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Drug abuse by RN's: unprofessional conduct? Case in point: Leib v. Conn. Bd. of Examiners for Nursing (411A.2d42-CONN.).
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Spouse's appeal on abortion rejected.
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Initial field testing of an instrument to measure: observable indicators of nursing home care quality.
The "Observable Indicators of Nursing Home Care Quality" instrument was developed as a new measure of nursing home care quality. The instrument is based on a theoretical model of quality nursing home care grounded in data from provider and consumer focus groups. The instrument was piloted in 10 Missouri nursing homes. Subsequent versions were tested in 109 Missouri and 11 Icelandic nursing homes. Content validity was established using experts. Concurrent and known groups validity was evaluated using Minimum Data Set quality indicators, survey citations, and a process of care measure. Interrater and test-retest reliabilities were calculated as well as coefficient alpha. The "Observable Indicators of Nursing Home Care Quality" instrument is a new measure that can be used by researchers, and potentially by regulators, consumers, or providers, to observe and score specific indicators of quality care following a 20- to 30-minute inspection of a nursing home.
Prevalence, incidence, management, and predictors of venous ulcers in the long-term-care population using the MDS.
OBJECTIVE: To describe the prevalence, incidence, management, and predictors of venous ulcers in residents of certified long-term-care facilities using the Minimum Data Set. DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: 32,221 residents admitted to long-term-care facilities in Missouri between January 1, 1996, and October 30, 1998. MAIN OUTCOME MEASURES: Version 2.0 of the Minimum Data Set was utilized. Assessment items included selected measures from background information, disease diagnoses, physical functioning and structural problems, health conditions, oral/nutritional status, and skin condition. MAIN RESULTS: Venous ulcer prevalence on admission was 2.5%. The incidence of venous ulcer development for long-term-care residents admitted without an ulcer at 90, 180, 270, and 365 days after admission was 1.0%, 1.3%, 1.8%, and 2.2%, respectively. The most frequent skin treatments for residents with a venous ulcer were ulcer care, dressings, and ointments. Factors associated with venous ulcer development within a year of admission were diabetes mellitus, peripheral vascular disease, and edema. CONCLUSION: Venous ulcer prevalence and incidence are greater in the long-term-care population than in the community at-large. Residents with a venous ulcer are likely to have comorbid conditions such as diabetes mellitus, peripheral vascular disease, congestive heart failure, edema, wound infection, and pain. Based on these data, risk factors such as history of leg ulcers, recent edema, diabetes mellitus, congestive heart failure, or peripheral vascular disease should prompt clinicians to carefully plan care that will manage a resident's risk for venous ulcer development.
Trial of platelet-inhibiting drug in scleroderma. Double-blind study with dipyridamole and aspirin.
In a randomized, double-blind, controlled study, 28 patients with early scleroderma received dipyridamole (225 mg/day) and aspirin (975 mg/day) or placebo for 1-2 years. No significant clinical or objective laboratory improvement was noted in either group. Platelet survival time, plasma renin activity, and coagulation tests were not predictive of disease course. Biomechanical and vascular tests of the hands correlated with clinical extent of skin induration and presence of finger ulcers, respectively.
Improving quality of care in nursing facilities. Gerontological clinical nurse specialist as research nurse consultant.
It is becoming increasingly common for nursing facilities to use Quality Indicators (QI) derived from Minimum Data Set (MDS) data for quality improvement initiatives within their facilities. It is not known how much support facilities need to effectively review QI reports, investigate problems areas, and implement practice changes to improve care. In Missouri, the University of Missouri-Columbia MDS and Nursing Home Quality Research Team has undertaken a Quality Improvement Intervention Study using a gerontological clinical nurse specialist (GCNS) to support quality improvement activities in nursing homes. Nursing facilities have responded positively to the availability of a GCNS to assist them in improving nursing facility care quality.
Prophylactic fluconazole promotes reepithelialization in full-face carbon dioxide laser skin resurfacing.
BACKGROUND AND OBJECTIVE: Laser skin resurfacing is used to treat photodamaged skin, rhytids, and acne scarring. Many patients are placed on antibiotics and antivirals pre- and postoperatively. The purpose of this study was to determine whether prophylactic fluconazole increased the rate of reepithelialization in patients undergoing full-face CO(2) laser skin resurfacing. STUDY DESIGN/MATERIALS AND METHODS: Ninety-one patients underwent full-face CO(2) laser skin resurfacing with the Coherent Ultrapulse 5000C. At least two passes of 300 mJ, density 5, were used except periocularly. Study group I consisted of 48 consecutive patients who received either cephalexin or ciprofloxacin for 7 days postoperatively. Study group II consisted of 43 patients who received 300 mg of fluconazole on postoperative days 3-8, in addition to ciprofloxacin. Both groups received acyclovir 400 mg t.i.d. pre- and postoperatively. RESULTS: Time to complete reepithelialization was compared between the groups by t-test. Group II reepithelialized significantly faster than group I (7.65 +/- 1.20 days vs. 10.27 +/- 2.94 days; P < 0.0001). Ninety-five percent of patients receiving fluconazole (group II) healed completely by day 9 versus only 53% of patients in group I. CONCLUSION: Fluconazole administered postoperatively between days 3 and 8 significantly promotes reepithelialization in patients undergoing full-face CO(2) laser skin resurfacing.
Glycosaminoglycan production in cultures of early and late passage human endothelial cells: the influence of an anionic endothelial cell growth factor and the extracellular matrix.
