Genetic alterations for increased coumarin production lead to metabolic changes in the medicinally important Pelargonium sidoides DC (Geraniaceae).

The medicinal plant Pelargonium sidoides is fast becoming threatened due to the overharvest of its tubers from the wild to produce a phytopharmaceutical for treating respiratory infections. The action of the coumarins is implicated in the efficacy of the commercial herbal extract with the highly oxygenated coumarins exhibiting the best anti-bacterial and anti-viral activity. Through this work we aimed at exploring the metabolic effects of Agrobacterium rhizogenes transformation. After confirmation of transgenesis using PCR amplification of the rol A (320 bp), rol B (400 bp) and rol C (600 bp) genes, metabolite profiles indicated a high level of variability between the different transgenic clones but these had more compounds compared to non-transgenic control cultures. This was represented by a two- to four-fold increase in detected metabolites in transgenic clones. We quantified several commercially important coumarins, flavonoids and phenolic acids. One of the clones had six out of nine of these metabolites. Overall, the concentration of these metabolites of interest were significantly changed in transgenic root cultures, for instance shikimic acid was recorded at the highest level in clone A4T-A. Production of key metabolites at significantly higher concentrations due to transgenesis and positive anti-bacterial activity exhibited by transgenic roots lends support to the idea of developing these clones as an alternative source that will allow for sustainable access to economically valuable secondary compounds of P. sidoides.

Pneumatocele formation in adult Escherichia coli pneumonia revealed by pneumothorax.

Pulmonary pneumatoceles are a rare complication of nosocomial pneumonia. They occur most often in staphylococcal infections and are hence more frequent in children. We report the case of an immunocompromised adult who shortly after digestive surgery developed Escherichia coli pneumonia which evolved rapidly towards pneumatocele formation revealed by pneumothorax.

Medication use by community-dwelling elderly with urinary incontinence.

Medication consumption patterns among community-dwelling elderly persons with chronic urinary incontinence were examined. All health professionals, including nurses, should be knowledgeable of the potential for adverse drug reactions. Continuing education and establishment of routine monitoring systems could help to reduce the risk of potential for adverse drug reactions and prevent drug-induced UI in patients.

Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence.

OBJECTIVE: To determine the incidence of surgically managed pelvic organ prolapse and urinary incontinence in a population-based cohort, and to describe their clinical characteristics. METHODS: Our retrospective cohort study included all patients undergoing surgical treatment for prolapse and incontinence during 1995; all were members of Kaiser Permanente Northwest, which included 149,554 women age 20 or older. A standardized data-collection form was used to review all inpatient and outpatient charts of the 395 women identified. Variables examined included age, ethnicity, height, weight, vaginal parity, smoking history, medical history, and surgical history, including the preoperative evaluation, procedure performed, and details of all prior procedures. Analysis included calculation of age-specific and cumulative incidences and determination of the number of primary operations compared with repeat operations performed for prolapse or incontinence. RESULTS: The age-specific incidence increased with advancing age. The lifetime risk of undergoing a single operation for prolapse or incontinence by age 80 was 11.1%. Most patients were older, postmenopausal, parous, and overweight. Nearly half were current or former smokers and one-fifth had chronic lung disease. Reoperation was common (29.2% of cases), and the time intervals between repeat procedures decreased with each successive repair. CONCLUSION: Pelvic floor dysfunction is a major health issue for older women, as shown by the 11.1% lifetime risk of undergoing a single operation for pelvic organ prolapse and urinary incontinence, as well as the large proportion of reoperations. Our results warrant further epidemiologic research in order to determine the etiology, natural history, and long-term treatment outcomes of these conditions.

Noninvasive techniques to manage urinary incontinence among care-dependent persons.

Approximately half of the nursing home residents in the United States are incontinent of urine, and the prevalence rates among community-dwelling elderly persons are significant. Behavioral treatments are first-line management for most cases of urinary incontinence, and these techniques are recommended in the urinary incontinence guidelines published in 1996 by the Agency for Health Care Policy and Research. This article emphasizes assessment and treatments for persons in whom urinary incontinence has been detected and who are cognitively or physically impaired that are appropriately performed by nurses with no special expertise in or knowledge of urinary incontinence.

International nurses' experiences seeking graduate education in the United States.

Nurses from many countries in the world continue to seek further education in the U.S. every year. This study examined their experiences (N = 83) and those of the host institutions (N = 35) in the U.S. regarding the difficulties each experienced in coping with unfamiliar curricula and cultural mores, as well as financial constraints.

A screening procedure for total N-nitroso contaminants in personal care products: results of collaborative studies undertaken by a CTPA Working Group.

