This study provides nurse managers with important and relevant staff views on the impact of working 12-hour shifts. In particular to those working within a critical care environment and suggests the challenge is to ensure existing systems and practices develop to improve on the less encouraging effects of working 12-hour shifts. It adds an understanding of the senior nurse's view on the positive and negative effects of managing and organizing staff off duty to safely run a department with 12-hour shifts.

BackgroundLate antenatal care and smoking during pregnancy are two important factors that are amenable to intervention. Despite the adverse health impacts of smoking during pregnancy and the health benefits of early first antenatal visit on both the mother and the unborn child, substantial proportions of women still smoke during pregnancy or have their first antenatal visit after 10 weeks gestation. This study was undertaken to assess the usefulness of geospatial methods in identifying communities at high risk of smoking during pregnancy and timing of the first antenatal visit, for which targeted interventions may be warranted, and more importantly, feasible.MethodsThe Perinatal Data Collection, from 1999 to 2008 for south-western Sydney, were obtained from the New South Wales Ministry of Health. Maternal addresses at the time of delivery were georeferenced. A spatial scan statistic implemented in SaTScan was then used to identify statistically significant spatial clusters of women who smoked during pregnancy or women whose first antenatal care visit occurred at or after 10 weeks of pregnancy.ResultsFour spatial clusters of maternal smoking during pregnancy and four spatial clusters of first antenatal visit occurring at or after 10 weeks were identified in our analyses. In the maternal smoking during pregnancy clusters, higher proportions of mothers, were aged less than 35 years, had their first antenatal visit at or after 10 weeks and a lower proportion of mothers were primiparous. For the clusters of increased risk of late first antenatal visit at or after 10 weeks of gestation, a higher proportion of mothers lived in the most disadvantaged areas and a lower proportion of mothers were primiparous.ConclusionThe application of spatial analyses provides a means to identify spatial clusters of antenatal risk factors and to investigate the associated socio-demographic characteristics of the clusters.

Extracranial Blood Flow Distribution During Carotid SurgeryAleksic M., Brunkwall J. Eur J Vasc Endovasc Surg 2009;38:552-5. Objective: The collateral function of the external carotid artery (ECA) for cerebral perfusion in cases of atherosclerotic occlusive disease of the internal carotid artery (ICA) is difficult to assess; for this reason, blood flow measurements were taken during carotid endarterectomy (CEA).Methods: Blood flow was measured before and after CEA using a transit-time flow meter at the carotid artery in 1000 patients who underwent CEA for high-degree (Ͼ70%) ICA stenosis. The data were collected prospectively and analysed retrospectively.Results: Median ICA blood flow increased significantly, up 46% from 160 ml min Ϫ1 (IQR: 100 -234 ml min Ϫ1 ) before CEA to 240 ml min Ϫ1 (IQR: 187-309 ml min 1 ) after CEA (P Ͻ 0.001). Median ECA blood flow dropped by 4%, from 152 ml min Ϫ1 (IQR: 108 -220 ml min Ϫ1 ) to 150 ml min Ϫ1 (IQR: 103-200 ml min Ϫ1 ) (P ϭ 0.001). Relative ICA blood flow volumes related to common carotid artery (CCA) flow increased from 58% before CEA to 73% after CEA, whereas relative ECA flow decreased from 54% to 44%.Conclusions: Increased blood flow in the ICA after CEA is accompanied by decreased ECA flow whereupon the absolute amount of this redistribution is relatively limited. A more profound evaluation of these haemodynamic conditions demands further study. Thoracic Outlet Syndrome in Children and Young AdultsMaru S., Dosluoglu H., Dryjski M., Cherr G., Curl G.R., Harris L.M. Eur J Vasc Endovasc Surg 2009;38:560-4.

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