The enculturation of our nursing graduates.

The transition from undergraduate nursing student to employment as a registered nurse is fraught with difficulties for a neophyte. This qualitative study used interviews and focus groups with graduate nurses from the Flinders University of South Australia in their first year of practice to ascertain their experiences as new graduates. The results reveal an enculturation of graduates not conducive to ongoing learning, consolidation of skills and application to practice. A rushed environment that was unpredictable, together with a lack of support, were recurrent themes from the graduates' perspective. Graduate nurse programs are run by institutions focused on outcomes and expenditure. There is little or no collaboration with the tertiary sector in providing appropriate programs according to graduates' needs. The graduates, as beginning practitioners, focused on not having the time to nurse holistically, an unrealistic workload, and the need for backup and continuous support on an individual basis. The wards, although possibly efficient and effective in providing health care, provided a culture where the graduates felt inadequate, rushed, overworked and unsupported, which is contrary to the aims and objectives of the graduate nurse programs. The nursing profession as a whole needs to develop a culture that is nurturing, enabling, supportive and protective of our young.

Localization of CAM II kinase-alpha, GAD, GluR2 and GABA(A) receptor subunit mRNAs in the human entorhinal cortex.

The human entorhinal cortex (ERC) is an important relay between neocortical association areas and the hippocampus. Pathology in this area, including disturbances in its unique cytoarchitecture and alterations in neurotransmitter receptor binding, has been implicated in several neuropsychiatric disorders but details of the patterns of gene expression for molecules involved in the major neurotransmitter systems in this cortex have been lacking. We used in situ hybridization histochemistry to localize the mRNAs for several proteins which are involved in excitatory and inhibitory neurotransmission in the human ERC. Labelling of mRNA for a glutamate receptor subunit (GluR2) and for a marker of glutamatergic cortical neurons (alpha type II calcium/calmodulin-dependent protein kinase) were distributed in a laminar manner which matched the cellular packing seen on the Nissl sections, with particularly high levels of labelling in the layer II (pre-alpha) cell clusters characteristic of this cortex. Cells labelled for the mRNA of 67 kDa glutamic acid decarboxylase, the synthesizing enzyme of GABA, were distributed diffusely throughout all layers, not concentrated in the cell clusters, and were present in higher numbers in layer III. The labelling of mRNAs for the alpha1, beta2 and gamma2 subunits of the GABA(A) receptor, however, was distributed in a laminar pattern similar to that for GluR2 and CAM II kinase mRNAs, implying a high concentration of inhibitory synapses on the excitatory cells which express these mRNAs.

Should I take my first offer? A graduate nurse survey.

The newly graduated registered nurses' experiences of applying for graduate nurse positions and securing employment in nursing has received little attention in academic nursing literature. This article reports on a survey questionnaire of a cohort of 1995 graduates from the School of Nursing at Flinders University of South Australia. The survey was the first phase of a research project dealing with the transition from education to employment or from university student to registered nurse. The aim of the survey was to explore the graduates' experiences of searching and applying for employment, and their entry into a graduate nurse program (GNP) or employment as a registered nurse. Results indicate a disjointed and haphazard road that graduates must negotiate to secure a position. Anecdotal evidence suggests significant angst among final year nursing undergraduates at Flinders University of South Australia regarding a GNP place. The application process is costly in time and money for graduates and employer organisations. The duplication is unnecessary in this era of economic rationalism, cost-effectiveness and sustainability. Nursing students in the final semester of their undergraduate program need to focus on developing their role as a registered nurse, but instead are focusing on multiple applications to GNPs or employment for when they are registered. It is argued that a consortium, which centralises the process of application, would be beneficial to the graduates. Also, the limited number of GNP places available in the acute care sector, indicates that graduate registered nurses are working as registered nurses without any formal support. The recommendation is that GNPs be extended into diverse settings where nurses work such as in aged care, nursing agencies, rural and remote services, and the community.

From university student to registered nurse: the perennial enigma.

