Psychiatric residents' scores on Machiavellianism

For self-reports by 21 psychiatric residents on measures of Machiavellianism and Uncertainty no significant difference was noted by year in residency program, education, age, or gender.

Surgical treatment of patients with open tibial fractures

Open tibial fractures are true surgical emergencies because of the risk of extensive infection to bone and devitalized soft tissue. The most serious consequence of open tibial fractures is osteomyelitis, which usually can be prevented by prompt surgical intervention within six to eight hours after injuries occur. Open tibial fractures often are the result of trauma from motor vehicle collisions, farm accidents, falls from heights, or gunshot wounds. Initial management of patients with multiple trauma injuries focuses on their life-threatening injuries before or during orthopedic surgical intervention for open tibial fractures. Orthopedic surgeons often work in collaboration with general, vascular, and plastic surgeons and perform multiple surgical procedures (eg, fasciotomy procedures for compartment syndromes, irrigation and debridement of wounds, application of external fixation devices, placement of intramedullary nails, possible limb amputations). The type and extent of open tibial fractures and soft tissue injuries determine the best treatment options for patients. Perioperative nurses should help patients focus on treatment choices for their open tibial fractures that ensure optimal surgical outcomes and maintain their quality of life.

The necessity for T-cryptantigen activation screening in babies with necrotising enterocolitis

OBJECTIVE

To determine the prevalence of T-cryptantigen activation (TCA) and its predictive value for severity of necrotising enterocolitis (NEC) in babies.

STUDY DESIGN

Prospective descriptive.

STUDY POPULATION

Thirty-four babies with NEC were prospectively screened for TCA at Tygerberg Hospital over a 6-month period. TCA screening was done by testing for red blood cell agglutination by the common peanut lectin, Arachis hypogea. Once TCA was confirmed, only washed red cells were administered to the babies and plasma-containing blood products were avoided. NEC was divided into suspected NEC (stage 1), classic NEC (stage 2) and fulminant NEC (stage 3).

MAIN OUTCOME MEASURES

Prevalence of TCA in babies with various stages of NEC; the association between TCA and bowel necrosis, need for surgery and mortality.

RESULTS

TCA was positive in 8 (24%) of the babies in this study. Six babies (18%) had stage 1 NEC, 10 (29%) had stage 2 NEC and 18 (53%) had fulminating or stage 3 NEC. All 18 babies with stage 3 NEC required surgery and TCA was present in 8 (47%) of them. Twelve babies (35%) died, 3 with TCA and 9 with no TCA. Babies with TCA had portal venous gas on abdominal radiographs (P = 0.037) and stage 3 NEC (P = 0.003) more often than babies with no TCA.

CONCLUSIONS

A strong association was noted between TCA and the fulminant form of NEC with bowel necrosis. TCA is a baby with NEC should alert the surgeon to the possibility of severe disease and the need to avoid plasma-containing blood products. Blood banks are urged to introduce routine screening for TCA in all babies with NEC.

Colonization with antibiotic-resistant Streptococcus pneumoniae in children with sickle cell disease

OBJECTIVE

Because of susceptibility to severe pneumococcal infection, children with sickle cell disease (SCD) routinely receive penicillin prophylaxis. Increasing rates of penicillin resistance have been reported throughout the world. Our objective was to assess the prevalence of nasopharyngeal colonization with Streptococcus pneumoniae and to assess the antimicrobial susceptibility of the organisms in children with SCD.

STUDY DESIGN

Nasopharyngeal cultures for S. pneumoniae were obtained from all children with SCD attending clinics in a statewide university-based network. Background colonization rates were determined in children attending day care centers in some of the same locations. All recovered S. pneumoniae organisms were tested for susceptibility to penicillin, and all resistant strains were examined for susceptibility to other antibiotics.

RESULTS

Overall nasopharyngeal pneumococcal colonization rates among children with SCD were 12%. Colonization was associated with age less than 2 years (p <0.001) and day care attendance for more than 20 hr/wk (p = 0.00005). More than half of these strains (62%) were resistant to penicillin, 33% having intermediate resistance (minimal inhibitory concentration 0.06 to 1 microgram/ml) and 29%, high level resistance (minimal inhibitory concentration > or = 2.0 microgram/ml). Penicillin resistance was associated with penicillin prophylaxis (p <0.01). Many of these organisms were also resistant to other classes of antibiotics.

CONCLUSIONS

Although penicillin prophylaxis and pneumococcal vaccine for patients with SCD have reduced overall nasopharyngeal colonization and disease caused by S. pneumoniae (p <0.001), a higher percentage of colonizing strains are now resistant both to penicillin and to other antimicrobial agents (p <0.01). Newer strategies for preventing disease and early management of suspected pneumococcal infection in these children must be developed.

