Relation between neurological status, refractive error, and visual acuity in children: a clinical study

The aims of the present study were: (1) to determine the refractive status and visual acuity of a group of 75 neurologically impaired children (5 to 192 months of age); and (2) to investigate the relation between the visual and neurological status of these children. Refractive error was determined using non-cycloplegic near retinoscopy and visual acuity was estimated using acuity cards (Keeler or Cardiff) and pattern-onset visual evoked potentials (VEP). Subjects demonstrated a markedly different distribution of refractive error from that of a neurologically normal age-matched population. Refractive error anomalies were more prevalent in children older than 5 years, suggesting abnormal refractive development. A wide range of visual acuity was found with both tests (acuity cards, 0.07 to 2.08 logMAR; VEP, O.78 to 2.68 logMAR). Visual acuity and refractive status varied with level and type of physical impairment. Level of intellectual impairment exhibited a weak relation with visual status.

Cognitive impairment, depression and the specificity of autobiographical memory in the elderly

Previous research has shown that both depressed (Williams & Scott, 1988) and elderly (Winthorpe & Rabbitt, 1988) people have difficulties in being specific in autobiographical memory. However, no study has examined the joint impact of cognitive impairment and affective disturbance. In this preliminary study, 22 elderly people with memory complaints were tested with the Autobiographical Memory Test, the Brief Assessment Schedule Depression Cards, Geriatric Depression Scale and the Mini-Mental State Examination. Results showed that autobiographical specificity decreased with increasing levels of cognitive impairment. Participants were more likely to produce overgeneral memories (omissions or generic memories) than extended or specific memories. There was little relation between severity of depression and specificity in autobiographical memory, consistent with previous suggestions that overgenerality in depression is a long-term cognitive style unaffected by state depression (Brittlebank, Scott, Williams & Ferrier, 1993).

Detection of somatic mutations of the bcl-2 oncogene in B cell lymphomas with the t(14;18)

The incidence of mutations within the first 582 bp of the open reading frame of the bcl-2 gene, has been investigated in presentation lymph node samples, from 7 cases with follicular non-Hodgkin's lymphoma (NHL), 1 case with centroblactic NHL, the DOHH, cell line derived from the immunoblastic transformation of a follicular NHL and one case with benign follicular hyperplasia. A total number of 43 point mutations within the examined portion of the bcl-2 gene were detected in the cases analysed including the DOHH, cell line. Similar analysis of peripheral blood lymphocytes from 2 normal individuals that lacked the t(14;18), revealed no mutations in one case and a single 101 bp A-->G transition in clone, in the other. Missense mutations were detected in 7/8 NHLs, the DOHH2 cell line and the case of benign follicular hyperplasia. There was a significantly higher frequency of mutations within the region corresponding to the BH1, one of the two known functional domains, of the bcl-2 protein. The same position, 445 bp of the bcl-2 gene, was found to be involved in missense mutations affecting the DOHH2 cell line and 3 cases with follicular NHL.

A mucosal irritancy test device for intraoral use in dogs

The objective of this investigation was to conduct, in dogs, a 6-hour acute mucosal irritation study of a new bioerodible treatment. The main problem was to retain the test drug in situ without extraneous irritation from the retention device. A buccal cup was machined from acrylic with a chamber capacity of 0.025 ml and a flange that could be ligated to a tooth. Ten female retired breeder beagles, 7 to 8 years old, with naturally occurring moderate periodontitis were examined and the upper canine teeth scaled to remove plaque and calculus. One week later the buccal cups were placed at the gingival margin of the upper canine teeth and fixed in place with wire ligature passing through holes in the flange and around the tooth, engaging shallow nicks made in the enamel near the gingival margin so the wire would not slide up and down. The buccal cup was further stabilized with glass ionomer cement placed on the crown and over the outer surface of the cup. Buccal cups were loaded with test, placebo, or no ointment by technicians in a scheme to which examiners were blind. Hourly examinations were made, and after 6 hours the cups were removed and gingival mucosa scored for irritation by a previously described method. All dogs tolerated the test and retained the cups for 6 hours. There was no mucosal irritation from the empty cups. We conclude that this new device can be used successfully for testing new agents for short-term mucosal irritancy.

