An examination of the last 10 years of mental health nursing

This article offers an examination of the mental health nursing articles published in the British Journal of Nursing during the last 10 years, and a commentary on how these reflect developments within this specialism. It identifies a number of clinical and professional issues, which have emerged over the last decade, including: community care; concerns over the quality of acute inpatient services; clinical supervision; and the integration of schools of nursing into higher education. Finally, the article identifies some clinical areas which it suggests warrant attention in the next decade such as child and adolescent mental health and mental health care for older people.     

Pfiesteria complex organisms and human illness

BACKGROUND: Pfiesteria piscicida and look-alike dinoflagellates are collectively known as Pfiesteria complex organisms (PCOs). The purposes of this paper are to evaluate the threat that PCOs pose to human health and to clarify some common misconceptions concerning these organisms. METHODS: References about P piscicida and PCOs were identified and reviewed using MEDLINE, Sea Grant databases, and other sources obtained from various Internet sites. RESULTS: Researchers exposed to aerosols of water containing P piscicida in a laboratory setting exhibited a variety of symptoms, including reversible cognitive impairment and loss of short-term memory. This led to multiple biologic, animal model, and epidemiologic studies that are reviewed and discussed. CONCLUSIONS: Exposure to P piscicida and possibly other PCOs can cause human illness. Until further isolation and purification of toxins from PCOs allows for development of tests to detect these toxins, predicting and documenting toxic PCO fish kills as well as potential PCO-related illness will be difficult.     

Oral bovine colostrum supplementation enhances buffer capacity but not rowing performance in elite female rowers

A randomized, double-blind, placebo controlled design was used in which 13 elite female rowers, all of whom had competed at World Championships, were supplemented with 60 g day-1 of either bovine colostrum (BC; n = 6) or concentrated whey protein powder (WP; n = 7) during 9 weeks of pre-competition training. All subjects undertook the study as a group and completed the same training program. Prior to, and after 9 weeks of supplementation and training, subjects completed an incremental rowing test (ROW1) on a rowing ergometer consisting of 3 3 4-min submaximal workloads and a 4-min maximal effort (4 max), each separated by a 1-min recovery period. The rowing test was repeated after a 15-min period of passive recovery (ROW2). The 4 max for ROW1 provided a measure of performance, and the difference between the 4 max efforts of ROW1 and ROW2 provided an index of recovery. Blood lactate concentrations and pH measured prior to exercise and at the end of each workload were used to estimate blood buffer capacity (beta). Food intake was recorded daily for dietary analysis. There were no differences in macronutrient intakes (p >.56) or training volumes (p >.99) between BC and WP during the study period. Rowing performance (distance rowed and work done) during 4 max of ROW2 was less than ROW1 at baseline (p <.05) but not different between groups (p >.05). Performance increased in both rows by Week 9 (p <.001), with no difference between groups (p >.75). However, the increase was greatest in ROW2 (p <.05), such that by Week 9 there was no longer a difference in performance between the two rows in either group (p >.05). b was not different between groups for ROW1 at baseline (BC 38.3 5.0, WP 38.2 7.2 slykes; p >.05) but was higher in BC by Week 9 (BC 40.8 5.9, WP 33.4 5.3 slykes; p <.05). b for ROW2 followed the same pattern of change as for ROW1. We conclude that supplementation with BC improves b, but not performance, in elite female rowers. It was not possible to determine whether b had any effect on recovery.     

The frequency and distribution of thiopurine methyltransferase alleles in Caucasian and Asian populations

