Incidence of meningitis and of death from all causes among users of cochlear implants in the United Kingdom.

BACKGROUND: During 2002, there was an increase in reports of bacterial meningitis among people with cochlear implants in Europe and North America. One model of implant, which included a space-occupying 'positioner', was recalled. Implantation of a positioner was shown to be a risk factor for meningitis among children in the United States. The situation in the United Kingdom was not known. METHODS: We ascertained the cohort of people who had received cochlear implants with intra-cochlear electrodes in UK hospitals prior to 1 October 2002 and were permanently resident in the United Kingdom. We compared the incidence of meningitis, and the causes and incidence of death from all causes, between the cohort and reference populations. RESULTS: Of 1851 children (66 with positioners), none had contracted meningitis. Neither the incidence rate of meningitis, nor the cumulative mortality from all causes, differed significantly between implanted children and values expected for the general population. Of 1779 adults (139 with positioners), five had contracted meningitis with three fatalities. No case of meningitis involved a positioner and four of the cases, including the fatalities, possessed risk factors unrelated to implantation. Although the incidence rate of meningitis was significantly higher in implanted adults than the general population, cumulative mortality from all causes was never higher, and was significantly lower at some time points after implantation. CONCLUSION: Specific evidence of the association between bacterial meningitis and implantation with a positioner that arose in the United States and mainland Europe during 2002 has not been found in the United Kingdom.

A comparison of kangaroo mother care and conventional cuddling care.

PURPOSE: To compare kangaroo mother care (KMC) and conventional cuddling care (CCC) in premature and small-for-gestational-age infants. DESIGN AND SAMPLE: Thirty mother-infant dyads in two Australian neonatal nurseries were randomly assigned to the KMC group or the CCC group. Both groups of mothers cuddled their babies for a minimum of two hours a day, five days a week while in the study, with the KMC group having skin-to-skin contact while the CCC group had contact through normal clothing. MAIN OUTCOME VARIABLE: The main outcome variables were infant weight gain, temperature maintenance during KMC and CCC, and length of hospital stay. RESULTS: The results showed no difference between groups on the Parental Stress Scale (NICU) or the Parental Expectations Survey. Infants in both groups experienced equivalent maintenance of or rise in temperature while out of the incubators, equal weight gain, equal length of stay in the hospital, and equal duration of breastfeeding.

Regulation of the germline immunoglobulin Cgamma1 promoter by CD40 ligand and IL-4: dual role for tandem NF-kappaB binding sites.

Transcription of germline Ig constant region genes and associated switch regions is an early and essential step in heavy chain class switch recombination. Transcription of the germline Cgamma1 and C epsilon Ig genes is induced by IL-4 via STAT6 activation; CD40 signaling can independently induce transcription of these genes and act in synergy with IL-4 to increase expression. In the present study, we investigated the role of three tandem NF-kappaB sites (site 1, -95; site 2, -71; site 3, -53) in the regulation of the germline Cgamma1 Ig promoter by CD40 Ligand (CD40L) and IL-4 in the mouse B lymphoma cell line, BCL1-3B3. Germline gamma1 transcripts are induced by CD40L and by IL-4 in BCL1-3B3 and the combination of signals is synergistic, as in normal B cells. EMSA with crude nuclear extracts demonstrated that stimulation with CD40L results in the induction of NF-kappaB complexes that bind to each of the three NF-kappaB sites and are composed mainly of p50 and RelB, but also include c-Rel and p65. Surprisingly, site-specific mutagenesis of the NF-kappaB sites did not reduce CD40-responsiveness of germline gamma1 promoter-luciferase reporter constructs transiently transfected into BCL1-3B3. Mutation in any one NF-kappaB site, however, significantly reduced overall transcriptional activity of the promoter, both basal and induced, suggesting a role in basal promoter function. In addition, activation of the promoter by IL-4 was blocked by mutation of all three NF-kappaB sites and similarly reduced by mutation of site 1, suggesting that NF-kappaB-STAT6 interactions may be necessary for STAT6-mediated transactivation of the germline gamma1 promoter. The results suggest that the three NF-kappaB sites may serve as a focus for formation of a higher-order transcription complex including STAT6, NF-kappaB and components of the basal transcription apparatus.

Correlates of condom use and attitudes to condoms and AIDS in a group of Darwin women.

This study investigated the use of condoms, attitudes to condoms and correlates of these in women in Darwin, Northern Territory, Australia. A survey using a Condom Attitudes Scale was administered to a convenience sample of 160 women. With regular partners, these women had a low level of use of condoms, with a somewhat higher level of use with casual partners. Their perceived risk of Human Immunodeficiency Virus and other sexually transmitted diseases was not strong. These women's attitude towards the condom was reasonably positive. The major factor that correlated with attitudes to condoms was the type of relationship with a partner. This paper demonstrates the need for health professionals to continue to promote condom use among women.

Evidence-based practice: an idea whose time has come.

