Intrathoracic meso-axial chronic gastric volvulus: erroneously investigated as coronary disease.

Gastric volvulus can result in complications such as gastric ischemia, perforation, and haemorrhage. There is consensus on repair upon diagnosis. We present a patient of gastric volvulus, who remained under the care of physicians with symptom of chest pain for over three years and was eventually treated by laparoscopic surgery.

"Burnout" in intensive care nurses.

The purpose of this research was to examine the relationship between burnout components and selected demographic variables in a group of intensive care unit nurses. This research hopes to heighten awareness of both intensive care nurses and hospital administrators of the importance of burnout in their work setting. A descriptive correlational study design was used to examine the extent of burnout according to selected demographic variables. Sixty-eight intensive care nurses from two hospitals and critical care courses at one university completed a demographic data form and the research questionnaire of the Maslach Burnout Inventory (MBI). Statistical analysis included non-parametric tests. Study results indicated low to moderate levels of total component scores in all intensive care nurses and on all three subscales of the assessment instrument. Results also indicated that, in this sample, younger nurses (20-29 years of age), separated and divorced nurses, and staff who work full time in ICUs were the most prone to emotional exhaustion. These research findings recommend support for ICU nurses to prevent burnout in their work setting. Further research is necessary to examine what kinds of working environments (job related stress) are effective in mitigating burnout amongst staff in the intensive care field.

An SNP map of human chromosome 22.

The human genome sequence will provide a reference for measuring DNA sequence variation in human populations. Sequence variants are responsible for the genetic component of individuality, including complex characteristics such as disease susceptibility and drug response. Most sequence variants are single nucleotide polymorphisms (SNPs), where two alternate bases occur at one position. Comparison of any two genomes reveals around 1 SNP per kilobase. A sufficiently dense map of SNPs would allow the detection of sequence variants responsible for particular characteristics on the basis that they are associated with a specific SNP allele. Here we have evaluated large-scale sequencing approaches to obtaining SNPs, and have constructed a map of 2,730 SNPs on human chromosome 22. Most of the SNPs are within 25 kilobases of a transcribed exon, and are valuable for association studies. We have scaled up the process, detecting over 65,000 SNPs in the genome as part of The SNP Consortium programme, which is on target to build a map of 1 SNP every 5 kilobases that is integrated with the human genome sequence and that is freely available in the public domain.

Genomic sequence and transcriptional profile of the boundary between pericentromeric satellites and genes on human chromosome arm 10q.

The organization of centromeric heterochromatin has been established in a number of eucaryotes but remains poorly defined in human. Here we present 1025 kb of contiguous human genomic sequence which links pericentromeric satellites to the RET proto-oncogene in 10q11.2 and is presumed to span the transition from centric heterochromatin to euchromatin on this chromosome arm. Two distinct domains can be defined within the sequence. The proximal approximately 240 kb consists of arrays of satellites and other tandem repeats separated by tracts of complex sequence which have evolved by pericentromeric-directed duplication. Analysis of 32 human paralogues of these sequences indicates that most terminate at or within repeat arrays, implicating these repeats in the interchromosomal duplication process. Corroborative PCR-based analyses establish a genome-wide correlation between the distribution of these paralogues and the distribution of satellite families present in 10q11. In contrast, the distal approximately 780 kb contains few tandem repeats and is largely chromosome specific. However, a minimum of three independent intrachromosomal duplication events have resulted in >370 kb of this sequence sharing >90% identity with sequences on 10p. Using computer-based analyses and RT-PCR we confirm the presence of three genes within the sequence, ZNF11/33B, KIAA0187 and RET, in addition to five transcripts of unknown structure. All of these transcribed sequences map distal to the satellite arrays. The boundary between satellite-rich interchromosomally duplicated DNA and chromosome-specific DNA therefore appears to define a transition from pericentromeric heterochromatin to euchromatin on the long arm of this chromosome.

Analysis of vertebrate SCL loci identifies conserved enhancers.

The SCL gene encodes a highly conserved bHLH transcription factor with a pivotal role in hemopoiesis and vasculogenesis. We have sequenced and analyzed 320 kb of genomic DNA composing the SCL loci from human, mouse, and chicken. Long-range sequence comparisons demonstrated multiple peaks of human/mouse homology, a subset of which corresponded precisely with known SCL enhancers. Comparisons between mammalian and chicken sequences identified some, but not all, SCL enhancers. Moreover, one peak of human/mouse homology (+23 region), which did not correspond to a known enhancer, showed significant homology to an analogous region of the chicken SCL locus. A transgenic Xenopus reporter assay was established and demonstrated that the +23 region contained a new neural enhancer. This combination of long-range comparative sequence analysis with a high-throughput transgenic bioassay provides a powerful strategy for identifying and characterizing developmentally important enhancers.

Cutting edge: homologous recombination of the MHC class I K region defines new MHC-linked diabetogenic susceptibility gene(s) in nonobese diabetic mice.