Legal issues in nonrelated infant adoption: nursing implications

PURPOSE

To highlight the legal issues surrounding nonrelated infant adoptions.

POPULATION

Parties in the adoption triad--the infant, the biological parent(s), and the adoptive parent(s).

CONCLUSIONS

Current adoption laws have been influenced by a historical stigmatization of adoption by society, states' sovereignty rights, and individual's constitutional rights. Controversies surrounding nonrelated infant adoptions have highlighted the inadequacies of the present system of adoption laws and regulations. Nurses can take a proactive role in their practice by acquiring a clear understanding of the legal issues surrounding adoption.

PRACTICE IMPLICATIONS

Knowledge about state adoption laws, regulations, and resources, as well as the legal issues surrounding infant adoption, will allow the nurse to take a proactive role in formulating and providing supportive interventions that assist all parties through the process.

Fluoxetine versus tricyclic antidepressants: a prospective multicenter study of antidepressant drug overdoses. The Antidepressant Study Group

This study compares the clinical course of tricyclic antidepressant and fluoxetine overdose. The study was a prospective case series of 9 urban hospital systems. Consecutive sampling of overdose patients presenting to emergency departments provided the participants for the study. The therapy was determined by each institution. Clinical, laboratory, economic impact, and coroners' information was gathered. Of 622 patients, 482 were excluded because of significant coingestants or lack of laboratory confirmation, leaving 124 tricyclic antidepressant and 16 fluoxetine cases. Twenty-seven percent of tricyclic antidepressant patients were alert on arrival to the emergency department; only 12.9% remained alert. The following were significantly more frequent after tricyclic antidepressant overdose: agitation, tachycardia, QRS prolongation, terminal R-wave deviation, intubation, coma, and admission to the intensive care unit. The mean tricyclic plus metabolite level was 777.6 ng/mL (range = 20-5260 ng/ mL), and the mean fluoxetine plus metabolite level was 496.4 ng/mL (range = 120-1930 ng/mL). There were two tricyclic antidepressant deaths. Of 179 total drug-ingestion deaths from the coroners' records, 38 were from tricyclic antidepressants and none from fluoxetine. Thus, tricyclic antidepressant overdoses resulted in more toxicity and more frequent admissions to the intensive care unit than did fluoxetine overdoses.

Concrete strategies for sensitizing youth-serving agencies to the needs of gay, lesbian, and other sexual minority youths

In the past few years, several authors have detailed the needs of gay and lesbian youths and the obstacles youth-serving agencies face in addressing their needs. How administrators and practitioners can make changes in agencies that are not adequately serving sexual minority youths has been unclear. This article uses the experiences of two youth-serving agencies to offer recommendations on agency philosophies concerning the social realities of sexual minority youths and on several ways of creating a safe, welcoming, and productive environment.

Nitric oxide inhibition of transforming growth factor-beta and collagen synthesis in mesangial cells

Culture of mesangial cells (MCs) in 5.6 vs. 30.0 mmol/l glucose for 3 weeks induced a sustained increase in protein kinase C (PKC) activity, transforming growth factor (TGF)-beta1 mRNA, bioactive TGF-beta, and collagen synthesis. Nitric oxide (NO), generated exogenously by the NO donor S-nitroso-N-acetyl, D,L-penicillamine (SNAP) or endogenously after the exposure of MC to interleukin-1beta (IL-1beta), suppressed bioactive TGF-beta in MCs cultured in 5.6 or 30.0 mmol/l glucose and suppressed or abolished increases in TGF-beta1 mRNA and collagen synthesis induced by high concentrations of glucose or phorbol 12,13-dibutyrate without altering values obtained with normal glucose concentrations. SNAP had a transient suppressive effect on PKC activity, which may explain at least in part some of the actions of SNAP. The selective inhibitor of PKC, bisindolylmaleimide (GFX), mimicked NO action. The ability of SNAP and IL-1beta to suppress TGF-beta and collagen synthesis was not mediated by cGMP, since the cGMP analog, 8-Br-PET-cGMP, did not mimic NO action and an antagonist of cGMP-dependent protein kinase, Rp-8-pCPT-cGMPs, did not prevent the inhibitory actions of SNAP. N-omega-L-arginine methyl ester (NMMA) increased TGF-beta in glomerular capillary endothelial cells (GCECs) and stimulated collagen synthesis by MC in a co-culture with GCECs. Captopril inhibited TGF-beta and collagen synthesis and increased cGMP in co-cultures of GCECs and MCs. These effects of captopril were abolished by NMMA, implying mediation by NO. Thus, endogenous NO produced by GCECs may modulate TGF-beta production by both GCECs and MCs and act to suppress matrix protein synthesis by MCs.

