Effect of dietary vitamin E and selenium supplementation on semen quality in Cairn Terriers with normospermia.

Among others, selenium (Se) and vitamin E (VitE) have been provided to dogs to improve semen quality. However, scientific evidence documenting an effect in dogs is lacking. The aim of this study was to investigate the effect of supplementation of these antioxidants on various ejaculate parameters in a randomized, double-blinded trial using Cairn Terrier males exhibiting normal seminal quality parameters. Three dogs each were fed a standardized diet and supplemented with 0.1 mg Se, 100 mg VitE or 0.1 mg Se + 100 mg VitE/dog for 3 months. Ejaculate analyses (volume, progressive motility, vitality, morphology, concentration) were performed before inclusion (D0) and after 1, 2 and 3 months (+1, +2, +3). At the same time, glutathione peroxidase (GSH-PX) and VitE in seminal plasma (SP) and GSH-PX in blood samples were determined. Vitamin E levels in SP were below the detection limit (1.0 mg/L) in all samples. GSH-PX in blood (164.0-2794.4 IU/L) and SP (18.4-4326.0 IU/L) was highly variable. Supplementation only significantly affected the total percentage of sperm head abnormalities (p = .011). Time significantly affected the percentage of morphologically abnormal sperm (p = .025), sperm head abnormalities (p = .007), proximal droplets (p = .001) and GSH-PX in SP (p = .015). Additionally, a significant interaction between time and group was identified for the percentage of membrane-intact sperm (p = .048), head abnormalities (p = .018), acrosomal defects (p = .043) and proximal droplets (p = .002). Although some effects could be identified for selected parameters, we failed to identify a clear trend about how a 3 months VitE and/or Se supplementation affects semen parameters in normospermic Cairn Terriers.

A nursing practice problem: failure to observe aseptic technique.

A study was conducted to assess nurses' adherence to a recently revised policy and procedure manual. Medical-surgical nurses (n = 217) were surveyed to assess their perceived ability to perform selected clinical procedures. A sample (n = 34) of respondents was then observed performing the procedures. Analysis of the 37 errors in performance revealed an unanticipated high number of errors (n = 33) in aseptic technique. Type of errors and projected reasons for their occurrence are given.

Critical care nurses' perceptions of obstacles and helpful behaviors in providing end-of-life care to dying patients.

BACKGROUND: Little is known about nurses' perceptions of obstacles or helpful behaviors ("helps") in providing end-of-life care in the intensive care setting. OBJECTIVE: To determine the importance of various obstacles and helps in providing end-of-life care as perceived by critical care nurses. METHODS: A questionnaire was mailed to 300 members of the American Association of Critical-Care Nurses. Nurses were asked to rate obstacles and helps in giving end-of-life care, and additional obstacles and/or helps, and answer demographic questions. RESULTS: Six of the top 10 obstacles were related to issues with patients' families that make care at the end of life more difficult, such as the family's not fully understanding the meaning of life support, not accepting the patient's poor prognosis, requesting more technical treatment than the patient wished, and being angry. Added obstacles related mostly to problems with physicians' behavior. Most helps were ways to make dying easier for patients and patients' families, such as agreement among physicians about care, dying with dignity, and families' acceptance of the prognosis. Added helps included allowing music, pets, and so forth into the patient's room. CONCLUSIONS: Nurses have difficulties with patients' families and physicians concerning end-of-life issues, especially when the behaviors remove the nurses from caring for a patient or cause the patient pain or prolong suffering. Nurses do not acknowledge having difficulty providing care to dying patients aside from conflicts that arise because of patients' families and physicians.

Nurses' beliefs and attitudes toward visiting in adult critical care settings.

