Anaemia is independently associated with mortality in patients with hepatocellular carcinoma.

BACKGROUND: Anaemia is frequent in patients with cancer and/or liver cirrhosis and is associated with impaired quality of life. Here, we investigated the impact of anaemia on overall survival (OS) and clinical characteristics in patients with hepatocellular carcinoma (HCC). MATERIALS AND METHODS: HCC patients treated between 1992 and 2018 at the Medical University of Vienna were retrospectively analysed. Anaemia was defined as haemoglobin level <13 g/dl in men and <12 g/dl in women. RESULTS: Of 1262 assessable patients, 555 (44.0%) had anaemia. The main aetiologies of HCC were alcohol-related liver disease (n = 502; 39.8%) and chronic hepatitis C (n = 375; 29.7%). Anaemia was significantly associated with impaired liver function, portal hypertension, more advanced Barcelona Clinic Liver Cancer stage and elevated C-reactive protein (CRP). In univariable analysis, anaemia was significantly associated with shorter median OS [9.5 months, 95% confidence interval (95% CI) 7.3-11.6 months] versus patients without anaemia (21.5 months, 95% CI 18.3-24.7 months) (P < 0.001). In multivariable analysis adjusted for age, Model for End-stage Liver Disease, number of tumour nodules, size of the largest nodule, macrovascular invasion, extrahepatic spread, first treatment line, alpha-fetoprotein and CRP, anaemia remained an independent predictor of mortality (adjusted hazard ratio 1.23, 95% CI 1.06-1.43, P = 0.006). CONCLUSIONS: Anaemia was significantly associated with mortality in HCC patients, independent of established liver- and tumour-related prognostic factors. Whether adequate management of anaemia can improve outcome of HCC patients needs further evaluation.

Oxidation-reduction properties of two engineered redox-sensitive mutant Escherichia coli malate dehydrogenases.

Redox potentials for two inactivating intrasubunit disulfides that link helix-5 and helix-9 in mutant Escherichia coli malate dehydrogenases have been determined. The Em is -285 mV when cysteines are at positions 121 and 305 and -295 mV when the cysteines are at positions 122 and 305. Oxidation to the disulfide affects kcat but not Km values. In the single V121C and N122C mutants, the Cys in helix-5 affects the Km for oxalacetate. The pH optimum in the direction of malate formation is affected by the redox state of the enzyme. Clearly, a disulfide bond can and does form between Cys residues substituted into positions 121 or 122 in the nucleotide binding domain and 305 in the carbon substrate binding domain of this NAD-dependent malate dehydrogenase. Apparently, crosslinking the domains interferes with catalysis.

Using research to establish protocols for practice: a statewide study of acute care agencies.

The purpose of the study was to examine research utilization practices relative to developing and revising practice protocols in acute care agencies in Delaware. Nurse leaders in 13 acute care agencies identified resource nurses most familiar with the development and revision of agency protocols. Thirty-two resource nurses from 11 agencies, representing critical care, emergency, general medical, general surgical, obstetric, and psychiatric nursing, were interviewed. Interviews were tape-recorded and transcribed. Examples of research-based protocols, defined as those supported by research citations, were obtained. The authors found that the majority of protocols submitted, although referenced, were not research-based. Most institutions used textbooks and standards to support nursing practice protocols. The authors concluded that nurses who are responsible for developing and revising agency protocols were not familiar with the use of research findings to guide the development or revision of protocols and were unsure what constituted the "use of research."

Statewide assessment of school-age children with asthma in Delaware.

In Delaware, asthma affects almost 14,000 children. The American Lung Association of Delaware and the University of Delaware surveyed school nurses to identify the needs of children with asthma and the services and accommodations available for these children. Researchers developed a survey instrument that was mailed to all Delaware schools (N = 324). The response rate was 38.6% (n = 125). According to respondents, a variety of protocols were in place regarding the administration of asthma medications. Respondents also reported that several measures had been taken to modify the school environment to improve air quality and reduce asthma triggers. Most respondents (77%) indicated they did not have asthma education programs in their schools. Findings from this study sparked development of a multidisciplinary Delaware Asthma Committee, an Asthma Education Center, and a statewide system for communicating with the parents of children with asthma.

