Accidental lipid overdose in a preterm infant: A case report.

BACKGROUND: Intravenous lipid emulsions (ILEs) provide essential fatty acids during parenteral nutrition (PN). Serious adverse events including death can occur from overdose. We report an accidental overdose in a preterm infant. METHOD: On Day 2 of life, a 29-week gestational age (GA) twin was accidentally given 47.5 mL of Intralipid20% (≈3x daily amount) in 50-minutes. RESULTS: No apparent clinical deterioration occurred, although blood samples were lipaemic. Outcomes at 2 years corrected GA were similar to that of his twin. Service changes were made to infusion packaging and administration to avoid similar errors. CONCLUSIONS: Medication errors in neonates are unfortunately common. Published articles usually focus on poor outcomes, which can increase the distress for parents of children where errors have occurred. Publishing the full spectrum of outcomes instead allows parents and professionals to be aware of all possibilities and lessons learnt, even if serious harm was avoided.

Changes in air quality in Mexico City, London and Delhi in response to various stages and levels of lockdowns and easing of restrictions during COVID-19 pandemic.

The impacts of COVID-19 lockdown restrictions have provided a valuable global experiment into the extent of improvements in air quality possible with reductions in vehicle movements. Mexico City, London and Delhi all share the problem of air quality failing WHO guideline limits, each with unique situations and influencing factors. We determine, discuss and compare the air quality changes across these cities during the COVID-19, to understand how the findings may support future improvements in their air quality and associated health of citizens. We analysed ground-level PM10, PM2.5, NO2, O3 and CO changes in each city for the period 1st January to August 31, 2020 under different phases of lockdown, with respect to daily average concentrations over the same period for 2017 to 2019. We found major reductions in PM10, PM2.5, NO2 and CO across the three cities for the lockdown phases and increases in O3 in London and Mexico City but not Delhi. The differences were due to the O3 production criteria across the cities, for Delhi production depends on the VOC-limited photochemical regime. Levels of reductions were commensurate with the degree of lockdown. In Mexico City, the greatest reduction in measured concentration was in CO in the initial lockdown phase (40%), in London the greatest decrease was for NO2 in the later part of the lockdown (49%), and in Delhi the greatest decrease was in PM10, and PM2.5 in the initial lockdown phase (61% and 50%, respectively). Reduction in pollutant concentrations agreed with reductions in vehicle movements. In the initial lockdown phase vehicle movements reduced by up to 59% in Mexico City and 63% in London. The cities demonstrated a range of air quality changes in their differing geographical areas and land use types. Local meteorology and pollution events, such as forest fires, also impacted the results.

Predictors of human PBDE body burdens for a UK cohort.

Human exposure to polybrominated diphenyl ethers (PBDEs) was investigated in a cohort of 20 UK adults along with their anthropometric covariates and relevant properties such as room surveys, lifestyle, diet and activity details. Selected PBDE congeners were measured in matched samples of indoor dust (n = 41), vehicles (n = 8), duplicate diet (n = 24), serum (n = 24) and breast milk (n = 6). Combined exposure estimates via dust and diet revealed total PBDE intakes of 104 to 1,440 pg kg-1 bw d-1 for ΣBDEs3-7 and 1,170 to 17,000 pg kg-1 bw d-1 for BDE-209. These adult intakes are well within health reference doses suggested by the European Food Safety Authority (EFSA) and the US EPA. Diet was the primary source of intake of BDE3-7 congeners for the majority of the cohort, with dust the primary source of BDE-209. Primary sources of PBDE exposure vary between countries and regions with differing fire prevention regulations. Estimated infant exposures (ages 1.5-4.5 years) showed that BDE-99 intake for one of the households did not meet EFSA's recommended margin of exposure, a further two households had borderline PBDE exposures for high level dust and diet intake. Males and those having a lower body fat mass had higher serum BDE-153. Higher meat consumption was significantly correlated with higher BDEs3-7 in serum. A reduction in dietary BDEs3-7 would therefore result in the greatest reduction in BDE-99 exposure. Rooms containing PUF sofas or armchairs over 20 years old had more BDEs3-7 in their dust, and rooms with carpets or rugs of that age had higher dust BDE-209. Dusting rooms more frequently resulted in significantly lower concentrations of all major congeners in their dust. Correlation between BDE-209 body burden and dust or diet exposure was limited by its low bioaccessibility. Although vehicle dust contained the highest concentrations of BDEs3-7 and BDE-209, serum BDEs3-7 correlated most strongly with bedroom dust.

High fat diet modifies the association of lipoprotein lipase gene polymorphism with high density lipoprotein cholesterol in an Asian Indian population.

