Mount Gould Hospital

Mounting financial pressures continue to challenge health care institutions. Nurse executives with responsibility for efficient nursing resources must ensure the integrity of their staffing systems. Are your systems accurate? Are they connected with each other and the budget? Do all nurse managers have a strong grasp of the staffing systems? This article provides a guide for you to connect and improve staffing processes and tools. In this way, nurse executives ensure operational excellence and financial resilience.

Destruction of peripheral nerves with chemical substances such as phenol and alcohol solutions was introduced as a novel therapeutic modality in the 1930s, but it became a popular method of treating severe, intractable pain associated with cancer in the mid 1950s. Severe chronic muscle spasticity often causes constant gnawing pain. Diagnostic nerve blocks with local anaesthetics are sometimes necessary to assess the risk/benefit ratio of chemical neurolysis. Phenol and ethyl alcohol are the drugs most commonly used for peripheral nerve and intrathecal blocks. Chemical neurolysis is most frequently used for blocks of the medial popliteal, the obturator, the sciatic and the musculocutaneous nerve of the arm. A number of factors contribute to the motor functional disability associated with long-standing upper motor neurone lesions. Administration of phenol or alcohol into the intrathecal subarachnoid space is generally reserved for severe symptomatic cases of lower limb spasticity refractory to other methods of treatment.

During World War Two 1.9 million people were evacuated from British cities where the risk of bombing was perceived to be highest. 1.5 million of these were children who, often unaccompanied, were sent to live with strangers. Two hundred and forty-five people who were evacuated as children were compared with 96 of similar age who did not experience evacuation. Within this self-selected sample, significant numbers of the evacuees were found to have experienced abuse and neglect. Pre-evacuation abuse made continued abuse likely during evacuation, while abuse during evacuation led to children being more likely to continue to be abused on their return home. Abuse during evacuation led to increased scores on the Impact of Event Scale and General Health Questionnaire, and to insecure attachment patterns. The role of evacuation and abuse in the maintenance of long-term psychological problems is discussed.

Impairment of language function (aphasia) is one of the most common neurological symptoms after stroke. Approximately one in every three patients who have an acute stroke will suffer from aphasia. The estimated incidence and prevalence of stroke in Western Europe is 140 and 800 per 100,000 of the population. Aphasia often results in significant disability and handicap. It is a major obstacle for patients to live independently in the community. When recovery from aphasia occurs, it is usually incomplete and patients are rarely able to return to full employment and other social activities. Currently, the main treatment for aphasia is conventional speech and language therapy. However, the effectiveness of this intervention has not been conclusively demonstrated and empirical observations suggest that spontaneous biological recovery may explain most of the improvement in language function that occurs in aphasics. The generally poor prognosis of the severe forms of poststroke language impairment (Broca, Wernicke and global aphasia), coupled with the limited effectiveness of conventional speech and language therapy has stimulated the search for other treatments that may be used in conjunction with speech and language therapy, including the use of various drugs. Dopamine agonists, piracetam (Nootropil®), amphetamines, and more recently donepezil (Aricept®), have been used in the treatment of aphasia in both the acute and chronic phase. The justification for the use of drugs in the treatment of aphasia is based on two types of evidence. Some drugs, such as dextroamphetamine (Dexedrine®), improve attention span and enhance learning and memory. Learning is an essential mechanism for the acquisition of new motor and cognitive skills, and hence, for recovery from aphasia. Second, laboratory and clinical data suggest that drug treatment may partially restore the metabolic function in the ischemic zone that surrounds the brain lesion and also has a neuroprotective effect following acute brain damage. An example of this is the nootropic agent piracetam. Extensive animal studies have demonstrated the beneficial effects of this and other drugs on neural plasticity, but data on humans are still sparse. This review provides a critical analysis of the current evidence of the effectiveness of these drugs in the treatment of acute and chronic aphasia.

Background: The modified Ashworth scale (MAS) is the most widely used method for assessing muscle spasticity in clinical practice and research. However, the validity of this scale has been challenged. Objectives: To compare the MAS with objective neurophysiological tests of spasticity. Methods: The MAS was recorded in patients with post-stroke lower limb muscle spasticity and correlated with the excitability of the α motor neurones. The latter was evaluated by measuring the latency of the Hoffmann reflex (H reflex) and the ratio of the amplitude of the maximum H reflex (Hmax) to that of the compound action motor potential of the soleus muscle (Mmax). Results: Data on 24 randomly recruited patients were analysed. Patients were divided into two groups according to their MAS score: 14 had a MAS score of 1 (group A) and 10 scored 2 (group B). The two groups were comparable with respect to age and sex, but in group A there was a longer period since the stroke. The H reflex latency was reduced and the Hmax:Mmax ratio was increased in both groups. The Hmax:Mmax ratio values were higher for group B but the differences were not statistically significant. Conclusions: There is a relation between the MAS scores and α motor neurone excitability, although it is not linear. This suggests that the MAS measures muscle hypertonia rather than spasticity.

Purpose : There is scant information at present on the effects of severe osteoarthritis (OA) of the knee joint on gait. In the present study the kinematic and kinetic parameters of gait and the pattern of activation of four lower limb muscles were examined during walking at a self-selected pace on level ground. The spatiotemporal parameters of gait were also computed. Methods : Measurements were made using a three-dimensional optico-electronic motion analysis system integrated with a force plate and telemetered electromyography. Results : Fifty-eight patients with severe OA of the knee and 25 age-matched healthy control subjects were examined. Patients demonstrated a significantly reduced walking speed, shorter stride length and a more prolonged stance phase of the gait cycle compared with the control subjects. They also had less range of motion at the hip, knee and ankle, joints and generated less moments and powers at the ankle and more moments at the knee than the control group. The differences were statistically significant for all parameters except the degree of ankle plantar flexion in stance. Activation of the rectus femoris muscle was prolonged in the patients group. Conclusions : It is concluded that the observed gait abnormalities were due to instability of the knee joint in stance. This may have important clinical implications for the rehabilitation of patients with severe OA of the knee.

The paper by Hurry & Storey ([2000][1]) raises some important points pertaining to the psychosocial assessment of young people presenting with deliberate self-harm (DSH) to accident and emergency (A&E) departments. It is disconcerting that only 54% of children in the 12-15 age group received a

This paper looks at the difficulties in applying second order ideas to therapeutic practice. It considers, first, what second order ideas are and how they relate to one another, second, what second order practice looks like, and third, the problems these ideas create when trying to apply them. It is argued that their pure application is impossible given our strong moral beliefs, but that there are good ethical and aesthetic reasons for taking such ideas as far as we can.‘There are always people who possess a theory they cannot act on.’(Leih Tzu from The Book of Leih Tzu)

Two differing cementation methods were investigated in an in vitro simulation of hip arthroplasty. The bone-cement interface pressures were recorded during cement injection and stem insertion in matched pairs of fresh cadaveric femora. Reduced viscosity cement injected with a cement gun and proximal seal was compared with injection of high viscosity cement and finger-packing in each pair. The resultant shear strength of the bone-cement interface was measured by push-out tests. Results were analysed using the Wilcoxon ranked sum test for paired samples. The Exeter method of cementation produced significantly higher mean and maximum pressures above the bleeding pressure of femoral bone at all interface levels during cement injection. This was associated with significantly greater mean shear strengths. The authors conclude that the Exeter pressurization system for cementation overcomes the effect of femoral bone bleeding and improves the quality of the bone-cement interface. This may contribute to reduction in the incidence of loosening in cement hip arthroplasty.