An enteral formula containing fish oil, indigestible oligosaccharides, gum arabic and antioxidants affects plasma and colonic phospholipid fatty acid and prostaglandin profiles in pigs

Evidence supports a pathogenic role of arachidonic acid-derived inflammatory mediators within the gastrointestinal tract of patients with inflammatory bowel disease. The purpose of this study was to assess the effects of an ulcerative colitis nutritional formula (UCNF) containing oligosaccharides, fish oil, gum arabic and antioxidants on plasma and colonic phospholipid fatty acid and prostaglandin profiles in pigs. Twenty-four growing barrows in two replications were equally randomized among four killing times (d 0, 7, 14 and 21), and one of two diets, a control and the UCNF. Diets contained comparable levels of protein, fat, and nonstructural carbohydrate and met 100% of the energy requirements of the pig. Intake and body weight were recorded daily while blood, urine and tissue samples were collected at time of kill. Within 1 wk of ingestion of the UCNF, the composition of plasma phospholipid fatty acids showed an increase in 20:5(n-3) and 22:6(n-3) (P < 0.0001) and a decrease in 20:4(n-6) and 18:2(n-6) (P < 0.0001). Similar effects were observed for the phospholipids in the colonic and cecal mucosa. Plasma prostaglandin E was unaffected by treatment, whereas thromboxane B2 and 6-keto-prostaglandin F1 alpha levels were significantly decreased after 7 d of UCNF ingestion. Ingestion of the UCNF resulted in a suppression in the synthesis of proinflammatory prostaglandins by cecal and colonic mucosal cells. Levels of colonic and cecal prostaglandin E, 6-keto-prostaglandin F1 alpha and thromboxane B2 were significantly decreased after 7 d of UCNF ingestion. These changes may have been mediated by rapid increases of (n-3) fatty acids into cellular phospholipids. Dietary supplementation with the UCNF may prove beneficial for patients with ulcerative colitis by modulating colonic prostaglandin synthesis.

"Current topics in health sciences librarianship": a pilot program for network-based lifelong learning

The long-term objective of this project is to make health sciences librarians more effective in their role by using emerging technologies to deliver timely continuing education (CE) programs to them regardless of their physical location. The goals of the one-year planning project at the William H. Welch Medical Library are to plan, implement, and evaluate a pilot CE program that includes (1) a three-day general-interest session organized in four tracks: Market Forces and Management, Information Technology and the Internet, Publishing and Copyright, and Education; (2) a one-day special topic session on the Informatics of the Human Genome Project; and (3) an electronic poster session in parallel with the general-interest session. The program will be offered in three simultaneous formats: (1) on-site, in a distance-learning classroom in Baltimore; (2) as a telecourse, in a similar classroom outside Washington, DC; and (3) online, via the World Wide Web. An electronic proceedings of the entire program will be published on the Web to serve as a continuously available CE resource for health sciences librarians. This paper gives an overview of the planning process, presents a status report on the programmatic and technical implementation of the pilot project at its midpoint, and discusses future directions for the program.

Fluid intake and urinary incontinence in older community-dwelling women

Urinary incontinence (UI) is a common problem and requires adjustment to self-care. Noninvasive methods to manage UI should be tried first. Although many individuals restrict fluid intake to reduce incontinent episodes, clinical hunches suggest that adequate hydration is more useful in the management of UI. This study was conducted to determine the effects of hydration on the number of UI episodes. Women were randomly assigned to 1 of 3 groups: increase fluid intake by 500 cc, maintain fluid intake at baseline level, or decrease by 300 cc. Thirty-two women kept fluid intake and output diaries for 5 weeks. Adherence to fluid intake protocols was poor, and consequently, quantitative results were nonsignificant. However, follow-up interviews revealed that 20 women reported decreased UI episodes since participating in the study and felt that the most significant learning was their recognition of the need to increase fluid intake. Community health nurses can provide guidance in self-assessment of fluid intake patterns to help manage UI.

