Ethical concerns block widespread patenting of embryonic advances.
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Animals↗
Biomedical subjects
M Louis
Publications and source records attributed to M Louis.
Spirituality for nurses and their practice.
This descriptive study compared the inclusion of spirituality in the practice of two groups of nurses: nurses prepared in parish nursing (PN) and nurses not specifically prepared in spiritual care (NonPN). The Spirituality in Nursing Care tool was used to determine sources of spiritual strength and spiritual experiences of the respondents, the application of spirituality in their practice, and the interventions and indicators they used in determining the need for spiritual assistance. Random sampling using U.S. postal codes selected 600 members from a national mailing list of nurses prepared in parish nursing and 600 similarly selected nurses not prepared in parish nursing. A total of 645 questionnaires were returned with complete data. The following question was asked: How do nurses prepared in providing spiritual care (PN) compare to nurses not similarly prepared (NonPN) in terms of: (a) personal sources of spiritual strength, (b) spiritual experiences, (c) application of spirituality in their practice, (d) identification of indicators of spiritual needs in their clients, and (e) interventions used to meet the spiritual needs of their clients? The findings indicate there are differences in how PN and NonPN groups of nurses respond to spirituality of self and their use of spirituality in clinical practice. It is suggested that parish nurses take the lead to further study spirituality and the indicators and appropriate interventions, and identify patient outcomes when spiritual needs are addressed by nurses in providing "holistic nursing practice."
Adult↗
Epidemic of pediatric deaths from acute renal failure caused by diethylene glycol poisoning. Acute Renal Failure Investigation Team.
CONTEXT: Contaminated pharmaceutical products can result in substantial morbidity and mortality and should be included in the differential diagnosis of deaths of unknown origin. OBJECTIVE: To investigate an outbreak of deaths among children from acute renal failure in Haiti to determine the etiology and institute control measures. DESIGN: Case-control study, cohort study, and laboratory toxicologic evaluation. SETTING: Pediatric population of Haiti. PARTICIPANTS: Cases were defined as Haitian residents younger than 18 years with idiopathic anuria or severe oliguria for 24 hours or longer. Febrile hospitalized children without renal failure were enrolled as control subjects. MAIN OUTCOME MEASURE: The odds of exposure to suspected etiologic agents among cases and controls. RESULTS: We identified 109 cases of acute renal failure among children. The clinical syndrome included renal failure, hepatitis, pancreatitis, central nervous system impairment, coma, and death. Of 87 patients with follow-up information who remained in Haiti for treatment, 85 (98%) died; 3 (27%) of 11 patients transported to the United States for intensive care unit management died before hospital discharge. A locally manufactured acetaminophen syrup was highly associated with disease (odds ratio, 52.7; 95% confidence interval, 15.2-197.2). Diethylene glycol (DEG) was found in patients' bottles in a median concentration of 14.4%. The median estimated toxic dose of DEG was 1.34 mL/kg (range, 0.22-4.42 mL/kg). Glycerin, a raw material imported to Haiti and used in the acetaminophen formulation, was contaminated with 24% DEG. CONCLUSIONS: An epidemic of severe systemic toxicity and deaths from DEG-contaminated acetaminophen syrup occurred in Haiti. Good manufacturing practice regulations should be used by all pharmaceutical manufacturers to prevent such tragedies.
Acetaminophen↗
Effect of ventral tegmental 6-hydroxydopamine lesions on the locomotor stimulant action of nicotine in rats.
Convergent evidence suggests that the locomotor stimulant effect of nicotine is mediated by nicotinic receptors located on mesolimbic dopaminergic neurons. However, 6-hydroxydopamine lesions of the ventral tegmental area, resulting in substantial depletion of nucleus accumbens dopamine, were recently reported to have no effect on nicotine-induced locomotion. The present study sought to re-examine this issue. Rats received bilateral infusions of 6-hydroxydopamine or vehicle into the ventral tegmental area. Starting 3 weeks later, locomotor activity was tested after subcutaneous injection of saline, nicotine (0.4 mg/kg base), amphetamine (0.5 mg/kg) or scopolamine (0.5 mg/kg). In lesioned animals, the locomotor stimulant effects of nicotine and amphetamine were greatly reduced, whereas saline and scopolamine-induced activity was scarcely affected. Dopamine denervation was assessed by autoradiography, using [125I]RTI-55 to label plasmalemmal dopamine transporters. Labelling was reduced in nucleus accumbens core and shell and in the ventral tegmental area (by 87, 81 and 70%, respectively), and in nigrostriatal areas (52-77%). The locomotor stimulant effects of nicotine and amphetamine were correlated with residual [125I]RTI-55 labelling in mesolimbic and nigrostriatal regions (r=0.6-0.8). The present results provide further evidence that the locomotor stimulant effect of nicotine is dependent on the integrity of ascending dopamine neurons.
