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PubMed1998

Nursing competencies: ground work in aged and extended care.

Competencies have been formulated for entry level nurses. Specialist and generic advanced nursing competencies are also being developed. This paper describes exploratory groundwork on aged and extended care nursing competencies derived from interviews with nurses, allied health staff, residents and their families from one setting. Critical Incident Technique1 was used to guide semistructured interviews with 29 participants. A thematic analysis of the data suggests that the Australian Nursing Council Inc.2 competencies make a useful but incomplete contribution to understanding the perceived role of nursing in aged and extended care. A conceptual framework developed from the data illustrates the interdependence of competencies with the context in which they are observed. The framework proposes a number of elements which have the potential to offer a means to better interpret nursing competence (critical aspects) in aged and extended care contexts.

Aged↗

PubMedDate not supplied

Extended paediatrics: acute care in children's homes.

The Extended Paediatric Service was established in 1996 to provide acute care services to children in their homes with the aim of reducing the number of hospital admissions for children and shortening hospital stays while maintaining continuity of care. Extended Paediatrics builds on, and extends, the principles of Discharge Liaison and Hospital In The Home programmes. The service is staffed by nurses who also work within the paediatric ward of the Launceston General Hospital, providing a high degree of continuity of care for these children. Children are admitted to the service through consultation between medical staff, nursing staff and the child's family. Between August 1996 and December 1999 a total of over 1200 visits to 48 children have been made for various treatments, for tests, education or follow up. Improved outcomes for children and their families have been reported by both staff and parents as a result of the service.

Child↗

PubMed2001

Myocardium extending from the left atrium onto the pulmonary veins: a comparison between subjects with and without atrial fibrillation.

Rapid discharges from the myocardium extendingfrom the left atrium onto the pulmonary vein (PV) have been shown to initiate AF, and AF may be eradicated by the catheter ablation within the PV. However, if there is any difference in the distribution patterns of the myocardial sleeve onto the PV between the subjects with and without AF is to be determined. Twenty-one autopsied hearts were examined. Eleven patients previously had AF before death and another 10 patients had normal sinus rhythm as confirmed from the medical records including ECGs before death. After exposing the heart, the distance to the peripheral end of the myocardium was measured from the PV-atrial junction in each PV. Then, the PVs were sectioned and stained and the distal end of myocardium and the distribution pattern were studied. The anteroposterior diameter of the left atrium was also measured. In 74 of 84 PVs, the myocardium extended beyond the PV-atrial junction. The myocardium was localized surrounding the vascular smooth muscle layerforming a myocardial sleeve. The peripheral end of the myocardial sleeve was irregular and the maximal and minimal distances were measured in each PV. The myocardium extended most distally in the superior PVs compared to the inferior ones and the maximal distance to the peripheral end was similar between the AF and non-AF subjects (8.4 +/- 2.8 vs 8.7 +/- 4.4 mm for the left superior and 6.5 +/- 3.5 vs 5.1 +/- 3.9 mm for the right superior PV, respectively). A significant difference was found in the maximal distance in the inferior PVs: 7.3 +/- 4.6 vs 3.3 +/- 2.8 mm for the left (P < 0.05) and 5.7 +/- 2.4 vs 1.7 +/- 1.9 mm for the right inferior PV (P < 0.001) in the subjects with and without AF, respectively. The diameter of left atrium was slightly dilated in AF patients but insignificantly (4.1 +/- 0.1 vs 3.6 +/- 0.1 cm, P > 0.07). The myocytes on the PV were less uniform and surrounded by more fibrosis in patients with AF compared to those without AF. In conclusion, the myocardium extended beyond the atrium-vein junction onto the PVs. The distribution patterns of the myocardium was almost similar between subjects with and without AF, but the histology suggested variable myocytes in size and fibrosis in patients with AF.

Aged↗

PubMed1994

Functional studies with substance P analogues: effects of N-terminal, C-terminal, and C-terminus-extended analogues of substance P on nicotine-induced secretion and desensitization in cultured bovine adrenal chromaffin cells.

