bluuebunny/crossref_metadata_2025_split huggingface dataset:
An American tale – professional conflicts in anaesthesia in the United States: implications for the United Kingdom
Authors: Kane M. , Smith A. F. 
Published: July 2004

SummaryProfessional conflict between nurse anaesthetists and anaesthesiologists in the United States of America is well known in the UK but has not been explored and documented in detail. We present an account, based on critical analysis of published literature and other documentary evidence, of the historical, professional and financial factors which have led to this. In the USA, anaesthesia developed as a nursing specialty until physicians began to take on this work after the Second World War. Payment arrangements between the 1960s and the 1990s made anaesthesiology a lucrative career choice for medical graduates and this led both to considerable growth in the number of anaesthesiologists and to a strengthening of the resolve of nurse anaesthetists to retain their scope of work and preserve their professional status. Changes in payment regulations in the 1980s and 1990s threatened anaesthesiologists' income and led to re‐appraisal of evidence over relative cost‐effectiveness and safety of different provider models. More recently, the terms of engagement have shifted from disputes over evidence to political lobbying to promote the professional capabilities and status of each of the anaesthesia providers. Factors of relevance to possible changes in the provision of anaesthesia in the United Kingdom are highlighted.
Effects of the European Working Time Directive on anaesthetic training in the United Kingdom
Authors: Sim D. J. , Wrigley S. R. , Harris S. 
Published: July 2004

SummaryDecreases in the hours worked by trainee anaesthetists are being brought about by both the New Deal for Trainees and the European Working Time Directive. Anticipated improvements in health and safety achieved by a decrease in hours will be at the expense of training time if the amount of night‐time work remains constant. This audit examined the effects of a change from a partial to a full shift system on a cohort of trainee anaesthetists working in a large district general hospital in the South‐west of England. Logbook and list analyses were performed for two 10‐week periods: one before and one after the decrease in hours. An 18% decrease in the number of cases done and an 11% decrease in the number of weekly training lists were found for specialist registrars. A 22% decrease in the number of cases done and a 14% decrease in the number of weekly training lists were found for senior house officers. Furthermore, a decrease of one service list per specialist registrar per week was seen, which will have implications for consultant manpower requirements.
Evaluation of Frova, single‐use intubation introducer, in a manikin. Comparison with Eschmann multiple‐use introducer and Portex single‐use introducer*
Authors: Hodzovic I. , Latto I. P. , Wilkes A. R. , Hall J. E. , Mapleson W. W. 
Published: July 2004

SummaryIn a randomised cross‐over study, 48 anaesthetists attempted to place a Frova single‐use introducer, an Eschmann multiple‐use introducer and a Portex single‐use introducer in the trachea of a manikin set up to simulate a grade 3 laryngoscopic view. The anaesthetists were blinded to success (tracheal placement) or failure (oesophageal placement). Successful placement (proportion, 95% confidence interval) of either the Frova introducer (65%, 50–77%) or the Eschmann introducer (60%, 46–73%) was significantly more likely than with the Portex introducer (8%, 3–20%). There were no significant differences between the success rates for the Frova and the Eschmann introducers. A separate experiment revealed that the peak force exerted by the Frova and Portex introducers was two to three times greater than that which could be exerted by the Eschmann introducer, p < 0.0001, indicating that the single‐use introducers are more likely to cause tissue trauma during placement.
Plasma volume changes associated with two hydroxyethyl starch colloids following acute hypovolaemia in volunteers
Authors: James M. F. M. , Latoo M. Y. , Mythen Michael G. , Mutch M. , Michaelis Christian , Roche A. M. , Burdett Edward 
Published: July 2004

SummaryThis randomised double blind prospective study compared the effective intravascular volume expansion and maintenance, with two types of starches following induced haemorrhagic hypovolaemia. Twenty healthy male volunteers aged between 18 and 65 year were bled 10% of their total blood volume in fully monitored conditions and under the supervision of a trained specialist doctor and research nurse. The lost blood volume was replaced using one of the starch solutions. Effective intravascular volume expansion was monitored hourly using the 51Cr radio‐labelled red blood cell dilution technique, we compared the effects of two hydroxyethyl starch colloid preparations, one a high molecular weight and the other a low molecular weight preparation, on the plasma volume changes over time. The large molecular weight starch (Hextend) provided a less well‐sustained volume expansion effect than the smaller one (Voluven)
Impact of spinal anaesthesia and obesity on maternal respiratory function during elective Caesarean section*
Authors: Von Ungern‐Sternberg B. S. , Regli A. , Bucher E. , Reber A. , Schneider M. C. 
Published: July 2004