An endothelial cell (EC) growth factor isolated from bovine brain stimulates in vitro growth of human umbilical vein endothelial cells, and permits long term serial propagation. In the presence of increasing concentrations of EC growth factor, confluent cultures of early (CPDL less than or equal to 20) and late (CPDL greater than 20) passage human endothelial cells exhibit an increased incorporation of 3H-glucosamine and Na235SO4 into the glycosaminoglycans (GAG), hyaluronic acid, chondroitin, chondroitin-4-sulfate, dermatan-4-sulfate, and chondroitin-6-sulfate. An increase in both labelled sulfated and nonsulfated GAG was observed in the cytosol, membrane, secreted and extracellular matrix fractions. In contrast, endothelial cells grown in the presence of EC growth factor contained decreased amounts of labelled heparan sulfate than cells grown without EC growth factor. Confluent cultures of early passage cells had significantly more labelled GAG but significantly less heparan sulfate than cultures of late passage cells on a per cell basis. Extracellular matrix from early passage cells contained about two- to seven-fold more labelled GAG than extracellular matrix from late passage cells, but only about half as much labelled heparan sulfate. Cell adhesion was enhanced when cells were grown in the presence of EC growth factor as compared to adhesion of cells grown without EC growth factor. Conversely, trypsin-mediated detachment of cells grown in the presence of growth factor was inhibited as compared to detachment of cells grown in medium without EC growth factor. The composition of the extracellular matrix influenced incorporation of labelled GAG into extracellular matrix. Early passage cells grown to confluence on a matrix from late passage cells incorporated significantly less labelled GAG into extracellular matrix than when grown to confluence on matrix from early passage cells. Incorporation of labelled GAG into extracellular matrix was significantly higher when late passage cells were grown on a matrix from early passage endothelial cells than when grown on matrix from late passage cells. We conclude that EC growth factor selectively stimulates incorporation of isotopic precursors into GAG in cultures of early and late passage endothelial cells but inhibits incorporation of radiolabel into heparan sulfate; early passage cells contain more GAG but less heparan sulfate than late passage cells, extracellular matrix controls the amount of GAG and heparan sulfate incorporated into matrix.(ABSTRACT TRUNCATED AT 400 WORDS)
The isolation and purification of two anionic endothelial cell growth factors from human brain.
Two anionic polypeptides which stimulate the proliferation of human umbilical vein endothelial cells have been isolated and purified to homogeneity from human brain using heparin affinity chromatography. The molecular weights of the polypeptides are 18,500 and 19,300; the isoelectric point for both polypeptides is at pH 5.2. The purified polypeptides differed in their ability to stimulate human endothelial cell growth. The half maximal activities observed for the 18.5 and 19.3 kilodalton polypeptides were at concentrations of 10.0 ng/ml and 0.9 ng/ml respectively.
Human brain-derived acidic and basic fibroblast growth factors: amino terminal sequences and specific mitogenic activities.
Extended amino terminal sequence determinations, made on both acidic and basic fibroblast growth factors from human brain, showed extensive homology with each other and with their respective bovine counterparts. Both human growth factors in the presence of heparin have equivalent specific mitogenic activities on human umbilical vein endothelial cells in culture whereas in the absence of heparin, the acidic mitogen is less than 1% as active as the basic growth factor.
The complete amino acid sequence of human brain-derived acidic fibroblast growth factor.
Acidic fibroblast growth factor is a potent mitogen for a variety of cells in culture, including vascular endothelial cells, and is angiogenic in vivo. The complete amino acid sequence of human brain-derived acidic fibroblast growth factor has been determined from amino terminal sequence analysis and carboxypeptidase A digestion of the whole protein and sequence analyses of peptides generated by tryptic, Staphylococcus aureus V8 protease and cyanogen bromide cleavages. A potential Asn-Gly-Ser glycosylation sequence is present in the human protein. The complete amino acid sequence is compared to that of the equivalent protein purified from bovine brain.
Isolation of nuclei using hexylene glycol.
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The controlled synthesis of peptides in aqueous medium. 8. The preparation and use of novel alpha-amino acid N-carboxyanhydrides.
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Isolated plasma membranes regulate neurotransmitter expression and facilitate effects of a soluble brain cholinergic factor.
The choice of which transmitter will be expressed by a neuron is influenced by diffusible differentiating factors produced by a variety of nonneuronal cells. In this study we show that human, bovine, and rat brains contain a soluble heparin-binding factor that stimulates cholinergic and peptidergic expression. We also show that neuronal contact with other cell membranes influences neurotransmitter development and acts synergistically with the effects of the soluble brain factor. Exposure of cultured sympathetic neurons to purified plasma membranes derived either from cultured Schwann cells or from cultured sympathetic neurons promoted expression of choline acetyltransferase (CAT), a cholinergic trait, and of substance P (SP). CAT activity and SP were also stimulated by a 50-kDa soluble protein that was purified 14,000-fold from human, calf, and rat brain by heparin-Sepharose affinity chromatography. CAT activity after concurrent treatment with plasma membranes and the soluble factor far exceeded the sum of the enzyme activities after the individual treatments, suggesting that membrane molecules and the factor facilitated each other. Thus, cell-surface molecules, which have been shown previously to influence neuronal morphogenesis and neurite elongation, may also help determine the transmitter phenotype of the neuron. Moreover, cell-surface molecules may modulate the effects of diffusible differentiating factors.
Creatine phosphokinase determination by the fluorescent ninhydrin reaction.
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Heterogeneity of human serum albumin. Report of two cases of bisalbuminemia.
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