Biomedical subjects
Publications and source records attributed to C M Kerr.
Nursing care plans should provide clear evidence of the quality of patient care provided. A study of a care plan used in a coronary care unit found that nurses were critical of the plan's format. Nurses need adequate education on the use of the chosen care plan and an understanding of the nursing model on which it is based.
Spontaneous recovery, and recovery following neostigmine 20, 35 or 50 microgram.kg-1 administered at 10 or 25% of recovery of the first twitch of the train-of-four, was assessed in 80 patients after rocuronium administration under continued isoflurane anaesthesia. In an additional 40 patients, isoflurane administration was discontinued and neostigmine 35 or 50 microgram.kg-1 was given at 10 or 25% recovery. The administration of neostigmine reduced the recovery times significantly. A neostigmine dose of 20 microgram.kg-1 resulted in slower recovery compared with the higher doses, particularly when reversal was attempted at a first twitch height of 10%. Higher doses of neostigmine given at a first twitch height of 25% resulted in rapid reversal of block [mean (SD) times of 7.0 (4.8) and 6.4 (1.9) min with the 35 and 50 microgram.kg-1 doses, respectively, for attaining a train-of-four ratio of 0.8]. Discontinuing isoflurane did not alter recovery times. The incidence of emetic symptoms did not differ between groups, including one group that received atropine instead of glycopyrronium in combination with neostigmine. We conclude that rocuronium block can be antagonised safely using a neostigmine dose of 35 microgram.kg-1, although recovery may be slightly slower if administered at a first twitch of 10% of control.
An adult feline right ventricular pressure overload (RVPO) model was used to examine the two S6 kinase (S6K) isoforms, p70(S6K) and p85(S6K), that are involved in translational and transcriptional activation. Biochemical and confocal microscopy analyses at the level of the cardiocyte revealed that p70(S6K) is present predominantly in the cytosol, substantially activated in 1-h RVPO (>12 fold), and phosphorylated in the pseudosubstrate domain at the Ser-411, Thr-421, and Ser-424 sites. p85(S6K), which was localized exclusively in the nucleus, showed activation subsequent to p70(S6K), with a sustained increase in phosphorylation for up to 48 h of RVPO at equivalent sites of p70(S6K), Thr-421 and Ser-424, but not at Ser-411. Neither isoform translocated between the cytosol and the nucleus. Further studies to determine potential upstream elements of S6K activation revealed: (i) similar time course of activation for protein kinase C isoforms (alpha, gamma, and epsilon) and c-Raf, (ii) absence of accompanying phosphatidylinositol 3-kinase activation, (iii) activation of c-Src subsequent to p70(S6K), and (iv) similar changes in adult cardiocytes after treatment with 12-O-tetradecanoylphorbol-13-acetate. Thus, these studies suggest that a protein kinase C-mediated pathway couples pressure overload to growth induction via differential activation of S6K isoforms in cardiac hypertrophy.
Learning by experience involves being able to reflect on a personal happening and through a process of analysis, come to understand it. Such an activity should result in 'deep learning' when carried out in a structured way. Higher education establishments are keen to develop such learning methods in students, as a secondary effect of this form of learning is to create student independence from the teacher. This is a much sought after ability as recent government changes have meant higher student numbers without a corresponding rise in teacher numbers. This threatens the quality of student knowledge unless it is compensated for in some way. This study sets out to examine the learning of two student groups. The experimental design was that of group comparison using matched pairs of students. One group, the experimental group, were exposed to reflective teaching methods, whilst the other group (the control group) were exposed to conventional teaching methods only. At the end of a set period of time, the learning achieved in both groups was estimated using an especially designed test paper. The results obtained from both groups were compared and it was found that there was no significant difference obtained in the learning between the groups (P>5%) Therefore, we concluded that students learnt just as well using reflective methods when compared to the conventional methods of learning. However, the potential for enhancement of learning was evident and invites further investigation. All the students in this study were on the Diploma in Higher Education (Nursing) course. The subject area used throughout the study was in the biological sciences.
Once thought to be under control, tuberculosis is now the number one cause of infection-related death worldwide and the sixth most significant cause of death overall. Transmission occurs by inhalation of airborne droplet nuclei that can be viable for days, and is facilitated by substance abuse, poverty, overcrowding, malnutrition, and, most importantly coinfection with human immunodeficiency virus. This article describes the history and current status of tuberculosis as a growing global health problem, transmission of the disease, risk factors for the general public and health care workers, and prevention of the disease.