SummarySpinal anaesthesia for Caesarean section has gained widespread acceptance. We assessed the impact of spinal anaesthesia and body mass index (BMI) on spirometric performance. In this prospective study, we consecutively assessed 71 consenting parturients receiving spinal anaesthesia with hyperbaric bupivacaine and fentanyl for elective Caesarean section. We performed spirometry during the antepartum visit (baseline), immediately after spinal anaesthesia, 10–20 min, 1 h, 2 h after the operation, and after mobilisation (3 h). Baseline values were within normal ranges. There was a significant decrease in all spirometric parameters after effective spinal anaesthesia that persisted throughout the study period. The decrease in respiratory function was significantly greater in obese (BMI > 30 kg.m−2) than in normal‐weight parturients (BMI < 25 kg.m−2), e.g. median (IQR) vital capacity directly after spinal anaesthesia; −24 (−16 to −31)% vs. −11 (−6 to −16)%, p < 0.001 and recovery was significantly slower. We conclude that both spinal anaesthesia and obesity significantly impair respiratory function in parturients.
Retracted: Reversal of vecuronium with neostigmine in patients with diabetes mellitus
Authors: Saitoh Y. , Hattori H. , Sanbe N. , Nakajima H. , Akatu M. , Murakawa M. 
Published: July 2004

SummaryReversal of vecuronium‐induced neuromuscular blockade with neostigmine was compared in two groups of 16 subjects: patients with Type 2 diabetes mellitus and normal controls. When the first twitch of the train‐of‐four had returned to 25% of the control value, neostigmine 40 μg.kg−1 and atropine 20 μg.kg−1 were given to reverse the neuromuscular blockade. The train‐of‐four ratio was lower at 3 min, 6 min, 9 min, 12 min and 15 min after reversal in the diabetic group than in the control group but the differences did not reach statistical significance. Fifteen minutes after reversal, the number of patients in whom recovery from neuromuscular blockade was judged insufficient to guarantee good respiratory function (train‐of‐four ratio < 0.74) did not differ between the groups. However, 15 min after reversal, the number of patients with a train‐of‐four ratio < 0.9 was significantly higher in the Diabetic Group than in the Control Group (15 vs. 10, p = 0.033).
Variation in the transcription of laboratory data in an intensive care unit
Authors: Black R. , Woolman P. , Kinsella J. 
Published: July 2004

SummaryManual transcription of numerical data is prone to error. We quantified the transcription error rate for blood results recorded in a critical care setting by comparing the handwritten and printed laboratory results in 100 consecutive patients in the intensive care unit, Glasgow Royal Infirmary. Nine hundred and fifty‐four sets of results with 4664 individual values were analysed. There was complete and accurate transcription in 67.6% (n = 645) of cases, a failure to transcribe in 23.6% (n = 225) and inaccurate transcription in 8.8% (n = 84). Transcription was significantly more accurate in the morning (p = 0.02). This study highlights that our current system of recording blood results is unreliable. These results strengthen the case for computerisation of the patient record in terms of data retrieval and transcription accuracy.
The effect of critical care outreach on postoperative serious adverse events
Authors: Story D. A. , Shelton A. C. , Poustie S. J. , Colin‐Thome N. J. , McNicol P. L. 
Published: July 2004

SummaryWe proposed that critical care outreach would decrease the incidence of postoperative serious adverse events and so conducted a sequential cohort study with a surveillance‐only phase (baseline) followed by an intervention phase. We studied high‐risk patients in a large Australian hospital. A critical care qualified nurse reviewed patients for the first three days after return to the general wards. During the intervention phase the nurse intervened in patient care where appropriate. We examined the incidence of 11 categories of serious adverse events per 100 patients during the first three days on the general wards during the surveillance and intervention phases. The surveillance phase had 319 patients and the intervention phase 345 patients. In a subgroup analysis, there were four myocardial infarctions per 100 patients in the surveillance phase and seven per 100 patients during the intervention phase (95% confidence interval: 1–7 infarctions per 100 patients increase). For the other 10 serious adverse events there were 19 per 100 patients in the surveillance phase and 11 per 100 patients in the intervention phase (95% confidence interval: 4–11 serious adverse events per 100 patients decrease). Outreach may have led to greater detection of myocardial infarctions while reducing the incidence of other serious adverse events.
Provision of long‐term venous access procedures by UK anaesthetists: A postal survey
Authors: Johnson D. , Bodenham A. 
Published: July 2004

