A comparison of screening times between the ThinPrep imager and conventional cytology

This small prospective study compared the time cytologists spend reviewing cervical cytology slides processed by the ThinPrep Imager (TPI) with screening times for conventional cytology slides (CS), to determine the effect, if any, of the TPI on productivity in our department. Some possible factors affecting TPI reading times, such as individual screener's experience with both specimen types, were also studied. We recorded the time taken to screen approximately 2,140 corresponding CS and TPI slides. The CS slides were screened by 22 cytologists, of whom 14 also read the TPI slides. The time taken to screen the slides at the conventional or review microscope was recorded, including any full reviews. Administrative duties including history checks and result entry were not included. Overall, the mean CS reading time was 5.6 minutes, (or 10.7 slides/hour) while the mean screening time for TPI was 2.9 minutes (20.6 slides/hour), a productivity increase of 92%. For the 14 cytologists who read both types of specimen, individual productivity increases ranged from 38.9 to 252%. Screener experience had little or no effect on TPI times, but slower CS readers were found to have greater increase in speed and productivity when using the TPI. This study has demonstrated a significant decrease in screening times for TPI when compared with CS (P = 0.001), resulting in significantly increased productivity (P = 0.001). Diagn. Cytopathol. 2009. © 2009 Wiley‐Liss, Inc.     

Transmural Mapping of Myocardial Refractoriness and Endocardial Dispersion of Repolarization in an Ovine Model of Chronic Myocardial Infarction

Background: Myocardial refractoriness and repolarization is an important electrophysiological property that, when altered, increases the risk of arrhythmogenesis. These electrophysiological changes associated with chronic myocardial infarction (MI) have not been studied in detail. We assessed the influence of left ventricular (LV) scarring on local refractoriness, repolarization, and electrogram characteristics. Methods: MI was induced in five sheep by percutaneous left anterior descending artery occlusion for 3 hours. Mapping was performed at 19 ± 6 weeks post‐MI. A total of 20 quadripolar transmural needles were deployed at thoracotomy in the LV within and surrounding scar. Bipolar pacing was performed from each needle to assess the effective refractory period (ERP) of the subendocardium and subepicardium. The activation (AT) and repolarization (RT) times, and modified activation recovery interval (ARI_m) were determined from endocardial unipolar electrograms recorded in sinus rhythm simultaneously from all needles. Scarring was quantified histologically and compared with electrophysiological characteristics. Results: Increased scarring corresponded with increased ERP (P < 0.01), decreased subendocardial electrogram amplitude (P < 0.001), and slope (P < 0.001). ERP did not differ between endocardium and epicardium (P > 0.05). The ARI_m and RT were prolonged during early myocardial activation (P < 0.001). After adjusting for AT, the RT and ARI_m were prolonged in areas of scarring (P < 0.001). After adjusting for electrogram amplitude, the ARI_m was prolonged in dense scar (P < 0.05). Conclusions: We confirmed histologically that scarring contributes to prolongation of repolarization, increased refractoriness, and reductions in conduction and voltage post‐MI. Prolongation of repolarization may be further augmented when local activation is earliest or electrogram voltage is decreased within scar.     

Lack of Whole-body Pharmacokinetic Differences of Halothane Enantiomers in the Rat

Background: Halothane is made and used as a racemate (an equimolar mixture of R- and S- enantiomers). This study was initiated to determine whether there were demonstrable enantiomeric differences in the whole-body pharmacokinetics of halothane that might have significance for studies in which racemate is used.

Methods: Adult male Wistar rats were exposed to halothane vaporized in the atmosphere of a closed constant volume chamber supplied with O2 commensurate with CO2 production. Concentrations of halothane enantiomers were measured by a specific gas chromatography-mass spectrometry method. Experiments were performed at four initial concentrations of halothane (0.1%, 0.5%, 1.0%, and 1.5% vol/vol). Enantiomeric differences in whole-body pharmacokinetics were assessed indirectly from the relative chamber atmosphere concentrations of halothane enantiomers.

Results: Concentrations of halothane decreased biphasically. The initial more rapid decrease was interpreted as incorporating absorption, distribution, and clearance; the slower decrease was interpreted as principally incorporating metabolic clearance. The ratio of concentrations of the two halothane enantiomers and of the ratios of the respective areas under the concentration-time curves remained constant without differing from unity at any time at any concentration of halothane. The dose-normalized areas under the concentration-time curves for the concentrations 0.1%, 0.5%, and 1.0% did not differ; that for 1.5% was significantly greater, suggesting nonlinear clearance, but the values did not differ significantly between enantiomers at any concentration.     

The Modified McBride Procedure: Clinical, Radiological, and Pedobarographic Evaluations

Nineteen patients (27 feet) with symptomatic hallux valgus who underwent modified McBride procedure were studied prospectively. The outcome measures included preoperative and postoperative American Orthopaedic Foot and Ankle Society's Hallux Metatarsophalangeal-Interphalangeal scoring, weight-bearing radiographs, and pedobarography using the EMED-SF*6 System. The average patient age was 49.7 years, and all patients were women. The average follow-up was 7 months. Results showed an average improvement in rating scale score from 53 to 87/100, in the hallux valgus angle from 32 degrees to 15 degrees, and in the first intermetatarsal angle from 15 degrees to 10 degrees. Pedobarographic analysis showed a statistically significant increase in the contact area of the hallux by 17.5% (P<.001), with a reduction of peak pressures of the hallux by 29% from 67.5+/-29.5 N/cm2 to 48+/-34 N/cm2 (P<.001; confidence interval, 9.887, 29.233) and the total foot by 8% from 89+/-26 N/cm2 to 82+/-25 N/cm2 (P<.05; CI, 0.727, 14.900). The overall satisfaction rate was 96%. We conclude that the modified McBride procedure has a role in patients with passively correctable hallux valgus and a supple metatarsocuneiform joint.     

The power of the word: some post-structural considerations of qualitative approaches in nursing research

This paper takes a post-structural position to discuss some issues related to the use of qualitative research methodologies in nursing research. Two fundamental assumptions which underpin qualitative approaches are explored in relation to how subjectivity is constructed in the process of data collection. These assumptions reveal an ideological position which proposes that reality can be apprehended by capturing the individual's point of view (subjectivity) and that qualitative researchers can directly represent this lived experience in language (linguistic representation). Post-structural approaches challenge these assumptions which are often an uncritically accepted part of the common sense world and therefore taken to be natural. It proposes that these views of subjectivity and language are not natural but rather cultural. There is a recognition of the wider sociopolitical and historical context in which nursing research takes place and a displacement of normative constructions of subjectivity. It provides nursing with the possibility of challenging existing power structures which determine the individual's experiences of health and illness.