Multiskilling the health care worker: some urgent concerns.
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Education, Nursing↗
Biomedical subjects
B L Cameron
Publications and source records attributed to B L Cameron.
Reflective peer journals: developing authentic nurses.
Nursing education courses often require students to write about their learning experiences in a journal or a log book. Students write the journal/log and submit it to the instructor. The instructor reads, comments, and may or may not grade it. This paper is a reflection on the use and misuse of journals in nursing education from the viewpoints of students and instructors. Related literature is integrated into a dialogue with concepts that relate to nursing education. A theoretical framework, a format and guidelines for peer journals are presented, along with the rationale for having students keep peer journals rather than student/instructor logs.
Education, Nursing, Baccalaureate↗
The nature of comfort to hospitalized medical surgical patients.
Historically, comfort has been a quintessential aspect of nursing practice. Currently, it is questionable whether or not comfort remains an integral facet of nursing care. The increasing trend to focus on the technological and institutional aspects of patient care rather than the individual's response to illness and subsequent treatment is heard again and again from the growing vocal consumer movement. This study of comfort from a patient's viewpoint (a grounded theory) attempted to address both the current state of comfort care found within nursing practice and the patient's view of what constituted comfort while in hospital. The most significant finding was that comfort was not a passive process whereby the patients waited in hope of receiving comfort (i.e. such as someone to come and soothe their fevered brows). Comfort was found to be a dynamic process, with each patient actively engaged in increasing personal comfort levels. Indeed, the lack of comfort was found to be the stimulus for patients to embark on a process called 'integrative balancing'.
Adaptation, Psychological↗
High porosity PTFE improves endothelialization of arterial grafts without increasing early thrombogenicity.
OBJECTIVE: High porosity (HP) (90 micron internodal distance) PTFE grafts were implanted into the carotid and femoral arteries of dogs to investigate early thrombogenicity, patency, and endothelialization. EXPERIMENTAL DESIGN: Standard PTFE (STD) grafts (30 micron internodal distance) were used as controls. 12 HP and 12 STD grafts were implanted into 6 dogs. Indium-111 labeled platelets were infused intravenously after graft implantation. A graft platelet accumulation index (GPAI) was calculated as the ratio of radioactive emission from the PTFE grafts excised at 48 hours to the emission from a native arterial segment. Another 12 HP and 12 STD grafts were implanted into femoral and carotid arteries to assess patency and endothelialization at 4 and 18 weeks. RESULTS: There was no significant difference in the GPAI of the HP and STD grafts at either the carotid (HP = 31.5 +/- 9.7, STD = 30.6 +/- 11.8; p > 0.05) or femoral (HP = 34.0 +/- 5.0, STD = 31.5 +/- 7.9; p > 0.05) positions. Combined data (carotid and femoral HP vs. carotid and femoral STD) also did not demonstrate a difference in GPAI (HP = 32.8 +/- 7.5, STD = 31.1 +/- 9.6; p > 0.05). Patency rates were the same at 4 weeks (75%), but greater in the HP grafts at 18 weeks (HP = 75%, STD = 37%; p > 0.05). No difference was noted in the percentage of graft endothelialization at 4 weeks (HP = 5.2 +/- 5.8, STD = 5.0 +/- 4.0; p > 0.05), however, at 18 weeks the HP graft had significantly more endothelial coverage compared to STD grafts (HP = 75.2 +/- 13.9, STD = 22.6 +/- 9.5; p < 0.01). CONCLUSIONS: Given that HP PTFE is no more thrombogenic than STD PTFE, and that it provides superior endothelialization, HP grafts should continue to be developed and studied for potential clinical use.
Animals↗
Modified polytetrafluoroethylene: indium 111-labeled platelet deposition on carbon-lined and high-porosity polytetrafluoroethylene grafts.
Platelet accumulation on carbon-lined (CL) and high-porosity (HP) polytetrafluoroethylene (PTFE) grafts was investigated in vivo. In experiment 1, 20 CL grafts and 20 control PTFE grafts, each 5 cm in length and 4 mm in diameter, were interposed into both carotid and femoral arteries of 10 dogs. In experiment 2, 12 HP grafts (90 microns mean internodal distance) and 12 control PTFE grafts were implanted in six dogs. Indium 111-labeled platelets were injected intravenously and the grafts were retrieved 48 hours later. Radioactivity of the grafts and a control segment of the carotid artery was counted. A graft platelet accumulation index (GPAI) was calculated as the ratio of emission from the graft compared to that from the control segment. The GPAI of the CL graft was significantly less than the GPAI of the control graft in both the carotid (control 29.7 +/- 5.46, CL 22.3 +/- 6.55; n = 9 [p < 0.05]) and the femoral arteries (control 30.7 +/- 9.65, CL 22.0 +/- 6.59; n = 9 [p < 0.05]). There was no significant difference in GPAI between the control and HP grafts in the carotid arteries (control 30.6 +/- 11.8, HP 31.5 +/- 9.71; n = 6) and in the femoral arteries (control 31.5 +/- 7.88, HP 34.0 +/- 4.97; n = 6). Carbon lining decreases platelet accumulation on PTFE grafts in the early postoperative period, and HP grafts do not exhibit increased platelet uptake.
Animals↗
Immunohistochemical determination of the estrogen receptor content of gastrointestinal adenocarcinomas.
