Reflex respiratory response to changes in upper airway pressure in the anaesthetized rat

1. We examined the upper airway (UA) motor response to upper airway negative pressure (UANP) in the rat. We hypothesized that this response is mediated by superior laryngeal nerve (SLN) afferents and is not confined to airway dilator muscles but also involves an increase in motor drive to tongue retractor and pharyngeal constrictor muscles, reflecting a role for these muscles in stabilizing the UA. 2. Experiments were performed in 49 chloralose-anaesthetized, tracheostomized rats. Subatmospheric pressure in the range 0 to -30 cmH(2)O was applied to the isolated UA. Motor activity was recorded in separate experiments from the main trunk of the hypoglossal nerve (XII, n = 8), the pharyngeal branch of the glossopharyngeal nerve (n = 8), the medial and lateral branches of the XII (n = 8) and the pharyngeal branch of the vagus (n = 8). Afferent activity was recorded from the whole SLN in six experiments. 3. All UA motor outflows exhibited phasic inspiratory activity and this was significantly (P < 0.05) increased by UANP. Tonic end-expiratory activity increased significantly in response to pressures more negative than -20 cmH(2)O. Bilateral section of the SLN also increased (P < 0.05) motor activity and abolished the responses to UANP. Electrical stimulation of the SLN inhibited inspiratory XII activity. SLN afferents were tonically active and inhibited by UANP. 4. We conclude that UANP causes a reflex increase in motor drive to pharyngeal dilator, tongue retractor and pharyngeal constrictor muscles via afferent fibres in the SLN. Tonic activity in SLN afferent fibres at zero transmural pressure exerts a marked inhibitory effect on UA motor outflow.

Mental health nurses' perceptions of nurse prescribing

AIMS

This study aimed to ascertain mental health nurses' perceptions of the advantages and disadvantages of nurse prescribing and to identify the educational needs of mental health nurse prescribers.

DESIGN

A questionnaire was designed and administered to a convenience sample in the UK of 73 mental health nurses in clinical practice, 14 working in in-patient settings and 59 in the community. Questions included both closed and open-ended items. Descriptive statistics were used for numerical data, and category analysis of the open-ended questions was undertaken by two of the researchers independently and then conjointly.

FINDINGS

The majority of respondents felt that mental health nurse prescribing would significantly improve clients' access to medication, improve compliance, prevent relapse and prove cost effective. However, many were anxious that they did not have sufficient knowledge and skills to assume responsibility for prescribing.

CONCLUSIONS

Although there would be benefits to clients and patients, further training, rigorous supervision and the co-operation of doctors will be required if mental health nurse prescribing is to yield the anticipated benefits.

Ideology and mental health care - two historical perspectives

Two dominant caring ideologies have prevailed in mental health care over the past two centuries and are observable in modern nursing theory and practice. The first is grounded in philosophy and focuses on such issues as: "What is it to be human?"; "How should the good life be lived?" and "What conditions enable human beings to realise their potential?" The best example of this humanistic approach can be seen in the care that was provided at the York Retreat in the late eighteenth and early nineteenth centuries. The second ideology is the result of the rise of biological psychiatry during and after the Second World War. Psychiatric nurses serving in the forces worked alongside doctors as autonomous practitioners and brought their considerably extended expertise back to their civilian work. This paper examines the ethos of the York Retreat and the innovative work of nurses during the Second World War and shows how they have influenced mental health nursing today.

Men in nursing: ambivalence in care, gender and masculinity

This paper briefly reviews some aspects of the history of men in nursing and suggests that for centuries men have been at the forefront of caring work, and that it was in the mid-nineteenth century when shifts in the nature of masculinity and femininity occurred, spearheaded by Florence Nightingale, which resulted in nursing becoming feminised. Drawing on techniques of oral history, this paper presents the experiences of two men who pioneered the return of men into nursing, and how their work changed in the course of their working lives. Both men saw a shift away from institutional hierarchies towards a more patient centred model, which accompanied comparable developments in their own thinking in different fields of nursing. There were differences in the work they did and how they constructed their pasts, yet there were also similarities in the way they developed their philosophy of caring for patients.

