Ingestion of Neospora caninum tissue cysts by Mustela species

Dogs are a definitive host of Neospora caninum, a protozoal parasite that causes abortion in cattle. Mustelids were tested to determine if they could also be definitive hosts. The procedures used were the same as those previously used to test dogs. Ermine (Mustela erminea), weasels (Mustela frenata) and ferrets (Mustela putorius) were fed N. caninum-infected mice. Neospora caninum oocysts were not observed. Mustelid faeces were fed to mice. The mice did not seroconvert and N. caninum was not detected in murine brains using tissue culture and PCR. The hypothesis that Mustela spp. are definitive hosts of N. caninum is not supported.

Evaluation of a partnership model of care delivery involving registered nurses and unlicensed assistive personnel

The employment of unlicensed personnel in Canadian acute care hospitals has been undertaken without clear evidence of outcomes for patients, caregivers, and hospital organizations. This quasi-experimental evaluation study was completed in a metropolitan Toronto acute care hospital to examine the effects of a new nursing care delivery system which included unlicensed assistive personnel. Most of the expected benefits of the newly implemented nursing care delivery system did not materialize leading to the conclusion that the employment of unlicensed assistive personnel in acute care hospital systems may not offer additional benefits for patients, caregivers, or hospital organizations. The processes and results of this study provide useful information for nurse administrators who are seeking effective and innovative care delivery systems that are designed to optimize patient, caregiver, and hospital outcomes.

Competency standards: clarifying the issues

'Competency standards' is by now a familiar term to most nurses, and the rate at which many nursing organisations are developing their own set of standards would seem to suggest that competencies are an unproblematic, natural and indeed essential pursuit for us all. However, a review of the literature reveals that the competency movement does not meet with universal agreement or approval and it is timely for nursing groups to exercise cautious deliberation before embracing competencies blindly.

Menopause: providing comprehensive care for women in transition

Knowledge and research on the physiological changes associated with menopause is steadily expanding. A partnership between women and health care providers can contribute to the quality of women's life expectancy which is estimated to be 79.1 years (United States Bureau of Census, 1993). Menopause is a normal phenomena of aging and women experiencing menopause must have access to comprehensive care, including a complete history, thorough physical exam, risk factor and age-appropriate screening, and patient education. Studies confirm women's lack of knowledge concerning menopause and the need for education on bodily changes and approaches to self-care during transition. Decline in the ovarian production of estrogen and the feedback effect of gondatropins leads to an increased follicle-stimulating hormone (FSH) of 40 mlU/mL. Vasomotor flushing, night sweats, vaginal dryness, shortening of the menstrual cycle with heavy flow progressing to longer cycles and scant flow and eventual cessation of menses for a period of 12 consecutive months confirms menopause. A program of screening and education for self-care can enhance women's quality of life.

Generating ideas for teaching mental health nursing

University teachers who prepare mental health nurses require a variety of teaching techniques to encourage students to engage with the subject matter and to prepare for unknown future problems and dilemmas that they must resolve. Mental health nursing requires the development of specific discipline knowledge, intellectual skills, such as the ability to think laterally and make ethical decisions, and personal attributes, such as maturity and tolerance, as well as practical experience in collaborative care. This article offers a number of strategies that teachers may use in their classes to promote the development of these mental health nursing skills. Other teachers might use these examples to trigger the development of their own repertoire of teaching skills for beginning mental health nurses.

Peer review. A strategy to enhance cooperative student learning

Peer review is an activity that encourages self-regulation in nursing practice. A learning activity was designed and implemented in an Australian nursing program to encourage student familiarity and proficiency in peer review. The experience of implementing this innovative learning and assessment strategy is discussed.

Clozapine: exploring clients' experiences of treatment

This paper presents the results of a case study exploring the subjective experience of Clozapine treatment in 10 clients at a major Australian psychiatric hospital. Data were categorized into: subjective improvements, observed improvements, subjective expression of concerns, side effects, and goals for the future. Responses provide direction for individualized mental health nursing care. For example, rehabilitation is ideally focused on each person's needs and goals. Such needs can best be identified by ongoing exploration of subjective and objective information.