The Postanesthesia Care Unit (PACU) is an area of high risk for the transmission of Mycobacterium tuberculosis. The Centers for Disease Control (CDC) have recommended administrative controls, engineering controls, and personal protection devices to reduce the risks; nevertheless, perianesthesia nurses inhale airborne pathogens. The CDC guidelines are enforced by the Occupational Safety and Health Administration (OSHA). If an exposure occurs, the health-care facility has an OSHA-mandated course of action. The cost of follow-up of exposed persons can be high, depending on the patient census of the PACU at the time of unprotected exposure. This report presents the CDC guidelines for follow-up of exposure and costs based on typical surgical volumes and admission patterns for a large hospital with 10 thousand or more annual surgical procedures.
This paper reports a case study of student and senior nurses at the Royal Free Hospital, London, England. Qualitative methods were used to investigate the perceptions of nursing upon which students and senior nurses based their activities on the wards. Differences were identified between the ways in which students and senior nurses 'saw' their day-to-day tasks. Analysis showed that these differences were based upon differing levels of conceptualization. Student nurses were found to operate with low levels of conceptualization and were thus unable to categorize or group the patients, procedures or problems confronting them. Senior nurses, on the other hand, operated with a high level of conceptualization and were able to perceive similarities in objects, events and processes and to differentiate these into categories, classes or patterns. This allowed them to prioritize lines of action and to respond to situations in a rational and effective way. The problem for nurse education, then, is how best to enable students to develop a professional level of conceptualization. Strategies are identified by which senior nurses might enable student nurses to develop concepts in relation to their nursing activities on the wards.
Fungal peritonitis is a rare complication in patients on continuous ambulatory peritoneal dialysis. We report five recent cases and their management. The fungi isolated were Candida albicans, C. parapsilosis, Exophiala jeanselmei, Drechslera spicifera, and a Fusarium species. Chemotherapy was attempted with various regimens including oral ketoconazole, intravenous or intraperitoneal amphotericin B, and oral flucytosine. Pharmacokinetic studies were done in two patients receiving treatment with one of these drugs. Three patients were cured of their fungal infection. Three patients whose Tenckhoff catheters were left in situ died, whereas two patients whose catheters were removed survived. Our experience suggests that removal of the peritoneal catheter should be considered once the diagnosis of fungal peritonitis is established.
Circadian rhythms of body temperatures, pulse rate, and respiration rate were measured in 11 subjects every 4 h during certain periods on two submarine patrols. Data on systolic and diastolic blood pressure were also obtained on five crew members during the first period. All the subjects of the first patrol were on an 18-h watch schedule (6 h on, 12 h off). During the second patrol, three subjects were on an 18-h watch schedule and three were on a 24-h watch schedule. Cosinor analysis for positive (P less than 0.05) detection of rhythm demonstrated that all subjects on the 18-h watch schedule developed 18-h cycles of body temperature, pulse rate, respiration rate, and systolic and diastolic blood pressure, which were then superimposed on the persisting 24-h cycles of the same function. The three subjects on a 24-h watch schedule did not show the 18-h cycles. Moreover, additional 12-, 36-, and 48-h cycles (harmonics and subharmonics of 24-h cycles) were found in all subjects on both patrols, attesting to the disintegration of circadian cycles under these conditions. Average sleep time tended to decrease toward the end of the patrol.
Ingestion of excess salt may be an important factor in the development of hypertension in individuals who are predisposed to this disease genetically or through environmental factors. Some physicians and consumer groups have encouraged mothers to prepare their own baby foods, in part because of their concern that the physiologically unnecessary salt that is added by some commercial baby food manufacturers may lead to hypertension in adult life. This study presents data on the sodium concentration in 70 samples of homemade baby foods prepared by 36 mothers. The mean estimated amount of added salt was 0.41%/weight--64% higher than the maximum recommended by the Food and Nutrition Board of the National Academy of Sciences. Home-prepared foods had a sodium concentration 1,005% higher than similar baby food products made by Heinz and Beech-Nut and 24% higher than products made by Gerber. The data suggest that advice to parents to prepare their own baby food or to feed their infant food from the table should be tempered with the knowledge that these foods may contain higher salt concentrations than the commercial baby foods.