Med-Match: An Interactive Game to Learn Medications for Clinical Practice

Knowing medications and their use in patient care is a component of safe practice. The Med-Match game transforms learning medications from a solitary task to an interactive activity. Educational games create real-life scenarios in a safe, context-rich environment without real-world consequences. Gaming is a form of active learning; learning occurs as a result of student-to-student interaction, peer feedback, and faculty debriefing. Although this activity was initially developed for nursing students, it can also be used with new RNs being oriented to a clinical setting or as an annual review for experienced nurses.

Care of the Neonate on Nasal Continuous Positive Airway Pressure: A Bedside Guide

Respiratory distress continues to be a major cause of neonatal morbidity. Current neonatal practice recommends the use of nasal continuous positive airway pressure (nCPAP) in the immediate resuscitation and continued support of neonates of all gestations with clinical manifestations of respiratory distress. Despite the many short- and long-term benefits of nCPAP, many neonatal care units have met resistance in its routine use. Although there have been numerous recent publications investigating the use and outcomes of various modes of nCPAP delivery, surfactant administration, mechanical ventilation, and other forms of noninvasive respiratory support (high-flow nasal cannula, nasal intermittent positive pressure ventilation), there has been a relative lack of publications addressing the practical bedside care of infants managed on nCPAP. Effective use of nCPAP requires a coordinated interprofessional team approach, ongoing assessment of the neonate, troubleshooting the nCPAP circuit, and parent education.

Format of Parent Education Material Preferred by New Mothers

A descriptive cohort study to determine new mothers' preferred modality for educational materials, and if the format impacted the mothers' perception of an evidenced-based practice safe sleep program. The sample included new mothers anticipating discharge from a mother-baby unit with their newborn. Participants responded to a four-item survey administered by a research assistant. Respondents' self-reported preferred format for patient education was technology-based materials in both cohorts. The video teaching material as compared with the paper handout was rated significantly higher by participants. Modalities of patient education in health care organizations need to be consistent with the changing ways people are learning and accessing information in their everyday life.

The Impact of a Mindfulness Intervention for Nurse Managers

Purpose: To examine the impact of a mindfulness intervention on nurse managers in an acute care hospital. Design: A pre/post intervention design with three data collection points: prior to, at the conclusion of, and at 3 months following the intervention. Method: A survey to measure the impact of a mindfulness workshops on nurse managers’ perception of professional quality of life, burnout, and perceived wellness. Findings: There were significant changes in the scores on the compassion satisfaction (T-1 mean 3.9, T-2 mean 4.5, p = .002) and burnout subscales (T-1 mean 3.4, T-2 mean 2.8, p = .016) of the Professional Quality of Life scale, and on personal burnout (T-1 mean 4.2, T-2 mean 3.8, p = .023) and work-related burnout (T-1 mean 4.0, T-2 mean 3.5, p = .029) on the Copenhagen Burnout Inventory scale, following the mindfulness intervention. The 3-month follow-up scores on compassion satisfaction were higher but not statistically significant ( p = .810). Scores on the burnout scales, while lower than the preintervention levels, were higher at the 3-month follow-up than immediately following the intervention. Conclusions: These findings suggest that mindfulness practices need to be reinforced. Without continuous reinforcement, it may become a self-care practice moved to the bottom of the list of things to be done among the activities of a busy day.

When a Baby Is Sent Away: Evidence to Support Best Practice After Neonatal Transport

Every day neonates are transported from the birth hospital to a tertiary neonatal care center. Separation of mother and neonate in the hours immediately following birth interrupts the bonding process and can have long-term implications for the mother-child relationship. This article synthesizes the literature focused on mothers' experiences with a neonate being transported to a tertiary NICU and identifies evidence-based practices specific to these situations.

The Infant Born to a Woman with Gestational Diabetes

Gestational diabetes mellitus (GDM) is defined as glucose intolerance with onset during pregnancy. During pregnancy, women with GDM develop insulin resistance, which results in altered glucose tolerance. As a result, there are frequent episodes of hyperglycemia and high levels of circulating amino acids, increasing the transfer of nutrients to the fetus. This article discusses the role of the mother-baby nursing in the care of neonates born to women with gestational diabetes.

