Nurse's difficulty and their educational needs regarding pediatric cancer care in Japan

Aim

Aiming at environmental arrangements for pediatric cancer patients and their families to receive appropriate medical care and support with a sense of security, the Japanese Ministry of Health, Labour, and Welfare designated 15 hub hospitals for childhood cancer. These hub hospitals have established networks with approximately 200 centers/hospitals treating pediatric cancer. In order to promote equal access to nursing, we investigated nurses' difficulties and needs at these treatment hospitals with limited experience in pediatric cancer nursing.

Methods

In order to examine education on pediatric cancer nursing, we investigated difficulties felt by treatment hospital nurses, their educational experience and their educational needs. A total of 584 nurses (66.51%) from 52 hospitals from which written consent was received completed the questionnaires.

Results

Nurses had difficulties regarding nursing care for patients with critical conditions, such as terminal care, and actions to be taken when a patient's physical condition rapidly changes. Nurses most strongly desired education on nursing care for patients with serious problems, such as terminal care, and follow‐up provided in the form of in‐ and hub‐hospital lectures.

Conclusion

Our study suggested that in order to provide nurses in treatment hospitals with education focusing on nursing care for patients with serious problems, education systems based on cooperation between hub and treatment hospitals are needed.

Significant increase in prostaglandin E-main urinary metabolite by laxative administration: comparison with ulcerative colitis

OBJECTIVE

To assess the production of prostaglandin E(2), an important chemical mediator in diarrhea induced by laxative administration, a prostaglandin E-main urinary metabolite (7alpha-hydroxy-5,11-diketotetranor-prosta-1,16-dioic acid, PGE-MUM) was measured in healthy volunteers and compared with the values of patients with ulcerative colitis.

METHODS

PGE-MUM was determined by a simplified immunoassay of bicyclic PGE-MUM and analyzed for the influence of laxative administration and active/remission phases of ulcerative colitis.

RESULTS

Administration of laxatives induced a significant increase in PGE-MUM in healthy volunteers. A significant elevation was also found in the active as compared with the remission phase of ulcerative colitis. The PGE-MUM levels were significantly correlated with our modified Talstad scores, clinical disease activity indices in ulcerative colitis. It was confirmed by time course studies of individual patients that changes in PGE-MUM correlated well with colitis activity.

CONCLUSION

Laxative administration induces production of prostaglandin E(2) as one of the chemical mediators, although its production grade is relatively low as compared with ulcerative colitis in the active phase.

[Emphysematous cystitis and neuropathy; a report of the case with diabetes mellitus]

A study was made of a 55 years old male, who suffered from emphysematous cystitis with diabetes mellitus. He had multiple complications due to diabetic neuropathy such as foot ulceration, oculomotor nerve palsy, peroneal nerve palsy and a neurogenic bladder. Klebsiella pneumoniae and Pseudomonous aeruginosa were cultured from urine specimens. There have been only 19 reported cases of emphysematous cystitis since 1962. Fourteen of these cases had diabetes mellitus.

[Endocrine disturbances in liver cirrhosis--focused on sex hormones]

Various endocrine disturbances are often observed in the patients with liver cirrhosis. We focused this paper on the sex hormones. Clinical features of male cirrhotic subjects are feminization(gynecomastia etc) and hypogonadism(testicular atrophy, reduced fertility, loss of libido, impotence etc). Chief abnormalities of sex hormones are a decrease in serum testosterone levels and an increase in serum estrogen levels accompanied by an increase in ratio of estrogen to testosterone in the patients with severe liver cirrhosis associated with the severity of hepatic dysfunction. Hyperestrogenization may be related with feminization of male cirrhotic subjects, whereas hypogonadism is the result of alcohol abuse per se, rather than the indirect consequence of liver cirrhosis.

Reduced sialylation of glycoproteins in nasal glands of patients with chronic sinusitis

This study was conducted to investigate the sialylations of glycoproteins in the nasal glands of patients with chronic sinusitis. Sialic acids were detected using lectin histochemistry, and the mRNA of sialyltransferase was evaluated by in situ hybridization histochemistry. Sambucus nigra agglutinin (SNA), which recognizes terminal sialic acids, strongly stained the glandular mucous cells of normal subjects, but not those of patients with chronic sinusitis. In situ hybridization histochemistry showed that the expression of alpha2,6 sialyltransferase mRNA was decreased in the secretory cells of patients with chronic sinusitis. Our present results suggest that a reduction in sialyltransferase activity at the mRNA level in the nasal glands may lead to the persistence of chronic sinusitis.

