Longitudinal study of the intensity of memorized labour pain

This study was designed to investigate various factors affecting the intensity of memorized labour pain. The study assessed 101 primiparas' and 95 multiparas' labour pain and related factors, such as physical, psychological and living environmental factors at three periods post-delivery: (i) within 24 h; (ii) at 1 month; and (iii) in year 1-2. The rate of the high group, whose intensity of memorized labour pain was larger than mean +1SD during the three postpartum phases, was 24.0%. The rate of the low group, whose intensity of memorized labour pain was smaller than mean + 1SD, was 9.7%. In the high group, the length of labour was longer than that in the low group, the rate of pregnancy disorder was higher, the self-control score during labour and delivery was worse and the rate of women with difficult birth was higher and that for those with low birth weight was lower. The high group obtained more family support but needed a longer time to adjust to childcare. There were significant differences between the high and low groups in all the factors.     

Do clinical nurse specialists and nursing unit managers believe that the provision of quality care is important?

The nursing profession has a long tradition of evaluating the quality of its product in order to ensure that the best possible care can be given However, in the climate of economic rationalism which prevails worldwide, it is possible that the emphasis on fiscal restraint has distracted nurses from their previous focus on quality This paper discusses the findings of two research studies designed to determine the competencies expected of nursing unit managers and clinical nurse specialists Discussion focuses specifically on their roles in the provision of quality care     

The first year as a staff nurse: the experiences of a first cohort of Project 2000 nurses in a demonstration district

This paper describes the experiences of eight staff nurses who were students in the first cohort of a Project 2000 course in a pilot district during their post–qualification year A qualitative approach, informed by phenomenological methodology, was adopted in order to present these experiences alongside the meaning attributed to them by the nurses Taped, focused group discussions, using semi-structured interviews, were analysed This yielded five themes which describe the structure of these experiences from'coming out of school' through to the acknowledgement and confidence in themselves as a different kind of nurse to those trained on previous traditional courses The findings suggest that the vision of the United Kingdom Central Council in proposing Project 2000 courses is likely to be realized These nurses had gained the competent technical and clinical skills expected of any nurse However, they also displayed skills previously absent in newly–qualified nurses, such as evidence of analytical decision–making and confident interpersonal skills, which are likely to enable them to take an equal place amongst other members of the multindash;professional team in the future Although competent practitioners, the process they had undergone to reach this had, at times, been traumatic The implications arising from the study are that more attention needs to be paid to the personal and professional development needs of Project 2000 nurses, both at the end of the course and in their first post-qualifying year     

A re-evaluation of the effect of pethidine on the length of labour

In a pilot study of a randomized controlled trial comparing pushing techniques in the second stage of labour, a surprise hiding was that there was a positive correlation between the amount of pethidine used for analgesia in the first stage of labour and an increasing length of both the first (F0.5687, P=0-0001, CI=0.33 to 0.74) and second stages (r=0-3204, P=0-037, CI=0-03 to 0.56). In order to investigate this further a review of the literature on the effect of pethidine on the length of labour was undertaken. The literature searched was the English-language literature, and MEDLINE and Index Medicus were used to identify pertinent papers. Studies selected were randomized controlled trials of pethidine given for pain relief in labour compared with placebo. As only five studies were identified other pertinent studies using the drug were scrutinized. The findings of this review are that, due to methodological flaws and studies with small sample sizes, the effect of pethidine on the length of labour in women has not been adequately assessed. However, there is a strong suggestion in the literature that the use of this drug is associated with a lengthening of labour and this association is dose-related. Studies in animals support this view. Those caring for women in labour should be aware of this side-effect of the analgesic most frequently given in labour in North America and the United Kingdom. As pethidine frequently does not provide adequate analgesia and has other side-effects, the search for an alternative analgesia should continue.     