A comparative study of the experiences of violence of English and Swedish mental health nurses

Recent studies suggest that violence in health care environments, especially mental health care, appears to be increasing. Although there is a lack of cross-cultural studies to prove it, this increase in violence would seem to be an international phenomenon. The present study sought to compare the extent and nature of violence encountered by mental health nurses in Sweden and England. Systematic studies of violence have previously been carried out independently in both countries but this was the first attempt to compare levels of violence. Clearly defined study protocols were put in place, an operational definition of 'violence' adhered to, and random samples recruited. A specially designed questionnaire was sent to every subject (Swedish nurses n=720; English nurses n=296) enquiring about the extent of nurses' exposure to violence, the nature and severity of the violence experienced, and the effect of violence on self-esteem and job satisfaction. Significant differences were found with English nurses experiencing more violence than their Swedish counterparts. Yet support for English nurses appeared to be less good than for Swedish nurses. Reasons for the differences are discussed along with possible measures to minimise the frequency of violence against nurses and the negative effects on their work.

The Wheels mutation in the mouse causes vascular, hindbrain, and inner ear defects

In a screen for mouse mutations with dominant behavioral anomalies, we identified Wheels, a mutation associated with circling and hyperactivity in heterozygotes and embryonic lethality in homozygotes. Mutant Wheels embryos die at E10.5-E11.5 and exhibit a host of morphological anomalies which include growth retardation and anomalies in vascular and hindbrain development. The latter includes perturbation of rhombomeric boundaries as detected by Krox20 and Hoxb1. PECAM-1 staining of embryos revealed normal formation of the primary vascular plexus. However, subsequent stages of branching and remodeling do not proceed normally in the yolk sac and in the embryo proper. To obtain insights into the circling behavior, we examined development of the inner ear by paint-filling of membranous labyrinths of Whl/+ embryos. This analysis revealed smaller posterior and lateral semicircular canal primordia and a delay in the canal fusion process at E12.5. By E13.5, the lateral canal was truncated and the posterior canal was small or absent altogether. Marker analysis revealed an early molecular phenotype in heterozygous embryos characterized by perturbed expression of Bmp4 and Msx1 in prospective lateral and posterior cristae at E11.5. We have constructed a genetic and radiation hybrid map of the centromeric portion of mouse Chromosome 4 across the Wheels region and refined the position of the Wheels locus to the approximately 1.1-cM region between D4Mit104 and D4Mit181. We have placed the locus encoding Epha7, in the Wheels candidate region; however, further analysis showed no mutations in the Epha7-coding region and no detectable changes in mRNA expression pattern. In summary, our findings indicate that Wheels, a gene which is essential for the survival of the embryo, may link diverse processes involved in vascular, hindbrain, and inner ear development.

The value of community mental health nurses based in primary care teams: 'switching the light on in a cellar'

This paper explores the impact of placing Community Mental Health Nurses (CMHNs) at two primary care practices in South Staffordshire. Data were collected by means of a questionnaire which was sent to primary care personnel at these practices, to ascertain their opinions with respect to the contribution of practice-based CMHNs. Overall, primary care personnel were satisfied with the quality of the service received from the CMHNs, especially in terms of improved communication. They felt that the new arrangements enabled a quicker and more efficient access to the services of the CMHN. The results are discussed in terms of the value of having CMHNs within the primary care setting, and in terms of service planning and future recommendations for mental health services within primary care.

Microdialysis perfusion of 5-HT into hypoglossal motor nucleus differentially modulates genioglossus activity across natural sleep-wake states in rats

