Mental health status as a predictor of emergency department visits and hospital readmissions post bariatric surgery: a retrospective cohort study

BACKGROUND

This retrospective cohort study aims to investigate emergency department (ED) visits and readmission after bariatric surgery among patients with a history of anxiety and/or depression. We predict that patients with a reported history of anxiety and/or depression will have more ED visits in the year following surgery than patients without a history of mental illness.

METHODS

Data were collected from the charts of all consecutive patients who underwent sleeve gastrectomy or gastric bypass surgery between March 2012 and December 2019. Data on baseline body mass index, mental health diagnosis and treatment and emergency department visits and hospital readmissions were retrospectively reviewed over the first year following surgery.

RESULTS

One thousand two hundred ninety-seven patients were originally included in this study and 1113 patients were included in the final analysis. Patients with a history of depression (OR 1.23; 95% CI 0.87-1.73), anxiety (OR 1.14; 95% CI 0.81-1.60), or both (OR 1.17; 95% CI 0.83-1.65) did not have a statistically significant increase in ED visits compared to patients without these disorders. Patients with a history of depression (OR 1.49; 95% CI 0.86-2.61), anxiety (OR 1.45; 95% CI 0.80-2.65) or both (OR 1.47; 95% CI 0.94-2.29) did not have a statistically significant increase in hospital readmissions in the first year after surgery compared to patients without these disorders. Patients treated with a sleeve gastrectomy were readmitted due to postoperative complications less frequently than those treated with other surgeries (OR 0.20; 95% CI 0.05-0.83).

CONCLUSION

Patients with a history of anxiety, depression or both did not have an increased rate of emergency department visits and hospital readmissions within the first year following bariatric surgery. This contradicts current literature and may be due to the multidisciplinary program patients undergo at this study's home institution.

Defining RNA oligonucleotides that reverse deleterious phase transitions of RNA-binding proteins with prion-like domains

RNA-binding proteins with prion-like domains, such as FUS and TDP-43, condense into functional liquids, which can transform into pathological fibrils that underpin fatal neurodegenerative disorders, including amyotrophic lateral sclerosis (ALS)/frontotemporal dementia (FTD). Here, we define short RNAs (24-48 nucleotides) that prevent FUS fibrillization by promoting liquid phases, and distinct short RNAs that prevent and, remarkably, reverse FUS condensation and fibrillization. These activities require interactions with multiple RNA-binding domains of FUS and are encoded by RNA sequence, length, and structure. Importantly, we define a short RNA that dissolves aberrant cytoplasmic FUS condensates, restores nuclear FUS, and mitigates FUS proteotoxicity in optogenetic models and human motor neurons. Another short RNA dissolves aberrant cytoplasmic TDP-43 condensates, restores nuclear TDP-43, and mitigates TDP-43 proteotoxicity. Since short RNAs can be effectively delivered to the human brain, these oligonucleotides could have therapeutic utility for ALS/FTD and related disorders.

Spanish-language bariatric surgery patient education materials fail to meet healthcare literacy standards of readability

BACKGROUND

The Hispanic population is the fastest growing ethnic minority in the United States, contributing to nearly half of the population growth over the last decade. Unfortunately, this population suffers from lower-than-average health literacy rates, leading to poorer health outcomes. Per the American Medical Association and National Institutes of Health, patient education materials (PEMs) should be written at no higher than a 6th grade reading level. Given that US Hispanic adults have the second-highest obesity prevalence, this study aims to analyze the readability of Spanish-language PEMs regarding bariatric surgery available in US-based academic and medical centers.

METHODS

A total of 50 PEMs were found via the query ""cirugía de pérdida de peso" site: (edu OR.org)" on the Google search engine. Thirty-nine sources met the inclusion criteria of belonging to a US-based academic or medical center and containing information regarding the indications for bariatric surgery, descriptions of the types of bariatric surgery, what to expect before and after surgery, or the risks and benefits of bariatric surgery. The excerpts were analyzed according to three readability formulas designed specifically for the Spanish language and evaluated for their reading grade level.

