Peripheral neuropathy associated with alpha 1-antitrypsin deficiency.

Peripheral neuropathy associated with alpha 1-antitrypsin deficiency is an uncommon condition. Several recent studies have investigated the possible roles of serum proteinase inhibitors in inflammatory neuropathies, such as multiple sclerosis, Landry-Guillain-Barré syndrome, and various chronic inflammatory demyelinating peripheral neuropathies. We present a case in which alpha 1-antitrypsin deficiency (proteinase inhibitor ZZ phenotype) was diagnosed in a young white man with clinical signs and symptoms of peripheral neuropathy and a history of Landry-Guillain-Barré syndrome. We wish to emphasize the importance of serum protein electrophoresis in the diagnostic workup of patients presenting with the clinical manifestations of peripheral neuropathy.

Biodistribution of radiolabeled [(3)H] CMT-3 in rats.

CMT-3 is a NON-ANTIMICROBIAL tetracycline (TC), chemically modified to enhance its collagenase-inhibitory property. This property is therapeutically useful in treating diseases such as periodontitis, cancer and arthritis. CMT-3 was labeled with tritium [(3)H] at Carbon 7. Four adult male Sprague-Dawley rats (350--400 g body weight) were gavaged once with a mixture of cold CMT-3 and [(3)H] CMT-3 (750 microCi). An additional four rats were gavaged for 2 days with cold CMT-3(15 mg/Kg/day) and on the third day the rats were gavaged with a mixture of cold and [(2)H] CMT-3 (750 microCi); and all 8 rats were placed in the metabolic cages. Blood samples were collected from the tail at multiple intervals from 1--14 hr after [(3)H] CMT-3 administration. At 14 hr, the rats were anesthetized, euthanized and various tissues including visceral organs were removed and weighed. The contents of GI tracts were emptied and added to the fecal pellets and weighed. The urine samples were collected and volume measured. Each tissue or organ was minced finely with scissors and 100 mg of tissue was digested in 1 ml of Tissue-solv (Packard Lab), for 4 hrs at 37 degrees C and each sample was diluted up to 10 ml of distilled water. A 100 microl aliquot was taken and diluted with an equal volume of glacial acetic acid, 10 ml of Atom-lite was added and counted for radioactivity in a liquid scintillation spectrometer. This biodistribution study revealed that over 14 hrs, 54% and 3% of [(3)H] CMT-3 were excreted in the feces and urine, respectively. The serum [(3)H] CMT-3 count reached its maximum value at about 12 hours. The tissues retained the CMTs as follow: muscle (23%); skin (2.41%); bone (1.72%); and the brain retained 0.21% of the label. The radioactive CMT-3 in the visceral organs is as follows: GI tract - its contents (8.9%); heart (0.41%), testis (0.41%); lungs >(0.16%); spleen (0.08%); liver (0.03%); kidneys > (0.02%).

Knowledge and perceived competence of home care nurses in pain management: a national survey.

This national mail survey assessed pain-related knowledge and subjective competence of a random sample of home care nurses across the United States. Other study objectives were to examine the relationship between nurse characteristics, knowledge and perceived competence, and assess continuing education practices. On average, the 1236 nurses scored only 56% of the items correctly, demonstrating stronger knowledge in pain assessment than treatment. Respondents reported most confidence in patient and family communication, discussion of advance directives and pain assessment. The lowest competence was reported in sophisticated pain treatment techniques. The relationship between knowledge and subjective competence was found to be highly significant. Sixty-three percent of the sample displayed a realistic assessment of their pain management knowledge, while 37% under- or overestimated what they knew. It is challenging to engage the latter group who overestimate their competence but score low on pain management knowledge. Educational strategies need to differentiate these two groups and target the audience appropriately.

Implementing national standards for cancer pain management: program model and evaluation.