To localize the MHC-linked diabetogenic genes in the nonobese diabetic (NOD) mouse, a recombinational hotspot from the B10.A(R209) mouse was introduced to the region between the MHC class I K and class II A of the NOD mouse with the recombinational site centromeric to the Lmp2/Tap1 complex by breeding the two strains. Replacement of the NOD region centromeric to the recombinational site with the same region in R209 mice prevented the development of diabetes (from 71 to 3%) and insulitis (from 61 to 15%) in the N7 intra-MHC recombinant NOD mice. Similarly, the replacement of the NOD class II A, E and class I D region with the same region in R209 mice prevented the diseases (diabetes, from 71 to 0%; insulitis, from 61 to 3%). In addition to the MHC class II genes, there are at least two MHC-linked diabetogenic genes in the region centromeric to Lmp2.

Birthing at home: the resolution of expectations.

OBJECTIVE: To describe the experience of ten couples who have had a home birth in Western Australia. DESIGN, SETTING AND PARTICIPANTS: Using a phenomenological approach, ten parent couples were interviewed and three home-birth videos observed. Of the ten couples, four discussed their first child's home birth. The remaining six couples had three or four children who had been born at home. FINDINGS: The essence of these parents' experiences of home birth was gained through identifying significant statements from transcripts and field notes and clustering these into the four themes of 'constructing the environment'; 'assuming control'; 'birthing'; and 'resolving expectations'. The first two themes were presented in a previous paper (Morison et al 1998). The latter two themes are now presented. The theme 'birthing' was where parents elaborated on their birth beliefs, discussed the actual birth and shared aspects of the relationship between the couple and the midwife. 'Resolving expectations' concerned the process of parents forming expectations, experiencing the reality of birth and then evaluating whether expectations were met. KEY CONCLUSIONS: The development of a supportive relationship between couples and their midwife was essential during this transition to parenthood. Resolving expectations was an essential process that the parents undertook to clarify the meaning of their birth experience, and thereby acknowledge its uniqueness. IMPLICATIONS FOR PRACTICE: The findings are important to midwives' practice as they reveal the value clients place on a shared philosophy about birth. Midwives, in any setting, can reflect on their own birthing beliefs and determine their compatibility with their clients' beliefs.

The use of questioning strategies by clinical teachers.

By using questioning and other appropriate teaching strategies, clinical teachers can facilitate the development of critical thinking, decision making and problem solving in students. This study examined clinical teachers' use of questioning and the variations in their use of questioning as a teaching strategy. Although there was a variation in the number of questions asked, predominantly low level questions were asked by 26 clinical teachers at two post-clinical conferences. Based on the findings of this study, it is recommended that clinical teachers are taught how to ask questions, particularly high level questions.

Undertaking research for the benefit of the rural community.

This paper discusses the importance of disseminating clinical research findings to improve nursing practice and, ultimately, the health of rural Australia. It is argued that nursing in all settings must be practised within the context of changing healthcare trends. Currently, these changes include the restructuring of health services toward a greater emphasis on community-based services, a redirection of the focus of care toward population health rather than hospital-based service provision, multidisciplinary clinical decision-making with the community as partner, and the need for all health professionals to maintain fiscal and clinical accountability. To chart the process and outcomes of care in these changing circumstances requires ongoing, systematic research. The global movement toward evidence-based healthcare practice is thus timely and necessary. In order to provide a foundation for evidence-based practice that will demonstrate quality, efficiency, effectiveness and community acceptability, employers must address both infrastructure and educational needs. Educators must be responsive to changes in the organisation and finding of care. Also both groups must work collaboratively toward ensuring dissemination of research information that will make a difference to patient and community outcomes. The key to success is ongoing communication between employers, educators, practitioners in the field, community members and professional organisations so that research findings can be analysed in simple language that increases utility and that provides a forum for valuing information from all sources.

Family health and health services utilisation in Belmont, Western Australia: a community case study.

This case study was designed to examine the self-defined health needs of families in one urban Western Australian community. We conducted 157 family interviews to examine the relationship between family sociodemographic variables and patterns of use of health services, which included services used within the previous 12 months, and what the family needed and wanted from these services. Questions covered perceptions of health, family health concerns and the role of the family health guardian. Quantitative analysis included frequencies, cross-tabulations, chi-squared tests and multiple regression analysis. Open-ended responses were categorised and analysed for common themes. Approximately 80 per cent of participants had used one or more health services during the previous 12 months and, despite 35.9 per cent of families having at least one family member with a long-standing illness, disability or infirmity, most (82.1 per cent) considered the family healthy. The correlational analysis revealed several associations. Predictably, younger persons reported higher health ratings and older persons had more health concerns. Larger families reported better perceived levels of health. Higher utilisation rates were recorded for families with children, who tended to use the general practitioner for general care and medication, whereas one-parent families used hospital and specialist care more often, and 98.7 per cent reported satisfaction with services. What they needed and wanted from their health service providers was 'full disclosure' and 'not being talked down to', and for specialists especially to be approachable and impart information simply and honestly.