Neostriatal dopamine depletion and locomotor abnormalities due to the Albino Swiss rat agu mutation

The sub-strain of Albino Swiss rat (AS/AGU) is a spontaneous mutation characterised by an ungainly, staggering gait, hindlimb rigidity, whole body tremor and (when symptoms are fully developed) difficulty in initiating movement; it exhibits a progressive decrease in dopaminergic cells within the substantia nigra. A breeding programme involving Albino Swiss (AS) and AS/AGU parent rats was used to produce the F1 offspring of AS x AS/AGU matings and, subsequently, F1 x AS/AGU back crosses. When adult, the movement of all animals was assessed blind by observers on three occasions, each animal being identifiable by a subcutaneous transponder implanted before weaning. All AS/AGU and half the F1 x AS/AGU back cross animals had abnormal gait, while all AS, F1 and the remaining F1 x AS/AGU backcross animals showed normal gait, implying that the mutation is recessive. Brains of males aged 12-15 months (n = 10 per group) were sectioned transversely on a cryostat (-20 degrees C) to produce a cut face just caudal to the anterior commissure (approximately Bregma -0.5 mm) and 1 mm diameter x 1 mm deep micropunches were taken from three areas of the caudate-putamen. Levels of dopamine were measured in all samples by high performance liquid chromatography with electrochemical detection (HPLC-ECD) followed by protein estimation. Levels of dopamine in the dorsal and middle caudate-putamen varied according to a simple inheritance pattern, being high in males from AS, F1 and F1 x AS/AGU back crosses without locomotor impairment, but lower in AS/AGU and F1 x AS/AGU back crosses with disordered gait. Dopamine levels in the ventral caudate-putamen did not show such a clear variation.

Support groups for visitors of residents in nursing homes

Contrary to popular myth, family members expressed the desire to be involved with loved ones residing in nursing homes. Open and continuous communication between the nursing staff and family members reduces anxiety and promotes beneficial results to nursing home residents. Although family members want to be kept informed about any changes in their loved one's status, they find it difficult to deal with mental deterioration and need additional support from the nursing staff.

Scientific writing and editing: a new role for the library

Traditional library instruction programs teach scientists how to find and manage information, but not how to report their research findings effectively. Since 1990, the William H. Welch Medical Library has sponsored classes on scientific writing and, since 1991, has offered a fee-based editing service for affiliates of the Johns Hopkins Medical Institutions. These programs were designed to fill an educational gap: Although formal instruction was offered to support other phases of the scientific communication process, the medical institutions had no central resource designed to help scientists develop and improve their writing skills. The establishment of such a resource at Welch has been well received by the community. Attendance at classes has grown steadily, and in 1993 a credit course on biomedical writing was added to the curriculum. The editing service, introduced in late 1991, has generated more requests for assistance than can be handled by the library's editor. This service not only extends the library's educational outreach but also generates a revenue stream. The Welch program in scientific writing and editing, or elements of it, could provide a model for other academic medical libraries interested in moving in this new direction.

Urinary incontinence in an acute care setting

OBJECTIVE

To determine the prevalence of urinary incontinence in an acute care setting and the approaches to the management of it.

STUDY DESIGN

An audit of hospital charts containing a diagnosis of urinary incontinence was conducted to gather data about patient demographics, related factors such as skin integrity and orientation, urinary tract infections, and nursing interventions. The audit was conducted by two data collectors who had an established interrater reliability at 100%.

RESULTS

A 0.87% prevalence rate of cases with a diagnosis of urinary incontinence was found. An additional 13% of cases were documented only in nurses' notes. Nursing comfort measures were the primary choice the management of urinary incontinence. Bladder training and discharge planning were implemented infrequently. Additional findings regarding gender and age distribution, mental status, and management strategies are reported.

CONCLUSIONS

Efforts to diagnosis and treat urinary incontinence must be directed to all age groups. Nursing protocols for accurate and consistent assessment, documentation, and discharge planning with follow-up should be implemented in the acute care setting so that patients can benefit from improved procedures to treat and manage urinary incontinence.

Mongolian gerbils (Meriones unguiculatus) absorb beta-carotene intact from a test meal

Because a yellow color has been observed in the fat pads of Mongolian gerbils fed a nonpurified diet, we designed the current study to determine whether adult male gerbils would absorb beta-carotene intact from a test meal. Thirty-five gerbils (80-90 g) were adapted to the laboratory and fed a standard purified diet free of beta-carotene for 16-19 d. Gerbils were then fed a test meal consisting of 279 nmol of beta-carotene as 10% water-soluble beadlets suspended in 0.5 mL of Ensure. Gerbils (n = 5) were killed at 0, 2, 4, 6, 12, 24 or 72 h after the test meal, blood was obtained by cardiac puncture, and tissues were taken for beta-carotene analysis. No beta-carotene was detected in serum at 0 or 72 h, whereas beta-carotene was present at all other sampling times. Serum beta-carotene peaked at 4 h, at a level of 88 nmol/L. beta-Carotene was detected in the liver of all groups; however, the concentration increased from -34 pmol/g to a maximum concentration of 926 pmol/g at 24 h after the test meal. Other tissues also contained beta-carotene. The results demonstrate that Mongolian gerbils, like ferrets and preruminant calves, absorb beta-carotene intact when beta-carotene is provided at a physiological level in a test meal. This species may be particularly useful for evaluation of the role of antioxidants, such as beta-carotene, in LDL oxidation.