The Risks Associated with Red Blood Cell Transfusion: Implications for Critical Care Practice

This systematic literature review informs the clinician caring for the critically ill patient of the risks associated with red blood cell (RBC) transfusion. Data were extracted from publications between 2008 and 2016 and were reviewed to determine their usefulness in providing evidence associated with the risk of receiving an RBC transfusion. They reveal that this intervention may exacerbate certain clinical conditions and increase mortality and morbidity rates. Further scientific study is needed to better inform clinical practitioners about the inherent risks and benefits associated with the common clinical intervention of RBC transfusion in the critically ill patient.

Partnering for Evidence-Based Practice

This column describes an academic service partnership to promote evidence-based practice.

Preeclampsia and Care of the Newborn

Preeclampsia is one of the most common complications in the last half of pregnancy. Mother-baby nurses are often present at the birth to provide neonatal care as well as ongoing care during the first days of life. This article discusses the implications of preeclampsia for the neonate and the role of the mother-baby nurse in the care of these infants.

Idea to Publication: Sharing Your Clinical Innovations

Nurses are actively involved in the development of innovative practice projects and in the development of evidence-based guidelines. But rarely are the ideas of nurses and clinical leaders shared in professional publications. This column discusses the importance of sharing one's work through publication and provides strategies to get started.

Quality Appraisal: Part I

Quality appraisal is an essential step in the evidence-based practice process. This column focuses on designating the level of evidence of the scientific research.

Quality Appraisal: Part II

Quality appraisal is an essential step in the evidence-based practice process. This column focuses on evaluating the quality of the individual study and its applicability to practice.

An evidence-based safe sleep teaching program

This column describes the experience of the units practice council in developing an evidence-based practice teaching program focused on safe sleep for newborn infants.

Preparing for NICU discharge: mothers' concerns

PURPOSE

To quantify mothers' concerns in anticipation of their infant's discharge from the NICU.

DESIGN

An exploratory, cross-sectional survey design was used.

SAMPLE

A convenience sample of 150 mothers.

MAIN OUTCOME VARIABLE

The focus was the mothers' concerns about their infant's impending discharge.

RESULTS

The mothers expressed confidence in their ability as a caregiver but expressed concern about being tired, the need for readmission to the hospital, and missing a change in the infant's conditions.

Five Years Later: Are Accelerated, Second-Degree Program Graduates Still in the Workforce?

This retrospective study explores the work activities of graduates from an accelerated, second-degree BSN program. There is documented growth in the number of accelerated, second-degree programs and the number of graduates from these programs. However, there are no published studies of whether or not these graduates are members of the workforce 5 years following graduation. This retrospective study found that the majority of the graduates are employed in nursing, and a large percentage have earned or are pursuing advanced degrees in nursing.

Are you statistically literate? A basic overview of statistics

The relationship between high oxygen levels and blindness in small preterm infants is common knowledge in today's NI CU. However 60 years ago, tiny babies were routinely given oxygen without knowledge of the relationship between the concentration of oxygen being administered and the subsequent outcome of the infant being blind.1 Today's knowledge is the result of research methods and statistical techniques that identified this relationship and predicted the consequences of high concentrations of oxygen administration.

What attracts second degree students to a career in nursing?

The fastest growing university-based nursing programs are the accelerated programs of study for students who hold a baccalaureate degree in another discipline and desire to change careers. Understanding the factors that attract these individuals to the study and practice of nursing is important for nursing recruitment and retention. In this article the author describes how she analyzed the stories of the first two cohorts of students (N=66) admitted to an accelerated, second degree program in the Southeastern United States. These stories, written by prospective students, described the factors that influenced their decision to pursue the study of nursing as a second career. A content analysis identified three themes: What I bring to nursing; Seeking satisfying work; and The missing piece. The findings provide insight into the factors that attract the second degree/career changing learner to the study of nursing. The author begins with a review of literature related to the reasons for choosing nursing as a profession and a description of the method used to analyze the stories written by the prospective students. This is followed by her presentation of findings, along with a discussion of the findings and the implications of the findings for educators and employers.

Do Nurse Preceptors Care?