BACKGROUND: Single nucleotide polymorphisms (SNPs) in lipoprotein lipase gene (LPL) have been shown to influence metabolism related to lipid phenotypes. Dietary factors have been shown to modify the association between LPL SNPs and lipids; however, to date, there are no studies in South Asians. Hence, we tested for the association of four common LPL SNPs with plasma lipids and examined the interactions between the SNPs and dietary factors on lipids in 1,845 Asian Indians. METHODS: The analysis was performed in 788 Type 2 diabetes cases and 1,057 controls randomly chosen from the cross-sectional Chennai Urban Rural Epidemiological Study. Serum triacylglycerol (TAG), serum total cholesterol, and high-density lipoprotein cholesterol (HDL-C) were measured using a Hitachi-912 autoanalyzer (Roche Diagnostics GmbH, Mannheim, Germany). Dietary intake was assessed using a semi-quantitative food frequency questionnaire. The SNPs (rs1121923, rs328, rs4922115 and rs285) were genotyped by polymerase chain reaction followed by restriction enzyme digestion and 20% of samples were sequenced to validate the genotypes obtained. Statistical Package for Social Sciences for Windows version 22.0 (SPSS, Chicago, IL) was used for statistical analysis. RESULTS: After correction for multiple testing and adjusting for potential confounders, SNPs rs328 and rs285 showed association with HDL-C (P = 0.0004) and serum TAG (P = 1×10-5), respectively. The interaction between SNP rs1121923 and fat intake (energy %) on HDL-C (P = 0.003) was also significant, where, among those who consumed a high fat diet (28.4 ± 2.5%), the T allele carriers (TT + XT) had significantly higher HDL-C concentrations (P = 0.0002) and 30% reduced risk of low HDL-C levels compared to the CC homozygotes. None of the interactions on other lipid traits were statistically significant. CONCLUSION: Our findings suggest that individuals carrying T allele of the SNP rs1121923 have increased HDL-C levels when consuming a high fat diet compared to CC homozygotes. Our finding warrants confirmation in prospective studies and randomized controlled trials.

Need for overnight respite for primary caregivers of hospice clients.

A major reason for admission of community hospice clients to the hospital is exhaustion of the primary caregiver. One way to prevent the problem of caregiver exhaustion may be the use of trained laypersons who remain overnight with the ill person, thereby providing respite that allows the caregiver to sleep. A survey was conducted to assess primary caregivers' appraisal of the need for overnight respite and their willingness to receive this support from trained laypersons. Thirty-seven primary caregivers, who used the services of a community hospice, were interviewed to determine primary caregivers' appraisals of problems, resources, and needs. Ten (27%) primary caregivers reported usually receiving 0 to 4 of sleep per night and 27 (73%) reported receiving > 4 h. Sleep time was described by the majority as insufficient, but insufficient, sleep was statistically not a main reason for hospital admission. Findings suggested that those in the 0- to 4-h category were more vulnerable to exhaustion. Seventy percent of respondents indicated that they would use the services of a trained layperson for overnight respite and an additional 6% indicated that they would under certain conditions.

Uncertainty and anxiety after mastectomy for breast cancer.

The purpose of this study was to determine the relationship between uncertainty and anxiety in women after mastectomy for breast cancer and to describe women's responses to partial or complete mastectomy for breast cancer during the early rehabilitative phase after surgery. A theoretical framework for the study was derived from the Scott, Oberst, and Dropkin Stress-Coping Model and from a review of the literature. Major study variables and variable measures were uncertainty, measured by the Mishel Uncertainty in Illness Scale (MUIS), and anxiety, measured by the State-Trait Anxiety Inventory (STAI). Twenty-five women admitted to two acute-care teaching hospitals for their first partial or modified radical mastectomy made up the convenience sample of this study. Data were collected 1-2 days before and 1-2 weeks after hospital discharge. From study findings, it was shown that only at the postdischarge testing was there a significant positive correlation between uncertainty and state anxiety. The development of appropriate interventions to assist breast cancer patients in dealing with the fears of recurrence and uncertainties regarding treatment effectiveness and sequelae has relevance for nursing practice.

The congruence of elderly client and nurse perceptions of the clients' self-care agency.

Congruence of client and nurse perceptions is vital to mutual goal-setting as a means of achieving self-care in the elderly. The purpose of this descriptive, correlational study was to explore the relationship between nurse and elderly client perceptions of the clients' self-care agency. A sample of 40 elderly client subjects and registered nurses' selected from two community health agencies, completed a questionnaire consisting of three instruments: (a) a demographic sheet; (b) the appraisal of Self-Care Agency Scale; and (c) the Perceived Health Status. Pearson product moment correlation coefficients were significant for the relationships between: (a) client and nurse perceptions of clients' self-care agency (r = 0.42, P less than 0.01); (b) client and nurse perceptions of clients' health status (r = 0.38, P less than 0.01; and (c) nurse perceptions of clients' self-care agency and nurse perceptions of clients' health status (r = 0.44, P less than 0.01). With increasing emphasis on health promotion of the elderly in the community, identified relationships may have potential implications for gerontological and community nursing practice.

