The impact of direct-fed microbials and enzymes on the health and performance of dairy cows with emphasis on colostrum quality and serum immunoglobulin concentrations in calves.

Thirty-six cows were blocked by calving date and randomly assigned to one of three treatments. Cows were on treatments 3 weeks prepartum through 8 weeks post-partum. Treatments were as follows: (i) no direct-fed microbial (DFM) or cellulase and amylase enzymes (C), (ii) 45.4 g/day of DFM (D) or (iii) 45.4 g/day of DFM and 18.2 g/day of enzyme (DE). Total mixed ration fed and refused were measured daily to determine dry matter intake (DMI). Blood samples were taken three times weekly and analysed for ß-hydroxybutyrate, glucose and non-esterified fatty acids. Body weight (BW) was measured weekly. Colostrum was weighed and analysed for IgA and IgG concentration. Calves were fed 4 L of colostrum within 2 hr of birth. Calf blood samples were taken at 0 and 24 hr for analysis of IgA and IgG concentrations and apparent efficiency of absorption. Milk yield was measured daily and samples collected weekly. Initial BW was different among treatments with D being lesser than C or DE treatments. Body weight, weight gain, efficiency of gain, DMI and blood parameters were unaffected. Treatment did not affect colostrum yield. Ash percentage of colostrum tended to increase with D and DE, while IgA and total solids yield decreased with D. Colostrum fat yield was decreased in D and DE. Treatments did not impact BW, serum IgA and IgG concentrations or apparent efficiency of absorption of calves. Post-partum BW, DMI, blood parameters, milk production and composition were unaffected by treatment. However, cows on D gained more BW and tended to have greater efficiency of gain compared to those on DE, but were similar to C. Somatic cell scores were greatest for D. Results indicate that DFM and enzyme supplementation did not improve health and performance of dairy cattle during the pre- and post-partum periods under conditions of this study.

Facilitating scholarship among clinical faculty.

This article describes an evolving model of clinical scholarship for clinical-track faculty. Contemporary literature regarding scholarship emphasizes broader definitions of scholarship among university faculty, usually with an implicit focus on university faculty with doctoral degrees. Discussions of clinical scholarship focus on scholarship projects with clear application to improved patient care. Clinical-track faculty in university settings serve as exemplars of professional nurse clinicians for their students and for community-based colleagues, and also participate in university life as full faculty. Furthermore, scholarship for clinical faculty is consistent with their participation as academic scholars and as clinical scholars. An important strategy for fostering scholarship among clinical faculty in one school was the creation of a position, Director of Clinical Scholarship, with responsibilities for strengthening organizational support for scholarship activities among clinical-track faculty. Examples of activities and resources designed to foster scholarship are presented, along with preliminary evaluation of scholarship activities of clinical-track faculty. J Prof Nurs 17:141-146, 2001.

Community-based nursing education and nursing accreditation by the Commission on Collegiate Nursing Education.

The purpose of this article is to describe the application of accreditation standards of the Commission on Collegiate Nursing Education (CCNE) in community-based nursing education. In response to changes in the health care delivery system, involving increased implementation of managed care systems, greater use of outpatient services, and increased care provided in community-based settings, baccalaureate nursing education is changing to incorporate student learning experiences in community-based settings. Community-based nursing care is characterized by the development of community-education partnerships, implementation of nursing interventions for prevention and health promotion, and collaboration to ensure continuity of care. Changes in the delivery system to increase community-based care necessitate changes in professional nursing education to ensure that graduates of baccalaureate nursing programs are prepared to practice in community-based settings. Accreditation is a mechanism to evaluate quality in educational programs. Accreditation by CCNE offers a process for assessing the quality of nursing programs while encouraging flexibility and innovation in those programs. The CCNE accreditation standards can be interpreted in the context of community-based education. Descriptions of the CCNE standards and examples of application of the standards in community-based nursing education are included.

Children's Yale-Brown Obsessive Compulsive Scale: reliability and validity.