This paper defines evidence-based practice, gives a brief history of EBP, addresses nurses' current usage of research, briefly examines the need for evidence-based practice, then addresses what evidence-based practice will mean to the profession. It is concluded that at present Australian nursing is in a stage of pre-evidence-based practice in which most Australian nurses neither read research nor apply research findings to practice. However, a demand for evidence-based practice will likely encourage nurses to use research in practice. Finally, professional strategies will be developed to encourage the introduction and evaluation of evidence-based nursing practice.

Effects of cabbage leaf extract on breast engorgement.

The effectiveness of cabbage leaf extract was compared with that of a placebo in treating breast engorgement in lactating women. In a double-blind experiment with a pretest/posttest design, 21 participants received a cream containing cabbage leaf extract, while 18 received placebo cream. The placebo group received equal relief to the treated group, with the two groups showing no difference on all outcome measures. However, mothers perceived both creams to be effective in relieving discomfort. Feeding had a greater effect than the application of cream on relieving discomfort and decreasing tissue hardness. It is therefore recommended that lactation consultants encourage mothers to breastfeed if possible to relieve the discomfort of breast engorgement.

Reliability and validity of an instrument to measure tissue hardness in breasts.

The author investigated the effectiveness of the Roberts Durometer, an instrument developed to measure human tissue hardness for a study on breast engorgement. The instrument is a small portable pressure gauge comprising a probe attached to a spring and contained in a tubular housing, connected to a dial gauge. The instrument was first trialed using foam rubber of differing hardness and football bladders of differing hardness. It was then used to measure the hardness of a non-pregnant, non-lactating human breast, followed by trials on postpartum women comparing breast tissue hardness on the day of birth with that of subsequent days. The instrument detected significant differences in hardness of foams, football bladders and human breast tissue. It was therefore considered suitable for measuring, in both research and clinical applications, hardness of breast tissue, which is a major physical feature of breast engorgement. Other clinical applications could include the hardness of abdominal and other skin tissues in conditions such as ascites, peritonitis and cellulitis.

Comparison of agar dilution, broth microdilution, disk diffusion, E-test, and BACTEC radiometric methods for antimicrobial susceptibility testing of clinical isolates of the Nocardia asteroides complex.

An evaluation was undertaken to determine the optimal method for the in vitro susceptibility testing of 26 Nocardia asteroides complex isolates to the following antimicrobial agents: amikacin, ampicillin, amoxicillin-clavulanate, ceftriaxone, ciprofloxacin, erythromycin, imipenem, minocycline, and trimethoprim-sulfamethoxazole. Five testing methods were studied including the agar dilution, broth microdilution, and disk diffusion methods, the epsilometer test (E-test), and the BACTEC radiometric method. Results for each antimicrobial agent and each testing method were interpreted as indicating susceptibility, intermediate susceptibility, or resistance according to current guidelines of the National Committee for Clinical Laboratory Standards (NCCLS) for bacteria that grow aerobically and were then compared to a "gold standard" susceptibility test result. The gold standard result for each Nocardia isolate was established by a consensus of the results of the majority of testing methods used in the study. When the results were combined for all antimicrobial agents tested against all Nocardia isolates by all methods, the BACTEC radiometric method produced the highest level of agreement (97.9%) with the consensus results and had the fewest very major (n = 1), major (n = 2), and minor (n = 2) errors. In contrast, the results of the agar dilution method were in least agreement (93.2%) with the consensus results, and this method also produced the most very major (n = 8), major (n = 4), and, along with the disk diffusion method, minor (n = 6) errors. For all test methods, interpretive errors were most frequent when testing ampicillin or amoxicillin-clavulanate. Moreover, for all Nocardia nova isolates tested, ampicillin susceptibility results by any of the testing methods were not in agreement with the results of testing for beta-lactamase by the nitrocefin (Cefinase) disk method. We conclude that among the methods evaluated, the BACTEC radiometric method appeared to be the best for determining the in vitro susceptibilities of members of the N. asteroides complex to a panel of nine antimicrobial agents. However, none of the test methods, including the BACTEC method, accurately predicted the ampicillin resistance of the N. nova isolates tested, all of which produced beta-lactamase. Presuming that this beta-lactamase hydrolyzes ampicillin, this disparity may relate to the NCCLS breakpoints that were used, which may require modification for this antimicrobial agent when tested against N. nova isolates.

Condom use in a group of aboriginal women.

This exploratory study investigated the attitudes of Aboriginal women in Darwin to the use of condoms to prevent HIV and other sexually transmitted diseases. An Aboriginal research assistant interviewed twelve women regarding their usage of and attitudes to the male condom and their attitude to the possibility of using a female condom. These women, like their ethnic minority counterparts in Africa and North America, had a fair level of knowledge about HIV, a low level of perceived risk of HIV and other sexually transmitted diseases, infrequent usage of male condoms with their partner, and negative attitudes to the male condom. Their attitude to the female condom was more positive. Educational programs and further research into the attitudes of women in remote communities are recommended.