Purification of E. coli-synthesized Pan proteins and development of a Pan-specific monoclonal antibody

The helix-loop-helix (HLH) transcription factors, Pan-1 (E47) and Pan-2 (E12), are produced by the mechanism of alternative transcript splicing. Pan-1 and Pan-2 were expressed in Escherichia coli, and a purification scheme was developed. Purified Pan-2 was used to immunize Smith-Webster mice and a hybridoma was generated that produced a monoclonal antibody (Yae) that specifically recognized both native and denatured Pan-1 and Pan-2. Deletion mapping and sequence transfer studies have localized the determinant recognized by the Yae antibody to the region 195-208 of Pan-2. This region is conserved in Pan-1 and Pan-2. The Yae antibody recognized in vitro-synthesized ITF-1, a third E2A (Pan) gene product also produced by the mechanism of alternative RNA splicing, but did not recognize the related HLH proteins, ITF-2, REB alpha, or REB beta. By Western blot assay of pancreatic acinar cells, the Yae antibody detected a single protein species of 72 kD that comigrated with in vitro-synthesized Pan-1 and Pan-2.

Kinetics of niacin supplements in lactating dairy cows

The kinetics of niacin supplements in lactating dairy cows and the stability of supplements during in vitro fermentation were examined. Four multiparous Holstein cows (200 DIM) with ruminal and duodenal cannulas were fed a TMR either unsupplemented or supplemented with 12 g/d of nicotinic acid, 12 g/d of nicotinamide, or 6 g/d combination of each niacin source in a 4 x 4 Latin square design. Ruminal and duodenal concentrations of nicotinic acid increased with niacin supplementation, but DMI, yields of milk and FCM, most measures of milk composition, ruminal VFA, and plasma NEFA and BHBA concentrations were unaffected by niacin supplementation at this stage of lactation. Apparent digestibilities of most nutrients were greater when both sources of niacin were supplemented than when either source was supplemented separately. Duodenal nicotinic acid concentrations were higher for cows supplemented with nicotinamide than for cows receiving nicotinic acid, but the opposite was true for nicotinic acid concentrations in plasma. The results of both experiments indicated that nicotinamide was converted rapidly to nicotinic acid by microorganisms in the reticulorumen. Supplementation with either nicotinic acid or nicotinamide effectively can increase the amount of nicotinic acid available to the cow; however, some source effects remain to be explained.

The interaction of sodium nitroprusside with peripheral white blood cells in vitro: a rationale for cyanide release in vivo

Isolated monocytes and polymorphonuclear leukocytes release the cyanide anion from the hypotensive agent, sodium nitroprusside. The proposed mechanism involves the production of hydrogen peroxide which oxidizes the substitution inert d6 iron(II) transition metal complex to a labile d5 iron(III) complex. Consequently, the release of cyanide becomes more favoured. This mechanism is supported by the chemical release of the cyanide anion from sodium nitroprusside in vitro by hydrogen peroxide and the demonstrated ability of monocytes and polymorphonuclear leukocytes to generate hydrogen peroxide ex vivo when chemically stimulated by the nitroprusside anion. The results suggest that within a clinical environment white cell counts and cell activation induced as a consequence of disease processes may be important for predicting the toxicity of sodium nitroprusside.

Capturing scarce resources: documentation and communication

When charting does not reflect nursing activities, reimbursement may be denied. Skilled nursing care documentation of quality care rendered allows for reimbursement. Accountability for nursing care goes beyond planning and implementation; it also includes responsible recording and communication of activities. There are many chronic conditions that benefit from nursing intervention yet are not part of admitting diagnoses. Urinary incontinence is an example of a common problem encountered by nurses in hospital settings that requires time, patience, knowledge, and skill to assist those having this condition. It is cost effective to provide the care necessary to improve the treatment and management of urinary incontinence; it is revenue effective to assure that nursing and medical documentation is complete to cover the cost of nursing time and expertise spent providing care to patients with this condition.

