Neurotransmission and neuromodulation in the chemosensory carotid body

The mammalian carotid body is a small chemosensory organ that helps maintain the chemical composition of arterial blood via reflex control of ventilation. Thus, in response to decreased PO2 (hypoxia), increased PCO2 (hypercapnia), or decreased pH (acidity), chemoreceptor glomus or type I cells become stimulated and release neuroactive agents that excite apposed sensory terminals of the carotid sinus nerve. The resulting increase in afferent discharge ultimately leads to corrective changes in ventilation so as to maintain blood gas and pH homeostasis. Recent evidence that the organ can also sense low glucose further emphasizes its role as a polymodal sensor of blood-borne stimuli. The chemoreceptors occur in organized cell clusters that receive sensory innervation from petrosal afferents and are intimately associated with the blood supply. Additionally, synaptic specializations between neighboring receptor cells allow for autocrine and paracrine regulation of the sensory output. Though not without controversy, significant progress has been made in elucidating the various chemotransductive pathways, as well as the neurotransmitter and neuromodulatory mechanisms that translate the receptor potential into an afferent sensory discharge. Progress in the latter has been hampered by the presence of a wide variety of endogenous ligands, and an even broader spectrum of receptor subtypes, that apparently help shape the chemoreceptor output and afferent discharge. This review will highlight recent advances in understanding the role of these neuroactive ligands in carotid body function.     

A nocturnal enuresis service for a deprived inner city

Aim: Glasgow is a city where 80% of the most deprived children in Scotland live within 20% of the overall population. Of 168000 children in Glasgow, an estimated 5000 aged 5-15 y have primary nocturnal enuresis. The aim of this study was to establish a nocturnal enuresis service for Glasgow. Methods: Needs assessment was performed and the incident cases were documented at school entry healthcare appraisal, at the age of 5 y. A cohort of these children was followed up at 8 y of age and symptom resolution was no better than natural remission. Parents, general practitioners, clinical medical officers and a hospital paediatrician were interviewed face-to-face about their need for a service. Results: Ten of 11 general practitioners expressed a need for a specialist service. Ten school nurse-led local nocturnal enuresis clinics were established. Accommodation, funding, default and managing alarms were major problems. School nurses enjoyed extra training and quickly became skilled therapists. Two research projects highlighted that most children at first attendance did not believe they could ever be dry, which predicted outcome. Deprived families, once motivated, could successfully undertake complex behavioural therapies. Conclusion: A comprehensive nocturnal enuresis service begins when children stop using night nappies at the age of 3-4 y. Appropriate waterproof mattress, duvet and pillow coverings should be advocated until 5 y, when desmopressin may be helpful. For continued wetting at the age of 7 y, a local service should be led by a team of well-trained nurses using enuretic alarms.     

An evidence-based specialist breast nurse role in practice: a multicentre implementation study

The objective of this study was to examine the feasibility, implementation, acceptability and impact of an evidence-based specialist breast care nurse (SBN) model of care in Australia. Primary data were collected from four diverse Australian breast cancer treatment centres over a 12-month period. The design was a multicentre demonstration project. Information about the provision of care and patient needs was collected through prospective logs. Structured interviews were conducted with women who received the SBN intervention ( N  = 167) and with a control group of women treated prior to the intervention period ( N  = 133). Health professionals ( N  = 47) were interviewed about their experience of the SBN. Almost all women had contact with an SBN at five scheduled consultations and 67% of women in the intervention group requested at least one additional consultation with the SBN. Women in the intervention group were more likely to receive hospital fact sheets and to be told about and participate in clinical trials. Ninety-eight per cent of women reported that the availability of an SBN would affect their choice of hospital, with 48% indicating that they would recommend only a hospital with a SBN available. Health professionals reported that SBNs improved continuity of care, information and support for the women, and resulted in more appropriate referrals and use of the time of other members of the team. In conclusion, the SBN model is feasible and acceptable within diverse Australian treatment centres; there is evidence that some aspects of care were improved by the SBN.     

The great ideas of biology

Four of the great ideas of biology are discussed: the cell as the basic structural and functional unit of life, the gene as the mechanism of heredity, evolution by natural selection, and life as chemistry. A fifth idea is explored whereby biological organisation is explained in terms of logical and informational processes and structures.     

Care of the Obesity Surgery Patient Requiring Immediate-Level Care or Intensive Care

Most bariatric surgery patients are triaged directly to the medical surgical floor postoperatively. However, patients at high risk due to comorbid factors, who have failed postoperative extubation or have suffered intraoperative complication, may require intensive care unit (ICU) or intermediate-level care (IMC). The special needs of the morbidly obese IMC/ICU patient include: triage, mobility, visiting, fluid resuscitation, management of sleep apnea, airway management, transporting for out of ICU procedures, and preventing pressure ulcers. Traditional approaches to nursing care require new thought when dealing with the massively obese. Our experiences with the special needs of these critically ill morbidly obese bariatric surgery patients are described.     

‘Burnout’ and its implications for the continuing education of nurses

The study sets out to review the literature on the topic of ‘burn-out’ in the nursing profession, in order to determine the implications there may be for the provision of continuing professional education for nurses. The literature suggests that burn-out is an increasing problem within the profession, and that it is a progressive disorder resulting from continuous job stress. ‘Burn-out’ involves extreme physical and emotional exhaustion in which the professional loses positive feelings of sympathy and respect for the people for whom they care. Three major areas of job stress have been identified which may contribute to burn-out. These are the demands of the particular job, the organisational factors and the personal characteristics of the individual. Many studies suggest the positive effects of educational programmes to combat the burn-out syndrome. The various intervention programmes concentrate on one or more of the following three main areas: self management, organisational improvements, and the use of support systems. It would appear that nurse education has a great part to play in the prevention of burn-out as all the potential causes discussed could be alleviated by the educational process.