Targeting the latent cytomegalovirus reservoir with an antiviral fusion toxin protein.

Reactivation of human cytomegalovirus (HCMV) in transplant recipients can cause life-threatening disease. Consequently, for transplant recipients, killing latently infected cells could have far-reaching clinical benefits. In vivo, myeloid cells and their progenitors are an important site of HCMV latency, and one viral gene expressed by latently infected myeloid cells is US28. This viral gene encodes a cell surface G protein-coupled receptor (GPCR) that binds chemokines, triggering its endocytosis. We show that the expression of US28 on the surface of latently infected cells allows monocytes and their progenitor CD34+ cells to be targeted and killed by F49A-FTP, a highly specific fusion toxin protein that binds this viral GPCR. As expected, this specific targeting of latently infected cells by F49A-FTP also robustly reduces virus reactivation in vitro. Consequently, such specific fusion toxin proteins could form the basis of a therapeutic strategy for eliminating latently infected cells before haematopoietic stem cell transplantation.

Evaluation of ASPAN's preoperative patient teaching videos on general, regional, and minimum alveolar concentration/conscious sedation anesthesia.

This descriptive study was undertaken as part of a clinical improvement effort by the ASPAN Research and Education Committees to evaluate adult patients' perception of and satisfaction with the ASPAN Preoperative Patient Teaching videotape on general, regional, and minimum alveolar concentration (MAC)/conscious sedation anesthesia. Research findings on the use of videotapes for preoperative education are mixed. Some studies have reported that the use of videotapes increases knowledge and decreases anxiety, whereas other studies have shown a minimal effect on knowledge and anxiety. A convenience sample of 96 adult patients was chosen from those who were scheduled for surgeries with the above anesthesia techniques in 11 US hospitals and/or surgical centers within 4 ASPAN regional boundaries. Patients viewed the videotape the day(s) before surgery and then completed ASPAN's Preoperative Anesthesia Patient Teaching Questionnaire to measure patient perception and satisfaction. Sixty percent of the patients were women, and 50% had a college degree or higher. The average age of the patients was 51 (+/-17.2). Overall satisfaction scores had a potential range of 10 to 40, with higher scores indicating greater satisfaction. The mean satisfaction score for this study was 35 (+/-6.6). No significant relationships were found between satisfaction with the videotape and age, gender, or educational level. Patients were asked to rank each of 4 teaching methods. Among the choices of individualized instruction, written materials, Internet-based instruction, and videotape, the videotape method was ranked as most preferred. The information obtained from this study will be used to modify and improve the content of the patient education videotape produced by ASPAN.

Ambulatory surgery: the growth of an industry.

Over a short 30 years, ambulatory surgery has grown from a few freestanding facilities to a continuously growing industry. This article gives a historical overview of that growth, while specifically documenting the impact that competition, regulation, capitation, technology, and the consumer have on nursing and a single industry.

Working alone: can it be done?

The new ASPAN Standards of PeriAnesthesia Nursing Practice, 1995 continue to recommend a minimum of two nurses in the PACU during phase I recovery. During the 1995 midyear meeting of the American Society of PeriAnesthesia Nurses, a position paper was passed in support of two nurses in the PACU during phase I recovery. Throughout the country, on some occasions, nurses continue to work alone in the PACU. This article suggests strategies for planning safe and competent care while working alone in the PACU.

Reflections of a postanesthesia care unit night nurse.

The American Society of PeriAnesthesia Nurses has long held the standard that two licensed personnel will be in the PACU during phase I of recovery. Not all areas of the country have been able to adhere to this standard. This is one nurse's reflections on the time spent "working alone" in the PACU. This article was written before the November 1995 ASPAN position paper on staffing issues. The author strongly feels that with the position paper in place, facilities will make a stronger effort to adhere to the standard and working alone will become a matter of historical record.

Conversations in ethics: exploring the literature.

Because of changes in the healthcare industry, many questions have surfaced concerning ethical dilemmas. We, on the ethics committee, thought it a good idea to publish some updated and informative literature concerning these dilemmas.

Research priorities for all phases of postanesthesia nursing: a survey by ASPAN.

This ASPAN survey was conducted by Research Committee members regarding the future of research for postanesthesia nursing and asked this question: What do postanesthesia nurses view as priorities for postanesthesia nursing research in various phases of practice? The design for the study was the Delphi technique, which uses a multiple, sequential survey to reach consensus among a group of experts. Four rounds of questionnaires were used to survey volunteer participants (N = 54). The group of experts remained stable (N = 41) for rounds 2 through 4. Findings from the survey indicated several areas of priorities for postanesthesia nursing. Of the top 10 ranked statements, 4 related to discharge criteria. Another high-priority area identified was pain management, with 5 statements pertaining to this subject being ranked in the top 10. Based on this small sample of postanesthesia nurses, this study provides a beginning step for prioritizing areas of research necessary to expand the body of knowledge for postanesthesia nursing.

The effects of postanesthesia care unit visits on anxiety in surgical patients.

The purpose of this study was to conduct a modified replication of a previous study designed to determine the preoperative and postoperative postanesthesia care unit (PACU) differences in levels of anxiety between patients who receive visitors in the PACU and patients who do not receive visitors. Differences between groups regarding memory of the PACU and the desire to have visitors were determined. A nonprobability sample of 40 adult patients scheduled for elective surgery was used to examine the differences in visual analog scale (VAS) scores of anxiety 1 to 2 hours before surgery, in the PACU, and 20 to 36 hours after surgery between the control and treatment groups. The State Anxiety Inventory, Form Y-1, and the VAS were administered to all participating patients to measure anxiety associated with surgical procedures. A self-report questionnaire was used to measure memory of the PACU and the desire for PACU visitors. The findings supported those of a previous study that indicated that the presence of family members and significant others in the PACU helped to decrease anxiety in surgical patients. It also supports patients' wishes to have visitors in the PACU after future surgeries.

The visiting needs of critically ill patients and their families.

The purpose of this article is to provide an overview of completed studies that consider visitors in critical care areas. Studies from coronary care, intensive care, pediatric PACUs, and adult PACUs are reviewed.