Performance of administrators, professionals, and paraprofessionals during community-based brain injury rehabilitation training

OBJECTIVE: Two related studies that evaluated the impact of a continuing education program about community-based rehabilitation on the performance of administrators, professionals, and paraprofessionals are presented. One study contained a second part that examined whether differences between pre-course test performance and post-course test performance might be accounted for by practice effects. DESIGN: Factorial mixed model designs. SETTING: University classroom. PARTICIPANTS: Three hundred and eight professionals, administrators, and paraprofessionals from a variety of community-based rehabilitation programs. INTERVENTION: The 4-day graduate-level course focused on three content areas: brain and behavior relationships, behavioral and cognitive intervention strategies, and a rehabilitation philosophy that emphasizes individual client rights. MAIN OUTCOME MEASURE: An examination completed before and immediately after taking the course. RESULTS: Professionals and administrators perform better than paraprofessionals when tested at the beginning and end of the training. However, the absolute differences among these groups were not substantial. In addition, the rate of learning course content was the same for administrators, paraprofessionals, and professionals. CONCLUSIONS: The results support the usefulness of training for all levels of staff and suggest that all levels of staff benefit in an equal fashion.     

A simplified habit reversal treatment for pica-related chewing

OBJECTIVES: The objectives of the study were to assess the suitability of a service for provision of emergency hormonal contraception by nurses. METHODS: Retrospective analysis was carried out of data obtained from the case records of 500 consecutive women who attended ABACUS (a city center-based family planning clinic in Liverpool, UK) for emergency contraception during the 7th and 9th months of the first year (1994) of the service. Similar data were collected for 100 consecutive women during 1 month of the third year (June 1996). The number of women who received emergency hormonal contraception was noted. In particular, details pertaining to the reasons for referral to the doctor and the trend of referrals were noted. RESULTS: The results indicate that during the first year the nurses independently issued emergency hormonal contraception to 37% of the women. They referred the remaining 63% to the medical staff. One-third of referrals were for ongoing contraception, especially oral contraception. Another third of referrals appeared to be due to 'nurse anxiety', as no medical or other cause was found for these referrals. During the third year, nurses dispensed emergency hormonal contraception to 64% of women. Among the remaining 36% of women who were referred to the doctor, 19% needed hormonal contraception. Referral reflecting 'nurse anxiety' significantly declined (1%) compared to the first year of service. CONCLUSIONS: Ongoing contraception, particularly initiation of oral contraception, was one of the main reasons for referral during the first year. Referral due to 'nurse anxiety' significantly declined with continued experience and may have reflected initial anxiety and the learning curve. With increased experience over the first 2 years, the outcome of this service showed encouraging improvement. The nurses now dispense emergency hormonal contraception to a majority of women.     

Factors affecting serum oxytetracycline levels in beef calves

Fifteen Aberdeen Angus steers, 295-364 kg, were dosed with either 4.4 or 11 mg of oxytetracycline hydrochloride/kg im. The antimicrobial activity of the serum was determined periodically, and the resulting data were treated statistically to determine the sources of variation. Variance in serum levels of oxytetracycline activity was attributed to dose, time of bleeding, order of dosing, animal, and assay. The total variance component was proportionately greater for the 11-mg/kg dose than for the 4.4-mg/kg dose. Animal variance increased with the higher dose level of oxytetracycline. The influence of dose on serum level was tested by applying a t test to the mean serum levels and their standard deviations at each bleeding time. The 4.4- and 11-mg/kg serum levels were significantly different (p less than 0.01) at all bleeding times. The 4.4-mg/kg serum levels mutliplied by 2.5 were not significantly different (p less than 0.05) from the 11-mg/kg serum levels at all bleeding times.     

Recurrent urothelial tumors following surgery for transitional cell carcinoma of the upper urinary tract

A retrospective analysis of 74 cases of transitional cell carcinoma of the renal pelvis and ureter treated at this institution over the past 30 years is presented. When nephrectomy alone or incomplete nephroureterectomy was performed, subsequent transitional cell carcinoma developed in 30% of the ureteral stumps. Subsequent bladder carcinoma occurred in 25% of the patients with primary upper urinary tract carcinoma. The type of initial surgery performed did not appear to influence this incidence of subsequent bladder tumors. Contralateral upper urinary tract carcinoma developed in only one patient. When nephroureterectomy is performed for carcinoma of the renal pelvis and ureter, a cuff of bladder that includes the ureteral orifice should be removed to obviate recurrent disease in the ureteral stump. Since single-incision nephroureterectomy did not include the intramural ureter in 50% of the cases in which it was performed, a second incision may be required for adequate exposure.     

Esophageal reconstruction with free jejunal grafts: an experimental study

Replacement of a long segment of esophagus for esophageal atresia or severe stenosis remains a special problem in children. The following studies were designed to test the hypothesis that a section of small bowel without serosa could survive as a free autologous transplant to replace part of the mediastinal esophagus. Laparotomy was performed in 20 adult cats, a loop of small bowel was resected and an end-to-end jejunojejunostomy was completed. The serosa of the resected bowel was removed and the mucosa-muscularis graft was used to replace a segment of the middle esophagus that was resected via a right thoracotomy. The interposed graft was entirely wrapped with adjacent skeletal muscle flaps. Postoperative studies include barium swallow and cine esophagograms, histology and blood vessel casts. Results are presented which show anatomical and functional survival of 16 grafts without blood vessel anastomoses or intrinsic vascular pedicles.     

Outcome of unsuspected pneumococcemia in children not initially admitted to the hospital

The records were reviewed of 97 episodes of unsuspected pneumococcemia in children not initially admitted to the hospital. Antimicrobial agents were prescribed at the first visit for 46 children; at the second visit 37 of them were improved and nine were not. No antimicrobial agents were prescribed at the first visit for 51; at the second visit 16 of these patients were improved and 35 were not. Pneumococcemia persisted in two treated children and in 13 untreated children. Meningitis was identified later in four children (two treated and two untreated). Although pneumococcemia in children may be a transient event, it may also persist or result in meningitis or other localized infections.