The Effect of Contingent Singing on Infants with Bronchopulmonary Dysplasia in the Neonatal Intensive Care Unit

A significant component of care for infants with bronchopulmonary dysplasia (BPD) is providing an optimal environment for supporting neurodevelopment and growth. Interventions that support the behavioral and physiologic stability of this population may play an important role in improving overall outcomes. Contingent singing is a music intervention that allows the caregiver to tailor certain musical elements, such as rhythm and tempo, to match behavioral and physiologic cues and support the infant in achieving optimal stabilization. A randomized crossover design was used to study the effect of contingent singing on the behavioral state and physiologic measures compared to standard care practices in the neonatal intensive care unit (NICU). Data were collected on a sample of 37 infants diagnosed with BPD. There were no significant differences in the physiologic measures or behavioral states of infants in the contingent singing sessions compared to control sessions. Parents and staff reported favorable views of music therapy in the NICU, and there were no adverse responses from infants during contingent singing. Further research is needed to determine the effectiveness of this intervention on the physiologic stability of infants with BPD.

Use of the Council Health Survey to Assess Shared Governance in a Pediatric Hospital During the COVID-19 Pandemic

This project used the Council Health Survey to evaluate the effectiveness of shared governance councils in a children’s hospital during the COVID-19 pandemic. A SWOT analysis was performed to assess the organization’s strengths, weaknesses, opportunities, and threats regarding council health and to inform strategies to sustain the shared governance environment. The well-established shared governance infrastructure allowed the organization to rapidly pivot council operations to sustain nurse engagement while balancing the unprecedented staffing and resource challenges of the pandemic. Organizations must remain flexible and innovative to maintain an environment supportive of nurse empowerment and shared governance during public health emergencies.

Parents' Perception of Fall Risk and Incidence of Falls in the Pediatric Ambulatory Environment

PURPOSE

To identify the parents' perspective of fall incidence and risks in the pediatric ambulatory environment.

DESIGN AND METHODS

A prospective descriptive correlational study was conducted in two large quaternary pediatric hospitals. Parents who accompanied their children to the clinic appointment were surveyed about falls their child experienced while at the clinic. Parent reported falls were compared to those reported in adverse event reporting systems (AERS) for the same period.

RESULTS

Data from 2327 completed parent surveys were analyzed. Parents reported 48 children fell and 139 falls. Only three falls were recorded in the AERS. Stepwise logistic regression was used to identify predictors of falls and a nomogram was created from the final model to facilitate patient fall risk screening. Three predictors of falls were identified: children under the age of five, children described by their parents as falling more at home than other children of the same age, and children who had a medical condition that impacts their ability to walk. A nomogram is provided to estimate the probability of falling for patients under 18 years of age in the ambulatory environment.

CONCLUSIONS

Parents may provide more reliable data regarding the incidence and risk factors for falls in the ambulatory environment than AERS, and it is possible to predict the probability of a fall given information from the parents.

PRACTICE IMPLICATIONS

Knowing who is at risk for falls creates opportunities for organizations to modify clinic procedures, train staff, and create physical environments that promote increased patient safety.

Call to Action: Addressing Pediatric Fall Safety in Ambulatory Environments

BACKGROUND

Pediatric falls in the ambulatory environment are a patient safety concern. Historically, fall safety efforts have focused on inpatient settings and are not transferrable to ambulatory environments. Minimal research and absence of ambulatory-specific guidelines from regulatory and global benchmarking bodies contribute to the void of knowledge. Consequently, there has been minimal progress in developing fall reduction strategies for the ambulatory environment.

PURPOSE

To review research evidence and findings from environmental assessments that included interprofessional stakeholder feedback to make recommendations for improving fall safety in the pediatric ambulatory environment.

METHODS

Implementation science was employed in two large pediatric quaternary hospitals to identify existing gaps and provided the foundation for translation of findings in the development of fall safety practice recommendations in the ambulatory environment.

RESULTS

Recommendations from the findings included identified barriers and tangible interventions within three broad categories: equipment and furniture, environment, and people. Purposeful inclusion of all areas in the ambulatory environment, integration of high reliability concepts, and partnering with parents were identified as pertinent factors associated with these recommendations.