OBJECTIVE: To assess the beliefs and attitudes of critical care nurses about the effects of visiting on patients, staff and family. DESIGN: Both interviews and questionnaires were used to gather data on nurses' attitudes and beliefs about visiting and open visiting according to the format of Ajzen and Fishbein's Theory of Reasoned Action. SETTING: Five Utah intensive care units and three Ohio intensive care units. SAMPLE: Critical care nurses in Utah (N = 29) and Ohio (N = 41) were interviewed to assess their beliefs about the effects of visiting on patients, families, nurses and nursing care delivery. RESULTS: Nurses believed the consequence of visiting was more positive for the patient from a psychological perspective than from a physiological perspective but that the effects might differ depending on the patient, the visitor and the circumstances. They believed that visiting had negative consequences for families, because they became exhausted, and that visiting was disruptive for nursing care delivery. Their attitudes about effects of visiting on nursing staff were consistently more negative than were attitudes about the effects on the patient and the family. CONCLUSION: To provide an optimal situation for visiting, its negative consequences must be minimized and nurses' attitudes and beliefs about visiting must be assessed and addressed.

Chest tube removal practices in critical care units in the United States.

BACKGROUND: Pain assessment and management are recognized as major problems in critical care settings. However, little is known about pain management practices related to medical procedures performed in the ICU, particularly removal of chest tubes. OBJECTIVES: To describe practices related to chest tube removal in the United States, with an emphasis on pain assessment and management. METHODS: A survey instrument was developed and mailed to 995 members of the American Association of Critical-Care Nurses who cared for patients with chest tubes. They were asked about chest tube removal practices in their institutions. RESULTS: Chest tubes are removed primarily by physicians and house staff, although 11% of respondents reported that specially trained nurses removed the tubes. Only 16% indicated that a prescription for pain medication was routinely available before chest tube removal. The drug administered most frequently was intravenous morphine sulfate, but the dose varied considerably. Nurses were generally satisfied (65.6%) with practices related to chest tube removal in their unit; nurses who were not satisfied (34.4%) wished to see better pain management practices (45%), removal of tubes by the patient's assigned nurse (17.8%), a protocol for tube removal (13.9%), notification of the nurse before removal (12.2%), and other changes (10%). CONCLUSIONS: Practices associated with chest tube removal, especially pharmacologic management of procedure-related pain, vary in critical care units. Caregivers are advised to develop practice policies to guide decisions about management of acute pain in this patient population.

Intensive care nurses' experiences with end-of-life care.

BACKGROUND: With much attention being focused on how patients die and whether or not they are provided appropriate care, the care of dying patients in intensive care units must be described and improved. OBJECTIVES: To describe end-of-life care in intensive care units as perceived by critical care nurses who have taken care of dying patients. METHODS: A semistructured interview guide was developed and revised after pretesting in a focus group of faculty clinicians with extensive, recent experience in intensive care. Four focus groups were held with randomly selected nurses from 4 intensive care units in 2 hospitals; participants had 2 years or more of experience and were working half-time or more. Tapes from each focus group were transcribed and reviewed by the investigators before the subsequent group met. Category labels were developed, and topics and themes were determined. RESULTS: "Good" end-of-life care in the intensive care unit was described as ensuring that the patient is as pain-free as possible and that the patient's comfort and dignity are maintained. Involvement of the patient's family is crucial. A clear, accurate prognosis and continuity of care also are important. Switching from curative care to comfort care is awkward. CONCLUSIONS: Disagreement among patients' family members or among caregivers, uncertainty about prognosis, and communication problems further complicate end-of-life care in intensive care units. Changes in the physical environment, education about end-of-life care, staff support, and better communication would improve care of dying patients and their families.

An examination of the physiologic basis for "coronary precautions".

The only restriction in the list of coronary precautions that is well supported by research is the restriction of stimulant beverages. The restriction of taking rectal temperatures and the rationale usually given, vagal stimulation, are not supported by clinical studies. The restriction of iced beverages has some support only if the amount of fluid is about 600 to 800 cc and if the patients is in the supine position, allowing the heart to be cooled. Limiting the ingestion of ice water to a glass of less at a time would seem to be supported by the studies reviewed and by a recent study of healthy young adults. In contrast to the conclusions drawn in this study, a recent national survey of nurses who care for cardiac patients revealed that coronary precautions remain in practice. Mean importance and frequency ratings for the individual restrictions were comparable to ratings for other commonly practiced nursing activities; however, the standard deviations for the mean ratings were greater for coronary precaution items than for others. Hopefully this article will summarize needed information, and nurses will be able to make decisions for practice on the basis of research rather than tradition.

