Nursing education and professional role acquisition. A longitudinal study of expectations and attitudes towards nurse role acquisition

This article deals with professional role acquisition in nurses and discusses results from three studies concerning expectations and attitudes towards this acquisition. The studies have been carried out in Sweden. The discussion comprises expressed expectations and attitudes of nurse students and registered nurses in relation to our theoretical perspectives presented in a former article. The theoretical perspectives concentrate on three aspects of social action: change-drama, interchange-ritual, and maintenance-routine. The results indicate that the professional nurse role is acquired according to a traditional pattern, in spite of changes in curriculum and goals of nursing education and health care. Changes made to develop and improve the conditions under which role acquisitions take place.     

Patient-specific contrast injection protocols for cardiovascular multidetector row computed tomography

OBJECTIVE: To develop patient-specific contrast injections for uniform enhancement of cardiovascular multidetector row computed tomography (MDCT) images. METHODS: Sixty-two patients were imaged using electrocardiogram (ECG)-gated spiral MDCT. Thirty patients (group 1) received a uniphasic injection; the remaining 32 patients (group 2) received patient-specific multiphasic injections. For group 2 patients, the vasculature between injection and imaging sites was considered a "gray box" whose transfer function was determined from a test bolus injection and the resulting enhancement in the left side of the heart. This transfer function was used to determine the injection necessary to achieve 250 Hounsfield units in the left side of the heart. Intraindividual and interindividual variation of enhancement were determined for both groups. Superior vena cava (SVC) artifacts were graded on a 4-point scale. RESULTS: The measured indices of intraindividual variation were significantly smaller in group 2 than in group 1 (P < 0.05), indicating improved uniformity with patient-specific injections. The interindividual variation of mean enhancement in group 2 was smaller than in group 1, but the difference was not significant. The severity of SVC artifacts was significantly reduced (P < 0.05) for thinner patients (<83 kg) in group 2 compared with similar patients in group 1. CONCLUSIONS: Patient-specific multiphasic contrast injections yielded more uniform enhancement in the left side of the heart on MDCT images with reduced intraindividual variation of enhancement compared with standard uniphasic injections. Patient-specific injections also reduced SVC artifacts in patients <83 kg.     

Measurements of antimicrobial drug concentrations in renal interstitial fluid using the diffusion chamber technique

Summary A technique is described to obtain renal interstitial fluid (RIF) from rabbits after implantation of diffusion chambers with permeable membranes of 0.45 µ porosity in both kidneys. Pharmacokinetic studies were conducted two to three weeks after implantation. No difference in gentamicin concentrations, as measured microbiologically, was seen between RIF withdrawn from the left and right kidney chambers at the same points in time. Simultaneous drug concentrations were determined in RIF and serum of rabbits after oral administration of ampicillin or nalidixic acid and after intramuscular injection of gentamicin. Ampicillin concentrations in RIF peaked at two hours with about one fourth of the peak concentration measured in serum at one hour. These curves crossed at 3.45 hours. In RIF, the maximum concentration of gentamicin found at two hours was again approximately one fourth of the serum peak level determined at half an hour. The gentamicin curves crossed at 3.15 hours. No levels of nalidixic acid could be detected microbiologically in serum and RIF. In collected urine, however, concentrations of this drug could be measured for several sampling periods. Our results show that this diffusion chamber technique can be useful in the pharmacokinetic examination of drugs, also with respect to their distribution in the kidneys.

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Bestimmung von Wirkstoffkonzentrationen in renaler Interstitialflüssigkeit mit Hilfe der Diffusionskammertechnik

Zusammenfassung Es wird eine Methode zur Gewinnung von renaler Interstitialflüssigkeit (RIF) durch Implantation von Diffusionskammern mit permeablen Membranen (Porengröße 0.45 µ) in beide Nieren von Kaninchen beschrieben. Pharmakokinetische Untersuchungen begannen zwei bis drei Wochen nach der Implantation. Unabhängig ob die Proben aus der linken oder der rechten Niere gewonnen wurden, waren die mikrobiologisch bestimmten Wirkstoffspiegelkonzentrationen, wie am Beispiel Gentamicin gezeigt werden konnte, praktisch gleich. Simultane Wirkstoffspiegel in RIF und Serum wurden nach oraler Verabreichung von Ampicillin und Nalidixinsäure und nach intramuskulärer Injektion von Gentamicin bestimmt. Die höchste Ampicillin-Konzentration in RIF wurde zwei Stunden nach Applikation gemessen und betrug ein Viertel der eine Stunde nach Verabreichung gefundenen Maximalwerte des Ampicillin im Serum. Die Serum- und die RIF-Kurven kreuzten sich 3,45 Stunden nach Substanzverabreichung. Für Gentamicin wurden die höchsten Spiegelwerte in RIF nach zwei Stunden bestimmt. Sie betrugen ebenfalls ca. ein Viertel der im Serum nach einer halben Stunde gefundenen Maximalwerte. Der Schnittpunkt beider Kurven lag bei 3,15 Stunden nach Applikation. Bei mit Nalidixinsäure behandelten Kaninchen waren mikrobiologisch keine antibakteriellen Aktivitäten in Serum und RIF nachweisbar, jedoch z. T. hohe Spiegel in Sammelurinproben. Die erhobenen Befunde bestätigen die Brauchbarkeit dieser Diffusionskammermethode für pharmakokinetische Untersuchungen antibakterieller Wirkstoffe auch hinsichtlich ihrer Verteilung in der Niere.

