A systematic review of magnetic resonance imaging in patients with an implanted vagus nerve stimulation system.

PURPOSE: Vagus nerve stimulation (VNS) is an effective adjunctive treatment for drug-resistant epilepsy (DRE) and difficult-to-treat depression (DTD). More than 125.000 patients have been implanted with VNS Therapy® System (LivaNova PLC) since initial approval. Patients with DRE often require magnetic resonance imaging (MRI) of the brain during the course of their disease. VNS Therapy System devices are labeled to allow MRI under certain conditions; however, there are no published comprehensive articles about the real-world experience using MRI in patients with implanted VNS devices. METHODS: A systematic review in accordance with PRISMA statement was performed using PubMed database. Full-length articles reporting MRI (1.5 T or 3 T scanner) of patients with implanted VNS for DRE or DTD and published since 2000 were included. The primary endpoint was a positive outcome that was defined as a technically uneventful MRI scan performed in accordance with the VNS Therapy System manufacturer guidelines and completed according to the researchers' planned scanning protocol without harm to the patient. RESULTS: Twenty-six articles were eligible with 25 articles referring to the VNS Therapy System, and 216 patients were included in the analysis. No serious adverse events or serious device-related adverse events were reported. MRI scan was prematurely terminated in one patient due to a panic attack. CONCLUSION: This systematic review indicates that cranial MRI of patients with an implanted VNS Therapy System can be completed satisfactorily and is tolerable and safe using 1.5 T and 3 T MRI scanners when performed in adherence to the VNS manufacturer's guidelines.

A home-based training programme improves family caregivers' oral care practices with stroke survivors: a randomized controlled trial.

OBJECTIVES: Stroke survivors experience poor oral health when discharged from the hospital to the community. The aim of this study was to evaluate the effectiveness of a home-based oral care training programme on knowledge, attitude, self-efficacy and practice behaviour of family caregivers. METHODS: A randomized controlled trial was conducted. The experimental group consisted of 48 family caregivers who received the home-based oral care training programme, and the control group consisted of 46 family caregivers who received routine oral care education. The outcomes were measured by the Knowledge of Oral Care, Attitude towards Oral Care, Self-Efficacy of Oral Care and Behaviour of Oral Care before the training programme, and at one and two months afterwards. The data were analysed using mixed model anova to determine differences in the outcomes between the two groups. RESULTS: The findings demonstrated that the intervention group had more knowledge (t = 8.80, P < 0. 001), greater self-efficacy (t = 3.53, P < 0.01) and better oral care behaviour (t = 11.93, P < 0.001) than the control group at one and two months, with statistically significant differences in oral care knowledge, self-efficacy and behaviour outcome over time. The attitude of the intervention group towards oral care practice was generally positive (mean of baseline and two month = 12.9 and 14.7), but no significant difference in attitude change between the control and intervention groups (t = 1.56, P = 0.12). The treatment interaction effect was significant for the family caregivers' behaviour of oral care at one and two months of the intervention for both groups. CONCLUSION: Our individualized home-based oral care education can achieve significant improvements in oral care knowledge and self-efficacy among family caregivers of stroke survivors, and it can sufficiently empower them to modify their oral care practices in a home-based healthcare environment.

Effect of family caregiver oral care training on stroke survivor oral and respiratory health in Taiwan: a randomised controlled trial.

OBJECTIVE: To evaluate the effectiveness of home-based oral care training programs on tongue coating (TC), dental plaque (DP), and symptoms of respiratory infection (SRI) in stroke survivors. METHODS: A single-blind, randomised, controlled trial conducted in a home-based setting over 2 months. Stroke survivors (n=48, experimental group) and their family caregivers received home-based oral care training programme while a control group of 46 stroke survivors and family caregivers received routine oral care education with swabs. TC, DP, and SRI were assessed at baseline and after one and two months, with results analysed using Mixed Model ANOVA. RESULTS: Poor oral hygiene and overall neglect of home oral care practices were observed at baseline. TC and DP scores were significantly reduced in the experimental group receiving the home-base oral care training program compared to the control group, who received only routine oral care education (P<0.001). The groupxtime interaction was significant, with decreased TC and DP scores for both groups at one month and at two months of additional care (when compared to baseline). The SRI scores were not significantly different between groups (P>0.05). The groupxtime interaction did not correlate with SRI for either group when compared to the baseline and to one month and two months of additional care. No adverse events were encountered and there was no external funding. CONCLUSIONS: Home-based oral care training programme had a beneficial effect on oral health as measured by TC and DP scores. The effect on SRI requires further longitudinal study.

Classification of IVS1-10T-->C as a polymorphism of BRCA1.