Caring is a concept foundational to person-to-person interaction. Mayeroff (1971) described three components of a caring relationship. This qualitative study uses stories written by nurse preceptors to explore the relationship between the preceptor and the new hire/preceptee. The analysis searched for evidence of the components of a caring relationship from the perspective of the nurse preceptor. This study fills a gap by describing the caring components of the preceptor’s behaviors. Enhancing our understanding of nurse preceptors’ behaviors to create a caring relationship with newly hired nurses is important for the profession and to the retention of nurses.

Health-related quality of life following a surgical weight loss intervention

Nursing is concerned with the well-being of the whole person; therefore, understanding the patient's perspective of the impact of a surgical weight loss intervention (SWLI) is essential. The purpose of this study was to examine the self-reported health-related quality of life of individuals after a SWLI. A convenience sample of participants in a post-SWLI support group completed the SF-12v2, a demographic form and a global quality of life measure. Findings indicate that although overall quality of life was rated excellent or very good, self-report of health-related quality on social functioning, vitality, and mental health was less positive. The findings of this pilot study indicate the need for research regarding the understanding of the meaning of psychosocial and physiological well-being to the person who undergoes a SWLI and a need for a more holistic support focus inclusive of psychosocial development strategies. As nurses committed to the wholeness of individuals, it is critical that we recognize the social and emotional needs of this emerging group of patients and implement strategies to enhance individual wholeness and well-being after SWLI.

Accelerated Second-Degree Program Evaluation at Graduation and 1 Year Later

For an individual with a prior bachelor's degree, the accelerated second-degree program offers the quickest route to becoming a registered nurse. But does this quick route lead to satisfaction with the educational experience and perceived effectiveness of preparation to be a professional nurse? The author reports the findings of a study of student satisfaction with an accelerated program of study and the perceived effectiveness of preparation for work as a professional nurse.

CAN-Care: An Innovative Model of Practice-Based Learning

The "Collaborative Approach to Nursing Care" (CAN-Care) Model of practice-based education is designed to meet the unique learning needs of the accelerated nursing program student. The model is based on a synergistic partnership between the academic and service settings, the vision of which is to create an innovative practice-based learning model, resulting in a positive experience for both the student and unit-based nurse. Thus, the objectives of quality outcomes for both the college and Health Care Organization are fulfilled. Specifically, the goal is the education of nurses ready to meet the challenges of caring for persons in the complex health care environment of the 21st century.

Arrhythmia knowledge: a qualitative study

OBJECTIVE

The objective is to identify and describe critical care nurses' perception of arrhythmia knowledge. In addition, this study is the first step in developing levels of arrhythmia competency.

DESIGN

A qualitative research design was used. Focus group technique using a semistructured group session, with a moderator, was used to gather data. Data were analyzed by the constant comparative method.

SUBJECTS

The subjects were critical care nurses who work in acute care settings where they read electrocardiographic data and make treatment decisions.

PROCEDURES

Five focus groups were conducted over a period of 12 months. Group size ranged from four to eight participants. Participants were asked to describe their perceptions of arrhythmia knowledge and to assign a rating score related to the level of knowledge needed to identify specific arrhythmias.

RESULTS

Basic, intermediate, and advanced levels of arrhythmia knowledge were identified. This study revealed a deficit in nurses' ability to recognize and identify specific arrhythmias including heart block, aberrant conduction, and tachyarrhythmias. Understanding of lead placement concepts varied greatly among participants.

CONCLUSIONS

The insight and perspective of critical care nurses related to the level of arrhythmia knowledge are needed for the development of competency measures and evidence-based teaching strategies.

Expedient liquid chromatographic method with fluorescence detection for montelukast sodium in micro-samples of plasma

This study describes an expedient assay for the analysis of the asthma medication, montelukast sodium (Singulair, MK-0476), in human plasma samples. After a simple extraction of the plasma, the drug and internal standard, quinine bisulfate, were measured by HPLC. The chromatographic system consisted of a single pump, a refrigerated autosampler, a C8 4-microm particle size radial compression cartridge at 40 degrees C and a fluorescence detector with the excitation and emission wavelengths set at 350 and 400 nm, respectively. The mobile phase which was delivered at 1.0 ml/min, was prepared by adding 200 ml of 0.025 M sodium acetate, pH adjusted to 4.0 with acetic acid, to 800 ml of acetonitrile, with 50 microl triethylamine. With a run time of only 10 min per sample, this assay had an overall recovery of >97% with a detection limit of 1 ng/ml. The inter- and intra-run relative standard deviations at 0.05, 0.2 and 1.0 microg/ml were all <9.2%, while the analytical recovery at the same concentrations were within 7.7% of the amount added.

