Open education resources to support the WHO nurse educator core competencies.

AIM: This paper describes an innovative approach to tackling the shortage of qualified nurse educators, which is a major constraining factor or 'bottle-neck' to improve the global supply of nurses, especially in low- and middle-income countries. BACKGROUND: The World Health Organization commissioned experts to develop Nurse Educator Core Competencies that describe expectations for this cadre of workers. In their deliberations, the WHO experts cited the challenges affecting the adoption of these competencies, particularly the lack of resources available for implementation. To address this specific challenge, a USA-based non-government organiization, Nurses International, has developed Open Education Resources (NI-OER) to support nurse educators with freely accessible curriculum materials and remote mentoring support. METHODS: This paper applies item analysis to consider how the NI-OER could assist higher education institutes and individual faculty members in meeting each of the WHO Nurse Educator Core Competencies. FINDINGS: The NI-OER is a good fit with six of the Nurse Educator Core Competencies and a partial fit with the other two. DISCUSSION: Congruence with the WHO Nurse Educator Core Competencies is an important validity check for the NI-OER. The ultimate goal of the NI-OER is to promote sustainable development through intermediate goals related to supporting faculty as they prepare nurses for current and future service needs. Technological solutions like the NI-OER cannot solve all aspects of a complex problem like the global nursing shortage but are an important tool. IMPLICATIONS FOR NURSING AND HEALTH POLICY: This resource has significant implications for nursing and health policy because it tackles several constraints to the global goal of increasing production and capacity of nurses. Combined with the organization's remote mentoring and communities of practice, the NI-OER appears to have the potential to support novice nurse educators with accessible, adaptable resources.

A mental health assessment and support team for community elders in Fife (EAST).

BACKGROUND: The aging population combined with the increased recognition of the need to assess elderly patients with mental health difficulties in their own environment encouraged service redesign in Fife with the focus on community assessment of older people with mental health needs. AIMS: To establish and assess the functioning of a joint Health and Social Services enhanced assessment and support team (EAST) for community-dwelling elders with significant mental health needs living in a Scottish health region, and to determine the impact of this team on the requirement for acute psychogeriatric hospital services. METHODS: Prospective three-year data collection of service activity involving EAST and the local psychogeriatric acute inpatient and day hospital facilities. RESULTS: EAST assessed 111 patients during the study, 83% with a diagnosis of dementia. The mean duration of assessment was six weeks with 9% of patients receiving an overnight home assessment and 6% requiring hospital admission. Overall there was a substantial reduction in utilization of both acute psychogeriatric admission beds and day hospital placements. CONCLUSIONS: Multi-agency community assessment of elders with mental health problems can be addressed effectively without recourse to hospital admission, which may allow resource release for further service developments.

Predictors of groin complications after balloon and new-device coronary intervention.

We reviewed the clinical course of 5,042 patients who underwent percutaneous transluminal coronary angioplasty (PTCA) using balloons or new devices: (stent, laser, directional and rotational atherectomy). A vascular complication was defined as the formation of a groin hematoma, bleeding, pseudoaneurysm, fistula, or the need for surgical repair. Vascular complications occurred in 309 (6.1%) patients, and 117 (2.3%) required vascular repair; among these patients, surgery was performed for correction of an an arteriovenous fistula in 12%, repair of pseudoaneurysm in 72%, repair for expanding hematoma and femoral artery lacerations in 10%, and retroperitoneal bleeding in 6%. The correlates of vascular complications were older age (66.8 vs 62.1 years; p < 0.0001), female gender (43% vs 26%; p < 0.0001), increased weight (82.1 +/- 16.46 vs 78.0 +/- 16.6 kg; p < 0.001), higher systolic blood pressure (140 +/- 25 vs 134 +/- 20 mm Hg; p < 0.001), increased heparin dose during the procedure (14,352 +/- 3,879 vs 13,599 +/- 3,508 IU; p = 0.001), administration of heparin after the procedure (232 vs 2,985 patients; p < 0.0001) and intracoronary stenting (14.9% vs 3.5%; p < 0.0001). Fifteen patients of 214 (7.0%) who underwent stent implantation had surgical repair. Vascular complications were not related to the size of the arterial sheath (8.11 +/- 0.8 vs 8.8 +/- 0.7Fr; p = 0.11) and the use of devices other than stents (laser, atherectomy) did not increase the rate of vascular complications.