Teaching metaphors of student nurses

This research focused on exploring the metaphors nursing students use to express their experience of university teachers' practice. A social constructivist approach to meaning underlies the process of interpreting student language in this study. The following evolved as major research questions: What are the metaphors students use to describe teaching? How do these metaphors operate? The research concluded that: students readily use metaphors to describe their experiences of teaching within the nursing degree programme; there is a pattern to the choice of metaphors; some of these images function as incremental or constructive metaphors, extending understanding of what it means to teach; others support current understandings and reflect taken-for-granted notions of teaching. Specific metaphors used by students to describe teaching were contextually analysed. A number of them may offer teachers of nursing insight, into their craft. Metaphors such as teacher as umpire, teacher as student, teaching with distance and teaching the big picture may be useful images for teachers to think about to guide their practice.

Learning contracts: an Australian experience

This paper explores the use of learning contracts - a tool that can facilitate self- directed learning that is specific to an individual student's needs. Reflection on the experience of using contracts within an Australian university highlighted some perceived benefits for learning and teaching as well as potential limitations and areas of concern. Recommendations for effective use of contracts in teaching nursing include: that teachers should be adequately prepared for additional roles required in the implementation of contracts; the tool itself should be simplified and easy to read; and, students should be assisted to set realistic goals and to think about quality learning.

Evaluation of abortions in cattle attributable to neosporosis in selected dairy herds in California

OBJECTIVE

To estimate the minimum rate of abortion attributable to infection with Neospora sp in selected California dairy herds.

DESIGN

Prospective study.

ANIMALS

Twenty-six dairy herds containing 19,708 cows were studied. Fourteen herds had a history of abortions attributable to neosporosis, and 12 were herds in which neosporosis had not been identified as a cause of abortions.

PROCEDURE

During a 1-year period, all available aborted fetuses were submitted to veterinary diagnostic laboratories to determine the cause of abortion. Reproductive records of cows that aborted were reviewed.

RESULTS

Neospora sp infection was the major cause of abortion identified (113/266 abortions, 42.5%). The majority (232/266, 87.2%) of the aborted fetuses were submitted from herds with a history of abortions attributable to neosporosis, and Neospora sp infection was identified as the causative agent in 101 of 232 (43.5%) of the abortions from these herds. Fewer aborted fetuses were submitted from the 12 herds that did not have a history of abortion attributable to Neospora sp; however, neosporosis was confirmed as a cause of abortion in 6 of these 12 herds and was identified as the causative agent in 12 of 34 (35.3%) abortions from these herds. The disease was widespread throughout the state (19/26 herds in our study). Available reproductive histories of cows that had abortions attributed to neosporosis were evaluated, and 4 cows were identified that twice aborted Neospora-infected fetuses.

CLINICAL IMPLICATIONS

Abortion attributable to Neospora sp infections can be expected to be a continuing major cause of abortion in dairy herds with a history of neosporosis as well as in dairy herds that have a history of sporadic abortions, but for which Neospora sp infections have not been previously identified as a cause of abortion. Subsequent pregnancies in cows that abort a Neospora sp-infected fetus also are at risk of infection, suggesting that the immunity provided by an initial infection is inadequate to prevent repeat infection or that cows can be persistently infected with Neospora sp.

The nurse as tour guide: a metaphor for debriefing students in mental health nursing

This article responds to the call by Heinrich (1992) to harness the power of metaphor to reenergize nursing classrooms. An overview of the power of metaphor is provided, as well as a description of a learning activity that prompted students to think metaphorically about a nursing experience. Students reflected on the image of nurse as tour guide and discovered theory being lived out in practice, new ways of understanding the role of the nurse, appreciation for the individual approach in nursing, and a new confidence in sharing and creating.

Doppler echocardiographic assessment of the hemodynamic benefits of rate adaptive AV delay during exercise in paced patients with complete heart block