Amphetamine↗
Persistent nicotinic blockade by chlorisondamine of noradrenergic neurons in rat brain and cultured PC12 cells.
Chlorisondamine (CHL) blocks behavioural responses to nicotine for several weeks or months in rats. Persistent blockade has also been demonstrated ex vivo, in assays of nicotine-evoked striatal dopamine release. Central administration of [3H]-CHL leads to long-term retention of radiolabel in nigrostriatal dopaminergic neurons and in few other cell groups. We investigated whether an analogous blockade also occurs in noradrenergic neurons in the brain and in cultured pheochromocytoma (PC12) cells, which have a similar noradrenergic phenotype. Administration of CHL (10 mg kg(-1) s.c. or 10 microg i.c.v.), 21 days prior, resulted in a near-total block of nicotine-evoked release of hippocampal [3H]-noradrenaline ([3H]-NA) from superfused rat synaptosomes; NMDA-evoked [3H]-NA release was unaffected. Three weeks after administration of [3H]-CHL (10 microg i.c.v.), preferential accumulation of radiolabel was observed in the locus coeruleus, which provides the entire noradrenergic innervation to hippocampus, as well as in previously noted structures. In rat pheochromocytoma (PC12) cells, nicotine evoked [3H]-NA release (EC50 approximately 30 microM). This effect was blocked by co-incubation with mecamylamine (10 microM) or CHL (1 microM) but was not affected by alpha-bungarotoxin. As in the hippocampus, the nicotinic agonist cytisine was at least as efficacious as nicotine. Acute exposure of PC12 cells to CHL 10 or 100 microM (but not 1 microM), followed by 90 min wash-out, almost completely blocked release evoked by 30 microM nicotine. More prolonged (24 h) exposure to CHL 100 microM (but not 1 or 10 microM), followed by 3 days of wash-out, partially inhibited release evoked by nicotine, leaving responses to high K+ unchanged. A significant (30%) reduction was also seen 5 days after exposure. We conclude that persistent nicotinic blockade by CHL is neither restricted to mesostriatal dopamine neurons, nor to the CNS, nor to neurons possessing the same nicotinic receptor pharmacology. In addition, the persistent blockade does not appear to result from an acute blocking action, but may be dependent upon intracellular accumulation of the antagonist.
Alkaloids↗
Particle size does not affect the rate of intracellular routing for ligands internalized by non-adsorptive pinocytosis.
The rate at which three different species of a fluid phase marker (horseradish peroxidase) reached the lysosomal compartment of mouse LM fibroblasts was compared. Initial observations suggested that the rate was a function of particle size. Adjustment of the concentrations of the various species of HRP to equal numbers of physical particles negated the apparent affect. Thus, particle size does not affect the intracellular routing of a ligand entering fibroblasts by non-adsorptive pinocytosis.
Animals↗
Initial results with one-year minimum follow-up of the first 146 patients with a uveal melanoma treated with protons at CPO (Orsay).
Proton therapy began at the 'Centre de Protonthérapie d'Orsay' (CPO) in September 1991. Our treatment protocol and the preliminary results have been presented on the first 146 irradiated patients with one-year minimal follow-up. The subsequent developments have also been mentioned.
Clinical Protocols↗
Nurse practitioners: reevaluation of the need for and willingness to hire by nurse administrators, nurse practitioners, and physicians.
A survey of all nurse administrators and advanced practice nurses and a simple random sample survey of licensed physicians in Nevada were completed to reevaluate the perceived need for and willingness to hire nurse practitioners (NPs). The reevaluation was deemed necessary based on a similar survey that was completed by these authors in 1990. At that time significant questions were raised concerning the lack of understanding of the role of NPs in and their contribution to the health care team. The results of the study clearly indicate that the unique contributions of the NP to the health care team should be further publicized and clarified. In addition, for some physicians, a significant disparity continues to exist between the optimal, collaborative role and the more readily accepted dependent role of the NP. The family NP (FNP) continues to be the most desired specialty for those who hire NPs.
Attitude of Health Personnel↗
[The Hospital of St. Pierre and Miquelon].