Predictors of coronary artery disease in patients with cocaine-associated myocardial infarction. Cocaine-Associated Myocardial Infarction (CAMI) Study Group

PURPOSE

To identify clinical criteria predictive of underlying coronary artery disease in patients with cocaine-associated myocardial infarction.

PATIENTS AND METHODS

Using a retrospective cross-sectional study design at 29 acute care hospitals, we identified 70 patients with cocaine-associated myocardial infarction who had a determination of the presence or absence of coronary artery disease. Clinical characteristics of patients with coronary artery disease (> 50% stenosis on cardiac catheterization or reversible ischemia on stress test) were compared with patients without coronary artery disease (< 50% stenosis on cardiac catheterization).

RESULTS

Compared with patients without coronary artery disease (n = 21), patients with coronary artery disease (n = 49) were older (42 versus 31 years; P < 0.001), had more traditional cardiac risk factors (2.3 versus 1.5; P < 0.001), more frequent history of hypertension (odds ratio [OR], 5.3; 95% confidence interval [CI], 1.4 to 20.4); more frequent family history of myocardial infarction (OR, 4.4; 95% CI, 1.3 to 15.1), more bradydysrhythmias (OR, 8.0; 95% CI, 1.0 to 65.5), and more likely to have an inferior infarct location (P = 0.04).

CONCLUSION

Age, number of cardiac risk factors, location of myocardial infarction, and bradydysrhythmias predict underlying coronary artery disease in patients with cocaine-associated myocardial infarction. If validated, this knowledge may be used to develop a medically appropriate, cost-effective evaluation strategy for patients following cocaine-associated myocardial infarction.

Obstructive sleep apnoea: diagnosis and management

Snoring and the associated syndrome of sleep apnoea can have severe effects on the lives of sufferers and their families. This article discusses why obstructive sleep apnoea is potentially fatal, and how it may be identified and managed.

Intralesional fluorouracil/epinephrine injectable gel for treatment of condylomata acuminata. A phase 3 clinical study

BACKGROUND AND DESIGN

A new intralesional sustained-release chemotherapy is under development as a treatment for condylomata acuminata; it is administered as an injectable gel that consists of fluorouracil and epinephrine with a purified bovine collagen as the gellant (fluorouracil/epinephrine gel). In this randomized, double-blind study, we evaluated the safety and efficacy of this intralesional treatment in 401 patients, using 2 active drug formulations (fluorouracil/epinephrine gel and fluorouracil gel alone) and a placebo. Each lesion was injected once a week for up to 6 weeks, and patients were followed up for 3 months.

RESULTS

A total of 359 patients with 1926 condylomata underwent evaluation. For all lesions treated with fluorouracil/epinephrine gel, the complete response (CR) rate was 77%. For all patients treated with fluorouracil/epinephrine gel, the CR rate was 61%. The fluorouracil/epinephrine gel was significantly more effective (P < .002) in treating condylomata than the fluorouracil gel without epinephrine (CR rate, 43%); both were superior to placebo (CR rate, 5%). At 3 months after completion of treatment, recurrence rates in patients with CRs were as follows: fluorouracil/epinephrine gel group, 50%; fluorouracil gel group, 58%. No clinically significant drug-related systemic reactions occurred. Finally, the type and severity of local tissue reactions of patients with a positive pretreatment collagen skin test result (6/401 [1.5%]) were similar to those of patients with a negative collagen skin test result.

CONCLUSION

The fluorouracil/epinephrine injectable gel is a safe and effective treatment for condylomata acuminata.