Estimation of human myocardial mass with MR imaging

The accuracy and reproducibility of magnetic resonance (MR) imaging in the determination of left ventricular mass in humans was investigated. Left ventricular wall volume was measured from ten short-axis, end-diastolic MR images that spanned the left ventricle. Mass was estimated on the basis of average left ventricular wall volume and an assumed myocardial density. To establish the accuracy of the technique, the authors imaged ten cadaver hearts and compared true left ventricular weight with the mass estimate based on MR imaging findings. In vivo determination of left ventricular mass was evaluated in 40 subjects, with resultant calculated masses of 156.4-319.3 g. Intra- and interobserver variabilities of the technique were analyzed in ten subjects. Both the intra- (r = .96, standard error of estimate [SEE] = 11.1 g) and interobserver variabilities (r = .91, SEE = 17.8 g) were excellent. Eight subjects were imaged on two separate occasions to evaluate reproducibility of the technique and confidence limits for a given measurement. For these eight, there was good correlation between the two estimates (r = .93, SEE = 21 g). The authors conclude that MR imaging yields highly accurate and reproducible estimates of left ventricular mass in humans in vivo.     

Twin embolization syndrome: prenatal sonographic detection and significance

Twin embolization syndrome (TES) is a complication of monozygotic twinning following in utero demise of the co-twin. Passage of thromboplastic material into the circulation of the surviving twin results in ischemic structural defects of the central nervous system, gastrointestinal tract, and genitourinary system. In six cases of this rare abnormality, sonographically normal fetuses subsequently demonstrated ventriculomegaly, porencephaly, cerebral atrophy, or microcephaly following demise of the co-twin. Extracranial abnormalities included small bowel atresia (two cases) and renal cortical necrosis (one case). Surviving twins all had neurodevelopmental delay at follow-up. Two fetuses were aborted because of sonographically apparent, progressively severe brain abnormality. The lone survivor of a dizygotic triplet gestation was normal, despite sonographic findings of TES in the co-triplets. Because of poor outcome, prenatal sonographic diagnosis of TES may influence antenatal or neonatal management of the surviving monozygous twin. Recognition of TES may permit accurate postnatal counseling of prognosis and recurrence risks.     

Hysterosalpingography in Infertility — An Experience of 3,631 Examinations

EDITORIAL COMMENT: The introduction of chromotubation — laparoscopy with instillation of methylene blue through the cervix — has in many centres replaced hysterosalpingography as the primary procedure for investigation of tubal patency in patients with infertility. Proponents of laparoscopy emphasize the value of inspection of the tubes for evidence of disease and assessment for suitability for repair if the tubes are occluded. Several studies comparing findings at laparoscopy and hysterosalpingography have reported that laparoscopy frequently finds significant tubal pathology when the salpingogram was reported as normal.     

Central nervous system lesions in pediatric patients: Gd-DTPA-enhanced MR imaging

Twenty pediatric patients, aged 2-18 years, with known or suspected masses in the brain and/or spinal cord were studied with magnetic resonance imaging at 0.6T with and without use of 0.1 mmol/kg gadolinium diethylenetriaminepentaacetic acid (Gd-DTPA). The multisection, multiecho imaging mode was utilized. Surgically proved mass lesions included astrocytoma (n = 6), medulloblastoma (n = 2), ependymoma (n = 1), craniopharyngioma (n = 1), oligodendroglioma (n = 1), germinoma (n = 1) and fibrosarcoma (n = 1). Presumptive diagnoses included astrocytoma (n = 3), arachnoid cyst (n = 1), tuberous sclerosis (n = 1), cryptic vascular malformation (n = 1), and normal (n = 1). There was dramatic enhancement in 11 of 20 patients, with improved definition of the presence and extent of lesions in six patients. No adverse effects were noted in any of the 20 patients. It is concluded that Gd-DTPA is useful in delineating the presence, extent, and number of certain lesions of the central nervous system in children.     

Granular cell tumour of the oesophagus: Endoscopic ultrasound appearances

A case of granular cell tumour of the oesophagus in a middle-aged woman is reported. The pathological features and appearances on endoscopic ultrasound (EUS) are described, and the role of EUS in the characterization of intramural oesophageal tumours is discussed.