The role of the community nurse on health committees.

With the changes in health care occurring in South Africa, new functions concerning the community nurse are being presented. The goal of the study was to explore and describe the role of the community nurse in health committees. An explorative, descriptive design was used and the empirical part was undertaken within the context of a metropolitan local authority. After conducting a literature study, six major roles of the community nurse on health committees were identified. After that a questionnaire was presented to community nurses to explore and describe their perceptions about the role of the community nurse on health committees. An interview schedule based on the literature study was drafted for presentation to selected members of health committees. Lastly guidelines describing the role of the community nurse on health committees were developed based on the findings of the study.

Mersilene mesh chin augmentation. A 14-year experience.

During the past 20 years, a variety of alloplastic materials have been introduced for chin augmentation. Mersilene mesh (Ethicon, Sommerville, NJ), introduced in 1950, demonstrates many qualities that make it an ideal implant. This article reviews the senior author's (S.W.P.) successful 14-year experience using Mersilene mesh chin implants. Between 1983 and 1997, 264 patients underwent chin implantation procedures. The results show a low rate of infection (0.8%) and displacement (1.5%). There were 14 temporary paresthesias and no cases of permanent anesthesia. There were no incidences of absorption, rejection, or extrusion. Mersilene provides a soft, natural appearance to the chin, and it continues to be our choice for chin implantation.

A ferrite core/metallic sheath thermoseed for interstitial thermal therapies.

An alternative form of ferromagnetic seed for thermal therapy has been developed following Matsuki, Murakami, and their colleagues [1]-[4]. A nearly lossless ceramic ferrite core (FC) is surrounded by an electrically conductive sheath. The FC has a high relative intrinsic permeability, typically 3000 at low magnetic field strengths, and a sharp transition from the ferrimagnetic state to the nonmagnetic state. The sheath is either a metallic tube or coating on the core. When this composite seed is excited with a radiofrequency magnetic field, large eddy currents are induced in the metallic sheath (MS) due to the concentrated magnetic flux in the core leading to Joule heating. Advantages of this configuration are that this ferrite core/metallic sheath (FC/MS) thermoseed has high power absorption efficiency and a sharp transition compared to ferromagnetic alloy systems; means of optimizing efficiency are apparent from simple expressions; the outer sheath can be of any biocompatible metal; the production method for the ferrites leads to large quantities of seeds with reproducible properties. The FC/MS configuration solves many of the technical problems that have hindered the clinical implementation of thermally regulating ferromagnetic implants for thermal therapies.

The child with HIV in day care and school.

HIV-infected children attend day care programs and schools in communities throughout the United States. This article examines the care of these children in the school and child care environment. Legal issues of school access, confidentiality, and school policies are discussed. Specific health, developmental, psychosocial, and educational needs of infected children are presented along with the roles that the nurse can play, as advocate and care provider for the child and family, and as school/community resource and educator.

Development and evaluation of the Active Treatment Client Rights Checklist.

The role of active treatment has been recognized as vital to the habilitation of persons with mental retardation; however, evaluating the provision of active treatment has been difficult. This study describes the development of the Active Treatment Client Rights checklist (ATCR), which was designed to facilitate the assessment, monitoring, and implementation of readily observable client active treatment services. This investigation provides an explanation of item content, initial reliability data (Phase I), and the results of implementation of the ATCR over a 2-year period in an ICF/MR facility with 29 living units serving nearly 500 clients (Phase II). The ATCR is highly reliable, valid, and useful in enhancing staff provision of active treatment. The most sensitive indicator of active treatment was shown to be related to frequency of functional interactions between clients and staff.

Educating school nurses to care for HIV-infected children in school.

Effects of an educational program on school nurses' knowledge and attitudes about human immunodeficiency virus (HIV) infection in children and changes in practice was investigated. Participants (N = 205) attended a one-day workshop held at 11 sites in New Jersey. Content was clinically focused and derived from a needs assessment of a sample of school nurses throughout New Jersey. An adult education format was used, with interactive and affective teaching strategies modeled on the AIDS Training Program of the California Nurses' Association. Subjects were pretested and posttested for knowledge and attitudes about HIV in children. An identical posttest mailed three months later included a self-report of change in practice since attending the workshop. Knowledge and attitude scores were significantly higher at program completion (p < .0001). Three months after the program, knowledge scores had fallen but not to pretest levels. No significant difference existed between attitude scores after the program and three months later. On self-report of change in practice, respondents indicated they institute or improved universal precautions, and were more comfortable in teaching children, staff, and their communities about HIV.