Oral pilocarpine improves radiotherapy-induced dry eyes

We report a patient with angiosarcoma of the scalp, who was treated with radiotherapy that included both orbits. Following treatment, he developed dry eyes, which improved with oral pilocarpine. Although this drug is used to stimulate salivary flow in patients with radiotherapy-induced xerostomia, it has not been reported before as a treatment for dry eyes following radiotherapy.

The need for pediatric-specific triage criteria: results from the Florida Trauma Triage Study

OBJECTIVE

The objective of the Florida Trauma Triage Study was to assess the performance of state-adopted field triage criteria. The study addressed three specific age groups: pediatric (age < 15 years), adult (age 15-54 years), and geriatric (age 55+ years). Since 1990, Florida has used a uniform set of eight triage criteria, known as the trauma scorecard, for triaging adult trauma patients to state-approved trauma centers. However, only five of the criteria are recommended for use with pediatric patients. This article presents the findings regarding the performance of the scorecard when applied to a pediatric population.

DESIGN

We used state trauma registry data linked to state hospital discharge data in a retrospective analysis of trauma patients transported by prehospital providers to any acute care hospital within nine selected Florida counties between July 1, 1991, and December 31, 1991. We used cross-table and logistic regression analysis to determine the ability of triage criteria to correctly identify patients who were retrospectively defined as major trauma. We applied the field criteria to physiologic and anatomy/mechanism of injury data contained in the trauma registry to "score" the patient as major or minor trauma. To make our retrospective determination of major or minor trauma we used the protocols developed by an expert medical panel as described by E. J. MacKenzie et al. (1990).

MAIN OUTCOME MEASURES

We calculated sensitivity, specificity, and the corresponding over- and undertriage rates by comparing patient classifications (major or minor trauma) produced by the triage criteria and the retrospective algorithm. We used logistic regression to identify which triage criteria were statistically significant in predicting major trauma.

RESULTS

Pediatric cases accounted for 9.2% of the total study population, 6.0% of all hospitalized cases, and 6.8% of all trauma deaths. Of the 1505 pediatric cases available for analysis, the triage criteria classified 269 cases as expected major trauma and 1236 cases as expected minor trauma. The retrospective algorithm classified 78 cases as expected major trauma and 1427 cases as expected minor trauma. The resulting specificity is 84.8% (15.2% overtriage), and the sensitivity is 66.7% (33.3% undertriage). Logistic regression indicated that, of the eight state-adopted field triage criteria, only the Glasgow coma score, ejection from vehicle, and penetrating injuries have a statistically significant impact on predicting major trauma in pediatric patients.

CONCLUSIONS

Although the state-adopted trauma scorecard, applied to a pediatric population, produced acceptable overtriage, it did not produce acceptable undertriage. However, our undertriage rate is comparable to the results of other published studies on pediatric trauma. As a result of the Florida Trauma Triage Study, a new pediatric triage instrument was developed. It is currently being field-tested.

Management of central venous catheter occlusions and repairs

Central venous catheter (CVC) occlusions have the potential of compromising patient care because of the inability to administer needed medications, parenteral nutrition, and blood products. The practitioner responsible for the care of these catheters can be instrumental in the diagnosis and treatment of catheter-related occlusions by becoming familiar with typical complications and their causes. This article describes the causes and possible solutions for some of the most common types of mechanical, thrombus, and precipitate occlusions with the CVC. A discussion of CVC fracture will help the practitioner in the resolution of this complication.

Least restrictive alternatives: do they really work?

Seclusion and restraint continue to spark debate regarding their therapeutic value and ethical, legal, and humanitarian implications, yet they remain frequently used forms of treatment in psychiatric settings. Identifying specific alternatives to seclusion and restraint use, teaching nursing staff how and when to use them, and determining their effect on patient outcome are important quality improvement issues. A quality improvement study conducted at a long-term care psychiatric facility identified alternatives that nursing staff used and their effect on reducing seclusion and restraint rates. A total of 773 incidents of disruptive behavior were managed with least restrictive alternatives and did not require the use of seclusion or restraint. One-to-one verbal intervention followed by medication as needed represented the most frequently used alternative. Total seclusion and restraint hours decreased by 31 percent, and restraint hours decreased by 47 percent.