Neonatal skin care: clinical outcomes of the AWHONN/NANN evidence-based clinical practice guideline. Association of Women's Health, Obstetric and Neonatal Nurses and the National Association of Neonatal Nurses

OBJECTIVE

To test the effectiveness of an evidence-based clinical practice guideline for neonatal skin care on selected clinical outcomes for newborns in neonatal intensive-care units (NICU), special-care units (SCU), and well-baby nurseries.

DESIGN

Prospective evaluation of the collaborative neonatal skin care research-based practice project of the Association of Women's Health, Obstetric and Neonatal Nurses and the National Association of Neonatal Nurses.

SETTING

NICU and well-baby units in 51 hospitals located throughout the United States.

PARTICIPANTS

Member site coordinators (N = 51) and the neonates (N= 2,820) observed during both the pre- and postimplementation phases of the project.

METHOD

Site coordinators received specialized education in neonatal skin care and implemented an evidence-based clinical practice guideline addressing 10 aspects of neonatal skin care. Baseline observations of skin condition, care practices, and environment of newly admitted neonates were collected by site coordinators. Postimplementation observations were then completed.

MAIN OUTCOME MEASURES

Skin condition was assessed with the Neonatal Skin Condition Score (NSCS), which ranges from a score of three (best condition) to a score of nine (worst condition), based on dryness, erythema, and skin breakdown. Changes in frequency of selected skin care practices were used to assess the effectiveness and feasibility of using the practice guideline in everyday clinical practice. Aspects of the care environment with potential effect on skin integrity were monitored to determine risk factors.

RESULTS

Fifty-one site coordinators made 11,468 systematic assessments of 2,464 NICU and SCU newborns and 356 well newborns. Baseline skin scores were better in well newborns compared with premature newborns. After implementation of the guideline, skin condition was improved, as reflected by less visible dryness, redness, and skin breakdown in both the NICU/SCU and well newborns. The guideline was integrated into care, as evidenced by increased use of emollients, particularly with premature infants, and decreased frequency of bathing. A relationship was shown between selected aspects of the environment and alterations in skin integrity.

CONCLUSIONS

Use of the AWHONN/NANN Neonatal Skin Care Research-Based Clinical Practice Guideline was successfully implemented at 51 sites, and effectiveness was demonstrated by changed care practices and improved skin condition in premature and full-term newborns. The results of this project support a wider dissemination of the project's practice guideline for neonatal skin care.

Neonatal skin care: evaluation of the AWHONN/NANN research-based practice project on knowledge and skin care practices. Association of Women's Health, Obstetric and Neonatal Nurses/National Association of Neonatal Nurses

OBJECTIVE

To develop and evaluate an evidence-based clinical practice guideline for assessment and routine care of neonatal skin, educate nurses about the scientific basis for practices recommended in the guideline, and design procedures that facilitate implementation of the project guideline into clinical practice.

DESIGN

Descriptive report of the collaborative neonatal skin care research-based practice project of the Association of Women's Health, Obstetric and Neonatal Nurses and the National Association of Neonatal Nurses.

SETTING

Neonatal intensive-care unit (NICU) and special-care nurseries and well-baby nurseries in 51 hospitals located throughout the United States.

PARTICIPANTS

Member site coordinators (N = 51), nurses who work at the selected sites, and the neonates observed during both the pre- and postimplementation phases of the project (N = 2,820).

METHOD

An evidence-based clinical practice guideline was developed, sites were selected from all respondents of the call for sites, site coordinator training was provided, data collection was facilitated by project-specific data collection tools, and the project was evaluated by the science team.