1. Serotonin (5-hydroxytryptamine, 5-HT) excites hypoglossal (XII) motoneurons in reduced preparations, and it has been suggested that withdrawal of 5-HT may underlie reduced genioglossus (GG) muscle activity in sleep. However, systemic administration of 5-HT agents in humans has limited effects on GG activity. Whether 5-HT applied directly to the XII motor nucleus increases GG activity in an intact preparation either awake or asleep has not been tested. 2. The aim of this study was to develop a novel freely behaving animal model for in vivo microdialysis of the XII motor nucleus across sleep-wake states, and test the hypothesis that 5-HT application will increase GG activity. 3. Eighteen rats were implanted with electroencephalogram and neck muscle electrodes to record sleep-wake states, and GG and diaphragm electrodes for respiratory muscle recording. Microdialysis probes were implanted into the XII motor nucleus and perfused with artificial cerebrospinal fluid (ACSF) or 10 mM 5-HT. 4. Normal decreases in GG activity occurred from wakefulness to non-rapid eye movement (non-REM) and REM sleep with ACSF (P < 0.01). Compared to ACSF, 5-HT caused marked GG activation across all sleep-wake states (increases of 91-251 %, P < 0.015). Importantly, 5-HT increased sleeping GG activity to normal waking levels for as long as 5-HT was applied (3-5 h). Despite tonic stimulation by 5-HT, periods of phasic GG suppression and excitation occurred in REM sleep compared with non-REM. 5. The results show that sleep-wake states differentially modulate GG responses to 5-HT at the XII motor nucleus. This animal model using in vivo microdialysis of the caudal medulla will enable the determination of neural mechanisms underlying pharyngeal motor control in natural sleep.

Primary mental health care: whose role is it anyway?

Nursing, in common with all healthcare disciplines, has had to respond to major developments in the wider context of health care. Shifts in government policy, changing preferences for the location of health care, over-stretched resources and new developments in medical technologies have all had a considerable impact on the modes of healthcare delivery, including nursing care. In times of rapid change, new healthcare roles emerge, others are reconstructed and some decline, as happened when fever nursing became obsolete owing to improvements in health care and living conditions during the first half of the twentieth century (Currie 1997). Over the past two decades, some nursing disciplines have expanded considerably--especially those based in the community--and specialist nursing roles in areas such as infection control, continence care, palliative care, psychotherapy, tissue viability and pain management have become commonplace. This article examines some of the implications of the 'new NHS' for practice nurses and community mental health nurses (CMHNs).

Feelings of professional fulfilment and exhaustion in mental health personnel: the importance of organisational and individual factors

BACKGROUND

Mental health personnel are at high risk for mental illness, burnout and suicide. Previous studies of this group of professionals have indicated the importance of organisational factors in explaining burnout, or exhaustion, and work satisfaction. This study looks more systematically at the contribution of organisational and individual factors to work-related exhaustion and to professional fulfillment, an expanded version of job satisfaction.

METHODS

A cross-sectional study of 1, 051 psychiatrists and mental health nurses in the city of Stockholm was carried out by postal questionnaire with a previously validated instrument. Multiple and logistic regressions were used to identify predictors of exhaustion and professional fulfillment.

RESULTS

Organisational characteristics were found to be more important than individual characteristics in predicting exhaustion and professional fulfillment in mental health professionals.

CONCLUSIONS

The results indicate that the psychosocial work environment and well-being of mental health professionals can be improved by concentrating on organisational factors such as efficiency, personal development and goal quality.

Evaluation of 11th rib extrapleural-retroperitoneal approach to the thoracolumbar junction. Technical note

OBJECT

The 11th rib extrapleural-retroperitoneal approach offers an alternative means for access to the thoracolumbar junction. It provides excellent operative exposure without the need to transgress the diaphragm, resulting in less morbidity and reduced risk of pulmonary complications. This approach, however, has been dismissed by many surgeons offering the unsubstantiated criticism that it affords limited access. Thus far, only technical descriptions of the operative procedure are available in the literature, without documentation of the clinical outcomes of these patients. In the current study the authors describe the 11th rib extrapleural-retroperitoneal approach to the thoracolumbar junction, and they evaluate the associated early and late morbidity in these patients.

METHODS

From September 1996 to August 1999, the authors collected prospective data of consecutive patients who underwent surgery for a variety of pathological conditions of the thoracolumbar junction via this approach. In 26 consecutive patients requiring an anterior spinal procedure, lesions located between T-10 and T-11 were studied and followed for a mean period of 17 months (range 1-36 months). There were 13 men and 13 women whose mean age was 47 years (range 16-80 years), with the following pathological entities: trauma (13 cases), neoplasm (six cases), infection (two cases), and deformity (five cases). There were no cases of neurological deterioration. There were no significant pulmonary complications, and only one patient required insertion of a postoperative chest tube.