The human cut homeodomain protein can repress gene expression by two distinct mechanisms: active repression and competition for binding site occupancy

By analogy with other homeodomain proteins conserved in evolution, mammalian Cut proteins are believed, as in Drosophila melanogaster, to play an important role in determining cell type specificity in several tissues. At the molecular level, Cut proteins appear to serve as transcriptional repressors. In this study, we have examined the mechanism by which the human Cut (hCut) protein down-regulates gene expression. The homeodomain and the three regions called Cut repeats are evolutionarily conserved and were previously shown to function as DNA binding domains. The carboxy-terminal region, although it does not show amino acid sequence homology per se, in all cases is enriched in alanine and proline residues, a distinctive feature of some transcriptional repression domains. Our results reveal two distinct modes of repression: competition for binding site occupancy and active repression. On one hand, the composite DNA binding domain formed by Cut repeat 3 and the Cut homeodomain was shown to bind to CCAAT and Sp1 sites within the tk gene promoter and to reduce gene expression, presumably by preventing activation by the corresponding transcription factors. On the other hand, the carboxy-terminal region of mammalian Cut proteins was found to function as an active repression domain in a distance-independent manner. We have further narrowed this activity to two subdomains that can independently repress activated transcription. Finally, we present a model to illustrate the two mechanisms by which Cut proteins repress gene expression.

Adolescent health in Russia: a view from Moscow and St. Petersburg

PURPOSE

The purpose of this study was to report on the current state of adolescent health in Russia.

METHODS

By means of site visits, literature review, discussions with Russian colleagues, and a scientific meeting in Moscow, data were collected on health status of youth, the organization of health services, and professional training.

RESULTS

Youth over the age of 14 are served in the adult health care system. Youth clinics are just now emerging. Substance abuse is a major issue; AIDS is rare. Rates of sexual intercourse parallel many western European countries; however, contraception is expensive by Russian standards and often not used. Those with behavioral, physical, and intellectual impairments tend to be educated in special settings and managed by psychiatrists.

CONCLUSION

The Russian health care system is undergoing radical transformation. The traditional Soviet system, with its heavy reliance on medical interventions and prolonged inpatient hospitalizations, is threatened by a lack of resources. Privatization of health care poses additional threats, as do the social transformations that are occurring. These changes create a very uncertain future for the health and well-being of youth in Russia.

Recent advances regarding attention deficit-hyperactivity disorder in adolescence

This paper reviews recent studies of attention deficit-hyperactivity disorder, focusing on research with implications for adolescents. Only 10 of the 31 recent investigations discussed employed an exclusively adolescent sample, necessitating considerable extrapolation from studies of children or adults or mixed samples with a wide range of ages. Significant advances include increased accuracy of predicting negative outcomes and the identification of adaptive skill dysfunction. Further information has become available on the long-term impact of attention deficit-hyperactivity disorder, and additional data have been reported on risk factors. Other reports have described typical services provided by pediatric and family medicine practices for attention deficit-hyperactivity disorder; beneficial effects of combined behavioral and pharmacologic treatment; absence of adverse effects of methylphenidate on cognitive constriction or tics; and disappointing results for nonstimulant pharmacotherapy. A National Institute of Mental Health multisite treatment study has recently been initiated.

Labouring the emotions: expanding the remit of nursing work?

Emotional labour has been an important topic of debate in nursing because of its perceived importance to those involved in the delivery of health care and to those patients who receive that care. The purpose of this paper is to consider what, if anything, this discussion has contributed to the sociological analysis of health care. A number of contributions to that analysis emerge. First, the discussion has revealed that emotional labour is a sizeable component of health care work which makes considerable demands on those delivering health care. Second, emotional labour has consequences for the position of women, for nurses and for patients, in the health care workplace and in wider society. Finally, the discussion on emotional labour has revealed a tension between the generally accepted theoretical move towards holism in health care and the practical reality of applying holistic health care in a society which continues to hold the scientific/biomedical paradigm in high regard.