Substance P (SP) and SP analogues, including C-terminal, N-terminal, and C-terminus-extended analogues, have been investigated for their ability to modulate nicotine-induced secretion from bovine adrenal chromaffin cells in culture. Secretion was monitored by measuring the release of endogenous catecholamines by electrochemical detection following separation on HPLC and the release of endogenous ATP with an on-line luciferin-luciferase bioluminescence technique. SP is known to have the following two effects on nicotine-induced secretion of catecholamines (see Livett and Zhou, 1991): inhibition of the nicotinic response and protection against nicotinic desensitization. Secretion induced by 10(-5) M nicotine was inhibited 70-80% by SP, SP-methyl ester, and the C-terminus-extended analogue SP-Tyr12-NH2, 65% by (Ala3)SP-NH2, 45% by the C-terminal analogue SP(4-11), and 20 and 5% by the N-terminal analogues SP(1-7) and SP(1-5), respectively, when these peptides were present at 3 x 10(-5) M concentrations. The order of potency was SP = SP-methyl ester = SP-Tyr12-NH2 > (Ala3)SP-NH2 > SP(4-11) > SP(1-7) > SP(1-5). SP, SP-methyl ester, and (Ala3)SP-NH2 protected against nicotinic desensitization by 40-55%, and SP(4-11) protected by 20% (all at 3 x 10(-5) M). In contrast, the N-terminal analogues SP(1-7) and SP(1-5) and the C-terminus-extended analogue SP-Tyr12-NH2 at 3 x 10(-5) M did not protect against nicotinic desensitization. Cyclo-SP(3-9), Ac-SP(3-9)-NH2, SP(3-9), and SP(3-6) had neither inhibitory nor facilitatory effects on secretion.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenosine Triphosphate↗

PubMedDate not supplied

The 24-hour shelf-life of cytapheresis platelet concentrates stored in polyvinyl chloride containers should be extended only with caution.

A recent publication suggested that the 24-hour allowable shelf-life of apheresis platelet concentrates collected by open-system techniques be extended to 48 hours because platelets collected in this fashion usually remain sterile for that length of time. The current studies, however, show that the quality of platelet concentrates deteriorates rapidly after storage for more than 24 hours in the relatively small-volume, polyvinyl chloride containers of currently marketed, open-system software, as evidenced by the falling pH, the disintegration of platelets, and the inability of platelets to recover from hypotonic shock. Platelets were markedly defective within 48 hours. Thus, it seems unwise to extend the shelf-life of such platelet concentrates beyond 24 hours solely because they are likely to remain sterile. Collection techniques and software must also be modified to ensure satisfactory platelet quality before the period of storage should be extended.

Blood Component Removal↗

PubMedDate not supplied

Commentary on the safety of red cells preserved in extended-storage media for neonatal transfusions.

Red cells preserved in extended-storage media are the standard product dispensed by many regional blood centers. When the red cells are intended for neonatal transfusion, concern exists about the safety of the relatively high quantities of additives present in these media. Definitive studies to address these concerns are not available. Therefore, to estimate the effects of additives and to delineate circumstances in which they might be harmful, the quantities transfused in defined clinical settings were calculated, and the following recommendations are offered for transfusing infants less than 4 months of age. First, red cells preserved in extended-storage media should present no substantive risks when used for small-volume (approximately 10 mL/kg) transfusions of premature infants and can be used without additional processing. Second, the risks of the most premature neonatal patients or those with severe renal and/or hepatic insufficiency cannot be defined clearly, and, because data are not available to ensure safety for these infants, removal of the additive medium and resuspension of the red cells in saline or albumin solution immediately before transfusion are recommended. Third, following a similar rationale, it seems prudent to avoid using entire units of red cells preserved in extended-storage media in massive transfusion settings (e.g., exchange transfusion, cardiac surgery, and extracorporeal membrane oxygenation). In these settings, the preservative medium should be removed and the red cells resuspended in the fluid that is most appropriate for the procedure that is planned. It must be emphasized that these recommendations are based on calculations and hypothetical settings, not actual data. Accordingly, they are tentative and should be altered as definitive information becomes available.

Adenine↗

PubMed2002

Continuous multilead ST-monitoring identifies patients with unstable coronary artery disease who benefit from extended antithrombotic treatment.

AIMS: Prolongation of anticoagulant treatment might reduce subsequent cardiac events in patients with unstable coronary artery disease. Multilead ST-segment monitoring identifies patients with a high risk of adverse outcome. The aim was to assess the value of multilead ST-monitoring in prospectively identifying patients who respond to extended anticoagulant treatment with low-molecular weight heparin when treated by a primarily non-invasive strategy. METHODS AND RESULTS: In this substudy of the FRISC II trial, ST-monitoring with a continuous 12-lead ECG or vectorcardiography was performed for 24 h in 629 patients with unstable coronary artery disease randomized to receive either the low-molecular weight heparin dalteparin, or placebo for 3 months after at least 5 days' dalteparin treatment in all patients. Ischaemic episodes were detected in 34% during ST-monitoring. In the group with ischaemic episodes, the extended dalteparin treatment was associated with a lower rate of death, myocardial infarction, or revascularization (35.2% vs 53.4%, relative risk reduction: 34%, P=0.01). In patients without ischaemic episodes, long-term dalteparin treatment had no effect. CONCLUSIONS: In patients with unstable coronary artery disease treated primarily with a non-invasive strategy, ischaemic episodes revealed while on multilead ST-monitoring identifies patients who benefit most from extended treatment with anticoagulants.

