Intercountry master's degree in nursing: policy implications for the Mozambican health system.

PURPOSE: Within an overarching evaluation framework, this study explored the experiences of course participants and administrators of an intercountry master's degree in nursing between South Africa and Mozambique. The lessons learnt were used to inform nursing and health policy for the Mozambican health system. METHODS: Kirkpatrick's four levels of training evaluation and a results-oriented approach to capacity change were integrated to form a hybrid evaluation framework to capture information about course implementation and the context/environment within which it was delivered. The study used quantitative and qualitative methods including a self-administered survey of course participants, document review, in-depth, semi-structured interviews with course administrators and two focus group discussions with course participants. FINDINGS: Participants enrolled in the course primarily to gain new knowledge and to improve health outcomes; course participants and administrators responded positively to the course design, course implementation and the quality of teaching. Knowledge and skills gained help to build graduates' confidence and boost their attitude towards nursing. Paradoxically, graduates felt powerless to transfer knowledge and effect change in practice. CONCLUSION: This collaborative, capacity development project produced postgraduate nurses in two areas of specialization, namely, critical care and trauma nursing and maternal and neonatal health. While course participants gained significant benefits in new skills and knowledge and a higher degree qualification, the rewards available to them in the public health system remain unclear. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Lessons learnt may serve to influence policy decisions about the role of the Ministry of Health and other stakeholders in sustaining the output and quality of postgraduate nurses for the Mozambican health system. A strategic approach informed by multilevel policies at government, organizational and managerial levels should be adopted to systematically minimize and remove barriers to the transfer and utilization of knowledge and skills in the workplace.

The use of experts and their judgments in nursing research: an overview.

Experts and their judgments are widely used in the fields of research, education, health care, law, commerce and technology. Expert judgment is known for its subjectivity and its potential for bias, which brings into question the accuracy and authenticity of judgmental data. At the same time there is acknowledgment of the valued contribution of judgmental data towards valid inferences in research and education. Maximizing the use of experts and their judgments has therefore become an endeavour of educationists and researchers alike. Since this is not a research article its purpose is to guide and assist nurse researchers with important methodological and ethical decisions when using experts. Experts must be used in the context of appropriate research methods such as the Delphi and Nominal Group techniques. Sampling of experts and sample size is determined by the type and quality of data and the availability of population data; purposive and maximum variation sampling techniques are recommended as appropriate when sampling experts. Universal research ethics must be applied with particular consideration of aspects which may influence the truth value of consensus among experts and marginalization of minority or extreme viewpoints. Quantification of judgmental data is recommended and is important to minimize bias and to increase the authenticity of research findings. The content includes: design considerations when using experts, sampling issues, ethical rules to be considered when enlisting experts and their judgments, optimal data collection approaches and managing judgmental data.

Journaling: a quasi-experimental study of student nurses' reflective learning ability.

The use of journaling or journal writing in clinical education is one of the strategies used to develop critical thinking. Reflective journal writing, as it is commonly known, can nurture many qualities of a critical thinker and promote thoughtful nursing practice. Using a quasi-experimental design in this study, reflective journaling was introduced to a sample of first year Bridging Course student nurses at a Private Nursing Education Institution, to assess its effectiveness in reflective learning. The study design enabled comparisons between two groups: one group of students assigned to do journaling (experimental group) and another group of students (control group) who did not journal. The students in the experimental group were given a period of eight weeks to journal their clinical experiences. At the end of this period, both groups were given an exercise, based on a clinical situation, to analyse reflectively and a comparison made on their performance. Descriptive statistics were used to analyse data and Fisher's Exact Test was used to determine the significance of differences observed within and between groups. The results showed that students in the experimental group performed better in exploring alternatives of action (p < 0.10) and formulating responses in similar future situations (p < 0.05) during the process of reflection. There was no significant difference between the groups' scores with regard to their ability to describe the clinical experience, to explore their related feelings, to evaluate the experience and to interpret/create meaning for themselves. Recommendations are made for continued student support and guidance during clinical education if reflection is considered to enhance reflective, thoughtful nursing practice.

Family-centred care in paediatric and neonatal nursing--a literature review.