CONCLUSION

This call to action recognizes the importance of utilizing an evidence-based approach for improvement and provides a framework for conducting an environmental assessment, which is an essential starting point to improve fall safety in the pediatric ambulatory environment. Guidance and support from research, regulatory and collaborative bodies, and healthcare organizations remains a critical need in improving fall safety.

Perceptions of the Moral Obligations of Pediatric Nurses During an Active Shooter Event in a Children's Hospital

PURPOSE

To explore and compare the perceptions of nurses and parent/family advisors regarding pediatric nurses' moral obligations to children and families during an active shooter event in a children's hospital.

DESIGN AND METHODS

This was a descriptive, exploratory study using survey methodology. A convenience sample of all licensed nurses and parent/family advisors from four children's hospitals across the United States were recruited. Surveys consisted of five primary domains including Appropriateness of National Guidelines, Personal Preparedness, Moral Accountability, Professional/Legal Concerns, and Personal Risk Expectations. Frequency counts and percentages were calculated for each survey item.

RESULTS

Data from 874 pediatric nurses and 81 parent/family advisors were analyzed. Most respondents believed the Run-Hide-Fight campaign should be changed to Secure-Preserve-Fight. Only 30% of nurses felt mentally prepared to respond to an active shooter event. Most respondents agreed that nurses have a professional duty to protect their patients, but agreed that it was a personal choice, not a moral obligation, to accept potentially fatal risks. Hospital setting and patient vulnerability often influenced nurses' perceived obligations to patients. Most respondents reported they would not leave their patient/child during an active shooter event.

CONCLUSIONS

Nurses feel morally obligated to patients, but must balance their own personal risk tolerance level against the need to protect patients and families.

PRACTICE IMPLICATIONS

Hospitals need in-depth active shooter training for both nurses and parents as well as safety plans that address both evacuation protocols and measures to secure in place to protect the lives of patients, families, and staff.

Practices and Perceptions of Face Mask Use in a Pediatric Health System During the COVID-19 Pandemic

BACKGROUND

Face coverings are recommended to help mitigate the spread of COVID-19. Guidelines regarding face mask use have evolved from the time when COVID-19 first emerged. Practices for face mask use in the United States vary widely.

METHODS

Clinical and nonclinical staff from a pediatric health care system were invited to complete a survey regarding perceptions and practices of face mask use during the COVID-19 pandemic. Overall results were analyzed, and subgroup analyses were conducted to compare clinical and nonclinical staff, and clinical staff who do and do not provide direct patient care.

RESULTS

The response rate was approximately 24% (1,128 of 4,698). Most respondents were clinical staff who provide patient care. A surgical/procedure mask was most often worn for patient care by 72% (P < .001). Most respondents (70%) reported wearing a cloth mask when not in the hospital (P < .001). Cloth masks were worn for a mean of 3.4 ± 3.9 d before washing. Frequent hand hygiene before putting on the mask, before removing, and after removing was reported as 56%, 44%, and 62%, respectively. The most common challenges reported were glasses fogging (69%), skin irritations (45%), and headaches (31%). Qualitative data revealed themes of feeling unsafe, beliefs and practices about COVID-19 and masks, mandates and enforcement of wearing masks, availability of personal protective equipment, and care delivery challenges.

CONCLUSIONS

Practices and perceptions of face masks varied among staff in a pediatric health care system. Some staff did not feel that masks are effective in preventing virus spread, and others did not feel safe in performing job duties. Hand hygiene for mask handling was not practiced consistently. A large number of staff reported having experienced challenges or health issues when wearing a mask. Clinical staff who provide direct patient care reported more issues than both nonclinical and clinical staff who do not provide care.

