Conditions underpinning success in joint service-education workforce planning

Vancouver Island lies just off the southwest coast of Canada. Separated from the large urban area of Greater Vancouver (estimated population 2.17 million) by the Georgia Strait, this geographical location poses unique challenges in delivering health care to a mixed urban, rural and remote population of approximately 730 000 people living on the main island and the surrounding Gulf Islands. These challenges are offset by opportunities for the Vancouver Island Health Authority (VIHA) to collaborate with four publicly funded post-secondary institutions in planning and implementing responses to existing and emerging health care workforce needs.     

Current status of late onset delusion in the elderly]

In the field of chronic delusions, authors make synthesis of the delusion with late emergence in the elderly. This delusion is at once replaced in the history of its nosographic position, then defined in its presentation. The question of its refer with depression and its place in the limits of dementia are approached. Authors outline the importance of biological, psychological and sociological factors in induction of this particular delusion to clarify the means for its management.     

Hormone and metabolite response to weight-lifting training sessions

Eleven weight-trained athletes (age X +/- SD = 33 +/- 5 yrs, weight = 72 +/- 10 kg) with a maximal performance in bench press at the beginning of the study (116 +/- 19 kg) were studied at rest, after a standardized submaximal training session, and after a maximal session once a month for 4 months to study the blood metabolites and hormonal changes during weight lifting. The submaximal load was six series of eight bench presses at 70% of maximal performance presses, and the maximal load was the maximal number of repetitions at the same work load. The levels of several metabolites (lactate, glycerol, triglycerides, beta-OH-butyrate) and hormones (norepinephrine and epinephrine) increased (P less than 0.05) after submaximal work and more after maximal work. Glucose, FFA, acetoacetate, insulin, testosterone, and cortisol did not change significantly or consistently. Lactate after maximal work was higher after the 4th training month (P less than 0.05). Other variables did not change much with training while the maximal number of repetitions in the last series increased slightly (P less than 0.05). In general, the changes observed were smaller than the ones reported for endurance or interval running, which use larger muscle groups. Nevertheless, weight lifting induced changes in blood metabolites which reflect a mobilization of both carbohydrates and lipids stores for energy.     

Psychological adjustment of critically injured patients three months after an unexpected,potentially life‐threatening accident

? Cognitive processing and meaning theories suggest that a patient’s psychological adjustment following a traumatizing event depends on an ability to cognitively integrate the trauma event and restore a sense of meaning in life. These processes may be facilitated by using coping strategies such as sharing concerns, mobilizing support, and reframing. ? A correlational study explored the magnitude of the relationships between psychological adjustment, cognitive processing, sense of meaning, and coping strategies in critically injured patients 3 months after a potentially life‐threatening injury. ? Fifty‐one critically injured patients completed the Brief Symptom Inventory, Bradburn’s Psychological Well‐Being Scale, Impact of Events Scale, the Meaning‐of‐Illness Questionnaire, and Family Crisis‐Oriented Personal Evaluation Scale in face‐to‐face interviews 8–12 weeks after the accident. Bivariate and partial correlation coefficients were used to test the main hypothesis, and Pearson correlation coefficients, to address the three research questions. ? The main hypothesis that psychological adjustment will be significantly related to cognitive processing, sense of meaning, and use of coping strategies in critically injured patients 3 months after the accident was partially upheld. ? Depressive symptomatology was found to be significantly associated with increased cognitive processing efforts and a decreased ability to acknowledge the accident’s negative effects on the self. ? In contrast, psychological well‐being was found to be significantly associated with decreased cognitive processing efforts and an increased ability to acknowledge the accident’s negative effects on the self. ? Restoring a sense of meaning, however, was found to be unrelated to sharing concerns, mobilizing support and re‐framing. The potential theoretical and clinical implications of the findings for nursing practice are discussed.     