OBJECTIVE: To evaluate the reliability and validity of a semistructured measure of obsessive-compulsive symptom severity in children and adolescents with obsessive-compulsive disorder (OCD). METHOD: Sixty-five children with OCD (25 girls and 40 boys, aged 8 to 17 years) were assessed with the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS). Interrater agreement was assessed by four raters in a subsample (n = 24). Discriminant and convergent validity were assessed by comparing CY-BOCS scores to self-ratings of depression, anxiety, and obsessive-compulsive symptoms. RESULTS: Internal consistency was high, measuring .87 for the 10 items. The intraclass correlations for the CY-BOCS Total, Obsession, and Compulsion scores were .84, .91, and .68, suggesting good to excellent interrater agreement for subscale and total scores. The CY-BOCS Total score showed a significantly higher correlation with a self-report of obsessive-compulsive symptoms (r = .62 for the Leyton survey) compared with the Children's Depression Inventory (r = .34) and the Children's Manifest Anxiety Scale (r = .37) (p = .02 and .05, respectively). CONCLUSIONS: The CY-BOCS yields reliable and valid subscale and total scores for obsessive-compulsive symptom severity in children and adolescents with OCD. Reliability and validity appear to be influenced by age of the child and the hazards associated with integrating data from parental and patient sources.

Trajectories and profiles of adaptive behavior in males with fragile X syndrome: multicenter studies.

We conducted two multicenter studies on adaptive trajectories and profiles in males with fragile X syndrome. Study 1 longitudinally assessed 29 males ages 1-20 years using age-equivalent scores from the Vineland Adaptive Behavior Scales. Fragile X boys ages 1-10 years showed significant gains in adaptive skills from first to second testing; males ages 11-20 years were stable in their adaptive development. Study 2 cross-sectionally examined 132 males ages 1-20 years. Significant age-related gains were found in boys ages 1-10, particularly in preschool children. Subjects ages 11-20 showed increased variability and nonsignificant relations between age and adaptive skills. Preliminary findings from 26 young adults with fragile X syndrome ages 21-40 years showed stable age-equivalent adaptive scores during these years. Relative strengths in daily living skills and weaknesses in communication were only evident among older subjects. Significant relations were found between adaptive behavior standard scores and IQ; these two scores also showed age-related declines that likely parallel one another. Findings are related to adaptive features in other genetic syndromes, and to directions for future adaptive behavior research.

Attitudes of IVF parents regarding the IVF experience and their children.

PURPOSE: to assess parental attitudes regarding the IVF experience, the IVF pregnancy, and issues associated with raising their IVF child(ren). METHOD: parents (184 couples) of IVF children born between 1982 and 1992 were mailed individual anonymous questionnaires. RESULTS: (31%) parents responded: 62 mothers and 41 fathers. One hundred-three (41%) of the mothers felt that our staff could have been more helpful during their pregnancy. Half the women subjects (52%) stated that they wished they had contact with other IVF couples during pregnancy. Fifty-two percent of the mothers reported that IVF created special feelings of attachment to the child, causing some difficulty with their initial separation. This was comparatively less an issue for fathers, with only 19% reporting similar difficulties (chi 2 = 8.39, P < 0.01). Ninety-eight percent of the subjects have told someone else about the IVF experience. Interestingly, 25% of the parents remained uncertain about whether they would tell the child. Sixteen couples (15%) had already told the child, and of the 57 (66%) who intended to tell the child later, they varied greatly in their views about which age would be appropriate (mean, 7.3 years; SD, 6.5 years; range, 2-21 years). CONCLUSIONS: The results suggest that women undergoing IVF might profit from greater contact with staff during pregnancy and, again, later when dealing with issues of separation. A substantial proportion of couples expressed some concerns about the issue of disclosure to the child and might profit from counseling when they feel the issue is current.

Issues in conducting intervention research in long-term care settings.

Originally we proposed a straightforward experimental design using quantitative data to test a series of hypotheses about how changes in the mealtime context and mealtime interactions would influence self-feeding behaviors and imposed disability. The design was clean and the interventions carefully delineated. We used a number of strategies for reducing threats to internal validity, some of which worked and some of which did not. Many of the problems we encountered in operationalizing this clinical experiment arose, not from the particular environment in which we worked, but from the nature of long-term care settings and the staffing patterns within those settings. To some degree, the problems we encountered are inherent to field experimentation in nursing in general. Often field experiments are reported as if no problems arose in implementation, yet no study is problem free. We believe acknowledging and understanding some of the sources of field noise in field experiments are almost as important as understanding the results of the study itself. The field noise is an indispensable part of the results.

Nursing intervention to promote functional feeding.

Results of this study suggest that specific nursing protocols can be designed to promote functional feeding for demented elders in nursing homes while enhancing the mealtime environment for both the demented elders and their caregivers. By nurses altering the feeding environment (context) alone, subjects received more food and drink, refused less food and showed more self-feeding. Major findings were that subjects demonstrated increased independence by refusing food more often and initiating self-feeding more frequently.

