The development of peer reflective supervision amongst nurse educator colleagues: An action research project.

This action research study developed the use of peer reflective supervision (PRS) amongst eight nurse educators contributing to an undergraduate Adult Nursing programme at a UK University. During the academic year (2013-14), nurse educator co-researchers met for an introductory workshop and then met regularly in pairs to facilitate each other's reflection. This provided an opportunity for nurse educators to reflect on identified issues linked to their role with a facilitative peer. Educators met three additional times in a Reflexive Learning Group (RLG), to gather data on their use of PRS. Audio-recordings from the RLGs were transcribed and analysed using Norton's (2009) thematic analysis framework. Co-researchers iteratively validated the data and an external validation group critically viewed the evidence. Overall, seven themes were generated from the three research cycles. These were: PRS as a Valuable Affirming Experience; Time Issues; Facilitation- Support, Trust and Challenge; Developing a Flexible 'Toolbox'; To Write or Not to Write; Drawing on Literature; and Requirement for Action. Findings add new evidence regarding use of a flexible toolbox of resources to develop reflection and offer practical guidance on the development of PRS. Nurse educators often experienced similar concerns, and a facilitative supervision structure allowed co-researchers to positively explore these. Recognition of work pressures and requirement for time and space for reflection was highlighted, particularly regarding writing, and exploring the literature, to develop critical analysis of experiences. The importance of action as part of the reflective process was emphasised. Co-researchers reported positive personal change as well as the opportunity to highlight issues through their reflection for further action within the organisation. The study adds constructive evidence for the use of reflection to explore professional work, make sense of experiences and develop positive action. It has transferability to a wider international audience interested in the development of reflection amongst colleagues and the use of insider research techniques to challenge and develop practice.

Audit of stapedectomy in the north west of England for 1996 and an analysis of the criteria used to describe success.

A questionnaire was used to collect information related to stapedectomy from all the NHS Trusts in the North West region. The data collected included the identity and rank of the surgeon, the age and sex of the patients, the side of the operation, the audiometric values of the air conduction audiogram preoperatively and postoperatively, and an account of any complications. The results were analysed and compared to national and international standards. The criteria for analysis of success in surgery for conductive hearing loss were reviewed.

A ten year audit of the management of cancers of the larynx and pharynx.

The Chief Medical Officers' expert advisory group (The Calman Hine report (1994) for the commissioning of cancer services suggested that services in the district general hospitals (DGH) should be called 'cancer units' and that such units should be closely linked to 'cancer centres'. The objective of these proposals would be to improve the quality of care to cancer patients. The report also acknowledges that these proposals are based on an inadequate understanding of the epidemiology of cancer within England and Wales and the way in which current configuration of services affects outcome. The authors make a plea for better documentation and recording of treatment and outcomes (i.e. audit) to fill this gap. Registration in cancer registries is of limited value in assessment of outcomes of care owing to lack of detail. This paper describes an audit of head and neck cancer in one department and attempts to define which patients might benefit from referral from the cancer units to the 'centres', and conversely, which patients would be better managed in the cancer units. If all patients with cancer of the head and neck were referred, the service in the cancer centres would be overwhelmed. Some system of triage will therefore be essential.

Leiomyosarcoma of the tongue: a very rare tumour.

We describe a leiomyosarcoma of the tongue in a 60-year-old man. The diagnosis was supported by immunohistochemical positivity for desmin and alpha-1 smooth muscle actin.

Intralaryngotracheal thyroid.

A case of intralaryngotracheal thyroid in a 57-year-old man is presented. The treatment modalities are considered and the previous literature is reviewed.

Protein synthesis in pulmonary alveolar macrophages. Source of amino acids for leucyl-tRNA.