Computer-Guided Pericardiocentesis: Experimental Results and Clinical Perspectives

Percutaneous pericardial puncture is a relatively safe and effective technique in case of large pericardial effusions when practiced under echographic or radiological control. The goal of our project is to improve the performance of this technique, mainly in case of smaller and loculated effusions using an accurate guidance towards a preplanned target, based on a model of the pericardial effusion. This paper presents preclinical results of this new computer-assisted technique used to reach the pericardial cavity. The procedure is divide into 3 steps: 1. acquisition of ultrasound data, using an echocardiographic device connected to a 3-D localizer and to a computer, 2. modeling procecure to define the optimal strategy taking into account the mobility of organs on a digital model, 3. guided puncture with a localized needle to reach the predefined target using a passive guidance system. After validation on a dynamic phantom and a feasibility study on dogs, an accuracy and reliability analysis protocol was realized on pigs with experimental pericardial effusion. Feasibility of the technique is demonstrated on animal study with an accuracy of at least 2.5 mm. Further clinical investigation is in progress using a more ergonomic and less cumbersome system. This study demonstrates the feasibility of computer-assisted pericardiocentesis. Beyond the simple improvement of the current technique, this could be a new way to reach the heart or a new tool for percutaneous access and image-guided puncture of soft tissues. Zusammenfassung Die perkutane Perikardpunktion ist ein relativ sicheres und wirksames Therapieverfahren bei größeren Perikardergüssen, wenn sie unter echokardiographischer oder radiologischer Kontrolle erfolgt. Das Ziel einer computergestützten Perikardpunktion ist es, die Punktionstechnik zu verbessern und insbesondere bei kleinen und gekammerten Perikardergüssen eine gezielte Punktion vornehmen zu können. Die Untersuchungen sind Modellversuche einer Perikardpunktion im Sinne präklinischer Datenerhebung. Eine Perikardpunktion mit Computerunterstützung lässt sich in drei Schritte aufteilen: 1. echokardiographische Datenerhebung im 3-D-Format, die in einen Computer eingespeist werden, 2. Wandlung der Daten in ein digitales Modell und 3. gezielte Punktion mit einer computermäßig lokalisierbaren Nadel, um das ausgewählte Ziel (lokalisierter Perikarderguss) zu erreichen. Nach Untersuchungen an einem dynamischen Phantom sowie einer weiteren Untersuchung an Hunden wurden Genauigkeit und Verlässlichkeit des Systems an Schweinen mit einer experimentell induzierten Perikarditis geprüft. Mit Hilfe des Systems kann die Punktion mit einer Genauigkeit von mindestens 2,5 mm erfolgen. Diesen Untersuchungen folgt gegenwärtig eine klinische Erprobungsphase an Patienten mit einem für die Klinik geeigneteren Prototypen. Die Untersuchung zeigt, dass eine computergesteuerte Perikardpunktion durchführbar ist. Sie stellt darüber hinaus eine Perspektive für einen perkutanen Zugang zum Perikard mit gezielter Punktion dar und lässt sich auch an anderen Punktionsorten anwenden.     

The opportunities and effectiveness of the health promoting primary school in improving child health--a review of the claims and evidence.

School health programs have been part of schooling for most of this century. The health promoting school is a recently developed concept which seeks to provide a multifaceted approach to school health. Will it provide a better frame-work to assist schools address the health issues of their students? This paper examines the development of the health promoting school and identifies its structural components. It reviews the claims and evidence which have emerged from the school health research literature which focus on primary schools. Findings indicate health gains for primary school students are difficult to assess, and will most likely occur if a well-designed program is implemented which links the curriculum with other health promoting school actions, contains substantial professional development for teachers and is underpinned by a theoretical model. The paper concludes by discussing how improvements can be made in more accurately assessing the effectiveness of the health promoting primary school in improving school health.     

Fluoxetine modulates motor performance and cerebral activation of patients recovering from stroke.

In order to determine the influence of a single dose of fluoxetine on the cerebral motor activation of lacunar stroke patients in the early phase of recovery, we conducted a prospective, double-blind, crossover, placebo-controlled study on 8 patients with pure motor hemiparesia. Each patient underwent two functional magnetic resonance imaging (fMRI) examinations: one under fluoxetine and one under placebo. The first was performed 2 weeks after stroke onset and the second a week later. During the two fMRI examinations, patients performed an active controlled motor task with the affected hand and a passive one conducted by the examiner with the same hand. Motor performance was evaluated by motor tests under placebo and under fluoxetine immediately before the examinations to investigate the effect of fluoxetine on motor function. Under fluoxetine, during the active motor task, hyperactivation in the ipsilesional primary motor cortex was found. Moreover, fluoxetine significantly improved motor skills of the affected side. We found that a single dose of fluoxetine was enough to modulate cerebral sensory-motor activation in patients. This redistribution of activation toward the motor cortex output activation was associated with an enhancement of motor performance.