Short-term vs long-term dexamethasone treatment: effects on rat diaphragm structure and function

The effects of dexamethasone treatment duration (2.5 vs 10 weeks) on diaphragm myosin heavy chain isoforms, fiber types, and contractile characteristics were studied in male rats. Compared with ad libitum-fed and pair-fed controls, dexamethasone significantly decreased body weight, costal diaphragm weight, and the relative expression of myosin heavy chain isoform MHC-2B. Compared with pair-fed controls, the effect on MHC-2B expression was greater after 10 weeks than after 2.5 weeks. Type I and type II costal diaphragm fiber atrophy occurred, and type II fiber atrophy was greater after 10 weeks. Costal diaphragm-specific forces were not affected significantly by dexamethasone, regardless of the treatment duration or control group comparison. Fatigue resistance indexes were increased significantly after long term treatment compared with pair-fed controls and after both short-term and long-term treatment compared with ad libitum-fed controls. In conclusion, the effects of dexamethasone on MHC isoform phenotype expression, fiber type costal diaphragm atrophy, and fatigue resistance were dependent on treatment duration, with greater effects after long-term (10 weeks) treatment.

Patient participation--a review of the literature

This article presents a critical review of the concept of patient participation. The concept of patient participation has become widely accepted in contemporary nursing practice. It is now part of the vocabulary of professional nurses and has been heralded as a means of enhancing decision making and human dignity and enriching quality of life. Patient participation in care is emerging as a growing movement wherein patients are assuming more responsibility for the prevention, detection and treatment of health problems in a manner that supplements or substitutes for professional services. The review concludes with some recommendations for nursing practice, education and research.

Using an interactive computer game to increase skill and self-efficacy regarding safer sex negotiation: field test results

This article describes the development, field testing, and evaluation of an interactive computer program, "Life Challenge," developed by the New York State Department of Health as a tool for enhancing adolescents' sense of self-efficacy in HIV/AIDS prevention programs. The computer kiosks were field tested in 13 sites serving high-risk adolescents. The program uses a time travel adventure game format to provide information and nonthreatening skill practice. Users record and play back their responses as they "negotiate" with their chosen partners. A proof of concept evaluation with analysis of 211 audio responses found that users took negotiating tasks seriously; statistically significant learning gains were achieved on knowledge items and in self-efficacy scores (greatest improvement for those with low baseline self-efficacy levels). Challenges and problems encountered in implementing the project are described, and the potential of using computers for skill practice and educational interventions in health education is explored.

Gender-specific effects of dexamethasone treatment on rat diaphragm structure and function

The effects of long-term dexamethasone treatment on diaphragm muscle were studied in female and male rats. Compared with pair-fed control animals, dexamethasone treatment did not significantly affect estrous cycling or peak serum estradiol levels; however, testosterone levels were significantly increased in females and decreased in males. Dexamethasone significantly reduced body and costal diaphragm weights, but to a lesser extent in females than in males. Reductions in diaphragm weight were proportional to reductions in body weight. In females and males, dexamethasone treatment significantly decreased diaphragm fiber (types I and II) cross-sectional area and the relative expression of myosin heavy chain isoform 2B. With the exception of type I fiber atrophy, these changes occurred to a lesser extent in females. Dexamethasone did not significantly affect specific forces. Dexamethasone significantly increased twitch one-half relaxation time and fatigue resistance indexes in males but not in females. In conclusion, the effects of long-term dexamethasone treatment were gender specific, with significantly fewer effects in females, and changes in serum testosterone levels were associated with these findings.

