Australian midwives: leaders in lactation consultancy

Midwives all over Australia are furthering their breastfeeding knowledge and skills, to lead the world in lactation support. The certification exam conducted by the International Board of Lactation Consultant Examiners has played a central role in this extraordinary revolution by setting competency standards, motivating the acquisition of specialist skills, and opening up career opportunities. However, it is the consumers, the mothers and babies, who are the principal beneficiaries.

DNA vaccines for bacterial infections

DNA vaccines are an exciting development in vaccine technology which may have a special role in preventing viral infections and as 'theracines' for cancer. Their use in preventing bacterial infections has, by comparison, been less well documented. While it is unlikely that traditional, highly successful and cheap vaccines for diseases such as diphtheria will be replaced by DNA vaccines, naked DNA may be particularly appropriate for preventing bacterial infections where cytotoxic T cells confer protection, or where a Th1 type T cell response mediates resistance. For example, DNA vaccines containing different mycobacterial antigens have been shown to inhibit overt infections by Mycobacterium tuberculosis in rodent models. The use of DNA vaccines in bacterial infections may be complicated by fundamental differences between prokaryotic and eukaryotic genes and gene products, including mRNA stability, codon bias, secondary structures surrounding native start sequences and glycosylation. These problems can be solved by re-synthesis of bacterial genes to produce 'new' sequences which are more highly expressed by eukaryotic cells.

Nutrition and cancer: educating the public through a health fair

Minnesota has a high incidence of dietary-associated cancer, including colorectal, breast, and prostate. To increase public awareness of cancer risks and health benefits of dietary behaviors, the Metro Minnesota Chapter of the Oncology Nursing Society (ONS) participated in a public education health fair. Supported by a Special Project Funding Grant from the ONS, 42 chapter members assisted more than 700 Metro area residents at seven locations to assess and improve their diet according to the American Cancer Society (ACS) guidelines. To evaluate the effectiveness of the project, a postcard survey was sent to 200 (29%) names randomly drawn from raffle entries. Seventy-five surveys were returned (38%). Ninety-five percent found the assessment helpful in evaluating their diet, and 80% made dietary changes in the two weeks following the health fair. Results indicate that nurses should continue to educate the public about the relationship between diet and cancer. Recommendations for further consideration include assessment of long-term effects of the health fair education format and provision of a brochure about ONS. Benefits included community education and ONS member participation in a chapter activity.

Determination of thiocyanate in plasma and saliva without deproteinisation and its validation as a smoking parameter

A simple photometric procedure was developed for the determination of thiocyanate (SCN-) in plasma and saliva without deproteinisation or dialysis. Fe(III) ions form a red coloured complex with SCN- with a maximum absorbance at 460 nm. Mercury(II) nitrate is used to run a sample blank. A manual and an automated version (COBAS BIO) of the method is described. The method is linear up to 5000 mumol/l SCN-. The CV of the between-run precision is 2.8-8% for the manual and 2.6-6.6% for the automated method. The SCN- plasma concentration was 21-134 mumol/l in nonsmokers and 44-260 mumol/l in smokers. In mixed saliva, the concentration is much higher than in plasma: 1.57-5.5 mumol/l in smokers and 0.79-3.9 mumol/l in nonsmokers. Plasma, but not oral fluid SCN-, is a valuable parameter for studying smoking habits in population surveys. However, its use is limited. In our experience only heavy smokers can be distinguished from nonsmokers.

Homogeneity of potassium chloride in small volume intravenous containers

The purpose of this investigation was to determine whether potassium chloride as an additive is distributed homogeneously throughout small volume parenteral solutions and whether the pattern of electrolyte distribution is identical for two types of delivery systems. The effect of purposeful mixing after addition of potassium chloride was also studied. Thirty-one registered nurses prepared two supplementary intravenous solutions consisting of 10mEq potassium chloride in 50ml of 5% dextrose solution. One solution was prepared in a soft polyvinyl chloride minibag (Viaflex, Baxter-Travenol), the other in a semirigid plastic burette (Buretrol, Baxter-Travenol). The solutions were discharged through a volumetric pump (IMED) and four aliquots were taken at regular intervals. Samples were chemically analyzed by flame photometry to determine the potassium concentration in each solution layer of the container. For each container type, there were significant differences in the potassium concentrations among the layers of solution. The pattern of distribution also differed significantly between the two containers. The strata in the minibag showed smaller variations in potassium concentration than did corresponding layers in the burette. Some single sample concentrations from burettes exceeded the expected concentration of 200mEq/L by 105mEq. Nurses manipulated the two types of containers differently. Thirty of 31 minibags were mechanically mixed, but only 11 of 31 burettes were treated in this way. When the effect of mixing was considered, solutions in mixed containers were essentially no different from those not agitated after addition of the electrolyte.

