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[An alternative methodology for the teaching of anatomy in nursing studies at the University of Carabobo].

An alternative methodology for the teaching of Human Anatomy which contributes to improve academic yield by Nursing students at the Faculty of Health Sciences of the University of Carabobo is presented. A total of 50 first-year Nursing students who participated in the experiment were divided into 2 groups, control and experimental. This research project was of the almost-experimental type and the work methodology was experimental-evaluation. Three instruments were used to obtain data: an investigation of the Lickert school type consisting of 40 proposals related to the students attitude concerning the study of this discipline and in view of a teaching methodology (EAEAM), accompanied by the school of Interests of Thurstone and by the Psychometric Test of Raven, to determine relationships in accordance with the research objectives. In function of the empirical results of the experiment and of revision of the literature pertaining to this theme, a methodological proposal is presented for the teaching of Human Anatomy; its theoretical-practical nature demands: previous study, observation, discussion and, fundamentally, subdivision, as an alternative to improve academic yield by Nursing students.

Anatomy↗

Revised European-American Lymphoma Classification.

The recently proposed Revised European-American Lymphoma Classification represents a serious attempt to overcome the controversies that have divided both pathologists and clinicians over the past three decades. It was formulated by 19 experienced hematopathologists, who agreed on a list of clinicopathologic entities, all well known from the literature and daily practice. Compared with previous schemes, the Revised European-American Lymphoma Classification offers the following advantages: 1) it incorporates all nodal and extranodal lymphoid tumors, including Hodgkin's disease; 2) it is histogenetically updated by recognizing new categories (such as the mantle cell category) and grouping tumors that need further validation to be considered as separate entities (eg, diffuse large B-cell lymphomas); 3) it avoids any morphologic grading, the clinical course of lymphomas being influenced by factors other than histology (tumor burden, cell kinetics, apoptotic rate, and so forth) and 4) it includes all molecular data (phenotype, genotype, cytogenetics, and so forth), which can assist in the diagnosis.

Hodgkin Disease↗

Treatment of colitis in Behçet's disease with thalidomide.

A 40-year-old Turkish man on busulphan treatment for chronic myeloid leukaemia was hospitalized with steroid resistant (up to 100 mg prednisolone/24 h for over 4 weeks) colitis. On the basis of concomitant orogenital ulceration and unusual, deep punched out ulcers in the colon and smaller ulcers in the terminal ileum, Behçet's disease of the bowel, manifesting as ileocolitis, was diagnosed. Leukaemic infiltration, Crohn's colitis, neutropenic colitis and infectious colitis were excluded by histology and cultures. Treatment with colchicine 2 mg/day improved the orogenital ulcers but with only minor improvement of the colitis. Thalidomide treatment (400 mg/day), however, dramatically improved the colitis within 7 days: fever and diarrhoea disappearing. Colonoscopy after 4 weeks of treatment revealed previously giant ulcers practically healed.

Adult↗

Clinical and cost comparison of three postoperative skin preparation protocols in CABG patients.

This descriptive pilot study includes a clinical and cost comparison of three preoperative skin preparation protocols (razor, clipper, and depilatory cream, in combination with whole body disinfection) in 82 patients undergoing coronary artery bypass graft (CABG) surgery. The clinical research protocol included an evaluation of body surface area, index of body hair growth, depilatory effect, skin integrity after depilation, and side effects of body disinfection with chlorhexidine solution, as well as protocol-specific evaluation criteria. The cost comparison was performed by keeping a record of the materials used and the workload for each separate activity associated with the three preoperative skin preparation protocols. Material and labor costs were calculated for each of the different aspects of the protocols. Clinical evaluation revealed that the clipper protocol (if necessary, in combination with cream depilation) is most convenient for depilation of patients with heavy hair growth. The depilatory cream protocol is an appropriate method to depilate patients with slight or moderate hair growth. The razor method should be eliminated from clinical practice due to previous documented evidence of an associated increased risk of postoperative wound infection. Cost calculations revealed that the median hospital cost (standardized for differences in hair growth index, working hours and nurse qualification levels) of the razor, clipper, and cream protocols is $6.13, $9.84, and $8.16 (U.S. dollars), respectively. In 1995, yearly raw (i.e. non-standardized) hospital costs for the three procedures were $14,402, $16,114, and $16,765, respectively, with 708 CABG procedures performed. Although changing to a clipper and/or cream protocol may be associated with an initial, although moderate, increase in hospital costs, compared to the razor method, substantial cost savings could be expected long-term. The superiority of these protocols is primarily due to a decreased incidence of postoperative wound infections, as compared to that associated with the razor protocol.

Aged↗

Practice development units: progress update.

Following a previous Nursing Standard article about the Seacroft Hospital practice development unit (1), this article describes the progress which has been made since. The author describes some of the problems the unit has encountered, explains how staff have managed change and analyses the implications for the PDU model which have arisen from those developments.