On the nature of Wisconsin Card Sorting Test performance in schizophrenia

Performance on the Wisconsin Card Sorting Test (WCST) is widely reported to be impaired in patients with schizophrenia. It has been hypothesized that the performance deficit on the WCST in schizophrenia is related to a dysfunction of the frontal lobe, specifically the dorsolateral prefrontal cortex. This hypothesis was tested by comparing a group of patients with schizophrenia to patients with low grade right or left frontal lobe tumors and a group of patients with non-frontal high grade tumors. The results demonstrated a remarkable similarity in performance on the WCST between patients with schizophrenia and patients with right frontal lobe tumors. Patients with left frontal lobe tumors, non-frontal tumors, and normal control subjects did not show the same pattern of performance. This study provides support for frontal lobe dysfunction in the symptomatology of schizophrenia.

Job strain among post office mailhandlers

A sample of 4,018 U.S. Post Office mailhandlers nationwide completed a questionnaire assessing job demands, decision latitude, hazardous conditions, supervisory support, physical exertion, physical/psychological strain, sleeping problems, muscle strain, and job dissatisfaction. Scales were obtained from Karasek's Job Content Questionnaire. Comparative data were available from the U.S. Quality of Employment Surveys (for "mail carriers and handlers") and two samples of contemporary working populations. Hierarchical multiple regressions controlled for age, sex, education, length of postal service, Vietnam veteran status, and marital status. Mailhandlers reported significantly higher levels of negative job characteristics than both the national and contemporary samples, and their levels of job demands and decision latitude place them in the "high strain" quadrant of Karasek's model. Women not only reported higher strain, job dissatisfaction, and sleeping problems than men, but also higher levels of negative job characteristics. While other demographic variables, particularly Vietnam veteran status, were associated with stress-related outcomes, structural aspects of the work environment were more strongly associated with outcome. The authors conclude that postal mailhandlers face a highly stressful work environment.

Patient participation: a concept analysis

The purpose of this paper is to present an in-depth analysis of the concept of patient participation. The analysis was undertaken using the method described by Walker and Avant. Patient participation is defined and the critical attributes are identified. Model, borderline and contrary cases illustrate what the concept is and is not. The meaning of patient participation is compared with patient partnership, patient collaboration and patient involvement, three related cases. The antecedents and consequences of patient participation are investigated to further refine the critical attributes. Empirical referents are illuminated. The value of concept analysis in relation to precise communication, critical thinking and the advancement of the knowledge base of nursing is discussed.

Garlic powder in the treatment of moderate hyperlipidaemia: a controlled trial and meta-analysis

OBJECTIVE

To determine the effect of 900 mg/day of dried garlic powder (standardised to 1.3% allicin) in reducing total cholesterol.

DESIGN

Double-blind, randomised six-month parallel trial.

SUBJECTS

115 individuals with a repeat total cholesterol concentration of 6.0-8.5 mmol/l and low-density lipoprotein (LDL) cholesterol of 3.5 mmol/l or above after six weeks of dietary advice.

INTERVENTION

The active treatment group received dried garlic tablets (standardised to 1.3% allicin) at a dosage of 300 mg three times daily. The control group received a matching placebo.

OUTCOME MEASURES

Primary end-point: total cholesterol concentration; secondary end-points: concentrations of LDL and high-density lipoprotein cholesterol, apolipoproteins (apo) A1 and B, and triglycerides.

RESULTS

There were no significant differences between the groups receiving garlic and placebo in the mean concentrations of serum lipids, lipoproteins or apo A1 or B, by analysis either on intention-to-treat or treatment received. In a meta-analysis which included the results from this trial, garlic was associated with a mean reduction in total cholesterol of -0.65 mmol/l (95% confidence intervals: -0.53 to -0.76).

CONCLUSIONS

In this trial, garlic was less effective in reducing total cholesterol than suggested by previous meta-analyses. Possible explanations are publication bias, overestimation of treatment effects in trials with inadequate concealment of treatment allocation, or a type 2 error. We conclude that meta-analyses should be interpreted critically and with particular caution if the constituent trials are small.