Social support in cardiac rehabilitation.

Since support from the primary social network is vital to an individual's cardiac rehabilitation, comprehensive nursing care includes assisting the recuperating person and partner to achieve optimal recovery. A model of collaborative social support, based upon the work of Corbin and Strauss (1984) and Norbeck (1988) is offered as a guide to the nursing process of assisting the recuperating individual and partner to work toward optimal recovery. A definition of social support is integrated with nursing actions of a) assessing collaborative potential, b) bringing the couple into open awareness, and c) assisting the couple to develop collaborative strategies to enhance cardiac rehabilitation. Although this model has face validity, it should be tested in clinical settings by practitioners and researchers.

Cancer nursing--a problem-finding survey. The London Nursing Research Consortium.

A survey was conducted to identify the most difficult patient-care problems encountered by nurses who care for patients with cancer and the most difficult problems personally experienced by nurses as a consequence of caring for these patients. Nurses who provided care to patients with cancer in two community health agencies, one cancer treatment center, one chronic care hospital, and three acute care hospitals were invited to participate. A total of 566 nurses responded (43% response rate). Results are presented by total sample for 15 top-ranked patient care problems, 10 top-ranked physical care problems, and 5 top-ranked personally experienced problems. Results are also presented as a qualitative analysis of 1,052 comments made by respondents. For all groups of nurses within the total sample, coping with diagnosis, disease progression, and emotional response comprised the top-ranked patient care problems. Nutrition and pain management were top-ranked physical care problems. Top-ranked personally experienced problems paralleled patient care problems. A comparison of study findings with two previous surveys to identify research problems indicated high consensus about important areas for cancer nursing research. Scott, Oberst, and Dropkin's Stress-Coping model will be used to guide development of the research program that began with this problem-finding survey.

The supportive role of the staff nurse in the hospital palliative care situation.

The supportive comforting role of the nurse is complex. Comprehensive supportive role behaviours need to be described for nurses in the hospital setting in order to identify actual role competencies, enhance the definition of professional practice, and evaluate clinical competence. As a first step in definition of this supportive role, an exploratory study was conducted with five registered nurses on a four bed palliative primary nursing unit in a hospital setting. Their supportive role behaviours were elicited in order to answer the following research question: What supportive nursing interventions are identified and described by staff nurses to promote physical, psychological, and spiritual comfort for palliative care patients? A model of supportive nursing care in the palliative care setting was generated from study findings and presented for testing through further research.

Effect of role clarity and empathy on support role performance and anxiety.

The purpose of this study was to examine wives' anxiety in response to their husbands' first myocardial infarction from the perspective of perceptions and interpretations of their support roles, their husbands' experience, their abilities to act supportively, and how these and other factors contributed to their degree of anxiety. Major study variables were: role clarity (measured by an instrument developed for the study), empathy (measured by the Barrett-Lennard [1978] Relationship Inventory), support role performance (measured by an instrument developed for the study), and anxiety (measured by the State-Trait Anxiety Inventory Form A [Spielberger, Gorsuch, & Lushene, 1970]). Four exogenous variables, husband's condition, previous experience in the support role, self-esteem, and trait anxiety, were used to test alternate hypotheses. Subjects were 82 wives of men admitted to three cardiac care units. Data were collected prior to the husband's hospital discharge and at 3 weeks postdischarge. Data were analyzed with path analysis procedures. Study findings supported two hypotheses, that support role performance has a direct negative effect on anxiety and trait anxiety has a direct positive effect on anxiety. Descriptive data obtained during the postdischarge interview provided documentation of uncertainty as another source of anxiety.

Use of the life history in pattern identification and health promotion.

The life history is presented as a tool for the identification of human patterning and as a process of nursing intervention for the promotion of health through expansion of consciousness. The life history process is presented in a pilot study involving a selected sample of eight persons aged 65. Qualitative study findings were interpreted through integration of two theoretical perspectives on patterning. Recommendations for further study are made that will increase the validity and reliability of life history as a measure of patterning and increase the ability to generalize study findings.

The Multiple Affect Adjective Check List: subscale intercorrelations from two independent studies.

Found the MAACL, the Anxiety, Depression and Hostility subscales to be intercorrelated in two independent studies (N = 84), thus raising doubts about their validity as measures of separate affective states. It is suggested that the scores of the subscales may usefully be summed to produce a measure of general negative affect.