Changes in heterosexual university undergraduates' HIV-related knowledge, attitudes and behaviour: Melbourne, 1989-1994

OBJECTIVE

To examine differences in the AIDS-related knowledge, attitudes and behaviours of first year university undergraduates in 1989 and 1994.

DESIGN

Comparisons were made between cross-sectional surveys, conducted in 1989 and 1994, of first year undergraduates at three Melbourne universities.

RESULTS

The 1994 cohort reported more positive attitudes toward, and better knowledge of, safe sex practices and less discrimination against perceived risk groups than did the 1989 cohort; however, this was due primarily to improvement among female undergraduates. Male undergraduates either demonstrated no improvement or a decline in pro-safe sex attitudes. A general increase was found in the proportion of respondents always using condoms for vaginal sex with casual and regular partners and for oral sex with casual and regular partners.

CONCLUSIONS

While the extent of sexual behaviour among these young people has remained essentially unchanged over the past five years, the extent of self-reported condom use has increased markedly. The general decline in attitudinal measures among young men contrasts with a marked improvement among young women and suggests the need for education programs targeted specifically at this group.

Differential increases in rat retinal ganglion cell size with various methods of optic nerve lesion

Optic nerve injury is a well established paradigm for studying a variety of neuronal responses, although the actual method of nerve severance is rarely taken into account. This study assessed changes to ganglion cell size in three different methods of optic nerve lesions. Adult rats underwent either one of two types of mechanical nerve crush, or an axotomy. Ganglion cells were visualised by retrograde labelling from the optic nerve with 4Di-10ASP, and soma size measured. Two weeks after lesion, mean soma size was increased in all groups. However, at 4 weeks, the crush groups continued to show an increase (60.5% larger than normal), while the mean cell size in the axotomy group was almost at normal levels (0.2% smaller than normal). This study supports the hypothesis that axotomy, and not simple crush, deprives ganglion cells of substances beneficial to cell survival.

Coping with downsizing: stress, self-esteem and social intimacy

As health care system continue to downsize, nurses will experience organizational changes, change in positions or sudden terminations. Acute care surgical nurses were surveyed to determine their perceptions of work-related stress, self-esteem and social intimacy during downsizing.

The concept of microglia in relation to central nervous system disease and regeneration

In a relatively short period of time, the microglial cell has gone from a strongly contested component of the central nervous system (CNS), to being recognised as one of the main players in the response to brain injury. Microglia are thought to arise from cells of haematopoietic origin, and enter the brain in response to naturally occurring cell death. As a result, the microglial cell is the representative of the immune system within the brain. However, the main role of microglia in the adult CNS is to respond to disruption of the homeostasis of the brain, whether that disruption comes from direct damage to neurons, neuronal degeneration or through disease. In this paper we investigate three main causes of cell death in the CNS: inherited degeneration, traumatic lesions and human diseases, and the microglial response to each. Then we examine the mechanisms by which microglia control their surroundings and the methods employed by these cells to instigate neuronal death. Recent observations suggest that under no conditions where neurons are dying or regrowing are microglia not involved, and control of microglia is likely to be just as important in regeneration as providing a favourable environment for neurons to grow. In short, microglia cannot be seen merely as cells of a certain type within the brain, possessing certain functions, but instead must be regarded as a concept that shapes the approaches taken to nervous system development, cell death, disease and trauma, and nervous system regeneration.

Postural sensitivity to visual flow in aging adults with and without balance problems

BACKGROUND

This study tested balance behavior of young adults and aging adults with and without balance problems in response to visual flow from a moving visual surround.

METHODS

Balance behavior was indexed by force plate measures of maximum anterior/posterior displacement of the center of foot pressure and horizontal shear forces. The sample included normal young adults (n = 13; mean age 23 years, +/- 7.5), normal aging adults (n = 13; mean age 76 years, +/- 6.5), and aging adults with balance problems not directly attributable to a diagnosable neurological disease or dysfunction (n = 13; mean age 79 years, +/- 5.8).

RESULTS

The balance-affected aging group had statistically greater sway responses than the young group when the stimulus was unexpected (as in the first trial; p < .05). Some individuals in each group had large responses that were statistical outliers from the group median. The balance-affected group had significantly greater shear forces than the young group.

CONCLUSIONS

Greater sway responses suggest over-reliance on visual cues for posture control in the balance-affected aging group, which may be related to underlying, borderline somatosensory deficits, as indicated by the patterns of subclinical indications for somatosensory impairments on neurological exams in this group. Visually sensitive postural control, however, may issue from several different underlying processes. Elevated shear forces during balance responses in the balance-affected group suggest a greater use of hip movements in addition to ankle movements for postural adjustments.