The polyp prevention trial I: rationale, design, recruitment, and baseline participant characteristics

The Polyp Prevention Trial (PPT) is a multicenter randomized controlled trial examining the effect of a low-fat (20% of total energy intake), high-fiber (18 g/1000 kcal), high-vegetable and -fruit (5-8 daily servings) dietary pattern on the recurrence of adenomatous polyps of the large bowel, precursors of most colorectal malignancies. Eligibility criteria include one or more adenomas removed within 6 months of randomization; complete nonsurgical polyp removal and complete colonic examination to the cecum at the qualifying colonoscopy: age 35 years of more; no history of colorectal cancer, inflammatory bowel disease, or large bowel resection; and satisfactory completion of a food frequency questionnaire and 4-day food record. Of approximately 38,277 potential participants with one or more polyps recently resected, investigators at eight clinical centers randomized 2,079 (5.4%; 1,037 in the intervention and 1,042 in the control arm) between June 1991 and January 1994, making the PPT the largest adenoma recurrence trial ever conducted. Of PPT participants, 35% are women and 10% are minorities. At study entry, participants averaged 61.4 years of age; 14% of them smoked, and 22% used aspirin. At the baseline colonoscopy, 35% of participants had two or more adenomas, and 29% had at least one large (> of = 1 cm) adenoma. Demographic, behavioral, dietary, and clinical characteristics are comparable across the two study arms. Participants have repeat colonoscopies after 1 (T(1)) and 4 (T(4)) years of follow-up. The primary end point is adenoma recurrence; secondary end points include number, size, location, and histology of adenomas. All resected lesions are reviewed centrally by gastrointestinal pathologists. The trial provides 90% power to detect a reduction of 24% in the annual adenoma recurrence rate. The primary analytic period, on which sample size calculations were based is 3 years (T(1) to T(4)), which permits a 1-year lag time for the intervention to work and allows a more definitive clearing of lesions at T(1), given that at least 10-15% of polyps may be missed at baseline. The final (T(4)) colonoscopies are expected to be completed in early 1998.

Psychosocial aspects of interventions in occupational safety and health

Attention to psychosocial hazards in work environments should become an increasingly important component of occupational safety and health interventions. Research findings have linked a number of measurable psychosocial characteristics with negative psychological and physiological consequences. Some serious physical health hazards have also been found to have psychosocial components. Several economic trends indicate that more jobs will be created with high levels of psychosocial hazards. These economic trends include a decline in wages, a move away from a manufacturing base, increased hours of work, a decline in unionization rates, and poorly implemented technological changes. Intervention strategies developed to reduce psychosocial stressors must address the multiple cause of psychosocial hazards and the multiple symptoms they produce. Additional challenges include assessing psychosocial changes within the sometimes contradictory framework of organizational and social changes. Nevertheless, comprehensive efforts to improve both the health and safety and the overall quality of working life need to incorporate psychosocial variables into their designs.

Evisceration after laparoscopic sterilization

A 35-year-old multiparous woman underwent laparoscopic tubal sterilization without intraoperative problems. Postoperatively, she had nausea and vomiting that failed to respond to antiemetics. The cannula incision site was soaked with serosanguineous discharge. Exploration of the wound revealed evisceration of 10 cm of necrotic small bowel. Resection anastomosis was performed and the patient recovered uneventfully.

Innovation and the role of the change agent

The implementation of change is a complex process, which requires a collaborative approach. Change agents need the flexibility to alter their role to suit local circumstances.

Making the most of an essential resource. Using skill mix for the benefit of staff and patients

1. For skill mix to be an attractive commodity in the internal market, clinical managers need to adopt a systematic approach to human resource management. 2. Lewin's change theory offers direction to clinical managers who need to adopt a rational approach to skill mix management. 3. Clinical managers need to adopt a variety of managerial roles and respond proactively to the changes in service provision by promoting an understanding of the importance of a balanced, innovative and empowered skilled workforce.

Applying pharmacokinetic data to gentamicin use

1. Pharmacokinetics deals with four vital processes: drug absorption; distribution, metabolism and elimination. 2. Knowledge of pharmacokinetic terms and concepts can lead to a more rational use of the drug gentamicin. 3. Application of pharmacokinetic data to gentamicin is vital to achieve a safe optimal therapy.