RESULTS

All 39 sources were at the college reading level per the Fry graph corrected for Spanish. Per the Spaulding formula, 37 sources were "Grade 12 + " and two sources were "Grade 8-10." Per the Fernandez-Huerta formula, 16 sources were at the 8th/9th grade reading level, 22 sources were at the 7th grade reading level, and one was at the 6th grade reading level.

CONCLUSION

The Spanish-language bariatric surgery PEMs available online from US-based academic and medical centers are generally above the recommended 6th grade reading level. Failure to meet the recommended sixth-grade reading level decreases health care literacy for Spanish-speaking patients within the United States seeking bariatric surgery.

Incidence of the major Brassica pests in northwestern Spain

Kale (Brassica oleracea L. acephala group) crops are common in northwestern Spain, where they are severely damaged by different insect pests. The damage notably affects the value of this crop because it is freshly consumed and fresh processed. The objective of this work was to determine the abundance and relative importance of the main Lepidoptera pests of Brassica crops for 6 yr at five localities in northwestern Spain and to relate the seasonal changes of larval populations and environmental conditions. Pheromone traps were used as a method of monitoring adults. Larval populations were monitored on kales by counting the larvae for several years and locations at different sample dates. Five species were found: Mamestra brassicae (L.); imported cabbageworm, Pieris rapae (L.); Pieris brassicae (L.); diamondback moth, Plutella xyllostella (L.); and Autographa gamma L. Proportions of each insect fluctuated over the years and in the different locations. M. brassicae was the most abundant (48.5% of the total of Lepidoptera species) followed by P. xyllostella (25%) and P. rapae (15%). The use of pheromone traps combined with plant sampling permitted the detection of two generations of M. brassicae. However, adult counts were not correlated to the number of larvae on plants.

Phenotypic stability and plasmid detection in Actinobacillus actinomycetemcomitans

The stability of hemolytic activity, antibiotic resistance and plasmid detection in Actinobacillus actinomycetemcomitans isolates were studied. These characteristics were stable for all experimental conditions. All tested isolates lost or changed some phenotypic characteristics such as colonial morphology and growth in liquid medium.

Intervención educativa comunitaria sobre la diabetes en el ámbito de la atención primaria

OBJECTIVE

To offer an educational alternative on diabetes, with the participation of patients with type 2 diabetes, their family members, and health care providers, adapted to local conditions and to these person's felt needs.

METHODS

Focused on the primary-care level, this program was carried out in the health area of El Guarco, which is in the province of Cartago, Costa Rica. The first stage of the project included a qualitative study of the knowledge and practices of both patients and health care providers, looking at diabetes prevention and control and the local availability of foods. Based on those results, an educational methodology was developed, educational manuals were written, and courses for health care providers, patients, and patients' families were implemented. Other strategies were developed to make the effort sustainable.

RESULTS

We found that patients did not associate family history or obesity with diabetes and that those persons were also confused about the symptoms of diabetes. Patients also received inconsistent nutrition messages from health care providers. Using the diabetes education manual as a base, the providers increased their knowledge of diabetes prevention, treatment, and education by an average of 85%. The diabetic patients who received educational training (mean age, 57.0 years, with a standard deviation of 8.9 years; 92% women) improved their glycemic control. Blood glucose levels decreased from 189 +/- 79 mg/dL (average and standard deviation) to 157 +/- 48 mg/dL (P < 0.05), and glycosylated hemoglobin (HbA1c) went from 11.3% +/- 2.4% to 9.7% +/- 2.3% (P = 0.05). There were no significant changes in body weight or lipid profile, except for triglycerides, which declined (P < 0.05).

CONCLUSIONS

This educational program was successfully incorporated into the regular activities of the El Guarco-area health centers. The primary-care level is ideal for carrying out educational programs for diabetes treatment and early detection that are directed at patients, their families, and health care providers.