Thiopurine methyltransferase metabolizes 6-mercaptopurine, thioguanine and azathioprine, thereby regulating cytotoxicity and clinical response to these thiopurine drugs. In healthy Caucasian populations, 89-94% of individuals have high thiopurine methyltransferase activity, 6-11% intermediate and 0.3% low, resulting from genetic polymorphism. Four variant thiopurine methyltransferase alleles were detected in over 80% of individuals with low or intermediate thiopurine methyltransferase activity. The wild-type allele is defined as TPMT*1 and the mutant alleles are TPMT*2 (G238C), TPMT*3A (G460A and A719G), TPMT*3B (G460A) and TPMT*3B (A719G). The frequency of these alleles in different ethnic groups is not well defined. In this study, DNA from 199 British Caucasian, 99 British South West Asian and 192 Chinese individuals was analysed for the presence of these variant alleles using polymerase chain reaction-restriction fragment length polymorphism and allele-specific polymerase chain reaction based assays. The frequency of individuals with a variant thiopurine methyltransferase genotype was: Caucasians 10.1% (20/199), South West Asians 2.0% (2/99) and Chinese 4.7% (9/192). Two TPMT*2 heterozygotes were identified in the Caucasian population, but this allele was not found in the two Asian populations. TPMT*3A was the only mutant allele found in the South West Asians (two heterozygotes). This was also the most common mutant allele in the Caucasians (16 heterozygotes and one homozygote) but was not found in the Chinese. All mutant alleles identified in the Chinese population were TPMT*3C (nine heterozygotes). This allele was found at a low frequency in the Caucasians (one heterozygote). This suggests that A719G is the oldest mutation, with G460A being acquired later to form the TPMT*3A allele in the Caucasian and South West Asian populations. TPMT*2 appears to be a more recent allele, which has only been detected in Caucasians to date. These ethnic differences may be important in the clinical use of thiopurine drugs.     

Clinical efficacy of metformin against insulin resistance parameters: sinking the iceberg

It has been increasingly recognised in recent years that type 2 (non-insulin-dependent) diabetes is part of a cluster of cardiovascular risk factors known as the metabolic syndrome, but also endorsed with such names as the deadly quartet, syndrome X and the insulin resistance syndrome. Atherosclerosis is the most common complication of type 2 diabetes among Europeans, and coronary artery, cerebrovascular and peripheral vascular disease are 2 to 5 times more common in people with this condition than in those without diabetes. These observations indicate that the treatment of type 2 diabetes requires agents that do more than simply lower blood glucose levels, and a therapy with both antihyperglycaemic effects and beneficial effects on dyslipidaemia, hypertension, obesity, hyperinsulinaemia and insulin resistance is likely to be most useful. In this respect, metformin has an important and established role: this drug has been shown to lower blood glucose and triglyceride levels, and to assist with weight reduction and to reduce hyperinsulinaemia and insulin resistance. Studies in the Israeli sand rat, Psammomys obesus, have indicated hyperinsulinaemia/insulin resistance to be the initial and underlying metabolic disorder in obesity and type 2 diabetes. Thus, the well established effect of metformin in reducing insulin resistance makes this drug an excellent candidate for the prevention of progression of impaired glucose tolerance to type 2 diabetes, and for the reduction of mortality associated with cardiovascular disease.     

Double blind placebo controlled trial of nebulised budesonide for croup

AIMS: To determine whether nebulised budesonide improves the symptoms or shortens the duration of stay of children admitted to hospital with a clinical diagnosis of croup. METHODS: A prospective, randomised, double blind placebo controlled trial. Patients received either nebulised budesonide or placebo every 12 hours. The main outcome measures were duration of inpatient stay and croup scores at 30 minutes, one, two, four, 12, and 24 hours. RESULTS: 87 patients (89 admissions) aged 7-116 months entered the trial. Nebulised budesonide was associated with a significant improvement in symptoms at 12 hours (95% confidence interval (CI) 1 to 3) and 24 hours (95% CI 0 to 3). Patients with an initial croup score above 3 demonstrated a significant improvement in symptoms at two hours (95% CI 1 to 3). Nebulised budesonide was also associated with a 33% reduction in the length of stay (95% CI 2% to 63%) when the confounding variables of age, initial croup score, and coryzal symptoms were taken into consideration. CONCLUSIONS: Nebulised budesonide is an effective treatment for children admitted to hospital with a clinical diagnosis of croup.     

Clinical effectiveness on an acute in-patient psychiatric unit

The paper outlines a model for addressing clinical effectiveness, and an illustration of how this is practically implemented through team working in a multidisciplinary in-patient environment. This is particularly relevant given the number of recent reports that highlight the need to develop and invest in the in-patient services. The difficulty in implementing evidence-based practice for mental health interventions is also addressed and initiatives being developed to enable a realistic approach in such an environment are described. The paper describes a structure and a process, using examples from audit, research and other initiatives particular to the unit, in providing accessible evidence based interventions for ward based staff, and improved clinical effectiveness generally.