     

Optimization of acquisition and contrast injection protocol for C-arm CT imaging in transcatheter aortic valve implantation: initial experience in a swine model

To determine the optimal C-arm computed tomography (CT) protocol for transcatheter aortic valve implantation (TAVI) in swine. In 6 swine, C-arm CT was performed using 5-s ungated acquisition during sinus rhythm with aortic root (Method 1) or peripheral (Method 2) injection, and during rapid ventricular pacing with root injection (Method 3). Additionally, 24-s ECG-gated acquisitions were performed during sinus rhythm with root (Method 4) or peripheral (Method 5) injection. Aortic root enhancement, presence of artifacts and contrast volumes were compared for all methods. Aortic root measurements were also compared between C-arm CT and multidetector-row computed tomography (MDCT). The best C-arm CT image set was identified and used to predict optimal angiographic projection angles during TAVI; predictions were compared to those from MDCT. Methods 1, 3, 4, and 5 yielded sufficient root enhancement with mild or moderate artifacts and aortic annulus, sinotubular junction, and mid-ascending aorta diameters similar to MDCT. Ungated C-arm CT (Methods 1, 3) required less contrast than ECG-gated C-arm CT (Methods 4, 5). Method 3 was optimal yielding images with high attenuation, few artifacts (2.0), and root measurements similar to MDCT using minimal contrast (36 mL). Predicted angiographic projections from Method 3 were similar to MDCT. Ungated C-arm CT during rapid pacing with aortic root injection required minimal contrast, yielded high attenuation and few artifacts, and aortic root measurements and predicted angiographic planes similar to those from MDCT.     

First rotavirus vaccine licensed: Is there really a need?

The first rotavirus vaccine was licensed in the United States on 31 August 1998 for the prevention of severe rotavius diarrhea in children. Despite this landmark in new vaccines, many pediatricians and public health professionals in Europe are uncertain of the need for this vaccine for the routine immunization of infants. In Europe, ample evidence suggests that rotavirus is the most common cause of hospitalizations for severe diarrhea among children, but proper studies documenting the disease burden of rotavirus or th cost-effectiveness of a rotavirus immunization program have only been conducted in the United Kingdom following epidemiologic models used in the United States. All children are infected with rotavirus during their first few years of life, 30-50% of diarrheal hospitalizations among children <5 years are due to this agent, and, by the age of 5 years, between 1 in 40 and 1 in 77 children in Europe and the United States may be hospitalized for rotavirus. The first vaccine is a live, oral preparation combining four different serotypes of rotavirus and administered in three doses with other childhood immunizations. The good efficacy against severe rotavirus diarrhea, the low risk of adverse side effects and the positive costeffectiveness equation have led the two major immunization advisory groups in the U.S. to recommend this vaccine for routine use in American infants. European physicians and policymakers should re-examine the epidemiology and disease burden of rotavirus diarrhea now that an effective method of prevention is at hand. □ Childhood immunization, diseases, rotavirus, vaccination .     

Tuberculosis in children: New diagnostic blood tests

The interferon-gamma-release assays were developed to overcome the pitfalls and logistic difficulties of the tuberculin skin test (TST) for the diagnosis of latent tuberculosis infection (LTBI). These blood tests measure the in vitro production of interferon-gamma by sensitized lymphocytes in response to Mycobacterium tuberculosis-specific antigens. Two interferon-gamma-release assays are registered for use in Canada: the QuantiFERON-TB Gold In-Tube assay (Cellestis Inc, Australia) and the T.SPOT–TB test (Oxford Immunotec, United Kingdom). Evaluation of these tests has been hampered by the lack of a gold standard for LTBI, and limited paediatric data on their use. It appears that they are more specific than the TST, and may be useful for evaluating TST-positive patients at low risk of true LTBI. Moreover, they may add sensitivity if used in addition to the TST in immunocompromised patients, very young children and close contacts of infectious adults. A summary of these tests, their limitations and their application to clinical paediatric practice are described.     

Pressure measurements and histological investigations after subcutaneous implantation of diffusion chambers in rabbits

Summary In separate experiments conducted in rabbits the pressure was measured in a subcutaneously implanted diffusion chamber system for collecting interstitial fluid, and a histological examination was made of the surrounding tissue. Three days after implantation the pressure was negative in all animals (- 4.23±2.5 mmHg). The diffusion chambers were well tolerated in tissue with minimal cell reaction. The lumen of the chambers remained free of cellular elements for up to 30 days.

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Druckmessungen und histologische Untersuchungen bei subkutan implantierten Diffusionskammern in Kaninchen

Zusammenfassung In getrennten Versuchen wurden bei Kaninchen Druckmessungen an einem subkutan implantierten Diffusionskammersystem zur Gewinnung interstitieller Flüssigkeit sowie histologische Untersuchungen des umgebenden Gewebes durchgeführt. Drei Tage nach Implantation war der Druck mit einem Mittelwert von - 4,23±2,5 mmHg bei allen Tieren negativ. Die Diffusionskammern zeigten eine gute Gewebsverträglichkeit bei minimaler Zellreaktion. Das Kammerlumen war bis zum 30. Tag frei von zellulären Elementen.

     

Lack of care givers'' knowledge causes unnecessary suffering in elderly patients

A comparative study of the personal hygiene of two groups of elderly women was carried out. The control group consisted of 35 healthy women aged 70-86. The experimental group consisted of 28 women aged 66-96 who were hospitalized in long-term care wards and who received help with their personal hygiene. The results show that care givers lack knowledge about the normal physiological ageing process in women, which prevents them from applying the eighth component of Virginia Henderson's nursing theory. In the group who received help with their personal hygiene, 25 (89%) had abnormal genital problems.