And the Beat Goes On: Heartbeat Recordings through Music Therapy for Parents of Children with Progressive Neurodegenerative Illnesses

Background: Music is a powerful therapeutic intervention to promote physical and psychological health, healing, and well-being. In pediatric palliative care, music therapists are often involved in preloss care. Heartbeat recordings (HBRs) synchronize the rhythm of the heartbeat into a favorite song. In preloss care, HBRs show promise in helping parents of children with progressive neurodegenerative illnesses (PNDI) cope with their chronic sorrow and the loss of their child. Objective: To explore the lived experience of HBRs for bereavement in the lives of parents of children with PNDI. Design: Phenomenological study. Setting/Subjects: Purposeful sample of 11 English-speaking parents of children with PNDI receiving palliative care services in an academic pediatric hospital were interviewed three months after receiving their child's HBR. Measurements: A semistructured interview guide was used to collect data concurrently with the mind mapping process. Results: Data from interviews revealed 4 major themes and 10 subthemes: (1) Bifocal View (parental lens vs. medical lens); (2) Navigating Life and Relationships (caregiver fatigue, grief and loss, marriage, job, brought us together, paying it forward); (3) Coping through Spirituality; and, (4) Legacy Creation (HBR as a connection, song selection). Conclusions: Parents of children with PNDI experience chronic sorrow. The HBR assisted in meaning-making that validated the child's life and supported the parents' expression of grief and their ability to cope. Further research is needed to validate the impact of HBRs in diverse populations.

Methodological Challenges Encountered in a Study of the Impact of Animal-assisted Intervention in Pediatric Heart Transplant Patients

PURPOSE

The purpose of this pilot study was to examine the impact of animal-assisted intervention (AAI) on ambulation, physiologic stability, patient satisfaction, and perceived benefit in hospitalized pediatric heart transplant patients.

DESIGN AND METHODS

This pilot study used a two-period, two-sequence cross-over design. Using a convenience sample of heart transplant patients between the ages six and nineteen, each subject participated in one AAI and one non-AAI study session over one week. All study sessions started with an aspect of walking.

RESULTS

Three males and two females participated. Average age was 15 years. Subjects walked on average 1906 ft during the AAI session as compared to 1933 ft in the non-AAI session. Subjects spent a longer time (17 min) walking in the AAI session as compared to the non-AAI session (15 min). Blood pressure and respiratory rates remained stable. All subjects reported they liked working with the dog. Eighty percent of subjects actively engaged in physical contact and communication with the dog. No safety-related adverse events were reported.

CONCLUSIONS

AAI may assist adolescent heart transplant patients to be more motivated to participate in therapeutic ambulation when walking with a dog. Further studies are needed to identify successful recruitment strategies in this highly vulnerable patient population.

PRACTICE IMPLICATIONS

Many clinical challenges exist in implementing AAI research in the pediatric heart transplant population. A conceptual model is introduced to better understand the methodological challenges of conducting AAI research in the hospital setting. Key components include research, organizational, AAI, subject and time factors.

Evaluating Evidence-Based Practice Knowledge and Beliefs Through the e-Learning EBP Academy

BACKGROUND

This research examined evidence-based practice (EBP) knowledge and beliefs before and after a 3-month e-learning program was implemented to build EBP capacity at a large children's hospital.

METHOD

Ten clinicians completed the development, implementation, and evaluation of the e-learning education, comprising phase one. Revision and participation by 41 clinicians followed in phase two. Participants in both phases completed the EBP Beliefs and Implementation Scales preintervention, postintervention, and 6 months after postintervention.

RESULTS

EBP beliefs and implementation increased immediately and 6 months after postintervention, with statistically significant increases in both phases. Participants in both phases applied knowledge by completing mentor-supported EBP projects.

CONCLUSION

Although EBP beliefs and implementation scores increased and e-learning provided flexibility for clinician participation, challenges arose, resulting in lower-than-expected completion. Subsequent revisions resulted in hybrid education, integrating classroom and e-learning with project mentoring. This funded e-learning research contributes knowledge to the growing specialty of professional development. J Contin Educ Nurs. 2017;48(7):304-311.

