Effects of alosetron on spontaneous migrating motor complexes in murine small and large bowel in vitro.

Alosetron (Lotronex) is a serotonin subtype 3 (5-HT3) receptor antagonist that alleviates symptoms of irritable bowel syndrome (IBS) in female patients. Alosetron may act centrally, involve the alteration of ascending pain sensation, or modulate peristaltic, secretory, or sensory function. To investigate further the mechanisms underlying its action and gender selectivity we recorded the effect of increasing concentrations of alosetron or ondansetron on spontaneous migrating motor complexes (MMCs) from isolated terminal ileum or colon from C57BL/6 mice. Both antagonists inhibited MMC frequency before affects on duration or amplitude. The threshold of inhibition for alosetron was 100-fold less in small intestine from females (20 nM) than from males. The opposite effect of gender was observed with ondansetron in the colon. All MMCs were abolished by either drug at 10 microM. Our results demonstrate that alosetron selectively inhibits MMC frequency in isolated preparations of murine bowel. Because contractile events in the ileum correlate with symptoms of IBS in humans, the gender selectivity of alosetron may be caused by a direct action within the small intestine.

Spontaneous migrating motor complexes occur in both the terminal ileum and colon of the C57BL/6 mouse in vitro.

We have studied migrating motor complexes (MMCs) in the isolated terminal ileum or colon (IMMCs and CMMCs respectively) of the C57BL/6 mouse. Periodic contractions occurred spontaneously in both preparations in the absence of intraluminal stimulation. After an initial period, complexes became synchronized between the oral and anal ends of the tissue, and could be observed for in excess of 7 h. The propagation velocity was 3.1+/-1.0 and 3.9+/-0.6 mm s(-1) in the ileum and colon respectively. IMMCs occurred every 6.01+/-0.39 min and had a duration of 86.3+/-10.4 s. The interval between CMMCs was smaller (3.52+/-0.31 min) and contractions were shorter in duration (30.7+/-3.6 s). In both preparations, these motor events were dependent on cholinergic transmission: blocked by hexamethonium (500 microM) and attenuated or blocked by atropine (1 microM). This study is the first demonstration of spontaneous migrating contractions in the isolated ileum or colon of the C57BL/6 mouse, the strain of choice for neurological transgenic and targeted mice.

Discharge of mothers and babies from hospital after birth of a healthy full-term infant: developing criteria through a community-wide consensus process.

OBJECTIVE: To ensure safe care of mothers and babies after birth, irrespective of length of hospital stay, and to ensure effective links between hospital and community postnatal services. METHODS: Program aimed toward consumers and professionals working with them in Ottawa-Carleton (750,000 persons.) All pregnant women in the community included. Program developed by professionals, institutions and community agencies. Information on current practices elsewhere and early discharge literature studied. New provincial survey on practice changes performed in Ontario. Emergency room utilization data analyzed. Discharge and post-discharge criteria, and a common prenatal education curriculum, developed. RESULTS: Multidisciplinary, multi-sectoral committees, institutions and agencies have developed programs for appropriate discharge practice and improved postnatal follow-up. Professionals have supported flexible discharge guidelines. CONCLUSIONS: Provided discharge criteria and follow-up are available, flexible discharge timing and safety appear compatible. The Ottawa-Carleton process to develop criteria and programs has allowed a collaborative, consensus-based approach to 'early' newborn discharge.

Breastfeeding the infant/child with a cardiac defect: an informal survey.

Despite the well-established benefits of breastfeeding, there is little literature about breastfeeding the infant with a congenital cardiac defect. This paper describes the experience of 12 mothers of infants with cardiac defects. These mothers responded to an informal survey and described numerous obstacles to success such as maternal fatigue, anxiety, separation from infant, institutional policy, and lack of support from health care providers. Mothers compared sources of help and identified coping strategies. Perceived benefits of breastfeeding included decreased illness, decreased stress, feeling part of the infant's health care team, and maintaining a relationship with the infant. Recommendations for assisting the mother nursing an infant with congenital heart disease are included.

Evaluation of a fetal monitoring education program.