Crucial issues related to the transition from university student to registered nurse are addressed, through a review of the literature. The considerable literature in this area indicates three distinct approaches in examining this question: there are personal and professional deficits which the new graduate must make up, the formal content of the university curriculum is deficient and must be replaced, the socio-political and professional contexts of practice constrains beginning practice. Each of these approaches is examined here in the expectation that uncovering these issues will encourage employers and educators to work together to resolve some of the current conflicts and difficulties inherent in the transition from university student to registered nurse. Various models of transition in current use are then explored, since support for the graduate is paramount for provision of a cost effective and efficient nursing service in a rapidly changing health service environment.

Increased density of entorhinal glutamate-immunoreactive vertical fibers in schizophrenia.

Gluatamtergic fibers have been immunocytochemically localized in the entorhinal cortex of postmortem schizophrenic brains. The density of small caliber vertical fibers was higher in schizophrenics than controls, with no significant increase in the number of large caliber fibers. Increased glutamatergic fiber density has been previously reported in the cingulate cortex. It is proposed that increases in glutamatergic fibers from the amygdala may be responsible for these changes and that they may play a central role in the pathophysiology of schizophrenia.

Use of MRI for measuring structures in frozen postmortem brain.

A method was developed for magnetic resonance imaging (MRI) of human autopsy brains stored long-term at -70 degrees C. Scanning brains at temperatures between -70 and -8 degrees C gave minimal MRI signals consistent with protons having limited freedom of movement at low temperature. Raising brain temperature improved the signal such that scanning at -1 degree C generated images with good in-plane resolution, grey/white matter contrast, and fine detail of cortical sulcal/gyral patterns. To validate the method, volume and area measurements were made using computerized image analysis on stored digital images of 14 brains from adult subjects of both genders and various ages. The data confirmed that brain volume was inversely correlated with age, and female subjects had smaller brains. This is a valuable new method for acquiring morphometric data from previously unscanned pathologic brains that are to be used for neurochemical and molecular investigations.

Long-term treatment of Nelson's syndrome with sodium valproate.

Eleven patients with Nelson's syndrome were given sodium valproate (Epilim, Sanofi). Plasma ACTH and cortisol levels were measured under carefully controlled conditions which were designed to eliminate spontaneous fluctuations in ACTH. At 6 weeks all 11 patients were reassessed while taking sodium valproate 600 mg/day; there was then a small but significant (P less than 0.05) reduction in plasma ACTH concentration. Six patients continued to take sodium valproate, and were reassessed at 1 year when five were taking 1200 mg/day and one patient was taking 600 mg/day. At 1 year for these six patients there had been an increase in mean plasma ACTH which was then not significantly different from basal values. The five patients who discontinued sodium valproate were also reassessed at 1 year, when there were no significant differences compared to basal or 6-week values. During therapy with sodium valproate, there were no significant changes in the half-life of plasma cortisol, plasma sodium and potassium concentrations, or serum liver enzymes. Weight gain on sodium valproate was the main reason for patients asking to discontinue therapy. Sodium valproate is not an effective long-term therapy for reducing plasma ACTH for patients with Nelson's syndrome.

A large outbreak of keratoconjunctivitis due to adenovirus type 8.

A large nosocomial outbreak of keratoconjunctivitis due to adenovirus type 8 is described. Two hundred cases were identified, 123 by isolation of the virus and 77 by detecting HI antibodies in convalescent sera. Infection usually presented as a severe keratoconjunctivitis, and 107 (54%) of infected patients developed sub-epithelial corneal opacities. The majority (66%) of infections were acquired at the accident and emergency department attached to a large urban eye hospital when patients attended for other reasons; trauma to the eye, especially corneal foreign bodies, was the most frequent cause for the initial attendance. Transmission of virus within the family occurred in 13% of cases, but there was little spread outside family or hospital environments. The outbreak lasted from May to September, 1982, but it was not confirmed by isolation of the virus until the end of June when control measures were instituted. Delay in applying control measures was probably the major factor accounting for this large, prolonged outbreak of epidemic keratoconjunctivitis.

Single daily dose short term carbimazole therapy for hyperthyroid Graves' disease.