Development and Evaluation of the Barriers to Nurses’ Participation in Research Questionnaire at a Large Academic Pediatric Hospital

The purposes of this study were to survey nurses at a large pediatric hospital to examine barriers to nursing research and to develop the Barriers to Nurses’ Participation in Research Questionnaire (BNPRQ) in preparation for its use at other institutions. The BNPRQ was created and refined through iterative pilot testing. Exploratory factor analysis was applied, and composite scores were computed for the identified factors. The two latent factors “Research Resources” and “Personal Relevance of Research” were extracted. The independent item “lack of time to do research” represented the largest barrier to research. Factor and item scores differed according to subject characteristics. Findings from this study will be used to create targeted interventions to reduce barriers to research participation prevalent in specific groups of nurses. By using the BNPRQ developed in this study, researchers and administrators at other institutions can identify and address barriers to research among their nurses.

The great American cookie experiment: engaging staff nurses in research

PURPOSE

The purpose of this study was to engage staff nurses in research in an informative and fun way by determining nurses' preference for sugar-free chocolate chip cookies versus regular chocolate chip cookies.

DESIGN AND METHODS

A descriptive, crossover, double-blinded study was performed using a convenience sample of 300 staff nurses.

RESULTS

Nurses preferred the texture, flavor, and overall preference of the regular chocolate chip cookie as compared with the sugar-free chocolate chip cookie (p<0.001).

IMPLICATIONS

The Great American Cookie Experiment remains a creative teaching strategy to enhance knowledge and engage nurses in the research process.

Social justice considerations in neonatal care for nurse managers and executives

This article presents the struggle between social justice and market justice within the current health care system, specifically issues affecting neonatal care. Community benefit is described and discussed as an aspect of social justice demonstrated by hospitals. The federal and state Children's Health Insurance Program also is discussed in relation to social justice and health care costs. Implications for managers and executives overseeing neonatal care are presented in relation to the economic and social issues.

Creating an Evidence-Based Practice Environment

There is increasing effort in promoting evidence-based practice (EBP) that supports the best possible care to patients and families. This article describes essential concepts for developing an environment of EBP and its implementation at a large pediatric hospital. Essential components for creating an EBP environment include vision, engagement, integration, and evaluation. An institutional initiative to decrease procedure-related pain demonstrates how EBP is used to improve clinical care.

hK5 and hK7, two serine proteinases abundant in human skin, are inhibited by LEKTI domain 6

BACKGROUND

Several skin diseases and atopic disorders including Netherton syndrome and atopic dermatitis have been associated with mutations and deviations of expression of SPINK5, the gene encoding the human 15-domain serine proteinase inhibitor LEKTI. The biochemical mechanisms underlying this phenomenon have not yet been fully clarified.

OBJECTIVES

To identify target proteinases of LEKTI important for processes of desquamation and inflammation of the skin which will enable the development of specific drugs.

METHODS

The inhibitory activities of LEKTI domains 6 and 15 were tested on a number of commercially available serine proteinases and also on the purified kallikreins hK5 and hK7. In addition, recombinant hK5 was used.

RESULTS

LEKTI domain 6 is a potent inhibitor of hK5 and hK7, whereas LEKTI domain 15 exhibits inhibitory activity on plasmin. hK5 and hK7 in particular are relevant to skin disorders.

CONCLUSIONS

The inhibition of hK5 and hK7 by LEKTI domain 6 indicates an important regulatory role of LEKTI in processes of skin desquamation and inflammation, which may explain the severe pathological symptoms associated with abnormalities of SPINK5 and/or its expression. Thus, LEKTI represents a potential drug for the treatment of these disorders.

Sleeping beauties: the impact of sedation on neonatal development

Sedatives are frequently administered in neonatal intensive care to induce sleep for diagnostic and radiology procedures, calm irritable infants, manage pain-related agitation, and enhance ventilation. The pharmacology and side effects of sedatives commonly used with neonates will be reviewed and placed within the context of their potential effect on neonatal development. Alternative caregiving strategies to minimize or eliminate the need for sedation will be discussed.