Mutations inactivating the tumor suppressor gene BRCA1 may be responsible for disease for up to 80% of familial ovarian cancer cases. In this syndrome, tumorigenesis classically initiates from an inherited mutation in one allele followed by somatic deletion of the normal allele. Sequencing of BRCA1 amplified from genomic DNA of lymphocytes and microdissected ovarian tumor cells of a familial ovarian cancer patient revealed three, rare heterozygous DNA variations (2418delA, 233G-->A, and IVS1-10T-->C) in both tumor and constitutional (lymphocyte) DNA. Thus, both copies of BRCA1 were retained in tumor. Haplotype analysis of the patient and four siblings assigned 2418delA to one copy of BRCA1 and 233G-->A and IVS1-10T-->C to the other. The DNA change, 2418delA, is considered a mutation that inactivated one BRCA1 allele because it caused a frameshift and generation of a premature stop codon, resulting in synthesis of a truncated peptide as evidenced by an in vitro protein truncation test. The DNA variation, 233G-->A, does not result in an amino acid change, and is considered a benign polymorphism. IVS1-10T-->C is a unique BRCA1 change that occurs in the last nucleotide of a consensus sequence for a branch site critical for RNA splicing. Therefore, we investigated whether IVS1-10T-->C deleteriously affected BRCA1 splicing or expression, and thereby inactivated the other BRCA1 allele. Using the technique of reverse transcription-polymerase chain reaction (PCR) with RNA isolated from lymphoid cell lines of the patient and of controls, no evidence was found that IVS1-10TC abnormally disrupted mRNA splicing or caused the absence of BRCA1 mRNA. Thus, IVS1-10T-->C is not harmful to BRCA1 function, and is classified a benign polymorphism. Retention of the normal BRCA1 allele in the tumor with the heterozygous germline BRCA1 mutation, 2418delA, indicated that mutational inactivation of both BRCA1 alleles was not required for tumorigenesis. It is possible that the normal allele may be functionally inactivated by a nonmutational mechanism.

Mutation analysis of BRCA1, TP53, and KRAS2 in ovarian and related pelvic tumors.

Cancer may be viewed as a genetic disease resulting from critical mutations that disrupt normal cell growth. To characterize the involvement of the BRCA1 and TP53 tumor suppressor genes and of the KRAS2 protooncogene in gynecologic cancer, mutation analysis of these genes was conducted in pelvic tumors of 85 patients that included 49 epithelial ovarian carcinoma cases. The 85 pelvic tumors contained 5 tumors with BRCA1 mutations, 33 with TP53 mutations, and 1 with a KRAS2 mutation. Each of the BRCA1 and KRAS2 mutations, and 25 of the TP53 mutations, were in ovarian carcinomas. Four of the BRCA1 mutations were germline and 1 was somatic. The 4 patients with germline BRCA1 mutations had an early age of disease onset (33-48 years) relative to the mean age of onset (58 years) of all 49 ovarian carcinoma patients, and 3 of these 4 patients had a family history of ovarian or breast cancer. None of the 4 tumors with germline BRCA1 mutations had a KRAS2 mutation or a TP53 mutation, despite a 51% frequency of TP53 mutations in the 49 ovarian carcinomas. Three of the 4 tumors with germline BRCA1 mutations retained a wild-type BRCA1 allele. The tumor with the somatic BRCA1 mutation contained a TP53 mutation and had no evidence for wild-type BRCA1 and TP53 alleles. These data suggest that both BRCA1 and TP53 were inactivated in 1 of 49 ovarian carcinomas. Moreover, mutational inactivation of both BRCA1 and TP53 did not occur in 4 tumors with a germline BRCA1 mutation. It has been proposed that tumorigenesis in cells with a heterozygous BRCA1 mutation requires inactivation of the wild-type BRCA1 and TP53 alleles, which results in genomic instability and acquisition of mutations in protooncogenes. Clearly, mutational inactivation of TP53 and the wild-type BRCA1 allele in ovarian tumors with a heterozygous, germline BRCA1 mutation is not an absolute requirement for tumor formation. It is possible that these alleles may be inactivated by nonmutational mechanisms or that other tumor formation pathways exist.

Low pH facilitates capsaicin responses in isolated sensory neurons of the rat.

The effects of capsaicin (CAPS; 30 nM, 300 nM, 3 microM) and acidic solutions (pH 6.6, 6.1, 5.6, 5.1) were studied in dorsal root ganglion (DRG) neurons from adult rats in short term culture using the whole cell patch-clamp technique and a system for fast drug application. At -60 mV holding potential, both CAPS 30 nM and 300 nM for 10 s did not induce a significant membrane current in pH 7.3. The first response to 3 microM CAPS at pH 7.3 yielded an inward current of 898 +/- 517 pA and with pH 6.1 the sustained proton-induced current was 365 +/- 153 pA. A more than additive current increase was observed when both agents were applied together even at subthreshold concentrations of CAPS or protons. Similar results were obtained at positive holding potential. Facilitation was also observed when extracellular pH 6.1 solution was applied immediately after discontinuation of 3 microM CAPS application but not when CAPS followed the application of pH 6.1 solution (n = 8). The proton-induced current as well as the CAPS-pH response both increased with proton concentration and showed the same short relaxation time relative to the CAPS response. The facilitation saturated near pH 5.6, and was present in repeated trials when responses to CAPS were markedly decreased due to tachyphylaxis. It is suggested that protonation of CAPS gated ion channels increases their open probability or conductance and modulates their kinetics.