Quality of life in patients with heart failure: do gender differences exist?

OBJECTIVE

The purpose of this study was to evaluate gender differences in quality of life (QOL) in a large sample of age-matched and ejection fraction (EF)-matched patients with heart failure.

DESIGN

Matched comparisons of secondary data were used.

SETTING

The setting consisted of multicenter Studies of Left Ventricular Dysfunction trials.

SAMPLE

The sample included 1382 patients (691 men and 691 women) who were age-matched and EF-matched.

OUTCOME MEASURES

Global QOL and the QOL dimensions of physical function, emotional distress, social health, and general health were measured using the Ladder of Life, items from the Profile of Mood States Inventory, the Functional Status Questionnaire, the beta-Blocker Heart Attack Trial instrument, and an item from the RAND Medical Outcomes Study instrument.

RESULTS

Women had significantly worse general life satisfaction, physical function, and social and general health scores than men. There were no significant differences found between gender groups for current life situation or emotional distress. After controlling for New York Heart Association classification, women still had significantly worse ratings for intermediate activities of daily living (a sub-dimension of physical functioning) and social activity.

CONCLUSIONS

Despite controlling for age, EF, and New York Heart Association classification, women had worse QOL ratings than did men for intermediate activities of daily living and social activity. Research should focus on identifying why differences exist and developing measures to improve QOL, particularly physical functioning, in women with heart failure.

Isolation and cloning of Streptomyces terminal fragments

Streptomyces species have a linear chromosome of approximately 8 Mb in size. Many strains also carry linear plasmids. Most of these linear elements contain terminal proteins covalently bound to the 5' ends of the DNA. Using a method for the visualisation of terminal DNA fragments in agarose gels, it was possible to see three fragments in S. rimosus and five fragments in S. avermitilis. The method was also used to clone the 298 bp BamHI fragment carrying the left end of plasmid SLP2. Analysis of the sequence showed that the end resembled other Streptomyces chromosome and plasmid ends, but there were eight palindromes (instead of seven) and a tandem duplication of a 14 bp sequence.

Altered expression of oligopeptide-binding protein (OppA) and aminoglycoside resistance in laboratory and clinical Escherichia coli strains

Oligopeptide-binding protein (OppA) is the periplasmic component of the major oligopeptide transport system of enteric bacteria. Genetic and biochemical evidence suggests that OppA plays a role in the uptake of aminoglycoside antibiotics in Escherichia coli K-12. Forty-six (82%) of 56 aminoglycoside-resistant mutants of E. coli K-12 selected in vitro had reduced or undetectable OppA levels, as compared with their parent strain. Moreover, nine (36%) of 25 aminoglycoside-resistant clinical isolates of E. coli expressed reduced or undetectable levels of OppA. No decrease in OppA expression was observed among aminoglycoside-sensitive E. coli strains from patients. Twenty-three (42%) of 56 aminoglycoside-resistant mutants of E. coli K-12 and six (24%) of 25 clinical isolates also were deficient for expression of ornithine or arginine decarboxylases, or both, and these deficiencies might negatively affect OppA expression by reducing polyamine synthesis. These results support the view that reduced OppA expression is associated with aminoglycoside resistance in E. coli strains.

The effect of transport on the rate of severe intraventricular hemorrhage in very low birth weight infants

OBJECTIVE

To determine the incidence of grade III or IV intraventricular hemorrhage in very low birth weight (VLBW) infants born at level I hospitals and transported to one tertiary center compared with those delivered at the same level III facility.

METHODS

We evaluated all newborns admitted to a large tertiary neonatal intensive care unit from June 1, 1992, through December 31, 1995. All live born infants with birth weights of 500-1200 g and at least 24 weeks' gestation were included. Neonatal transports within 24 hours of delivery from 11 level I facilities were compared with those delivered at the same level III center with respect to grade III and IV intraventricular hemorrhage. Various antenatal and neonatal data were collected.

