American Association of Critical-Care Nurses demonstration project: patients' recollections of critical care

Although more patients are surviving illness that requires critical care, little is known about the impact of the critical care experience on patients as they recall it. In this study we describe 59 patients' recollections of the critical care experience within 24 to 48 hours after transfer from the unit. Responding to an open-ended series of questions, patients accurately identified why they were admitted to critical care units. Actions related to observations, technical care, alleviation of concerns, and self-care promotion were recalled by patients. Nurses were the persons most frequently associated with such actions. In contrast, physicians were most frequently cited as the source of information about their health condition. Almost half of the patients who were willing and able to be interviewed described the impact of the experience as positive or neutral. Pain and sleeplessness were the major problems identified by patients.

American Association of Critical-Care Nurses Demonstration Project: profile of excellence in critical care nursing

The American Association of Critical-Care Nurses developed a Demonstration Project to document fiscal costs and patient care effectiveness of critical care nursing in a unit characterized by valued organizational attributes. Data were collected by interview, observation, and written surveys from 42 nurses, 68 physicians, and 192 patient admissions. Decentralized administration, participatory management, high rate of CCRN certification, all-registered nurse staff, and high nurse-physician collaboration were present. Organizational and clinical outcomes were positive: high satisfaction, low turnover, low mortality ratio, no new complications, high patient satisfaction. The proportion of charges for nursing-controlled factors was low compared with proportion of total stay spent in the unit. Aspects of structure, process, and outcome can be measured simultaneously in critical care; these measurements indicate that positive organizational and clinical outcomes coexist with valued aspects of the organizational environment.

Developmental intervention program for high-risk premature infants: effects on development and parent-infant interactions

Developmental follow-up studies have documented that low birth weight infants are at high risk for mental and physical disabilities, despite recent advances in neonatal intensive care. Moreover, parent-infant bonding is hampered by the barriers created by technical equipment. This study evaluated a program of hospital and home-based developmental interventions designed to enhance the development of high-risk, preterm infants and the quality of communication between infants and their caregivers. Treatment and contrast groups consisted of 41 premature infants weighing less than 1800 g at birth. Treatment took a preventive approach, consisting of daily multimodal interventions in-hospital and twice-monthly interventions by child development specialists in the child's home, through 12 months adjusted age. Infants in the contrast group received traditional, remedially oriented care. The Bayley Scales of Infant Development were used to measure mental and psychomotor development, and the Greenspan-Lieberman Observations System (GLOS) was used to analyze the behavioral characteristics of infant-caregiver interactions. Developmental interventions had positive, significant effects on mental development and on the quality of caregiver-infant interactions. Changes in mental development were not independent of changes in the GLOS.

Specific thromboxane synthetase inhibition and retinopathy in insulin-dependent diabetics

We have previously reported that specific thromboxane synthetase inhibition may be associated with a reduction in albumin excretion rate in insulin-dependent diabetics (IDD). We now report studies of retinal morphology assessed by serial fluorescein angiography in 25 insulin-dependent diabetics during a 16-week double-blind, randomized, placebo-controlled study of the specific thromboxane synthetase inhibitor UK-38,485. Assessment of angiograms was by, computerized image analysis indicating the percentage area of vascularization and, panel scoring by 4 ophthalmologists who scored the posterior pole in each of the 4 angiograms "blind" according to a prearranged system. There was no significant change in percentage area of vascularization in either placebo or "active" group during the study. Panel scoring, however, suggested that some patients deteriorated whilst others remained unchanged or improved. There was, however, no significant difference in these parameters between those subjects on UK-38,485 and those on placebo. We conclude that specific thromboxane synthetase inhibition is not associated with any significant change in diabetic retinopathy over a 4-month period of study.

Human monocyte recognition of complement-coated lymphoblastoid cells

The macrophage system in man plays a significant role in the detection of foreign cells. The mechanisms by which macrophages recognize malignant cells, however, are not well understood. We used human monocytes and four lymphoblastoid cell (LC) lines derived from human acute lymphocytic leukemia to investigate the initial recognition of tumor cells by monocytes. IgM antibody mediated the binding of these cells to monocytes only in the presence of complement. The stepwise addition of complement components to IgM-coated LC indicated that C3 was necessary to monocyte binding. Similarly, monocyte recognition of IgM-coated LC was maximal in the presence of sera from patients with congenital C5 or C6 deficiency, but absent in the presence of sera deficient C4 or from a patient with congenital C2 deficiency. Complement activation was associated with C3 consumption and the deposition of substantial amounts of C3 on to LC. Although 3H-C3 bound to LC appeared stable for 2 hours, approximately 4.0 +/- 2 X 10(5) 3H-C3 per LC was necessary for monocyte recognition, compared to approximately 2.7 +/- 0.5 X 10(3) 3H-C3 per RBC. The data indicate that LC can be recognized by monocytes through complement by mechanisms similar to nonmalignant target cells. However, substantial amounts of C3 are necessary to induce monocyte recognition of IgM-coated LC and, thus, such complement mediated recognition may be inefficient.

