Do registered nurses have the tools to appropriately assess student nurses in the taking and interpretation of electrocardiograms?

The Nursing and Midwifery Council highlights that, at the point of qualifying, registered nurses should be able to undertake routine investigations, interpret and share the findings, as appropriate. This includes electrocardiograms. Registered nurses who act as practice assessors for student nurses need to have the skills themselves to be able to appropriately assess the student. This article investigates whether practice assessors hold the appropriate knowledge and skills to be able to undertake assessments. The understanding of the terminology ‘interpreting findings’ can be seen in different ways and this could influence nurses' skills acquisition. At what point does a nurse not require supervision and is considered competent in the skill of taking an electrocardiogram and interpretation? There is no national standard in England to agree the level at which competence is achieved. Student training in practice may vary due to the placement experiences gained throughout their training. From reviewing the literature and standards, it is suggested that registered nurses have varying standards of skills when it comes to interpreting electrocardiograms, derived from their training both as a student and as a nurse. It may also be influenced by the Registered Nurses workplace setting and whether regular and specialist electrocardiogram analysis is required. There appears to be no published evidence/information into current training provision for electrocardiogram analysis within England within a student nurses core curriculum.

Protocol for the Analysis of Cross-Sections from Gilded Surfaces

This paper describes the protocol currently used at the Victoria and Albert Museum for the scientific analysis of water, oil and lacquer gilding in cultural heritage objects. The purpose of the protocol is to guide scientists, curators and conservators in their routine investigations, and address questions about the characteristics of gilded surfaces, their number, sequence, date, composition and stratigraphic details. Each protocol step is described in detail and is accompanied by practical examples taken from the analysis of an 18th-century Chippendale table and the 20th-century statue of the Spirit of Gaiety. The merits of individual analytical techniques and equipment are also evaluated.

Detection and Quantification of Anti-oxidant markers like Rutin, Catechin, Quercetin, Gallic acid, Ellagic acid, Ferulic acid, Vitexin and Mangiferin in Herbal raw materials available in market belongs to Rutaceae family by HPTLC Technique

The primary aim of the study is to detect the flavonoids, phenolic acids and xanthones in three commercial herbal raw materials namely Aegle marmelos, Citrus aurantifolia and Murraya koenigii obtained from Rutaceae family used in daily domestic needs to confirm the presence of mentioned common secondary metabolites in herbal raw materials. Results of the study clearly revealed that these raw materials from rutaceae family contains flavonoids, phenolic acids and xanthones. The developed HPTLC method can be employed for the routine investigations of flavonoids, phenolic acids and xanthones in herbal raw materials. Aegle marmelos, Citrus aurantifolia and Murraya koenigii was ascertain the presence of Rutin and shows the 0.072%,0.005%0.002% respectively. Ellagic acid was originate to be not more than 0.004% each of Aegle marmelos and Citrus aurantifolia. Quercetin was found to 0.034% .062% 0.021% respectively in all test three extracts. Vitexin was found to be 0.019% in Citrus aurantifolia. Murraya koenigii revels presence of 0.002%, 0.001% of mangiferin and catechin respectively

Silver nanoparticles in the fetal brain: new perspectives in understanding the pathogenesis of unexplained stillbirths

We report, for the first time, the surprising presence of toxic nanoparticles, especially silver, in the brain of a fetus, who died unexpectedly at the end of a regular pregnancy. After an accurate autopsy, including the examination of the fetal annexes, an in-depth anatomopathological study of the nervous system and a search by scanning electron microscopy of nanoparticles in the brain, we highlighted the sequence of events that may have led to this fetal death, triggered primarily by the transition of nanosized xenobiotics from the mother to the fetal bloodstream. From this report emerges the importance of considering the search of nanosubstances in the brain during routine investigations following unexpected and unexplained fetal and infant deaths.

Abdominal epilepsy presenting as recurrent intractable vomiting

Abdominal pain is a symptom associated with both serious and non serious medical issues, is a frequent complaint in childhood. Abdominal epilepsy (AE) is a rare cause of chronic recurrent abdominal pain. AE is usually seen in paediatric group, but there is recorded documentation even in adults. AE is almost always a diagnosis of exclusion. We herein report a case of a 13 years old female patient with h/o recurrent bouts of abdominal pain with vomiting, all routine investigations and imaging modalities were normal. Since all common causes were ruled out, an EEG was taken which showed epileptiform discharges. She was started on anti-epileptic drugs (AEDs), which resulted in symptomatic relief and EEG taken one month after initiation of treatment turned out to be normal.

