The task of administering anaesthesia requires the clinician to be vigilant for long periods of time to detect the onset of adverse conditions. Large amounts of data must be analysed in real-time and, if a problem is detected, it must be diagnosed as a matter of urgency, this being done while other management protocols are being carried out. For these reasons it would be of benefit if automated decision support could be provided for anaesthesia monitoring, to lighten the cognitive load on the anaesthetist. The Sentinel anaesthesia monitor has been developed with this objective in mind. It uses a fuzzy time-domain pattern matching technique, termed fuzzy trend templates, to detect vaguely specified patterns in multiple physiological data streams. These patterns are representative of symptoms associated with undesirable patient states. The system is capable of detecting trends and states such as 'significant rise' and 'high', and associating vague duration and temporal intervals with individual trends. Fuzzy trend templates have proven to be quite intuitive to specify, given linguistic (anaesthetists') knowledge about the problem domain. Sentinel's implementation of fuzzy trend templates also uses an extension to fuzzy logic based on the theory of evidence, to handle situations where desired information is not available, for example, when sensors are not being used. In off-line testing, Sentinel has achieved sensitivity and specificity of above 90% in the diagnosis of seven common or serious conditions that can arise during anaesthesia.

Anesthesia, General↗

PubMedDate not supplied

Scores on the Nursing Child Assessment Teaching Scale for father--toddler dyads.

Fathers of 49 Canadian children (ages 13 to 24 months) were observed interacting with their child at home using the Nursing Child Assessment Teaching Scale (NCATS). Consensus ratings from two observers were used in the analysis. Compared with the NCATS reference data for 164 mothers of similar ethnicity and marital status with similar-aged children, mothers were more responsive than fathers in the interactions. Mothers had significantly higher scores on the overall Total NCATS score, on the Total Parent score, and on the Parent Contingency score than the fathers. In contrast, children were more responsive to fathers than mothers. Children interacting with their fathers had significantly higher Total Child scores and higher Child Contingency scores than those interacting with their mothers. Maternal and paternal age and education were not correlated to scores on the NCATS. Implications for practitioners are discussed and the results are compared to a study of mothers and fathers interacting with children ages 2 to 12 months old in which the observations were measured by the NCATS. Results suggest that NCATS cutoff scores used to identify mothers in need of intervention should be used with caution for father--toddler interactions.

Adult↗

PubMedDate not supplied

Women's experiences of barriers to support while caregiving.

This qualitative study explored women's perceptions of barriers to support during family caregiving in a Canadian setting. Twenty mothers of premature infants and twenty women caring for an older person who is cognitively impaired were interviewed in-depth over 18 months. Both groups of women preferred that support be offered to them and identified numerous barriers to requesting support. Perceived barriers included an obligation to provide care, loss of independence and self-esteem, concern for burden on others, the desire to excuse others from providing support, the inability to reciprocate support, fear of refusal or exposure, nonsupportive actions, the time and effort needed to coach others to provide effective support, and the lack of available, competent help. Some of these barriers reflect personal costs to the woman caregiver. Other barriers reflect societal norms that family caregiving is the responsibility of women.

Adult↗

PubMedDate not supplied

Minimal breastfeeding.

Current advice to breastfeeding mothers is that breasts must be emptied regularly and frequently to help maintain lactation. A method of maintaining lactation, minimal breastfeeding, in which mothers nurse once or twice a day without expressing the breast between breastfeedings was investigated. A convenience sample of 30 mothers using minimal breastfeeding was interviewed monthly until weaning. These mothers used minimal breastfeeding as a method of slow weaning, a way to combine breastfeeding and work, and a means of comfort-nursing older infants. In all cases, weaning occurred because the mother or the infant chose to wean, not because of insufficient milk. The authors conclude that for working mothers who cannot express between feeds, breastfeeding can still be maintained, and that minimal breastfeeding is an important alternative to weaning.

Adult↗

PubMedDate not supplied

Use of nursing diagnosis with population groups.

The authors report findings of a study done to examine the use of nursing diagnosis by community health nurses (n = 15) and students (n = 20) who worked with population groups. Results of the analysis of the open-ended questionnaires and student assignments indicate that many of the diagnoses, both wellness and deficit, could be classified in relation to the concepts present in published classification systems. Issues raised by the study about the use of nursing diagnosis with population groups include: incorporating wellness diagnoses in the NANDA Taxonomy, identifying when a group diagnosis is appropriate, determining whether to give priority to a behavioral or an environmental focus, and selecting the level of abstraction.

Community Health Nursing↗

PubMedDate not supplied

Impact of carotid endarterectomy upon cognitive functioning. A systematic review of the literature.