OBJECTIVE: To evaluate the effectiveness of a fetal monitoring education program in increasing nurses' knowledge and clinical skills. DESIGN: Multicenter randomized control trial. SETTING: Twelve hospitals in eastern Ontario, Canada. PARTICIPANTS: One hundred nine volunteer registered nurses randomly assigned, within each hospital, to an experimental (n = 47) or control (n = 62) group. Ninety-six nurses (40 in the experimental group and 56 in the control group) completed the 6-month follow-up (88% retention). INTERVENTIONS: The experimental group participated in a 1-day fetal monitoring workshop and a review session 6 months later. MAIN OUTCOME MEASURES: Performance on a 45-item knowledge test and a 25-item skills checklist. The passing score was at least 75% correct on each test. RESULTS: The percentage of nurses in the experimental group passing both the knowledge and the clinical skills tests after the workshop was significantly higher (p < 0.01) than that of the nurses in the control group: 68.1% versus 6.5%, respectively. A large difference between the groups remained at the 6-month follow-up (experimental, 45%; control, 6.5%). The performance of the nurses in the experimental group improved to an 85% pass rate after they attended the 6-month review session. CONCLUSION: This comprehensive, research-based program is effective in increasing fetal monitoring knowledge and clinical skills.

Two evaluations of combined mother-infant versus separate postnatal nursing care.

Combined mother-infant postnatal nursing care was compared with traditional, separate postpartum and newborn care in two studies. In Study I, self-administered questionnaires were completed by 408 mothers and 63 staff nurses. Data were collected both before and after mother-infant care was implemented. Benefits of the new system included increased maternal competence and satisfaction with parent education, parent-infant contact, and the nurse-client relationship, increased staff satisfaction, with no increase in operational cost. There were no breastfeeding differences, but ways to improve duration were implied by reasons for stopping. These findings were replicated in a separate setting with similar sample sizes. However, in the latter case, low staff ratios appeared to limit the benefits of mother-infant care to multiparas rather than primiparas.

The provision and evaluation of a neonatal resuscitation program.

The need to train perinatal staff in neonatal resuscitation is widely accepted; however, standardized educational programs have not been available. This study used a randomized control trial to evaluate a one-day neonatal resuscitation education program with 190 nurses. Experimental subjects receiving the program had significantly improved knowledge and skill performance. Knowledge, but not skill performance, was maintained at six months for the experimental group. There was a significant relationship between subjects' self-rating of knowledge and performance, suggesting that this method could be used to prioritize staff for basic or refresher training. An effective format and evaluation instruments for neonatal resuscitation training have been developed. Strategies to maintain skills should be addressed in future research.

Evaluating hospital postnatal nursing care: development of the instruments.

Measures of the quality of hospital postnatal nursing care were developed for an evaluative study of the benefits of combined mother-infant versus traditional separate staffing patterns. Two hundred mothers completed instruments designed to measure maternal competence, patient satisfaction, establishment of breast-feeding in hospital and breast-feeding success at 6 weeks, and 28 nursing staff completed measures of staff satisfaction. The internal consistency and test-retest reliability of scales were supported by alpha coefficients of .60 to .89 and correlation coefficients of .74 to .80. A 90% participation rate and a 97% completion rate were achieved for the maternal sample. Evidence is presented for instrument content, construct, and predictive validity.

Combined mother-infant nursing care.

A survey of five Canadian agencies where mother-infant nursing has been implemented found that there is a significant trend toward this concept of care. Agency characteristics, program operational details, the change process, and benefits are examined. Recommendations are made regarding program planning, and the need for more rigorous program evaluation is emphasized.

The surgical aspects of hyperparathyroidism.

We followed up 250 patients surgically treated for hyperparathyroidism. Selective venous catheterization with radioimmunoassay was an effective method of preoperative localization, but its greatest contribution was in patients needing reexploration of the neck. Because of a 15 percent incidence of multiple gland involvement, we tried to identify all glands, if possible. If more than one gland was abnormal, it also was removed. If three or four glands were abnormal, a subtotal parathyroidectomy was done. Five patients showed persistent hyperparathyroidism because of failure to find or remove all hyperfunction tissue: two patients were successfully treated at a third operation; one has not undergone reexploration, and two have parathyromatosis. Only one patient developed late recurrent hyperparathyroidism. The removal of a single adenoma is adequate providing the remaining glands are grossly and histologically normal. Hypoparathyroidism is a potential, although uncommon, risk following subtotal parathyroidectomy.