Biomedical subjects
Publications and source records attributed to M R Ventura.
The addition of diethylamine to Stille alkylation reactions using stannanes improves yields by reducing beta-hydride elimination and reduction reactions, it also serves as a substitute for other additives such as Cu(I)I.
A generally applicable strategy for the synthesis of a range of polyoxygenated cyclohexane natural products has been developed. The enantioselective syntheses of (-)-theobroxide, a polyoxygenated cyclohexane natural compound with potent growth inducing properties in potato microtubers has been achieved via a 1,2 O-silyl migration between trans-hydroxyl groups and a remote hydroxyl directed epoxidation of an enone derived from quinic acid. A thus derived alpha-iodoenone was subjected to Stille coupling with tetramethylstannane to afford the first title compound. A similar strategy enabled a route to the complete asymmetric synthesis of the acetylenic phytotoxin (+)-harveynone. By selective reduction of (-)-theobroxide, (+)-epiepoformin was also prepared in enantiopure form and similarly, stereoselective reduction of (+)-harveynone completed the first enantioselective synthesis of (-)-asperpentyn, another natural compound with antimicrobial activity.
AIMS: The aim of the study was to evaluate the efficacy and safety of acarbose in patients with Type 1 diabetes mellitus (DM). METHODS: A multicentre double-blind, randomized, placebo-controlled study was performed. After a 6-week run-in, 121 patients were randomized to acarbose or placebo and to high- or low-fibre diet for 24 weeks. Acarbose dose was 50 mg t.d.s. for the first 2 weeks and 100 mg t.d.s. for the subsequent weeks. RESULTS: At the end of 24 weeks of treatment the intention to treat analysis showed that acarbose compared with placebo decreased 2 h postprandial plasma glucose levels (12.23 +/- 0.83 vs. 14.93 +/- 0.87 mmol/l; F = 6.1, P < 0.02) (least square means +/- SEM). No significant effect of acarbose was recorded on HbA1c or on the number of hypoglycaemic episodes. The effect of acarbose on blood glucose control was not influenced by the amount of carbohydrate and/or fibre intake. The incidence of adverse events were 75% and 39% in acarbose and placebo groups, respectively; they were mild and confined to the gastrointestinal tract. CONCLUSIONS: The use of acarbose in combination with insulin reduces postprandial plasma glucose levels in Type 1 diabetic patients who are not satisfactorily controlled with insulin alone but without significant effect on HbA1c.
The article reports a study whose purpose was to develop and test the Patient Record Pain Management Assessment Tool, an instrument to evaluate compliance with the American Pain Society's quality assurance standards on acute pain and cancer pain in chart documentation. Content validity, overall validity, and interrater reliability were all found to be acceptable. The instrument is therefore a useful tool for documenting the level of pain management practice in institutional settings.
Quality assessment and improvement (QAI) is a rapidly evolving component of health care. Its operationalization in clinical practice can be greatly enhanced by information sharing, best practice networking, and communication of experiences and resources. Nurses play a key role in both QAI and information sharing in this endeavor. Electronic communication supports the rapid sharing of QAI-related information across agencies to link nurses with a common interest in continuously improving the quality of health care delivery. It offers the opportunity to diminish the barrier of distance, which is especially relevant for nurses in rural areas. Before electronic communication was established as an information-sharing mechanism, however, the readiness of nurses in both rural and urban/suburban settings was assessed. A convenience sample of nurses in western New York, who were surveyed via written questionnaire regarding electronic communication, most often described their comfort in using this medium as uncertain. This finding supports the need for preliminary preparation focusing upon the skills and experience needed to utilize the computer as a communication medium.
A phenomenological approach was used to examine nursing staff's experiences using physical restraints. A total of 12 nurses from a tertiary hospital participated in one of three focus groups. Exploring the attitudes of nurses can contribute to a better understanding of how decisions are made concerning restraints. An analysis of the focus group data resulted in a description of the lived experiences of nurses using restraints. Seven themes emerged from the data, one of which reflected that the nurses felt ambiguous about restraints, yet they made judgments and justified their decisions after assessing patient characteristics, environmental safety, and unit traditions. Nurse clinicians could use the focus group method to sensitize themselves to the staff's needs and to allow staff the opportunity to share ideas and to dispel misconceptions about restraints.
