Do clinicians know how to use pulse oximetry? A literature review and clinical implications

Pulse oximerry has become one of the most commonly used tools in the clinical environment for assessing patients' oxygenation status. It is employed almost continuously in critical care areas and frequently in the general ward environment. Although it is a much better tool for determining hypoxia than the human eye, its use is limited if clinicians do not understand relevant physiological principles, such as the oxyhaemoglobin dissociation curve and the inherent limitations of the device. Furthermore, the risk for compromised patient safety is significant if clinicians fail to recognise the potential for false or erroneous readings. This paper explores the research which has examined clinicians' comprehension of pulse oximetry. Fourteen studies examining clinicians' knowledge of pulse oximerry were reviewed. These studies revealed significant knowledge deficits about pulse oximerry amongst nurses, doctors and allied health professionals, all of whom used this technology frequently. Alarmingly, those lacking an adequate understanding of pulse oximerry included senior, experienced clinicians. The studies were limited by their use of convenience sampling and small sample sizes. Further research is needed to better understand the significance of this problem and to examine how principles of pulse oximerry are taught to nurses and other health professionals at the undergraduate and postgraduate levels. Educators and clinicians alike must ensure that a safe level of knowledge for the use of pulse oximerry is maintained in order to ensure that patient outcomes are not compromised.

Shaping practice: worksheets as social artefacts

Part of a broader research project on the development of mathematical understanding in primary classrooms, the research reported in this paper focused on how opportunities to learn about percentage in two classrooms were shaped by worksheets. The words in the text, the way that the teachers replicated these orally, a grid used to illustrate the concept of percentage, the genre of both mathematical and non-mathematical aspects of the worksheet's presentation, and the calculation methods presented were all potentially influential aspects. It is argued that the "knowledge" conveyed by the texts of the worksheets was distributed over a much wider field than the classrooms involved.

A loop-shaping approach to intelligent control

In this paper, we propose a loop-shaping approach to in telligent control with dynamically constructed neurocon troller. In the proposed control scheme, the process uncer tainly is reduced in the controller rather than in the process, without explicit identification of the process under control. The inherent noise/distrurbances in the process are utilized to satisfy persistency of excitation condition. The use of a reference model in form of a filter allow the frequency response of the closed-loop to be adapted in line with the changes in frequency response of the filter. The approach is evaluated on the example of control of polymerization reactor with promising results.

Maternal and neonatal influences on, and reproducibility of, neonatal aortic pulse wave velocity

Aortic pulse wave velocity (aPWV), a noninvasive measure of vascular stiffness, is an independent predictor of cardiovascular disease both before and in overt vascular disease. Its characteristics in early life and its relationship to maternal factors have hardly been studied. To test the hypothesis that infant aPWV was positively related to maternal anthropometry and blood pressure (BP) at 28 weeks gestation, after adjusting for neonatal anthropometry and BP, 148 babies born in Manchester were measured 1 to 3 days after birth. A high reproducibility of aPWV, assessed in 30 babies within 3 days of birth, was found with a mean difference between occasions of –0.04 m/s (95% CI: –0.08 to 0.16 m/s). Contrary to our hypothesis, a significant inverse relation was found between neonatal aPWV (mean: 4.6 m/s) and maternal systolic BP (mean: 108.9 mm Hg; r=–0.57; 95% CI: –0.67 to –0.45) but not maternal height nor weight. Neonatal aPWV was positively correlated with birth length, birth weight, and systolic BP. In multiple regression, neonatal aPWV remained significantly inversely associated with maternal systolic BP (adjusted ß coefficient: –0.032; 95% CI: –0.040 to –0.024; P<0.001), after adjustment for maternal age, birth weight, length, and neonatal BP (all independently and positively related to aPWV) and for gestational age, maternal weight, and height (unrelated). These results suggest that infant aPWV may be a useful index of infant vascular status, is less disturbing to measure than infant BP, and is sensitive to the gestational environment marked by maternal BP.

Teacher or trainer? The shaping of teacher identity in adult education contexts

In response to changing government funding priorities there has been a shift away from the provision of needs based language and personal development courses for adults in community based contexts towards the delivery of vocational education. Much vocational education is characterized by competency-based curriculum and outcomes influenced by the needs of the current labour market as well as economic driven initiatives such as competitive tendering for short-term course funding. These trends have resulted in changes to the nature of curriculum, assessment, and the purpose and nature of the delivery of courses to adult learners. In turn, these changes affect the ways in which teachers see themselves and carry out their roles as professionals. This paper explores the ways in which the current discourses of vocational education shape teacher identities across a variety of vocational education contexts and the ways in which teacher identities are played out through training and teaching practices.

Shaping a more inclusive learning environment

This Project began as a Higher Education Equity Program Funding Application in March 1999, titled 'Electronic Provision of Information Resources to Students who have a Print Disability.'
Since 1999, mainstreaming of the project objectives has enhanced the access to higher education at Deakin University by students who have a print disability. Our objectives were and are:
• to integrate the provision of information resources to students who have a print disability with procedures already in place for providing information resources to other students
• to provide teaching materials electronically to empower independent learning
• to make information resources on reading lists more accessible to university students who have a print disability
• to establish a mechanism to obtain materials electronically from publishers
A growing number of people who have a print disability use computer technology to access electronic information. This paper will describe the policies, workflows, and procedures that have been implemented at Deakin University, specifically within the Learning Services area, to shape a more inclusive learning environment.

Shaping the self through psychotherapeutic means : gender and cross-generational perspectives

This paper explores psychotherapeutic themes and modes of thought emerging in interviews with mothers and daughters participating in a cross-generational study of young women 'on the margins'. The focus of the discussion is two-fold. First it discusses current theoretical debates concerning the ascendancy of psychotherapeutic modes of constituting the self, and argues that we require closer attention to the gendered and differentiated ways in which these are registered and articulated. Second, it considers the significance of 'happiness' and the ways in which pairs of mothers and daughters draw upon a repertoire of psychotherapeutic discourses to represent their relation to schooling, self, family, and work. It concludes with some speculative observations about the significance of attending to the psychotherapeutic turn for understanding contemporary femininity, the desire for openness as a measure of a good relationship (and of democracy), and contemporary aspirations of happiness.