The impact of a nurse externship program on the transition process from graduate to registered nurse: Part III. recruitment and retention effects.

This is the third and final part of a series of articles that report the findings of a study that investigated the effects of a summer externship program on the transition into a professional role among nurses who participated in a summer nurse externship program at an acute care pediatric hospital. Specifically, this article reports the retention and recruitment benefits of a summer nurse externship program for the institution from 1998 through 2003. A total of 153 externs out of the 193 (79.0%) assumed a registered nurse position at the institution, and 77% remained in that role for 12 months. Overall, the nurse extern program for this institution appeared to be an effective recruitment and retention strategy that is on par with the institution and national data for retention and turnover data.     

Towards performance measurement in reconstructive surgery: a multicentre pilot study of free and pedicled flap procedures.

OBJECTIVES: To pilot the acceptability and feasibility of clinical audit in free and pedicled flap reconstruction. To establish a baseline flap failure rate in participating units, so that a sample size calculation could be performed for future national audit. METHODS: A proforma was piloted over a 3-month period in four participating units, during which time data on 93 reconstructive procedures involving free and pedicled flaps was collected. The patients included those where large transfers of tissue were required such as for coverage of grade IIIb compound tibial fractures and breast reconstruction after mastectomy, and also smaller flap transfers such as after skin cancer excision. RESULTS: The proforma was found to be acceptable to clinicians and the feasibility of the data collection process was established. Overall there was a total flap survival of 89% and secondary operations to the donor or recipient sites were required in 11% of patients. CONCLUSIONS: This study demonstrates the feasibility of comparative audit for free and pedicled flap procedures using the methods proposed. Based on the incidence of flap failure observed in this pilot study, at least 18 months of prospective data collection on consecutive patients is required to fulfil the statistical requirements of comparative audit. The establishment of a routinely collected minimum dataset is proposed as one means of meeting these requirements.     

Intracranial circulation: pulse-sequence considerations in three- dimensional (volume) MR angiography

The technique and feasibility of magnetic resonance (MR) angiography of intracranial vessels were studied in 35 healthy volunteers. Variations in image orientation, repetition time (TR), and flip angle were evaluated to determine their effects on flow-related enhancement. Gradient modifications--including echo time (TE), motion compensation, bandwidth, and field of view--were also studied in an effort to reduce motion-induced phase shifts. Results indicated that a FISP (fast imaging with steady precession) sequence with a TR of 50 msec, TE of 15 msec, velocity compensation in the read and section-select directions, acceleration compensation in the read direction, anisotropic volume, and a 1.25-mm partition thickness produced three-dimensional angiographic MR images that were accurate and reproducible in the depiction of the major intracranial vessels. Difficulties with field of view, persistent signal void secondary to higher-order motion, and spatial resolution remain major problems requiring additional study.     

Infraclavicular median nerve compression caused by a lipoma

The most common site of median nerve compression is in the carpal tunnel, the most common of all entrapment neuropathies. Less frequent entrapment neuropathies of the median nerve include the anterior interosseous and pronator syndromes in the proximal forearm. Even less commonly seen is entrapment at the infraclavicular segment of the brachial plexus. Median nerve compression at the level of the axilla has been reported as being caused by anomalous axillary arch muscles, anomalous vascular perforations of the nerve or its roots, the pectoralis minor muscle, and a thickening of the deltopectoral fascia. To the authors' knowledge, this is the first report of compression at that level by a benign tumor.     

Paediatric dacryocystorhinostomy

Of 258 cases of dacryocystorhinostomy performed on children in the period September 1981 to September 1991, 130 were for simple, unresolved congenital nasolacrimal duct obstruction. Other indications for surgery included punctal agenesis, lacrimal fistula, post-traumatic and post-inflammatory canalicular obstruction. Of 177 children without canalicular pathology, 171 (96%) were relieved of symptoms with one operation, without canalicular intubation. Of 81 cases with canalicular disease, 55 of 70 (79%) who underwent DCR plus canalicular intubation, and 10 of 11 who underwent DCR plus Lester-Jones tube, were substantially improved with one operation. No child required peroperative or postoperative blood transfusion. Dacryocystorhinostomy in childhood, in experienced surgical hands, is a safe procedure, achieving relief of symptoms in most cases, particularly in the absence of canalicular disease.     

The effect of perioperative beta-blockade on the pulmonary function of patients undergoing major arterial surgery.

INTRODUCTION: Concern about the potential detrimental side-effects of beta-blockade on pulmonary function often dissuades against their perioperative use in patients undergoing major arterial surgery (especially in those with chronic obstructive pulmonary disease (COPD)). In this study we aimed to establish prospectively the clinical relevance of these concerns. METHODS: After ethics committee approval and individual informed consent, the pulmonary function of twenty patients (mean age 68.7 years (range 43-82), 11 males) scheduled to undergo non-emergency major vascular surgery was studied by recording symptoms and spirometry before and after institution of effective beta-blockade. Fifteen patients (75%) had significant smoking histories (mean pack years/patient=50), while 12 (60%) had COPD. RESULTS: All patients tolerated effective beta-blockade satisfactorily without developing either subjective deterioration in symptoms or significant change on spirometry. The mean change in FEV1 following adequate beta-blockade was 0.05+/-0.24 liters (95% CI -0.06 to +1.61), p=0.35, giving a mean percentage change of 3.18%+/-11.66 (95% CI -2.26 to 8.62). CONCLUSIONS: Previously held concerns about worsening pulmonary function through the short-term use of beta-blockers should not dissuade their perioperative usage in patients with peripheral vascular disease. Furthermore, the accuracy of pulmonary function tests in preoperative assessment and risk stratification also appears unaffected by this therapy.     

Proliferation rates in epidermis of patients with graft-versus-host disease, non-specific inflammation and normal skin.

There is evidence that epidermal stem cells or their early progeny may be the targets in graft-versus-host disease (GVHD). The early progeny should be a proliferating group of daughter cells more concentrated in areas just above or adjacent to stem cell regions. We have, therefore, compared proliferative rates of keratinocytes within relevant subregions of the epidermis using the AgNOR stain on biopsies from patients with GVHD, non-specific inflammatory infiltrates (NSI) and normal skin. We concurrently evaluated T cell infiltration using immunohistology on paraffin-embedded tissue with UCHL-1 antibody. Fifty-one bone marrow transplant patients were evaluated in each of three temporal groups (days 7-20 post-transplant, days 20-40 post-transplant, and days 80-100 post-transplant). In each of these groups, 5-9 patients with a histological diagnosis of GVHD were compared to similar numbers of patients with a histological diagnosis of non-specific dermatitis.(ABSTRACT TRUNCATED AT 250 WORDS)