Development of procedures for determining the amino acid requirements of chickens by the indicator amino acid oxidation method.

To better understand the amino acid requirements of chickens, a method is needed to determine a point estimate of the requirement. A method developed to determine the amino acid requirements of piglets and human infants by using the oxidation rate of an indicator amino acid as the test parameter was adapted for use in growing chickens. Polycarbonate chambers measuring 30 x 40 x 30 (L x W x H) were constructed to house one small mature chicken or several small immature chickens and to trap exhaled CO2. In the first experiment, 10-d-old chicks (250 to 300 g each) were feed deprived for 12 h and given 1 g of a methionine-deficient diet (gavage) with L-[1-C14]phenylalanine. Peak oxidation of L-[1-C14]phenylalanine occurred between 30 and 90 min (-200 dpm/g). A linear rate of oxidation (slope = -1.84; r2 = 0.96) was achieved by 120 min after feeding until after 180 min, when oxidation stabilized at a low rate. The second experiment tested different chambers and chicks with the same treatment to show repeatability. There were four chicks (250 to 300 g each) in each of three apparently identical chambers. Chicks were given two meals labeled with L-[1-C14]phenylalanine, 2 h apart. The CV for the 0- and 30-min collections were 17 and 10%, respectively. The CV for the remaining collections remained at <4%. These data supported a system of two feedings, 2 h apart to reduce variability and a collection period that included up to 3 h after the second feeding.

Studies on feeding peanut meal as a protein source for broiler chickens.

Four experiments were conducted to compare the performance of broilers fed soybean meal (SBM) versus peanut meal (PNM) as protein sources. Ross x Ross 208 broiler chickens were placed in battery brooders (Experiments 1 to 3, four replicates of 8 chicks per treatment) and floor pens (Experiment 4, four replicates of 34 chicks per treatment). In Experiment 1, addition of 0, 0.1, 0.2, and 0.3% Thr to a corn-PNM-based diet increased 0 to 18 d BW gain (BWG; 0.374c vs. 0.495b vs. 0.508b vs. 0.508b kg, respectively) and decreased feed conversion ratio (FCR; 2.09c vs. 1.63b vs. vs. 1.54b vs. 1.54b g/g, respectively) compared to the corn-SBM-based control diet (BWG = 0.593a and FCR = 1.36a). In Experiment 2, diets were formulated with the same amino acid minimums, and as the percentage of PNM increased in the diets (0, 10, 20, and 32%), BWG decreased (0.560a vs. 0.532a vs. 0.521a vs. 0.458b kg, respectively) and FCR increased (1.72b vs. 1.71b vs. 1.79bc vs. 1.86c g/g, respectively). In Experiment 3, addition of Thr to a corn-PNM-based diet increased BWG (-Thr = 0.284c vs. +Thr = 0.397b kg) and decreased FCR (-Thr = 1.60b vs. +Thr = 1.54b g/g). The BWG and FCR were best for the corn-SBM-based control diet (0.499a kg and 1.38a g/g, respectively). In Experiment 4, during the growing period (18 to 42 d), significant interactions occurred between protein source (PNM vs. SBM) and protein level (16 and 20% vs. 24%) for BW and FCR but not for carcass, breast, or leg quarter yield or fat pad weights (P < 0.05) at 42 d of age. Technical (not economic) performance of birds fed PNM was similar to SBM at the highest protein levels fed. PNM could be used as a protein source for broilers under appropriate economic conditions.

Studies on the feeding of cupric sulfate pentahydrate, cupric citrate, and copper oxychloride to broiler chickens.