Adult↗

PubMed2006

Preventing relapse beyond 5 years: the MA.17 extended adjuvant trial.

For patients with hormone-receptor-positive breast cancer, the risk of relapse remains significant even after successfully completing 5 years of adjuvant tamoxifen. The use of tamoxifen beyond 5 years is not recommended, but the need to protect against relapse following tamoxifen is clear. The third-generation aromatase inhibitors offer a new approach to treating postmenopausal women with receptor-positive early stage breast cancer through the potent and specific systemic inhibition of estrogen synthesis. MA.17, a large, randomized, double-blind, placebo-controlled phase III study, investigated whether extended adjuvant therapy with letrozole following completion of around 5 years of standard tamoxifen therapy could prolong disease-free survival in postmenopausal women with hormone-receptor-positive or receptor-unknown early stage breast cancer. The updated analyses of the trial results (median follow-up, 2.5 years) confirm that letrozole significantly reduced the risk of recurrent breast cancer (42%) regardless of the patient's nodal status or receipt of prior chemotherapy, and significantly reduced the risk of distant metastasis (40%). Importantly, letrozole as extended adjuvant therapy achieved a significant improvement in overall survival in women with node-positive disease. Mortality was reduced by 39% among the approximately 2,500 women with node-positive disease randomized in the study. Letrozole showed minimal side effects compared with placebo; adverse effects on bone metabolism of uncertain clinical significance were the most noteworthy side effect. Thus, the updated results from the MA.17 trial support the previous findings and show extended adjuvant therapy with letrozole to be a well-tolerated protection against the continuing risk of breast cancer recurrence for thousands of women currently receiving standard adjuvant tamoxifen. The re-randomization of MA.17 patients to an additional 5 years of letrozole or to no treatment will provide further insights into the benefits and side effects of long-term treatment.

Antineoplastic Agents, Hormonal↗

PubMed2002

Extended surgery in bilio-pancreatic cancer: the Japanese experience.

Aggressive surgery has been used in bilio-pancreatic cancers in many institutions in Japan. Approaches in pancreatic cancer include extended lymph node and soft tissue dissection in patients with ductal carcinoma of the pancreatic head. In biliary tract disease, approaches have included hepatectomies with or without vascular resection, reconstruction designed according to the extent of disease in individual patients, and combined liver and pancreas resection (hepatopancreatoduodenectomy) in locally advanced disease. Based on current experience, portal vein resection can be recommended in both pancreatic cancer and hilar cholangiocarcinoma and in select patients with gallbladder disease. Extended dissection of para-aortic lymph nodes is recommended in hilar cholangiocarcinoma but not in gallbladder disease; extended lymph node dissection in pancreatic cancer currently is being evaluated in a randomized controlled trial. Hepatopancreatoduodenectomy is recommended for select patients with gallbladder cancer.

Bile Duct Neoplasms↗

PubMed2001

The extended trochanteric osteotomy in revision hip arthroplasty: a critical review of 166 cases at mean 3-year, 9-month follow-up.

We conducted a retrospective review of 192 consecutive revision hip arthroplasties with an extended proximal femoral osteotomy performed from 1992 through January 1998. Of these osteotomies, 166 had a minimum of 2 years of clinical and radiographic follow-up (range, 2-7.5 years; average, 3 years, 9 months). All patients had a femoral reconstruction with an extended trochanteric osteotomy and an extensively porous-coated, cementless femoral component. The average age at revision was 65.8 years (range, 26-84 years). Of the 166 osteotomies, 2 nonunions (1.2%) and 1 malunion (0.6%) were identified. Seventeen hips (10.2%) required reoperation. Pain and walking scores improved from a mean of 6.5 preoperatively to 9.8 postoperatively. The extended trochanteric osteotomy heals predictably and enhances the surgeons' ability to address many difficult issues encountered in revision arthroplasty.

Adult↗

PubMed2000

Evaluation of the donor site morbidity after lateral arm flap with skin paddle extending over the elbow joint.