The 15-domain serine proteinase inhibitor LEKTI: biochemical properties, genomic organization, and pathophysiological role

Proteinases are involved in specific and non-specific proteolytic reactions, and participate in many pathophysiological processes. Normally, they are regulated by endogenously produced proteinase inhibitors which, thus, represent lead structures for the development of therapeutics. We succeeded in partially isolating and cloning a novel human serine proteinase inhibitor which, according to its structure and the expression pattern of the corresponding gene, was termed lympho-epithelial Kazal-type-related inhibitor (LEKTI). This inhibitor is of special interest because it exhibits an extraordinarily large number of 15 potentially inhibitory domains and is of pathophysiological importance for the severe congenital disease Netherton syndrome. Here, we review the as yet known data on protein structure, biochemical properties, genomic organization and gene expression. Furthermore, the relevance of LEKTI for several disorders pointing out its possible future therapeutic value, is discussed.

Purification and characterization of the first archaeal aconitase from the thermoacidophilic Sulfolobus acidocaldarius

The first archaeal aconitase was isolated from the cytosol of the thermoacidophilic Sulfolobus acidocaldarius. Interestingly, the enzyme was copurified with an isocitrate lyase. This enzyme, directly converting isocitrate, the reaction product of the aconitase reaction, was also unknown in crenarchaeota, thus far. Both proteins could only be separated by SDS gel electrophoresis yielding apparent molecular masses of 96 kDa for the aconitase and 46 kDa for the isocitrate lyase. Despite of its high oxygen sensitivity, the aconitase could be enriched 27-fold to a specific activity of approximately 55 micromol x min(-1) x mg(-1), based on the direct aconitase assay system. Maximal enzyme activities were measured at pH 7.4 and the temperature optimum for the archaeal enzyme was recorded at 75 degrees C, slightly under the growth optimum of S. acidocaldarius around 80 degrees C. Thermal inactivation studies of the aconitase revealed the enzymatic activity to be uninfluenced after one hour incubation at 80 degrees C. Even at 95 degrees C, a half-life of approximately 14 min was determined, clearly defining it as a thermostable protein. The apparent K(m) values for the three substrates cis-aconitate, citrate and isocitrate were found as 108 microM, 2.9 mM and 370 microM, respectively. The aconitase reaction was inhibited by the typical inhibitors fluorocitrate, trans-aconitate and tricarballylate. Amino-acid sequencing of three internal peptides of the S. acidocaldarius aconitase revealed the presence of highly conserved residues in the archaeal enzyme. By amino-acid sequence alignments, the S. acidocaldarius sequence was found to be highly homologous to either other putative archaeal or known eukaryal and bacterial sequences. As shown by EPR-spectroscopy, the enzyme hosts an interconvertible [3Fe--4S] cluster.

Influence of practice environment and nurse characteristics on perinatal nurses' responses to ethical dilemmas

BACKGROUND

Previous research on nurses' responses to ethical dilemmas has focused either on nurse characteristics or on practice environment characteristics, but has not examined both influences concurrently.

OBJECTIVE

To explore the relative contributions of practice environment characteristics and nurse personal and professional characteristics to perinatal nurses' willingness to be involved in activities to resolve clinical ethical dilemmas.

METHODS

A descriptive correlational design and hierarchical multiple regression were used to examine responses of 127 perinatal nurses to three instruments: the Nursing Ethical Involvement Scales (NEIS), Perinatal Values Questionnaire (PVQ), and Demographic Data Sheet (DDS).

RESULTS

The organizational variable, nursing influence, accounted for the greatest amount of variance in nurses' reported resolution actions, with nurses' concern about ethics and consequentialist values also contributing significantly. The three predictors together accounted for 31% (24% adjusted) of the variance in actions to resolve clinical ethical dilemmas. Level of nursing education was not a statistically significant influence.

CONCLUSIONS

These results suggest that nurses are more likely to be involved in dilemma resolution activities when they perceive themselves to have higher levels of influence in their practice environments and higher levels of concern about the ethical aspects of clinical situations. Nurses who emphasize consideration of morally relevant aspects of individual patient situations (consequentialist value orientation) and deemphasize adherence to abstract standards, rules, and policies also are more likely to be involved in dilemma resolution.

Problem-based learning in the NICU

Problem-based learning has been used by individuals from various professions and in a wide array of academic and clinical settings. The primary benefits of PBL are that it allows learners to be actively engaged in the learning process and that it can help to strengthen problem-solving skills for learners on any level. PBL can be used effectively in the NICU for both novice and advanced practice nurses.

