available for high risk patients. Several indices will be used to evaluate this pilot scheme including balance measurements, confidence scales, supported interviews and diaries. Final evaluation will be in March 2004.     

Interpersonal mental health nursing: research issues and challenges

Since Peplau outlined her perceptions of psychiatric/mental health nursing in (1952) interpersonal relationships has been considered by many as the core of practice. In the intervening period of almost a half century many researchers and theorists have endeavoured to develop and integrate Peplau's framework into day-to-day nursing activity. However, more recently, as a result of the fusion between the professional nursing agenda and the wider political agenda, the importance of interpersonal relationships and the individuality of psychiatric/mental health nursing is being questioned. This questioning is represented in the debate about the aetiology of mental illness, the choice of research methods to determine treatment outcomes and by association the role and value of the psychiatric/mental health nurse. This paper will focus on the interpersonal nature of psychiatric/mental health nursing and explore possible research approaches aimed at explicating its core. Attention will be given to the necessity of using pluralistic methodology in order to do so.     

Time course and calcium dependence of sustained bronchoconstriction induced by deep inhalation in asthma.

We studied six asthmatic patients who showed a progressive decrease in FEV1 when successive forced expiratory maneuvers were performed at 1-min intervals. We determined the time course of changes in specific airway conductance following a single deep inhalation (DI) and the ratio of maximum expiratory flow at 40% of FVC from maximal and partial flow-volume curves (MEF40M/P) during a series of forced expiratory maneuvers. Specific airway conductance measured 3 s after DI was increased by 11 +/- 6 (SE)%, which was not significantly different from an increase of 23 +/- 8% observed in six healthy control subjects. Later (i.e., 10 to 40 s after DI) specific airway conductance was significantly less than the pre-DI value in asthmatic but not in healthy subjects. Mean FEV1 decreased significantly by 28% from the first to the eighth forced expiratory maneuver performed during a period of 15 min, whereas MEF40M/P was not significantly changed and remained always significantly greater than 1. The voltage-dependent calcium channel antagonist nifedipine significantly prevented the reduction of FEV1 without affecting MEF40M/P. We conclude that, in some asthmatic individuals, DI may induce a transient bronchodilatation followed by a calcium-dependent sustained bronchoconstriction. We suggest that the initial bronchodilatation is due to the mechanical interdependence between airways and lung parenchyma, whereas the sustained bronchoconstriction is due to contraction of the airway smooth muscle.     

Competency-based learning applied to nursing management

The ability to manage change has become an essential skill for all managers, particularly those employed within the Health and Social Services. It is recognized that managers may have received an introduction to management concepts and skills within their professional education but require more specific management development. The government approach to adult education with an increased emphasis on vocational training as opposed to professional education (Hyland 1991) has had an important impact upon the theory and practice of nurse management. Nurses are now required to demonstrate, not only the appropriate knowledge and theory of management, but also the competencies necessary to fulfil their role. This is becoming an important dimension of management development programmes. This paper discusses aspects of competency based learning and considers how these concepts are applied to a higher education nurse management programme on 'Managing Change'. The difficulties experienced in applying vocational standards to professional education within the culture of a higher education will be explored, difficulties identified and some alternatives offered.     

Linguistic entrapment: medico-nursing biographies as fictions

This paper argues that in their trainings health professionals are encouraged to use language naively as if it were a transparent medium of scientific communication We contend that language use, particularly in the field of mental health care, should be studied in terms of its social functions and attention should be paid to the inevitably constructive nature of language in patients'records, in order that a'fictional distance'opens up between patients and their records Recent developments in literary theory and narrative analysis can be deployed as theoretical frameworks to understand this process, and we suggest that more attention to the use of language should be included in the educational programmes for health care professionals to counteract the risk of'linguistic entrapment'or'incarceration'