An evaluation of the effects of Tai Chi Chuan and Chi Kung training in patients with symptomatic heart failure: a randomised controlled pilot study.

OBJECTIVE: To study the effect of Tai Chi on exercise tolerance in patients with moderate heart failure. DESIGN: Randomised parallel group study balanced for baseline variables. SETTING: Cardiology Department, Royal Hallamshire Hospital. PATIENTS AND METHODS: 52 patients (42 men, mean age (68.9 years), range (46-90 years), and 10 women, mean age (70.0 years), range (58-82)) with chronic heart failure (New York Heart Association symptom class II-III) were studied. Patients were randomised to Tai Chi Chuan twice a week for 16 weeks or to standard medical care without exercise rehabilitation. MAIN OUTCOME MEASURES: The primary outcome measure was the change in the distance walked in the shuttle walk test. Secondary outcome measures were changes in symptom scores and quality of life indices. RESULTS: Objective measures of exercise tolerance did not improve significantly with Tai Chi, but patients having Tai Chi exercise had an improvement in symptom scores of heart failure measured by the Minnesota Living with Heart Failure Questionnaire (comparison of deltas, -2.4 control vs -14.9; p = 0.01), and depression scores measured by the SCL-90-R questionnaire (-2.9 vs -6.8; p = 0.12) compared with those patients in the control group. CONCLUSION: In patients with chronic heart failure, 16 weeks of Tai Chi training was safe, with no adverse exercise related problems. It was enjoyed by all taking part and led to significant improvements in symptoms and quality of life.

An observational study of patients receiving homeopathic treatment.

BACKGROUND: Observational studies have recently contributed useful information to the debate about the utility of homeopathic treatment in everyday practice. AIM: To gather data about routine homeopathic general practice. SETTING: Eighty general medical practices in Belgium where physicians were members of the Unio Homoeopathica Belgica. METHODS: All patients and their physicians visiting the practices on a specified day completed a questionnaire. RESULTS: A total of 782 patients presented with diseases of all major organ systems which were of sufficient severity to interfere with daily living in 78% of cases. Compared to previous conventional treatment, patients reported that consultations were much longer but costed less. One or more conventional drug treatments were discontinued in over half (52%) of the patients: CNS (including psychotropic) drugs (21%), drugs for respiratory conditions (16%) and antibiotics (16%). Conventional drugs were prescribed to about a quarter of patients (27%), mostly antibiotics and cardiovascular medication. The antibiotics were almost exclusively (95%) used to treat respiratory infections. Prescription costs (including conventional medicines) were one-third of the general practice average. Patients' satisfaction with their homeopathic treatment was very high (95% fairly or very satisfied), and ratings of their previous treatment was much lower (20%). The great majority (89%) said that homeopathy had improved their physical condition; 8.5% said that it had made no difference, 2.4% said that homeopathy had worsened their condition. Physicians' ratings of improvement were similar. Previous conventional treatment had improved 13% of patients, made no difference to 32%, and had worsened the condition of over half (55%). A similar pattern was seen for psychological symptoms. CONCLUSIONS: Patients were very satisfied with their homeopathic treatment, both they and their physicians recorded significant improvement. Costs of homeopathic treatment were significantly lower than conventional treatment, and many previously prescribed drugs were discontinued.

Undergraduate student nurses' expectations and their self-reported preparedness for the graduate year role.

AIMS OF THE STUDY: The study identifies third-year nurses' expectations of the graduate nurse role and ascertains how prepared they feel to fulfil this role. BACKGROUND: The literature substantiates that the university-workplace transition is marked by differences between students' expectations of the graduate year and the realities of practice they encounter in the workforce setting. Nursing professionals and health service employers continue to debate the expectations required of the new nurse graduate. Yet there is little assessment of graduate nurses' expectations of the workplace. This study describes student nurses' expectations of the graduate year and the extent to which they regard themselves as well- or ill-prepared. DESIGN: Third-year student nurses (n=105) from a 3-year Bachelor of Nursing (BN) course at a large Metropolitan University in Australia were surveyed. A group of nursing academics and their senior colleagues in the clinical setting designed a questionnaire in light of common themes derived from literature on the graduate year role. Responses were examined and analysed using descriptive statistics. RESULTS: Responses revealed that student nurses tended to favour large public hospitals, and sought a good graduate programme with associated opportunities for guidance and support. Most expected to achieve good working relationships with both professional colleagues and patients. Final year students expressed some apprehension about meeting the performance expectations of the workplace, given their self-perceived lack of clinical experience. CONCLUSION: When asked about their initial expectations of the workplace, third year student nurses expressed little apprehension and reported high levels on scales of organizational commitment and professionalism. The research literature suggests that divisions exist between students' expectations of the graduate year and the actual work experience. The expectations of the graduate year described in this study offer a student-centred perspective that contributes to future planning and policy directions of undergraduate curricula, graduate year programmes and nurse retention.

Association between sudden infant death syndrome and prone sleep position, bed sharing, and sleeping outside an infant crib in Alaska.

OBJECTIVE: To determine the contribution of prone sleeping, bed sharing, and sleeping outside an infant crib to sudden infant death syndrome (SIDS). METHODS: We conducted a retrospective descriptive study of all SIDS cases in Alaska from January 1, 1992, through December 31, 1997. Reviewed data sources included maternal and infant medical records, autopsy reports, birth and death certificates, police and state trooper death scene investigations, and occasionally home interviews. RESULTS: The death certificate identified SIDS as a cause of death for 130 infants (cause-specific infant mortality rate: 2.0 per 1000 live births). Among infants for whom this information was known, 113 (98%) of 115 were found in the prone position, sleeping outside an infant crib, or sleeping with another person. By contrast, 2 (1.7%) were found alone and supine in their crib (1 of whom was found with a blanket wrapped around his face). Of 40 infants who slept with a parent at the time of death, only 1 infant who slept supine with a non-drug-using parent on an adult nonwater mattress was identified. CONCLUSION: Almost all SIDS deaths in Alaska occurred in association with prone sleeping, bed sharing, or sleeping outside a crib. In the absence of other risk factors, SIDS deaths associated with parental bed sharing were rare.

