A method for foetal heart rate monitoring during magnetic resonance imaging using Doppler ultrasound

A means of monitoring foetal heart rate (FHR) during magnetic resonance imaging (MRI) is presented. Foetal heart rate was measured using a modified standard Doppler ultrasound based monitor. The transducer and lead from the monitor required alteration to reduce interference and distortion in the MR images to acceptable levels. These changes enabled high quality images to be produced with insignificant additional noise and distortion when the foetal heart rate was recorded simultaneously.     

Non-A, non-B hepatitis associated with blood transfusion

Posttransfusion hepatitis of the non-A, non-B variety continues to be a significant problem in current hemotherapy. This disorder is many times more common than transfusion-associated disease caused by hepatitis B virus, cytomegalovirus, and Epstein-Barr virus, and also seems to be viral in origin. Several potential etiological agents have been implicated, but none has been identified with certainty, despite concerted efforts at doing so. Clinical disease is usually attended by few symptoms and signs, but evolution to chronic liver disease is distressingly common; over 50 percent of all cases of non-A, non-B posttransfusion hepatitis manifest this transition. Efforts at prevention of non-A, non-B hepatitis associated with blood transfusion have thus far been hampered by the lack of reliable laboratory markers for carriers of this disease, and controversy exists over the implementation of screening tests on blood donors, using such nonspecific indicators of possible viral carriage as serum alanine aminotransferase levels. It is probable, however, that simple measures such as more restrained blood usage, encouraged by greater educational efforts within the medical community, could be beneficial in minimizing the number of new cases of non-A, non-B posttransfusion hepatitis seen each year in the United States.     

Nurses' attitudes, behaviours and perceived barriers towards pressure ulcer prevention

Background. Pressure ulcers are not a plague of modern man; they have been known to exist since ancient Egyptian times. However, despite the increasing expenditure on pressure ulcer prevention, pressure ulcers remain a major health care problem. Although nurses do not have the sole responsibility for pressure ulcer prevention, nurses have a unique opportunity to have a significant impact on this problem. Aims and objectives. The specific aims of the study were to identify: ? Staff nurses’ attitudes towards pressure ulcer prevention. ? The behaviour of staff nurses’ in relation to pressure ulcer prevention. ? Staff nurses’ perceived barriers towards pressure ulcer prevention. Design. A cross‐sectional survey method was used. Methods. A randomly selected sample of staff nurses (n = 300) working in an acute care setting in an urban location was invited to participate. Data were collected using a prepiloted questionnaire. Data analysis was carried out using SPSS version 10 and SPSS Text Smart version 1.1. Results. The nurses surveyed demonstrated a positive attitude towards pressure ulcer prevention. However, prevention practices were demonstrated to be haphazard and erratic and were negatively affected by lack of time and staff. These barriers prevented the nurses’ positive attitude from being reflected into effective clinical practice. Education, although poorly accessed, or made available, was rarely cited as impeding practice in this area. Conclusion. This study suggests that positive attitudes are not enough to ensure that practice change takes place, reinforcing the complex nature of behavioural change. Implementation strategies should introduce ways in which key staff can be empowered to overcome barriers to change. Relevance to clinical practice. This study provides a unique exploration of Irish nurses’ attitudes, behaviours and perceived barriers towards pressure ulcer prevention, thereby contributing to the body of knowledge on this subject. As tissue viability is a new and emerging speciality, this information will contribute to evidence based practice in this area of patient care and will form the basis for the development of an educational strategy for pressure ulcer prevention and management.     

Hemispheric alpha asymmetries of aphasic and normal subjects: Results from recognition and recall tasks using visually presented words of high and low imagery

Abstract

Hemispheric alpha asymmetries of normal males, normal females, and male aphasics were observed from anterior and posterior placement sites for recall and recognition of visually presented high and low imagery words, and during resting conditions. No significant differences were observed during the resting conditions between groups. However, during visual presentation of words the aphasics demonstrated significantly less alpha in the right hemisphere, while no differences were observed for the normal subjects. Both fluent and non-fluent aphasics demonstrated right hemisphere alpha suppression across stimulus and task conditions. The non-fluent aphasics demonstrated lower overall alpha power levels across hemispheres than did the fluent aphasics. Results are discussed relative to the aphasics becoming more dependent upon the processing resources of the intact right hemisphere during the course of language recovery.     

Examining attention and cognitive processing in participants with self-reported mild anomia

Background: People who report mild anomia following stroke often score near or within normal limits on traditional assessments of language. Based on evidence of cognitive influences on linguistic production in people with aphasia, this study examined non-linguistic, cognitive function and its potential influence on word retrieval in individuals with mild anomia.