CONCLUSIONS

The 11th rib extrapleural-retroperitoneal approach was successfully used to treat patients with a variety of lesions in the thoracolumbar junction and was associated with little morbidity. The authors believe that previous criticism suggesting that this approach provides only limited access is unsubstantiated.

General practitioners' perceptions of community psychiatric nurses in primary care

The management of and responsibility for the care of people with mental health problems in the community is increasingly being assumed by general practitioners (GPs) and primary care personnel. As primary care groups (PCGs) evolve, so must their expertise in managing people with a wide range of mental health problems. It is expected that all mental health professionals will participate in this development, although it is likely that community psychiatric nurses (CPNs) will be the largest professional group involved, with a significant part to play in the shaping, management and delivery of mental health services. To date, there has been little research into how CPNs are perceived by other primary health care professionals. This study seeks to provide an insight into how GPs assess the contribution of CPNs in primary care. Overall, the results of the study suggest that GPs view CPNs favourably and consider that they have an important role to play. Greater involvement in primary care raises issues about the education and preparation of CPNs, their professional development and supervision needs.

The Effects of Guided Imagery andMusic Therapy on Reported Change in Normal Adults

This study explores the main changes gained from Guided Imagery and Music (GIM) therapy as described by former clients. It also explores whether gains are integrated into the clients' lives and if those changes stabilize over periods of time after finishing GIM therapy. Questionnaires were sent to GIM therapists who forwarded them to former GIM clients. Twenty-five former GIM clients returned questionnaires directly to the researcher. Results show that the main gains reported by former clients of GIM therapy are (a) getting more in touch with one's emotions, (b) gaining insights into some problems, (c) spiritual growth, (d) increased relaxation, and (e) discovering new parts of oneself. Results also show that GIM therapy might be helpful for clients with symptoms of anxiety and/or fear, and for clients who want to increase their self-esteem. Changes gained during GIM therapy appear to stabilize over a period of time after finishing GIM therapy. They improved after termination of therapy, especially in the mental and transpersonal areas.

Violence in mental health care: the experiences of mental health nurses and psychiatrists

Violence against mental health service personnel is a serious workplace problem and one that appears to be increasing. This study aimed to ascertain the extent and nature of violence against mental health nurses and psychiatrists, and to identify what support, if any, they received following exposure to violence. Mental health staff working within five West Midlands Trusts in the United Kingdom were surveyed using a postal questionnaire to investigate the extent and nature of violence they encountered in their daily work. There was an overall response rate of 47%, which included a response rate for psychiatrists of 60% (n=74) and for mental health nurses of 45% (n=301). Though both groups experienced violence at work, nurses were found: to have been exposed to violence significantly more during their career; to have been a victim of violence within the previous 12 months of the survey; and to have suffered a violent incident involving physical contact. Whilst a higher proportion of nurses than psychiatrists received some support following a violent incident, a large proportion of both groups did not receive any, although most felt in need of it. The implications of this study for training and management are discussed.

Individual and organizational well-being in psychiatric nursing: a cross-cultural study

Although health care systems around the world are undergoing rapid changes, there is an absence of comparative studies of how these changes affect nurses' well-being and work life. The purpose of this study was (i) to identify and describe possible differences between the psycho-social work environments of English and Swedish mental health nurses, and (ii) to attempt to explain these differences. 1016 psychiatric nurses from Stockholm (Sweden) and Birmingham (England) responded to a postal questionnaire on their psycho-social work environment and feelings of professional fulfillment, mental energy and work-related exhaustion. The study was given ethical clearance in Stockholm and Birmingham. Results indicated that while the English nurses rated their organizational well-being more favourably, Swedish psychiatric nurses reported greater individual well-being than their counterparts. Multiple regression analyses indicated that self-esteem was important for explaining mental energy and work-related exhaustion, but less so for explaining professional fulfillment, which was predicted primarily by organizational factors. When controlling for self-esteem, which was higher amongst the Swedish nurses, the differences in professional fulfillment and mental health were no longer significant. Reasons for the differences in self-esteem and experiences of the workplace are discussed. Low response rate may have contributed to a selection bias.