Is a nursing shortage on the way?

682 patients underwent treatment for varicose veins of lower extremities (VVLE). 641 patients with thrombophlebitis of VVLE were operated: in 62.9% of patients urgent operation and in 37.1% delayed operation after conservative treatment were made. Operation procedure comprised removal of all thrombotic varicose veins and ligation of communicant veins. The treatment of acute thrombophlebitis affecting anatomically intact veins in 41 patients was conservative. Comparative evaluation of the results of treatment evidences, that active surgical policy is justified as it leads to a decrease of complication rate, shortening of hospital stay duration 2 times and reduction of disability period. Conservative treatment of acute thrombophlebitis in intact veins is advisable.     

HELLP syndrome: undiagnosed in a case of impending rupture of uterus. A case report

Eleven patients with chronic renal failure who were being treated with haemodialysis three times a week were monitored for a total of 34 haemodialysis sessions. Erythrocyte 2,3-biphosphoglycerate (2,3-BPG) concentration was analysed immediately before initiation of bicarbonate haemodialysis and 1 h afterwards. The 2,3-BPG concentration was expressed relative to the haemoglobin tetramer (Hb4) concentration as the 2,3-BPG/Hb4 ratio and compared with blood gas analyses and biochemical variables important for characterizing uraemia. During the first hour of haemodialysis the 2,3-BPG/Hb4 ratio decreased (p < 0.002), but the magnitude of the decrease did not significantly correlate with the 2,3-BPG/Hb4 ratio measured before haemodialysis (p=0.104). The decrease is most likely to be caused by the haemodialysis procedure itself. Mechanical stress on the erythrocytes is believed to cause the 2,3-BPG to escape; it is then removed by haemodialysis. Physiologically, an increase in 2,3-BPG would be expected to counteract the hypoxia which is frequently observed during haemodialysis. However, the present results show the opposite, a decrease in 2,3-BPG. No significant correlation was shown between the haemoglobin concentration and the 2,3-BPG/Hb4 ratio before dialysis (p=0.414). The pH showed a significant positive correlation with the 2,3-BPG/Hb4 ratio before dialysis, whereas the arterial pO2 and the 2,3-BPG/Hb4 ratio before dialysis were insignificantly negatively correlated. The concentrations of calcium, phosphate, creatinine, urea and albumin did not correlate significantly with the change in 2,3-BPG/Hb4-ratio after 1 h. The 2,3-BPG/Hb4 ratio (p=0.03) sampled just before dialysis correlated significantly and positively with the total weekly dosage of erythropoietin given to the patients.     

Historical research in nursing: standards for research and evaluation

Historical research, a method of inquiry that combines science and literature, often supports a common thesis that an informed understanding of nursing history provides insights that can contribute effective approaches to current professional issues. Historical research was formally recognized by the American Nurses Association (ANA) in 1965. A review of 11 recent historical research studies supports the concept that adherence to established standards of research and presentation contributes to the value of historical research. While relating an interesting story is an intrinsic element of historical research, the research gains purpose and meaning when the presentation of data includes a statement of purpose utilizing a research question, a review of literature establishing a relation to the greater nursing community, and a concluding analysis relating the research to current and future professional issues.     

The case for case studies in nursing research: the problem of generalization

The development and progression of human breast neoplasia is characterized by the accumulation of numerous somatic genetic alterations. Although mutation of the p53 tumor suppressor gene is one of the most common alterations identified in invasive carcinomas, it is not clear whether mutations usually occur in noninvasive lesions before the development of invasion. To investigate the presence and heterogeneity of p53 mutations in breast neoplasia, we studied a morphological spectrum of paired lesions including invasive carcinomas and adjacent noninvasive epithelial lesions. Using 18 invasive ductal carcinomas with known p53 mutations, tissue samples were microdissected from formalin-fixed, paraffin-embedded tissue sections, and mutations in exons 4-8 of the p53 gene were identified by PCR amplification, single-strand conformational polymorphism, and direct sequencing. Multiple geographically distinct foci of invasive carcinoma were microdissected from six different invasive carcinomas, and all samples from each case had the same mutation. The absence of mutation heterogeneity provides evidence that p53 mutations occurred at the time of, or before, the clonal selection of the dominant component of the invasive carcinoma. To delineate the timing of p53 inactivation further in these cases, histological slides were reviewed to identify all noninvasive epithelial lesions. There were eight cases with associated ductal carcinoma in situ (DCIS), and in total, 27 distinct tissue samples representing a spectrum of histological subtypes and grades of DCIS were microdissected. In all 27 samples, the identical p53 mutation was identified in the DCIS as was present in the invasive carcinoma. In contrast, no p53 mutations were identified in any of the 21 microdissected foci of epithelial hyperplasia analyzed, including one sample with atypia. Together, these findings provide support that p53 mutations commonly occur early in breast neoplasia, usually at the stage of DCIS, but are not often identified in foci of hyperplasia. These findings support an important biological role for p53 mutation in progression from noninvasive precursors in breast neoplasia and provide further evidence that p53 mutation could have potential use as a molecular marker.     