BACKGROUND AND PURPOSE: The extent to which carotid endarterectomy (CEA) influences cognitive functioning has been the subject of a number of studies often with conflicting conclusions. This paper systematically reviews the literature in an attempt to clarify this issue. RESULTS: Although the majority of studies (16/28) reported an improvement in cognition after surgery, a substantial minority (12/28) found no change. Studies before 1984 tended to report an improvement, while later studies tended to report no change in cognition. Cognitive improvement was also more likely the longer the time interval between CEA and assessment. The studies were found to differ on many methodological factors, e.g. sample size, type of patient and control group, severity and side of carotid stenosis, the range of cognitive tests and timing of postoperative assessment. CONCLUSION: Given the conflicting findings, and the methodological issues, it is not possible to draw a clear conclusion regarding the impact of carotid endarterectomy upon cognition. Future research which pays attention to these methodological factors is needed in order to adequately resolve the current debate.

Carotid Arteries↗

PubMedDate not supplied

Effect of experimental ischemia on neurotransmitter amines in the gerbil brain.

In the gerbil cerebral infarction was produced by unilateral carotid ligation. 3.5 hours later, when the neurological deficit was fully developed, hemisphere dopamine (DA) showed little change from normal. It seems unlikely that changes in DA are the direct cause of the turning behavior shown by these animals. Slight changes in norepinephrine (NE) occurred on the operated side but 4 hydroxy-3-methoxy phenyl-ethyleneglycol sulphate (MOPEG-SO4) levels were not affected. Significant falls in 5-hydroxytryptamine (5-HT) and 5-hydroxyindole acetic acid (5-HIAA) were found on the operated side but there was also a trend for both 5HT and 5-HIAA to fall on the unoperated side. These changes occurred in clincally affected and unaffected animals and their clinical significance is unproven.

Animals↗

PubMedDate not supplied

The effect of haematocrit on cerebral perfusion and clinical status following carotid occlusion in the gerbil.

The effect of haematocrit on the sequelae of carotid occlusion has been studied in the gerbil stroke model. In 72 animals one carotid artery was clipped. After 30 minutes, the area of cerebral hemisphere filling with a carbon suspension administered intravenously was measured on coronal brain slices and related to the haematocrit. Exchange transfusion of autologous packed red blood cells or plasma produced a haematocrit range of 26% to 59%. At high haematocrit a larger area of non perfusion was more commonly encountered, and the anterior cerebral artery territory was more frequently affected along with that of the middle cerebral. Fifty-seven animals had temporary occlusion of both carotid arteries. Survival was adversely affected at high haematocrit. The role of haematocrit in affecting the pathophysiology of cerebral ischaemia is discussed.

Animals↗

PubMedDate not supplied

Prognostic significance of severity of carotid atheroma in early manifestations of cerebrovascular disease.

Two hundred and fifteen patients with transient ischaemic attacks, reversible ischaemic neurological deficit, or completed stroke were studied angiographically. The appearances of the carotid bifurcation were classified as normal, irregular, stenosed or occluded and the possible prognostic significance of the angiographic categories sought in a follow up study. Over a mean follow up period of 4.1 years 12% of patients were found to have died, and 10% had had a stroke. Fourteen percent had TIAs and 5.1% had sustained a myocardial infarction. Mortality and stroke risk were greatest with carotid occlusion which was least often followed by TIAs. Strokes, but not TIAs, were less frequent in the presence of normal angiograms.

Arterial Occlusive Diseases↗

PubMedDate not supplied

Effect of blood pressure on prevalence of carotid atheroma.

In an attempt to elucidate the mechanism by which hypertension acts as a risk factor for major non-haemorrhagic stroke, its effect on the prevalence of carotid atheroma has been studied angiographically. The carotid angiograms of 269 patients with cerebral tumours have been reviewed for evidence of coincidental atheromatous change. The prevalence of signs of arterial disease at the carotid bifurcation proved to be greater amongst patients with an elevated casual blood pressure reading, though the effect was small and confined to subjects over 50 years of age. It is argued that other factors must contribute to the connection between hypertension and the risks of cerebral infarction.

Adult↗

PubMedDate not supplied

Atrial fibrillation, TIAs and completed strokes.

A retrospective survey of 1076 patients with completed strokes and 789 with transient ischemic attacks (TIAs) revealed that 5.6% of those with completed strokes but only 1.6% of those with TIAs were in atrial fibrillation. TIAs in the presence of atrial fibrillation tended to last longer than 60 minutes except in individuals who had coexistent carotid disease that might have been the source of their attacks. It is suggested that emboli from the fibrillating atrium rarely cause brief TIAs, and more usually cause 'long' TIAs or completed strokes.

Adult↗