Does community-based experience alter career preference? New evidence from a prospective longitudinal cohort study of undergraduate medical students.

CONTEXT: Previous studies have shown that most medical students want a hospital-based career, but the protagonists of community-based teaching predict that increased community exposure within undergraduate curricula will alter subsequent career preferences. OBJECTIVES: To evaluate the impact on career preference and other attitudes of a year with substantial community exposure, compared with a year of hospital-based learning. DESIGN: Questionnaire to student cohort before and after two consecutive levels of the course, one with, and the other prior to, substantial community placement. SETTING: Sheffield Medical School. SUBJECTS: Total of 260 students in the third and fourth year of the MBChB degree. RESULTS: There were significant differences in career preference and attitude to primary care after the year with a community placement, with more students expressing a preference for a community-based career. This was particularly true for women, and less true for non-European students. Conversely, the hospital-based students, especially men, showed a significant change toward hospital-based careers. CONCLUSION: The findings support the hypothetical advantages of shifting medical education to primary care settings, both in encouraging a career in general practice and in the retention of appropriate professional attitudes.

Clinical nurses as teachers of nursing students.

A questionnaire survey of 304 nurses working in clinical areas of 16 hospitals was conducted to investigate the nurses' attitudes to teaching university nursing students during clinical placements. The survey also identified the information and support that clinicians needed to assist them in their teaching role. The study found that most participants saw teaching students as a part of their role; they felt adequately prepared to teach and gained satisfaction from it. Clinicians needed information about students' level of nursing education and what universities expected their students to gain from clinical placements. They expected university clinical teachers to be accessible and to be involved with teaching their students clinical aspects of practice. Less than half the RNs thought that students on clinical placements were adequately taught by their universities' clinical teachers.

First year RNs' actual and self-rated pharmacology knowledge.

A questionnaire survey was conducted of first year registered nurses whose postal details were recorded on the Victorian Nursing Council's 1994 mailing list. The nurses were asked to self-rate their knowledge of five categories of pharmacology and to answer questions that tested their knowledge of the same categories. The survey also obtained data related to aspects of the nurses' pharmacology education. The mean test score of the 363 respondents to the survey was 55.8%. The number of months worked as an RN and participation in a graduate year program were significantly correlated with test scores, i.e. longer experience as an RN and participation in a graduate program were associated with higher scores. There was a significant correlation between the groups' overall self-rating of their knowledge and their total test scores but the RNs' self-ratings overestimated their knowledge of drug administration and legal aspects of drug use. The study indicates that many newly registered nurses have an inadequate knowledge of pharmacology. Recommendations for improving the teaching and learning of the subject are drawn from the nurses' evaluation of aspects of their undergraduate and post-registration experience.

Changes in haemodynamic parameters following Tai Chi Chuan and aerobic exercise in patients recovering from acute myocardial infarction.

In this study, 126 patients (90 males, average age 56 years, range 39-80) were randomised to Wu Chian-Ch'uan style Tai Chi (38), aerobic exercise (41) or a non-exercise support group (47) following acute myocardial infarction. Patients attended twice weekly for three weeks then weekly for a further five weeks. Heart rate and blood pressure were recorded before and after each session. Over the 11 sessions of exercise there was a negative trend in diastolic blood pressure only in the Tai Chi group (Rs = 0.79, p < 0.01). Significant trends in systolic blood pressure occurred in both exercise groups (Rs = 0.64 and 0.63, both p < 0.05). Only four (8%) patients completed the support group eight-week programme which was less than the number completing Tai Chi (82%; p < 0.001) and aerobic exercise groups (73%; p < 0.001).

A clinical learning milieu: nurse clinicians' attitudes to tertiary education and teaching.

A target population of 742 registered nurses (RNs) who had direct contact or potential for direct contact with college nursing students were surveyed regarding their attitudes to the transfer of undergraduate nurse education to the tertiary sector, and to helping teach/supervise students. The RNs were located at 19 of 21 hospitals providing clinical experience for students of one college during semester one in 1989; 490 (66%) returned completed questionnaires. These bedside nurse clinicians were clearly divided on whether the transfer would ultimately benefit the nursing profession. Despite this, nearly all preferred to work in a hospital providing clinical experience for college students; they saw teaching as an essential part of the RN's role and gained satisfaction from it.

Psychological treatment in general practice.

A clinical psychologist was attached to two group practices in Sheffield for 1.5 sessions each per week. A total of 238 patients was seen during 26 months. Of those completing therapy, 72 per cent made satisfactory progress. In the three months after stopping treatment patients made significantly fewer (36 per cent) visits to the surgeries and received significantly fewer (50 per cent) prescriptions for psychotropic drugs than in the three months before referral. These changes were maintained one year later in the three-month period 12 to 15 months after discharge. The result has been to provide largely successful therapy for a population of patients for whom adequate treatment was previously unavailable. This suggests that it would be worthwhile to expand psychological services in general practice still further as advised by the Department of Health and Social Security.

Psychiatric day care.

Day care for psychiatric patients can be effective in returning the patient to a normal life in the community, or for relieving the strain on a family. Objectives should be clearly defined, with the therapeutic team working closely together. Programs should cater to the individual's needs wherever possible and should be able to deal with a broad range of symptomatology.