Evaluation of a course for charge nurses on caring for people with dementia

The provision by nurses of appropriate levels of care for people with dementia is considered to be adversely affected by the inadequate provision of post basic education. This paper reports on a study that seeks to evaluate the effectiveness of a brief educational programme for charge nurses caring for people with dementia. In addition it focuses on behavioural change resulting from the course, for example, the degree of involvement of relatives in the care of their family member. The course is seen as a model for short courses for nurses working in this area. Qualitative methodology was utilized involving questionnaires and focused group interviews. The evaluation of the course incorporated pre- and post-test design. The study identified factors that enhanced the charge nurses' educational experience. These factors included a course design incorporating andragogical teaching methods and the implementation of an action plan. The study also highlighted problems experienced by charge nurses in implementing an action plan. The action plan demonstrated that the type of involvement of relatives is more complex than presupposed and depended on such factors as the fear experienced by the relative of being left with the responsibility to care for their family member should they offer to contribute to their care in hospital. Recommendations for the design of future courses are made.     

The use of qualitative methods in the study of parents' experiences of care on a children's surgical ward

User satisfaction with the care of hospitalized children is examined in this paper It is argued that parents are proxy consumers but that their status is conditional on the way in which they exercize choices Parents' involvement in the care of their children means that the term 'user' is more appropriate than 'consumer' Methodological problems in the assessment of user satisfaction are discussed A study of the experiences of parents of 24 children discharged from a surgical ward of a children's hospital is described and the implications for the assessment of user satisfaction reviewed The study demonstrates that qualitative methods have value in the assessment of user satisfaction with care A particular strength of qualitative methods of inquiry is that limitations of users' choice in care can be assessed     

The knowledge base of health visitors and district nurses regarding products in the proposed formulary for nurse prescription

The background to the legalization of nurse prescribing is reviewed and a small questionnaire survey of health visitors and district nurses described Significantly more district nurses than health visitors wanted to become nurse prescribers Health visitor knowledge of some parasiticidal lotions and antifungal agents was found to be variable and the recommended dose of paracetamol for post-immunization pyrexia was recognized by less than two-thirds of the sample District nurse knowledge of lactulose was limited in comparison to their knowledge of alginate and hydrocolloid dressings, however, their knowledge of factors other than dressing type which enhance or delay healing was variable The mean knowledge scores of both the health visitors and district nurses were unacceptably low for prescribing purposes The majority of the total sample stated that they would like further training, with a preference for such provision in the form of study days     

Mental health nursing in the 1950s and 1960s revisited

From the post-War period to the 1960s, immense changes took place in the philosophy, organization and delivery of mental health care in the UK. These changes were driven by the financial burden that Bevan's National Health Service imposed on the British Government, by the dynamism and vision of psychiatrists and mental health nurses returning from the War, and by a new social and cultural consciousness, which put minority groups such as the mentally ill onto the political agenda. This paper seeks to explore some of these complex interactions and to show how the closure of mental hospitals was the inevitable outcome of movements both inside psychiatry and far beyond it. An awareness of the historical context of mental health care can assist planners and providers to avoid the many pitfalls that have been made by our predecessors.     

Retrospective geometric correlation of MR, CT, and PET images

Magnetic resonance imaging, computed tomographic, and positron emission tomographic studies of the brain provide complementary information, and many patients undergo more than one of these studies during the course of their diagnostic workup and treatment. A new technique for quantitative geometric correlation of such studies makes it possible to create integrated multimodality images by mapping features from one image onto an image obtained with another modality. The coordinate transformation between any pair of images is found by a semiautomatic algorithm for matching models of the patient's external surface as depicted in the two data sets. The resultant hybrid images, which combine complementary features of different studies, are often more useful for diagnosis and treatment planning than are the original single-modality images. The algorithm can also be used for spatial registration of baseline studies with follow-up images created with the same modality, which allows tracking of a lesion to detect subtle interval changes in size and shape. This technique can be applied to images acquired in routine clinical practice, since it is completely retrospective and does not necessitate special positioning or landmarking of the patient.     

Adult-onset genetic disease: mechanisms, analysis and prediction

Recombinant DNA technology has made possible the localization and isolation of disease-related genes, the tracking of disease-related alleles through family pedigrees, the direct detection of the pathological lesion itself and the in vitro expression of both normal and mutant genetic information at the mRNA and protein levels. Undoubtedly the most immediate practical spin-off from recombinant DNA technology in medical genetics has been in the sphere of improved disease diagnosis and prediction, where advances have been dramatic. We review the nature of inherited disease, current approaches to its analysis, diagnosis and prediction, mechanisms of gene mutation and the available techniques for mutation detection. Also examined are the various genetic factors that can alter the relationship between genotype and clinical phenotype. Finally, the genetics of selected adult-onset disorders are explored in the context of considering the accuracy and reliability of disease prediction.      

Pulmonary lymphangitic carcinomatosis: CT and pathologic findings

The authors retrospectively reviewed the computed tomographic (CT) scans, biopsy specimens, autopsy results, and lobectomy specimens of 21 patients who had lymphangitic carcinomatosis. Ten-millimeter collimation CT scans were obtained from all patients, and selected 1.5-mm CT scans were obtained from ten patients. In five patients, the diagnosis was established with open lung biopsy, lobectomy, or autopsy; in nine, with bronchial biopsy or transbronchial biopsy; and in seven, with clinical and radiologic criteria. Certain characteristic findings on CT scans were evident: uneven thickening of bronchovascular bundles, thickening of isolated interstitial lines, and the presence of polygonal lines. These findings may be seen on CT scans even if the findings on chest radiographs are normal or nonspecific. The pathologic basis for these characteristic CT findings may relate to tumor thrombi in lymphatic vessels rather than edema and fibrosis, at least in the early stages of disease.     

Musculoskeletal tumors: improved depiction with linear combinations of MR images

With postprocessing, the authors produced a single hybrid image that combines the complementary information in conventional T1- and T2-weighted magnetic resonance (MR) images. A 1-T MR imager was used to produce T1- and T2-weighted images (repetition time, msec/echo time, msec: 500/30, 1,500/120) of patients with various primary bone tumors. Various weighted sums and differences of these images were then formed. Weighted subtraction allowed formation of hybrid images with high contrast between tumor and all adjacent normal tissues (muscle, fat, bone marrow), unlike the original T1- and T2-weighted images. Certain weighted sums of the acquired images simultaneously display the high signal-to-noise and clear anatomic detail of the T1-weighted technique along with the high contrast between extraosseous tumor and muscle of the T2-weighted image. A single hybrid MR image can contain useful characteristics both of T1- and T2-weighted images, making it easier for one to detect the extent of an abnormality.