SummaryLong‐term venous access is widely used in hospital and in the community for cancer chemotherapy, total parenteral nutrition and long‐term administration of antibiotics. There is a large variety of catheters, ports and other devices designed to facilitate these treatments. A postal survey of anaesthetic departments in England, Wales, Scotland and Northern Ireland was undertaken to assess the role of anaesthetists in this area of clinical practice. Two hundred and fifteen out of 276 (78%) anaesthetic departments responded. Forty‐three percent of departments (92 out of 215) provided some form of long‐term vascular access service. Twenty‐two percent of departments which provided this service (20 out of 92) had anaesthetists with sessional allocation for such procedures. Such work represents a significant workload for anaesthetic departments which is likely to increase over time.
Ximelagatran, a new oral direct thrombin inhibitor, for the prevention of venous thromboembolic events in major elective orthopaedic surgery. Efficacy, safety and anaesthetic considerations
Authors: Rosencher N. 
Published: July 2004

SummaryThe oral direct thrombin inhibitor ximelagatran shows great promise for prevention of venous thromboembolic events following major elective orthopaedic surgery. Its consistent and predictable pharmacokinetics and pharmacodynamics across a wide range of patient populations allow administration with fixed dosing and with no coagulation monitoring. In orthopaedic surgery clinical trials, ximelagatran was effective and well tolerated compared with standard therapy, with dose and timing relative to surgery important factors in determining its optimal profile. In European trials, an initial 3‐mg postoperative dose of subcutaneous melagatran, the active form of ximelagatran, followed by oral ximelagatran 24 mg twice daily achieved similar efficacy and safety to enoxaparin. Although the risk of spinal haematoma following neuraxial anaesthesia is rare, it is increased by the concomitant use of anticoagulants. In orthopaedic surgery trials with ximelagatran to date, complications such as spinal haematoma have not been reported. The pharmacokinetic profile of ximelagatran suggests that concurrent use with neuraxial anaesthesia should require no further precautions than those currently necessary with low‐molecular‐weight heparin.
The air elimination capabilities of pressure infusion devices and fluid‐warmers
Authors: Schnoor J. , Macko S. , Weber I. , Rossaint R. 
Published: July 2004

SummaryPressurised infusion devices may have only limited capability to detect and remove air during pressurised infusions. In order to assess pressure infusion systems with regard to their actual air elimination capabilities four disposable pressure infusion systems and fluid warmers were investigated: The Level 1® (L‐1), Ranger ® (RA), Gymar® (GY), and the Warmflo® (WF). Different volumes of air were injected proximal to the heat exchanger and the remaining amount of air that was delivered at the end of the tubing was measured during pressurised infusions. Elimination of the injected air (100–200 ml) was superior by the RA system when compared to L‐1 (p < 0.01). The GY and WF systems failed to eliminate the injected air. In conclusion, air elimination was best performed by the RA system. In terms of the risk of air embolism during pressurised infusions, improvements in air elimination of the investigated devices are still necessary.
Analysis of the moral habitability of the nursing work environment
Authors: Peter Elizabeth H. , Macfarlane Amy V. , O'Brien‐Pallas Linda L. 
Published: July 2004

Background.  Following health reform, nurses have experienced the tremendous stress of heavy workloads, long hours and difficult professional responsibilities. In recognition of these problems, a study was conducted that examined the impact of the working environment on the health of nurses. After conducting focus groups across Canada with nurses and others well acquainted with nursing issues, it became clear that the difficult work environments described had significant ethical implications.Aim.  The aim of this paper is to report the findings of research that examined the moral habitability of the nursing working environment.Methods.  A secondary analysis was conducted using the theoretical work of Margaret Urban Walker. Moral practices and responsibilities from Walker's perspective cannot be extricated from other social roles, practices and divisions of labour. Moral‐social orders, such as work environments in this research, must be made transparent to examine their moral habitability. Morally habitable environments are those in which differently situated people experience their responsibilities as intelligible and coherent. They also foster recognition, cooperation and shared benefits.Findings.  Four overarching categories were developed through the analysis of the data: (1) oppressive work environments; (2) incoherent moral understandings; (3) moral suffering and (4) moral influence and resistance. The findings clearly indicate that participants perceived the work environment to be morally uninhabitable. The social and spatial positioning of nurses left them vulnerable to being overburdened by and unsure of their responsibilities. Nevertheless, nurses found meaningful ways to resist and to influence the moral environment.Conclusions.  We recommend that nurses develop strong moral identities, make visible the inseparability of their proximity to patients and moral accountability, and further identify what forms of collective action are most effective in improving the moral habitability of their work environments.
Implementing local pay systems in nursing and midwifery
Authors: Meerabeau Elizabeth , Corby Susan , Druker Janet , White Geoffrey 
Published: July 2004