The expression and characterization of five recombinant murine alpha 1-protease inhibitor proteins

The Mus musculus alpha 1-protease inhibitor gene cluster encodes five highly related proteins. The most significant amino acid polymorphisms lie within the reactive-site loop which is important in determining serpin substrate specificity. All five genes are transcribed in M. musculus adult liver and presumably secreted into plasma. In an attempt to characterize their protein products all five cDNAs were expressed in recombinant mammalian cells and the protease inhibition activity of each determined. Only two of the proteins were efficient inhibitors of neutrophil elastase, the major physiological target of the sole human alpha 1-protease inhibitor (antitrypsin). Four of the proteins were active against chymotrypsin, while no substrate could be identified for the fifth.

Mapping 638 STSs to regions of human chromosome 3

The initial step of mapping STSs to chromosome 3 has been by mapping to a reference panel of 21 somatic cell hybrids containing fragments of chromosome 3. In this study we map 638 STSs to 23 bins on chromosome 3. The bin information greatly facilitates further mapping by radiation hybrids and YAC clones.

What medical schools and universities can learn from one another

Colleges and universities devoted to undergraduate education and non-medical graduate education (hereafter called "universities") have much to teach medical schools and much to learn from them. Universities and medical schools differ significantly in their sources of revenue, cultures of promotion and tenure, academic values, and decision-making processes. Yet from the experience of universities, medical schools can learn innovative techniques of curriculum assessment and teaching, how to handle diversity issues, and ways to expand the definition of scholarship. In turn, medical schools can help teach universities the importance of fiscal and regulatory accountability, the benefits of interdisciplinary efforts, the practical benefits of problem-based learning, and techniques for adjusting to rapid change. The authors, all with medical school faculty backgrounds, developed the views reported in this article when they were Fellows in a leadership training program sponsored by the American Council on Education (ACE). They urge their colleagues to reach out beyond their specialties and departments and learn from higher education institutions that are grappling with problems analogous to those faced by medical schools.

Machiavellian scores of nursing faculty and students

The purpose of the research was to identify differences in scores on Machiavellianism between nursing faculty and students. Measurement of Machiavellianism was on the Mach V Scale completed by 33 nursing faculty, 47 RN students completing the nursing baccalaureate, and 58 senior generic students in one baccalaureate nursing program. Each subject received a research packet coded for retrieval of the nonrespondents and reducing selection bias associated with large nonresponse. Analysis showed no significant difference between groups and none related to education, age, clinical specialty, or for (faculty and student) groups.

Mitogenic factors released from smooth muscle cells are responsible for neointimal cell proliferation after balloon catheter deendothelialization

Smooth muscle cell (SMC) proliferation results in neointimal formation in response to selective deendothelialization. The neointimal SMC are characteristically different from normal, medial SMC. The major difference is that neointimal SMC have a higher proliferation rate. The high proliferation rate has been observed 15 weeks after endothelial injury. In this study, it is noted that neointimal SMC release some mitogenic factor(s) which is(are) responsible for inducing persistent SMC proliferation in an autocrine manner. The SMC were cultured from the media of normal rabbit aorta as well as the neointimal tissue formed 15 weeks after an endothelial injury. From the culture of the neointimal SMC, the conditioned medium was collected and growth factors, including PDGF-AB, TGF-beta 1, TGF-beta 2, and bFGF, were assayed. The conditioned medium was used to culture the medial SMC from normal rabbit aorta. The mitogenic effect of the conditioned medium was evaluated by the incorporation of [3H]thymidine into the SMC. Results demonstrated that PDGF-AB and TGF-beta 1 were increased in neointimal SMC-conditioned medium. After incubation with the conditioned medium, medial SMC incorporated significantly higher [3H]thymidine, compared to incubation with control medium (P < 0.01). The data indicate that endothelial injury induces production of some growth factors, including PDGF and TGF-beta, by the neointimal SMC. These growth factors may act in an autocrine manner to stimulate SMC proliferation for a long time following a single deendothelialization.