The purpose of this quasi-experimental (pre and posttest) study was to test a model pain management program (PMP) to implement the American Pain Society (APS) quality assurance standards for the management of acute and chronic cancer pain using a continuous quality improvement (CQI) approach to improve professionals' knowledge and skills, patient satisfaction, and to identify areas needing improvement. The sample consisted of 1210 nurse responses and 698 interviews of patients with pain during hospitalization at a major urban cancer center. The PMP provided a structure (standards), educational opportunities, and training in CQI methods. Outcome measures included a patient evaluation questionnaire and concerns checklist; nurse knowledge, attitude and barriers questionnaire; and focus groups to identify areas needing improvement. Significant improvements were found in patients' satisfaction, nurses' knowledge and attitude scores, and reductions in nurses' perceptions of barriers. Focus groups revealed the need for improved communication among disciplines about pain and better assessment of patients unable to self-report. The program met its goal of implementing the APS standards, educating nurses, and identifying "system" problems, and improving overall patient satisfaction.

Chest tube insertion: a prospective evaluation of pain management.

OBJECTIVE: To evaluate pain associated with chest tube insertion in a group of patients with malignant pleural effusions. DESIGN: Prospective case series. SETTING: Acute care cancer center in an academic institution. PATIENTS: Fifty-two patients with symptomatic malignant pleural effusions. Twenty-six evaluated by conventional approach to chest tube insertion (group 1), 26 evaluated after institution of a new chest tube protocol (group 2). INTERVENTIONS: A new protocol was designed to improve pain control during chest tube insertion. The protocol included improved housestaff and nursing education, premedication, proper insertion techniques, and more liberal and precise delivery of local anesthetic. OUTCOME MEASURES: Both groups were evaluated by a verbal self-report scale (1-10) to assess pain and anxiety. RESULTS: The mean pain rating in group 1 was 6.2 (+/-0.76) compared with 3.7 (+/-5.6) in group 2 (p < 0.01). In group 1, pain or anxiety was 9 or 10 in 12 of 26 on a scale of 1 to 10, compared with 2 of 26 in group 2 (p < 0.001). Anxiety rating was 4.5 (+/-0.72) in group 1 compared with 1.5 (+/-0.54) in group 2 (p < 0.01). CONCLUSIONS: Chest tube insertion was associated with an unacceptably high level of pain and anxiety in our hospital. A new protocol, including housestaff education and changes in nursing policies, technical aspects, local anesthetic dose and delivery, and pre-medication, allowed us to approach the goal of a painless chest tube insertion.

How much time do nurses spend teaching cancer patients.

As patients live longer and hospital stays grow shorter the demand for nurses to teach effectively and efficiently increases. Given the current nursing shortage, nurses have less time available to do teaching. As a result, hospitals will have to be creative in providing quality education in a cost-effective manner. A descriptive study was undertaken to establish a baseline on how much time nurses actually spend teaching. Seven to ten consecutive admissions on each inpatient unit for a total of one hundred twenty-one patients were enrolled into the study during a seven-day period. All patient/family teaching was documented until the patient was discharged or transferred. Data were collected on a total of 825 days of patient hospitalization. The average teaching time per patient per day (pppd) was 16.6 min. This teaching time amounts to 128 h a day and costs the center $2355 in nurses hourly wages each day or $859,657 per year. This study has established that nurses spend a significant amount of time teaching and has estimated its cost. It provides a baseline for making comparisons in teaching methodologies. Patient Education closed circuit television (CCTV) may be an alternative to one-on-one teaching and decrease the amount of time the nurse spends in repetitive teaching.

A comparison of four endotracheal tube holders.