Mandatory continuing professional education: trends and issues.

Mandatory Continuing Professional Education is a major issue for nurses in Australia today. The overseas experience is that MCPE has been in force for nursing in half of the United States for twenty years and has just been implemented in the United Kingdom. The major arguments against it are that it violates the principles of adult education and professional behaviour. The major arguments for it are that it protects the public against incompetence and voluntary CPE does not work. The major issues are its effectiveness, cost, educational implications, impact on the workplace and methods of regulation.

The rural nurse-practitioner: concepts and issues.

This paper reviews concepts, issues and research findings related to the role of the nurse-practitioner; in particular, findings related to the role of the rural nurse-practitioner are considered. Issues related to the nurse-practitioner, including effectiveness, physician acceptance, client acceptance, models of practice, legal issues, reimbursement, licensure and educational implications are discussed. It is concluded that the nurse-practitioner is a valuable profession.

A profile of nurse-academics in Australian universities.

This study investigates qualifications, level of employment, state and territory differences, and gender of nurse-academics in Australian universities. It describes these personal and professional characteristics and the interactions of some characteristics. Frequency descriptions were done to describe data, and cross-tabulations and analysis of variance were used to investigate relationships. The most significant findings were that not enough nurse-academics are qualified at the doctoral level, and nurse-academics are underrepresented at senior levels in comparison with all Australian academics. Recommendations for strategies to encourage and facilitate suitably qualified nurse-academics to undertake doctoral study are made.

A snapshot of Australian nursing scholarship 1993-1994.

This study investigates Australian nursing academics' publications in nursing and health journals in 1993-94. It describes the personal and professional characteristics of the authors, characteristics of the articles and interactions among these characteristics. Frequency descriptions were done to describe data and cross-tabulations were used to investigate relationships. The major findings about the authors are that few nurse-academics are publishing, that those who do publish are mainly senior academics, and that there are differences in publication rates among the states. The major findings about articles were that the majority of articles were in domestic journals, the major type of scholarship is research scholarship and that there is a shift away from teaching scholarship articles. The major focus of research scholarship is medical-surgical-nursing, with a quantitative approach, correlational design, convenience sample and no theoretical framework. Recommendations are made for further research which does not restrict scholarship to that appearing in journals and which investigates factors that constrain and facilitate scholarship.

Boomerang pillows and respiratory capacity in frail elderly women.

An exploratory study was done to determine whether frail elderly women placed on boomerang pillows would have an altered minute volume after 10 minutes. A convenience sample of 18 subjects took part in the study. A repeated measures design was used in which subjects served as their own controls. After 10 minutes on the boomerang pillows, there was a significant reduction in the minute volume of subjects. Boomerang pillows may be contraindicated in people with reduced lung capacity due to age; however, further research on a larger sample of frail elderly women is indicated.

A comparison of chilled and room temperature cabbage leaves in treating breast engorgement.

This study compared the effectiveness of chilled and room temperature green cabbage leaves in reducing the discomfort of breast engorgement in postpartum mothers. Twenty-eight lactating women with breast engorgement used chilled cabbage leaves on one breast and room-temperature cabbage leaves on the other for a two-hour period. Pre-treatment pain levels were compared with post-treatment levels for both conditions. There was no difference in the post-treatment ratings for the two treatments; mothers reported significantly less pain with both treatments. We concluded that it is not necessary to chill cabbage leaves before use.

A comparison of chilled cabbage leaves and chilled gelpaks in reducing breast engorgement.

This study compared the effectiveness of chilled green cabbage leaves and chilled gelpaks in reducing breast engorgement in postpartum mothers. Thirty-four lactating women with breast engorgement used chilled cabbage leaves on one breast and chilled gelpaks on the other for up to eight hours. Their pain levels were established pre-treatment and compared post-treatment for both conditions. There was no difference in the post-treatment ratings for the two treatments. Mothers reported a statistically significant drop in pain with both treatments; 68 percent obtained relief within one to two hours. The majority of mothers preferred the cabbage leaves.

Boomerang pillows and respiratory capacity.

An experimental study was done to determine whether subjects placed on boomerang pillows would have lower vital capacities than subjects placed on straight pillows after 30 minutes. A sample of 42 subjects took part in the study in a nursing laboratory. A crossover design was used in which subjects were measured in both conditions. The findings indicated that there was no significant difference in the vital capacities of subjects in the two conditions. An associated finding was that the vital capacities were significantly lower in a semi-Fowler's position than in a straight chair. It was concluded that boomerang pillows are safe to use for persons without respiratory problems. Further research is needed into the effect of boomerang pillows on persons with respiratory deficits.

The academic administrator's role in ... the sudden death of a resident physician.

In an academic administrator's role, writes Kathy Roberts, one's day-to-day responsibilities involve the management of a wide variety of administrative matters; however, no amount of training totally prepares one for the sudden death of a resident physician and the consequences thereof. Roberts describes just such an incident and how her organization dealt with it.