Motor unit synchronization measured by cross-correlation is not influenced by short-term strength training of a hand muscle

The purpose of the study was to quantify the strength of motor unit synchronization and coherence from pairs of concurrently active motor units before and after short-term (4–8 weeks) strength training of the left first dorsal interosseous (FDI) muscle. Five subjects (age 24.8 ± 4.3 years) performed a training protocol three times/week that consisted of six sets of ten maximal isometric index finger abductions, whereas three subjects (age 27.3 ± 6.7 years) acted as controls. Motor unit activity was recorded from pairs of intramuscular electrodes in the FDI muscle with two separate motor unit recording sessions obtained before and after strength training (trained group) or after 4 weeks of normal daily activities that did not involve training (control group). The training intervention resulted in a 54% (45.2 ± 8.3 to 69.5 ± 13.8 N, P = 0.001) increase in maximal index finger abduction force, whereas there was no change in strength in the control group. A total of 163 motor unit pairs (198 single motor units) were examined in both subject groups, with 52 motor unit pairs obtained from 10 recording sessions before training and 51 motor unit pairs from 10 recording sessions after training. Using the cross-correlation procedure, there was no change in the strength of motor unit synchronization following strength training (common input strength index; 0.71 ± 0.41 to 0.67 ± 0.43 pulses/s). Furthermore, motor unit coherence z scores at low (0–10 Hz; 3.9 ± 0.3 before to 4.4 ± 0.4 after) or high (10–30 Hz; 1.7 ± 0.1 before to 1.9 ± 0.1 after) frequencies were not influenced by strength training. These motor unit data indicate that increases in strength following several weeks of training a hand muscle are not accompanied by changes in motor unit synchronization or coherence, suggesting that these features of correlated motor unit activity are not important in the expression of muscle strength.

The role of supervision in the training of a psychoanalyst

This paper discusses the role of clinical supervision in psychoanalytic training. It also discusses the impact of training modes on the psychoanalytic organisations that use these different models of training. The paper argues that psychoanalytic training consists of a unique combination of personal analysis, study of psychoanalytic theory and research and clinical supervision. Given the variation of these three components and their possible interactions, an overly prescriptive view of training can be detrimental and counterproductive. The effectiveness of psychoanalytic supervision is to a significant degree dependent upon a trainee being engaged in personal analysis. Clinical competency requires extensive clinical experience obtained in a variety of settings and with a broad exposure to patient groups. The detrimental implications of restrictive and reductive views on psychoanalytic training that seek to specify quantitative criteria rather than clearly articulate clinical competencies are discussed.

Designing the future in wound care: the role of the nurse practitioner

The nurse practitioner is emerging as a new level and type of health care. Increasing specialisation and advanced educational opportunities in nursing and the inequality in access to health care for sectors of the community have established the conditions under which the nurse practitioner movement has strengthened both nationally and internationally. The boundaries of responsibility for nurses are changing, not only because of increased demands but also because nurses have demonstrated their competence in varied extended and expanded practice roles. The nurse practitioner role reflects the continuing development of the nursing profession and substantially extends the career path for clinical nurses.

This paper describes an aspect of a large-scale investigation into the feasibility of the role of the nurse practitioner in the Australian Capital Territory (ACT) health care system. The paper reports on the trial of practice for a wound care nurse practitioner model in a tertiary institution. In the trial the wound care nurse practitioner worked in an extended practice role for 10 months. The nurse practitioner practice was supported, monitored and mentored by a clinical support team. Data were collected relating to a range of outcomes including definition of the scope of practice for the model, description of patient demographics and outcomes and the efficacy of the nurse practitioner service.

The findings informed the development of clinical protocols that define the scope of practice and the parameters of the wound care nurse practitioner model and provided information on the efficacy of this model of health care for the tertiary care environment. The findings further suggest that this model brings expert wound care and case management to an at-risk patient population. Recommendations are made relating to ongoing research into the role of the wound care nurse practitioner model in the ACT health care system.

The interface of acute and aged care: the role of the nurse in provincial area

Objective: This study was to investigate issues that arose from pre-admission to post-discharge, for people in Toowoomba, Queensland over the age of 65 admitted to an acute facility. This paper concentrates on a significant concern that emerged from the latge amount of data collected during this project, that is, the role of the nurse in the continuum of health care involving elderly people.

Method: The study involved a multi-site, multi-agency and multi-method (qualitative and quantitative) approach. Data was collected from regional service providers, the Department of Health and Aged Care (DHAC), the Australian Bureau of Statistics (ABS), Home and Community Care (HACC), the Aged Care Assessment Team (ACAT), elderly people who had been discharged from regional hospitals and their carers, residents of regional aged care facilities, area health professionals and elderly regional hospital inpatients.

Results: The data indicated that nurses in this provincial area currently play a limited role in preadmission planning, being mostly concerned with elective surgery, especially joint replacements. While nurses deliver the majority of care during hospitalisation, they do not appear to be cognizant of the needs of the elderly regarding post-acute discharge.

Conclusion: The recent introduction of the model of nurse case management in the acute sector appears to be a positive development that will streamline and optimise the health care of the elderly across the continuum in the Toowoomba area. The paper recommends some strategies, such as discharge liaison nurses based in Emergency Departments and the expansion of the nurse case management role, which would optimise care for the elderly person at the interface of care.