Pro- and anti-inflammatory actions of ricinoleic acid: similarities and differences with capsaicin.

We have investigated the pro- and anti-inflammatory effects of ricinoleic acid (RA), the main active principle of castor oil, in an experimental model of blepharitis induced by intradermal injection of carrageenan in the guinea-pig eyelid and its possible capsaicin-like mode of action on acutely dissociated rat dorsal root ganglia (DRG) neurons in vitro. Topical treatment with RA (10-100 mg/guinea-pig) or capsaicin (1-10 mg/guinea-pig) caused eyelid reddening and oedema. At lower doses (0.3-3 mg/guinea-pig and 0.009-0.09 mg/guinea-pig for RA and capsaicin, respectively) both drugs significantly potentiated the eyelid oedema induced by carrageenan. The tachykinin NK1 receptor antagonist FK 888 (0.59 mg/kg s.c.) abolished the potentiation of carrageenan-induced eyelid oedema induced by either RA or capsaicin. The neutral endopeptidase inhibitor, thiorphan (1.3 mg/kg i.v.) significantly enhanced the potentiation of carrageenan-induced eyelid oedema produced by RA. This potentiating effect was abolished by FK 888. Repeated (8 days) topical application of RA (0.9 mg/guinea-pig) or capsaicin (0.09 mg/guinea-pig) inhibited the carrageenan-induced eyelid oedema. This anti-inflammatory effect was accompanied by a reduction (75%-80% of SP and 46%-51% of NKA) in tachykinin content of the eyelids, as determined by radioimmunoassay. In dissociated rat DRG neurons, RA (0.1 mM for 5 min) significantly inhibited the inward currents induced by application of capsaicin (1 microM) and/or low pH (5.8), without inducing any currents by itself or changing voltage-dependent currents. Moreover, after 24-h incubation, RA (0.1 mM) significantly decreased the capsaicin (1 microM)-induced calcitonin gene-related peptide (CGRP) release from rat DRG neurons, whereas acute drug superfusion did not evoke CGRP release by itself. Summarizing, RA possesses capsaicin-like dual pro-inflammatory and anti-inflammatory properties which are observed upon acute and repeated application, respectively. However, unlike capsaicin, RA does not induce inward current in DRG neurons and it is devoid of algesic properties in vivo.

UV photoelectron spectroscopy and ab initio characterization of valence orbital structures and conformations of neutral phosphate esters.

The HeI UV photoelectron spectrum of trimethyl phosphate (TMP) has been measured and interpreted with the aid of SCF molecular orbital calculations carried out with STO-3G, STO-3G* and 4-31G basis functions. The photoelectron spectrum of TMP is more accurately reproduced by results from 4-31G calculations than by results from STO-3G or STO-3G* calculations. However, all three basis sets yield results which predict the same assignment of the photoelectron spectrum. Results at the 4-31G level indicate that whether calculations are based on crystallographic bond angles and bond lengths or on STO-3G optimized geometries has little effect on the energetic ordering of the upper occupied orbitals. The energetic ordering of orbitals is also found to be only weakly dependent upon the torsional angle phi, describing rotation of ester groups about P-O bonds and upon the torsional angle psi, describing rotation of methyl groups about C-O bonds. For trimethyl phosphate, with C3 symmetry, the vertical ionization potentials of the upper occupied orbitals are 10.81 eV (8e), 11.4 eV (9a), 11.93 eV (7e), 12.6-12.9 eV (8a and 6e), 14.4 eV (7a) and 15.0-16.0 eV (5e and 6a). Calculations at the 4-31G level indicate that many of the highest occupied orbitals in neutral dimethyl phosphate and methyl phosphate have energies and electron distributions similar to orbitals in TMP. For TMP, a search for optimized values of phi and psi has been carried out at the STO-3G*level. In agreement with previous NMR studies and with classical potential calculations, the STO-3G* results indicate that both the gauche (phi = 53.1 degrees) and anticlinal (phi = 141.9 degrees) conformations are thermally accessible. Also in agreement with the classical potential calculations, the STO-3G* results predict that in the all gauche conformation energy is minimized when the methyl groups assume a staggered geometry (psi = 60 degrees to 80 degrees) and that an energy maximum occurs for an eclipsed geometry (phi = 0 degrees to 20 degrees). A study of the dependence of optimized values of O-P-O ester bond angles on the torsional angles, phi, was carried out at the STO-3G, STO-3G* and 4-31G levels. The results demonstrate that for C3 symmetry, the coupling of O-P-O angles to phi is influence by repulsive steric interactions.