Intravenous leiomyomatosis with cardiac extension

A woman with intravenous leiomyomatosis experienced syncope 7 years after a total abdominal hysterectomy and oophorectomy for a uterine fibroid. The workup revealed a tumor that extended from the iliac veins to the right ventricle. It was totally removed under cardiopulmonary bypass. One year later, the patient was found to be asymptomatic and without evidence of tumor recurrence.

Evaluation of left ventricular performance by gated radionuclide angiography

Gated radionuclide angiography (RVG) in orthogonal projections was used to evaluate left ventricular volume, ejection fraction, and segmental wall motion. Images of the left ventricle at end-diastole and end-systole were outlined in two projections using a simple manual method. The perimeter drawings were digitized on a desktop computer, interfaced to an XY recorder and left ventricular volumes and ejection fraction calculated. The results were compared to contrast left ventriculography (CVG) in the same projections. RVG and CVG gave similar results for end-diastolic volume (r = .87, P less than 0.001), end-systolic volume (r = .95, P less than 0.001), and ejection fraction (r = .89, P less than 0.001) over a wide range of values. In 92% of all left ventricular segments analyzed, RVG and CVG showed only minor differences in the analysis of wall motion. Reproducibility of the method by a trained observer was excellent. Interobserver trials demonstrated that less well-trained observers consistently over- or underestimated volumes, emphasizing the need for prior experience in RVG analysis. Use of this manual method for analysis of gated equilibrium RVG in orthogonal projections appears to be a reasonably accurate, reproducible method for evaluating left ventricular function.

Left ventricular volume from paired biplane two-dimensional echocardiography

To evaluate the applicability of two-dimensional echocardiography to left ventricular volume determination, 30 consecutive patients undergoing biplane left ventricular cineangiography were studied with a wide-angle (84 degrees), phased-array, two-dimensional echocardiographic system. Two echographic projections were used to obtain paired, biplane, tomographic images of the left ventricle. We used the short-axis view (from the precordial window) as an anolog of the left anterior oblique angiogram, and the long-axis, two-chamber view (from the apex impulse window) as a right anterior oblique angiographic equivalent. A modified Simpson's rule formula was used to calculate systolic and diastolic left ventricular volumes from the biplane echogram and the biplane angiogram. These methods correlated well for ejection fraction (r = 0.87) and systolic volume (r = 0.90), but only modestly for diastolic volume (r = 0.80). These correlations are noteworthy because 65% of the patients had significant segmental wall motion abnormalities. The volumes determined from the minor-axis dimensions of M-mode echograms in 23 of the same patients correlated poorly with angiography.

Combination vasodilator therapy for severe chronic congestive heart failure

A patient with severe, chronic congestive heart failure was unresponsive not only to conventional therapy, but also to nonparenteral nitroglycerin and isosorbide dinitrate; he became nitroprusside dependent. Oral minoxidil therapy produced a significant decrease in systemic vascular resistance and an increase in cardiac output, with no tachycardia, hypotension, or decrease in systemic and pulmonary venous pressures. The addition of sublingual isosorbide dinitrate decreased venous pressures and produced a further increase in cardiac output. The combination of oral minoxidil and sublingual isosorbide dinitrate maintained clinical and hemodynamic improvements, and the patient could be weaned off nitroprusside. Deterioration in hemodynamics occurred with the withdrawal of minoxidil. Therapy with oral hydralazine produced hemodynamic effects comparable to those of oral minoxidil. These observations suggest that chronic reduction of impedance to left ventricular ejection with minoxidil or hydralazine is possible in patients with severe intractable heart failure and deserves further clinical trial.

Serratia marcescens endocarditis: a regional illness associated with intravenous drug abuse

From 1969 to 1974, 19 cases of Serratia marcescens endocarditis were observed in the San Francisco Bay Area. Seventeen patients were intravenous drug users, and Serratia caused 14% of all addict-associated endocarditis in San Francisco. Serratia strains were nonpigmented and had typical antibiotic sensitivities, except that 9 of the isolates exhibited colonial variation, with each variant having different antibiotic sensitivities. Aortic or mitral valves were involved in 13 patients, and heart failure developed in 9 of these. Twelve patients had embolic episodes to brain, iliofemoral arteries, or lung. Five of 6 patients with tricuspid valvulitis were cured by antibiotics either with (1) or without excision of the valve. All 12 patients with aortic or mitral valvulitis treated medically died; 11 had unremitting sepsis. Aortic valve replacement and antibiotics were effective in 1. Gentamicin combined with either carbenicillin or chloramphenicol was the most effective treatment regimen.