To determine if rate adaptation of the atrioventricular (AV) delay (i.e., linearly decreasing the AV interval for increasing sinus rate) improves exercise left ventricular systolic hemodynamics, we performed paired maximal semi-upright bicycle exercise tests (EXTs) on 14 chronotropically competent patients with dual chamber pacemakers. Nine patients with complete AV block (CAVB) and total ventricular pacing dependence during exercise comprised the experimental group. Pacemakers in these patients were programmed randomly to rate adaptive AV delay (AVDR) for one EXT and fixed AV delay (AVDF) for the other EXT. AVDF was 156 msec; AVDR decreased linearly from 156-63 msec from rates of 78-142 beats/min. The other five patients had intact AV conduction and comprised the control group who were exercised in identical fashion while their pacemakers were inhibited throughout exercise to assure reproducibility of hemodynamic measurements between EXTs. Cardiac hemodynamics were calculated using measured Doppler echocardiographic systolic aortic valve flows recorded suprasternally with an independent 2-MHz Doppler transducer during a graded ramp exercise protocol. For analysis, exercise was divided into four phases to compare Doppler measurements at submaximal and maximal levels of exercise: rest, early exercise (1st stage), late exercise (stage preceding peak), and peak. Patients achieved statistically similar heart rates between EXTs at each phase of exercise. Although at lower levels of exercise cardiac hemodynamics did not differ, experimental patients (with CAVB) showed a statistically significant benefit to cardiac output at peak exercise with heart rates of 129 +/- 13 beats/min (AVDR: 9.4 +/- 2.8 L/min; AVDF: 8.2 +/- 2.6 L/min, P = 0.002), stroke volume (AVDR: 74.1 +/- 25.6 mL; AVDF: 64.3 +/- 24.4 mL, P = 0.0003), and aortic ejection time (AVDR: 253.3 +/- 35.7 msec; AVDF: 226.7 +/- 35.0 msec, P = 0.002). Duration of exercise, peak rate pressure product, peak aortic flow velocities, and acceleration times did not differ. In contrast, control group patients (intact AV conduction throughout exercise) showed no statistical differences between any hemodynamic parameters measured at any phase of exercise from the first to second exercise test. These data demonstrate that systolic cardiac hemodynamics measured echocardiographically at the high heart rates achieved with peak exercise are improved with AVDR compared to AVDF in chronotropically competent patients with complete AV block. This is due primarily to improved stroke volume and a longer systolic ejection time with AV delay rate adaptation.

Visualization of implantable defibrillator patches by two-dimensional echocardiography

Implantable cardioverter defibrillators are being used with increasing frequency for the management of life-threatening ventricular arrhythmias. In order to determine whether the titanium mesh of the defibrillator patch causes ultrasonographic acoustical interference, 30 patients underwent prospective serial echocardiographic examination. In addition, studies were reviewed to determine whether the defibrillator patches could be visualized with standard two-dimensional echocardiography. In no patient did the anterior patch produce acoustical interference, and, unless specific measures were utilized (such as a standoff pad, a zoom feature, or a 5-MHz transducer), the patches were rarely visualized.

Dynamic changes in left ventricular outflow tract flow velocities after amyl nitrite inhalation in hypertrophic cardiomyopathy

Doppler echocardiography was performed in 21 patients with hypertrophic cardiomyopathy (HC), in nine patients with no evidence of left ventricular (LV) hypertrophy by two-dimensional echocardiography, and in five patients with systemic hypertension and concentric LV hypertrophy. The LV outflow tract (LVOT) peak velocity was recorded by continuous wave Doppler technique at rest and after amyl nitrite inhalation. The LVOT pressure gradient was calculated by the modified Bernoulli equation. A significant increase in heart rate and a drop in systolic blood pressure were observed in all patients after amyl nitrite inhalation; no adverse effects were encountered. The peak LVOT velocity and pressure gradient increased significantly after provocation in all patients, but the increase was much more pronounced in patients with HC (peak LVOT velocity increased from 2.2 +/- 0.8 to 4.3 +/- 1.0 m/sec and peak gradient increased from 22 +/- 17 to 78 +/- 36 mm Hg). The Doppler spectral signal in patients with HC demonstrated a characteristic contour, with peak velocity occurring in late systole. However, the observed increase in LVOT peak velocity was not statistically different between treated (with beta-blockers and calcium blockers) and untreated patients with HC. We conclude that LVOT peak velocity and pressure gradients in patients with HC can be readily assessed by Doppler echocardiography both at rest and after amyl nitrite inhalation. The dynamic changes in LVOT velocity induced by this provocation have certain characteristic features in obstructive HC but appear to be independent of the medical regimen used, at least in the dosages tested in our study.

Depression among adolescent mothers: a pilot study

Eighteen women less than 22 years old, who had their first child during adolescence, were assessed with a standard in-depth diagnostic interview for the presence of and/or history of depression and other disorders. Eight of the 18 women (44%) had experienced at least one episode of major depressive disorder at some point in their lives. A majority of episodes had their onset during pregnancy. Moreover, six women (33%) were experiencing a diagnosable form of depression at the time of the interview. Most of the women who had been depressed experienced at least part of their depression while they were raising their children. Whereas these preliminary findings need to be replicated due to the small sample size, they draw attention to the need for the integration of mental health assessment and treatment in service programs for adolescent mothers.