[The nursing labour market in Canada (1985-1999)]. / Le marché du travail en soins infirmiers au Canada (1985-1999).

This literature review analysed both published and unpublished scientific and professional studies on the nursing labour market in Canada within the period of 1985 to 1999. The goal was to conduct a situational analysis utilising statistical data and canvassing all concerned parties to extract their points of view. The analysis revealed significant cyclical variations in the evolution of the workforce, particularly with respect to auxiliary nurses, such as the perceived existence of major problems in recruiting new professionals in the field and retaining existing professionals in their organisations, the lack of homogeneity in educational training programmes, and the co-existence of several operational structures for organising nursing care, of which there is a lack of evaluation on their effectiveness. The results of the literature review identify the necessity to further develop the knowledge base on such a relevant dimension of the nursing labour market.

The importance of bacterial sepsis in intensive care unit patients with acquired immunodeficiency syndrome: implications for future care in the age of increasing antiretroviral resistance.

OBJECTIVE: To describe the clinical characteristics and outcomes of patients with acquired immunodeficiency syndrome (AIDS) admitted to the intensive care unit (ICU). DESIGN: An observational cohort study with retrospective chart review. SETTING: ICU of an urban university medical center. PATIENTS: Consecutive ICU admissions of patients with AIDS at an urban university medical center between December 1993 and June 1996. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: For each patient, we recorded ICU admission diagnosis, clinical characteristics, and outcome. Among 129 ICU admissions of patients with AIDS, 102 (79%) were admitted for infections, of which (45%) had infections caused by bacteria. Pseudomonas aeruginosa, Staphylococcus aureus, and other enteric pathogens were the most frequent isolates. Pneumonia accounted for 65% of 102 admissions for infections. Overall hospital mortality was 54%, but mortality was higher (68%) for patients with bacterial sepsis. Neutropenia was associated with differences in unadjusted survival rates, whereas CD4 counts were not. Independent predictors of hospital mortality included increasing acute physiology scores and severity of sepsis. CONCLUSIONS: In our ICU, among patients with AIDS, sepsis resulting from bacterial infection is now a more frequent cause of admission than Pneumocystis carinii pneumonia. Severity of illness and the presence of severe sepsis were the clinical predictors most associated with increased mortality. Patients who are not receiving or responding to highly active antiretroviral therapy may become as likely to be admitted to an ICU with a treatable bacterial infection as with classic opportunistic infections. Therefore, broad-spectrum empirical antibacterial therapy is particularly important when the etiology of infection is uncertain.

Safety among health-care workers in the NHS.

Within the health service one sometimes comes across the perception that the environment is by its very nature a safe environment. This is not necessarily so. The hospital environment contains man hazards, some of which may potentially be lethal, or cause disability or long-term ill health. This article looks at the importance of good health and safety in the health-care environment, and reviews the types of hazards and problems that might be present, and the legal requirements that apply.

Captopril versus placebo in congestive heart failure: effects on oxygen delivery to exercising skeletal muscle.

The effects of captopril versus placebo on oxygen consumption in the exercising leg have been examined using Doppler measurements of femoral flow and arteriovenous oxygen difference. Twenty patients with heart failure were randomized to captopril 25 mg (N = 10) or placebo (N = 10). Maximal supine exercise of one leg was performed before treatment and again 1 h and 4 h afterwards. Systemic haemodynamic variables were unaffected by placebo, but captopril increased stroke index at peak exercise from 26 +/- 3 to 34 +/- 3 ml beat-1 m-2 and reduced pulmonary artery wedge pressure from 26 +/- 3 to 16 +/- 3 mmHg (P less than 0.05). Despite the captopril-induced improvement in left ventricular function, exercise duration did not increase significantly and peak values for femoral flow (1059 +/- 178 to 938 +/- 134 ml min-1, P = NS), and oxygen consumption (134 +/- 26 to 111 +/- 18 ml min-1, P = NS) in the exercising leg were unaffected. Cutaneous flow, as reflected by skin temperature (27.5 +/- 0.4 to 27.6 +/- 0.4 degrees C, P = NS), was also unaffected. In the patients randomized to captopril, the acute improvement in left ventricular function was abbreviated and, after 4 h, all variables had returned towards baseline. Moreover, when the invasive studies were repeated after four weeks chronic treatment responsiveness to converting enzyme inhibition had attenuated and there were no detectable differences between the captopril and placebo groups. These data have demonstrated an acute captopril-induced improvement in left ventricular function in patients with congestive heart failure. Nevertheless the beneficial acute response was abbreviated predicting the development of early tolerance. Oxygen delivery to the exercising leg showed no tendency to increase either acutely when left ventricular function was significantly improved, or chronically when systemic responsiveness had attenuated. Thus irrespective of its effects on left ventricular function, captopril does not increase nutritive flow to exercising skeletal muscle in congestive heart failure.

Pulsed Doppler ultrasound compared with thermodilution for monitoring cardiac output responses to changing left ventricular function.

To determine the responsiveness of the pulsed Doppler technique to pacing and drug induced changes in left ventricular function 125 simultaneous cardiac output measurements by pulsed Doppler ultrasound and thermodilution were compared in 12 patients. The Doppler velocity frequencies were analysed using a signal averaging process and the validity of this method first tested in vitro. This showed almost perfect linearity of pulsed Doppler and electromagnetic flow determinations in a test rig. Although data points showed greater scatter in the clinical study, a highly significant linear relation between cardiac output measurements by pulsed Doppler and thermodilution was confirmed by regression analysis (r = 0.88, p less than 0.001). Certain mean values for cardiac output by the two techniques differed, however, by up to 0.9 litre.min-1. Despite this, changes in cardiac output in response to pacing, inotropic stimulation with dobutamine, and vasodilatation with nitrates were directionally similar, indicating a useful role for the pulsed Doppler technique in monitoring responses to treatment in the intensive care unit. Pulsed Doppler also provided a simple measure of left ventricular contractile function. Thus the inotropic response to dobutamine produced a significant rise in peak aortic flow velocity, and this variable was unaffected by either pacing or nitrate induced vasodilatation.

Comparison of the effect of amitriptyline in standard and sustained-release formulations on cardiac systolic time intervals.

Eight healthy male volunteers were given single doses of 75 mg standard and sustained-release amitriptyline in a double-blind, crossover trial. Systolic time intervals (STI) were measured hourly on drug and base-line days. Plasma amitriptyline and nortriptyline were measured hourly on drug days. To correct for diurnal variations, STI values on drug days were compared with values of base-line days at the same hour. Both formulations of amitriptyline produced initial decreases in heart rate (followed by a return to normal values) and a significant decrease in ventricular electrical systole (QTc), which began before plasma amitriptyline could be detected. One of the eight volunteers showed T wave depression following amitriptyline. The preejection period (PEPc) increased significantly in three of the eight volunteers (max 19%), and this change was due to an increase in true isovolumetric contraction time (TICT). The left ventricular ejection time (LVETc) decreased significantly in all volunteers (5%, p less than 0.001), the change being greater after sustained-release amitriptyline. Standard amitriptyline produced larger changes than sustained-release amitriptyline in QTc and PEPc. The overall increase in the PEP/LVET ratio, indicating an impairment of cardiac function, was twice as large after standard than after sustained-release amitriptyline (38% and 16%, respectively). The possible mechanisms of cardiac effects of amitriptyline are discussed. Our findings indicate that a sustained-release preparation may be safer than a standard preparation of amitriptyline, particularly if there is a risk of cardiac complications.