Twenty-one patients with hyperthyroid Graves' disease were treated with carbimazole 30 mg daily, given as a single dose. Propranolol was also given for the first 3 weeks. All became clinically euthyroid with normal serum thyroxine (T4) levels, usually within 1-3 months. Patients with large goitres and raised serum alkaline phosphatase concentrations took longer to respond. In 19 patients a positive thyroid stimulating hormone (TSH) response to intravenous thyrotrophin releasing hormone (TRH) developed. Carbimazole was stopped soon after (median time of treatment 18 weeks, range 9-41 weeks) and 18 patients have been followed. Seven of these (39%) have remained in remission from hyperthyroidism for more than one year (median 77 weeks). Carbimazole 30 mg once daily is a convenient and effective treatment for hyperthyroid Graves' disease. Many patients will achieve prolonged remissions if treatment is stopped when serum T3 and T4 levels are in the low-normal range, usually 2-4 months after clinical euthyroidism has been reached.

An evaluation of plasma exchange for Graves' ophthalmopathy.

Eighteen patients with ocular manifestations of Graves' disease were treated by plasma exchange. Detailed clinical, ophthalmological and orthoptic assessments were made including computerized axial tomography and A + B scan ultrasound of the orbits. Seventeen different ocular parameters were separately rated for each patient. The changes recorded were small, statistically insignificant, and no patient was cured of ocular disease. There were no significant correlations between the ocular changes recorded and age, sex, duration of ophthalmic symptoms, the presence of thyroid antibodies, the number of exchanges, or the concurrent administration of azathioprine.

Cushing's disease treated by total adrenalectomy: long-term observations of 43 patients.

Forty-three patients were treated by total adrenalectomy for pituitary-dependent Cushing's disease. The median period of observation was 10 years (range one to 20 years). Thirty-eight patients (88 per cent) had rapid and lasting remissions. Of the 38 in remission, 21 became pigmented but without pituitary enlargement, 11 became pigmented with evidence of further pituitary expansion (Nelson's syndrome) and six neither became pigmented nor showed pituitary expansion. Pituitary expansion was associated with high plasma ACTH values, and treatment of pituitary tumours by surgery or radiotherapy gave poor results. However, when compared with alternative methods of treatment, total adrenalectomy for Cushing's disease is still satisfactory for many patients, despite advances in pituitary surgery, and has advantages over 'medical adrenalectomy' with drugs.

Cushing's syndrome, nodular adrenal hyperplasia and virilizing carcinoma.

A 48-year-old hypertensive diabetic woman rapidly became virilized. Urine 17-oxo-and oxogenic steroids and plasma testosterone, androstenedione, DHEA, DHEA-sulphate and androstenediol were greatly elevated. Plasma cortisol was constantly high and was not suppressed by dexamethasone. Circulating immunoreactive ACTH was consistently detectable at 18-24 ng/l. A 450 g carcinoma arising from a nodular hyperplastic right adrenal gland was resected. Production by the tumour of 17a-hydroxypregnenolone, 17a-hydroxyprogesterone and five C-19 steroids, but very little prenenolone, progesterone or cortisol, was shown by blood sampling, tumour culture and dramatic falls after operation. The plasma cortisol fell to half, with no diurnal variation, consistent with persistent Cushing's syndrome, and the plasma ACTH rose to 55 ng/l. She died 3 months later from a myocardial infarction. Autopsy revealed a pituitary basophil adenoma at a site where radiologically there had been an indentation in the fossa floor for at least 7 years. The left adrenal gland showed nodular hyperplasia. Therefore we conclude that mild pituitary-dependent Cushing's syndrome may have been present for many years before development of a virilizing carcinoma. This case demonstrates that adrenal carcinoma in man can sometimes develop as a consequence of nodular adrenal hyperplasia which may in turn be due to long-standing trophic hyper-stimulation.

Anabolic steroids in athelics: crossover double-blind trial on weightlifters.

Thirteen experienced male weightlifters taking high-protein diets and regular exercise took part in a double-blind crossover trial of methandienone 10 or 25 mg/day to seeif the drug improved athletic performance. Their improvemments were significantly greater on methandienone than on placebo; their body weights rose (though this seemed to be associated with water retention); and systolic blood pressure rose significantly. Methandienone caused many side effects, and three men had to withdraw because of them. All side effects disappeared after the drug was stopped. Anabolic steroids are effective only when given combination with exercise and high-protein diet. We deprecate their use in athletics but can suggest no way of stopping it.