Preoperative hair removal: a case report with implications for nursing

Experimental acute subdural hematoma in the rat has been shown to produce a zone of apparent infarction under the clot, and excitatory amino acid toxicity appears to play a role in the damage observed. We report the effect of dextromethorphan, a commonly used antitussive and a noncompetitive NMDA-type glutamate receptor antagonist, on the volume of histologic damage seen at 72 h after acute subdural hematoma in the rat. Sixty-five Long-Evans rats underwent placement of acute subdural hematoma using the "cranial window" model. Fourteen animals received oral dextromethorphan, 10 mg/kg/dose, twice daily for 3 days, and an additional 20 animals also received a single 20 mg/kg intraperitoneal dose 15 min after clot placement in addition to the oral regimen. Control animals received equal volumes of sterile water. Brain lesions in all animals were characterized by well-circumscribed infarctions underlying the subdural hematoma. Lesion volume in control animals was 88.3 +/- 9.3 mm3 (mean +/- standard error of the mean), while animals receiving dextromethorphan had significantly smaller lesions, which was independent of dosing schedule (59.9 +/- 9.2 mm3)(p = 0.0403). Animal weight was also found to be a significant covariate (p = 0.038). Because of its safety in humans and efficacy as a neuroprotectant in a variety of models, dextromethorphan may be a promising agent for clinical use, particularly in children.     

The chief of nursing practice: a model for nursing leadership

The role and structure of the Canadian Health Care System and its facilities are changing rapidly. Regionalization, decentralization, and flattening of hierarchical structures have occurred in governments and institutions. Traditional management roles, including the Vice President/Director of Nursing have been eliminated. There is a need to create a new model of nursing leadership if nurses are to continue to provide quality patient care. This article describes the initiative at Women's College Hospital to meet the expressed needs of nurses by developing a unique nursing role. The development of the chief of nursing practice role is defined within the context of the changing environment and Kanter's theory of empowerment. The position of the chief of nursing practice is a role model for nursing leadership and one that is pivotal for the professional identity of nursing, and for the provision of high quality patient care.     

Child care research: A case for Canadian national standards.

Research on child care is reviewed with respect to the effects of (1) licensing/regulation and (2) teacher education on the provision of high quality care for young children and developmental outcomes. A model is proposed indicating direct and indirect links between licensing and regulation, teacher education, the quality of child care, and child development outcomes. Discussion focuses on critical differences in American and Canadian demographics and attitudes toward social assistance and how this influences interpretation of research findings. Using the Canadian context as a framework, recommendations are made for national standards regarding (1) licensing and regulation of child care and (2) teacher education. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pulmonary embolism and impending paradoxical embolism: a role for transesophageal echocardiography?

Thrombolysis is advocated as the treatment of choice for hemodynamically important pulmonary embolism. This paper reports the case of a patient with subacute massive pulmonary embolism in which thrombolysis was not considered appropriate because transesophageal echocardiography demonstrated a patent foramen ovale and impending paradoxical embolism.     

Specialism in nursing: the case of nursing care for elderly people

Is elderly care nursing a specialty? This paper reports results from an interview-based study which aims to uncover the distinctive elements of nursing work with elderly people. Within the context of sociological literature on specialism it is concluded that a case for seeing elderly care nursing as a specialty area can be made. However, that case has implications for the continued marginalization of elderly people in society.     

Necrotizing fasciitis: case study of a nursing dilemma

Necrotizing fasciitis usually manifests as a low grade cellulitis that quickly deteriorates to a limb and life threatening soft tissue infection. Immediate surgical debridement is essential, after which wound management becomes the nurse's primary concern. Case #1 reports on a 72 year old female who, upon presenting to the ER with a "sore bottom," subsequently had these diagnoses: (1) anal-rectal abscess, (2) Fournier's gangrene, (3) ulcerative enterocolitis, (4) chronic blood loss/anemia, and (5) protein caloric malnutrition. After debridement, her anal-rectal wound extended from labia to left buttocks. Care was multidisciplinary and included applying a water based aloe gel and saline soaked gauze twice a day. After 45 days, the wound exhibited a pink base with granulation tissue and contraction of the wound edges. Case #2 reports on a 48 year old male with seroma of the left leg secondary to a crush injury. Within three days he developed deep vein thrombosis in that leg as well as two large seroma cavities on either side of the thigh. Care included packing with the aloe gel and saline soaked sponges. Two weeks after admission, the anterior wound was covered with a split thickness skin graft while partial closure of the lateral cavity was attempted unsuccessfully with retention sutures. After five weeks, healing was complete for the anterior wound and 95 percent complete for the posterior wound.     

The impending death of psychoanalysis.

Although psychoanalysis once dominated psychology, evidence now points to the waning influence of psychoanalytic theory in psychological science, psychiatric diagnosis, undergraduate instruction, and graduate training. In this article I describe 7 self-destructive behaviors exhibited by psychoanalysts that contributed to the precipitous decline of psychoanalytic theory in recent years. I then outline three strategies for retaining those features of psychoanalysis that are scientifically and clinically useful while jettisoning those that are dated and inaccurate. These strategies might enable scientific psychologists and research-minded practitioners to reinvigorate psychoanalytic theory during the 21st century. (PsycINFO Database Record (c) 2010 APA, all rights reserved)