Assessing risk using different cholesterol-screening methods

The purpose of this study was to compare total capillary, total venous, risk ratio, high-density lipoprotein and low-density lipoprotein measures of cholesterol to determine whether total capillary cholesterol is a valid measure to use in cholesterol screening. An announcement and a registration form were distributed with employee paychecks announcing a cholesterol-screening programme. Capillary and venous samples were collected from screening participants (n=285). Results indicated false negatives in total capillary cholesterol in 17.21-34.4% of cases compared with other methods of cholesterol measurement. Due to the high number of misclassifications, health educators should not use total capillary cholesterol as a predictor of risk for heart disease, nor as a measure for referral during cholesterol screenings.

Risk/benefit profile of arsenic trioxide

Approximately 20%-30% of patients with acute promyelocytic leukemia (APL) who are treated with the current standard all-trans retinoic acid and anthracycline-based chemotherapy regimen suffer relapse. In the mid-1990s, studies from China reported the effective use of arsenic trioxide in achieving complete remission in patients with APL. In the United States, a multicenter trial of this agent in 40 patients with relapsed APL following conventional therapy confirmed the positive safety and efficacy outcomes of a smaller 12-patient pilot study. Common adverse events were hyperleukocytosis, APL differentiation syndrome, prolonged QT interval on electrocardiogram, skin rash, and hyperglycemia.

Nutritional issues in patients with severe neutropenia

OBJECTIVES

To provide information on the assessment and management of the nutritional needs of patients with severe neutropenia.

DATA SOURCES

Textbook chapters, research articles, and review articles.

CONCLUSIONS

Malnutrition is a common result of high-dose chemotherapy treatment. Clinical outcomes are directly related to careful assessment, early intervention, and ongoing evaluation and monitoring in the severely neutropenic population.

IMPLICATIONS FOR NURSING PRACTICE

Early assessment, management, and psychological support are essential in meeting the needs of this patient population.

Effects of sex composition by class and instructor's sex on physical self-efficacy of college men

The relationship of sex composition of class and instructor's sex to Physical Self-efficacy has yielded conflicting results in several studies. This study examined the relationship of sex composition of class and instructor's sex to scores on Physical Self-efficacy, Perceived Physical Ability, and Physical Self-presentation Confidence of 80 male students enrolled in one of four sections of a strength training class. Analysis indicated no significant difference on Physical Self-efficacy between male students who were enrolled in all male classes or in coeducational classes; improvements in scores on Physical Self-efficacy were not specific to the sex composition of the class or sex of the instructor and no significant difference on Perceived Physical Ability and Physical Self-presentation Confidence between male students who joined an all male class or a coeducational class. Perceived Physical Ability improved from the pretest to the posttest in all classes; and no improvement in scores for Physical Self-presentation Confidence was found in all classes. In conclusion, the analysis showed sex composition of the class and sex of the instructor were not significantly related to scores for self-efficacy.

Recognizing and managing anemia

Anemia is not an uncommon problem. Knowledge of a few common laboratory tests can be helpful when caring for patients with anemia. By reviewing approaches to classifying, evaluating, and managing patients with common anemias, nurses will be prepared to care for patients with an anemia more confidently.

Oprelvekin: an alternative treatment for thrombocytopenia

Oprelvekin (Neumega, Genetic Institute Co., Cambridge, MA) is a thrombopoietic growth factor approved by the U.S. Food and Drug Administration for the prevention of severe thrombocytopenia following myelosuppressive chemotherapy in patients with nonmyeloid malignancies. The most common side effects are edema, dyspnea, tachycardia, and conjunctival redness. Patient-care concerns include appropriate timing of administration, patient selection, dosing and administration issues, and the early identification and management of side effects.

The novel lipid delivery system of amphotericin B: drug profile and relevance to clinical practice

PURPOSE/OBJECTIVES

To review the drug profile and nursing implications associated with the new lipid amphotericin preparations.

DATA SOURCES

Published articles, abstracts, professional communications, drug manufacturer prescribing information, and personal experience.