Pharmacokinetics and bioavailability of fluconazole in two groups of males with human immunodeficiency virus (HIV) infection compared with those in a group of males without HIV infection

Fluconazole pharmacokinetics, including absolute bioavailability, were determined for one group of controls (n = 10) and two groups of people with human immunodeficiency virus (HIV) infection (those with CD4+ T-cell counts of less than [n = 4] or greater than [n = 9] 200 cells per mm3). Twenty subjects received four doses of fluconazole; three doses were oral (50, 100, and 400 mg), and one dose was intravenous (either 50, 100, or 400 mg). The other three subjects received one or two doses. The groups were comparable in terms of the weight, body mass index, and estimated creatinine clearance of the subjects, but the people with HIV infection were older. Pharmacokinetic parameters indicated linearity in all subjects; the area under the plasma concentration-time curve and the maximum concentration increased in proportion to the dose. The fraction of an oral dose of fluconazole absorbed approximated unity in all three groups of subjects. The mean (+/- standard deviation) plasma clearance of fluconazole was lowest in the group of subjects with low CD4+ T-cell counts; the value for this group was 0.74 +/- 0.19 liter/h, compared with 0.97 +/- 0.19 liter/h in the group with HIV infection and CD4+ T-cell counts of greater than 200 cells/mm3 and 1.18 +/- 0.23 liter/h in the group of control subjects (P < 0.05). The volume of distribution was lower in those with HIV infection (P = 0.04, corrected for weight). The half-life was longest in people with HIV infection and low CD4+ T-cell counts (P = 0.01). This study has shown that some differences do exist between the pharmacokinetics of fluconazole in people with HIV infection and those in noninfected controls.

Evaluation of GM-CSF mouthwash for prevention of chemotherapy-induced mucositis: a randomized, double-blind, dose-ranging study

Uncontrolled clinical trials have shown that parenteral administration of GM-CSF reduces the frequency of chemotherapy-induced mucositis. The mechanism of this effect could be related to acceleration of haematopoiesis and/or increase in functional activation of WBC. We conducted a double-blind, placebo-controlled, dose ranging study of GM-CSF (mol-gramostim) mouthwash in patients with breast cancer during the first treatment cycle of a combination chemotherapy regimen which has historically produced dose-limiting (grade > or = 3) mucositis in approximately 39% of patients. Subjects were randomized to receive either placebo mouthwash (0.1 percent albumin) or one of four concentrations of GM-CSF mouthwash (0.01, 0.1, 1.0 or 10 mcg/ml). The primary endpoint was to evaluate the relationship between dose of GM-CSF mouthwash received and probability of grade > or = 3 mucositis using a logistic model. Solutions were administered four times daily starting within 24 hours of chemotherapy initiation and continuing until the end of the cycle (day 21). Mucositis was assessed on days 1-6, 10, 15 and 21. Day 6 plasma samples were assayed for GM-CSF. Forty-five patients were evaluable for response (nine per dosing group). A 42% risk (15/36) of mucositis grade > or = 3 was evident on day 15 in patients receiving GM-CSF compared to 2 of 9 patients on the placebo arm. No evidence of dose response was found by logistic regression. Five patients had a detectable plasma concentration of GM-CSF (56-209 pg/ml). A positive correlation between GM-CSF dose and leukocyte recovery was noted (P = 0.04).

Machiavellianism and medical career choices

Medical career choices and Machiavellianism of 36 junior and 37 senior medical students at one private midwestern medical school were studied. Machiavellianism was measured by the Mach V Scale. Students choosing psychiatry did not score significantly higher on Machiavellianism than those choosing medicine, surgery, or other clinical medical specialties. This is contrary to previous research which indicated those medical students choosing psychiatry scored higher on Machiavellianism. There were no significant differences in Machiavellianism scores from two different age groups (20-30 yr. and 31-40 yr.). No significant differences were reported in Machiavellianism scores of 45 male and 29 female medical students or between junior and senior medical students.

Machiavellian characteristics among nurses

The study of Machiavellian traits in the research literature represents a significant variable that affects professional career choice and behavior in the work environment. This research examines the following hypotheses: 1. the degree of Machiavellian orientation will be the same for hospital nursing administrators and nurse educators; and 2. head nurses will reveal high Machiavellian scores.

Cryosurgical ablation of the prostate

A new surgical procedure, cryosurgical ablation of the prostate, offers patients with organ-confined prostate cancer another treatment option. The advantages of this cryosurgical technique are complete ablation of prostatic cancers without radical prostatectomy procedures, less blood loss, decreased hospital stays, reduced health care costs, and minimal associated morbidity. Some possible complications of cryosurgical ablation of the prostate procedures include incontinence, impotence, rectal freezing from inadequate monitoring of the freezing process, urethrocutaneous and urethrorectal fistula formations, and urethral tissue sloughing. The intraoperative nurse's prime responsibility is to monitor the subfreezing temperatures of the cryoprobes. Postoperatively, patients have only a few perineal incisions covered with sterile dressings and a suprapubic catheter. Most patients have minimal discomfort that is managed easily with opiate analgesics.