Near death experiences: critical care nurses' attitudes and interventions.

A patient is successfully resuscitated after a trauma or serious illness. It is increasingly common for such a patient to report having experienced a feeling of calm and peace, a feeling of being separated from the body, and/or a sense of moving through a dark tunnel ending at a bright light. Such experiences are known as near death experiences. What are critical care nurses to make of such accounts reported to them by their patients? This article explores critical care nurses' interests in, knowledge of, and attitudes towards the near death experience, and it identifies nursing interventions that critical care nurses can use during and after the patient experiences near death.

First-time mothers' perceptions of prenatal care services.

This study sought to uncover information regarding prenatal care services as reported by primiparas. Inadequate prenatal care has been linked with the delivery of low birth weight (LBW) infants and infant mortality. This secondary analysis of a larger study (N = 426) examined the need for and availability, accessibility, and use of prenatal care services by primiparas (n = 141). Results indicated that primiparas delivering LBW infants reported less satisfaction with information on birth control and less information on infant feeding. In addition, mothers of LBW infants reported more often than mothers of normal birthweight infants that transportation and finances were barriers to prenatal care. Childbirth preparation class was the only predictor variable for birth weight in this study.

Predicting NCLEX-RN performance: cross-validating an identified classification procedure.

This study was an attempt to cross-validate a procedure from an earlier study for predicting NCLEX-RN performance. In the original study, a discriminant function was developed on 313 baccalaureate nursing graduates (1988 through 1990), which used 15 variables to correctly categorize more than 91 per cent of them on NCLEX-RN performance. This study used 142 subjects who graduated in 1991 and 1992 to evaluate the adequacy of the classification procedure. Subjects in this more recent sample differed significantly from those in the first on several variables, including SAT scores, physiology grades, and nursing grades. Eight-four per cent of the subjects in the cross-validation sample were correctly classified using the original discriminant function. More than 62 per cent of failures and 87 per cent of passes were correctly categorized. These results suggest that it is statistically and ethically sound to use this discriminant function to identify future students in danger of NCLEX-RN failure.

The effects of imagery abilities and mental rehearsal on learning a nursing skill.

Nursing demands competency in numerous psychomotor skills. Using theory from Paivio (1986), Anderson (1976, 1985), and Bandura (1986), this attribute-treatment study explored the interactive effects of imagery skills and various combinations of physical and mental practice on learning a skill. The author assessed 108 nursing students for imagery abilities and randomly assigned them to a physical practice (PP), mental rehearsal (MR), or a combined mental rehearsal plus physical practice (MR + PP) group. After learning to apply and remove sterile gloves, subjects were evaluated on their performance. A 3-factor ANOVA was performed and a significant main effect for practice condition was obtained. Subjects in the MR+PP condition performed significantly better than subjects in the MR condition but not the PP condition. These findings have important implications. Incorporating the use of mental rehearsal as an adjunct to physical practice in an effort to facilitate skill acquisition was found to be beneficial.

Evaluating the affective domain. Consider a Likert scale.

An affective component of learning exists in every educational program developed, yet evaluating this aspect remains a challenge for nurse educators. An attitudinal scale should be considered one means of discovering nurses' attitudes and beliefs relative to a particular learning experience. Practical guidelines for developing and improving Likert scales, as well as interpreting scores, are the focus of this article.

Maintenance of human cytomegalovirus genome in human diploid fibroblast cells.

Human embryo lung cells pretreated with a combination of human leukocyte interferon and acyclovir were infected with human cytomegalovirus (HCMV) and treated daily for 14 days with the same inhibitor combination. After removal of the inhibitors, the incubation temperature was maintained at either 37 or 40.5 degrees. Incubation of infected cells at 37 degrees after inhibitor removal resulted in progressive virus-specific cytopathology and eventually total destruction of the cell culture. However, HCMV-infected cells incubated at 40.5 degrees after inhibitor removal exhibited little or no virus-induced cytopathology and HCMV remained noninfectious for 8 days. After extended incubation at 40.5 degrees, infectious HCMV was readily detectable even though virus-specific cytopathology was not evident. Reducing the incubation temperature from 40.5 to 37 degrees resulted in stimulation of infectious virus replication and subsequent destruction of the infected cell culture monolayer within 10 days.