Background.  The paper is based on a case study, which was part of a Department of Health commissioned research study covering 10 National Health Service (NHS) trusts in England that had adopted a range of approaches to the employment terms and conditions of nurses, midwives, and other non‐medical staff, as the precursor to evaluating Agenda for Change, the modernized pay system for the NHS.Aim.  The aim of this paper is to discuss a case study of the effects of changing nurses’ pay progression.Methods.  Fieldwork took place in 2000, and included interviews with managers, union representatives and other staff, and analysis of internal documents.Findings.  Findings discussed include the constraints on managers when devising a new pay system, the time and detailed work needed and the challenges of assessing their effects (particularly in relation to patient care). Although the latter are difficult to assess, staff involved in the scheme reported benefits from the closer focus on competences which resulted from the scheme.Conclusions.  The effects of changes to pay schemes are difficult to assess, and the evaluation of the proposed national scheme (Agenda for Change) will be challenging.
School nurses: policies, working practices, roles and value perceptions
Authors: Croghan Emma , Johnson Carol , Aveyard Paul 
Published: July 2004

Background.  In the UK, school nursing has recently been at the forefront of policy change, with school nurses being considered pivotal to child‐centred public health practice. There is very little literature on this topic and, in particular, little that is written from a practitioner perspective.Aim.  This paper reports a survey that examines the work of school nurses compared with the expectations of their first line managers and policy‐makers in government, in order to discover any potential practical or ideological areas of conflict.Methods.  We first applied a theoretical framework of sensitizing concepts to the historical, political, cultural and contextual background of school nursing. Following this, 46 school nurses in the West Midlands region of the UK were randomly selected and asked to complete a questionnaire about their personal characteristics, experience, training and working practices. The 38 nurses who completed this were then interviewed. Job descriptions for school nurses and governmental job expectations were obtained from various official sources and compared with the self‐reported practices of school nurses.Findings.  All the nurses met the work criteria of their local employers, except in respect of health needs assessment activities, which two nurses had not yet attempted. All 38 also carried out a range of additional work activities, including providing sexual health services and parental support clinics. They also had a diverse range of skills and qualifications relevant to supporting the needs of their local communities. Qualitative data from interviews provided a useful insight into nurses’ feelings of being valued by their clients and by local and national employers, and feelings of professional undervaluing by their peers. They felt positive about role changes in the last few years, and that they supported the child‐centred public health role advocated by public policy.Conclusions.  The practice of the school nurses in this study covered what employers and policy‐makers required, with the notable exception of health needs assessment, which nurses were uncomfortable and unconfident about. The theoretical framework used provides a useful starting point for examining how school nursing has developed into its current role.
Nurses’ attitudes towards lesbians and gay men
Authors: Röndahl Gerd , Innala Sune , Carlsson Marianne 
Published: July 2004

Background.  During the last decade, official policy and Swedish legislation have strengthened the legal rights of homosexuals and demanded tolerance for this group. There is evidence in the literature that homosexual patients have experienced negative attitudes and poor quality care from nurses, and may be unwilling to disclose their sexuality because of fears of discriminatory treatment.Aims.  The aim of this paper is to report a study that investigated the attitudes of nurses towards lesbians and gay men and nurses beliefs about the causes of homosexuality.Method.  The study had a descriptive, comparative design. The Attitudes Toward Homosexuality Scale was used, along with Causes of Homosexuality Questionnaire. The participants were Registered Nurses and Assistant Nurses from one infectious disease clinic in central Sweden (response rate 67%, n = 57), and students enrolled in a university nursing programme and in upper secondary assistant nurses’ training (response rate 62%, n = 165).Results.  In general, participants expressed positive attitudes (62%). Nurses expressed the most positive attitudes, whereas the assistant nursing students expressed the least positive attitudes. A minority of the sample (30%) expressed neither positive nor negative attitudes. The most common belief about the cause of homosexuality was that it was congenital. Those who held this belief expressed more positive attitudes towards homosexuality than those who believed that homosexuality was acquired. Limitations of the study were that the sample was relatively small and not randomly selected.Conclusion.  This study demonstrated that attitudes have improved towards homosexuals compared with earlier international studies, although more needs to be done to increase the positive attitudes among the nursing staff and students with neutral attitudes (neither positive nor negative attitudes) to enhance the wellbeing of homosexual persons. General education about homosexuality is a necessary beginning to make homosexual patients visible, which is an important aspect of practical nursing ethics.