Clinicopathological profile of hoarseness of voice

<p class="abstract"><strong>Background:</strong> Hoarseness of voice is one of the most common symptoms bringing a patient to an ear, nose and throat (ENT) Out Patient Department (OPD). Hoarseness of voice may arise from wide spectrum of diseases ranging from mild infections to fatal malignancies. Hence a study was done to know the incidence, etiology, predisposing factors and clinical profile of patients presenting with hoarseness of voice.</p><p class="abstract"><strong>Methods:</strong> The study was carried out in the Department of ENT, JNU IMSRC, Jaipur from Aug 2017 to July 2018. All the patients coming to ENT OPD with complaint of hoarseness of voice during that period underwent detailed history, clinical examination and routine investigations to know the exact cause of hoarseness. </p><p class="abstract"><strong>Results:</strong> A total of 126 cases with male:female ratio of 1.68:1 were analyzed. Patients age ranged from 13 to 82 years with majority of patients presenting in 4^th decade. Most commonly hoarseness was seen in labourers (42.06%) with most common cause being vocal cord paralysis (23.01%) and majority of patients having smoking as the commonest predisposing factor (65%).</p><p class="abstract"><strong>Conclusions:</strong> The etiology of hoarseness varies from trivial infections to serious malignancies. In our tertiary centre which is at the outskirts of the city majority of the patients coming to OPD are from rural area and most of these patients are labourers by occupation and have a habit of smoking bidis.</p>

Role of serum bilirubin in predicting the severity of acute appendicitis

Background: The aim of the study was to establish the role of hyperbilirubinemia as a new diagnostic tool to predict gangrenous/perforated appendicitis.Methods: A prospective study carried for 9 months (March 2018 to November 2018) at Rajarajeswari Medical College and Hospital. All patients admitted with clinical diagnosis of acute appendicitis and posted for surgery were included in the study. Serum total bilirubin results will be compared with Rajarajeswari Medical College and Hospitals laboratory reference values. These cases will be operated and clinical diagnosis will be confirmed per-operatively and post-operatively by histopathological examination. Final histopathological examination will be considered as a gold standard for diagnosing and categorizing patients as having normal appendix, acute appendicitis and acute appendicitis with perforation and/or gangrene. Based on histopathological examination patients will be categorized as positive (acute appendicitis with perforation and/or gangrene) and negative (acute appendicitis without perforation or gangrene).Results: Sensitivity of serum bilirubin in case of perforated/gangrenous appendicitis was found to be 90%. Specificity of serum bilirubin was found in case of perforated/gangrenous appendicitis was found to be 90.47%. Positive predictive value and negative predicting value of serum bilirubin in perforated/gangrenous appendicitis was found to be 81.8% and 95% respectively with p value of 0.003.Conclusions:Serum total bilirubin is an easily available and cheap and can be estimated from the same blood sample withdrawn for routine investigations, if added to routine investigations, then diagnosis of complicated appendicitis can be made with fair degree of accuracy.

A prospective study of clinical manifestations of snake bite in government general hospital

Background: Snake bite is an occupational and rural hazard because India has always been a land of exotic snakes. Although full burden of human suffering attributable to snake bite remains obscure, hundreds of thousands of people are known to be envenomed and tens of thousands are killed or maimed by snakes every year. This study is aimed at studying the clinical manifestations in snake bite at government general hospital.Methods: This Prospective Observational study was done from March 2019 to August 2019 in Government General Hospital Nalgonda. A total of 60 cases male and female admitted with snake bite were studied based on inclusion and exclusion criteria. All patients were done routine investigations, ECG was done to rule out cardiac anomalies. Patients below 12 years, pregnant women and patients with previous heart ailments were excluded from the study. The study was carried out in all patients fulfilling the inclusion and exclusion criteria.Results: A total of 60 patients 35 females and 25 males presented during the study period. Most of the patients presented with pain at the site 40(66%), Nausea 30(50%), Swelling 25(42%), Paraesthesia 25(42%), Bleeding 15(25%), Ptosis 15(25%), Sweating 10(17%), Cellulitis 10(17%) and dyspnoea 5(9%). Among the ECG manifestations- Tachycardia- 30(50%), Ischaemia 5(9%), Sinus arrythmia 2(4%), Myocardial Infarction-0.Conclusions: It was Observed from the study that the pt. had more of Haemolytic presentation than neuroparalytic presentation. Pain at the site was the most common presentation followed by nausea. Some patients developed neuroparalytic symptoms like cellulitis, and paraesthesia. Further it was observed that timely shifting to the Hospital and administration of Anti-Snake venom prevented major manifestations in the patients.

Preoperative assessment

This chapter covers the preoperative assessment of children. It gives general guidance on how to communicate with patients and their families. There is a detailed section on history taking, examination, and routine investigations. The management of common issues that present just prior to surgery, e.g. upper respiratory tract infections, infectious diseases, and the innocent heart murmur, are discussed. The controversy of immunization and anaesthesia, and the requirements for pregnancy testing and DVT prophylaxis, are discussed. Finally, the different forms of premedication are described.