Autoradiographic identification of a gastrin receptor on the human parietal cell

Gastrin plays an important role in regulating gastric acid secretion and gastrointestinal mucosal growth but its cellular sites of action in man have not been determined. Using cryostat sections of gastric mucosal tissue we have identified (125I-gastrin binding followed by fixation-wet emulsion autoradiography) and characterized (125I-gastrin binding followed by counting) a gastrin receptor binding site in the human stomach. This site displayed binding characteristics similar to those observed in isolated cell systems: specifically, 125I-gastrin binding was rapid (t1/2 approximately 10 min at 37 degrees C), temperature-dependent (3.5 fold more radioligand bound at 22 degrees C than at 4 degrees C) and saturable. The binding of the radioligand was also tissue specific and was five-fold greater in the gastric body than in the gastric antrum and duodenum. In the autoradiographs, silver grains were localized only to parietal cells and not to other epithelial cell types. In the presence of 40 nM gastrin grains were no longer present over parietal cells demonstrating that these sites were both saturable and of high affinity. These data provide the first demonstration of gastrin binding sites (putative receptors) on parietal cells in the human stomach and suggest that gastrin acts directly on these cells to help regulate gastric acid secretion and/or mucosal growth.

A novel gastrin-binding protein in the human eosinophil

A specific and saturable interaction between 125I-gastrin and eosinophils was discovered in autoradiographs of human gastric mucosal tissue and confirmed in isolated and enriched preparations of WBC's. Gastrin displaced 125I-gastrin from eosinophils in a dose-dependent manner with a D50 = 11 uM. Scatchard analysis of the saturation curve indicated a single binding site of low affinity (Kd = 4.14 uM) and high capacity (Bmax = 430 umoles/mg protein). The gastrin binding protein was localized to the granular core of the eosinophil and found to have a molecular weight of approximately 15 kDa following chemical crosslinking of radioligand to granules and SDS/PAGE. Based on its molecular weight and granular location and the charge characteristics of gastrin, the gastrin binding protein in the human eosinophil is most likely major basic protein. In vivo this interaction might act to limit the cytotoxic potential of MBP on tissues and/or attentuate gastrin concentrations thereby helping regulate gastric acid secretion and mucosal growth.

Individualized developmental care for very low-birth-weight infants: a critical review

Developmental care has been widely accepted and implemented in neonatal intensive care units across the country. Its proponents suggest that individualized developmental care is effective in reducing infant morbidity and length of hospital stay and improving neurodevelopmental outcomes. Although individual components of developmental care have been researched in more depth, few studies have examined a total developmental care protocol. This article critically examines the research base on individualized developmental care and discusses implications for clinical practice and future research.

Prenatal screening for hemoglobinopathies. II. Evaluation of counseling

Learning during genetic counseling is often below expectations, especially in the context of genetic screening. In this report we describe learning as a result of genetic counseling of 298 pregnant women identified as hemoglobinopathy carriers, 234 with sickle cell trait and 64 with beta-thalassemia trait. Counseling was designed to provide the information needed in a simple, clear, and nondirective manner. A special videotape produced for this purpose provided dramatization and a role model illustrating an appropriate response. After viewing the videotape the counselee had an opportunity to question the counselor and to have any misconceptions corrected. Questionnaires revealed significantly increased knowledge as a result of counseling in each of the three hemoglobinopathy subject areas tested-namely, clinical manifestations, genetics, and prenatal diagnosis. Five factors correlated with higher knowledge scores after counseling-namely, a younger patient age, more years of education, knowledge of having trait before this identification, knowledge of the baby's father having trait before counseling, and having no prior children.