Male commercial broiler strain chickens were fed either a control diet (based on corn and soybean meal) or the control diet supplemented with cupric sulfate pentahydrate, copper oxychloride, or cupric citrate in two experiments conducted in floor pens. In Experiment 1, feeding copper at 125 mg/kg diet for 42 d significantly increased broiler growth; and the response from cupric citrate was significantly better than either cupric sulfate or copper oxychloride. In Experiment 2, the inclusion of copper from cupric citrate was reduced to 63 mg/kg and the length of the experiment was increased to 56 d. Cupric sulfate pentahydrate and copper oxychloride treatments increased weight gain by 4.9% and cupric citrate increased weight gain by 9.1%. The feed conversion ratios (grams of feed:grams of gain of live birds) in the birds fed copper were not significantly different from those fed the basal diet (P > 0.05) unless corrections were made for the weights of the dead birds; the adjusted feed conversion ratios (grams of feed:grams of gain of live birds + grams of gain of mortalities) for the copper-treated birds in Experiments 1 and 2 were 5.2 and 7.6% lower, respectively, than the ratios of birds fed the basal diets. Plasma copper levels increased in supplemented chicks by 35% in Experiment 1 and 24% in Experiment 2. Liver copper levels in both experiments were increased by 26% with copper supplementation. Mortality was not affected by dietary treatment in either experiment (P > 0.05).

Induction down under.

An Australian hospital revamped its induction arrangements for new interns (the equivalent of pre-registration house officers in the UK) in response to negative comments about the traditional programme. The programme was rebuilt to meet their challenge--the result being both more practical and more enjoyable. The three major components of the new programme were skills stations, intern shadowing and a treasure hunt.

Primary adenocarcinoma arising at an ileostomy site: an unusual cause of bowel obstruction.

Adenocarcinoma of the ileostomy stoma is a rare complication of ileostomy. An instance of adenocarcinoma of the ileostomy stoma, which presented as a small bowel obstruction, is reported in a 58 year old woman who had nearly a 30-year history of abdominal problems that had been treated conservatively.

Klatskin tumours: a 20 year experience.

The management of 27 patients who presented with cholangiocarcinoma of the hepatic confluence over the past 20 years is reviewed, and the dramatic changes, both in accuracy of diagnosis and modes of treatment, are documented. All 27 presented with jaundice, three underwent laparotomy only, four had a T-tube inserted, one had a straight transhepatic tube inserted, seven U-tubes were placed and four patients underwent surgical resection. More recently, seven patients were drained percutaneously and a further patient was treated by an endoscopic stent. There were six postoperative deaths. Of the 24 who received active treatment, the mean survival was 8 months with a range of 0-40 months. The advantages and disadvantages of the various methods of diagnosis and treatment are discussed. The possible role of radiotherapy and chemotherapy are reviewed briefly.

Percutaneous drainage of subphrenic biliary collections using a Ring-McLean sump catheter.

This communication reports three consecutive cases of subphrenic biliary collections, resulting from biliary procedures. All were successfully treated percutaneously using a 16 French Ring-McLean sump drainage catheter without the need for secondary surgical intervention. Although percutaneous drainage of fluid collections is now commonplace, this is the first reported use of this drainage catheter for subphrenic biliary collections.

Fractured neck of the femur (DRG 210/211): prospective outcome study.

BACKGROUND: An ageing population will increase the need for resources to treat patients with a fractured neck of femur (DRG 210/211). Provision of these resources will be helped by a better understanding of current practices. METHODS: A prospective study of outcome at discharge for 100 consecutive patients with DRG 210/211 was conducted at five Victorian metropolitan teaching hospitals to assess length of stay and the reasons for any variations. RESULTS: The major influences on timing of discharge were: delayed availability of rehabilitation beds; the timing of referral and assessment by the Geriatric Assessment Team; delay in surgery more than 24 h after admission; and development of postoperative complications. CONCLUSION: The efficient management of patients with DRG 210/211 requires a strong protocol of treatment and referral strategies with adequate resources.