Extracellular, intracellular and tRNA-bound leucine pools of the adherent pulmonary alveolar macrophage were examined to determine the relationships between them and the precursor for protein synthesis. When cells were cultured in media of various leucine concentrations, the patterns of isotope distribution in intracellular and extracellular leucine did not correlate with the patterns seen in protein-bound leucine. hence, the free leucine pools cannot be used reliably as precursors for calculating rates of protein synthesis. tRNA-bound leucine, however, behaved isotopically as if it were the precursor. Constant synthetic rates were calculated using the tRNA specific activity over a wide range of leucine concentrations. In addition, by measuring the tRNA-bound specific activities of three different amino acids, leucine, valine and phenylalanine, and their respective specific activities in protein, we were able to calculate independently three separate but identical synthetic rates. At physiological amino acid concentrations, the macrophage intracellular leucine pool and the tRNA-bound leucine pool received less than half of their amino acids from extracellular sources. At 5 mM external leucine, the intracellular specific activity was indistinguishable from that of the medium leucine, but the specific activity of the tRNA-bound leucine pool remained only about 50% that of the extracellular value. The most straightforward interpretation of why the tRNA-bound leucine did not flood with external label under conditions where the intracellular pool has reached equilibrium is to propose that some portion of the leucine for protein synthesis is derived directly from protein turnover before the degradation products have mixed with the common amino acid pool.

Effects of kaolinite on amino acid transport and incorporation into protein by rabbit pulmonary alveolar macrophages.

A study was made of the effects of kaolinite, an aluminum silicate found in cigarette smoke and in alveolar macrophages of cigarette smokers, on the in vitro function of rabbit alveolar macrophages. Macrophages lavaged by standard procedures were incubated as adherent monolayers in the presence or absence of kaolinite, and amino acid incorporation into protein and transport subsequently measured. In the presence of dialyzed serum, kaolinite slightly inhibited incorporation into protein during the first 2 to 3 hr of incubation, after which incorporation ceased and a large percentage of newly synthesized protein was released (50% effect at approximately 0.5 mg/ml kaolinite). A dual-isotope experiment indicated that any change in the synthesis of protein which may have occurred was not selective for any protein or group of proteins. Kaolinite also stimulated noncompetitive amino acid accumulation after 2 to 3 hr in the presence of serum. The effects of kaolinite were immediate when incubations were conducted in the absence of serum. Control experiments showed all of the effects of the aluminum silicate to be on the cells and not on the incubation medium. These results suggest that kaolinite is cytotoxic and exerts its effects by a mechanism similar to that proposed for magnesium silicates and silica, in which the naked silicate is immediately cytotoxic, but if coated with serum protein must first be uncoated by lysozomal enzymes before destroying the cells.

Acute stress and the brain norepinephrine uptake mechanism in the rat.

The kinetic constants for norepinephrine uptake in cerebral cortical homogenates were determined in vitro immediately following an acute stress consisting of either forced immobilization, cold-wet exposure, combined cold-plus-restraint, swim stress, or electric footshock in the rat. The kinetic constants, apparent Km and Vmax, for uptake of 3H-l-norepinephrine were significantly increased only following 10 min swim at 22 degrees or following 5 min electric footshock. When severe hypothermia accompanied the stress, the findings suggested that a profound reduction in body temperature was associated with depressed responsiveness of brain noradrenergic mechanisms to stress including decreased uptake kinetic constants. In a series in which the duration of electric footshock was varied from 2 to 30 min, it was noted that the NE uptake kinetic constants were increased at 5 min, but were similar to paired controls at 2, 10 and 30 min following the onset of footshock. It was concluded that various acute stresses did not elicit a generalized response of the cortical NE uptake mechanism to stress in the rat. Furthermore, when uptake kinetic constants did change with stress, the values were often within the range of normal values seen in the rat.

Osteoradionecrosis of the temporal bone.

A series of twenty-nine cases of osteoradionecrosis of the temporal bone is described. Two patterns occur: a localized involvement of the tympanic plate which resolves after the spontaneous separation of a sequestrum of bone, and a more diffuse necrosis of the temporal bone with a high risk of involvement of adjacent structures, in particular the brain, labyrinth and facial nerve and to a lesser extent the temporomandibular joint and the parotid gland. Localized osteonecrosis occurs more commonly when the temporal bone is in the periphery of an irradiated field whereas irradiation aimed primarily at the temporal bone is more likely to be followed by diffuse disease. The use of megavoltage irradiation has not led to the disappearance of the complication which may occur as much as twenty years after the completion of the course of radiotherapy.