Selection and use of clinical rating instruments in child psychiatric nursing.

TOPIC: The selection of appropriate clinical rating instruments and integration of their findings in child psychiatric nursing practice may not be clear. PURPOSE: To offer guidance concerning the selection and application of clinical rating instruments SOURCES: A review of recent literature of commonly used parent and teacher checklists, clinician-rated instruments, structured diagnostic interviews, and child self-reports. CONCLUSION: Clinical rating scales have an important place in clinical practice and research in child and adolescent psychiatric settings. Selecting an appropriate instrument depends on the purpose, developmental level of the child, and expertise of the clinician--and requires careful consideration.

Tourette syndrome: update and review.

Tourette Syndrome is a movement disorder of childhood onset, characterized by multiple motor and phonic tics. In addition to tics, some children exhibit repetitive habits and recurring thoughts, and others may manifest problems of inattention, impulsiveness, and hyperactivity. Over the past two decades there has been increased interest in Tourette Syndrome, because it provides a useful model for examining the interaction of genes and environment, as well as neurobiology and behavior. This article provides school nurses and nurses working in school-based clinics with a general review of Tourette Syndrome and associated disorders.

Cerebrospinal fluid biogenic amines in obsessive compulsive disorder, Tourette's syndrome, and healthy controls.

To examine the role of noradrenergic, dopaminergic, and serotonergic mechanisms in the pathobiology of obsessive compulsive disorder (OCD) and Tourette's syndrome (TS), concentrations of tyrosine (TYR), norepinephrine (NE), 3-methoxy-4-hydroxyphenylethylene glycol (MHPG), homovanillic acid (HVA), tryptophan (TRP), and 5-hydroxyindoleacetic acid (5-HIAA) were measured in the lumbar cerebrospinal fluid (CSF) of 39 medication-free OCD patients, 33 medication-free TS patients, and 44 healthy volunteers. CSF TYR concentrations were reduced (p < .05) in the OCD patients compared to the healthy subjects. CSF NE in TS patients was 55% higher than in healthy controls (p < .001) and 35% higher than in OCD patients (p < .001). After covarying for height, CSF HVA levels were reduced (p < .05) in the OCD group compared to TS patients but not compared to the normal volunteers. No mean differences in CSF MHPG, TRP, and 5-HIAA were observed in this study across the three groups. The CSF NE data support the hypothesis that noradrenergic mechanisms are involved in the pathobiology of TS. Alterations in the balance of noradrenergic, dopaminergic, and serotonergic systems are likely involved in the pathobiology of OCD.

Tourette's syndrome, Part I: Definition and diagnosis.

Tourette's syndrome (TS) is a neuropsychiatric disorder characterized by a changing repertoire of motor and phonic tics that typically begin in childhood and exhibit a fluctuating course. Obsessive-compulsive symptoms and problems of inattention, overactivity, and impulsiveness are present in some cases. Historically, TS has been viewed as a severe disorder. However, data from epidemiologic and family-genetic studies indicate that it shows a wide range of severity. This article, the first of two parts, examines the current notions concerning the origin, pathophysiology, and diagnosis of TS. The second article will present three cases and describe contemporary approaches to treatment.

Tourette's syndrome, Part II: Contemporary approaches to assessment and treatment.

Clinical assessment of a child with Tourette's syndrome (TS) includes a careful review of motor and phonic tics. In addition, commonly associated problems of such as obsessive-compulsive symptoms, or symptoms of attention deficit hyperactivity disorder (inattention, impulsiveness, and overactivity) should also be evaluated. Treatment almost always includes education of the child, family, and school personnel concerning the natural history and behavioral boundaries of the disorder. Other treatment interventions depend to a great extent on the primary source of impairment. This article, the second of two parts, presents three illustrative cases and reviews current treatment interventions for children and adolescents with TS.

Trajectory of adaptive behavior in males with fragile X syndrome.

Adaptive behavior in males with fragile X syndrome was longitudinally examined in 17 subjects, ages 1 to 17. Subjects received adaptive behavior evaluations on two occasions within one of three age periods. All domains of the Vineland Adaptive Behavior Scales increased from youngest to oldest age groups, yet older subjects (ages 10 to 17) showed significant declines in their adaptive behavior scores from first to second testing. A relative strength in Daily Living Skills and weakness in Socialization emerged only among older subjects. There was a significant relationship between adaptive behavior and mental age scores in all subjects. Discussion emphasized the parallels between declines in IQ and adaptive behavior as well as the need for further research on adaptive skills in young adults with fragile X syndrome.

