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Biomedical subjects

C Miaskowski

Publications and source records attributed to C Miaskowski.

At least 91 records · Page 5Linked to original sources
PubMed1992

The problem of pain in children with cancer: a research review.

Pain in a child with cancer poses significant challenges for nurses. However, little research has been conducted in the area of pediatric cancer pain to guide clinical assessments and interventions. The purpose of this paper is to present a review of the research studies conducted on pediatric cancer pain over 13-1/2 years. The review of the cancer pain research studies is organized around several concepts that include approaches to cancer pain assessment and management as well as the presentation, incidence, and etiology of pain associated with childhood malignancy. Relevant clinical findings from the review of the literature are highlighted. Emphasis is on the major nursing implications from these studies, and suggestions are made for future nursing research.

Adaptation, Psychological↗
PubMed1991

Contribution of supraspinal mu- and delta-opioid receptors to antinociception in the rat.

This study evaluated the contribution of supraspinal opioid receptors to the production of antinociception, in the rat. I.c.v. administration of a selective mu- (DAMGO) and a selective delta- (DPDPE), but not a selective kappa- (U50,488H) opioid receptor agonist, produced significant dose-dependent increase in mechanical nociceptive thresholds. ICI 174,864, a delta-opioid receptor antagonist, completely blocked the antinociceptive effects produced by DPDPE ([D-Pen2,D-Pen5]enkephalin) at a dose that had no effect on the increases in nociceptive thresholds produced by DAMGO ([D-Ala2,N-MePhe4,Gly5-ol]enkephalin). The simultaneous i.c.v. administration of a low-antinociceptive dose of DAMGO or DPDPE given in combination with sequentially increasing doses of the other opioid agonist, produced synergy (i.e., a more than additive antinociceptive effect), at the lower doses tested. The results of these experiments provide evidence to support the suggestion that both supraspinal mu- and delta-opioid receptors contribute to the production of antinociception, in the rat.

3,4-Dichloro-N-methyl-N-(2-(1-pyrrolidinyl)-cycloh↗
PubMed1991

Dissociation of antinociceptive and motor effects of supraspinal opioid agonists in the rat.

This study compared the antinociceptive and motor effects produced by intracerebroventricular administration of selective mu- (DAMGO) and delta- (DPDPE) opioid receptor agonists in the rat. Changes in nociceptive thresholds were measured using the Randall-Selitto paw-withdrawal test and changes in motor coordination were evaluated using the rotarod treadmill test. Both DAMGO and DPDPE produced statistically significant, dose-dependent increases in mechanical nociceptive thresholds compared to vehicle controls. However, in the motor coordination studies, neither opioid agonist produced statistically significant changes in rotarod performance scores. The dissociation of antinociceptive and motor effects at this supraspinal site differs from the strong association between antinociceptive and motor effects produced by intrathecal administration of the same opioid agonists.

Analgesics↗
PubMed1991

Comparison of the antinociceptive and motor effects of intrathecal opioid agonists in the rat.

This study compared the antinociceptive and motor effects produced by intrathecal administration of selective mu-, delta-, and kappa-opioid receptor agonists in the rat. Changes in nociceptive threshold were measured using the Randall-Selitto paw-withdrawal test and changes in motor coordination were evaluated using the rotarod treadmill test. Each opioid agonist produced statistically significant, dose-dependent increases in mechanical nociceptive thresholds compared to vehicle controls. In the motor coordination studies, DAMGO and DPDPE, but not U50,488H, produced statistically significant decreases in rotarod performance scores compared to vehicle controls. The results of these studies suggest that motor side-effects produced by opioid agonists need to be considered when interpreting the results of antinociceptive tests that are dependent on a normally functioning motor system.

3,4-Dichloro-N-methyl-N-(2-(1-pyrrolidinyl)-cycloh↗
PubMed1991

Chemotherapy update.

The administration of chemotherapy is one of the major forms of cancer treatment. Recent progress in the use of chemotherapeutic agents has evolved from an understanding of the basic mechanisms of tumor cell kinetics and the molecular and biochemical basis for individual and multidrug resistance patterns. These advances have led to the development of novel approaches to the administration of cancer chemotherapeutic agents. Nurses must remain knowledgeable about these concepts to understand the mechanisms underlying the administration of various combinations of cancer chemotherapy.

Antineoplastic Agents↗
PubMed1990

Analgesic synergy and improved motor function produced by combinations of mu-delta- and mu-kappa-opioids.