Results of dacryocystorhinostomy in 96 patients

Between years 1895 and 1995, 112 patients underwent dacryocystorhinostomy in the Department of Otorhinolaryngology at Tampere University Hospital. A questionnaire considering the recent symptoms of patients was sent to 108 patients. Four of the patients have died. Ninety-six patients returned the questionnaire. Seventy-nine (61 primary operations) lacrimal systems underwent dacryocystorhinostomy (DCR) by external approach (Toti) and 25 (23 primary operations) by transnasal approach (West). Mean follow-up time was 5 years and 8 months. In extranasal DCR group 13% (8/61) of patients required a re-operation and of the others 85% (45/53) were satisfied with the result and still chose the same operation. In transnasal surgery group 30% (7/23) of patients required a re-operation and of the others 56% (9/16) were satisfied and still chose the same operation. Twelve extranasal DCR were made due to trauma or congenital deficiency and 67% of them reported relief of their symptoms. In both groups the results were significantly better if silicon tubes were introduced after operation between eye and nose to keep the lacrimal system open.

Effects of oxygen radicals on ciliary motility in cultured human respiratory epithelial cells

There are few reports about direct effects of specific oxygen products on ciliary function because of their instability and reactivity. We investigated the direct effects of superoxide anion (O2-) and of hydrogen peroxide (H2O2) on the ciliary function of human respiratory epithelial cells, using monolayer cell cultures, high speed video analysis of frequency (CBF), amplitude (CBA), and coordination of ciliary beats and evaluating the surface structural changes of ciliated cells at the same time. 10(-2) M H2O2 decreased ciliary beat activity. The CBF was 36.5 +/- 4.4% and the CBA was 51.0 +/- 3.8% of the baseline (time = 0) after 5 min (all p < 0.001). Catalase (2 micrograms/ml) abolished the ciliotoxic effect of H2O2. The O2- produced by reaction of xanthine (0.06 mM)-xanthine oxidase (0.04 U/ml) caused a temporary rapid increase of 26.8 +/- 1.7% in CBF and an increase of 42.5 +/- 4.1% in CBA after 15 sec (all p < 0.001). Superoxide dismutase significantly reduced these increases. Results indicated that O2- activated ciliary function with a temporary increase in O2(-)-production. This suggests that the removal of H2O2 from the O2- reaction is important in improving mucociliary clearance in excessive oxygen metabolites.

Effect of exogenous ATP and physical stimulation on ciliary function impaired by bacterial endotoxin

The effects of exogenous ATP and physical stimulation on ciliary beat depressed by lipopolysaccharide from Pseudomonas aeruginosa were studied in cell culture. Both the ciliary beat frequency (CBF) and the amplitude (CBA) of human respiratory cells in monolayer cell cultures were studied by using a differential interference microscope equipped with a high speed video. Both the ATP and the physiol stimulation stimulated temporarily the depressed CBF and CBA. In both groups the CBF and CBA increased in 1 min to the initial level and then gradually decreased to the level before the stimulation. The duration of the ATP stimulation on the CBF (10.1 +/- 1.8 min) and CBA (10.1 +/- 2.3 min) were significantly better than the duration of physical stimulation on CBF (8.0 +/- 1.8 min) and CBA (6.8 +/- 1.6 min). However, the areas under the CBF/CBA curves (from the beginning of stimulation until the initial level of CBF or CBA was reached again) did not differ significantly. After the removal of the bacterial toxin the CBF was restored to the initial level. In the present study the adenosine receptor antagonist could not prevent the ciliostimulative effect of exogenous ATP combined with the physical stimulation. Both exogenous ATP and physical stimulation have a clear but temporary stimulative effect on the ciliary beat depressed by bacterial toxin, ATP being slightly more effective. It seems that the effects of ATP are not mediated by adenosine receptors.