RESULTS

Thirty-seven newborns (11%) experienced grade III or IV intraventricular hemorrhages among 329 who met study criteria. There were 27 cases (9%) in the 285 inborn neonates compared with 10 of 44 outborn cases (23%) (P < .02, 95% confidence interval 0.15, 0.87). The mean gestational age of the neonates with grade III or IV intraventricular hemorrhages was significantly lower in the inborn group, which further emphasizes the finding. No other study factors explained the difference.

CONCLUSION

We found a higher risk for grade III or IV intraventricular hemorrhage developing in VLBW infants born at level I hospitals and transported to the tertiary care center compared with those born at the level III facility. This data should be considered when analyzing the potential effects of perinatal deregionalization.

Quality of life in women with symptomatic HIV/AIDS

Despite the increasing incidence of cases of human immune deficiency virus (HIV) infection and of acquired immune deficiency syndrome (AIDS) in women, there is a serious lack of information about those women's quality of life (QoL). The purpose of this exploratory descriptive study was to describe QoL using an HIV-specific instrument (the HOPES) every 2 months over a 4-month period in a convenience sample of 44 women with symptomatic HIV/AIDS. Changes in physical, psychological, social, sexual dimensions, and overall QoL were evaluated along with the frequency of the most prevalent distressing items. The mean scores of the global QoL, physical and psycho-social summary scales were significantly different over the 4-month data collection period: quality of life improved. The most prevalent disruptions were in the psycho-social domain, including financial problems, worry about the family, distress about losing others from HIV, and worry about disease progression. The most prevalent physical disruptions included reduction in energy, difficulties with daily activities and frequent pain. Married women appeared to be more vulnerable to disruptions in QoL over time. In addition to the use of conventional disease-specific parameters for the ongoing follow-up of women with HIV/AIDS, the systematic use of a QoL assessment can provide a focused approach to monitoring problems and targeting interventions. Such an approach is especially important for nurses who assist women living with the symptoms of HIV/AIDS.

Potential consequences of widespread antepartal use of ampicillin

OBJECTIVE

Recommendations for the use of antenatal antibiotics in obstetrics have increased in the past few years, especially for prophylaxis against group B streptococci, for prolongation of the latency time in patients with preterm premature rupture of the membranes, and as an adjuvant treatment in preterm labor. Our objective was to determine whether the use of antenatal ampicillin affects the incidence of and resistance of early-onset neonatal sepsis with organisms other than group B streptococci.

STUDY DESIGN

A prospective cohort study was performed between January 1, 1991, and December 31, 1996. Every case of blood culture-proven neonatal sepsis was prospectively surveyed. The type of bacteria isolated, drug resistance, antenatal antibiotic use and treatment indication, gestational age at delivery, and other antenatal and outcome variables were gathered. Early-onset neonatal sepsis was defined as disease onset within 7 days after birth.

RESULTS

A total of 42 cases of early-onset neonatal sepsis among 29,897 neonates delivered were found during the 6-year period. Of these, 15 cases were due to group B streptococci and 27 were the result of non-group B streptococcal organisms (21 gram-negative rods and 6 gram-positive cocci). Among the 27 non-group B streptococcal cases, 15 mothers had received antenatal ampicillin and 13 of the 15 bacterial isolates from these neonates (87%) were resistant to ampicillin, versus only 2 ampicillin-resistant isolates (17%) among the 12 cases in which no antenatal antibiotics were administered (P = .0004). Of the 15 mothers who were treated with ampicillin, 13 received more than 1 dose. In evaluating each year of the study, the overall administration of antibiotics to pregnant women in the antenatal period increased from <10% in 1991 to 16.9% in 1996. The incidence of early-onset neonatal sepsis with group B streptococci decreased during this time, whereas the incidence of early-onset sepsis with non-group B streptococcal organisms, especially Escherichia coli, increased.