DATA SYNTHESIS

Three lipid amphotericin B (AmB) preparations have been approved by the U.S. Food and Drug Administration (FDA). The first agent, amphotericin B lipid complex (Abelcet, Liposome Co., Princeton, NJ), a ribbon-like structure, was approved in November 1995 for the treatment of aspergillosis in patients who are refractory to or intolerant of conventional amphotericin B therapy and for invasive fungal infections. In November 1996, amphotericin B cholesteryl sulfate complex for injection (Amphotec, Sequus Pharmaceuticals, Menlo Park, CA), a second preparation composed of a disc-like structure, received FDA approval for the treatment of invasive aspergillosis in patients in whom renal impairment or unacceptable toxicity precludes the use of conventional AmB therapy and in patients in whom prior AmB therapy has failed. Amphotec frequently is referred to as amphotericin B colloidal dispersion (ABCD). The third formulation, a liposomal preparation composed of vesicles, liposomal amphotericin B or L-AmB (AmBisome, Fujisawa USA, Inc., Deerfield, IL, and Nexstar Co., Boulder, CO) recently received FDA approval for three indications. All of these preparations accumulate in organs of the reticuloendothelial system as opposed to the kidneys. Further studies of lipid AmB are needed to help clarify the usefulness of each AmB preparation. The most common side effects of lipid AmB preparations are chills and fever.

CONCLUSIONS

Lipid-based AmB preparations are well-tolerated treatments with mild to moderate side effects. These preparations have some advantages over conventional AmB.

IMPLICATIONS FOR NURSING PRACTICE

Nurses in clinical settings can focus on staff and patient education, including identification and management of side effects associated with the lipid-based AmB preparations. Patient-care concerns include appropriate patient selection, dosing and administration issues, and the prevention, early identification, and management of toxicities.

Involvement of adult rehabilitation patients in setting occupational therapy goals

OBJECTIVE

This preliminary study was designed to determine whether occupational therapists involve patients and their families in a goal-setting process and, if so, to identify the methods used.

METHOD

Thirty registered occupational therapists practicing in adult physical rehabilitation settings were audiotaped during an initial evaluation. Researchers reviewed corresponding documentation and interviewed each subject. Twenty-three patient and family involvement criteria were generated from standards developed by accreditation commissions and health care professions.

RESULTS

Data revealed that although subjects did involve patients and families in a goal-setting process, a number of criteria were not attempted, thus much potential for involvement was unrealized. Subjects with scores above and below one standard deviation from the mean were identified to determine which patient participation criteria had the highest discrepancies. Discrepancies included (a) verbal preparation of the patient and family for initial and ongoing treatment, purposes and procedures of evaluation and treatment, and potential outcomes of treatment, (b) attempts to elicit the patient's concerns, and (c) collaboration with the patient to establish treatment goals.

CONCLUSION

Factors that might have influenced subjects' use of a patient participation approach included the application of a specific theory or technique, time constraints, patient's age, and assumptions about the patient's cognitive status.

Solar flares: an overview

This is a survey of solar phenomena and physical models that may be useful for improving forecasts of solar flares and proton storms in interplanetary space. Knowledge of the physical processes that accelerate protons has advanced because of gamma-ray and X-ray observations from the Solar Maximum Mission telescopes. Protons are accelerated at the onset of flares, but the duration of any subsequent proton storm at 1 AU depends on the structure of the interplanetary fields. X-ray images of the solar corona show possible fast proton escape paths. Magnetographs and high-resolution visible-band images show the magnetic field structure near the acceleration region and the heating effects of sunward-directed protons. Preflare magnetic field growth and shear may be the most important clues to the physical processes that generate high energy solar particles. Any dramatic improvement in flare forecasts will require high resolution solar telescopes in space. Several possibilities for improvements in the art of flare forecasting are presented, among them: the use of acoustic tomography to probe for subsurface magnetic fields; a satellite-borne solar magnetograph; and an X-ray telescope to monitor the corona for eruptions.

Electrooptic Fabry-Perot filter: development for the study of solar oscillations

Observations of nonradial solar oscillations require Doppler velocity measurement at many points over the photosphere with a velocity resolution better than 1 m/s. An attractive form of imaging spectrophotometer for such a task utilizes a thin, solid, electrically tunable Fabry-Perot interference filter or etalon made of an electrooptic material such as lithium niobate (LiNbO(3)). The problems to be overcome in producing such an etalon for an imaging spectrophotometer are discussed and practical solutions demonstrated on the basis of measurements made on prototype devices.

Solar Flares, Proton Showers, and the Space Shuttle

The space shuttle era will focus renewed attention on the hazards of the space environment to human habitation. The chief unpredictable hazard for astronauts is energetic proton radiation from solar flares. In some orbits, there is no reasonable level of shielding material that will protect shuttle occupants from potentially lethal doses of radiation. The effects of a solar flare that occurred druing the first flight of the Columbia are discussed and current flare research reviewed. The emphasis is on progress made during the recent international Solar Maximum Year toward understanding the origins of proton showers.