MAIN OUTCOME MEASURES

Diversity and numbers of sites represented, patient representation, site coordinator knowledge of neonatal skin care pre- and postimplementation, use of project-designed implementation tools, satisfaction with project guideline and the data collection process, changes in practices and product use, and site coordinators' experiences during guideline implementation.

RESULTS

Fifty-one sites completed the project, representing NICU, special-care, and well-baby nurseries in both academic and community hospital settings in 27 states. Registered nurses working in these sites totaled 4,754 full-time equivalent positions (FTEs) (in NICU/special-care and well-baby nurseries). Site coordinators demonstrated increased knowledge of research-based neonatal skin care and satisfaction with the implementation tools and data collection process. Product use changed, reflecting acquisition of new knowledge. Barriers to implementation of the guideline were identified.

CONCLUSIONS

The AWHONN/NANN Neonatal Skin Care Research-Based Practice Project demonstrated increased knowledge among site coordinators who received training, facilitated changes in neonatal skin care as defined by the practice guideline, and thus advanced evidence-based clinical practice.

Culturally sensitive care during childbirth

The objective of this study was to identify culturally grounded meanings of the concepts of comfort, presence, and involvement in the context of the childbirth experience. This was an exploratory study using a descriptive, qualitative design. The sample was made up of Black and White American women more than 18 years of age, who had given birth within the past 72 hours, and spoke English as their primary language. The analytical protocol followed was content analysis-i.e., the systematic reduction and simplification of data. To increase the validity and reliability/reproducibility of the analytic strategy, the researchers independently reviewed the process of data reduction to ensure conceptual clarity and consistency in the classification and elucidation of data. The conclusion reached was that differences exist between Black and White American women as regards descriptions and expectations about the concept of comfort and involvement during the labor and birth experience. These findings have implications for individual nursing practice behaviors as well as for the development of unit-based policies and prenatal education.

Sensitive assay for the determination of cefazolin or ceftriaxone in plasma utilizing LC

A rapid, specific and very sensitive liquid chromatographic assay using standard ultraviolet detection has been developed to measure cefazolin (CFZ) or ceftriaxone (CFX) in small samples (200 microl) of plasma using either drug as the internal standard for measurement of the other. A rapid extraction was performed using C18 bonded Sep Pak cartridges with high extraction efficiency for both drugs. The chromatographic system employed the use of a Nova-Pak C18 4-microm cartridge with a radial compression system preceded by a Guard-Pak with a C18 insert. The mobile phase consisted of an aqueous solution containing 10 mM of dibasic potassium phosphate and 10 mM cetyltrimethylammonium bromide (pH 6.5) with acetonitrile (73:27 v/v). The drug and internal standard (CFZ/CFX) were detected using a UV detector set at a wavelength of 274 nm. Assay results were linearly related to the concentration (r > 0.997) for the wide range which was examined (0.005-120 microg/ml) for either drug. We report the precision, accuracy, recovery, linearity, sensitivity and specificity of this assay. The intra-run and inter-run CV was less than 9.02%. This method is currently being used for clinical therapeutic monitoring and pharmacokinetic studies of CFZ and CFX in patients undergoing cesarean section.

Optimization of oral etoposide dosage in elderly patients with non-Hodgkin's lymphoma using the fraction of dose absorbed measured for each patient

This study was undertaken to investigate the pharmacokinetics of etoposide for optimizing its oral dosage in elderly patients with non-Hodgkin's lymphoma (NHL) using the fraction of dose absorbed calculated from the data generated from first oral and intravenous doses in the same patient. Twenty-three NHL patients (ages 61-95 years) entered this study. Each received 50 mg/m2 of etoposide by 1-hour i.v. infusion, which was repeated every 24 hours for 5 days. The second cycle commenced on day 21, with etoposide being administered by mouth at a dose as close to 50 mg/m2 as possible. Serial blood samples were collected and analyzed for etoposide by HPLC. The fraction of dose absorbed (F) was calculated as F = (AUCor/AUCi.v.) (Di.v./Dor), and etoposide was then given orally for the following 20 days at a daily dose equivalent to Dor/F. After 1 week free of etoposide administration, a second cycle of oral etoposide at the adjusted dose was given for 21 days. The mean +/- SD values for t1/2 beta, tmax, Cmax, CLTor, and MRT observed following the first oral dose were 8.98 +/- 4.84 h, 1.39 +/- 0.96 h, 0.083 +/- 0.046 mg.L-1/mg.m-2, 1.89 +/- 1.2 L.h-1/m2, and 10.37 +/- 2.76 h, respectively, and those observed following the first intravenous dose were 8.05 +/- 5.11 h, 1.57 +/- 0.17 h, 0.142 +/- 0.043 mg.L-1/mg.m-2, 1.25 +/- 0.44 L.h-1/m2, and 7.69 +/- 1.53 h, respectively. The mean +/- SD of F was 0.80 +/- 0.34. The data obtained indicate that optimization of etoposide oral dosage using F yielded good clinical results while keeping the morbidity at a level that is similar to that of the i.v. administration.