Ciliary motility and surface morphology of cultured human respiratory epithelial cells during ciliogenesis

We used human respiratory epithelial cells in floating culture to study the motility and surface morphology of the cilia during ciliogenesis. Ciliary motility and surface morphology was examined by a high-speed video system and electron microscopy, respectively. On day 8 of floating culture, but rarely before, cells with numerous moving short cilia with mean ciliary beat frequency (CBF) of 17.8 +/- 2.5 Hz (mean +/- SD) were seen. The mean CBF was highest on day 10 (19.6 +/- 3.9 Hz) and reached 17.4 +/- 2.5 Hz on day 14. The ciliary beat amplitude (CBA) was recognized on day 8, abruptly increased on day 9, then continued with aging of the culture. The intracellular coordination of ciliary beats was poor on day 8 with random beat direction but improved up to day 12 when the intracellular uniform beat direction was established. However, intercellular coordination remained absent even on day 14. Results suggest that immature short cilia have a rigid beat pattern. With the elongation of the resulting whip-like movement, the ciliary beat was gradually synchronized. Although a ciliary elongation seems to be required for making intracellular coordination, other factors are involved in intercellular coordination. Also, a high CBF does not always indicate the activity of mature cilia.

Effect of exogenous ATP on ciliary beat of human ciliated cells studied with differential interference microscope equipped with high speed video

To study the detailed effects of exogenous adenosine triphosphate (ATP) on ciliary function, we used the differential interference microscope equipped with high speed video and evaluated ciliated cells from the human sinus mucosa in monolayer culture. With this system it was possible to evaluate all parts of ciliary motility with a minimum of interference from the mucous membrane, secretory cells and the autonomic nervous system. The best direct ciliostimulative effect of exogenous ATP on ciliary beat frequency (CBF) and ciliary beat amplitude (CBA) was observed at concentrations of ATP ranging from 10(-5) M to 10(-3) M. Exogenous ATP appeared to normalize the slightly damaged ciliary motility in groups with an initial CBF of 14 Hz or higher. When the CBF was less than 14 Hz, ATP produced an increase in CBF greater than 40%, an increase in CBA greater than 30%, but these did not reach the normal level in 5 min. The biggest increases: 59.9% in CBF and 40.7% in CBA were seen in the group with an initial CBF less than 9 Hz. In the cells with a low initial CBF and unsynchronized motility exogenous ATP increased the synchrony of ciliary movement together with an increase in CBF and CBA.

Degeneration of human respiratory cell ciliary beat in monolayer cell cultures

The degeneration of ciliary beat of human respiratory cells was studied in monolayer cell cultures by using a differential interference microscope equipped with a high speed video system. This method for studying ciliary beat in cell cultures on collagen-coated cover glasses is quite advantageous, because it allows for detailed study of all parts of ciliary function and not just ciliary beat frequency (CBF). In the present study both CBF and ciliary beat amplitude (CBA) were found to decrease continuously from the 1st day after plating but the wave form of ciliary beat did not change. Cultures with high cell density provided better preservation of normal ciliary beat for a longer period. In contrast, ciliary beat degenerated quickly in cultures with low cell density. CBF and CBA in cell cultures less than 5 days after plating were always high, supporting use of these cultures for studies of normal ciliary motility.

[Efficacy of individual smoking cessation instructions for general smokers among clients of a health center]

Smoking cessation instruction for individuals using a standardized smoking cessation manual and a handout developed by the authors was studied in a controlled trial among employees who visited a health center for Industrial Safety and Health Law mandated annual health examinations. Smokers in the study group were given 5-10 minutes smoking cessation instruction mainly by public health nurses and nutritionists following the above-mentioned manual and using the handouts. Subjects in both groups were interviewed by telephone to assess changes in smoking habits one month after the first contact. Smoking clients who came on Friday (132) and on Monday (93) were assigned to study and control groups, respectively. One hundred and nineteen members (90.2%) of the study group and 88 (94.6%) of the control group were successfully followed until one month after the initial contact. Seven subjects in the study group were not smoking one month after the instruction, while no one gave up smoking in the control group (p less than 0.05). It was confirmed by telephone survey that 6 of the 7 subjects who were not smoking at one month were still maintaining abstinence from smoking one year after the instruction. Smokers who did not stop smoking reported a reduction in their smoking dose in the study group. Lighter smokers reacted more readily to instruction than did heavier smokers and the knowledge level of subjects was positively associated with the success rate.