'Becoming a mother'— developing a new theory of early motherhood

This paper explains the methods used in a grounded theory analysis of the experience of 55 first-time mothers in Australia, presented in the first of this series of two papers. The categories identified in the research are realising, readiness, drained, aloneness, loss and working it out, encompassed in the core category becoming a mother. Specifically, this paper extends the analysis and explains the application of a'paradigm model' and the identification of a Basic Social Process (BSP). The paper links the analysis to the literature on early motherhood from nusing, midwifery, feminist, and sociological research. A substantive theory is proposed to explain women's experience in becoming mothers that demonstrates how, when responsive to the needs of those researched, a grounded theory analysis can provide a framework for nursing and midwifery care.     

SONOGRAPHY : A VALUABLE MODALITY IN EVALUATION OF CHRONIC NON-TRAUMATIC DISORDERS OF THE SHOULDER JOINT

Chronic non-traumatic shoulder pain may be due to arthralgia, shoulder myalgia, glenohumeral synovitis, adhesive capsulitis, or degenerative joint disease. Clinical skills and routine radiography may not be adequate to establish the diagnosis. This study was designed to assess the role of sonography in such a setting. Twenty-six consecutive patients attending the clinical immunology outpatient department for chronic shoulder pain were evaluated. Based on our findings, we have described 4 distinct sonographic patterns. Pattern 1 consisted of the normal sonographic appearance with semicircular smooth humeral head profile parallel to which was an echo-free synovial space measuring 1-2 mm. This pattern indicated shoulder arthralgia or myalgia without intrinsic shoulder joint disease. Pattern 2 consisted of reduction in the echo-free space indicative of adhesive capsulitis. Pattern 3 consisted of uniform increase in this space, thus indicating active synovial inflammation with effusion. Pattern 4 showed irregularity of the humeral head with reduction in the gleno-humeral joint space and loss of parallelism between the humeral head and the surrounding gleno-humeral synovial space. This last pattern indicated advanced deformed inflammatory or degenerative arthritis. It is concluded that these 4 sonographic patterns will be of considerable help in pinpointing the diagnosis in cases of chronic non-trumatic shoulder pain.     

Comparison of the use of Tanner and Whitehouse, NCHS, and Cambridge standards in infancy

The British (Tanner and Whitehouse) and American (National Center for Health Statistics, NCHS) growth standards are widely used internationally, although the data are now over 30 years old. Routine weight data was retrieved from the child health records of a complete annual cohort of 3418 children aged 18-30 months to test the validity of these standards for modern infants. Compared with the Tanner and Whitehouse standards, Newcastle children rose initially and then fell a mean of 0.7 SDs between 6 weeks and 18 months, resulting in a threefold difference in the proportion of children below the 3rd centile at different ages. NCHS standards showed a similar pattern. When compared with modern standards from the Cambridge growth study, there was a much closer match, although Newcastle children showed a slight gain by the age of 1 year. Existing standards for weight introduce inaccuracy into the estimation of centile position in the early months of life. As both standards show similar problems this probably represents a real secular change due to changes in infant nutrition. These findings support the need to develop new national growth reference standards.     

The influence of BIBW22BS, a dipyridamole derivative, on the antiproliferative effects of 5-fluorouracil, methotrexate and gemcitabine in vitro and in human tumour xenografts

Dipyridamole is known as a potent inhibitor of facilitated diffusion-mediated nucleoside transport as well as a modulator of ‘classical’ multidrug resistance. BIBW22BS, a derivative of dipyridamole, has been found to be 20-to 100-fold more potent in the reversal of multidrug resistance when compared to the parent compound. In parallel, we studied the efficacy of BIBW22BS in the modulation of the antiproliferative effects of 5-fluorouracil, methotrexate and gemcitabine in human cancer cell lines. BIBW22BS, at non-toxic concentrations up to 1.0 μM, increased the antiproliferative effects of 5-fluorouracil 2- to 6-fold in seven of the eight colon cancer cell lines tested in a dose-dependent manner. The addition of 1.0 μM BIBW22BS to methotrexate resulted in a slight increase in the antiproliferative effects, but inhibited the activity of gemcitabine 30- to 100-fold in various cancer cell lines. In vitro, no notable difference was found between BIBW22BS and dipyridamole in their capacity to modulate the activity of the antimetabolites studied. BIBW22BS did not affect the growth inhibition induced by 5-fluorouracil or gemcitabine in human tumour xenografts grown subcutaneously in nude mice. We confirmed the higher potency of BIBW22BS when compared to dipyridamole in the reversal of drug resistance in the Pgppositive COLO 320 cell line.     

LORAZEPAM IN STUPOR

SUMMARY The use of lorazepam in relieving catatonic symptoms is illustrated by the dramatic response in a stuporous patient. The treatment allows further investigations and management. It is recommended that clinicians familiarise themselves with this simple pharmacological intervention.