Teaching Leadership/Followership to RN-to-MSN Students

Leadership theory is important but a successful leader must at times be a follower. Leadership and followership concepts need to be taught together in a practical exercise. Decision-making, conflict, and resolving interpersonal communication problems are all part of both roles. As individuals become aware of their own leadership styles and inherent strengths and weaknesses, they will be more effective members of management teams. Nurses in leadership roles must work effectively with peers in group activity. To be successful in organizational decision-making, nurses must learn to work with individuals with similar leadership and followership styles as well as with differing points of view. Followership is as indispensable as leadership for success in nursing management roles.

Parenting classes: focus on discipline

Nurses in community settings have an opportunity to provide instruction related to health and life-style needs. An important consideration is the parental role. A particularly controversial and opinion-laden aspect of parenting is disciplining children. Discipline provides children with the security of clearly enforced rules to help them learn self-control and social standards. Parenting classes are worthwhile for people who have little formal or informal preparation. A survey of middle-class elementary school district parents' and childrens' attitudes toward discipline was conducted to develop meaningful parenting classes. Parents' feelings about being a mother or father were surprisingly negative. A parent educational program was developed to cover child growth and development and disciplinary practices. Parent evaluations led to continuation and an expansion of this program to other schools within the area.

Direct spectroscopic determination of functional sulphydryl groups on intact cell surfaces by surface-enhanced resonance Raman scattering

Semi-quantitative and direct determination of labelled sulphydryl groups on the surface of intact erythrocytes has been accomplished for the first time with surface-enhanced resonance Raman scattering (SERRS). The method, which involves the use of citrate-reduced silver colloids, is sensitive and selective. A 10(-8) M effective concentration of picomole quantities of sulphydryl groups was determined in the presence of the normally overwhelming signal from haemoglobin. This seminal study suggests that SERRS may be applied to other in situ, site-directed labelling experiments.

Action of sodium aurothiomalate on erythrocyte membrane

The number of sulphydryl groups on the erythrocyte membrane has been assessed as a function of nutritional status for two groups of patients, one receiving non-steroidal anti-inflammatory drugs (NSAIDs) and the other receiving sodium aurothiomalate (Myocrisin). The patients receiving NSAIDs had a significantly higher number of sulphydryl groups in both the glucose depleted and glucose activated states than the patients receiving sodium aurothiomalate. The study focuses on the hexose transport protein where there is a specific binding site for gold using the two sulphydryl residues on helices 11 and 12 of the protein. The data suggest that the strong binding of gold to the erythrocyte membrane occurs via thiol pairs rather than by isolated sulphydryl groups and that there are possibly two further binding sites for gold on the membrane, the identities of which are still unclear.

Groshong versus Hickman catheters

There has been an increasing need for safe and efficient means of establishing vascular access in the patient with cancer. Recently, the use of percutaneous cannulation of the central veins, using guidewires, venous dilators and tearaway introducer sheaths, has become a popular method of establishing such access. The greatest concerns with the use of such catheters include sepsis, thrombus formation within the vein and catheter malfunction. The current study compared the incidence of these complications with Groshong (Cath Tech CV catheters with Groshong valve) and Hickman (Bard Access Systems vascular access catheters) catheters. Although there was no significant difference in septic complications and thrombus formation between the two groups, there was a significant (p less than 0.05) difference in catheter malfunction. Patients with Hickman catheters experienced significantly less problems with one way intermittent and one way catheters than did patients with Groshong catheters. We conclude that, based on catheter function, the Hickman catheter appears to be a more favorable alternative when compared with the Groshong catheter in the patient with cancer.

An evaluation of pulsus alternans in closed-chest dogs

Pulsus alternans is a condition in which the arterial pressure generated by the heart oscillates between two levels on a beat-to-beat basis. We evaluated the onset of pulsus alternans in chronically instrumented dogs subjected to tachycardia and inferior vena caval occlusion. During pulsus alternans, the left ventricular (LV) end-diastolic volume (EDV) was larger before the strong beats (28.7 +/- 5.3 vs. 25.9 +/- 4.5 ml, P less than 0.001 by paired t test), suggesting that the Frank-Starling mechanism participates in the alternating difference in end-systolic pressure. In addition, however, the ratio of pressure to volume at end systole was greater in the strong beats (2.01 +/- 0.36 vs. 1.46 +/- 0.45, P less than 0.005 by paired t test), a difference that cannot be explained by the Frank-Starling mechanism alone. This indicates that there is also a difference in end-systolic inotropic states between strong and weak beats. These changes occurred without significant alterations in beat-to-beat levels of coronary flow. The time constant of isovolumic pressure fall (T) was faster for the strong beats (37.5 +/- 4.2 vs 61.1 +/- 12.7 ms, P less than 0.002 by paired t test). The onset of oscillation in T preceded the onset of changes in LVEDV and LV systolic pressure in every case by an average of seven beats (range 3-11), suggesting that abnormalities of intracellular calcium handling led to the occurrence of pulsus alternans.(ABSTRACT TRUNCATED AT 250 WORDS)