Suspended mothering: women's experiences mothering an infant with a genetic anomaly identified at birth

PURPOSE

To develop an understanding of the experiences of women who give birth to an infant with a genetic anomaly not identified during the prenatal period.

DESIGN

Exploratory design using selected qualitative methods.

SAMPLE

Seven mothers of liveborn infants with a genetic anomaly characterized by physical attributes evident at birth.

MAIN OUTCOME VARIABLE

Mother's expressions of suspended mothering.

RESULTS

Two themes emerged that characterize the experience of suspended mothering: diminished maternal role and false protection. PRACTICE RECOMMENDATIONS: Facilitating maternal involvement in decision making requires giving women unbiased information in a supportive manner.

Plasma and urinary selenium in Saudi Arabian patients with dilated cardiomyopathy

We measured selenium (Se) levels in the urine and blood plasma samples of 72 Saudi Arabian patients with dilated cardiomyopathy (DCM) and 70 control subjects of the same origin. To correct for differences in the hydration state of the subjects, the selenium concentration for each urine sample was normalized by dividing it by the concentration of creatinine (CREAT) in the same sample. The median (and range) of the values found for the concentration of Se in plasma, urine, and normalized concentration in urine for the control subjects was 1.306 (0.66-2.50) microM, 0.478 (0.05-2.00) microM, and 56.7 (10.6-426.5) microM Se/M CREAT, respectively, whereas, for the patients, it was 1.246 (0.53-2.45) microM, 0.39 (0.05-1.90) microM, and 75.1 (4.9-656.2) microM Se/M CREAT, respectively. Additionally, the patients were separated into three subgroups according to the severity of their disease state as judged by NYHA procedure, and were then compared to the control group. Only group 4 (the most severe state of the disease) had a significantly lower concentration of urinary Se than the control group. However, the difference became nonsignificant when normalized for CREAT levels. There was no significant difference in the plasma Se levels between the controls and any of the patient groups. As the plasma Se in the control group and in the DCM patients both fell on the low end of the "normal" range, with the patients being marginally lower than the controls, there is no firm evidence from this study to suggest that Se is related to the high incidence rate of DCM found in Saudi Arabia.

Neonatal skin care: the scientific basis for practice

OBJECTIVE

To review the literature addressing the care of neonatal skin.

DATA SOURCES

Computerized searches in MEDLINE and CINAHL, as well as references cited in articles reviewed. Key concepts in the searches included neonatal skin differences; neonatal skin and care practices for skin integrity; neonatal skin and toxicity; permeability; and contact irritant sensitization.

STUDY SELECTION

Articles and comprehensive works relevant to key concepts and published after 1963, with an emphasis on new findings from 1993 to 1999. One hundred two citations were identified as useful to this review.

DATA EXTRACTION

Data were extracted and organized under the following headings: anatomy and physiology of the skin; physiologic and anatomic differences in neonatal skin; nutritional deficiencies; skin care practices; and care of skin breakdown.

DATA SYNTHESIS

Newborns' skin is at risk for disruption of normal barrier function because of trauma. In light of available evidence about differences in neonatal skin development, clinical practice guidelines are suggested for baths, lubrication, antimicrobial skin disinfection, and adhesive removal. In addition, basic care practices are suggested for maintaining skin integrity, reducing exposure to potentially toxic substances, and promoting skin health beyond the neonatal period. Preventive care recommendations are made for reducing trauma, protecting the skin's immature barrier function, and promoting skin integrity.

