What do nurses and therapists think about the positioning of stroke patients?

BACKGROUND: At present, there are a number of different positioning strategies for stroke patients, but these are mainly based on clinical experience rather than research. Prior to developing a study to evaluate the effect of positioning on outcome after stroke, it was important to establish if nurses in our hospital had given much thought to the positioning of stroke patients. AIM OF THE STUDY: This study aimed to explore whether nurses working on the stroke unit at a Scottish teaching hospital held different views on the positioning of conscious and unconscious stroke patients to nurses working on other wards with stroke patients and therapists. METHODS: Questionnaires on various aspects of patient positioning were sent to 150 nurses and 25 therapists working in five specialities where stroke patients are cared for in a large teaching hospital. FINDINGS: Overall, the majority of nurses and therapists (74%) believed that the best position for conscious stroke patients was sitting in a chair. Also, 80% of them believed that the best position for unconscious stroke patients was lying on the nonparetic side. There was less of a consensus between nurses and therapists working in the five specialities as to whether it was appropriate for conscious or unconscious stroke patients to lie on their paretic side, lie supine or sit propped-up in bed in either a 30 or 70 degrees angle. CONCLUSIONS: The lack of consensus between nurses working in the five specialities is probably because at present there is little research to guide nursing practices for the positioning of stroke patients. Therefore, research to confirm which positions improves or hinders outcome after stroke is essential. Indeed, positioning is a simple inexpensive strategy, which could have a substantial public health impact, as stroke is so common.     

Three‐Dimensional Ultrasound Imaging of Mammary Ducts in Lactating Women

Objective. The main function of the breast is to produce milk for offspring. As such, the ductal system, which carries milk from the milk‐secreting glands (alveoli) to the nipple, is central to the natural function of the breast. The ductal system is also the region in which many malignancies originate and spread. In this study, we aimed to assess the feasibility of manual mapping of ductal systems from 3‐dimensional (3D) ultrasound data and to evaluate the structures found with respect to conventional understanding of breast anatomy and physiology. Methods. Three‐dimensional ultrasound data of the breast were acquired using a mechanical system, which captures data in a conical shape covering most of the breast without excessive compression. Manual mapping of the ductal system was performed using custom software for data from 4 lactating volunteers. Results. Observational results are presented for ultrasound data from the 4 lactating volunteers. For all volunteers, only a small number of ductal structures were engorged with milk, suggesting that the lactiferous activity of the breast may be localized. These enlarged ducts were predominantly found in the inferior lateral quadrant of each breast. The observation was also made that the enlarged, milk‐storing parts of the duct were spread throughout the ductal system and not directly below the nipple as conventional anatomy suggests. Conclusions. Ultrasound visualization of the 3D structure of milk‐laden ducts in an uncompressed breast has been shown. Using manual tracing, it was possible to track milk‐laden ducts of diameters less than 1 mm.     

Verbal communication: what do critical care nurses say to their unconscious or sedated patients?

The importance of using verbal communication in the care of critically ill patients has long been known. Both qualitative and quantitative studies have presented evidence of the benefits of effective communication. This non-participant observational study aimed to explore how much and what types of verbal communication critical care nurses use when caring for unconscious or sedated patients. Sixteen critical care nurses were observed in 4-hour episodes and their verbal communication was transcribed and timed at source. Seven categories of verbal communication and a 'core concept' emerged on analysis of the raw data. Medical investigations/interventions performed on the patients increased the amount of communication used. The participants in this study were found to use a greater variety and amount of verbal communication than participants in other studies. The findings of this study highlight the need for formal support systems and continued education for nurses about the benefits of verbal communication.     

Mental health nursing policy — an exploratory qualitative study of managers'' opinions

Mental health nursing policy — an exploratory qualitative study of managers’ opinions During the 1990s, much of the legislation and policy that pertains to mental health services has sought to direct them towards a virtually exclusive concern with the seriously mentally ill, typified by the following recommendation from a recent Department of Health review of mental health nursing that stated: ‘The essential focus for the work of mental health nurses lies in working with people with serious or enduring mental illness’. On the other hand, pressure from the primary health care sector suggests the need for services to be provided for the less seriously mentally ill, particularly through the auspices of general practice fundholders. Following a review of the literature, a small-scale, exploratory study was initiated to seek answers to the following research question: How is the policy focus urging reorientation to the severely mentally ill viewed by nurse managers who have a responsibility through Mental Health Resource Centres and Community Mental Health Teams, to provide mental health services? The study was based within a Welsh National Health Service (NHS) Trust that employed six nurse managers of Community Mental Health Teams (CMHTs). Four of the managers additionally had responsibility for Community Mental Health Resource Centres (CMHRCs). Of the population of six managers, four composed the sample for the investigation. A qualitative research approach was employed, utilizing semistructured interviews as the data collection tool. Analysis of the data revealed that managers were finding creative solutions in order to meet the conflicting demands placed upon them. The research findings also indicated that many of the obstacles to providing a needs-led service were structural in origin, and could be resolved by central strategic intervention.     

Mechanical loading regulates protease production by fibroblasts in three-dimensional collagen substrates

Mechanical loading is important in tissue formation and remodelling, notably in wound repair. The aim of this study was to measure the effects of controlled loading on the release of extracellular matrix protease activities by fibroblasts. Fibroblast populated collagen lattices were subjected to external cyclical loads through a computer controlled unit incorporated into a culture system, a tensioning-Culture Force Monitor. Cyclical loading was compared to untensioned and statically loaded gels (tethered endogenous contraction). Overall changes in a range of protease activities were monitored (chiefly by zymography) as measures of the cyto-mechanical response to these loads. Under static load, 2.5- and 13-fold more matrix metalloproteinase-2 was produced than matrix metalloproteinase-9, at 24 and 48 hours. Total matrix metalloproteinase-9 increased 37 fold on cyclical loading. Total matrix metalloproteinase-3 and urokinase plasminogen activator activities were dramatically reduced on cyclical loading while tissue type plasminogen activator activity was increased. Comparison with cell responses on stiffer substrates (collagen sponges) identified similar matrix metalloproteinase responses to load, but at much reduced levels (4-6 fold matrix metalloproteinase-9 stimulation on loading), showing the importance of matrix compliance to this mechano-response. In conclusion, physiological mechanical loading of fibroblasts in three dimensional collagen lattices elicited complex and substantial changes in matrix modifying proteases. These changes suggest that cells switch between expression of comparable protease activities mainly influencing cell-matrix interactions associated with migration or more generalized extracellular matrix remodelling.