Who is responsible for research utilization?

In summary, difficulties exist when critical care staff nurses attempt to use research or, perhaps, do not even think about using research. However, the responsibility for facilitating research utilization is shared by nurses in various settings. We all need to make major changes to assist in that process before we ask why staff nurses are not using research.

Analysis of the research about heparinized versus nonheparinized intravascular lines.

This article is a review and analysis of published and unpublished research on the efficacy of both dilute heparin solutions and normal saline solutions in flushing and maintaining the patency of vascular catheters. Twenty studies involving both intravenous and intraarterial catheters in pediatric and adult patients are summarized and analyzed both quantitatively and qualitatively. Thirteen studies that were conceptually similar were subjected to a meta-analysis; no significant difference in duration of patency was found between intravascular catheters flushed with saline solution and those flushed with a heparinized solution. Implications for changing practice based on research findings are discussed.

Perspectives on exercise and aging.

This discussion has particular implications for those involved in the care of the older patient with cardiac disease Without increased attention to research that addresses exercise and aging, decisions about the future activity of the elderly person who has sustained a coronary event may be biased by subjective notions. The question remains regarding whether this individual will be given the same options for rehabilitation as one who happens to be middle-aged. Clearly, there is a need to study the responses to exercise of the elderly with and without diagnosed heart disease. There is also need for a greater number of longitudinal studies such as those of Robinson et al. These studies might compare the exercise responses of active, inactive, and athletic individuals from young adulthood to old age.

Positional oxygenation changes in air-transported neonates.

The effect of position on oxygenation was compared in 24 critically ill, premature neonates during pressurized, fixed-wing transport. The purpose of the study was to assess if there is a significant change in the arterial oxygen tension in the supine, prone, or prone-free positions during air transport. Neonates with endotracheal tubes in place who (1) had radiologic evidence of hyaline membrane disease, (2) had an umbilical artery catheter in place, and (3) required at least 1 hour of air transport to a level III intensive care center were admitted into the study after parental consent. There was an average 8% increase in oxygenation in the prone and prone-free positions when compared with the supine position. Although this difference might be considered clinically significant for the critically ill premature neonate, there was no statistically significant difference in arterial oxygen tension among the three positions tested in this study.

Using the journal club as a component of the research utilization process.

Although journal clubs are recommended for research utilization, the various ways in which journal clubs are conducted do not always lead to research utilization. Major institutional changes in practice must be preceded by a comprehensive literature search and a complete review. An example is provided of how a series of journal clubs using the comprehensive search approach led to research utilization.

Electrocardiographic response to ice water ingestion.

To determine the necessity of restricting ice water for patients with acute myocardial infarction (MI) we performed studies in 89 patients who had been admitted to a coronary care unit with a diagnosis of acute MI or "rule out MI." Using a split-plot factorial repeated-measures design, we randomly assigned patients to position and sequence of volume. A Marquette Augmented Cardiograph was used to obtain 12-lead electrocardiogram (ECGs) at baseline and at 3, 10, and 25 minutes after ingestion of 200 or 400 ml ice water. Multivariate analysis of variance (MANOVA) was used to assess the significance of each factor alone and in interaction for both ST segments and T waves for 11 leads. The preliminary analysis of variance showed significant difference (p less than 0.10) in ST segments for position in several leads and in T waves for disease in several leads. Differences did not continue to be significant when they were considered across the four time periods (MANOVA); then time and volume were the significant variables for most leads. Mean change scores for ST segment (0.01 to 0.05) and T wave amplitude (0.01 to 0.88) were not clinically significant; however, a few patients had significant changes in ST segment of greater than 1 mm and T wave amplitude of greater than 10 mm. A few patients exhibited T wave inversion, suggesting a third level of significance: clinically detectable differences.(ABSTRACT TRUNCATED AT 250 WORDS)

Patterns of postnatal weight changes in infants with very low and extremely low birth weights.