CONCLUSIONS

The increased administration of antenatal ampicillin to pregnant women may be responsible for the increased incidence of early-onset neonatal sepsis with non-group B streptococcal organisms that are resistant to ampicillin. At this time penicillin G, rather than ampicillin, is therefore recommended for prophylaxis against group B streptococci. In addition, future studies are needed to determine whether alternate approaches, such as immunotherapy or vaginal washing, could be of benefit.

Developing a team for multicultural, multi-institutional research on fatigue and quality of life

PURPOSE/OBJECTIVES

To describe the process of establishing a multisite team to conduct research with a multicultural focus on fatigue.

DATA SOURCES

Articles, book chapters, personal experience.

DATA SYNTHESIS

Teamwork facilitated development of a productive professional working group, sharing of resources, and data collection culminating in a research proposal for studying cancer-related fatigue in a multicultural population.

CONCLUSIONS

Establishing a common goal by investing time, committing to the process, and establishing trust was the secret to effective team functioning.

IMPLICATIONS FOR NURSING PRACTICE

The prospect of multi-institutional collaboration has implications for oncology nurses in the areas of research and practice. Goals that could not be achieved easily in the setting of a single institution are reached more easily with multisite collaboration and teamwork.

Emotional distress in women with symptomatic HIV disease

This article describes emotional distress in 44 women with Human Immunodeficiency Virus (HIV) symptomatic disease. Measures of self-reported symptoms of anxiety and depression revealed that emotional distress was prevalent in this group and may be sufficiently robust to warrant clinical diagnoses. Limits to functioning and disruptions in physical well-being were found to be associated with both anxiety and depression. Additionally, level of optimism was inversely related to anxiety and depression, and social support was inversely related to anxiety. These findings indicate that emotional distress in women with HIV disease is associated with, and could be ameliorated by, interventions targeted at functional status, social support, and level of optimism.

Comparative efficacy of exosurf and survanta surfactants on early clinical course of respiratory distress syndrome and complications of prematurity

OBJECTIVES

To determine the comparative efficacy of Exosurf Neonatal and Survanta surfactants on the early course of respiratory distress syndrome (RDS), arterial blood gases, ventilatory support, outcome morbidity rate, and complications of prematurity and RDS.

STUDY DESIGN

Medical records from 203 premature newborn infants undergoing mechanical ventilation for respiratory distress syndrome, and who received up to four rescue doses of either Exosurf or Survanta, were retrospectively reviewed.

RESULTS

All groups were comparable for birth weight and gestational age. Although the two randomized groups were similar in severity of RDS based on fraction of inspired oxygen (FIO2) and ventilatory support, a significantly greater improvement in respiratory function as evidenced by FIO2, mean airway pressure, alveolar-arterial partial pressure of oxygen difference, and oxygen index, was observed in the Survanta group from 12 hours (p < 0.05) through 48 hours (p < 0.01). Comparison of outcome morbidity rate by gestational age showed a higher occurrence of retinopathy of prematurity (p < 0.02) among the older infants (28 to 32 weeks) who were treated with Exosurf.

CONCLUSION

Survanta exerted a significantly faster response in the early clinical course of RDS compared with Exosurf. However, no difference in the impact on eventual respiratory outcome was observed. We therefore conclude that both surfactants are effective for the treatment of RDS.

Quality of life and the cancer experience: the state-of-the-knowledge

PURPOSE/OBJECTIVES

To address the state-of-the-knowledge concerning quality of life (QOL) issues and the cancer experience from theoretical, research, clinical, and educational perspectives.

DATA SOURCES

Published books and articles and a panel of experienced QOL experts who convened at the Oncology Nursing Society's State-of-the-knowledge Conference on Quality of Life in February 1995.

DATA SYNTHESIS

Despite the evolution and support of QOL in oncology nursing practice, education, and research, there remains gaps in theory, research, and practice related to QOL. This article explores these gaps in knowledge and recommends future directions for QOL theory, research, education, and practice.

CONCLUSIONS

Further conceptual work and resolution of QOL methodologic issues to guide clinical practice and education are warranted. The impact of cultural variables and precancer life experiences on patients' perceptions of QOL also must be addressed.

