An evaluation of nursing documentation as it relates to pro re nata (prn) medication administration : a research report presented in partial fulfilment of the requirements for the degree of Master of Nursing in Mental Health at Massey University

Aims of the project: l. To investigate if documentation related to pro re nata (Latin, prn) medication administration by mental health nurses, in a particular Forensic Psychiatry Clinic, in a metropolitan city in New Zealand, complies with the requirements of the National Mental Health Sector Standards (Ministry of Health, 1997), the specific District Health Board's policies, the local policies of the Forensic Psychiatry Clinic, the Code of Conduct for Nurses and Midwives (Nursing Council of New Zealand, 1999) and follows the nursing process. 2. To investigate whether there are any variations in the documentation practices between nursing shifts. Methods: A retrospective file audit was conducted at a forensic psychiatry clinic in a city in New Zealand. Non-random sampling was used. Data was collected from all admissions in 2002 that had prn medication administered during the first four weeks. A document questionnaire was designed to capture the required data to answer the research questions Results: From the sample of 27 files data was collected from up to 170 nursing entries. This was primarily a descriptive and exploratory study. None of the nursing entries met all the requirements of the National Mental Health Sector Standards (Ministry of Health, 1997), company policies, local area policies and/or the Code of Conduct for Nurses and Midwives (Nursing Council of New Zealand, 1999) in relation to nursing documentation. Nearly 47% of the prn medication administered had no documentation, apart from that in the medication-recording chart, to indicate it had been given. Approximately 85% of prn administrations had no evidence of an assessment prior to administration. Where it was documented that a client had requested medication. nearly 82% had no evidence of assessment. A large number of prn medications were administered from prescriptions that did not meet legal or policy requirements. Evidence of planning was lacking in the documentation with nearly 98% of the notes not indicating the rationale for a choice of route of administration where this was permitted on the prescription. No nursing entry offered a rationale for the choice of dose where this was allowed. The name of the medication, dose, route and/or time administered was frequently missing. Of the prn administrations considered for an outcome, nearly 60% had no documented outcome. Little difference was found in the nursing documentation between the shifts. However it was noted that for day and aftenoon shift, the earlier in the shift the medication was administered the less likely there was to be any mention of the medication being administered. Conclusion: The findings established extremely poor documentation practices. The lack of evidence of patient assessment, prior to administration of the medication in the documentation, raises the issue of whether this is being done prior to prn medication administration or simply not being documented. The documentation left questions about decision making in the planning of administration. The large number of medication administrations lacking a documented outcome raises uncertainty about nurses' knowledge of evaluating care, or even whether they are actually evaluating the care given. As a result of these findings, it is recommended that further research in this area be undertaken in New Zealand

Flattening Functions on Flowers

Let $T$ be an orientation-preserving Lipschitz expanding map of the circle \T. A pre-image selector is a map \tau:\T\to\T with finitely many discontinuities, each of which is a jump discontinuity, and such that $\tau(x)\in T^{-1}(x)$ for all x\in\T. The closure of the image of a pre-image selector is called a flower, and a flower with $p$ connected components is called a $p$-flower. We say that a real-valued Lipschitz function can be Lipschitz flattened on a flower whenever it is Lipschitz cohomologous to a constant on that flower. The space of Lipschitz functions which can be flattened on a given $p$-flower is shown to be of codimension $p$ in the space of all Lipschitz functions, and the linear constraints determining this subspace are derived explicitly. If a Lipschitz function $f$ has a maximizing measure $S$ which is Sturmian (i.e. is carried by a 1-flower), it is shown that $f$ can be Lipschitz flattened on some 1-flower carrying $S$.Comment: Accepted for publication and confirmed for december 200

Definition: Asomatognosia

Peer reviewedFinal Accepted Versio

On transfer operators for continued fractions with restricted digits

For any non-empty subset I of the natural numbers, let {Lambda}I denote those numbers in the unit interval whose continued fraction digits all lie in I. Define the corresponding transfer operator Formula. for Formula, where Re (rß) = {theta}I is the abscissa of convergence of the series Formula. When acting on a certain Hilbert space HI, rß, we show that the operator LI, rß is conjugate to an integral operator KI, rß. If furthermore rß is real, then KI, rß is selfadjoint, so that LI, rß : HI, rß -> HI, rß has purely real spectrum. It is proved that LI, rß also has purely real spectrum when acting on various Hilbert or Banach spaces of holomorphic functions, on the nuclear space C{omega} [0, 1], and on the Fréchet space C{infty} [0, 1]. The analytic properties of the map rß ↦ LI, rß are investigated. For certain alphabets I of an arithmetic nature (for example, I = primes, I = squares, I an arithmetic progression, I the set of sums of two squares it is shown that rß ↦ LI, rß admits an analytic continuation beyond the half-plane Re rß > {theta}I

The relationship between apamin binding and channel block in KCa2 potassium channels.

Small conductance calcium-activated potassium channels (KCa2.1,2.2,2.3) are widely distributed throughout the body and are involved in diverse physiological processes including the regulation of neuronal firing and smooth muscle contraction. They are also potential targets in the treatment of cardiac arrhythmia. The KCa2.2 and 2.3 members of the family are blocked by the peptide toxin apamin at low concentrations, however, the mechanism of block by apamin is unclear. In electrophysiological experiments apamin has been reported to block Kca2.2 and 2.3 with IC50 ~100 pM and ~1nM respectively. In contrast, in ligand binding experiments using [125I]-mono-iodoapamin it has been found that apamin does not discriminate between Kca2.2 and 2.3 and that it binds with significantly higher affinity ( ~5pM). This discrepancy has led to the suggestion that, rather than acting as a classical pore blocker, apamin exerts its action by an allosteric mechanism. It is notable that the ligand binding studies reported so far have been conducted with isolated cell membranes in non-physiological solution with low ionic strength. We have investigated this discrepancy between results from ligand binding and electrophysiological studies by comparing binding of [125I]-mono-iodoapamin and inhibition of KCa2 current in intact HEK 293 cells using identical physiological solutions. In these conditions we found that apamin bound to KCa2.1 and KCa 2.3 with KL 60 and 606 pM, close to values of IC50 from electrophysiological experiments. We also compared the ability of some known SK channel blockers, UCL 1848, UCL 1684, gallamine and dequalinium, to displace labelled apamin and inhibit KCa2 current. With these compounds we found a good correlation between K¬i and IC50. These findings suggest that the discrepancy between binding and block might arise from differences in the experimental protocols used. To examine this we examined apamin block of KCa2 current in low ionic strength solutions in which NaCl was iso-osmotically replaced by sucrose. In these conditions 100 pM apamin caused 92 ± 0.1 % block as against 51 ± 5 % block in physiological ionic strength. We conclude that binding data obtained from membrane preparations must be interpreted with care when making comparisons with data from functional experiments and that this has implications for current views on the mechanism of action of apamin as an SK channel blocke

The development and performance of European private equity..

In this paper we analyse the development of the European private equity sector: how it has grown, the distribution of investments, and the returns. From being a niche sector only a few years ago, the private equity sector within Europe has emerged from the shadows and is becoming increasingly the focus of attention. In part this is due to the sheer amount of capital being raised by the private equity sector.