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Biomedical subjects

D N Rutledge

Publications and source records attributed to D N Rutledge.

At least 19 recordsLinked to original sources

Study of the behaviour of amino acids in aqueous solution by time-domain NMR and high-resolution NMR.

The study of protein hydration by time-domain NMR is complicated by the great number of interactions involved, resulting from the presence of several amino acids and the possible modifications produced by the various structures. Moreover, a good comprehension of the molecular interactions of the simple amino acids in solution is essential to elucidate the mechanism of the biological functions of proteins. Measurements of transverse relaxation rates of the protons of water (R(2) = 1/T(2)) in aqueous solutions of amino acids such as L-glycine, L-asparagine, L-arginine and L-tryptophan were carried out in order to study the effects of chemical exchange and molecular diffusion on the amplitude of R(2). The values of R(2) measured by the Carr-Purcell-Meiboom-Gill (CPMG) sequence were studied while varying the solution pH and the parameters of the CPMG sequence. The dependence of R(2) on pH and tau (inter-pulse delay between the first and the second pulses of the CPMG sequence) is interpreted in terms of chemical exchange between the protons of water and those of the labile amino acid groups. This interpretation was confirmed by the analysis of the proton spectra acquired using a 300 MHz NMR spectrometer.

Amino Acids↗

Hydration properties and the role of water in taste modalities of sucrose, caffeine, and sucrose-caffeine mixtures.

Solution properties of sapid molecules are informative on their type of hydration (hydrophobic or hydrophilic) and on the extent of the hydration layer. Physicochemical properties (intrinsic viscosity and apparent specific volume) and nuclear magnetic resonance (NMR) relaxation rates R(1) and R(2) for pure sucrose, bitter molecule caffeine, and their mixture were found to be relevant in the interpretation of the effects of these solutes on water mobility. Likewise, surface tension, contact angles with a hydrophobic surface, and the adhesion forces to this type of surface of the aqueous solutions of sapid molecules were found to discriminate between their effects on water cohesion and also between their taste qualities. The interpretation of the two sets of independent experimental results, namely physicochemical and spectroscopic data, helps in the elucidation of the role of water in sweet and bitter taste chemoreception.

Caffeine↗

Breast cancer detection: knowledge, attitudes, and behaviors of women from Pennsylvania.

PURPOSE/OBJECTIVES: To assess relationships among breast cancer detection behaviors and selected variables in healthy women. DESIGN: Correlational study. SETTING/SAMPLE: A sample of 1,000 women was selected randomly from the 16,500 members of the General Federation of Women's Clubs of Pennsylvania. Respondents (N = 538; 54% response rate) were predominately white, well educated, lived in urban areas, and had an average age of 60 years. METHODS: Mailed packets with a professionally designed, scannable survey instrument that included questions related to detection behaviors, a risk index, health behaviors, attitudes, and knowledge. MAIN RESEARCH VARIABLES: Breast cancer detection behaviors: mammography, clinical breast examination (CBE), breast self-examination (BSE). Structural/demographic variables: age, education, residence, knowledge of breast cancer and detection methods, teaching history, encouragement, and risk index (family/medical history). Predisposing variables: susceptibility, benefits/barriers, confidence, social norms and influence, and general health motivation. FINDINGS: Women reported moderate/high adherence to recommendations for early detection of breast cancer. Mammography behavior was predicted by older age, being encouraged by a doctor or nurse, and greater risk. CBE predictors were greater knowledge and risk along with greater benefits, social norms, and health motivation. BSE behavior was predicted by having had BSE technique checked, greater knowledge, greater risk, decreased barriers to BSE, and higher health motivation. CONCLUSIONS: Common predictors of breast screening behaviors include risk (family/medical history), knowledge, and general health motivation. IMPLICATIONS FOR NURSING PRACTICE: Educational efforts can be designed specifically to influence variables related to compliance with early breast cancer detection behaviors.

Adult↗

An NMR relaxation study of the state of water in gelatin gels.

A combination of 1H and 23Na NMR is used to probe the dynamic state of water in gelatine gels as the water content is lowered from 70% to dryness. A sharp increase in the proton and sodium transverse relaxation rates is observed as the water content falls from 20 to 15% while the proton longitudinal and dipolar cross relaxation rates show a maximum at ca. 15%. We show that these observations can be understood if monolayer coverage occurs at 15% and multilayers of less strongly interacting hydration water are formed between 15 and 20%. Above 20% the water appears to behave as an unperturbed bulk phase.

Desiccation↗

Barriers to research utilization for oncology staff nurses and nurse managers/clinical nurse specialists.

