Biomedical subjects
Publications and source records attributed to D Recker.
Shared governance teams require a good decision making process. After identifying the root cause of a problem, finding a solution that addresses the right issues begins. An issues flow chart and decision-making process were developed to help teams better identify and solve problems.
The paradigm is shifting in health care. The current emphasis is on total quality management (TQM). The authors describe a model, Quality in Daily Work (QIDW), which may be used to assist in the implementation of TQM at the unit level. QIDW is patterned after Juran's Trilogy of quality planning, quality control, and quality improvement.
Preoperative cardiac surgical teaching done on a preadmission vs postadmission basis did not affect subjects' perception of importance of preoperative information or preparation. Hospital teaching methods must be examined so that patient learning is individualized and available when the patient is ready to learn. Preoperative teaching on a preadmission basis may also facilitate admission of the cardiac surgical patient the day of surgery, which could shorten the length of stay.
Standard techniques used in order to quantify the severity of aortic valve stenoses in clinical practice comprise: transthoracic echocardiography, namely, by determining maximum and mean transvalvular gradients and evaluating aortic valve areas, as well as invasive techniques which quantify aortic valve areas through hemodynamic pressure measurements and application of the Gorlin formula. Since the introduction of the multiplane TEE technique, it has become feasible to scan the aortic valve in a strictly horizontal plane and quantify the aortic valve orifice by planimetry. In this study, we investigated 23 patients with various degrees of aortic valve stenoses. We compared aortic valve areas, which had been planimetrically determined by multiplane TEE scans, and mean aortic valve gradients (standard TEE technique) with pressure gradients and valve areas derived from hemodynamic measurements obtained during cardiac catheterization, and have found that the valve areas as well as the mean pressure gradients correlate well.
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We have described how we revised our critical care orientation according to Gordon's FHPs. The process will require continuous review and revision. Research is necessary to determine the effectiveness of an orientation organized by a nursing framework in facilitating holistic nursing practice.
Caring for the critically ill long-term patient is a challenge. Although such patients must remain in the critical care environment because of the nursing expertise they require, they are often viewed as low-priority patients by the staff because of two factors. One factor relates to the nurse. Critical care nurses, typically action-oriented, function best during crisis intervention and are rewarded for technical skills and efficiency. The other factor relates to the patient. The critically ill long-term patient's needs are different from those of patients most often seen in critical care units; therefore, required nursing interventions are different. These interventions may not be within the nurse's usual repertoire of knowledge and skills and may also be physically and psychologically draining. Implementation of appropriate strategies has the potential for reducing length of stay, cost to the patient and the hospital, and stress for the critical care staff.
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We previously described a domain in the 5' half of the human immunoglobulin kappa enhancer which could bind nuclear proteins in vitro, as detected by a lambda exonuclease protection assay. A second more 3' binding domain in the enhancer has now been detected by a similar assay employing a different exonuclease, the T7 gene 6 exonuclease. Using this assay and starting with a pig spleen nuclear extract, we have purified 5000-fold a protein that binds to the 3' domain. In a DNase I footprint experiment the partially purified protein protects a 27 bp segment in the enhancer centered around the sequence CAGGTGGC, which corresponds to the kappa E2 sequence motif described in the mouse kappa enhancer. The protein, designated NF-kappa E2, also appears to bind at a position downstream of kappa E2, at or near the kappa E3 site. Proteins capable of binding at kappa E2 are found in several mammalian species and are expressed in both lymphoid and non-lymphoid tissues.
The contribution of plasma membrane 5'-nucleotidase (E.C. 3.1.3.5) to intracellular purine degradation and release was evaluated in cultured human lymphoblasts. B-lymphoblasts and T-lymphoblasts are characterized by high and low levels of plasma membrane 5'-nucleotidase activity, respectively. After radiolabeling of the cellular adenine nucleotide pools with [8-14C]adenine, deoxyglucose-induced purine nucleotide degradation resulted in a 2-2.5 times greater release of cellular radioactivity from the B-lymphoblasts than from the T-lymphoblasts. Specific inhibition of plasma membrane 5'-nucleotidase with 50 microM alpha, beta-methylene adenosine diphosphate (AMPCP) did not decrease purine release during deoxyglucose-induced nucleotide degradation. Similarly, the inhibition of B-lymphoblast membrane 5-nucleotidase did not alter the incorporation of [8-14C]adenine into the nucleotide pool. Therefore, to explain the relatively high release of purine nucleotide degradation products in B-lymphoblasts when compared with T-lymphoblasts, cytoplasmic 5'-nucleotidase activity was investigated in these cell lines. B-lymphoblasts have seven times more cytoplasmic 5'-nucleotidase activity for dAMP and two to three times more activity for other purine nucleoside 5'-monophosphates than do T-lymphoblasts at pH 7.4. Membrane and cytoplasmic nucleotidase activities are produced by different enzymes that can be distinguished by differences in pH optima, Michaelis constants for purine substrates, divalent cation requirements, and susceptibilities to AMPCP inhibition. The data suggest that plasma membrane 5'-nucleotidase hydrolyzes extracellular nucleoside 5'-monophosphates only. Cytoplasmic 5'-nucleotidase most likely regulates the degradation of intracellular nucleoside 5'-monophosphates and may be responsible for the increased purine release observed in B-lymphoblasts.