A literature review of family-centred care in paediatric and neonatal nursing was undertaken as part of a research project. This research intended to ascertain the knowledge and attitudes of paediatric and neonatal qualified nurses and nurse educators towards family-centred care as it pertains to infants and children in hospitals in the Gauteng Province. A definition of family-centred care is difficult to formulate mainly due to the lack of consensus about its meaning. Additionally, the diverse societal contexts within which family-centred care is applied further complicate its definition. Internationally in developed countries, family-centred care is viewed as care, which is parent-led in consultation with the nurse practitioner. A family-centred care model for the South African context needs to be developed with the focus on parent participation, a precursor of family-centred care. This article traces the early developments in parental care for hospitalised children with specific reference to the USA, the UK and South Africa. Precursor concepts in family-centred care are described followed by a cursory overview of the reality of family-centred care, its cultural dimensions and matters of family strengths and choices in family-centred care.

Marrying modern health practices and technology with traditional practices: issues for the African continent.

One of the main sessions at the 2001 22nd Quadrennial Congress of the International Council of Nurses in Denmark explored the harnessing of modern health technologies for contemporary health care. The session theme of 'marrying the old and the new' is particularly important in societies where modern medicine and technology coexist with traditional approaches to health care; in this instance, its coexistence with traditional medicine in African societies. This coexistence has not been easy for many African countries. For some, overt exclusion from health care systems through prohibitive legislation has become the order of the day for traditional practitioners. On the other hand, there has been an increasing interest in traditional practices among modern health practitioners and a willingness to collaborate. Similarly, traditional practitioners are slowly beginning to incorporate aspects of modern medicine into their practice; notably the use of science and technology. This report describes the interface of modern medicine and technologies with traditional approaches to health care. Benefits and concerns raised by genetic, information, solar and environmental technologies at this interface, are discussed. Selected traditions and the challenges these bring to the practice arena, research, education and policy, are presented together with suggestions to reconcile old and new.

Autonomic dysreflexia and primary afferent sprouting after clip-compression injury of the rat spinal cord.

Spinal cord injury leads to many forms of autonomic dysfunction including autonomic dysreflexia, a condition involving recurrent episodes of paroxysmal hypertension and associated bradycardia. This hypertension may reach intensities that are life-threatening. We investigated autonomic dysreflexia and the sprouting of central processes of primary afferent neurons (a potential mechanism for autonomic dysreflexia) in a clinically-relevant calibrated clip-compression model of spinal cord injury in the rat. Autonomic dysreflexia was induced by colon distension in the conscious rats 2 weeks after severe (50-g) clip compression injury of the spinal cord at the 4th thoracic segment. The central arbor of small-diameter primary afferent fibers in laminae III-VII of the spinal cord dorsal horn was also assessed at 2 weeks after cord injury by quantitative morphometry, using calcitonin gene-related peptide as a marker. In response to colon distension, arterial pressure increased by 41 +/- 3 mmHg from a resting value of 109 +/- 4 mmHg, and heart rate decreased by 124 +/- 13 beats/min from a value of 515 +/- 16 beats/min (n = 7). Minimal locomotor function was recovered by these rats: by 2 weeks after injury they attained scores of only 3.1 +/- 1.3 on the Basso, Beattie and Bresnahan scale. Histopathology of the clip-compression lesion site in the cord consisted of extensive central necrosis extending several segments rostral and caudal to the lesion. Quantitative measures of the small-diameter afferent arbors revealed significant increases in area ranging from 20-27% in thoracolumbar segments caudal to the injury (n = 5) in comparison to sham-injured rats (n = 6). A second study was done to assess the impact of severity of injury on the relationship between the size of the primary afferent arbors and autonomic dysreflexia. At 2 weeks after milder (20-g) clip injury at T4, rats exhibited responses to colon distension that were not those associated with autonomic dysreflexia (n = 5). Arterial pressure increased by only 16 +/- 3 mmHg and heart rate tended to increase (+19 +/- 12 beats/min). These rats attained a locomotor score of 7.1 +/- 0.4 by 2 weeks. The lesions at the injury site also contained necrosis and mild cavitation within the gray matter. No change in the small-diameter afferent arbor was detected at 2 weeks after the 20-g clip injury at T4 (n = 6 rats). These findings suggest that after severe but not mild clip compression injury of the spinal cord, sprouting of the afferent component of the spinal reflex are contributes to the development of autonomic dysreflexia. Neither dysreflexia, nor changes in the afferent arbor size occurred after mild cord injury. This clinically relevant clip compression cord injury model, studied more frequently for locomotor function, is excellent for investigating mechanisms for the development of autonomic dysreflexia and strategies for its prevention.