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Canada↗
[Protontherapy: physical and technical basis].
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Head and Neck Neoplasms↗
The repeated measurement of vital capacity is a poor predictor of the need for mechanical ventilation in myasthenia gravis.
OBJECTIVE: Testing the hypothesis that, in myasthenia gravis (MG), repeated measurements of vital capacity (VC) and various parameters derived from this measurement [median or lowest value of measured VCs during hospitalization, VC values < 20 ml/kg body weight (BW) or < 13 ml/kg BW, or an index assessing the variability of VC values during the whole ICU stay] could predict the need for intubation and mechanical ventilation (MV), as has been shown in other neuromuscular diseases with respiratory failure. DESIGN: Retrospective study with medical chart revision of all the patients with MG and respiratory failure admitted to our intensive care unit between 1985 and 1993. SETTING: Medical intensive care unit (15 beds) of a university hospital. PATIENTS AND METHODS: Five patients suffering from ten episodes of acute respiratory failure due to their decompensated MG. Repeated measurements of arterial blood gases and VC by trained respiratory therapists, at least every 4 h. RESULTS: There was no difference in any of these parameters between patients eventually requiring MV (four episodes) and those in whom mechanical ventilation was not necessary (six episodes). CONCLUSIONS: VC repeated measurements is a poor predictor of the need for further MV in MG patients. This can probably be ascribed to the erratic nature of MG, a disease whose course is largely influenced by many parameters (infection, treatment modifications, initiation of corticosteroid therapy, stress, psychological factors, etc.). Early admissions to the ICU of MG patients with respiratory dysfunction is thus recommended.
Adolescent↗
The Gal(alpha 1-4)Gal-specific tip adhesin of Escherichia coli P-fimbriae is needed for pyelonephritis to occur in the normal urinary tract.
Nonobstructive acute pyelonephritis in humans is most often caused by P-fimbriated Escherichia coli. P-fimbriae are heteropolymeric fibers carrying a Gal(alpha 1-4)Gal-specific PapG adhesin at its distal end. The pyelonephritic strain DS17 expresses P-fimbriae from a single gene cluster. A mutant strain, DS17-8, which expresses P-fimbriae tacking the PapG adhesin, was constructed by allelic replacement introducing a 1-bp deletion early in the papG gene. In cynomolgus monkeys, DS17 and DS17-8 were equally able to cause bladder infection, whereas only the wild-type strain DS17 could cause pyelonephritis as monitored by bacteriological, functional, and histopathological criteria. Since DS17, but not DS17-8, adheres to renal tissue, these data underscore the critical role of microbial adherence to host tissues in infectious disease and strongly suggest that the PapG tip adhesin of P-fimbriae is essential in the pathogenesis of human kidney infection.
Adhesins, Escherichia coli↗
Nurse practitioners: need for and willingness to hire as viewed by nurse administrators, nurse practitioners, and physicians.
The problem investigated in this project was the identification of need for and desire to hire nurse practitioners in a rural western state. Participants included licensed nurse practitioners, nurse administrators of licensed agencies, and licensed physicians in the state of Nevada. The survey examined the participant groups' views of the need for and their desire to hire nurse practitioners. The findings showed differences among the groups in relation to their education levels and whether they were practicing in rural or urban areas. The most pronounced finding was the indicated need for more information related to the role and functions of nurse practitioners before hiring them. Recommendations for future study are also included.
Attitude of Health Personnel↗
[Thrombosis of the right auricle in pulmonary embolism: value of echocardiography and indications for thrombolysis].
The presence of a right atrial thrombus is a recognized predictive factor of high mortality in patients with pulmonary embolism. In this report we describe two cases in which a free-floating thrombus in the right atrium was demonstrated by echocardiography; it resolved rapidly in both cases after thrombolytic therapy which resulted in a rapid clinical improvement and favorable outcome. During the acute phase of pulmonary embolism, a dilated right ventricle, a dilated pulmonary artery, a left ventricle of small size and paradoxical motion of the interventricular septum can be detected by echocardiography. In cases of massive pulmonary embolism or when there is doubt regarding the diagnosis, this noninvasive method serves to guide diagnostic and therapeutic decisions. In the special case where a right atrial thrombus is detected by echocardiography, thrombolytic therapy seems warranted.
Aged↗
Nasal positive pressure ventilation in patients with acute respiratory failure. Difficult and time-consuming procedure for nurses.
