Seasonal variation in suicide in a predominantly Caucasian tropical/subtropical region of Australia.

Seasonal variations in suicide were examined in a Caucasian population living relatively close to the equator. A spring/early summer peak, but no secondary autumn peak, was found for males. An autumn trough was found for females. No significant seasonal variation was found for rurality, distance from the equator, employment status, or methods of suicide. Post-mortem blood alcohol levels were higher in spring and summer, possibly reflecting socialization patterns. The modest associations are consistent with suggestion that climatic influences may produce greater variation in suicide rates where the climatic variation itself is greater.

Blindness, fear of sight loss, and suicide.

Numerous studies have examined the emotional impact exerted by sight loss. Research has tended to focus on clinical-diagnostic rather than therapeutic-preventive aspects. Blindness and sight restoration have been reported to induce both temporary and longer term psychopathology, usually followed by psychosocial readjustment. However, in some cases, readjustment may not occur and suicide may result. Together with an extensive review of available literature, the authors present cases taken from their psychological autopsy study database. When compared with a hearing-impaired control group, impaired sight alone can acutely affect otherwise psychologically healthy individuals. Ophthalmologists need to be aware of this problem and to develop closer collaboration with mental health professionals. Serious consideration of this problem and definition of clear guidelines may prevent suicidal behaviour.

Restructuring of cardiovascular services at Children's Hospital, Boston, Massachusetts.

BACKGROUND: In recent years there has been growing concern about the turbulence and many uncertainties in the health care environment. The leaders of the Cardiovascular Departments at Children's Hospital in Boston recognized the need to position themselves more effectively for providing quality cardiovascular services in the future. METHODS: A transformational strategy for leadership and organization of cardiovascular services was designed by the physician and nursing leaders of the Cardiovascular Departments. The new Cardiovascular Program included changes in governance administration and clinical operations. RESULTS: A Governance Board was appointed to oversee the fiscal and clinical affairs of the unified Cardiovascular Program. The operating budget was reduced by 10% (2.1 million dollars) over a 2-year period. This goal was achieved with creative restructuring in three areas: (1) personnel, (2) supplies, and (3) ancillary usage. CONCLUSIONS: This organizational innovation is a model for collaborative practice. It is hoped that this new model will allow the faculty and staff to improve upon a tradition of excellence in clinical care and will help in retaining an environment and spirit conducive to the generation of new knowledge.

Transformation of the cardiovascular program. Leadership and organization.

The development of this organizational innovation continues to provide many challenges and opportunities for all involved. The authors emphasize that although cost containment is perhaps the most noticeable effect thus far, it is not the central goal of this endeavor. Obviously, it is important to be conscious of reducing costs in this very competitive health-care environment where quality of care is in danger of being substituted for lower-priced care. The challenge before all of us is to maintain excellence and efficiency less expensively within a collegial and risk-willing environment, as external forces seem to be countercurrent to these efforts. We hope that this new model for providing cardiovascular services within the institution will allow us to continue to improve our tradition of excellence in clinical care and will help us in retaining an environment and spirit conducive to the generation of new knowledge. The more long-lasting result achieved to date is the level of creativity and commitment demonstrated by all staff toward our common vision. The other articles in this issue of Nursing Clinics exemplify the collaborative spirit of our CVP and offer some initial evidence about the early effects of these changes.

Caring for parents of critically ill infants and children.

This article provides an overview of the literature reviewing the stresses and needs of families of critically ill children. These needs and stresses are summarized and organized to provide a framework for the research-based standard of care that is presented for parents of critically ill children.

Driving under the influence--a level-I trauma center's experience.

Alcohol-impaired driving is a major issue confronting today's society. New legislation is emerging to help curtail this ongoing problem. To evaluate the legislative effects in terms of outcome pertaining to injured drivers, we analyzed the records of 116 consecutive motor vehicle drivers who were admitted to our trauma center over a 16-month period. Medical reports, police reports, and drivers' abstracts were reviewed. Of the 116 drives, 61 (53%) had blood alcohol concentrations that exceeded the legal limit (blood alcohol level greater than or equal to 100 mg/dL) on arrival at the emergency department. Only four of these patients were ticketed for driving under the influence and received the mandatory suspension of their driver's license. None was convicted of this offense, which carries criminal charges and a revocation of the driver's license. Mechanisms for efficient collection of blood specimens and mandatory occurrence reporting are two recommendations that merit investigation to obviate further escape of injured, intoxicated drivers from the legal net. In addition, alcohol rehabilitation and education cannot be overlooked and should warrant strong societal support.

Pharmacologic interventions for the neonate with compromised cardiac function.

The developmental aspects of myocardial performance must be considered when pharmacologic agents are used to support the neonate with compromised cardiac function. Neonatal cardiovascular function is characterized by a limited preload reserve, decreased ventricular compliance, limited contractile reserve, and CO that is primarily dependent on the HR. Nurses caring for these neonates need a baseline understanding of normal cardiovascular physiology to evaluate the effectiveness of pharmacologic interventions to augment CO. Neonatal nurses play a pivotal role in the therapeutic management of pharmacologic interventions to provide safe, high quality care for the sick neonate.

Prevention of intraoperative myocardial injury by pretreatment with pharmacological agents.

Pharmacological agents administered prior to the institution of myocardial anoxia or ischemia may protect the myocardium by preventing ATP depletion, structural damage to cell membranes and organelles, and postanoxic disturbances in coronary microcirculation. Propranolol, dipyridamole, nitroglycerin, and mannitol all have the potential to protect the myocardium in one or more of these ways and thus have promise for clinical use.