Early recognition of neonatal abdominal wall necrotizing fasciitis

Necrotizing fasciitis (NF) of the abdominal wall occurring in newborns is associated with a 50% mortality rate. Improved survival requires early diagnosis followed by aggressive surgical débridement. During a 10-year period, we treated 7 infants who developed NF. During the same period, 32 infants were admitted with omphalitis that did not progress to NF. The patients with omphalitis and those with NF were compared. Tachycardia, abnormal white blood cell counts, induration, and violaceous skin discoloration were seen exclusively in the NF patients. Polymicrobial infections were documented in 28% of the omphalitis patients and 86% of the NF patients. All omphalitis patients survived, whereas 5 of 7 (71%) NF patients died. Adjuvant hyperbaric oxygen therapy was used for 4 infants with NF, 2 of whom survived (50%). NF is a highly morbid disease, that can be distinguished from other infant abdominal wall infections by the skin changes, white blood cell counts, heart rate, and microbiologic results. Prompt diagnosis of NF improves survival when combined with aggressive surgical débridement.

Effect of long-term undernutrition on male and female rat diaphragm contractility, fatigue, and fiber types

The effects of long-term undernutrition (10 wk) on diaphragm contractility, fatigue, and fiber type proportions were studied in male and female rats. Contractility and fatigue resistance indexes were measured in an in vitro diaphragm costal strip preparation by using direct stimulation at 37 degrees C. Undernutrition allowed for continued growth in males and females but with substantial reductions in weight gain. Relative to control rats of the same sex, final weights were significantly lower in undernourished males (74 +/- 3%) than females (90 +/- 5%), but weight gain was not significantly different between undernourished males (58 +/- 5%) and females (60 +/- 3%). Only in males did undernutrition significantly reduce costal diaphragm weight (to 77 +/- 5% of control). Diaphragm forces, normalized for cross-sectional area, were not significantly different from male or female control values. Fatigue resistance indexes (fatigue/baseline force) were increased at all stimulation frequencies in undernourished males but not in undernourished females. Costal diaphragm atrophy, involving types I and II fibers, occurred in undernourished males but not in undernourished females. In conclusion, despite long-term undernutrition reducing weight gain to similar levels in males and females (relative to control), there was excellent preservation of diaphragm weight, function, and structure in females but, although diaphragm atrophy occurred, there was preserved contractility and increased fatigue resistance in males.

Is this the best intervention? A case study approach to decision-making

It can be difficult to challenge the decision of a doctor, but if nurses believe that a decision is wrong, it is their duty to do so. This article shows how a structured decision-making process can not only aid nurses to do this, but can also aid them in all areas of clinical practice.

Are you prepared to be their advocate? Issues in patient advocacy

Patient advocacy is fraught with legal, ethical and professional difficulties. This article describes some of the advocacy issues that are likely to be encountered in a palliative care setting, and shows how decision-making must reflect legal and ethical considerations.

Labor union programs to reduce or prevent occupational stress in the United States

In the United States, most efforts to reduce occupational stress continue to focus primarily on personal stress management. However, there has been a growing awareness that personal coping techniques have limited effectiveness and that sources of stress in the work environment need to be altered. Research on workplace sources of stress has been spurred and guided by Karasek's "job strain" or "job demands-control" model, and the University of Michigan model of the stress process. In addition, a model of occupational stress interventions developed by Karasek provides a useful framework for stress prevention activities. U.S. labor unions have undertaken a variety of activities at all stages of the stress process described by this stress intervention model to reduce or prevent the health hazards associated with occupational stress. These programs and strategies include employee assistance programs, educational programs, stress surveys, medical studies, stress committees, collective bargaining, organizing and public awareness, and lobbying and political action. These programs are described and analyzed in relation to models of occupational stress, as well as to the economic context faced by labor unions today, and continuing obstacles to work environment reform.