Clinical Nursing Research↗

Studies on neurosteroids XV. Development of enzyme-linked immunosorbent assay for examining whether pregnenolone sulfate is a veritable neurosteroid.

An enzyme-linked immunosorbent assay (ELISA) of pregnenolone sulfate (PREGS) has been developed for examining whether it is a veritable neurosteroid. 11alpha-Hemiglutaryloxy-PREGS was newly synthesized and conjugated with bovine serum albumin (BSA), which was injected to rabbits for the production of anti-PREGS antibodies. A bridge-heterologous ELISA system employing the sequential saturation method exhibited a high sensitivity with a midpoint of 30 pg. Although the antibody showed some cross-reactivity with PREG (4.4%), it easily discriminated other related steroids reported to exist in the mammalian brain. The rat brain homogenate was treated with hexane and subjected to an OASIS HLB cartridge, which was washed with AcOEt to remove the unconjugated steroids, and then the desired sulfate was eluted with EtOH. The recovery rate of PREGS through the pretreatment was satisfactory, but its brain levels in the preliminary experiments were much lower than those previously measured by gas chromatography (GC)-mass spectrometry (MS) after solvolysis. These results practically agreed with our previous results by liquid chromatography (LC)-electrospray ionization (ESI)-MS without deconjugation.

Animals↗

The assessment of the bactericidal activity of surface disinfectants. III. Practical tests for surface disinfection.

The results of both previous articles on the comparison of practical tests for surface disinfection are summarized. They are the DGHM test of the German Society for Hygiene and Microbiology, the AFNOR test NF-T 72-190 of the French Association for Standardization, the quantitative carrier test (QCT) of Van Klingeren, the Leuven test and the quantitative surface disinfection test (QSDT). The comparison of the techniques followed in these tests seems to indicate that the differences in the operating technique are likely to influence the test results. There is, however, a close correlation among the results of all but the AFNOR test, although there remains a statistically significant difference in the reduction factors: the Leuven test and the QCT are the more severe tests, whereas the AFNOR and DGHM tests are the less severe ones. The QSDT gives divergent results, which could be attributed to the influence on the resuscitation of the surviving bacteria.

Colony Count, Microbial↗

SSRI-induced sexual dysfunction: fluoxetine, paroxetine, sertraline, and fluvoxamine in a prospective, multicenter, and descriptive clinical study of 344 patients.

The authors analyzed the incidence of sexual dysfunction (SD) with different selective serotonin reuptake inhibitors (SSRIs; fluoxetine, fluvoxamine, paroxetine, and sertraline) and hence the qualitative and quantitative changes in SD throughout time in a prospective and multicenter study. Outpatients (192 women and 152 men; age = 39.6 +/- 11.4 years) under treatment with SSRIs were interviewed with an SD questionnaire designed for this purpose by the authors and that included questions about the following: decreased libido, delayed orgasm or anorgasmia, delayed ejaculation, inability to ejaculate, impotence, and general sexual satisfaction. Patients with the following criteria were included: normal sexual function before SSRI intake, exclusive treatment with SSRIs or treatment associated with benzodiazepines, previous heterosexual or self-erotic current sexual practices. Excluded were patients with previous sexual dysfunction, association of SSRIs with neuroleptics, recent hormone intake, and significant medical illnesses. There was a significant increase in the incidence of SD when physicians asked the patients direct questions (58%) versus when SD was spontaneously reported (14%). There were some significant differences among different SSRIs: paroxetine provoked more delay of orgasm or ejaculation and more impotence than fluvoxamine, fluoxetine and sertraline (chi 2, p < .05). Only 24.5% of the patients had a good tolerance of their sexual dysfunction. Twelve male patients who suffered from premature ejaculation before the treatment preferred to maintain delayed ejaculation, and their sexual satisfaction, and that of their partners, clearly improved. Sexual dysfunction was positively correlated with dose. Patients experienced substantial improvement in sexual function when the dose was diminished or the drug was withdrawn. Men showed more incidence of sexual dysfunction than women, but women's sexual dysfunction was more intense than men's. In only 5.8% of patients, the dysfunction disappeared completely within 6 months, but 81.4% showed no improvement at all by the end of this period. Twelve of 15 patients experienced total improvement when the treatment was changed to moclobemide (450-600 mg/day), and 3 of 5 patients improved when treatment was changed to amineptine (200 mg/day).

1-Naphthylamine↗

Advancing quality of urinary incontinence evaluation and treatment in nursing homes through translational research.

AIM: This article presents the development of ongoing research to improve the evaluation and treatment of urinary incontinence (UI) in nursing homes through "A Model for Use of the Urinary Incontinence Guideline in US Nursing Homes" under the initiative Translating Research into Practice (TRIP II). BACKGROUND: The previous research provided the definition of the clinical practices needing improvement, the relative size of the population needing care, and an estimate of the manpower required. The model proposed nurse practitioners (NPs) as consultants to nursing homes to perform the basic incontinence evaluation and treatment, thereby (1) improving incontinence evaluation and treatment, (2) reducing UI, (3) reducing complications, and (4) increasing cost savings attributable to UI. APPROACH: A quasi-experimental research design with pre- and post-comparison was selected utilizing four control and four experimental NP caseloads followed for 16 weeks post-onset (n = 320). FINDINGS: Findings are not yet available from this study, which is ongoing. DISCUSSION: The real-world challenges presented by this translational research and their solutions are discussed.