NURSING IMPLICATIONS

Oncology nurse clinicians, educators, and researchers must continue to work collaboratively to enhance the knowledge base regarding QOL and to improve the nursing care provided to individuals with cancer.

Combined effects of antenatal corticosteroids and surfactant supplementation on the outcome of very low birth weight infants

Antenatal corticosteroids in preterm pregnancy may result in the reduction of the incidence of respiratory distress syndrome (RDS) and neonatal mortality. It is well known that postnatal use of surfactant in very low birth weight (VLBW) infants with RDS results in decreased neonatal morbidity and mortality. To evaluate the additive beneficial effects of combined antenatal corticosteroids and postnatal use of rescue surfactant on the outcome of VLBW infants, we retrospectively reviewed 286 maternal/infant charts of preterm infants with gestational ages 23 to 32 weeks and birth weights 501 to 1500 gm who were born at our institution from 1991 through 1994. Of the 87 (30%) infants who were treated with corticosteroids before birth, 41 (47%) had RDS, and of the 199 (70%) infants who were not treated with corticosteroids before birth, 162 (81%) had RDS (p < 0.001). The infants who had RDS and who were treated with corticosteroids before birth had a decreased incidence of pulmonary air leaks and a decreased need for diuretic therapy. In addition, they had a significant reduction in O2 requirement and ventilator settings as reflected by FIO2, mean airway pressure, ventilator rate, O2 index, and A-aDO2 before they received the first dose of rescue surfactant (p < 0.05 to p < 0.01) in contrast to other VLBW infants who had RDS and who were not treated with corticosteroids before birth. We conclude that antenatal corticosteroid therapy in threatened premature labor combined with the use of postnatal rescue surfactant is associated with a decreased incidence of RDS and may be beneficial for reducing the severity of RDS and improving the eventual outcome of VLBW infants.

Emotional distress in men with life-threatening illness

This descriptive survey explored the relationship of health status, functional status, stressful life events, stress resistance resources and emotional distress in 60 men with life-threatening illness (N = 30 with cancer and N = 30 with AIDS). Sixty-two percent met CES-D criteria for clinical depression. This study's results supported the hypotheses that poorer functional status and greater negative stressors are associated with both higher levels of hopelessness and depression. Twenty-four patients constituted a group with severe emotional distress. This group was significantly different from the less vulnerable group with poorer functional status (KPS), a greater number and severity of negative stressors, less satisfaction with social support, and less hopefulness.

Cloning and characterization of an alpha-amylase gene from Streptomyces sp WL6

An alpha-amylase gene from Streptomyces sp WL6 was cloned on a 3.1kb DNA fragment, which was completely sequenced. The 3088 nucleotide sequence obtained contains three putative coding regions in the same orientation. The one corresponding to the structural region of the alpha-amylase gene has a deduced amino acid sequence of 459 residues, showing up to 71% identity to other alpha-amylases. An incomplete ORF was identified upstream the alpha-amylase gene, and the deduced product presents some homology to proteins involved in catabolic regulation.

The relationship of stressful life events, health status and stress-resistance resources in persons with AIDS

Depression and hopelessness are major problems in persons with AIDS (PWAs). This study provides a paradigm for viewing these mental health states as outcomes that are dependent on stressors, physical health states, and stress-resistance resources. The sample consisted of 30 male, English-speaking PWAs with stage IV AIDS. A significant positive relationship was found between negative life events and the measure of depression, and number of complications and depression. Satisfaction with social support, intrapersonal hope, and global hope were all significantly, negatively associated with hopelessness. The findings support the importance of stress-resistance resources in promoting mental health in PWAs.

