Indacrinone: modification of diuretic, uricosuric, and kaliuretic actions by amiloride.

The response to indacrinone, a new indanone diuretic, was studied in 12 healthy subjects. Ten milligrams alone and in combination with either 2.5 mg or 5 mg amiloride was given in a randomized double-blind study with placebo control to study its action and to assess the optimum combination. Indacrinone alone induced an increase in urine flow rate and in sodium, potassium, and hydrogen ion excretion for at least 8 hr. Indacrinone also induced an initial uricosuria in the first 4 hr, followed by urate retention in the subsequent 12 to 24 hr, with no resultant change in the mean 24-hr urate excretion and minimal changes in the serum urate concentrations. The addition of 2.5 mg amiloride to the 10 mg indacrinone lowered potassium excretion to control levels, whereas addition of 5 mg amiloride resulted in net retention of potassium. With both doses of amiloride, the increased free hydrogen ion excretion after indacrinone returned to placebo levels. There were minor increases in serum creatinine, consistent with volume depletion due to the diuresis. There was a reduction in urinary calcium excretion. Our study shows that the combination of 10 mg indacrinone and 2.5 mg amiloride induces useful diuresis with minimal overall effect on urate, potassium, and hydrogen ion excretion.

Preclinical cognitive decline in late middle-aged asymptomatic apolipoprotein E-e4/4 homozygotes: a replication study.

In a previous cross-sectional study of 100 asymptomatic individuals aged 49-69, we reported age-related decline in immediate and delayed memory that was steeper in apolipoprotein E (apoE)-e4/4 homozygotes than in members of other genetic subgroups. These findings were preliminarily based upon the statistical problem of multiple comparisons. We therefore sought to replicate these findings in a new cohort. From 1998 to 2000, 80 asymptomatic residents of Maricopa County, AZ were recruited through newspaper ads. 20 apoE-e4/4 homozygotes, 20 e3/4 heterozygotes, and 40 e4 noncarriers were matched (1:1:2) by age, gender, and years of education. All had normal neurologic and psychiatric examinations, including Folstein minimental status exam (MMSE) and Hamilton depression scale, and underwent a battery of neuropsychological tests identical to those in our previous study. The groups were well-matched for age (55.9+/-5.9 years), gender (60% women), and education (15.9+/-2.2 years), and were demographically similar to our previous cohort. Complex figure test recall was lower in e3/4 heterozygotes than noncarriers, but there was no significant difference between e4/4 homozygotes and noncarriers. There were no other significant differences in mean test scores between groups, but Wechsler adult intelligence scale-revised (WAIS-R) digit span showed a significant negative correlation with age in the e4/4 homozygote group relative to e4 noncarriers (p=0.008) as we had found in our previous study. In conclusion, we found a significant negative correlation of WAIS-R digit span with age in apoE-e4/4 homozygotes relative to e4 noncarriers in two separate cohorts, possibly reflecting an age-related effect on frontal lobe function in this genetic subgroup.

Stem corrections for ionization chambers.

Ionization chambers often exhibit a stem effect, caused by interactions of radiation with air near the chamber end, or with dielectric in the chamber stem or cable. These interactions contribute to the apparent measured exposure. To determine the stem efffect for several common ionization chamber systems, exposures were measured with TLD capsules placed at the center of 60Co fields of various sizes. These exposure measurements then were repeated with various ionization chamber systems, including two Victoreen R meters (25- and 100-R chambers), a Capintec 192 dosimeter with a Farmer 0.6-cm3 probe, a PTW transit dose probe, and an EG and G IC-18 probe with a Keithley 610-B electrometer. From a comparison of TLD and ionization chamber measurements of the variation in exposure rate with field size, stem corrections for the different systems were determined within 1%.

Chronic dementia. Challenges in feeding a patient.

1. For the SDAT/MID patient, the nurse must determine food preferences and ability to eat, meet nutritional needs, and have a basic understanding of what techniques might assist professional and family caregivers with appropriate feeding techniques. 2. Ensuring adequate nutrition requires a multidisciplinary approach. Nurses must collaborate with dietitians and other health care professionals regarding food selection, feeding techniques, and environmental management that maximize nutritional outcomes. 3. There is a need for continuing research into nutritional needs and dietary interventions for dementia patients in all stages of illness and in all settings.

When traditional care falls short. Caring for people with atypical presentations of cortical dementia.

