The role of communication in the alteration of patient-care practices in hospital--a prospective study

In infection control, ward practices often need alteration, as in Queen Mary Hospital, Hong Kong, when a policy was introduced to discontinue the recapping of needles among nurses. Nine randomly selected wards were divided into three groups (A, B and C) of 3 wards each. From an initial survey, nurses were divided into those who agreed with the discontinuation (the 'agreeables') and those who did not (the 'non-agreeables'). Methods used to introduce the policy included a simple announcement through the nursing hierarchy in group A (control), a passive method (posters and pamphlets) was added in group B and both passive and active methods (in-service lectures) were used in group C. Five weeks later, behavioural change was assessed by another survey and by an unannounced direct needle-count. Only 21% of the nurses changed their practice by simple announcement. For the 'agreeables', 85% changed by the passive method and no further improvement was observed when the active method was added. However, 83% of the 'non-agreeables' changed their practice when the active method was used while the passive method alone changed only 21%. Six months later, a third survey indicated that when the active method was included the change persisted at over 85%, while a 36% change was noted for the 'agreeables' who were only exposed to the passive method.

A note on early indicators of non-adherence to a cardiac rehabilitation programme

Of 44 patients enrolled in a study to examine rehabilitation efficacy from myocardial infarction (MI), seven experimental subjects did not adhere to the rehabilitation programme. Serendipitous differences in early cortisol levels following admission for MI differentiated adherent from non-adherent subjects at six to 12 weeks post-MI.

Energy expenditure during front crawl swimming: predicting success in middle-distance events

Male (n = 25) and female (n = 14) competitive swimmers were studied during tethered (breaststroke) and free (front crawl) swimming to determine the validity of calculating exercise oxygen uptake (VO2) from expired gas samples taken immediately after the activity. Based on a single 20-s recovery VO2, the swimmers' VO2 max was correlated with performance in a 400-yd (365.8-m) front crawl swim. The best predictors of VO2 max for trained swimmers were lean body weight and stroke index (r = 0.97). The single best predictor of performance in the 365.8-m front crawl swim was the distance per stroke (r = 0.88), whereas the combination of distance per stroke and VO2 max (ml/kg LBW/min) correlated 0.97 with performance in the swim. This study demonstrates that it is possible to accurately determine the VO2 during maximal and submaximal swimming using a single, 20-s expired gas collection taken immediately after a 4-7 min swim. These findings demonstrate the importance of stroke technique on the energy cost and variations in performance during competitive swimming.

Metabolic characteristics of skeletal muscle during detraining from competitive swimming

After 5 months of intense training, eight male swimmers were studied during 4 wk of inactivity. Biopsy specimens from the deltoid muscle revealed that its respiratory capacity (QO2) decreased by 50% (5174 to 2559 microliter X h-1 X g-1) after 1 wk of inactivity. Subsequent weeks of detraining did not change the QO2. Although the trained swimmers' muscle phosphofructokinase and phosphorylase activities were significantly higher (P less than 0.05) than those from a group (N = 8) of untrained men, 4 wk of detraining had no effect on these enzyme activities. Mean (+/-SE) resting muscle glycogen concentrations were significantly higher (P less than 0.05) for the trained swimmers (153 +/- 3 mmol X kg-1) than for the untrained men (85 +/- 7.5 mmol X kg-1). Over the 4 wk of inactivity, the swimmers' muscle glycogen progressively decreased from 153 (+/- 3) to 93 (+/-7) mmol X kg-1. After a standard 183-m swim at 90% of the swimmer's best time for that distance, blood lactate rose from a mean of 4.2 (+/-0.8) at week 0 to 9.7 (+/-0.8) mmol X 1(-1) at week 4. These observations demonstrate dramatic changes in the metabolic characteristics of the swimmer's muscle with a 1-4-wk interruption in training.

Psychological issues arising from the development of new male contraceptives

Reading et al. (Bulletin, October 1982) report low correlations between morning erectile frequency and diary card records of sexual behavior, and consider difficulties in accurately assessing the monthly frequency of such erections. It seems that the authors have a problem that may derive from the assumption that erections are always associated with sexual arousal. I would argue that this is not the case. If the authors consider the frequency with which morning erections are maintained following micturation, I suspect they would find a lower incidence of early morning erection than they have hiterto. A full bladder in the morning is frequently associated with erection, with detumescence following micturation (Fielding, R. unpublished observations on a single case study for 16 years). Is it possible, therefore, that to consider the term erection as synonymous with sexual arousal can sometimes confuse the simple minds of men? The authors also considered whether retarded ejaculation is perceived as positive or negative. Obviously, this would depend on the duration of retardation. Total retardation would, I predict, prove to be an effective, though unpopular means of contraception, whilst a contraceptive which trebled or quadrupled the duration of intercourse might be much more popular. Finally, as an effective male contraceptive would function by preventing spermatogenesis only, and as spermatozoa constitute less than 1% of the total volume of ejaculatory fluid, no significant changes in the volume of ejaculate should occur. Perhaps contrary to the author's assumption than basic information on the subject is lacking, it has been there under our noses, so to speak, all the time.

A note on behavioural treatment in the rehabilitation of myocardial infarction patients

Ten patients, diagnosed as suffering acute myocardial infarction were allocated to an Experimental (behavioural counselling with relaxation training) group, or a Control (waiting list) group. Measures of electromyogram activity, covert and self-rated anxiety, serum enzymes, length of illness and outcome were made. Experimental subjects had 12 weekly sessions of counselling on a variety of topics relating to psychological adaptation to the illness, plus relaxation training. The results show a significant reduction in muscle tension in experimental subjects after training. Significant changes were also found respecting covert anxiety. Self-rated anxiety and SGOT levels were related. More experimental than control subjects returned to work.