Aims: This study explored the following research questions: Do people with mild anomia have impaired performance on tasks which require (a) automatic vs controlled processing and/or (b) selective attention relative to neurologically typical controls?

Methods & Procedures: A total of 14 participants with mild anomia and 9 neurologically typical controls were tested using Covert Orienting of Visuospatial Attention Test (COVAT), alone and with linguistic interference, at two interstimulus intervals (ISI) representing automatic and controlled processing.

Outcomes & Results: Participants with anomia showed significantly slower responses on COVAT alone at 100 ms ISI (automatic processing) compared with controls. The groups did not differ significantly during COVAT alone at 800 ms ISI (controlled processing). Additionally, similar priming patterns were exhibited by both groups on COVAT alone during both interstimulus intervals, indicating an intact validity effect. However, participants with anomia demonstrated significantly delayed response times during the COVAT with linguistic interference, regardless of ISI.

Conclusions: Overall, participants with mild anomia demonstrated impairments most notably when interfering stimuli were present, indicating deficits in automatic processing and selective attention. Study results support clinical evaluation of non-linguistic cognitive abilities in individuals reporting anomia who score near or within normal limits on language assessments.     

Suboptimal vitamin D status is a highly prevalent but treatable condition in both hospitalized patients and the general population

PURPOSE: To heighten awareness of the problems related to the high prevalence of suboptimal vitamin D status in hospitalized patients and the general population, including an overview of vitamin D biology, how vitamin D status is defined, the negative health issues associated with suboptimal vitamin D status, indications for treatment, treatment strategies, and controversies in the field. DATA SOURCES: (a) Literature review was performed using PubMed and CINAHL databases to locate and review medical, nursing, and nutritional journals. (b) Authors' recent prospective studies of 100 patients in a general tertiary hospital rehabilitation unit and 51 nonhospitalized volunteers. CONCLUSION: Poor vitamin D status (ranging from suboptimal to overt deficiency) is common in both hospitalized patients and ostensibly healthy individuals of all ages and geographic latitude. Suboptimal vitamin D status is associated with muscle weakness, functional deficits, and perhaps longer length of stay of hospitalized patients. Predictors of vitamin D status include race, poor nutrition, advanced age, use of multivitamins, ultraviolet light exposure, and grip strength. Fortunately, treatment with 50,000 IU of vitamin D(2) for several weeks is a very inexpensive and safe yet effective treatment to replete vitamin D status. IMPLICATIONS FOR PRACTICE: NPs should be aware of the indications for monitoring vitamin D status and the appropriate treatment for suboptimal vitamin D status. Improving vitamin D status may improve a patient's functional ability, therefore decreasing falls and preventing fractures, decreasing length of stay in the hospital, and decreasing the cost of health care. Providers can potentially improve the life of older adults by educating patients on the importance of vitamin D supplementation.     

A trial of an activating intervention for chronic back pain in primary care and physical therapy settings

In primary care and physical therapy settings, we evaluated an intervention for chronic back pain patients which incorporated fear reducing and activating techniques. Primary care patients seen for back pain in primary care were screened to identify persons with significant activity limitations 8-10 weeks after their visit. Eligible and willing patients were randomized (N=240). A brief, individualized program to reduce fear and increase activity levels was delivered by a psychologist and physical therapists. Over a 2 year follow-up period, intervention patients reported greater reductions in pain-related fear (P<0.01), average pain (P<0.01) and activity limitations due to back pain (P<0.01) relative to control patients. The percent with greater than a one-third reduction in Roland Disability Questionnaire scores at 6 months was 42% among Intervention patients and 24% among control patients (P<0.01). Over the 2 year follow-up, fewer intervention patients reported 30 or more days unable to carry out usual activities in the prior 3 months (P<0.01). The adjusted mean difference in activity limitation days was 4.5 days at 6 months, 2.8 days at 12 months, and 6.9 days at 24 months. No differences were observed in the percent unemployed or the percent receiving worker's compensation or disability benefits, but these outcomes were relatively uncommon. We conclude that an intervention integrating fear reducing and activating interventions into care for chronic back pain patients produced sustained reductions in patient fears, common activity limitations related to back pain, and days missed from usual activities due to back pain.     

Heterogeneity of HLA-BW35 based on the diallelic BW4-BW6 system.

Utilizing the diallelic BW4-BW6 system of antigens and antibodies, we divided subjects possessing HLA-BW35 into two groups, depending on the association of their BW35 antigens with BW4 or BW6, and demonstrated in family studies that the associated antigens appeared to be inherited together. Absorption experiments were performed to establish the validity of the typings. Anti-human beta2-microglobulin was used in an effort to "map" the location of the BW4 and BW6 antigenic determinants on the HLA molecule.