OBJECTIVE: To compare four methods (Lillihei harness, Comfit, Dale, and SecureEasy) of securing endotracheal tubes in orally intubated adult patients in the intensive care unit. DESIGN: Prospective, quasiexperimental. SETTING: University-affiliated oncology critical care unit. SUBJECTS: One hundred twenty-one adult patients who were orally intubated. OUTCOME MEASURES: Endotracheal tube stability, facial skin integrity, patient and registered nurse satisfaction. INTERVENTION: Data collection was conducted on 121 orally intubated subjects. Subjects were evaluated every 12 hours for stabilization of the endotracheal tube and integrity of facial skin. On extubation, patient and nurse satisfaction with the method were assessed. RESULTS: Pearson chi square revealed the SecureEasy holder to be the most secure (p = 0.044). Of all variables that possibly affect extubation, presence of prolonged coughing and gagging had the greatest impact in terms of accidental extubation or dislocation of the endotracheal tube. The fewest incidents of facial skin breakdown occurred with the SecureEasy and Dale holders. Patient complaints regarding discomfort with turning were least common with the Lillihei harness. The SecureEasy holder was associated with the highest degree of nurse satisfaction. CONCLUSIONS: Results of this study suggest that the SecureEasy holder is the preferred alternative method for securing endotracheal tubes when the standard method with tape is not desirable. These results are similar to those reported in a previous investigation in which the adequacy of the SecureEasy holder was assessed.

Breast cancer detection: knowledge, attitudes, and behaviors of women from Pennsylvania.

PURPOSE/OBJECTIVES: To assess relationships among breast cancer detection behaviors and selected variables in healthy women. DESIGN: Correlational study. SETTING/SAMPLE: A sample of 1,000 women was selected randomly from the 16,500 members of the General Federation of Women's Clubs of Pennsylvania. Respondents (N = 538; 54% response rate) were predominately white, well educated, lived in urban areas, and had an average age of 60 years. METHODS: Mailed packets with a professionally designed, scannable survey instrument that included questions related to detection behaviors, a risk index, health behaviors, attitudes, and knowledge. MAIN RESEARCH VARIABLES: Breast cancer detection behaviors: mammography, clinical breast examination (CBE), breast self-examination (BSE). Structural/demographic variables: age, education, residence, knowledge of breast cancer and detection methods, teaching history, encouragement, and risk index (family/medical history). Predisposing variables: susceptibility, benefits/barriers, confidence, social norms and influence, and general health motivation. FINDINGS: Women reported moderate/high adherence to recommendations for early detection of breast cancer. Mammography behavior was predicted by older age, being encouraged by a doctor or nurse, and greater risk. CBE predictors were greater knowledge and risk along with greater benefits, social norms, and health motivation. BSE behavior was predicted by having had BSE technique checked, greater knowledge, greater risk, decreased barriers to BSE, and higher health motivation. CONCLUSIONS: Common predictors of breast screening behaviors include risk (family/medical history), knowledge, and general health motivation. IMPLICATIONS FOR NURSING PRACTICE: Educational efforts can be designed specifically to influence variables related to compliance with early breast cancer detection behaviors.

Interaction of Uromyces phaseoli and Meloidogyne incognita on Bean.

Uromyces phaseoli, the causal agent of bean rust, suppressed shoot and root growth of three bean cultivars, reducing root weight more than shoot weight. The greatest suppression of root weight was on the cultivar that appeared most susceptible by visual ratings of shoot symptoms. Meloidogyne incognita suppressed shoot and root growth of all test cultivars; root weight reductions differed among cultivars identical in susceptibility to this pathogen in root-gall rating tests. Infection of plants with both pathogens suppressed plant weights significantly more than did infection by either pathogen alone, evidencing an additive effect. U. phaseoli and M. incognita on the same plant influenced the reproduction of one another, presumably through effects on the host. Fungal uredia were reduced in size and sporulation capacity; M. incognita produced fewer root galls, and fewer eggs per egg mass.

Interactions among selected endoparasitic nematodes and three pseudomonads on alfalfa.

Meloidogyne hapla, Pratylenchus penetrans, and Helicotylenchus dihystera, reduced the growth of 'Saranac AR alfalfa seedlings when applied at concentrations of 50 nematodes per plant. All except P. penetrans reduced seedling growth when applied at 25 per seedling. M. hapla reduced growth when applied at 12 per seedling. Nematodes interacted with three pseudomonads to produce greater growth reductions than were obtained with single pathogens, suggesting synergistic relationships. Ditylenchus dipsaci, applied at 25 or 50 nematodes per seedling, reduced plant weight compared with weights of control plants, but did not interact with test bacteria. All of the nematodes except D. dipsaci produced root wounds which were invaded by bacteria.

