The expanded role of the critical care nurse: a review of the current position

The advanced practice role of the registered nurse is a topic that is currently being debated both nationally and internationally. This paper examines the literature as it relates to role expansion within nursing in general and more specifically to critical care nurses. The role of the critical care nurse is changing and this has occurred as a result of historical evolution, the use of increasing technology, the blurring of medical and nursing roles and current workforce shortages. The literature reviewed identifies some of the factors that have propelled this process and examines the use of terminology as it relates to advanced practice roles and their titles. Finally, the attributes and educational preparation required to perform at an increased level are examined.     

Persistence in breastfeeding: a phenomenological investigation

The experience of mothers who continue to breastfeed when other alternatives are available has received little attention. To examine the underlying meaning of the reality of persisting with breastfeeding, a phenomenological approach is used. Based on interviews with breastfeeding mothers, the author explores the meaning of continuing to breastfeed in relation to a mother's decision to breastfeed, the problems encountered, the relationship between mother and baby, being committed and choosing a time to stop. The aim of the author is to stimulate thinking beyond taken for granted attitudes towards breastfeeding and to enhance understanding of what breastfeeding and continuing to breastfeed is like for mothers in a deeper more meaningful way.     

Update on TORCH infections in the newborn infant

TORCH infections are unique in their pathogenesis and have potentially devastating clinical manifestations. Congenital toxoplasmosis remains an important cause of blindness, although avoiding exposure to cats and uncooked meat can prevent it. Congenital syphilis has declined in incidence due to mandatory prenatal testing and effective therapy. The incidence of congenital and neonatal varicella and of congenital rubella has been lowered due to vaccination. Perinatally acquired HIV infection continues to increase at a frightening pace in the developing world. The use of antiretroviral therapy in mothers and the newborn, however, has resulted in a decrease in incidence in the United States. While cytomegalovirus remains the most common cause of congenital infection in the United States, the possibility of effective treatment with Ganciclovir (Hoffman-LaRoche, Basel, Switzerland) has emerged from recent studies. In neonatal herpes, selective use of cesarean delivery and antiviral therapy can decrease incidence and improve outcomes.     

Extending the nursing role in Emergency Departments: Challenges for Australia

As nursing has developed as a profession there has been a continual evolution of the scope of practice in which nurses work. Emergency nursing practice is an example where recently there has been a rapid expansion in the nature and scope of practice. This change in practice has largely resulted from increasing public demand on emergency departments, medical and nursing shortages and governmental pressure to reduced emergency department waiting times and patient length of stay.There have been a number of models worldwide in which the expansion of the Emergency Nurses role has occurred. Recently in New South Wales the Clinical Initiative Nurse role has been developed as an advanced practice role with the objective of initiating treatment based on advanced clinical assessment and to assist emergency departments to meet benchmarks and key performance indicators (KPIs). The scope of practice of this new role did not extend to that of a Nurse Practitioner who is able to discharge patients, prescribe medication and provide medical referral.The variation in advance practice nursing roles in Australia and worldwide has contributed to confusion and uncertainty. The aim of this paper is to explore the various advanced practice roles that may be encountered in emergency nursing practice and examine some of the advantages and limitations to the implementation of these roles.     

Efficacy of lower-energy biphasic shocks for transthoracic defibrillation: : A follow-up clinical study

Objective

This clinical study prospectively evaluated the first-shock defibrillation efficacy of 150-joule impedance-compensated, 200-μF biphasic truncated exponential (BTE) shocks in patients with electrically-induced ventricular fibrillation (VF), and compared it with a historical control group treated with 200-J monophasic damped sine (MDS) shocks.

Methods

Ventricular tachyarrhythmias were induced in patients undergoing electrophysiologic (EP) testing for ventricular arrhythmias or testing of an implantable cardioverter-defibrillator (ICD). A 150-J shock was delivered as the primary therapy to terminate induced arrhythmias in the EP group, and as a “rescue” shock when a single ICD shock failed to terminate the arrhythmias in the ICD group.

