In an effort to meet the increasing demand for bedside caregivers, nurse extender programs have proliferated over the past 2 years throughout the country. Standards for their job descriptions, however, are as varied as the number of programs. At Braintree Hospital, a great deal of time and effort has been spent to develop a program that is managed and supervised by registered nurses and that supports the appropriate delegation of tasks that do not require the skill of a professional nurse. Merker and Burkhart (1990) supported the use of a nurse extender to enhance the delivery of patient care and suggested that nursing administrators need to assess the current environment, define a strategy for the use of nurse extenders, and then implement that strategy. They also noted that because all healthcare facilities differ, it is important that each facility design its own program to meet its individual needs.

Clinical Competence↗

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All creatures great and very, very small.

Explore the source record for details and available documents.

Adult↗

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Gut peptides and food in the gut produce similar satiety effects.

We compared the satiety effects and mechanisms of action of food stimuli delivered to anatomically restricted areas of the gut with the satiety effects and mechanisms of action of the gut peptides cholecystokinin (CCK) and bombesin (BBS). When food is limited to contact with the pregastric and gastric gut surfaces at a test meal, rats stop eating and display the fixed sequence of postprandial behaviors which characterizes normal satiety. This "gastric satiety" effect is unaffected by total abdominal vagotomy. Intraperitoneal administration of BBS produces a large, specific, and dose-related inhibition of food intake at a test meal; this action, like the gastric satiety effect of food, is unaffected by total abdominal vagotomy. Since a BBS-like peptide is present in high concentration in the stomach, these parallels between gastric satiety and BBS-induced satiety suggest that an endogenous BBS-like peptide plays a role in gastric satiety. When small amounts of food are infused directly into the small intestine of sham feeding rats, they stop eating and display the behavioral satiety sequence. This "intestinal satiety" effect requires the synergistic input of oropharyngeal food stimulation in close temporal association. Intraperitoneal administration of CCK alone to sham feeding rats stops eating and elicits the behavioral satiety sequence; this action, like the intestinal satiety effect of food, requires the synergistic input of oropharyngeal food stimulation in close temporal association. Since CCK is present in high concentration in the upper small intestine, and is released into the circulation by food at this site, the parallels between intestinal satiety and CCK-induced satiety suggest that endogenous CCK plays a role in intestinal satiety.

Animals↗

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Neural disconnection of gut from brain blocks bombesin-induced satiety.

Systemically administered bombesin reduces food intake in rats, mice, baboons, and humans. The mechanism of action is unknown. We report here that presumed neural disconnection of the gastrointestinal tract from the brain blocked the reduction of food intake by exogenous bombesin at a test meal in rats. We also found that bombesin increased the postprandial intermeal interval, and that this effect was not blocked by neural disconnection.

Animals↗

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Proglumide fails to increase food intake after an ingested preload.

Proglumide, a selective antagonist of exogenous cholecystokinin in vitro, also inhibits the reduction of food intake induced by the systemic administration of cholecystokinin octapeptide (CCK-8) in food deprived rats. On the basis of an increase in the size of a brief test meal which followed an oral preload and treatment with a single dose of proglumide, it was suggested that a role for endogenous cholecystokinin in satiety had been demonstrated. We attempted to replicate this finding and could not under very similar experimental conditions. Subsequently, we tested whether other proglumide doses would antagonize the satiating effect of a larger oral preload on test meal intake. When these results were also found to be negative, we confirmed that proglumide (at several doses) significantly antagonized the reduction in food intake induced by exogenous CCK-8 under our conditions. Since proglumide antagonized the satiating effect of exogenous CCK-8, but did not increase food intake after oral preloads that were presumed to release endogenous CCK, we conclude that a reliable satiating effect of endogenous CCK remains to be demonstrated.

Animals↗

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Pharmacological examination of cholecystokinin (CCK-8)-induced contractile activity in the rat isolated pylorus.

