Teaching pain management: how to make it work.

What are effective strategies for teaching and molding attitudes toward pain management? Nursing responsibility for pain management involves a complex decision-making process affected by many variables. Traditional pain management classes omit critical content and strategies that may affect implementation of the information. Techniques and resources for the educator planning pain management programs are presented in this article. Achieving positive changes in behavior related to pain management requires a well-developed plan that incorporates model-based instruction in both cognitive and affective domains.

The transfusion needs of an autologous bone marrow transplant patient with IgA deficiency.

BACKGROUND: Transfusion management of the patient who is undergoing a marrow or peripheral blood stem and progenitor cell transplantation is often challenging. The situation is further complicated when the patient is IgA deficient with circulating anti-IgA. CASE REPORT: This report describes an approach to transfusion therapy primarily using red cells washed by automated techniques and cryopreserved autologous plateletpheresis components. Additional platelet support was provided with manually washed allogeneic plateletpheresis components. Autologous fresh-frozen plasma was collected concurrently, and IgA-deficient allogeneic units were ordered and kept in storage, but they were not needed during transplantation. The patient experienced no transfusion sequelae as a result of the IgA deficiency. CONCLUSION: With this approach, the transfusion needs of an IgA-deficient patient were adequately met during bone marrow transplantation.

Ex vivo expansion of CD34+ umbilical cord blood cells in a defined serum-free medium (QBSF-60) with early effect cytokines.

To investigate the clinically applicable conditions that support substantial expansion of both primitive and more mature hematopoietic cells of umbilical cord blood (UCB) for transplantation in adults, enriched CD34+ cells from 8 fresh UCB samples and 4 expanded UCB products were cultured in defined serum-free medium (QBSF-60) in the presence of a cytokine combination of SCF, Flt-3-ligand (FL), thrombopoietin (TPO), IL-3 for up to 2 weeks. Fresh medium with cytokines was supplemented or exchanged at day 4, day 7, and day 10. The proliferative response was assessed at day 7, day 10, and day 14 by evaluating the following parameters: nucleated cell (NC), clonogenic progenitors (colony-forming unit-granulocyte-macrophage [CFU-GM], burst-forming unit-erythrocyte [BFU-E], CFU-GEMM, and high-proliferative potential colony-forming cell [HPP-CFC]), immunophenotypes (CD34+ cells and CD34+ subpopulations), and LTCIC. Simultaneously numerical expansion of various stem/progenitor cells, including primitive CD34+CD38-HLA-DR- subpopulation and LTCIC, CD34+ cells, and clonogenic progenitors to mature nucleated cells, were continuously observed during the culture. An average 103.32 +/- 71.37 x 10(6) CD34+ cells (range 10.12 x 10(6)-317.9 x 10(6)) could be obtained from initial 1.72 +/- 1.13 x 10(6) UCB CD34+ cells after 10-14 days cultured under the described conditions. Sufficient CD34+ cells (>50.0 x 10(6)) for transplantation in adults would be available in all but one UCB collections after 10-14 days expansion. The expanded CD34+ cells sustained most of the in vitro characteristics of initial unmanipulated CD34+ cells, including clonogenic efficiency (of both primitive and committed progenitors), the proportion of CD34+CD38-HLA-DR- subpopulation, and the expansion potential. Initial addition of IL-3 to the cocktail of SCF + FL + TPO had positive effects on the expansion of both primitive and, especially, the more mature hematopoietic cells. It accelerated the expansion speed and shortened the optimal culture time from 14 days to 10 days. These results indicated that our proposed short-term culture system, consisting of QBSF-60 serum-free medium with a simple early acting cytokine combination of SCF + FL + TPO, could substantially support simultaneous expansion of various stem/progenitor cell populations involved in the different phases of engraftment. It would be a clinically applicable protocol for ex vivo expansion of CD34+ UCB cells.

An honors program: directing our future leaders.

Development of future leaders is a priority of nurse educators. In this article an honors program, which was initiated to prepare students who would contribute to nursing science and become effective leaders, is described. The process used to gain faculty and administrative support is highlighted. The discussion also includes specifics regarding recruitment and selection of students and sequencing of courses. Evaluation of the program suggests that graduates assume leadership positions within the profession. Honors programs such as this one help to prepare leaders and scholars for tomorrow.

Pain assessment in elders: practical tips.

The number of painful conditions and diseases increase as elders live longer. Pain can alter physical functioning and quality of life, and pain assessment in this unique population is a special challenge because pain can affect cognitive status, mood, and function. When the elder presents with pain, the practitioner must often deal with vague comments, reluctance to describe pain, and degrees of cognitive impairment. This article provides information on how to address barriers to pain assessment and current research that will help the practitioner devise strategies to obtain the data for an accurate and valid pain assessment.

Encephalopathy and seizures induced by intravesical alum irrigations.

Hemorrhagic cystitis is a significant toxic effect of cyclophosphamide therapy. Continuous bladder irrigation of a 1% alum solution is a simple and generally safe method of chemical cautery to treat the bleeding urothelium. We report four cases of encephalopathy coincident with elevated aluminum levels as well as one patient who developed seizures while receiving continuous bladder irrigations with alum. All patients had significant renal insufficiency. We recommend the cautious use of alum irrigation in patients with renal impairment and monitoring of serum aluminum levels to prevent excessive accumulation and toxicity.

[Bronchial carcinoma and pulmonary hypertension. Significance for lung resection]. / Bronchialkarzinom und pulmonale Hypertonie. Bedeutung für die Lungenresektion.

In 227 patients with bronchial carcinoma whose forced expiratory volume was less than 2.5 l, measurements revealed a mild but significant rise in mean pulmonary arterial pressure at rest and on mild exercise (60 W). There was no clinically useful correlation between the degree of pulmonary hypertension and other measurable values, such as stage of the tumor or spirometric, whole-body plethysmographic, scintigraphic, electrocardiographic and blood-gas measurements. The degree of pre-operative pulmonary hypertension in 142 operated patients correlated with neither postoperative complications nor with post-operative mortality. Six months after lung resection there was a mild rise in pulmonary artery mean pressure among 30 patients, statistically significant only in those after pneumonectomy at rest. These results do not justify routine pre-operative right-heart catheterization. This should be reserved for patients with marginal ventilatory findings and cardiac risk factor.