OBJECTIVE: To describe (1) short-term postnatal weight loss and gain patterns in infants with very low and extremely low birth weights and (2) the variables that may affect these weight change patterns. DESIGN: Descriptive, retrospective review. SETTING: University hospital in the intermountain western United States. SUBJECTS: Sixty-two charts of infants admitted to a university neonatal intensive care unit from July 1990 through November 1992 were reviewed. Infants who weighed 1000 grams or less were categorized as extremely low birth weight (ELBW) and infants weighing 1001 to 1500 grams were categorized as very low birth weight (VLBW). Each group was comprised of 31 infants. Fifty percent of the sample were male, and 50% were female. Eighty-five percent of the sample were Anglo-American, and 15% were non-Anglo-American. MEASURES: Data were collected on a three-part data collection tool and included demographic and treatment variables. RESULTS: A significant difference was found in the maximum percent weight lost between the two groups, with the ELBW group losing a mean of 14.77% of birth weight and the VLBW group losing a mean of 11.35% of birth weight (t = 2.45, p < 0.05). The day the infants reached their nadir weight was significantly different between the two groups. The ELBW group reached their nadir on day of life 7, and the VLBW group reached their nadir on day of life 6 (t = 2.00, p < 0.05). No significant difference was noted in the time to return to birth weight between the two groups, with a mean of 15 days to return to birth weight. Factors associated with postnatal weight changes were intraventricular hemorrhage, use of diuretics and steroids, day of life when nadir weight occurred, and maximum percent of weight lost. Many of the independent variables were significantly interrelated to each other (r = -0.90 to r = 0.91, p < 0.01 to p < 0.001). However, only the variables that correlated with time to return to birth weight were entered into the regression analysis. These variables included number of days diuretics were given before return to birth weight, maximum percent of weight lost, and day of life the infants reached their nadir weight. Number of days diuretics were given before return to birth weight correlated significantly with time to return to birth weight (r = 0.77, F = 26.66, p < 0.0001) although maximum percent of weight lost and day of life the infants reached their nadir weight had a minimal effect. CONCLUSIONS: Further research into the effects of diuretic therapy on weight changes in this population of infants may lead to interventions to minimize the negative effects of diuretics on return to birth weight. In addition, the older growth charts may not be applicable to this population of infants. Generation of new growth charts that provide growth curves based on these data could be useful in developing nutritional therapies that would promote growth and possibly decrease the length of hospital stay for these infants.

Metabolic bone disease in very-low-birth-weight infants: assessment, prevention, and treatment by neonatal nurse practitioners.

OBJECTIVE: To describe the current practice of neonatal nurse practitioners in assessing skeletal health and preventing and treating metabolic bone disease in very-low-birth-weight infants. DESIGN: Descriptive, retrospective survey. PARTICIPANTS: Neonatal nurse practitioners in the continental United States were systematically randomly selected. A 64% response rate was obtained (112). MAIN OUTCOME MEASURES: Responses to questions about assessing skeletal health and preventing and treating metabolic bone disease in very-low-birth-weight infants. RESULTS: Current practice of neonatal nurse practitioners includes assessing skeletal health of very-low-birth-weight infants on the 7th (47.3%) or 14th (19.6%) day of life, with subsequent assessments every 7 (63.3%) or 14 (18.8%) days. Neonatal nurse practitioners (85.1%) estimate the incidence of metabolic bone disease at less than 15%. Neonatal nurse practitioners initiate total parenteral nutrition (99%), provide parenteral calcium and phosphorous in ratios of 1.3-1.7:1 (9%), and add powdered fortifier (90.1%) and liquid fortifier (25.2%) to expressed breast milk. All respondents use formulas made for premature infants. Physical therapy is used by 46.8% of neonatal nurse practitioners. CONCLUSIONS: Neonatal nurse practitioners underestimate the incidence of metabolic bone disease. Parenteral calcium and phosphorous are given but in quantities that differ from the recommended ratio. Most neonatal nurse practitioners use formulas made for premature infants and add powdered fortifier to expressed breast milk. Although physical therapy is prescribed, more research on its effect on bone mineralization is warranted before this practice is recommended without reservation.