Synopsis A modified procedure for the determination of total N-nitroso compounds in personal care products was evaluated in collaborative studies organized through the UK Cosmetic Toiletry and Perfumery Association (CTPA). The method offers a true 'totals'determination in that a solution of the whole sample is analysed. Samples are dissolved/suspended in water or aqueous THF, and nitrite/nitrite ester interferences are removed by prior treatment with sulphamic acid. The treated test solution is denitrosated in a single reaction with HBr/acetic acid, in refluxing n-propyl acetate, and 'total'N-nitroso compounds are determined in a chemiluminescence reaction of the released nitric oxide with ozone. The use of a propyl acetate denitrosation solvent and of higher concentrations of HBr have improved both the sensitivity (routine limit of determination at 10 mugkg(-1)) and water tolerance of the method. The method was shown to recover N-nitrosamines quantitatively, and to be sufficiently repeatable and reproducible to be used as a screening technique for N-nitroso compounds in personal care products.

An update on the AHCPR guideline implementation.

Publication in 1992 of national Clinical Practice Guidelines for Urinary Incontinence in Adults by the US Department of Health and Human Services, Agency for Health Care Policy and Research (AHCPR) brought together in one document, for the first time, all the relevant material on the diagnosis and treatment of urinary incontinence. These guidelines also provided data about the effectiveness of various treatment options. Dissemination has been enhanced through massive distribution to professional and lay groups as well as making copies available at no charge by telephone (1-800-358-9295). Because of the volume of new research on incontinence, the guidelines are now being revised and updated with publication expected in 1995. This guideline is especially relevant for nursing because nurses are often the first, and may be the only, health professional with whom patients will discuss this embarrassing problem.

Resistance to change: understanding the aides' point of view.

Nursing home units are subcultures of the entire facility, with values, attitudes and norms that are passed from aide to aide. Changes in work routines may threaten your workers' effectiveness. Helping your nursing staff adapt will always remain a challenge.

Behavioral management strategies for urinary incontinence.

Behavioral interventions are recommended by Agency for Health Care Policy and Research Clinical Guideline as the first line of treatment for most types of urinary incontinence. This article defines and briefly describes the six behavioral treatment techniques and discusses the research base for the efficacy of each type of intervention. Caveats and needed research are also presented.

The effects of patterned urge-response toileting (PURT) on urinary incontinence among nursing home residents.

OBJECTIVE: To test an individualized form of habit training for urinary incontinence (UI) among long-stay cognitively and/or physically impaired elderly nursing home residents over time. DESIGN: Randomization of subjects occurred by nursing home unit. Baseline wet checks were done hourly for one 24-hour period at 3-week intervals over 12 weeks followed by 72 hours of continuous electronic monitoring to establish precise voiding patterns for each subject. The 12-week intervention period was administered by indigenous staff after they attended a 4-hour UI educational program. Subjects were followed an additional 12 weeks to determine the extent of maintenance of the intervention among staff and subjects. SETTING: Four non-profit nursing homes; west, mid-west, east coast. PATIENTS: Consent was obtained from 154 (71%) who met primary inclusion criteria. Forty-one failed the secondary inclusion criteria leaving 113 who entered the 37-week study. Eighty-eight completed the study (experimental = 51, control = 37); all were physically and/or mentally impaired, averaged age 85, and had either urge or urge/stress UI. RESULTS: UI was significantly decreased during the 3-month period (P less than 0.001). Eighty-six percent showed improvement over baseline while one-third improved 25% or more over their baseline UI rate. The control group's UI increased during the same period of time. The volume of UI among the experimental group also decreased (P less than 0.005) while the control group's UI volume increased. CONCLUSIONS: The training program was effective in reducing UI though compliance among nursing staff averaged only 70% of the prescribed toileting times. The success of this approach is similar to other recently described behavioral programs but achieved the reduction using only regular nursing staff. This individualized approach supports the recent regulatory thrust to individualize care to promote and maintain functional abilities and autonomy.

Effect of an incontinence training program on nursing home staff's knowledge, attitudes, and behavior.

To test a behavioral approach for urinary incontinence (UI), 166 staff in four nursing homes participated in a quasi-experimental study that measured knowledge and attitudes about UI and compliance with toileting protocols. The intervention group (N = 96) showed a slight increase in knowledge; their attitudes remained positive over the four testing times. Compliance with the more critical component of the toileting protocol was only 72%, although evidence existed that the protocol reduced UI. Results are discussed in terms of the sociocultural environment of nursing homes.

Issues in implementing clinical research in nursing home settings.

Researchers at four nursing home sites experienced similar problems in the informed consent process when they attempted to access a frail, cognitively impaired population to conduct a collaborative, quasi-experimental two year clinical trials study on urinary incontinence. In addition, similar institutional barriers were experienced in these geographically distant and dissimilar nursing homes. The study involved working closely with indigenous licensed nursing and nurse aide staff to implement the independent variable, an individualized toileting prescription. Successful strategies used to overcome barriers in conducting the research will be described.