Treating depression in well older adults: use of diaries in cognitive therapy

A study was conducted with 103 community-based, low-income, well elderly persons who resided in high-rise apartments and were functionally independent. The nursing framework was Roy and Roberts' (1981) adaptation model and techniques from Beck's (1976) theory on cognitive therapy. This study had the dual purpose of determining nurses' ability to identify normal adaptive reactive depression and use techniques from cognitive therapy for depressed subjects. These nurses were able to identify depression using the Diagnostic and Statistical Manual of Mental Disorders (third edition, revised) guidelines with 92% accuracy. Participants were divided into three groups: control group, crafts group, and experimental group. Over 8 weeks, the experimental group received nursing intervention aimed at reinforcing positive input thought patterns. Daily diaries were used for discussion. The experimental group demonstrated a significant reduction in depressive symptoms. The group receiving craft classes decreased their depression scores, suggesting attention-effects depression. The control group demonstrated no significant change in depression scores.

Therapeutic FES: from rehabilitation to neural prosthetics

The purpose of this paper is to review the therapeutic applications of electrical stimulation and to focus on functional neuromuscular electrical stimulation (FES), which is the production of useful muscle contractions for joint stability and limb movement. The use of FES to improve patient function during the recovery period after illness or injury and the transition to FES neural prosthetic systems for patients who do not fully recover will be discussed. Emphasis will be given to the maintenance of posture and the production of purposeful movement from the perspective of technologies and clinical strategies that are available today and from the perspective of those technologies that have the potential for transfer to community health care in the near future.

Renal function after cardiopulmonary bypass in children: comparison of dopamine with dobutamine

We have compared low dose dopamine with dobutamine in conserving renal function in 142 children younger than 10 yr undergoing cardiopulmonary bypass (CPB). Patients were allocated randomly to receive a continuous infusion of either dopamine 2.5 micrograms kg-1 min-1 (group 1) or dobutamine 2.5 micrograms kg-1 min-1 (group 2) from the time of induction of anaesthesia. Administration of inotropes and diuretics was controlled strictly to agreed regimens. There was no clinical or statistically significant difference between the two groups in postoperative urine output, serum concentration of creatinine, fractional sodium excretion or need for diuretic therapy. This was true also of the subgroup of patients who received no other inotropic support. However, the subgroup of patients in group 1 who underwent periods of CPB in excess of 2 h (n = 17) had persistently greater postoperative serum concentrations of creatinine. Low dose dopamine did not appear to be superior to dobutamine for protection of renal function in these patients.

Influence of exercise-induced myocardial ischemia on the pattern of left ventricular diastolic filling: a Doppler echocardiographic study

Previous studies using Doppler echocardiography to evaluate left ventricular diastolic filling have shown that myocardial ischemia induced by coronary balloon angioplasty or atrial pacing results in a decrease in the left ventricular inflow peak early (E) to peak atrial (A) velocity ratio. To investigate the effects of exercise-induced ischemia on Doppler-derived filling variables, 20 patients with coronary artery disease and exercise-induced electrocardiographic changes and regional wall motion abnormalities determined by two-dimensional echocardiography were evaluated and compared with 20 patients without evidence of exercise-induced ischemia. Doppler echocardiography was performed at rest and immediately after exercise before the resolution of exercise-induced wall motion abnormalities. Peak E and A velocities increased from rest to postexercise in both the ischemic and nonischemic groups, although the ischemic group demonstrated a greater increase in peak E velocity (from 68 +/- 15 cm/s at rest to 88 +/- 22 cm/s after exercise) than the nonischemic group (70 +/- 13 to 77 +/- 18 cm/s) (p less than 0.05 for the difference in response between groups). Accompanying these changes was a slight increase in the peak E/A velocity ratio in the ischemic group (1.04 +/- 0.28 at rest to 1.13 +/- 0.42 after exercise) versus a decrease in the nonischemic group (1.07 +/- 0.30 to 0.90 +/- 0.28) (p less than 0.05 intergroup difference).(ABSTRACT TRUNCATED AT 250 WORDS)