The actions of cholecystokinin (CCK) in the production of a satiety-like state have been suggested to be mediated via receptors for CCK which are located in the pylorus. We investigated the actions of CCK and other pharmacological agents upon the isolated rat pylorus in vitro. We used the change in isometric tension of the tissue preparation (contraction amplitude) as the measure of the effects of the pharmacological agents. Cholecystokinin COOH-terminal octapeptide (CCK-8) was observed to elicit contraction in a dose-dependent manner, with the half-maximal dose (ED50) in the vicinity of 1 nM. Rapid desensitization to CCK was observed. The contraction amplitude was atropine-independent, and was not significantly antagonized by a wide variety of other pharmacological agents. The Na+-channel blocker tetrodotoxin was without effect upon contractile amplitude, as was the K+-channel blocker 4-aminopyridine, except at very high concentrations. Neurotensin, bombesin, and the substance P and bombesin antagonist spantide all elicited contraction in the isolated tissue; neurotensin had a similar potency to CCK-8 and bombesin was 10-15-fold less potent than CCK-8. Unsulfated CCK-8 was at least 170-fold less potent than sulfated CCK-8 and tetragastrin was at least 500-fold less potent than CCK-8. These results suggest that pyloric CCK receptors, which appear to have a pharmacological profile typical of peripheral CCK receptors, may have a physiological role in the peptidergic control of gastric emptying in the rat.

Animals↗

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Decreased behavioral effects of daily intracerebroventricular bombesin.

Intracerebroventricular (ICV) bombesin increases grooming and decreases food intake in rats. We examined tolerance to these effects by administering a daily injection of either saline or 25 ng bombesin to rats for 8 days via lateral ventricular cannulas. Food intake and grooming were monitored. After 8 days bombesin no longer increased grooming or decreased food intake in bombesin-treated rats, but did increase grooming and decrease food intake in saline-treated rats. This development of behavioral tolerance conflicts with previous reports using larger doses and demonstrates that repeated small doses of ICV bombesin produce different effects from larger doses.

Animals↗

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Trypsin inhibitor and maternal reunion increase plasma cholecystokinin in neonatal rats.

Intragastric soybean trypsin inhibitor increased plasma CCK bioactivity by 87% in nondeprived, 9-12-day-old rat pups. Reunion with the dam for 1 h after overnight maternal deprivation also increased plasma CCK significantly. These results demonstrate that CCK can be released from the small intestine of rats as early as postnatal day 9.

Animals↗

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Peripheral factors in the mediation of cholecystokinin-induced satiety as assessed by comparative potencies of cholecystokinin antagonists.

Cholecystokinin COOH-terminal octapeptide (CCK-8) produces a satiating effect in the rat and other animals upon peripheral administration. Although it has been demonstrated that the receptors which mediate this action are located in the periphery and are of the CCK-A subtype, their anatomical location has not been firmly established. A dense population of CCK receptors in the pyloric sphincter has been suggested as a candidate. We here quantify the potency of several CCK antagonists to inhibit the contractile effect of CCK-8 on the rat pyloric sphincter in vitro. The potent and selective antagonist MK-329 has a Schild pK of 8.85; the less potent but selective antagonist lorglumide (CR-1409) a pK of 6.37; the related antagonist phenoxyacetylproglumide (phi oAc proglumide) a pK of 5.1; and the weak parent compound proglumide a pK of about 3.3. These data can be compared with the potencies of these compounds to inhibit the actions of CCK-8 to produce satiety in the rat; this comparison supports the contention that CCK receptors of the rat pyloric sphincter could in part mediate the satiety effect produced by exogenous CCK-8.

Animals↗

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Measurement of regional cerebral blood flow, blood volume and oxygen metabolism in patients with sickle cell disease using positron emission tomography.