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Continuous improvement of care depends upon the efforts of all nursing personnel. Supervisors facilitate quality program operations in their specific areas; head nurses document outcomes; and staff nurses identify problems and contribute to planning. All join in evaluating appropriateness of patient care and in modifying approaches for greater effectiveness.
Peripheral arterial obstructive disease (AOD) affects an estimated 2.4 million persons in the United States, resulting in disability, morbidity, and even death in the elderly. Insight into the general well-being (GWB) of patients who have AOD can enhance the comprehensiveness of nursing care provided to these patients. GWB was examined in a study of 170 patients with peripheral AOD treated at a Veterans Affairs Medical Center (VAMC). The GWB instrument constructed by Dupuy and used extensively by the Rand Corporation was administered to provide an objective measure of well-being. Two open-ended questions regarding patients' concerns associated with their AOD provided more subjective information. The mean GWB score for the VAMC patients was lower than the mean score reported by the Rand Corporation for a group of healthy individuals, and this lent support to the construct validity of the instrument. The general health and vitality subscales appeared to have the widest difference in mean scores. Within the VAMC patient sample, GWB did not vary among age groups but did vary slightly in an inverse direction with the severity of the circulatory impairment. The concerns noted included fear of increased pain, lack of mobility, and fear of amputation.
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Publishing is a worthwhile goal, achievable when separated into manageable steps and when the science and art of writing are addressed. The value of publishing is explored and several approaches to developing and publishing a manuscript are presented.
Nursing research most often requires human subjects. Consequently, an essential component in planning and conducting research entails recruitment of subjects who knowledgeably consent to participate. A well-established theoretical base exists regarding sampling techniques and procedures for research methods. The operationalization of the theory into practical terms may be of interest to the clinical nurse specialist (CNS) who frequently assumes a leadership role to both conduct nursing research in practice settings and to advise other nurses interested in conducting research. The recruitment efforts in four different nursing studies were compared and contrasted in an effort to determine effective and efficient approaches to this issue. Sample populations included nurse practitioners, patients, nurse aides, and nurse educators. Methods of recruitment included direct contact, mail, and telephone contact. While the settings, purposes, and designs of the studies varied, some common elements regarding subject recruitment were suggested. The recruitment methods have been described, along with the implication in terms of practical application for conduct of nursing research by CNSs.
The number of clinical nurse researcher positions seems to be increasing in healthcare agencies today. There are some unique features of the clinical nurse researcher role, including the complexities of a research position, the relatively recent introduction of the role in some clinical settings, and the frequency with which the position is coupled with other major clinical, administrative, or educational responsibilities. To increase the effectiveness of both the chief nurse executive and the clinical nurse researcher during the employment interview, the authors discuss five lines of inquiry that the interviewer or candidate can use.
We know that programs to deliver health care to the homeless are springing up all over the nation, but are they effective? Hunter, Crosby, Ventura and Warkentin attempt to get a sense of what data is being collected. In doing so, they identify the difficulties in collecting data on this transient population.
The intervention program described began with teaching patients in simple terms about PVD, associated risk factors, and why change is important. Teaching aids such as posters and booklets were used to supplement discussion. Positive reinforcement was emphasized. Phone calls, follow-up visits, encouragement and praise were frequent. Newsletters focusing on different aspects of the various risk factors were developed and mailed monthly. Patients were encouraged and helped to develop an individualized program of change based on discussions and practicality. They were encouraged to start slowly and increase gradually. Emphasis was placed on reinforcement, self-help, and praise for efforts. Patients were encouraged to keep a brief daily log of progress and thoughts. Regularly scheduled physical assessments provided a tool to assess change and provide tangible evidence of their ability to set a goal, follow through, and make life-style change.
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An information synthesis was conducted at the Department of Veterans Affairs Medical Center, Buffalo, New York, to determine the extent to which nurse practitioner (NP) effectiveness had been established in the existing literature. Three hundred fifty documents were reviewed by experts and 102 documents were deleted from the analysis phase. Fifty-six documents referred to as the Better Studies contained the most relevant and valid findings and were compared with a model developed to represent NP effectiveness. NPs were found to effectively provide a wide range of health care services. They can function as independent health care providers as well as collaborative members of the health care team. NPs have been found to have a positive influence on patient-related outcomes. There should be continued use and support of NPs in health care delivery systems. Recommendations for additional study are presented.