Isoproterenol increases CREB phosphorylation and olfactory nerve-evoked potentials in normal and 5-HT-depleted olfactory bulbs in rat pups only at doses that produce odor preference learning.

Norepinephrine (NE) and serotonin (5-HT) are important modulators of early odor preference learning. NE can act as an unconditioned stimulus (UCS), whereas 5-HT facilitates noradrenergic actions. In this study, we examined the phosphorylation of an important transcription factor, cAMP response element binding protein (CREB), which has been implicated in long-term-memory formation (McLean et al. 1999) during NE-induced odor preference learning in normal and olfactory bulb 5-HT-depleted rat pups. We also examined NE modulation of olfactory nerve-evoked field potentials (ON-EFPs) in anesthetized normal and bulbar 5-HT depleted pups. Systemic injection of 2 mg/kg isoproterenol (beta-adrenoceptor agonist) induced odor preference learning, enhanced pCREB expression in the olfactory bulbs at 10 min after odor pairing, and increased ON-EFPs in normal rat pups but not in bulbar 5-HT-depleted rat pups. A dose of 6 mg/kg isoproterenol, which was ineffective in modulating these measures in normal rat pups, induced odor preference learning, enhanced phosphorylated CREB (pCREB) expression, and increased ON-EFPs in bulbar 5-HT-depleted pups. These outcomes suggest that NE and 5-HT promote specific biochemical and electrophysiological changes that may critically underlie odor preference learning.

Trauma patients' rights during resuscitation.

Doctors and nurses working in hospital emergency departments face ethical and moral conflicts more so than in other health care units. Traditional curricular approaches to health professional education have been embedded in a discriminatory societal context and as such have not prepared health professionals adequately for the ethical realities of their practice. Furthermore, the discourse on ethical theories and ethical principles do not provide clear-cut solutions to ethical dilemmas but rather serve as a guide to ethical decision-making. Within the arena of trauma and resuscitation, fundamental ethical principles such as respect for autonomy, beneficience, non-maleficience and justice cannot be taken as absolutes as these may in themselves create moral conflict. Resuscitation room activities require a balance between what is "ethically" correct and what is "pragmatically required". Because of the urgent nature of a resuscitation event, this balance is often under threat, with resultant transgression of patients' rights. This article explores the sources of ethical and moral issues in trauma care and proposes a culture of human rights to provide a context for preserving and protecting trauma patients' rights during resuscitation. Recommendations for education and research are alluded to in concluding the article.

Diffuse cerebral vasospasm with ischemia after resection of a cerebellopontine angle primitive neuroectodermal tumor in a child.

This case report describes a 15-month-old female who developed diffuse cerebral vasospasm after resection of a cerebellopontine angle primitive neuroectodermal tumor. The patient developed an acute dense left hemiparesis 16 days postoperatively with partial right ptosis. Initial magnetic resonance imaging and diffusion study were unremarkable, though a magnetic resonance angiography 1 day later demonstrated severe intracranial vasospasm of both carotid and vertebral arteries. The vasospasm was confirmed with cerebral angiography. The patient progressed to bihemispheric infarcts with laminar necrosis despite combination therapy with anticoagulation, pharmacological hypertension, hypervolemia, and nimodipine. The clinical course, radiographic, and pathological findings are presented.

Marshmallows cause an outbreak of infection with Salmonella enteritidis phage type 4.