Prenatal screening for hemoglobinopathies. I. A prospective regional trial

Prenatal hemoglobinopathy screening was chosen as a model system for the study of patient receptivity to unsolicited genetic information. Providers of prenatal care in Rochester, NY, were offered free testing of all their prenatal patients and genetic counseling of women found positive. The 18,907 prenatal samples tested in a 5-year period represented 35.1% of the pregnancies in the Rochester metropolitan region. A hemoglobinopathy was found in 810 pregnancies (4.3%). Of the 21 different types of hemoglobinopathies detected, the most common were sickle cell trait (59%), hemoglobin C trait (19%), beta-thalassemia trait (11%), and hemoglobin E trait (5%). At the time of phlebotomy, 75% of the pregnancies were of less than 18 wk duration. Sixty-six percent of the pregnancies occurred in patients unaware of their diagnosis, and 80% occurred in patients unaware that they might be at risk for a child with a serious blood disorder. Of the 810 positive pregnancies, 551 (68%) occurred in patients who came for counseling. Of 453 women counseled during their first screened pregnancy, 390 (86%) said they wanted their partners tested and 254 (55%) had their partner tested. In the 77 pregnancies thus found to be at risk, the couple was too late for prenatal diagnosis in 12 cases, and the condition for which the fetus was at risk was too mild in 12 cases. Prenatal diagnosis was offered in the remaining 53 pregnancies and was accepted by 25 couples (47%). These results indicate that unselected patients in the primary care setting in this region, even though pregnant, are receptive to and utilize genetic information.

Prenatal screening for hemoglobinopathies. III. Applicability of the health belief model

A comprehensive prenatal hemoglobinopathy screening program in Rochester, NY, has been described in a preceding paper in this issue of the Journal. A woman identified as a carrier may face three decisions. The first is whether to accept the offer of counseling. The second is whether to have her partner tested. If her partner also tests positive, then the third decision is whether to accept the offer of prenatal diagnosis. This report analyzes factors affecting her decision, with special attention being given to factors invoked by the Health Belief Model. Factors predicting that a patient who we identified as a carrier would come for counseling included the following: patient had no prior knowledge that she is a carrier (P less than .001), a gestational age less than 18 wk (P less than .01), and Caucasian race (P less than .05). For sickle cell trait counselees and beta-thalassamia trait counselees, factors found to predict patient's intent to have partner tested were the following: a greater postcounseling knowledge of the disease (P less than .009), a lesser perceived burden of intervention (P less than .011), and belief that the partner is also a carrier (P less than .008). Also for sickle cell trait counselees and beta-thalassemia trait counselees, factors predicting that the partner actually will be tested were the following: living with the partner (P less than .001), gestational age at identification less than or equal to 18 wk (P less than .001), a lesser perceived burden of intervention (P less than .002), and a greater perceived seriousness of the disease (P less than .05).(ABSTRACT TRUNCATED AT 250 WORDS)

Do pregnant women benefit from hemoglobinopathy carrier detection?

A 45% sample of all pregnancies in Rochester, N.Y. over a five-year period showed that 4.2% of pregnant women had a hemoglobinopathy. Sixty-six percent of these women did not know they had such an abnormality, and 80% did not understand its reproductive significance. Sixty-eight percent of women informed they were positive came for counseling. Fifty-seven percent of counseled women had the baby's father tested. Forty-seven percent of couples at risk offered amniocentesis wanted it. (table; see text) A woman was more likely to want her partner tested if she had a more thorough knowledge of the disease or viewed having an affected child as more burdensome. The partner was more likely to come for testing if the couple were living together than if living apart. Prenatal hemoglobinopathy screening is accepted by providers and pregnant women, at least when expert services are provided at no charge to either. Women and couples use the information provided to pursue their reproductive goals.

Nifedipine-haloperidol combination in the treatment of Gilles de la Tourette's syndrome: a case study

Anecdotal case reports have been published describing the use of the calcium channel blockers verapamil and nifedipine to provide rapid and dramatic relief in refractory Gilles de la Tourette's syndrome (TS). The authors' case presentation illustrates that, although these two drugs may not always work alone, they can be successfully used in combination with other medications for treating refractory TS.

Catatonia as a manifestation of paraneoplastic encephalopathy

The psychopathological, electrophysiological, and pathological features of a 58-year-old woman suffering from anaplastic lung carcinoma with paraneoplastic encephalopathy are presented. The predominant behavioral manifestation was a catatonic syndrome that was partially responsive to clonazepam. Although a variety of neurological, psychiatric, and other causes of catatonia have been reported, this is the first reported case of catatonia caused by paraneoplastic encephalopathy.