Results

Ninety-six patients received study shocks. The preshock rhythm was classified as VF in 77 patients and as ventricular tachycardia (VT) in 19 patients. First-shock success rates for VF and VT were 75 out of 77 (97.4%) and 19 out of 19 (100%) for the 150-J BTE compared with the historical control rates of 61 out of 68 (89.7%) and 29 out of 31 (94%) for 200-J MDS. The first-shock success rate for VF treated with 150-J BTE was technically equivalent to that of 200-J MDS (p = 0.001). The transthoracic impedance did not vary between groups, yet the peak current delivered by the 150-J BTE shock was about 50% lower.

Conclusions

This study demonstrated that 150-J shocks of this impedance-compensated, 200-μF BTE waveform provided very high efficacy for defibrillation of short duration, electrically-induced VF. These lower-energy biphasic shocks had a success rate equivalent to that of 200-J MDS shocks, and they provided this efficacy while exposing patients to much less current than the monophasic shocks.     

硼硅酸盐生物玻璃的生物活性测试及其细胞相容性

目的：测定硼硅酸盐玻璃的生物活性及其细胞相容性,开发一类以硼作为玻璃结构网络主要形成体的生物活性玻璃。 方法：实验于2005-10/2006-08在上海同济大学材料科学与工程学院实验室完成。在硅酸盐生物玻璃,45S5玻璃,中引入B2O3,制备不同硼含量（摩尔百分比为15.4,30.7,46.1）的用于骨组织工程材料硼硅酸盐玻璃。以45S5玻璃为对照,通过X射线衍射方法确定生成羟基磷灰石晶体的速度,来评价硼硅酸盐的生物活性;在美国密苏里-罗拉大学生物实验室作成骨细胞在玻璃片上的接触实验和黏附试验,并通过扫描电镜和光学显微镜评价硼硅酸盐玻璃对成骨细胞的相容性。 结果：①生物活性：随着硼含量提高,硼硅酸盐玻璃的羟基磷灰石生成速度加快,结晶度增加,说明它们的生物活性逐渐提高。②细胞相容性：与45S5玻璃相比,硼含量高的玻璃,对成骨细胞生长有抑制作用;但在玻璃片界面附近或玻璃片表面的成骨细胞,总体上仍然有较高的存活率,呈现出良好的生长形态。 结论：硼硅酸盐玻璃是一类很有发展前景的骨组织工程支架材料,它不仅具有良好的生物活性,而且对成骨细胞具有较好的细胞相容性。     

Maternal immunization to Gov system alloantigens on human platelets

BACKGROUND: Immunization to platelet alloantigens can occur during pregnancy or after the transfusion of blood components. Platelet alloantibodies can cause neonatal alloimmune thrombocytopenia and posttransfusion purpura. Transfusion-induced alloimmunization to a novel platelet alloantigen system, Gov, expressed on the 175-kDa glycosyl phosphatidylinositol-anchored platelet glycoprotein, CD109, was previously described. This report describes three unrelated patients who were alloimmunized to Gov(a) or Gov(b) during pregnancy. STUDY DESIGN AND METHODS: Platelets were typed by using radioimmunoprecipitation for HPA-1a, -3a, -5a, -5b, Gov(a), and Gov(b) and by polymerase chain reaction-restriction fragment length polymorphism for HPA-1a, -1b, -3a, and -3b. Maternal sera were screened for platelet antibodies by using radioimmunoprecipitation and the antigen capture assay. RESULTS: Patients 1 and 2 were investigated after the diagnosis of neonatal alloimmune thrombocytopenia in their children, and alloantibodies specific for Gov(b) and Gov(a), respectively, were detected in maternal serum. Serum from patient 3, who had mild idiopathic thrombocytopenia purpura with no detectable autoantibody, was found to contain alloantibodies to Gov(b) and to HPA- 5b, presumably as a result of immunization during pregnancy. Platelet typings confirmed that the patients were at risk for alloimmunization to the respective antigen. CONCLUSION: This report of three cases of maternal alloimmunization to antigens in the Gov system indicates that immunization can occur via placental transfer of antigen and that Gov system alloantibodies may be associated with neonatal alloimmune thrombocytopenia.