The free lateral arm flap may be extended to include the skin over the lateral aspect of the elbow and the forearm. However, extending the flap beyond the lateral condyle has been thought to interfere with the elbow function. The aim of this study was to assess the donor site morbidity after placement of the skin paddle across the lateral aspect of the elbow joint. Seventeen consecutive lateral arm flaps with a skin paddle designed over the elbow joint were performed for different indications. Eleven patients were followed up postoperatively for a minimum of 6 months. The range of motion, torque, power and endurance of the elbow joint were recorded using a Cybex 340 isometric dynamometer. The values of the operated elbow were compared to those of the unoperated elbow and the deficits were expressed in percentages. The touch sensation in the territory of the posterior cutaneous nerve of the forearm was assessed using Semmes-Weinstein monofilaments. Patient satisfaction was evaluated with a self-assessment scale. The donor site scar was stretched in one patient. No patient complained of elbow pain or cold intolerance. Elbow mobility was not significantly affected by flap harvesting (P = 0.06). An extension deficit of 4% was found in four patients. The mean torque, power and endurance deficits were 7.3%, 7.5% and 4.4% respectively as compared to the contralateral side. Complete loss of sensation was not present in any of the donor sites. However, an area of hypoaesthesia with a mean size of 45 cm(2)(range 20-75 cm(2)) was found on the posterolateral surface of the forearm. Patient satisfaction with the donor site was rated high. From this retrospective review it appears that elbow function was not significantly affected by extending or planning the lateral arm flap over the lateral condyle.

Adolescent↗

PubMed2002

Extended rat-ear flap model: a new rodent model for studying the effects of vessel supercharging on flap viability.

A new extended rat-ear flap model, with both an axial and a random component, is described. The flap is based on an axial supply by the posterior auricular artery and the posterior facial vein. The random portion, consisting of the rat dorsum, is capable of being supercharged at two separate sites-in the scapular and pelvic regions. There are several advantages to this composite flap. It is a combined axial and random flap. When used as a free flap, the viability of the axial portion serves as an indicator for anastomotic patency. The random portion allows for the investigation of the effects of pharmaceutical manipulation or surgical intervention, e.g., flap supercharging. The results indicate that the axial supply alone can cover approximately 50 percent of the extended rat-ear flap. Moreover, adding supercharging perforators to the random portion significantly increases the area of flap survival. Of interest, an axial vascular supply, coupled with more distal dorsal perforators (pelvic) than proximal (scapular) perforators, may increase survival for the so-called "watershed" area in the middle of the random portion of the flap. Additionally, this study also investigated the relative importance of arterial supply vs. venous drainage, using the extended rat-ear flap model. The flap was either supercharged with both the perforators of the scapular and pelvic arteries, or both scapular and pelvic veins. The results of the study suggests that augmenting venous drainage provides statistically significant improvement (87 percent vs. 51.6 percent) in increasing flap survival, when compared to augmenting the arterial supply. Arterial supercharging provided no improvement in flap survival, when compared to no supercharging (axial vessels + arterial supercharging, 51.6 percent vs. axial vessels alone, 49.9 percent). The results also suggest that providing adequate venous outflow is more important than providing additional arterial blood, and that impaired venous outflow may contribute to some cases of flap failure. However, it should be kept in mind that the best flap survival occurs with both arterial and and venous supercharging.

Animals↗

PubMed2003

Extended-spectrum beta-lactamases.

Extended-spectrum beta-lactamases, most commonly found in Klebsiella pneumoniae and Escherichia coli, have increased markedly in the past decade, particularly in the intensive care unit setting. The problem has been significant in the United States but is even more prevalent in parts of Latin America and Asia. These plasmid-mediated beta-lactamases confer resistance to broad-spectrum beta-lactam antibiotics, including third- and fourth-generation cephalosporins, aztreonam, and extended-spectrum penicillins. Other resistances, such as aminoglycoside resistance and trimethoprim/sulfamethoxazole resistance, are often cotransferred on the same plasmid. Fluoroquinolone resistance is often associated, resulting in an organism that is resistant to most of the usual antimicrobial options. Although carbapenems are currently considered the drugs of choice for these pathogens, widespread use of these agents may lead to other resistance problems. Due to limited therapeutic options, prevention and control measures are important. Traditional infection control measures, such as contact precautions, are recommended to prevent spread in intensive care units. In addition, because this type of antimicrobial resistance appears to be particularly influenced by antibiotic utilization, antibiotic control measures may also be a very important intervention in limiting the spread of extended-spectrum beta-lactamases.

Journal Article↗

PubMed2004

Extended trapezius myocutaneous free flap for the reconstruction of a foot defect lacking adjacent recipient vessels.