Short-insert libraries as a method of problem solving in genome sequencing.

As the Human Genome Project moves into its sequencing phase, a serious problem has arisen. The same problem has been increasingly vexing in the closing phase of the Caenorhabditis elegans project. The difficulty lies in sequencing efficiently through certain regions in which the templates (DNA substrates for the sequencing process) form complex folded secondary structures that are inaccessible to the enzymes. The solution, however, is simply to break them up. Specifically, the offending fragments are sonicated heavily and recloned, as much smaller fragments, into pUC vector. The sequences obtained from the resulting library can subsequently be assembled, free from the effects of secondary structure, to produce high-quality, complete sequence. Because of the success and simplicity of this procedure, we have begun to use it for the sequencing of all regions in which standard primer walking has been at all difficult.

Constructing a home birth environment through assuming control.

OBJECTIVE: The purpose of this qualitative study was to describe the experience of couples who have had a home birth. DESIGN, SETTING AND PARTICIPANTS: A phenomenological approach was used to provide an understanding of the human experience of home birth in Western Australia. The research design consisted of a field study, in which 10 parent couples were interviewed and three videos of home births observed. Of the ten couples, four couples spoke of their first baby's home birth and the remaining six couples had three or four children who had been born at home. FINDINGS: The couples' experiences of home birth were gained through identifying significant statements from transcripts and field notes, and clustering these into the following four themes: 'constructing the environment'; 'assuming control'; 'birthing'; and 'resolving expectations'. The themes of 'constructing the environment' and 'assuming control' are described in detail in this paper. 'Constructing the environment' describes how couples adapted the physical environment, and established support to create a positive birth environment. 'Assuming control' discusses exerting control and taking responsibility for the birth. The remaining themes of 'birthing' and 'resolving expectations' are described in a subsequent paper (Morison et al, in press). KEY CONCLUSIONS: The research furnishes an insight into the couples' experience of home birth. The lived experience of birthing at home involved a process where a couple actively created an environment that enabled them to assume control and responsibility for the birth. IMPLICATIONS FOR PRACTICE: The findings are important for midwives in any setting, as they reveal the extent to which some parents value the right to assume control and responsibility for the birth of their baby. Although the physical environment of a home birth cannot be replicated in every setting, issues specific to the birth environment are relevant to all midwives.

Unlicensed assistive personnel in the critical care unit: what is their role?

Driven by an economic imperative, the use of unlicensed assistive personnel (UAP) has proliferated in the health care system, however, their use in the critical care (CC) environment remains relatively new. An analysis of the first phase of a mixed method study, in which interviews with 17 CC nurses were conducted in order to provide data upon which to devise a larger survey, provides insight into the potential uses and misuses of these UAP. An examination of the transcripts, field notes, and diagrams and a comparison of the emerging categories to the literature assisted in identifying several themes important to CC nursing practice. Three themes identified in the analysis--ongoing vigilant assessment, quick response and seeing the whole picture--provide evidence that if UAP are asked to complete tasks allocated to them in other areas, CC nurses will be robbed of vital, albeit subtle, aspects of their nursing practice. As reflective practitioners, CC nurses must be wary of giving away tacit features of their role which enable them to synthesise contextual variables with espoused theory and experience, in order to ensure optimal patient care and outcomes.

Community parenteral therapy project: a pilot study.

The pilot study reported in this paper was devised to develop and compare service delivery models that would achieve the provision of high quality parenteral therapy care to patients in the Gold Coast District Health Service community. All data were collected on 113 patients for a 12-month period, January to December 1996. The study compared the provision of outreach nursing services and contracted nursing services on measures of satisfaction and cost. The study showed that patient and carers indicated a preference for community care, medical officers advocated the benefits of administering parenteral therapies in the community, general practitioners were interested in managing future community parenteral therapies, and contracted (nurse) service providers endorsed the development of a parenteral therapy resource centre. The findings also revealed considerable potential cost savings in community-based care.

Caring for the dying: nurses' experiences in hospice care.

This article reports on a phenomenological study of nurses' experiences of caring for dying patients in a Western Australian hospice. Data obtained from indepth interviews with nine experienced hospice nurses were analysed using Colaizzi's method. The five major themes that emerged from the data indicated that: nurses were transformed by the experience of caring for dying patients; the hospice context influenced caring; caring was embodied in nurse-patient interactions; caring extended to patients' families and nurses developed strategies to cope with their experience. The implications of the findings are that awareness of the effects of their caring activities on patients, their families and themselves is essential to nurses' maintenance of self and to their ability to enable patients to make choices. Suggestions are made for future research of the importance of caring contexts in both comforting patients and in preparing them for death.