Cortisol and catecholamines changes as functions of time-of-day and self-reported mood

Six male graduate students, unrestricted in their lifestyle, collected their own urine over a seven-day period: it was analysed for cortisol, noradrenaline, adrenaline and dopamine. At each urination subjects self-assessed their mood. On two separate days, blood samples were collected at 4-hourly intervals for plasma cortisol assay. Mean plasma cortisol levels showed the expected circadian variation, but two subjects had divergent patterns. Mean urine cortisol accumulation also showed circadian variation with a 2-4 hour lag behind plasma values. Mean urine catecholamine levels showed both time of day and considerable individual variation. A statistical procedure, involving comparison of two models, was developed to determine differences between subjects' excretion patterns. An underlying common pattern of cortisol and catecholamines excretion was found. Regression of hormone levels against self-assessed mood changes revealed correlations of (1) adrenaline accumulation with physical fatigue, (2) cortisol with alertness and (3) ratios of adrenaline, noradrenaline and dopamine with tenseness and irritability.

Influence of 2-deoxy-D-glucose on feeding in the rat at different times of the light-dark cycle

Two concentrations of 2-deoxyglucose (2-DG) were injected into adult male Long-Evans rats at four times during the 12:12 light/dark cycle. At low concentrations (300 mg/kg) in the first 3 h of a 6-h test period, 2-DG significantly increased feeding (268%) in the early part of the light period (EL) when compared to uninjected and saline-treated controls. In the late light (LL), 2-DG increased feeding by 48% but this was not statistically significant. For the high-concentration groups (750 mg/kg), 2-DG increased feeding by 240% in the EL, 117% in the LL, 50% in the early dark (ED) and 45% in the late dark (LD). As there was no significant interaction, it was concluded that 2-DG facilities feeding at all times of the day. In the second 3 h of the recorded 6 h, 2-DG decreased feeding by 37-45% in the ED and middle dark (MD) when compared to controls, although the suppression was significant only for the low concentration of 2-DG. There was some support from data on water intake and latencies to eat and drink for the view that 2-DG-induced feeding was not secondary to thirst stimulated by hypertonic injection fluids. It is concluded that 2-DG injection facilitates feeding for a few hours but the net effect on food intake may be reduced in the light, and even nullified in the dark, by a subsequent reduction of intake in rats with free access to food.

Free-running activity rhythms in the rat: entrainment by melatonin

The pineal gland hormone melatonin may play a role in synchronization of rat circadian rhythms. Free-running activity rhythms of the rat were entrained by a daily melatonin injection, with entrainment occurring when the onset of activity coincided with the time of daily injections. When injections were stopped, activity rhythms became free-running again. Thus in pharmacological experiments, the time of day of melatonin administration is crucial.

Evidence for a separate meal-associated oscillator in the rat

Three experiments were conducted to explore the relationship between food availability and the wheel running activity rhythms of intact rats. In two experiments re-entrainment when meal times were changed was studied. The rats showed an increase in activity immediately prior to a regular feeding time and this increase was more rapid when rats had been fed at that time in an earlier condition. Some evidence of transients at a former meal time was observed when the meal time was shifted to later in the day, but not when the meal time was shifted to earlier in the day. This led to the hypothesis that ad lib feeding masks rather than abolishes meal-entrained activity. In a third experiment, therefore, rats were entrained to a daily meal under a light-dark (LD) cycle, then placed in constant dark (DD) on ad lib food with occasional periods of deprivation. A burst of activity associated with the former meal time occurred during the deprivation period, but not during ad lib periods; it returned during subsequent deprivation. It is concluded that meal feeding entrains a separate oscillator with a period different from the oscillator entrained by the LD cycle.

The media as an approach to adolescent health education

A series of eight 60-second dialogues was cooperatively produced by the Tacoma-Pierce County Health Department's Adolescent Clinic and KTAC Radio, Tacoma, Washington. The format was one in which the radio announcer made a statement concerning adolescent health, followed by an adolescent's asking a specific health question, a response being made by a health professional, and the announcer's concluding by giving a local resource and phone number. Included in this series were questions about weight reduction, scoliosis, headaches, hypertension, sexually transmitted diseases, temper and anger, stress, and fatigue. The dialogues were aired ten times a day at times appropriate for the adolescent listener. In addition to acquainting the adolescent with clinic and community services, this series gave answers to many developmental questions that may influence the adolescent's behavior and self-concept.