PURPOSE/OBJECTIVES: To describe and compare barriers to research utilization faced by oncology staff nurses and nurse managers/clinical nurse specialists (CNSs) and to compare these to barriers identified by other nurses. DESIGN: Exploratory descriptive. SETTING: National. SAMPLE: Proportional random sample of 2,000 Oncology Nursing Society (ONS) staff nurses (n = 769) from seven practice settings. ONS participants recruited oncology staff nurses (n = 331) and nurse managers/CNSs involved in cancer care (n = 407). METHODS: Mailings, including a demographic questionnaire and Barriers Scale, were sent to ONS nurses, and reminder postcards were sent to increase the return rate. MAIN RESEARCH VARIABLES: Barrier categories: characteristics of the adopter (nurse), organization, innovation (research itself), and communication, individual item barriers. Nurse and worksite characteristics. FINDINGS: Differences existed in oncology nurses' perceptions of the extent to which the adopter, organization, and innovation characteristics served as obstacles to research utilization. Nurse managers/CNSs perceived that each of these acted as a greater barrier than did staff nurses. Both groups perceived communication characteristics as a moderate barrier. Oncology nurses, as a group, responded similarly to other nurse samples regarding research and communication characteristics. Perceptions of oncology nurse managers/CNSs were similar to those of administrators in other studies. Oncology staff nurses rated barriers lower than nurses, including clinicians, in other samples. CONCLUSIONS: For oncology nurses, organization, research, and communication barriers persist as impediments to research utilization. Nurse adopter characteristics may be diminishing as obstacles for staff nurses but not for nurse managers/CNSs. The decreased strength that oncology nurses attributed to barriers may reflect a benefit of practicing nursing in a specialty. IMPLICATIONS FOR NURSING PRACTICE: Decreasing known barriers would facilitate research-based practice in oncology. Nurse leaders can create environments conducive to research utilization by altering existing mechanisms, facilitating access to nursing research experts, supporting time for research utilization efforts, giving authority for practice changes, and offering continuing education related to research utilization processes. Nurse managers/CNSs need to increase their familiarity with research and research utilization, ensuring their awareness of pertinent clinical findings. Perceptual gaps between staff nurses and nurse managers/CNSs regarding research utilization require discussion and formal investigation. Researchers must communicate in clinician-friendly ways. All nurses need to demand and facilitate access to research findings.

Adult↗

Cancer-related diarrhea: selected findings of a national survey of oncology nurse experiences.

PURPOSE/OBJECTIVES: To describe oncology nurse experiences with disease- and treatment-related diarrhea in patients with cancer, including assessment methods and pharmacologic/supportive care. DESIGN: Descriptive. SAMPLE/SETTING: 1,288 (26%) of 5,000 randomly selected Oncology Nursing Society members employed full-time in adult clinical settings in the United States. METHODS: Mailed survey with scannable booklets. MAIN RESEARCH VARIABLES: Nurse perceptions of disease and treatment-related issues associated with diarrhea in patients with cancer, along with currently used assessment criteria and nursing care. FINDINGS: Nurses in this sample routinely encounter diarrhea in their patients with cancer. They commonly assess/document diarrhea by noting its presence or absence, with a minority of nurses using a rating tool. When indicated, most nurses prepare patients for probable diarrhea. This preparation includes both verbal and written instructions about diet, skin care, drug therapy, and treatment of severe diarrhea. Nurses report that primary drug therapy for diarrhea consists of over-the-counter agents. Supportive care consists of fluid/electrolyte replacement, skin care and diet modifications, and also bowel rest and parenteral nutrition for severe diarrhea. For these nurses, the most important factors influencing choice of management strategies are symptom relief and physician and patient preference. CONCLUSIONS: Although the majority of nurses in this study report providing anticipatory guidance, patient education, and supportive diarrhea management, they are not assessing diarrhea systematically. They report common use of nonprescription medications, with pharmacologic interventions varying with severity of diarrhea. IMPLICATIONS FOR NURSING PRACTICE: Targeted education is needed to help nurses implement systematic assessment and documentation. Efficacy of diarrhea-management strategies and protocols must be tested-specifically, optimal timing and types of skin care, dietary changes, and bowel rest.

Adult↗

Use of research-based practices by oncology staff nurses.

PURPOSE/OBJECTIVES: To determine the extent to which oncology staff nurses adopted eight specific research-based practices and the impact of demographic and resource factors on adoption of these practices. DESIGN: Cross-sectional mail survey. SETTING: National. SAMPLE: 1,100. METHODS: Network sampling techniques: 2,000 Oncology Nursing Society (ONS) staff nurses were randomly and proportionally selected from seven practice setting categories; each ONS nurse was asked to recruit a non-ONS staff nurse colleague. Both groups completed the Oncology Nursing Practice Questionnaire, which measures adoption of eight research-based practices. MAIN RESEARCH VARIABLES: Extent of adoption, including awareness, persuasion, and implementation of eight specific practices; nurse demographics; and work-related resources. FINDINGS: Awareness was high, with 53%-96% of nurses reporting awareness of the eight practices. Overall, 28% were aware of all practices while 10% were aware of half or fewer. Less-aware nurses differed from other nurses in demographics and resources. Computed "extent of adoption" scores showed that almost 90% of aware nurses used seven of the practices at least sometimes. CONCLUSIONS: Oncology staff nurses with awareness of a practice were implementing the practice in their organization. IMPLICATIONS FOR NURSING PRACTICE: The findings establish a need for developing educational programs to enhance awareness of specific practices and to creatively reach nurses who are unlikely to seek programs outside their employing agencies.