Thirty-six cases of Salmonella enteritidis phage type (PT) 4 infection, mainly in children, were notified in one local authority in the two weeks beginning on 23 October 1995. Twenty-four cases and 42 controls nominated by cases were included in a case control study, which showed a significant association between illness and the consumption of marshmallow confectionery from a bakery. S. enteritidis PT4 was isolated from samples of the marshmallow, and all isolates had the same plasmid and pulsed field gel electrophoresis profiles. The marshmallow had been made using raw egg white, which shows that not all caterers follow the Department of Health's advice.

The changing clinical pattern of Reye's syndrome 1982-1990.

OBJECTIVE: To describe trends in the clinical pattern of Reye's syndrome in the British Isles between 1982 and 1990; and to determine the relation between any changes and the June 1986 warnings against the use of aspirin in children. DESIGN: Development, and application to reported cases, of a scoring system designed such that patients showing the typical clinical and pathological features of 'classical' Reye's syndrome scored highly. The relations between 'Reye scores' and a number of explanatory variables were explored using multivariable analysis. SETTING: British Isles. SUBJECTS: 445 cases fulfilling the Reye's syndrome case definition reported to the surveillance scheme between January 1982 and December 1990. MAIN OUTCOME MEASURE: Individual 'Reye score'. RESULTS: Cases with high scores were more likely to have occurred in the 4 1/2 year period before June 1986 compared with the subsequent period (p < 0.006). Numbers of cases in the low and intermediate score categories declined by about 50% after June 1986, whereas those in the high category fell by 79%. High scorers were more likely to have received aspirin (p < 0.0001) and were older than intermediate and low scorers (p < 0.008). No relation was identified between score and season of onset. CONCLUSIONS: The decline in Reye's syndrome after the aspirin warnings cannot be explained entirely, as has been proposed, by improved diagnosis of 'Reye-like' inherited metabolic and other disorders: this would not account for the greater decline of the high scoring subgroup which also contained those cases most likely to resemble 'classical' Reye's syndrome and to have received aspirin. This study provides further evidence for the role of aspirin in a subset of cases meeting the standard diagnostic criteria for Reye's syndrome and supports the need to consider this disorder as a heterogeneous group of conditions including Reye-like inherited metabolic disorders.

Continuous, on-line DNA sequencing using a versatile infrared laser scanner/electrophoresis apparatus.

A new apparatus for continuously detecting fluorescently labeled DNA fragments is based on infrared fluorescence technology. This technology combines state-of-the-art developments in chemistry, laser technology, and detection, while achieving improved reliability, sensitivity, and flexibility for applications including DNA sequencing. DNA molecules labeled with a novel infrared fluorophore are detected during electrophoresis using a scanning infrared fluorescence microscope. The microscope consists of a laser diode for exciting the fluorophore and a silicon avalanche photodiode for detecting the infrared emission. Optimum conditions for detection and throughput are obtained by adjusting electrophoresis, scanning and imaging parameters. Typical DNA sequencing runs (test templates) allow identification of over 500 bases per sample with greater than 99% accuracy.

Gelled diet for screwworm (Diptera: Calliphoridae) mass production.

A rearing system based on a diet gelled with Water-Lock G-400, a synthetic superabsorbent (poly(2-propenamide-co-2-propenoic acid, sodium salt)) (WL), was compared with the standard rearing system (liquid diet suspended in acetate fibers) for the mass production of screwworms, Cochliomyia hominivorax (Coquerel). The WL rearing system yielded 2% heavier pupae, 32% higher egg to pupa survival, and required 54% less diet and 88% less labor than the standard rearing system. Other advantages of the WL system include reduced susceptibility to suboptimal environmental conditions and labor practices and characteristics conducive to centralization and mechanization of rearing procedures.

A national outbreak of salmonellosis from yeast flavoured products.

A national outbreak of salmonellosis caused by a rare serotype occurred between July and November 1989. A total of 40 cases of Salmonella manchester infection were identified by the PHLS Division of Enteric Pathogens with a further 7 cases reported from Scotland. The median age of those affected was one year. All strains from the outbreak carried a 70mDal plasmid with a distinctive restriction endonuclease. A statistical association was found between infection and consumption of nationally distributed savoury corn snacks. Samples of autolysed yeast powder and flavourings used in the manufacture of many processed foods were also found to be positive for S. manchester.