Intubation and mechanical ventilation are well-established techniques in the management of patients with acute respiratory failure; however, there are situations in which these procedures cannot be used safely for various reasons. A recently described noninvasive technique, nasal positive-pressure ventilation (NPPV), has been developed for home ventilation of certain patients with chronic ventilatory insufficiency. We hypothesized that NPPV could be used in selected patients in whom intubation and mechanical ventilation were clearly indicated, but not immediately possible, or even contraindicated. Six patients were treated with NPPV during an episode of acute respiratory failure and enrolled in a prospective study. We found that NPPV was successful in avoiding intubation, but only in the three patients suffering from a restrictive pulmonary disorder, whereas the procedure was unsuccessful in patients with obstructive disorders. Moreover, in every patient, acute NPPV was very time-consuming for the nursing staff: in patients with restrictive disorders, a nurse had to monitor a patient submitted to NPPV during 41 +/- 9 percent of the duration of ventilation and during 91 +/- 9 percent of the NPPV time in patients with obstructive disorders. We conclude that acute NPPV may be attempted in selected patients with acute respiratory failure, predominantly patients with restrictive respiratory disorders, but that this procedure is very time-consuming for nurses.
Acute Disease↗
College students' image of nursing as a career choice.
This article reports a study of the image of nursing among college students. It has been inferred that the poor image of nursing has a negative impact on recruitment into the profession. A convenience survey of two groups of college students was instituted to determine the image of nursing in relation to an ideal career, and to discover if any factors make the choice of nursing as a career more likely. The responses of 163 nonnursing students were compared to those of 93 nursing students. These findings indicate that the image of nursing as a career choice among nonnursing college students correlated with their ideal career at r = .4072. As expected, nursing students correlated nursing with their ideal career more positively (r = .5941) than the nonnursing students. Implications for nursing and suggestions for further study are included.
Adult↗
Respiratory response to histamine- and methylcholine-induced bronchospasm in nonsmokers and asymptomatic smokers.
The respiratory response to bronchospasms of the same magnitude induced by inhalation of histamine or methylcholine was measured non-invasively, using bellow pneumographs, in nonsmokers and asymptomatic smokers. In each subject, tidal volume (VT), breathing frequency (f) and inspiratory time (TI) were obtained on two different days, in a randomized crossover fashion, with the following sequence: basal conditions, after inhalation of buffered saline as a control and after histamine or methylcholine inhalation. Basal and control conditions did not differ from each other and were the same for both groups. The respiratory responses to both bronchoconstrictors did not differ from each other and were also the same in both groups: VT increased, f and TI remained unchanged. Thus, VT/TI, an index of respiratory drive, also increased. In nonsmokers the increased VT/TI and the associated increase in minute ventilation were both correlated to the decrease in FEV1. These correlations were not found in smokers. Although they have different effects on airway irritant receptors, inhaled histamine and methylcholine induce the same respiratory response in nonsmokers and smokers. Thus, the presumed smoking-related changes in airway mucosa permeability do not seem to influence the direct stimulating effect of histamine on these endings. The absence of correlation between FEV1 and VT/TI changes in smokers suggest that smoking might affect the respiratory drive in acute drug-induced bronchospasm.
Administration, Inhalation↗
Effects of a specific benzodiazepine antagonist (RO 15-1788) on cerebral blood flow.
RO 15-1788, a specific benzodiazepine antagonist, although it effectively antagonizes the clinical effects of benzodiazepines (i.e., sedation and amnesia), can also induce subjective agonist effects such as sedation or inverse agonist effects such as anxiety. The purpose of this study was to investigate in seven healthy volunteers the effect of RO 15-1788 on cerebral blood flow when intravenously injected alone or with midazolam and to compare its effects with midazolam administered alone. Cerebral blood flow was measured with the 133xenon inhalation technique and the drugs were administered simultaneously in a double-blind, randomized fashion during the four following sessions: placebo-placebo; midazolam-placebo; RO 15-1788-placebo; midazolam-RO 15-1788. No difference in cerebral blood flow was noted between the placebo-placebo, the RO 15-1788-placebo, and the RO 15-1788-midazolam sessions--although midazolam injected alone decreased cerebral blood flow by 30%. The sedation, amnesia, and the electroencephalograph (EEG) and muscle tone changes observed with midazolam-placebo were not present during the RO 15-1788-placebo and RO 15-1788-midazolam sessions. This study demonstrates the absence of effects of RO 15-1788 on cerebral blood flow when injected alone and the efficacy of this new drug in antagonizing the depressant effects of midazolam on cerebral hemodynamics.
Adult↗