Nursing diagnoses and functional health patterns in patients receiving external radiation therapy: cancer of the digestive organs.

A descriptive study using clinical methodology was conducted to identify and describe core and site-specific symptoms reported by 15 patients with cancer of the digestive organs who received external radiation therapy. A 47-item Radiation Symptom Scale was designed by the investigators for this study. Symptoms identified by patients with a mean occurrence of at least "sometimes" were considered potential defining characteristics and were submitted to a panel of experts for identification of nursing diagnoses. Seventeen nursing diagnoses, with their associated defining characteristics, were identified and classified within eight Functional Health Patterns (FHP). Half of the nursing diagnoses were formulated within the Nutritional-Metabolic and Elimination patterns. Four of the FHPs were related to primarily functional patterns; four were primarily psychological-behavioral. Results of the study describe the nursing needs of patients who receive radiotherapy to the digestive organs.

Measurement of mealtime interactions among persons with dementing disorders.

Difficulty in eating and refusal to eat are common problems for severely demented persons. Feeding can be one of the most frustrating and complex daily tasks performed by caregivers of demented elders in institutional settings. This paper describes the development of a new method for measuring caregiver-elder feeding activities and interactions--the Feeding Traceline Technique (FTLT). The FTLT, which involves both the transcription of videotape recorded data and the coding of data for computer input, is designed to account for all mealtime behaviors of both feeders and elders, to account for the cyclic and repetitive nature of eating and to permit quantification of complex interactions between feeders and institutionalized residents. Data describing the reliability and validity of the method are presented. Issues discussed relate to the units of analysis, the time and energy expenditure of the method in comparison to the yield of information, and the effect of videotaping on measurement.

Double-blind, crossover trial of fluoxetine and placebo in children and adolescents with obsessive-compulsive disorder.

Rigorously designed clinical trials have demonstrated the efficacy and safety of fluoxetine in adults with major depressive disorder and obsessive-compulsive disorder (OCD) but not in patients below 18 years old. This report describes a randomized, double-blind, placebo-controlled, fixed-dose (20 mg qd) trial of fluoxetine in 14 children and adolescents with OCD, ages 8 to 15 years old; the study was 20 weeks long with crossover at 8 weeks. Obsessive-compulsive symptom severity was measured on the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) and the Clinician's Global Impression-Obsessive Compulsive Disorder scale (CGI-OCD). The CY-BOCS total score decreased 44% (N = 7, p = .003) after the initial 8 weeks of fluoxetine treatment, compared with a 27% decrease (N = 6, p = .13) after placebo. During the initial 8 weeks, the magnitude of improvement for the fluoxetine group significantly exceeded that for the placebo group as measured by the CGI-OCD (p = .01) but not by the CY-BOCS (p = .17). The most common drug side effects were generally well tolerated. The results suggest that fluoxetine is a generally safe and effective short-term treatment for children with OCD.

Feeding nursing home residents with Alzheimer's disease.

The purpose of this exploratory, descriptive study was to identify and categorize the behaviors of caregivers and residents that elicit, sustain, or extinguish feeding. Although preliminary analysis yielded initial categories, mutually exclusive categories were difficult to distinguish. Relationships among identified cues and specific feeding behaviors are being examined in further analysis. The relationship between specific feeding behaviors and the environmental context of feeding is also being examined. The goals of studying feeding behaviors in nursing home residents with Alzheimer's disease are to enhance mealtime for both residents and caregivers and to encourage functional feeding behavior as much as possible. Identification of behaviors that elicit, sustain, and extinguish functional feeding can facilitate development of behavioral and environmental nursing interventions to promote functional feeding.

K-ABC profiles in children with fragile X syndrome, Down syndrome, and nonspecific mental retardation.

Etiology-specific profiles of intellectual abilities were compared in three groups of males with mental retardation using the Kaufman Assessment Battery for Children (K-ABC). Subjects included 10 males with fragile X syndrome, 10 with Down syndrome, and 10 with nonspecific mental retardation who were equated on both mental and chronological age. Across all three groups, sequential processing was lower than simultaneous processing or achievement, and particular subtests (e.g., Gestalt Closure) were relative strengths. Although boys with Down syndrome showed less extreme patterns of domain strengths and weaknesses, they showed a significant strength in the Sequential Processing Hand Movements subtest. In contrast, the Hand Movements subtest was lowest of all K-ABC subtests for males with fragile X syndrome. Implications were discussed for more fine-tuned research and intervention efforts.