Vasopressin levels in infants during the course of aseptic and bacterial meningitis

We measured urine vasopressin (VP) once daily on days 1 through 3 in 18 patients hospitalized with meningitis. Urine VP values were 215 +/- 100, 116 +/- 44, and 69 +/- 23 pg/mL on days 1 through 3, respectively, for children with bacterial meningitis and 34 +/- 14, 20 +/- 4, and 15 +/- 4 pg/mL for those with aseptic meningitis. Urinary VP levels of infants with bacterial meningitis were significantly greater than those of healthy ambulatory subjects (n = 18) on all three study days; VP values of infants with bacterial meningitis were also greater than those of infants with aseptic meningitis on study days 2 and 3. The VP levels for the subjects with aseptic meningitis were significantly greater than those of the controls on day 1 only. None of the infants exhibited the clinical syndrome of inappropriate antidiuretic hormone secretion.

The experience of pain and perceptions of quality of life: validation of a conceptual model

Pain is a common symptom of terminally ill cancer patients and a major challenge for hospice care. This paper presents a conceptual model of the relationship between pain and quality of life that was derived from the authors' previous research. The model should prove useful to hospice clinicians and researchers in evaluating the impact of palliative care on the quality of life.

Uncertainty in illness theory: a replication of the mediating effects of mastery and coping

The purpose of this investigation was to replicate a test of the mediating functions of mastery and coping and to determine whether the relationships found in the initial test of the model would hold with a sample more heterogenous than the original sample. One hundred women receiving treatment for gynecological cancer participated in the investigation. Of the 14 relationships in the model, only 5 replicated significant paths and had overlapping confidence intervals. Two moderators were proposed to explain the differences between the initial and replication tests of the model and to improve the specificity of the theory.

Vasopressin levels and pediatric head trauma

The syndrome of inappropriate secretion of antidiuretic hormone is associated with head trauma; however, there are no reports concerning vasopressin levels in pediatric patients with head trauma. Urine vasopressin in eight children (mean +/- SEM, age 7.5 +/- 1.6 years, range 1 to 15 years) was measured by radioimmunoassay during their hospitalization for head trauma. Urine vasopressin values for ten healthy children (mean age 5.4 +/- 1.3 years) and for eight children hospitalized for systemic antibiotic treatment of infections (age 5.9 +/- 1.8 years) also were obtained. Urine vasopressin, urine and serum sodium concentration and osmolality, urea nitrogen, creatinine, and fluid intake were measured within 24 hours of admission and daily for the following two days. For the first three days following head trauma, mean urine vasopressin levels in pediatric patients with head trauma were increased (P less than .05) compared with those of healthy children. Despite fluid restriction to 85% of maintenance level, 25% of patients with head trauma exhibited the clinical syndrome of inappropriate secretion of antidiuretic hormone (hyponatremia, increased urinary sodium, diminished serum osmolality, and urine osmolality greater than serum osmolality). Urine osmolality greater than 800 mosm/kg was associated with markedly increased urine vasopressin levels (200 to 1,650 pg/mL); children with this finding may be at particular risk for the syndrome of inappropriate secretion of anti-diuretic hormone without restrictive water intake.

Collaborative nursing research: anatomy of a successful consortium

The purpose of this paper is to describe the collaborative efforts of one successful research group. The Tube Feed Consortium Group was composed of seven investigators who lived in four different geographic locations. One of the members served as principal investigator and chairman of the group; the others as coinvestigators. A coinvestigator served as principal investigator in each location, managing subcontracted budgets and scientific concerns. This structure promoted efficiency in budget management, conflict management, and division of labor. Major advantages to this approach to the conduct of research included (a) a large number of subjects studied in a relatively short time period; (b) a data collection structure, which permitted wider generalization than data collected in one institution by one investigator; (c) a mechanism for direct replication and replication with expansion; (d) maximum usage and distribution of resources between investigators. Mechanisms established early in the history of the group helped to achieve maximum communication, resolve potential conflicts, ensure reliability of data, ensure publication and presentation rights of collaborators, and manage the overall budget and subcontracts. The group remained intact for eight years, completed all the proposed studies plus other related studies, presented numerous papers, and continues to publish findings of these endeavors.