Family and carer smoking control programmes for reducing children's exposure to environmental tobacco smoke

Background: Exposure to other people’s cigarette smoke (environmental tobacco smoke, or ETS) is an important child health issue.
Objectives: To determine the effectiveness of interventions aiming to reduce exposure of children to ETS.
Search strategy: The Tobacco Addiction Group register of studies was searched.MEDLINE, EMBASE and four other health and psychology databases were searched electronically, bibliographies of retrieved primary studies were checked and specialists in the area consulted.
Selection criteria: Controlled trials with or without random allocation were included in this review if they addressed participants (parents and other family members, child care workers and teachers) involved with the care and education of infants and young children (aged 0-12 years). All mechanisms for reduction of children’s environmental tobacco smoke exposure, and smoking prevention, cessation, and control programmes targeting these participants are included. These include smoke free policies and legislation, health promotion, social behavioural therapies, technology, education and clinical interventions.
Data collection and analysis: Two reviewers independently assessed studies and extracted data. Due to heterogeneity of methodologies and outcomes, no summary measures were possible and results were synthesised using narrative summaries.
Main results: Nineteen studies met the inclusion criteria, one of which was subsequently excluded. Three interventions were targeted at populations or community settings, seven studies were conducted in the well child health care setting and eight in the ill child health care setting. Twelve of these studies are from North America. In 12 of the 18 studies there was reduction of ETS exposure for children in both intervention and comparison groups. In only four of the 18 studies was there a statistically significant intervention effect. Three of these successful studies employed intensive counselling interventions targeted to smoking parents. There is little difference between the well infant, child respiratory illness and other child illness settings as contexts for parental smoking cessation interventions. The fourth successful intervention was in the school setting targeting the ETS exposure of children from smoking fathers.
Authors’ conclusions: Brief counselling interventions, successful in the adult health setting when coming from physicians, cannot be extrapolated to adults in the setting of child health. There is limited support for more intensive counselling interventions. There is no clear evidence for differences between the respiratory, non-respiratory ill child, well child and peripartum settings as contexts for reduction of children’s ETS exposure.

Readmission to intensive care : a review of the literature

Acutely ill patients are commonly found on general hospital wards; some of these are patients who have been recently discharged from an intensive care unit (ICU). These patients may require a higher level of care than other ward patients and, due to the acuity of their illness, are at risk of readmission to ICU. Research has indicated that patients readmitted to ICU have mortality rates up to six times higher than those not readmitted and are eleven times more likely to die in hospital. Numerous studies have retrospectively examined these readmissions but, despite this, there is still no clear indication of why ICU readmissions occur or what the common characteristics of readmitted patients are. This literature review examines the published studies on patients who have been readmitted to ICU. Further research is needed to explore why readmissions to ICU occur and the type of patient who is at greatest risk for readmission.

Ethnic aged discrimination and disparities in health and social care : a question of social justice

Older overseas-born Australians of diverse cultural and language backgrounds experience significant disparities in their health and social care needs and support systems. Despite being identified as a 'special needs' group, the ethnic aged in Australia are generally underserved by local health and social care services, experience unequal burdens of disease and encounter cultural and language barriers to accessing appropriate health and social care compared to the average Australian-born population. While a range of causes have been suggested to explain these disparities, rarely has the possibility of cultural racism been considered. In this article, it is suggested that cultural racism be named as a possible cause of ethnic aged disparities and disadvantage in health and social care. It is further suggested that unless cultural racism is named as a structural mechanism by which ethnic aged disparities in health and social care have been created and maintained, redressing them will remain difficult.

Agency nursing work in acute care settings: perceptions of hospital nursing managers and agency nurse providers

• There is a paucity of research in investigating agency nursing work from the perspectives of hospital nursing managers and agency nurse providers.

• This exploratory paper examines the hospital nursing managers' and agency nurse providers' perceptions and experiences of agency nursing work.

• Individual, in-depth interviews were conducted with three agency nurse providers and eight hospital nursing managers. Because of the lack of previous research in this area, an exploratory, semi-structured interviewing technique was deemed appropriate.

• Three major themes emerged from interview data: planning for ward allocation, communication and professionalism.

• In planning for ward allocation, hospital managers were primarily concerned with maintaining adequate numbers of nursing staff in the ward settings. A major concern for agency nurse providers was inappropriate allocation of temporary staff.

• Communication was valued in different ways. While hospital managers focused on communication between the agency nurse and other permanent members of the health care team, agency providers were concerned with exchanges between agencies and hospital organizations, and between the agencies and agency nurses.

• For both groups, responsibility for professional development and the status of agency nursing as a career choice for graduate and experienced nurses were the focal aspects for consideration.

• A limitation of this study is the small number of individual interviews conducted with hospital nursing managers and agency nurse providers. Nevertheless, the findings represent the views of 11 individuals in senior managerial roles.

• The findings reinforce the need to enhance collaboration between hospitals and nursing agencies, and to examine how divergent views of agency nursing work could be reconciled – with the aim of providing quality patient care.