Lung carcinoma: survey of 2286 cases with emphasis on small cell type.

Lung carcinoma is the commonest major malignancy in men in the United States and its incidence is increasing rapidly in women. It is estimated that there will have been 117,000 new cases and 101,300 deaths in 1980. The 2286 patients with lung carcinoma admitted to the Hospital of the University of Mississippi from 1955 to 1980 were reviewed by decades of chronology and of life, with respect to age, cell type, sex and racial incidence. The greatest age incidence was in the sixth and seventh decades; cell types overall were epidermoid (45% of the patients), adenocarcinoma (12% of the patients), small (oat) cell (21% of the patients), and others (22% of the patients). There was a steady increase in the incidence of disease in females, adjusted for total hospital admissions, and a less certain increase among black patients. Twenty-eight per cent of 250 patients with small cell carcinoma so studied exhibited some feature of the paraneoplastic or paraendocrine syndromes. In 41 patients with small cell carcinoma treated with multiple drug chemotherapy, there was an overall response rate of 50% and an additional "stable disease" rate of 28%. Mean survival period in this group was 52 weeks, compared with 12 weeks in patients whose diseases went untreated. Clearly, definite progress is being made, not only in our knowledge of the biology of lung carcinoma, in general, but in the treatment of small cell carcinoma in particular.

Developing clinical indicators for cholecystectomy.

This study sets out to develop a set of clinical indicators for the frequently performed procedure, simple cholecystectomy. Four hundred consecutive cases of cholecystectomy were reviewed retrospectively and data were collected regarding the pre-operative condition of the patient as well as any postoperative complications. From this database a set of clinical indicators for simple cholecystectomy are recommended: wound infection rate 4.5%, re-operation or performance of another therapeutic procedure 3.5%, length of stay 7 days, and mortality < 0.025%. These threshold figures are to serve only as a 'flag' to possible problems.

Colorectal resection in Victoria:a comparison of hospital based and individual audit.

BACKGROUND: The results of personal audit have not been tested against a hospital-based audit previously and the results of two such audits of colorectal resection in the State of Victoria have provided this opportunity. In addition, data reflecting the results of colorectal resection across a range of hospitals and surgeons in the Victorian community have been obtained. METHODS: A total of 535 patients undergoing a colorectal resection, with an anastomosis performed, were studied in two serially conducted prospective audits arranged by the Standards Sub-Committee of the Victorian State Committee. One study was public hospital-based and the second was based on voluntary reporting by individual surgeons. RESULTS: Similar results were obtained in each study, demonstrating the accuracy of individual reporting. The combined results (wound infection rate 12.3%, anastomotic leak rate 3.7% and mortality 4.5%) are compared to previously published data. CONCLUSIONS: In the State of Victoria the results of audit by individual surgeons performing colorectal resection were similar to the hospital-based audit. The results obtained compare favourably with previously published data.

Clinical indicators in colorectal surgery.

Two studies conducted in the state of Victoria have tested potential clinical indicators and the suggested thresholds for resection of colorectal carcinoma where an anastomosis has been performed. These studies involving 535 patients were independent of one another: one hospital based and one surgeon based. Threshold figures for these draft indicators have been compared with the study figures and found to be similar. It is suggested that wound infection (elective operation without formation of a stoma), anastomotic leak (clinically recognized) and mortality (elective operations in patients under the age of 80 years) are the most appropriate clinical indicators of colorectal resection for carcinoma.

Bile duct injury during laparoscopic cholecystectomy: a report of the Standards Sub-committee of the Victorian State Committee of the Royal Australasian College of Surgeons.

A survey of Victorian surgeons performing laparoscopic cholecystectomy was carried out. This report discusses the bile duct injuries identified in the survey. Twelve injuries were recorded, a rate of 0.2%. Three of the 12 required formal repair, the other 9 being treated by T-tube alone. Possible mechanisms of these injuries, the experience of the surgeon, the role of operative cholangiography and delays in recognition of the injury are discussed.