1 People with chronic dementias receive care and support with programs designed for people with Alzheimer's disease, meaning a significant minority of patients will not benefit as a result of atypical or unusual presentations of cortical decline. 2 When patients have atypical presentations of dementia, nurses must recognize the unusual symptoms, assess care needs, and develop appropriate management strategies. 3 For patients with chronic dementia, individualized care planning includes knowledge of: 1) the patient's culture; 2) their past habits, activities, and preferences; 3) their remaining abilities; 4) the regions of the brain affected, histopathology, and size of the affected area; 5) the usual trajectory for the disease type; and 6) external demands. 4 Conducting research on assessment and care of people with atypical presentations of dementia is very difficult because of their rare nature and lack of recognition by health practitioners who may diagnose the patients with Alzheimer's disease.

Whole disease care planning: fitting the program to the client with Alzheimer's disease.

Care of the person with a chronic dementing illness is best approached from a conceptual perspective. As the "whole disease care planning" model demonstrates, care is logically derived from knowledge of the client's premorbid characteristics, and intervention strategies develop from following the individual's daily routine and simplifying it as the disease progresses. Although it is impossible to discuss the entire scope of care planning for demented adults in a brief article, this information can help nurses determine which intervention strategies to pursue based on the sociocultural background of clients and their level of functional loss. The desired outcomes at all levels of care include maximizing the potential for safe function by controlling for excess disability and providing appropriate levels of assistance; participation in activities as desired by the client; and minimizing discomfort and maximizing expressions of comfort.

Shining through: the humor and individuality of persons with Alzheimer's disease.

1. Elders with diminished levels of cognitive functioning are capable of providing meaningful, consistent responses that illustrate individual expressions of self. 2. The demented elder's history and experiences may provide important clues to understanding his or her current behaviors, verbalizations, and perceptions. 3. Humor may be used as a therapeutic intervention for persons with dementia and as a coping strategy for caregivers.

Standardized care plan. Managing Alzheimer's patients at home.

1. Family-provided care of members with Alzheimer's disease and related disorders (ADRD) is complicated by the presence of secondary behavioral symptoms, such as agitation, that lead to caregiver depression, burden, and breakdown. 2. Caregiver education to manage secondary symptoms in ADRD can be simplified by using a theoretical framework of person-environment fit, providing a selection of interventions to modify the environment to reduce demand on the dwindling resources of the demented person. 3. The Progressively Lowered Stress Threshold (PLST) model identifies six areas of stress for persons with ADRD fatigue, change of caregiver, environment or routine, demands to achieve beyond capability, multiple and competing stimuli, affective response to perceived losses, and physical stressors.

Care of the patient with Alzheimer's disease living at home.

Although the majority of people with Alzheimer's disease and related disorders are cared for in the home for most of their illness, there are few resources available on a consistent basis for nursing interaction. Nurses employed in a variety of settings provide ongoing information and support for families and caregivers in order to provide well-informed care. Because of the complexity of symptom presentation and care, the use of a simple conceptual model can be a valuable aid, helping families to understand behavioral alterations. The evaluation of behaviors as stress related assists both families and caregivers in determining the cause and effect of activities and environment to assist in enhancing comfort and life quality for both.

Caring for people with Alzheimer's disease using the conceptual model of progressively lowered stress threshold in the clinical setting.

Care of the people with Alzheimer's disease and related disorders (ADRD) has been fraught with controversy, often resulting in competing philosophies about what constitutes the "correct" approach. Whether developing an individualized plan of care or specialized programming, it is helpful to use a conceptual framework. The Progressively Lowered Stress Threshold (PLST) conceptual model has been used extensively for planning individualized care for patients with ADRD, developing specialized environments and programming, evaluating outcomes of interventions, and serving as the theoretical framework for nursing research. This article describes use of the PLST model in a clinical setting.

Managing the care of patients with irreversible dementia during hospitalization for comorbidities.

Caring for the patient with AD hospitalized with comorbidities is a nursing challenge. By educating staff, using the PLST model, working with families, and implementing patient-focused care, positive outcomes are not only possible but probable. It is important for staff to work with caregivers in all aspects of care of the patient incorporating the patient's personal and medical historical knowledge into the care plan. Nursing facilities and families can provide a wealth of information, and communication before and after hospitalization maximizes positive outcomes for all concerned.

Managing constipation using a research-based protocol.

Constipation, a common health problem particularly for elderly and hospitalized patients, can cause abdominal pain, discomfort, gas, headaches, nausea, anorexia, a bad taste in the mouth, and potentially adds to functional loss and length of stay. As part of a quality improvement initiative, a research-based interdisciplinary protocol was developed to prevent constipation in hospitalized immobile vascular surgery patients. Using a combination of dietary fiber, increased fluid, and hygiene measures over a 3-year period, incidence of constipation was reduced from 59% to about 9%. The incidence of impaction was eliminated and requests for laxatives and enemas were reduced from 59% to about 8%.