Recently there have been several reports documenting the presence of estrogen receptors (ERs) in human gastrointestinal (GI) malignancies, raising the possibility that these cancers may be hormonally manipulated. To test this hypothesis, 68 frozen GI tissue specimens were examined for the presence of ERs within the cell nuclei by immunohistochemical staining. There were 51 cancers (25 gastric, 26 colon) and 17 normal tissue specimens (six gastric, 11 colon). Tissue sections 4 to 6 microns thick were incubated with monoclonal antibody H222SP psi, then stained by the peroxidase-antiperoxidase technique for visualization of the ER. The staining was semiquantitatively graded from 0 to 3+ depending on both the intensity of staining and the percentage of cell nuclei stained. A breast cancer specimen known to be strongly positive for the ER was used as a positive control. The 30 male and 21 female cancer patients had a median age of 59 years. All tumors were adenocarcinomas. Eight per cent of the gastric cancers were poorly differentiated, while 94 per cent of the colon cancers were moderately well to well differentiated. Using weak staining of at least 20 per cent of the cell nuclei as the minimum requirement for an ER positive tumor (1+, 0/51 tumors and 0/17) normal specimens were positive for ER. Only three out of 25 (12%) gastric tumors, and two out of 26 (8%) colon tumors demonstrated any staining; each exhibited weak staining of only five to ten per cent of the tumor nuclei.(ABSTRACT TRUNCATED AT 250 WORDS)
Adenocarcinoma↗
Small bowel obstruction in patients with a prior history of cancer.
To assess the efficacy of operative and nonoperative therapy of small bowel obstruction (SBO) in patients with a previous diagnosis of cancer, a review of 54 cases was carried out. The 32 men and 22 women had a mean age of 58 years. At presentation with SBO, 26 patients (48%) had known recurrent cancer. Forty patients were initially treated nonoperatively; 11 (28%) had resolution of their SBO after a mean of 7 days of nasogastric suction. Five of 11 patients developed recurrent SBO prior to death. Thirty-seven patients underwent laparotomy, 14 on the day of admission and 23 after failure of nasogastric suction. Twenty-five of 37 (68%) had obstruction due to recurrent carcinoma. Small bowel obstruction due to recurrent cancer occurred earlier (21 +/- 5 months) than SBO from benign causes (61 +/- 18 months; p < 0.01). Mean survival for patients with malignant obstruction (5 +/- 1 month) was significantly shorter than for those with benign obstruction (50 +/- 10 months; p < 0.001). The 30-day and in-hospital mortality rates for the 25 surgically treated patients with malignant SBO were 24% and 28%, respectively; in 9 of 25 (36%), the obstruction failed to fully resolve. The only factor predictive of in-hospital mortality was obstruction secondary to cancer (p < 0.05). The median posthospital survival for surgically treated patients with malignant SBO was only 2.5 months. We conclude that: (1) patients should be given an initial trial of nonoperative therapy; (2) patients with no known recurrence or a long interval to the development of SBO should be aggressively treated with early surgery if nonoperative treatment fails; and (3) for patients with known abdominal recurrence in whom nonoperative therapy fails, the results of surgical palliation are grim. Innovative approaches are needed to maximize palliation while also limiting morbidity and mortality.
Adult↗
Nurses offer home health-care alternatives. Part II.
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Child↗
In vivo study of a high-porosity polytetrafluoroethylene graft: endothelialization, fluid leakage, and the effect of fibrin glue sealing.
Standard polytetrafluoroethylene (PTFE) grafts (30-microns internodal distance, ID) (ST grafts), high-porosity PTFE grafts (90 microns ID) (HP grafts), high-porosity PTFE grafts preclotted with autogenous blood (BHP grafts), and high-porosity PTFE grafts presealed with fibrin glue (FHP grafts) were implanted in both common carotid and femoral arteries of 18 dogs. Of the three high-porosity groups, the FHP graft showed the shortest bleeding time. Seromas and/or hematomas occurred as follows: ST grafts 1, HP grafts 7 (P < .05 vs ST), BHP grafts 5 and 2 with FHP grafts. Fibrin glue was observed in all histological sections of 1-week samples, but by 4 weeks it was almost totally absorbed. No endothelialization (ET) was measurable at 2 weeks. By 4 weeks ET extended for a short distance from each anastomosis and there were no significant differences between the four graft groups. At 18 weeks, the HP, BHP, and FHP grafts showed a significant increase in ET compared with the ST graft (P < .01) but there were no significant differences between the three types of high-porosity graft. The differences in patency rates and neointimal thicknesses did not reach statistical significance. High-porosity PTFE grafts showed superior endothelialization in dogs; however, the enlarged ID of PTFE grafts increased intraoperative bleeding and postoperative seroma formation. Fibrin glue sealant controlled bleeding through the graft wall without affecting graft healing, but its sealant effect was not enough to prevent late fluid leakage.
Animals↗
Fine needle aspiration cytology of breast ductal carcinoma in situ.
To evaluate the role of fine needle aspiration cytology (FNAC) in identifying in situ breast carcinoma, we reviewed 19 FNACs of histologically confirmed pure or predominantly ductal carcinoma in situ (DCIS). The cytologic diagnosis was positive for malignancy in 53%, suspicious in 31% and nondiagnostic in 16%. An intraductal lesion was suggested prospectively in 21%. Retrospective review showed three distinctive cytologic criteria in cases with DCIS: (1) cohesive groups of atypical ductal cells associated with scattered, individual malignant cells or a necrotic background; (2) hyperplastic ductal cells with associated malignant cells or necrosis; and (3) true tissue fragments composed of cohesive epithelial cells with a cribriform pattern. One or more findings were present in 81% of the malignant or suspicious FNACs; 19% could not be distinguished cytologically from invasive carcinoma. We studied a control group of 30 invasive ductal carcinomas; one or more criteria were found in 35% of cases with no or a minor DCIS component but in 73% of those with an extensive DCIS component. We conclude that these three criteria deserve further study as an aid in suggesting DCIS on FNAC.
Adult↗