Foot reconstruction requires tissue that is durable and can withstand the extremes of pressure and stress. The trapezius myocutaneous flap has not been used previously as a free flap for foot reconstruction. In this report, the trapezius was used as an extended myocutaneous free flap for the reconstruction of a foot wound lacking adjacent and adequate recipient vessels. The extended trapezius flap may be one of the longest free flaps that can be harvested. The indications for the use of this flap are limited. In an extremity that lacks adequate recipient vessels adjacent to the defect, this flap can be extended such that more proximal vessels in the leg can be used as the recipient vessels without the need for vein grafts to bridge the distance. The donor-site morbidity of this flap is minimal when the superior fibers of the trapezius muscle and its innervation are preserved.

Accidents, Traffic↗

PubMed2006

Extended-donor criteria liver allografts.

Extended-donor criteria liver allografts do not meet traditional criteria for transplantation. Although these organs offer immediate expansion of the donor pool, transplantation of extended-donor criteria liver allografts increases potential short- and long-term risk to the recipient. This risk may manifest as impaired allograft function or donor-transmitted disease. Guidelines defining this category of donor, level of acceptable risk, principles of consent, and post-transplantation surveillance have not been defined. This article reviews the utilization, ethical considerations, and outcomes of extended-donor criteria liver allografts.

Donor Selection↗

PubMed1996

The extended transseptal approach in complex mitral valve surgery--evaluation of risks and benefits.

The extended transseptal approach to the mitral valve was used in 32 patients undergoing isolated or combined mitral valve surgery. In all cases exposure of the entire mitral valvular apparatus was excellent. Two patients died of low output within 30 days of surgery. No cause of death was related to the extended transseptal approach. In one early patient reexploration revealed arterial bleeding from the right atrial suture line which was caused by damage to the sinus nodal artery. In 7 patients temporary atrial conduction disturbances occurred which completely resolved within 10 days after responding well to dual-chamber pacing. Temporary ventricular pacing was necessary in two patients with preoperative bradyarrhythmia. In two patients undergoing mitral re-do surgery a permanent ventricular pacer was implanted. The extended transseptal approach offers an excellent exposure of the entire mitral valve both in primary isolated or combined mitral surgery particularly in re-do surgery where the primary standard vertical left atriotomy is impeded or the conventional transseptal approach gives only limited access. Temporary atrial dysrhythmia is not crucial and is easily controlled by short-term dual-chamber pacing.

Arrhythmias, Cardiac↗

PubMed1998

Extended hiatoplasty--a simple maneuver to lengthen the intraabdominal esophagus during abdominal fundoplication.

AIM: The aim of this paper is to describe a simple technique of extended hiatoplasty to achieve intraabdominal placement of the distal esophagus and evaluate it manometricaly. METHODS: Twelve mongrel dogs were submitted to esophageal manometry using a balloon system and continuous pull-through technique, before and after being submitted to laparotomy and extended hiatoplasty. Parameters measured included length of the HPZ, maximal recorded pressure and maximal end-expiratory pressure. Pre- and post-operative values were compared using the Wilcoxon non-parametric test accepting 0.05 as a level of significance. RESULTS: There was a significant post-operative increase in the length of the HPZ from 48.22 (+/- 4.33) mm to 68.69 (+/- 14.17) mm (p < 0.05). No significant change in the recorded values of maximal pressure or maximal end-expiratory pressure could be detected. The results indicate that an additional portion of the esophagus was exposed to the positive intraabdominal pressure and that this extended hiatoplasty can be used, together with a fundoplication, to increase the efficacy of the gastro-esophageal barrier.

Animals↗

PubMed2004

The hydrophobic effect: molecular dynamics simulations of water confined between extended hydrophobic and hydrophilic surfaces.

Structural and dynamic properties of water confined between two parallel, extended, either hydrophobic or hydrophilic crystalline surfaces of n-alkane C(36)H(74) or n-alcohol C(35)H(71)OH, are studied by molecular dynamics simulations. Electron density profiles, directly compared with corresponding experimental data from x-ray reflectivity measurements, reveal a uniform weak de-wetting characteristic for the extended hydrophobic surface, while the hydrophilic surface is weakly wetted. These microscopic data are consistent with macroscopic contact angle measurements. Specific water orientation is present at both surfaces. The ordering is characteristically different between the surfaces and of longer range at the hydrophilic surface. Furthermore, the dynamic properties of water are different at the two surfaces and different from the bulk behavior. In particular, at the hydrophobic surface, time-correlation functions reveal that water molecules have characteristic diffusive behavior and orientational ordering due to the lack of hydrogen bonding interactions with the surface. These observations suggest that the altered dynamical properties of water in contact with extended hydrophobic surfaces together with a partial drying of the surfaces are more indicative of the hydrophobic effect than structural ordering, which we suggest to be independent of surface topology.

Journal Article↗