Adult↗

Building organizational capacity to engage in research utilization.

The Orange County Research Utilization in Nursing (OCRUN) Project developed a regional network of nursing service organizations (NSOs) with a shared commitment to building organizational capacity to engage in research use. Over 3 years, 20 nursing service and 6 academic institutions participated in the OCRUN Project, sending 374 nurses to tiered OCRUN continuing education courses that focused on role-specific research utilization competency development. The project influenced nurse executives' perceptions of organizational readiness for change and catalyzed changes in strategic goals, accountability, and resources, ultimately influencing each NSO's reported research utilization processes and outcomes. Recommendations stemming from the OCRUN Project address potential NSO strategies to enhance research use.

California↗

Exploration of factors affecting mammography behaviors.

Of an estimated pool of 1,700 potential participants, only 382 (22%) eligible women participated in a low-cost breast cancer screening program offered to university and medical center employees. Because most women were still available and data were needed to understand why the opportunity to participate was refused by so many, a survey was done to determine factors related to mammography behavior. Three distinct groups of women were identified according to health beliefs, mammography behaviors, and modifying factors. Women who participated in the mammogram program were predominantly well-educated working women who were aware of mammography and its relationship to the breast cancer trajectory; they were affected by cost and convenience issues. One group of women did not participate in the program offered because they had had a recent mammogram; these women were at high risk for breast cancer and perceived mammography to be beneficial. The women who did not participate for other reasons were in nonprofessional jobs, had lower levels of education, and tended not to participate in the health care system as readily as women in the other groups; they perceived themselves less susceptible to breast cancer, valued mammography less, and knew less about breast cancer.

Adult↗

Amphotericin B-induced shivering in patients with cancer: a nursing approach.

Shivering is a common and distressful reaction associated with administration of amphotericin B, a systemic antifungal agent. Shivering occurs as a result of the drug's intrinsic pyrogenicity, and thus resembles febrile shivering. This heat loss phenomenon has metabolic as well as psychologic costs. The intervention approach to amphotericin B-induced shivering includes reporting the phenomenon, restoring lost heat, modifying the rate of heat loss, altering the physiologic determination of heat loss, and giving drugs to suppress shivering. Specific suggestions for interventions are discussed. Supportive care of the patient with cancer who is receiving this drug is briefly mentioned as it relates to thermoregulatory principles. Possible areas of future inquiry into shivering suppression are mentioned.

Amphotericin B↗

Changes in well-being of women cancer survivors following a survivor weekend experience.

PURPOSE/OBJECTIVES: To determine the long-term effects on quality of life (QOL) of women cancer survivors following a retreat experience. DESIGN: One-group repeated measures. SETTING: Southern California. SAMPLE: Participants in two 1998 Healing Odyssey Retreats (N = 41; response rate 67%). Most women were married (50%), had breast cancer (93%), and had been diagnosed within two years of the retreat (69%). Participants' mean age was 48 years. METHODS: The rehabilitative retreats took place in a mountain retreat center and consisted of multiple experiences guided by experiential learning theory. Exercises aimed to help women learn new tools for dealing with the challenges of cancer, treatment, and recovery. The QOL-Breast Cancer survey was used to collect data preretreat, immediately postretreat, at six weeks postretreat, and at six to seven months postretreat. MAIN RESEARCH VARIABLES: QOL subscale scores (physical, psychological, social, and spiritual well-being) and overall QOL scores. FINDINGS: At preretreat, women scored lower on psychological and social well-being than on physical and spiritual well-being. Total QOL, physical, psychological, and spiritual well-being scores differed significantly over time, with a significant increase immediately following the retreat that was maintained at six weeks and six months. Social well-being at six months was significantly greater than at the other three points. CONCLUSIONS: The Healing Odyssey Retreats enhanced women cancer survivors' total QOL-specifically their well-being in four dimensions. IMPLICATIONS FOR NURSING PRACTICE: Women who seek programs dealing with living life more fully after cancer and connections with other survivors may benefit from rehabilitative efforts such as this retreat.

Adaptation, Psychological↗

Sensitivity and specificity of lump detection in breast models.

Lump detection accuracy in models provides an index of ability to detect lumps in breast tissue. Recent research suggests poor lump detection accuracy in nontrained persons. Following individualized nurse-provided instruction in breast self-examination (BSE), 113 well-educated white women exhibited 89% mean lump detection sensitivity and 81% mean specificity (sensitivity = number of lumps correctly identified divided by actual lumps; specificity = percentage of exams completed without detection of false lumps). Problems with hands were potentially linked to poor specificity. Completeness of search was significantly associated with sensitivity. Lumps most unlikely to be detected were those in the fleshy upper outer quadrant of torso models. High accuracy levels here may be attributable to timing of assessments, homogeneous sample, models used, numbers/sizes of lumps, and long search times. BSE instruction should emphasize complete search, examination of outer quadrant of breasts, and assessment of hand problems.

Adult↗