A pilot study to investigate the impact of interactional television on student evaluation of faculty effectiveness.

While the dominant theme of distance education research has been the learner, learner achievement is not necessarily the only important consideration in assessing the effectiveness of ITV programs. With nearly half of the nursing programs recently surveyed by Reinert and Fryback (1997) offering or planning to offer distance learning in the near future, researchers and developers must seek to understand the impact of ITV on the teacher. These programs require faculty who are committed and prepared to teach outside of the traditional classroom. Selection of faculty requires attention to appropriate qualifications and knowledge of strategies to bridge teacher-learner separation created by distance education. Faculty, peers, and administrators should consider the teaching environment when interpreting data designed to evaluate teacher effectiveness of ITV teaching.

Laryngeal mask airway: indications and management for critical care.

The laryngeal mask airway is the newest tool for airway management during the perianesthesia period. This device has joined other resuscitation equipment on emergency carts. Critical care nurses must be prepared to care for patients for whom laryngeal mask airways are indicated and used. A solid understanding of the purpose and placement of the laryngeal mask airway is necessary for safe removal of the device. Policies and procedures should be developed to define standards of care and responsibilities for care of patients with a laryngeal mask airway.

Practice characteristics of the dual certificant--CPAN/CAPA.

Little information is available regarding the practice of nurses who hold two perianesthesia certification credentials (CPAN/CAPA) and their motivation in achieving a dual certification distinction. Achievement of certification in both areas of perianesthesia nursing is a significant accomplishment. Nurses with dual certification are a valuable asset to the profession, their employer, and the perianesthesia patient. The characteristics of this unique group were surveyed by the American Board of Perianesthesia Nursing Certification, Inc. The findings have implications for nurse managers, educators, and perianesthesia colleagues.

Vasodepressor syncope: the common faint.

Perianesthesia patients and families are susceptible to vasodepressor syncope. Understanding the physiological mechanisms responsible for syncope, the Bezold-Jarisch reflex, will allow the perianesthesia nurse to minimize the physical and emotional sequele of the common faint.

Reducing the pain of venipuncture.

Patient satisfaction with nursing care is the strongest predictor of overall satisfaction. Reducing discomfort of routine procedures, such as venipuncture for an intravenous insertion, can contribute to perceived satisfaction. This article reviews three common pharmacological interventions that can be used by perianesthesia nurses to reduce the pain of venipuncture.

Pruritus and urticaria.

Pruritus and urticaria frequently occur during the perianethesia period. Knowledge of the physiology of these symptoms can assist the perianesthesia nurse to identify the appropriate nursing and medical interventions.

Recognizing Horner's syndrome.

Horner's syndrome is a dramatic finding identified by perianesthesia nurses after regional anesthesia. This article describes the relationship between Horner's syndrome and regional anesthesia while explaining the signs and symptoms as they relate to blockade of the sympathetic nervous system.

Nystagmus: benign or significant?

Nystagmus is a broad symptom describing unusual ocular movements. The peri-anesthesia nurse may identify nystagmus as a preoperative condition, as an event during recovery from general anesthesia, or as a pathological finding. Understanding the physiology of nystagmus provides a basis for nursing assessment and intervention.

Dementia: a complex symptom.

The number of perianesthesia patients with dementia increases yearly. Understanding the physiology and functional impairments of these patients will improve the perianesthesia nurse's ability to create a safe environment, communicate effectively, and reduce discomfort.

An integrative review of postanesthesia care unit phase I patient outcome research: 1982 to 1993.

Specialty nursing practice tends to define itself by a set of competencies believed to be essential by the practitioner. A specialty practice rarely is the result of patient outcome research. Although nurses have been caring for postoperative patients since the early 1900s, a review of published PACU phase I patient outcome nursing research has not been reported. As part of a larger study, an integrative review of phase I postanesthesia research was conducted to investigate compliance with the scientific method and to examine whether reported research findings link the nursing process with patient outcome. Data were collected from identified PACU phase I research studies published between 1982 and 1993. The table of contents from 16 nursing journals were examined to identify published studies. The sample for the integrative review consisted of 43 studies meeting inclusion criteria. Data from the 43 studies were collected independently by two researchers on Post Anesthesia Research Literature Instrument coding sheets developed for the review. Findings indicated that the scientific method was used with varied levels of sophistication. The linkage of nursing process with patient outcome did not appear explicit in the studies reviewed.