CONCLUSIONS

This review generated evidence with which to create a new and comprehensive practice guideline for clinicians. Evaluation of the guideline is under way at 58 U.S. sites.

Neonatal skin care: the scientific basis for practice

OBJECTIVE

To review the literature addressing the care of neonatal skin.

DATA SOURCES

Computerized searches in MEDLINE and CINAHL, as well as references cited in articles reviewed. Key concepts in the searches included neonatal skin differences; neonatal skin and care practices for skin integrity; neonatal skin and toxicity; permeability; and contact irritant sensitization.

STUDY SELECTION

Articles and comprehensive works relevant to key concepts and published after 1963, with an emphasis on new findings from 1993 to 1999. One hundred two citations were identified as useful to this review.

DATA EXTRACTION

Data were extracted and organized under the following headings: anatomy and physiology of the skin; physiologic and anatomic differences in neonatal skin; nutritional deficiencies; skin care practices; and care of skin breakdown.

DATA SYNTHESIS

Newborns' skin is at risk for disruption of normal barrier function because of trauma. In light of available evidence about differences in neonatal skin development, clinical practice guidelines are suggested for baths, lubrication, antimicrobial skin disinfection, and adhesive removal. In addition, basic care practices are suggested for maintaining skin integrity, reducing exposure to potentially toxic substances, and promoting skin health beyond the neonatal period. Preventive care recommendations are made for reducing trauma, protecting the skin's immature barrier function, and promoting skin integrity.

CONCLUSIONS

This review generated evidence with which to create a new and comprehensive practice guideline for clinicians. Evaluation of the guideline is under way at 58 U.S. sites.

The role of selenium deficiency in dilated cardiomyopathy in Saudi Arabia

BACKGROUND

Selenium deficiency is implicated in the etiology of endemic juvenile dilated cardiomyopathy in China, and in sporadic cases in other countries. The aim of this study was to evaluate the role of selenium deficiency in the pathophysiology of dilated cardiomyopathy in the Saudi Arabian population.

PATIENTS AND METHODS

Plasma and urine selenium concentrations from 72 Saudi patients with confirmed dilated cardiomyopathy were compared with corresponding values from 70 control subjects of the same national origin who had normal ventricular function.

RESULTS

Plasma and urine selenium concentrations (mean+/-SD) were 1.347plusmn;0.45 and 0.49+/-0.37 micromol/L, respectively, for the patient group, and 1.32+/-0.41 and 0.60+/-0.41 micromol/L, respectively, for the control group. The differences in the values between the two groups were statistically insignificant.

CONCLUSION

In the Saudi population, dilated cardiomyopathy is not caused by selenium deficiency.

Simultaneous high-performance liquid chromatography analysis of azithromycin and two of its metabolites in human tears and plasma

This article describes a high-performance liquid chromatographic (HPLC) method for the measurement of azithromycin (AZI) and two of its metabolites, 9a-N-desmethylazithromycin (ADES) and N-desmethylazithromycin (NDES), in human tears and plasma. The drug, metabolites, and internal standard (n-propylazithromycin [IS]) were detected electrochemically after injection of the extracted sample into the HPLC system. The peak height ratio (AZI, ADES, or NDES to IS) varied linearly, with concentrations in the ranges of 0.1 mg/L to 2.0 mg/L (tears) and 0.01 mg/L to 2.0 mg/L (plasma) of AZI, ADES, and NDES; the correlation coefficient (r) was more than 0.994 mg/L for all of the compounds (n=6). The analysis of tear samples collected at different intervals within 12 hours to 144 hours after a dose of 20 mg/kg of AZI from a trachoma patient yielded concentrations ranging from 1.52 mg/L to 0.34 mg/L for AZI, 0.79 mg/L to 0.27 mg/L for ADES, and 1.99 mg/L to less than 0.20 mg/L for NDES. The concentration of AZI in plasma ranged from 0.15 mg/L to 0.01 mg/L, whereas ADES and NDES were undetectable.