Prenatal hemoglobinopathy screening: receptivity of Southeast Asian refugees

Because of the availability of safe, accurate prenatal diagnosis for hemoglobinopathies, we wanted to know if pregnant women identified as carriers of a hemoglobinopathy by prenatal screening use this information to determine whether their fetus is at risk. Blood from all pregnant women served by a 40 percent sample of prenatal care providers in Rochester, New York, over 51 months underwent Hb electrophoresis and MCV +/- Hb A2 determination. The frequency of positive was 33/229 (14 percent) for Southeast Asians versus 567/15,824 (3.6 percent) for non-Southeast Asians. Of the positives, 29 (88 percent) Southeast Asians came for counseling versus 348 (61 percent) others. Of those counseled, 26 (90 percent) Southeast Asians had their partners tested, as did 211 (61 percent) others. Of the partners tested, 17 (65 percent) Southeast Asians were also positive compared to 44 (21 percent) others. Of couples offered prenatal diagnosis, 50 percent of each group (4/8 and 17/34) accepted. Of those accepting, all Southeast Asians actually underwent the procedure, while seven (41 percent) others miscarried or failed to keep their appointment. Thus, in our pregnant population, Southeast Asians are four times more likely to be hemoglobinopathy carries than non-Southeast Asians, and Southeast Asian carriers are four times more likely to warrant, want, and undergo prenatal diagnosis for a hemoglobinopathy than non-Southeast Asian carriers.

Source of calcium and cholinergic contraction of the rat portal vein and the sheep coronary artery

To demonstrate the heterogeneity in behavior of the rat portal vein and the sheep coronary artery, we studied the effect of cholinergic stimulation and its dependence upon extracellular ions. Since acetylcholine produces a contraction antagonized by atropine (pA2 9.5), these effects must be mediated by muscarinic receptors. alpha- and beta-adrenergic blocking agents or a drug which destroys noradrenergic nerve endings (6-hydroxydopamine) do not modify the effects of acetylcholine. In a calcium-free medium (EGTA 10(-4) M), the portal vein, unlike the coronary artery, doses not contract to acetylcholine or caffeine. In the coronary artery only the phasic component of the cholinergic contraction is maintained in a calcium-free medium. Verapamil and cobalt abolish the cholinergic contraction of the portal vein, but inhibit only the tonic component in the coronary artery. In a calcium-free medium, hyperosmotic solutions (290 mM sucrose) produce a moderate contraction which occurs slowly in both vessels. In the coronary artery, a sodium-calcium exchange does not appear to participate in the sustained tonic component of the cholinergic contraction. Electron microscopy demonstrates differences between the two blood vessels regarding the size of the sarcoplasmic reticulum. The coronary artery uses calcium both from extra- and intracellular sources. Portal vein is extremely dependent of the extracellular calcium but we were unable to give direct evidence of the utilization of calcium from intracellular pools during the cholinergic contraction of the rat portal vein.

Stress fracture of the navicular bone. Nine cases in athletes

Nine cases of stress fractures of the tarsal navicular bone were treated in athletes. The diagnosis was made with radiographs and bone scan within 6 months. Only two patients were treated surgically. The only poor result was seen in a patient in whom the fracture was only explored.

The binding characteristics of 125I-gastrin and 125I-CCK8 to guinea pig fundic gastric glands differ: is there more than one binding site for peptides of the CCK-gastrin family?

The binding of biologically active 125I-labeled derivatives of the C-terminal octapeptide of cholecystokinin (125I-CCK8) and gastrin (125I-G) to dispersed guinea pig fundic glands were compared at 24 degrees C. Although both peptides share the same C-terminal pentapeptide sequence, differences were found in the amount of each radioligand bound to fundic glands, their dissociation behavior, and their Scatchard plots. However, each peptide was able to displace the other radioligand from the glands at nM concentrations which indicated that both peptides bound to the same site. The different binding characteristics observed for 125I-G and 125I-CCK8 most likely resulted from the different dissociation rates of each peptide.