The contribution of enhanced purine salvage to the decreased total purine excretion associated with allopurinol therapy was measured by the intravenous administration of tracer doses of [8-(14)C] adenine to four patients with gout and normal purine salvage enzyme activity and four patients with the Lesch-Nyhan syndrome and absent purine salvage activity. The mean cumulative excretion of radioactivity 5 days after the adenine administration to patients not receiving and receiving (off and on) allopurinol therapy was 6.1% and 3.6% of infused radioactivity for gouty subjects and 15.9% and 20.8% for the Lesch-Nyhan patients. Urate pool size and urate turnover, as measured by pool labeling with [2-(14)C]uric acid, were substantially decreased in both groups of patients during allopurinol therapy. The intestinal loss of uric acid was estimated from these pool measurements on and off allopurinol. With a correction for this extrarenal purine loss, the mean cumulative excretions of radioactivity 5 days after adenine administration to patients off and on allopurinol therapy were 11.9% and 4.8% for the gouty subjects and 31.7% and 24.5% for the Lesch-Nyhan patients. In vitro studies demonstrated no alteration of the synthesis or degradation of adenine nucleotides by allopurinol in cultured human diploid fibroblasts. These observations suggest that enhanced purine salvage is an important component leading to decreased purine excretion during allopurinol therapy.
The contribution of reduced purine salvage to the hyperuricemia associated with hypoxanthine-guanine phosphoribosyltransferase deficiency was measured by the intravenous administration of tracer doses of [8-(14)C]adenine to nine patients with normal enzyme activity, three patients with a partial deficiency of hypoxanthine-guanine phosphoribosyltransferase, and six patients with the Lesch-Nyhan syndrome. The mean cumulative excretion of radioactivity 7 d after the adenine administration is 5.6+/-2.4, 12.9+/-0.9, and 22.3+/-4.7% of infused radioactivity for control subjects, partial hypoxanthine-guanine phosphoribosyltransferase-deficient subjects, and Lesch-Nyhan patients, respectively. To assess relative rates of nucleotide degradation in control and hypoxanthine-guanine phosphoribosyltransferase-deficient patients two separate studies were employed. With [8-(14)C]inosine administration, three control subjects excreted 3.7-8.5% and two enzyme-deficient patients excreted 26.5-48.0% of the injected radioactivity in 18 h. The capacity of the nucleotide catabolic pathway to accelerate in response to d-fructose was evaluated in control and enzyme-deficient patients. The normal metabolic response to intravenous fructose is a 7.5+/-4.2-mmol/g creatinine increase in total urinary purines during the 3-h after the infusion. The partial hypoxanthine-guanine phosphoribosyltransferase-deficient subjects and Lesch-Nyhan patients show increases of 18.6+/-10.8 and 17.3+/-11.8 mmol/g creatinine, respectively. Of the observed rise in purine exretion in control subjects, 40% occurs from inosine excretion and 32% occurs from oxypurine excretion. The rise in total purine excretion with Lesch-Nyhan syndrome is almost entirely accounted for by an elevated uric acid excretion. Increases in urine radioactivity after fructose infusion are distributed in those purines that are excreted in elevated quantities.The observations suggest that purine salvage is a major contributor to increased purine excretion and that the purine catabolic pathway responds differently to an increased substrate load in hypoxanthine-guanine phosphoribosyltransferase deficiency. The purine salvage pathway is normally an important mechanism for the reutilization of hypoxanthine in man.
The purpose of this study was to establish the reliability and validity of the multiple choice orientation tests used in one critical care unit. A criterion-referenced measurement framework was used to develop 10 orientation tests covering five content areas, two tests for each content area. A sample of 40 critical care nurses (CCNS) and 31 medical-surgical nurses completed the tests. Standard reliability and validity measures were performed including: test-retest, parallel forms, construct and decision validity and item analysis. Parallel form correlations ranged from .46 to .90 (P < .05). Test-retest correlations ranged from .56 to .93 (P < .01). A significant (P < .01) difference was found between the scores of the critical care nurses and medical-surgical nurses for nine of the tests. Reliability and validity were supported for the tests. This study identifies one process that can be used in test development.
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