This study evaluated the effects of intrathecal administration of a low-analgesic dose of the selective mu-agonist DAMGO co-administered with sequentially increasing doses of either the selective delta-agonist DPDPE or the selective kappa-agonist, U50,488H on mechanical nociceptive thresholds in the rat. Potent analgesic synergy was observed with both combinations. Since an elevation in nociceptive threshold can result from motor deficits, as well as true analgesia, we also evaluated the effects of the combination regimens on motor coordination using a rotarod apparatus. The combination regimens produced significantly less motor deficits than those observed when DPDPE and U50,488H were administered as single agents. These findings of enhanced analgesia with decreased motor side-effects associated with administration of fixed mu/delta or mu/kappa combinations suggest that co-administration of opiates that act at different receptors may constitute a superior approach to the treatment of pain.

3,4-Dichloro-N-methyl-N-(2-(1-pyrrolidinyl)-cycloh↗
PubMed1990

Intracerebroventricular naloxone produces a dose-dependent, monotonic increase in nociceptive threshold in the rat.

The intrathecal administration of the opiate antagonist naloxone produced a dose-dependent biphasic change in mechanical nociceptive threshold, in the rat hindpaw. Lower doses (50 pg to 500 ng) produced analgesia while higher doses (5 to 50 micrograms) resulted in successively less analgesia. In contrast, the intracerebroventricular administration of naloxone up to a dose of 5 micrograms (i.e. a dose 10,000 times greater than that required to produce a maximal analgesic effect) only produced analgesia. The ability to differentiate between the analgesic and pain-enhancing properties of naloxone by administration at different anatomical sites is compatible with the suggestion that the analgesic and pain-enhancing effects of naloxone are produced by separate mechanisms of action.

Analgesics↗
PubMed1990

Kappa- and delta-opioid agonists synergize to produce potent analgesia.

This study evaluated the interaction of the analgesic effects of a selective kappa- (U50, 488H) and a selective delta- ([D-Pen2,5]enkephalin, DPDPE) opioid agonist, co-injected intrathecally, using the Randall-Selitto paw-withdrawal test, in the rat. Intrathecal administration of both U50, 488H and DPDPE, as single agents, produced dose-dependent increases in mechanical nociceptive threshold. However, when the dose-response curves for both U50, 488H and DPDPE in the presence of a low-analgesic dose of the other agent were compared with the dose-response curves for the respective agonist administered alone, the curves for the combination regimens were shifted to the left. A statistically significant deviation from parallelism between the dose-response curves of the single versus the combined agents, as well as isobolographic analysis, demonstrates that the simultaneous administration of opioid agonists, the act at kappa- and delta-opioid receptor sites, can produce analgesic synergy.

3,4-Dichloro-N-methyl-N-(2-(1-pyrrolidinyl)-cycloh↗
PubMed1990

Changes in oxytocin and vasopressin content in posterior pituitary and hypothalamus following pantethine treatment.

Pantethine, a cysteamine precursor, depletes somatostatin in the cerebral cortex and hypothalamus and prolactin in the anterior pituitary and hypothalamus. This study investigated the effect of pantethine on oxytocin and arginine vasopressin content in the posterior pituitary and hypothalamus. Male Long-Evans rats were injected intraperitoneally with escalating doses of pantethine (i.e., 146.7 mg, 293.4 mg and 586.6 mg/100 gm body weight). Hormone content was determined by radioimmunoassay. Three hours after pantethine treatment, the oxytocin content in the posterior pituitary and the hypothalamus was markedly reduced with all doses of the drug. Vasopressin content in the posterior pituitary and hypothalamus was decreased but to a lesser extent than oxytocin and only with the highest dose of pantethine. Pantethine may act to reduce oxytocin and vasopressin content through intracellular conversion to cysteamine. The exact mechanism of action of pantethine on oxytocin and vasopressin remains to be elucidated.

Analysis of Variance↗
PubMed1990

Certification for oncology nurses: maturing of a discipline.

Certification for oncology nurses shares many similarities with board certification in medicine. Within the specialty of oncology nursing, certification provides one measure of excellence and signals a commitment to oncology nursing practice. Since the beginning of oncology nursing certification in 1986, over 7,200 nurses have become certified. This article describes the certification process for oncology nurses and discusses ways in which physicians can assist in this process.

Certification↗
PubMed1990

The future of oncology nursing. A historical perspective.

This article provides a perspective on the history of oncology nursing and the technologic and societal factors that have impacted on the development of this specialty. This article attempts to raise issues that will confront the profession of nursing as it moves into the twenty-first century. I hope that the comments and questions about the future made in this article will challenge nurses to participate in charting a preferred future for the profession of nursing in the twenty-first century.

Delivery of Health Care↗
PubMed1990

Oral complications of cancer therapies. Management of mucositis during therapy.

