Survey of hand symptoms in pregnancy

In a study of 1216 pregnancies, 427 (35%) patients reported hand symptoms. Symptoms of the same quality and distribution were reported by 40 (30%) of 132 control subjects within the previous year, and although invariably mild, these symptoms suggest that pregnancy may aggravate a pre-existing condition. Fewer than 20% of the 427 affected patients described a classic median-nerve symptom distribution (carpal tunnel syndrome), while 12% of patients described an ulnar-nerve distribution, which is thought to represent a genuine and previously underestimated occurrence of ulnar-nerve neuropathy in pregnancy. In 69% of patients, hand symptoms were generalized. Most symptoms were bilateral, commenced in the third trimester and resolved soon after delivery. There was a significant correlation of hand symptoms in pregnancy with the presence of preeclampsia, tight rings, the weight at confinement, the birth weight and a history of premenstrual bloating. Operative intervention was not required for any patient.     

The internal consistency and intra-rater reliability of an assessment practice grid for community nurses

The development of instruments to measure clinical competence in nursing shows little evidence of a systematic approach and studies of reliability and validity are absent. The present study was carried out using data on practice assessment collected in the course of a post-registration nursing programme. The data were analysed for internal consistency and intra-rater reliability. The instrument used to assess practice in the present study is highly internally consistent and there is evidence to support intra-rater reliability. However, further development and testing of the instrument is required.     

Survey of carer satisfaction with the quality of care delivered to in-patients suffering from dementia

Quality assurance in British National Health Service provision stresses the importance of taking account of the consumer's viewpoint Elderly patients with dementia are not always able to contribute usefully to satisfaction surveys Therefore, their carers' views were sought in order to assess the quality of services offered to this client group Forty-one carers of patients discharged from the eight wards for the elderly mentally ill in Leicestershire, England, were randomly selected Individual focused interviews were conducted in carers' own homes Both quantitative and qualitative data were obtained by use of a questionnaire designed to tap the patients'/carers' experiences from preadmission, through hospital stay to post-discharge Interviewees were asked to describe their favourable/unfavourable impressions of, and reactions to, all aspects of hospital care These interviews were tape-recorded Analysis of the data included quantitative measurements of scale ratings Grounded theory was used to analyse qualitative data A wealth of information was uncovered using this research technique Much that was positive about the service was elicited However, carers highlighted areas where they felt the quality of care could be improved within all the foci discussed Twenty-two recommendations for quality improvements in service provision were made in the report as a result of this survey     

Investigating employment following spinal cord injury: outcomes,methods, and population demographics

Purpose: The purpose of this review was to synthesize the literature about spinal cord injury and employment, focusing on sample demographics, indicators of employment outcome, and the methods used. The review included literature from the previous decade; 2006–2017.

Methods: A systematic quantitative literature review methodology was utilized, wherein papers’ characteristics were extracted and categorized in a database according to their topics, employment outcome indicators, populations, locations, and methods. Frequency tables were generated and cross-tabulated to yield conclusions about the outcomes of the studies and the methods and samples used to yield these outcomes.

Results: The review highlighted three key themes; the emergence of broader employment outcome measures that go beyond employment rate; a lack of consistency in the reporting of sample characteristics such as time since injury or ethnicity; and the relative lack of research focusing on people with newly acquired spinal cord injury.

Conclusions: The literature review identified a number of limitations in the existing research including the lack of standardized reporting of employment outcomes and a need for increased consistency in reporting sample characteristics. In addition, there are gaps in the research about people with newly acquired spinal cord injury, particularly regarding the timing of interventions.

• Implications for Rehabilitation

• Spinal cord injury has the potential to disrupt a person’s career across their lifespan.

• Employment rate is the gold standard for evaluating employment outcomes.

• Broader measures of employment, including job retention and hours worked, have potential in evaluating and improving the quality of employment outcomes for this population.

• Further research with people with newly acquired spinal cord injuries would better support the provision of vocational rehabilitation services earlier in a person’s rehabilitation, potentially preserving jobs.

     

Role of the clinical facilitator

This article looks at and considers, in the light of current developments within nurse education, the role of the clinical facilitator, emphasising that within a changing educational environment such a role is both essential and feasible.The authors conclude that all trained staff within the clinical area (especially where learners are employed) should accept their individual roles as facilitators, and in this context recognise their own and the students' self-worth.     

Dietary lipid modulation of ventricular fibrillation threshold in the marmoset monkey.

Programmed electrical stimulation was used to examine the ability of long-term dietary lipid modulation to influence myocardial vulnerability to the induction of ventricular fibrillation in adult marmoset monkeys (Callithrix jacchus). Marmosets fed diets supplemented (to a total of 28.5% of the energy as fat) with polyunsaturated fatty acid (PUFA)-rich tuna fish oil or sunflower seed oil had significantly elevated mean ventricular fibrillation threshold compared with those fed a saturated animal fat supplemented diet or a reference diet not supplemented with fat (11.2% of the energy as fat). Fibrillation threshold was reduced during acute myocardial ischemia induced by coronary artery occlusion but still remained higher in the PUFA-fed animals than either the control or the ischemic threshold in reference or saturated fat supplemented animals. Dietary tuna fish oil was associated with a low incidence of sustained fibrillation episodes and no fatalities. These results indicate that myocardial substrate vulnerability to arrhythmic stimuli is increased during ischemia in a nonhuman primate model but dietary PUFA can reduce vulnerability under both normal and ischemic conditions. Reduced dietary fat intake alone was without effect.     

The palliative care clinical nurse consultant: An essential link

This study describes the role of acute hospital palliative care nurse consultants and makes recommendations about future directions for the role development of this role. While the palliative care nurse consultant role is accepted in the acute setting there is little evidence or literature about what contributes to the success of this role. A three-phase study was undertaken to describe the role of palliative care nurse consultants in acute hospitals in Melbourne, Australia. The first phase of the three-phase study, involving in-depth qualitative interviews with the palliative care nurse consultants, is reported in this article. Using open-ended semi-structured questions, 10 palliative care nurse consultants were interviewed using open-ended questions about aspects of their role and the interviews were thematically analysed. Four main themes were identified that clarified the role; being the internal link; being the lynch pin; being responsive and being challenged. The palliative care nurse consultants were the first point of introduction to palliative care and thus they saw a significant role in introducing the concept of palliative care to those requiring palliative care, their families and others. They are an important link between the settings of care required by people accessing palliative care—acute, in-patient palliative care and community care. The palliative care nurse consultants saw themselves in leadership positions that in some ways defy boundaries, because of the inherent complexity and diversity of the role. The palliative care nurse consultants’ role appears to be pivotal in providing expert advice to staff and people requiring palliative care, and connecting palliative care services both within the hospital and to external services.