Brief psychodynamic psychotherapy: interrater agreement and reliability of individually specified outcomes

We tested Malan's method of constructing outcome criteria in brief dynamic psychotherapy by positing a core neurotic problem, psychodynamic outcome criteria, and psychodynamically oriented target criteria for 41 neurotic outpatients receiving either psychotherapy or behavioral therapy. We found that trained raters could assess psychodynamic problems and outcomes with high interrater reliability and agreement. Using these measures with behavioral therapy as well as psychodynamic therapy patients, we found that the psychodynamic ratings could be extended to patients not treated psychodynamically. Thus, we feel individualized psychodynamic ratings can be used to assess treatment effects on a reliable psychodynamic basis, and that individualized ratings can be extended to studies which contrast specific psychodynamic outcomes to those of other treatments.

Food and water deprivation: changes in rat feeding, drinking, activity and body weight

Groups of male rats totally food deprived for periods up to 96 hr, water ad lib do not totally regain body weight lost through deprivation. Degree of body weight defence was estimated by fitting statistically a curve to the predeprivation baseline data and extrapolating the curve over the deprivation and postdeprivation period. From group data, body weight is not fully defended. However, marked individual differences in degree of body weight defence were noted. During food deprivation the daily drinking cycle persists for approximately 48 hr, then a reduction in nocturnal drinking appears. General activity increases but only in the light period. After food restitution, the main hyperphagia is confined to the first post-deprivation day. Additional, subtle long term effects of overeating in the light period are also found. In contrast to food deprived groups, water deprived groups accurately defend body weight. During water deprivation daily food intakes decrease immediately whereas nocturnal activity decreases after approximately 72 hr of deprivation has elapsed. After the termination of water deprivation the immediate response is gross hyperdipsia, but again subtle long term effects are apparent. Total daily food intake increases for many days but the increase is not confined to either light or dark periods. Water intake is similarly affected. These results are evaluated in relation to the notion of a body weight set-point regulating feeding behavior. Some limitations on the value of the findings in terms of species differences and lack of ecological validity are also discussed.

Persistence of rat nocturnal feeding and drinking during diurnal presentation of palatable diet

Male laboratory rats were fed a highly palatable diet during the light phase of a 12:12 LD cycle. Nocturnality of feeding was reduced from approximately 77% of the total daily intake to 56%. Increase in diurnal feeding was attributable to the ingestion of a large meal at the beginning of the L phase. Reduction of nocturnal feeding was attributable to decreased ingestion in the first 3 hr of the D phase. Outside these times the daily feeding pattern was unmodified. These findings do not represent a reversal of the feeding rhythm as previously reported, but a modification which is not consistent with interpretation as a phase-shift. Throughout the testing period total daily food intake remained unchanged and body weight was defended despite the increase in calories ingested. Daily drinking patterns and total daily water intake were not significantly altered by the experimental manipulation.

A chronometric approach to the study of feeding behavior

In many mammalian genera, the stimulus to feed is intimately associated with circadian rhythms. This stimulus arises from within the brain from biological time-keeping systems. Such a chronometric approach to feeding behavior follows from a consideration of the terrestrial mammal's space-time pattern within the ecological niche. The ecological niche is a division of time as well as space. The restriction of certain behaviors to certain times of day and the concomitant evolution of nocturnality or diurnality represent strong advantages for survival in the wild. Experimental data, primarily from studies on the rat, in support of the chronometric approach, include: the reinstatement of cyclic feeding patterns after food deprivation; the continuation of circadian pattern of wheel running and nocturnal drinking during food deprivation; consideration of the ontogeny of the feeding pattern; the phenomenon of anticipatory appetite--the experimental demonstration that time of day can act as a conditioned stimulus for feeding; the evaluation of rhythms in digestion, absorption and assimilatory biochemical processes; the realization that many of these rhythms are not simply a consequence of the presence of food in the gut; the realization that the brain exerts considerable control over the peripheral rhythmic nutritional processes via ANS and endocrinological systems; and the fact that within the brain the SCN and structures well known to be involved in nutritional regulation, such as the VMH, LHA and monoamine systems, may all be involved in the circadian pattern of feeding. Further, the function of these neurological structures may be understood better by consideration of data from temporal changes in feeding patterns.