This paper reviews the purposes of an oral care protocol, the major components of an oral care regimen, and oral care protocols and studies done to date. Many questions remain in the area of optimal oral care for the patient experiencing mucositis as a sequela of cancer treatment. Research is needed on types and use of mouth rinses, effective, harmless, and pleasant lip lubricants, appropriate analgesic and anti-inflammatory combinations, and the effectiveness of a variety of devices for oral cleansing, to name a few areas. As outpatient oncology services grow, oral care protocols must be developed to meet the needs of ambulatory patient populations. Oral care regimens must be safe, easy to use, and economical as well as effective to ensure patient and staff compliance. Research on the management of mucositis must be conducted in both inpatient and outpatient settings. Finally, in order to obtain sufficient sample sizes and optimize data collection, these studies will need to be conducted by multidisciplinary teams (including dentists, oncologists, radiation therapists, and nurses) across multiple sites. Not until large-scale clinical trials are done on the treatment of mucositis will we be able to optimize the therapeutic regimen for the patient.

Humans↗
PubMed1989

Quality assurance issues in oncology nursing.

Oncology nursing has been given the challenge to determine if oncology patients are provided with the highest quality nursing care. Inherent in this challenge is the development of indicators to measure clinical excellence in oncology nursing practice as well as organizational excellence. The Standards of Oncology Nursing Practice by the Oncology Nursing Society (ONS) and the American Nurses' Association (ANA) provides the framework for the development of specific clinical indicators to measure oncology nursing practice. These standards contain structure, process, and outcome criteria to measure oncology nursing practice. Within these practice standards, emphasis is placed on 11 high-incidence problem areas that can occur in cancer patients at any stage of the disease process, regardless of the care setting. These problem areas should serve as the broad basis for the development of specific clinical indicators to measure the quality of nursing care provided to the oncology patient. This report provides suggestions for possible clinical indicators based on the ONS/ANA Standards and the scope of care provided by nursing to oncology patients. This report also discusses problems and issues related to quality assurance in cancer nursing, i.e., (1) the diversity of the patient populations that are cared for by oncology nurses; (2) the lack of research on clinical indicators in oncology nursing practice; and (3) the lack of a national data base on cancer nursing practice to aid in the establishment of "thresholds of acceptable performance." Possible solutions and recommendations for action are given.

Attitude of Health Personnel↗
PubMed1988

Immobilization stress affects oxytocin and vasopressin levels in hypothalamic and extrahypothalamic sites.

Oxytocin (OT) and vasopressin (VP) have been localized in various sites within the central nervous system outside the classic hypothalamo-neurohypophyseal axis. This study investigated the effect of immobilization stress on the levels of OT and VP in the hypothalamus, pons-medulla, and the cervical, thoracic, and lumbosacral segments of the spinal cord. Male Long Evans rats were immobilized for 1 min and sacrificed by guillotine. The tissues were dissected out and homogenized in 0.1 N HCl. The hormone content was determined by radioimmunoassay (RIA) in Sep-pak extracted samples. The data show a decrease in OT content of 33.6% (P less than 0.02) and 42.4% (P less than 0.01) in the hypothalamus and pons-medulla, respectively. In the spinal cord, however, OT levels were increased by 39.1% (not significant), 51.1% (P less than 0.05), and 87.6% (P less than 0.001) in the cervical, thoracic, and lumbosacral segments respectively. The VP content of the hypothalamus and pons-medulla did not change. However, in the spinal cord, the VP content was also increased by 101.4% (P less than 0.01) and by 143.7% (P less than 0.01) in the cervical and lumbosacral segments. The levels of VP in the thoracic segment did not change. The data demonstrate that stress can alter hypothalamic and extra-hypothalamic levels of OT as well as spinal cord levels of VP. The exact physiological effects of these changes, particularly within the spinal cord, remain to be elucidated.

Animals↗
PubMed1987

Cyclic variations in spinal cord levels of oxytocin and vasopressin during the stages of the rat estrous cycle.

Oxytocin (OT) and vasopressin (VP) have been localized to numerous central nervous system locations outside the classic hypothalamo-neurohypophyseal tract including all levels of the spinal cord. To date, the physiological function of these peptides within the spinal cord is unknown. The purpose of this study was to determine if the variations exhibited by pituitary OT and VP during the stages of the estrous cycle in the rat were also present in the spinal cord. The stage of the estrous cycle was determined by vaginal smears in female Long Evans rats. Following decapitation, the cervical, thoracic, and lumbosacral segments of the spinal cord were isolated and homogenized, and the hormones were extracted from the tissue with the Sep-pak method. OT and VP content were determined by RIA. A cyclic variation in spinal cord OT and VP was present, with maximal levels occurring in diestrus, a time in the estrous cycle when LH and estradiol levels are lowest. Our results suggest that spinal cord OT and VP may be regulated by ovarian hormones. These data represent the first documented changes in spinal cord levels of OT and VP under physiological conditions.

Animals↗