Case study of neuroleptic-induced akathisia: important implications for individuals with mental retardation.

Neuroleptic-induced akathisia is a relatively common side effect of neuroleptic medication, characterized by a subjective sense of restlessness and the inability to sit still. It has been associated with aggression, anxiety, sleep disturbance, and suicide among patients who have mental illness. These side effects are fairly well-researched in the psychiatric literature but rarely addressed in the mental retardation literature. The prevalence, types of akathisia, differential diagnosis, and treatment were reviewed and a relevant case report presented. The importance of the diagnosis and treatment of neuroleptic-induced akathisia in individuals with mental retardation was discussed.

Heating pattern of helical microwave intracavitary oesophageal applicator.

Helical microwave intracavitary oesophageal (HMIO) applicators were designed to operate at frequencies of 433 MHz and 915 MHz. Heating patterns were studied within muscle-equivalent phantom by thermographic camera and fibreoptic thermometers. The results showed that frequency significantly influenced the microwave heating pattern. The 433 MHz applicator had a single power deposition region, the longitudinal specific absorption rate (SAR) distribution appeared to be nearly even, and the maximum SAR value occurred close to the centre of the active length of the applicator. The 915 MHz applicator had two power deposition regions, the peak SAR values occurred at about 1/4 and 3/4 of the active length respectively. The radial SAR distribution suggested that there is no obvious difference between the 433 MHz and 915 MHz applicators in that the average radial penetration of 50% surface SAR (RP50) was about 0.65 cm. It was also shown that power deposition was axially symmetric for both 433 MHz and 915 MHz HMIO applicators. It is shown that better impedance matching is more important for intracavitary hyperthermia than for external hyperthermia. Choosing HMIO applicators in clinical practice is also discussed.

Experimental assessment of phased-array heating of neck tumours.

An investigation of phased-array microwave systems (PAMS) for non-invasively inducing hyperthermia, primarily in neck lesions, has been done with implications for applications at other sites such as lung and pelvis. Our general approach was to combine numerical and analytical approaches with parallel experimental studies. In this paper we will concentrate only on the experimental aspects. The object, such as a homogeneous cylindrical phantom or a neck phantom, was encircled with several standard applicators driven by a single source, but with relative phase and amplitude control over each applicator. The relative phases of the applicators were adjusted by using an implanted monopole antenna connected to an HP network analyser. Power was applied and the specific absorption rate (SAR) was determined by using split phantoms and thermography or by measuring temperature transients dT/dt, recorded by implanted thermometer probes. We found that at 915 MHz for our applicators (SMA Co.) the centre of an 11 cm diameter muscle-like phantom heated to about 33% of the value at the surface in front of the applicator. Similarly, we were able to show significant SAR at the centre of realistically sized neck phantoms using four phased apertures of 915 MHz. Furthermore, substantial improvement was observed if the frequency was lowered to about 400 MHz.

Results of a phase I regional hyperthermia device evaluation: microwave annular array versus radiofrequency induction coil.

The safety and efficacy of two devices in producing elevated temperatures in bulky deep tumours was evaluated in 11 patients with 12 tumours. Nine of 11 patients had pelvic tumours. Each patient was given a separate trial heating with the microwave annular phased microwave array system (APAS) and the radiofrequency concentric magnetic induction coil (MI), and evaluation was based upon paired comparison of power-limiting patient tolerance endpoints as well as intratumoural temperatures achieved. Toxicity was minimal with either device. On average, 66 per cent of intra-tumoural (IT) temperatures reached greater than 41 degrees C with the APAS, and 12 per cent of IT temperatures reached greater than 41 degrees C with the MI (P less than 0.001). Thirty-two per cent of IT temperatures were greater than 42 degrees C with the APAS, compared to 7 per cent with MI (P less than 0.001). Although the annular microwave array is more complex to use, it has a significantly higher likelihood of achieving temperatures in the therapeutic range near 42 degrees C in deep pelvic tumours than does the magnetic induction coil.