Infant-feeding practices. Mothers' decision making.

Fifty-one primarily low-income, single, black mothers completed a questionnaire. More than one-half of the sample population reported that decisions about infant feeding were made by the end of the first trimester. Almost one-third of the mothers decided to breastfeed. Of that group, one-half supplemented breastfeeding with formula. More than one-half of the sample reported that external factors influenced their final decisions about infant feeding. More than one-half of the sample population reported that a nurse never discussed infant feeding with them. The role of nursing in infant-feeding decisions and patient teaching needs to be reevaluated.

Comparing two methods of topical anesthesia used before intravenous cannulation in pediatric patients.

INTRODUCTION: The purpose of this study was to compare the efficacy of two methods of topical anesthesia before venipuncture or intravenous cannulation of pediatric patients to assess which type of topical anesthetic would better alleviate pain in the least amount of time with the greatest success rate of cannulation. METHODS: This study was a randomly controlled trial of 100 preoperative pediatric patients aged 5 to 21 years. The following methods of topical anesthesia were compared: (a) iontophoresis of a topical solution of 2% lidocaine with epinephrine 1:100,000 using a Phoresor Dose Controller (PDC) with Numby Stuff electrodes and a eutectic mixture of local anesthetic and (b) 2.5% lidocaine and 2.5% prilocaine (eutectic mixture of local anesthetics [EMLA] cream). RESULTS: Children reported less pain with iontophoresis (M = 0.08) compared with EMLA cream (M = 1.88, P < .001). Time to accomplish topical anesthesia was shorter with iontophoresis (13 minutes) compared with EMLA cream (60 minutes, P < .001). Failure to accomplish venipuncture occurred 5 times with the iontophoresis method and 8 times with the EMLA method (not significant). No dermal burns resulted from use of iontophoresis. DISCUSSION: We conclude that use of iontophoresis in pediatric patients is safe, rapid, and significantly more effective than is EMLA cream in reducing pain associated with venipuncture or intravenous cannulation.

Roles and responsibilities of clinical nurse researchers.

A follow-up survey of 142 nurse researchers employed in clinical settings (NRECS) was conducted 10 years after the first one conducted by Knafl, Bevis, and Kirchhoff in which only 34 individuals qualified for inclusion. An 80-item questionnaire included items about the structure of the position, processes used, variables that may influence outcomes, and outside activities. When ineligible persons were excluded, the response rate was 75 per cent. Most commonly NRECS had positions in clinical settings only (55.7 per cent), offices (75.5 per cent), some staff (72.6 per cent), and secretarial support (52.8 per cent), and they usually reported to the chief nurse executives (71.7 per cent). Although the majority of NRECS reported responsibility for research activities, the average time spent on research is only 50 per cent. Most (82 per cent) have a nursing research committee, but NRECS also sit on other research-related committees in the department or hospital. Details about salary, responsibilities, and processes will be helpful to those preparing themselves or others for this role, for those who wish to start such a position for themselves or another, or for those in the role wanting to know how other NRECS perform.

An approach to publishing an edited book.

This article outlines the steps taken by the authors to publish a co-edited nursing research book to assist nurses interested in editing a book or writing a book chapter. The authors' experiences are used to help illustrate the preparation and editing of manuscripts. Collaboration among co-editors, chapter authors (contributors), and the staff of the publishing company is vital when publishing an edited book.

Issues and challenges in clinical nursing research.

In this article, issues encountered that are problematic in conducting research in clinical settings are discussed along with potential solutions. Subject accrual, compatibility of the research protocol with day-to-day operation of the clinical site, gaining cooperation from groups of health professionals, and obtaining required approvals are the most common problems encountered. Overcoming these problems does not mean the elimination of them; awareness and acknowledgement of these problems in the planning process will minimize the negative influence they may have on the study.