Comparison of three rewarming methods in a postanesthesia care unit.

Postoperative hypothermia is problematic because patients in postanesthesia care units (PACUs) often feel very cold, and unrecognized or prolonged postoperative hypothermia can aggravate patients' underlying cardiovascular disorders. The researchers compared three methods of rewarming PACU patients who had undergone laparotomy procedures. Patients were assigned randomly to three groups. Each patient in group one received the standard PACU rewarming intervention (ie, two warmed thermal blankets and a hospital bedspread). Each patient in group two received the standard PACU rewarming intervention plus a reflective blanket. Each patient in group three received the standard PACU rewarming intervention plus a reflective blanket and a reflective head covering. Nurses measured patients' vital signs on admission to the PACU and every 15 minutes thereafter until patients' sublingual temperatures reached 36 degrees C (96.8 degrees F). No significant temperature differences occurred among patients in the three groups, but an inverse relationship existed between patients' PACU admission temperatures and the time they required to reach normothermia.

Introducing a music program in the perioperative area.

Music can touch patients deeply and thus transform their anxiety and stress into relaxation and healing. Patients with cancer who undergo surgical procedures are highly stressed. To help alleviate these patients' stress and improve their comfort, perioperative nurses at Memorial Sloan-Kettering Cancer Center (MSKCC), New York, surveyed surgical patients and staff members about introducing a perioperative music program. This article reviews the literature on the use of music in perioperative care settings and describes MSKCC's decision to evaluate and then implement a music program.

Unit-based research forums: a model for the clinical nurse specialist to promote clinical research.

Although nurse researchers have generated research findings, practitioners in clinical practice have not consistently utilized them. Evaluation and modification of clinical practice through research is a key component of the role of the clinical nurse specialist (CNS). In this paper, an innovative model is described in which the Clinical Nurse Specialist coordinates specialty-based clinical research through the use of unit-based research forums, an outgrowth of unit-based quality assurance. Such a model allows staff at the unit level to engage in problem-solving dialogues, resulting in increased use of research findings and generation of original research.

Developing an educational needs assessment.

Nurse educators routinely are asked to assess learning needs. Step-by-step guidelines for formulating and implementing an educational needs assessment are provided. The nurse educator who is familiar with conducting a needs assessment can obtain required baseline information to make decisions in various situations.

Using the coefficient of correlation in method-comparison studies.

The coefficient of correlation (R) is one of the most commonly computed statistics in method-comparison studies. Usually, it is simply quoted without interpretation. In this paper, we show how R may be used to detect interference, nonlinearity, and misuse of the imprecision components. Specifically, one may precisely predict what R should be by considering the imprecisions of the two methods being compared, even before the comparison is performed. When the actual R disagrees with the predicted R, then one of the mentioned effects is present. We also describe a statistical test to detect these effects at the P = 0.05 level, then evaluate this test by using computer simulation and present two examples of its use. We also present the theory underlying the usage of R, including how R is affected by the distribution and range of the data, by the joint imprecisions of the methods being compared, by the sample size, and by the randomness of the specimen-selection process.

Correct and incorrect estimation of within-day and between-day variation.

Between-day variance is an ambiguous term representing either total variance or pure between-day variance. In either case, it is often incorrectly calculated even though analysis of variance (ANOVA) and other excellent methods of estimation are available. We used statistical theory to predict the magnitude of error expected from using several intuitive approaches to estimation of variance components. We also evaluated the impact of estimating the total population variance instead of pure between-day variance and the impact of using biased estimators. We found that estimates of variance components could be systematically biased by several hundred percent. On the basis of these results, we make recommendations to remove these biases and to standardize precision estimates.