Regional cerebral blood flow, blood volume, fractional oxygen extraction and oxygen consumption were measured by positron emission tomography in six patients with sickle cell disease to see how oxygen delivery to the brain is maintained in the presence of both anemia and a low oxygen affinity hemoglobin. Both regional cerebral blood flow and blood volume were found to be markedly increased compared to values obtained from 14 normal subjects in the same age range. The mean fractional oxygen extraction was not significantly different in the two groups. Mean oxygen consumption in the two groups was also not significantly different but low values in individual patients with sickle cell disease and the presence of atrophy on the CT-scans of three of them were suggestive of some neuronal loss in patients without any history of nervous system involvement. In view of the known high values of cerebral blood flow and metabolism in childhood, it is suggested that when compounded by anemia and abnormal red cells, a hypercirculatory state may make patients in this age-group particularly prone to ischemic infarction.

Adult↗

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No evidence for transhemispheric diaschisis after human cerebral infarction.

Forty-four studies of regional cerebral blood flow (rCBF), fractional oxygen extraction (rOER) and oxygen consumption (rCMRO2) were made on twenty-five patients with recent internal carotid artery territory infarcts. The purpose was to study flow-metabolism relationships in the contralateral hemispheres, and to investigate whether contralateral rCMRO2 was depressed as a result of the recent infarcts. Two groups of controls were included for comparison--seventeen normal volunteers, and ten patients with proven extracranial cerebrovascular disease but without evidence of cerebral infarction. The results demonstrated that: contralateral hemispheric rCMRO2 was less variable than regional oxygen availability (the product of rCBF and arterial oxygen content). This was due, in part, to the effect of individual variations in PaCO2 on rCBF, but other uncontrolled factors, such as intracranial pressure, may have had influences. As a result, rCMRO2 did not correlate with rCBF; mean rCMRO2 in the contralateral hemispheres was 12% lower than normal (a significant difference), but was not different from the value found in patients with extracranial vascular disease in whom there was no evidence of infarction or ischemia; contralateral rCMRO2 did not correlate with the size of the infarct in the opposite hemisphere. It is concluded that rCMRO2 cannot be inferred from rCBF measurements in uncontrolled human studies (as frequently done in the past), and that depression of contralateral rCMRO2 may have preceded infarction in the opposite hemisphere, a consequence of the previous influences of diseases that predispose to stroke.

Adult↗

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Medical supplies for travelers to developing countries.

BACKGROUND: There has been little research to date on the use of medicines and first aid supplies by travelers. In some developing countries such products may be difficult to obtain, and there is the danger that substandard medicines may be purchased. As space for medical supplies in the luggage of many individuals, particularly backpackers, may be restricted, it is important to identify correctly those items most likely to be needed. OBJECTIVES: The aim of this study was to survey a cohort of travelers from the UK visiting a variety of destinations in developing countries, regarding the medical supplies taken and used during their trip. METHOD: Travelers visiting a specialist travel pharmacy in London, UK were recruited consecutively into the study. Only those planning to visit destinations in South America, Asia, Africa or the Middle East for < or = 2 weeks and returning to the UK were included. Participants were handed a questionnaire to be posted back when they returned to the UK, asking them to note those items that they included in the kit, those actually used, and any others obtained while they were away. All subjects had consulted the pharmacist concerning the medical kit appropriate for their trip. RESULTS: Two hundred and ninety-nine travelers volunteered to take part, of whom 127 returned the postal questionnaire. Analgesics and medication for the treatment of diarrhea were most likely to be used, but many types of wound dressing were unlikely to be required. Twenty individuals (16%) required antibiotics, with eight people purchasing them while they were away. Thirty-two (31%) individuals did not use insect repellents despite traveling to potentially malaria-endemic countries. Only seven subjects purchased any other items while they were away. CONCLUSION: The items most likely to be required by travelers to developing countries are analgesics, treatments for diarrhea, antiseptics and sticking plasters. The provision of antibiotics to certain travelers is probably justified.

Adolescent↗