Lower urinary tract reconstruction in patients with bladder exstrophy after failed primary treatment in early childhood

The results of neonatal surgery for bladder exstrophy are not very satisfactory. A significant percentage of patients present in later childhood or adolescence for correction of their residual deformities. We have reconstructed 26 patients, correcting their entire urogenital and cosmetic deformity in a one-stage procedure. The results show that one-stage total reconstruction is possible and is preferable to serial correction of the various individual abnormalities. The principles of surgical reoperation in adolescence are the same as those now established for the primary correction in neonatal life.     

A double-blind clinical trial to compare the efficacy of an active based cream F14001 against a placebo non-active based cream for the treatment of pressure ulcers in a population of elderly subjects

A double-blind clinical trial was conducted to compare the efficacy of an active based cream against a placebo non-active based cream in the healing of superficial pressure ulcers in a population of geriatric hospital patients and residents in community nursing homes. The active group showed a small significant beneficial effect at week four. The overall results of the trial also demonstrated a significant improvement in ulcer size over the duration of the trial period in both active and placebo groups.     

Attention-Deficit/Hyperactivity Disorder: A Neurodevelopmental Approach

TOPIC. Attention-deficitlhyperactivity disorder is frequently overdiagnosed when a complete evaluation by a knowledgeable clinician is not undertaken. Because of the recent negative media campaign regarding psychos t im ulan t medication, it becomes more imperative that a thorough and accurate evaluation be completed before starting children and adolescents on psychostimulant medications.
PURPOSE. To describe the neurodevelopmental perspective in the assessment and treatment of ADHD.
SOURCES. Published literature and clinical experience.
CONCLUSION. It is useful in practice to conceptualize the dmelopmental path of children with ADHD not as disordered but as delayed, and to build on each child's strengths. The neurodmeloprnental approach provides the child psychiatric nurse a child-focused framework for assessment and development of individualized interventions.     

Prevalence of auditory hallucinations in nurses in mental health

Seventy-nine nurses and student nurses working in the mental health field were asked to complete a questionnaire that asked about the prevalence of their experience of events that might be considered as examples of auditory hallucinations. Eighty-four per cent of the 55 nurses who returned the questionnaire described having experiences that might be described as auditory hallucinations. This level of prevalence is broadly consistent with other studies, and the difference between voices considered to indicate 'schizophrenia' and voices perceived as normal or unimportant is discussed. The relevance of these findings for the process of diagnosis and for the attitudes of nurses working in the mental health field towards voices reported by clients is highlighted.     

Guidelines for clinical nurse specialist education

A recent survey of clinical nurse specialist (CNS) programs found significant differences among the programs in the number of classroom and clinical hours required and some variation in curricular content. To address these differences, the National Association of Clinical Nurse Specialists (NACNS) developed Guidelines for Clinical Nurse Specialist Education and charged the Education Committee of NACNS with testing and refining them. This article describes the methods used by the Education Committee to test and refine the Guidelines and presents the finalized document. The 18 Guidelines provide quality indicators for CNS programs in the areas of organization and faculty, program admissions, curriculum, clinical resources and experiences, and program evaluation. NACNS recommends that these Guidelines be used in addition to accreditation standards to evaluate CNS programs and to guide development of new CNS programs.     

Methanol poisoning: a review and case study of four patients from Central Australia

Methanol intoxication, a rare and potentially lethal form of poisoning, usually results from ingestion and occasionally inhalation of methanol. Initial symptoms of blurred vision, elongated anion gap and metabolic acidosis are typically delayed and may not at first be recognised as methanol-related complaints. Once diagnosed, treatment must be prompt and definitive. As well as general supportive care, ethanol infusion, dialysis and alkalinization form the mainstays of treatment.

The cases described in this paper are compared to previous reports from other countries worldwide and contrast the variance in outcome often seen in methanol poisoning. The paper describes two tragic deaths and two lucky survivors, all of whom had consumed a cocktail of methanol and other alcoholic beverages at the same party.

The ICU nurse's role in managing the methanol-intoxicated patient relies on that person's sound knowledge of the unusual biochemical reactions occurring in the body and the need to institute definitive and supportive measures to help both patient and family recover.     

Nurses need to become better patient educators

Education is an important and necessary part of patient care. To achieve this nurses need to develop patient teaching as a major part of their role. There is little evidence that nurses are doing this effectively at present. Many obstacles seem to interfere with this practice but all of them seem to originate from inadequate preparation.This paper looks at the nurse's role as a patient educator, at its effectiveness now, and at the current obstacles. It suggests that urgent curriculum review is necessary so that this important area does not continue to be neglected.