Aged↗

Career destinations seven years on among doctors who qualified in the United Kingdom in 1988: postal questionnaire survey.

OBJECTIVE: To report the career choices and career destinations in 1995 of doctors who qualified in the United Kingdom in 1988. DESIGN: Postal questionnaire. SETTING: United Kingdom. SUBJECTS: All doctors who qualified in the United Kingdom in 1988. MAIN OUTCOME MEASURES: Current employment. RESULTS: Of the 3724 doctors who were sent questionnaires, eight had died and three declined to participate. Of the remaining 3713 doctors, 2885 (77.7%) replied. 16.9% (608/3593; 95% confidence interval 16.1% to 17.8%) of all 1988 qualifiers from medical schools in Great Britain were not working in the NHS in Great Britain in 1995 compared with 17.0% (624/3674; 16.1% to 17.9%) of the 1983 cohort in 1990. The proportion of doctors working in general practice was lower than in previous cohorts. The percentage of women in general practice (44.3% (528/1192)) substantially exceeded that of men (33.1% (443/1340)). 53% (276/522) of the women in general practice and 20% (98/490) of the women in hospital specialties worked part time. CONCLUSIONS: Concerns about recruitment difficulties in general practice are justified. Women are now entering general practice in greater numbers than men. There is no evidence of a greater exodus from the NHS from the 1988 qualifiers than from earlier cohorts.

Career Choice↗

The use of pit and fissure sealants.

This paper reviews key issues of sealant use and methodology and poses recommendations to inform the discussion toward a consensus statement by participants. A comprehensive review of sealant literature, including policy recommendations from previous conferences that reviewed best practices for sealant use, was completed. Building on previous review papers and on previous policy statements by dental and public health groups, this paper discusses key questions about sealant use in light of contemporary caries data and cost-benefit analyses. In addition, newest material advancements are reviewed to establish the next step in sealant improvement for young patients.

Cost-Benefit Analysis↗

[Sexual dysfunction secondary to SSRIs. A comparative analysis in 308 patients].

UNLABELLED: The authors analyze the incidence of sexual dysfunction (SD) with different SSRIs (Fluoxetine, Fluvoxamine, Paroxetine and Sertraline) and hence the qualitative and quantitative changes in SD throughout time 308 outpatients (169 women, 139 men; mean +/- SD age = 41 +/- 7) under treatment with SSRIs were interviewed with an SD questionnaire designed for this purpose by the authors including questions about the following items decreased libido, delayed orgasm or anorgasmia, delayed ejaculation inability to ejaculation, impotence and general sexual satisfaction. Patients with the following criteria were included: normal sexual function before SSRIs intake, exclusive treatment with SSRIs or associated with benzodiazepines, previous heterosexual or self-orone current sexual practices. We excluded patients with previous sexual dysfunction, association of SSRIs with neuroleptics, recently hormone intake and significant medical illnesses. RESULTS: There is a significant increase in the incidence of SD when the physicians ask the patients direct questions (55.29%) versus spontaneous SD reported (14.2%). There are some significant differences among different SSRIs paroxetine provoked more delay of orgasm/ejaculation and more impotence than fluvoxamine, fluoxetine and sertraline (Chi square p < 0.05). Only 22.6% of the patients had a good tolerance about their sexual dysfunction. SD has positive correlation with the dose. The patients experienced substantial improvement in sexual function when the dose was diminished or the drug was withdrawn. Men showed more incidence of sexual dysfunction than women but women's sexual dysfunction was more intense than men. Seven of nine patients (77.7%) experienced total improvement when the treatment was changed to Moclobemide (450 mg/day) and two of four patients (50%) improved when treatment was changed to Amineptine.

1-Naphthylamine↗

Childhood migraine in general practice: clinical features and characteristics.

Previous studies have evaluated the clinical features and characteristics of migraine in selected children attending hospital clinics. There have, however, been no community studies on the prevalence and characteristics of migraine in children aged 3-11 years in British general practice. In this study, a total of 1,083 children (from 1,104 registered with a general practice) and their parents were interviewed. Possible migraine sufferers took part in an extended interview that assessed various characteristics of the patients and their attacks. The survey showed that migraine attacks started in infancy, and migrainous children were more likely to have mothers with migraine. Some clinical features were found to be age-dependent. Compared with similar hospital surveys there was a lower frequency of attacks recorded but the prevalence of aura was similar to that found in previous studies.

Age Factors↗

Attaining a correct diagnosis of COPD in general practice.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is common. Diagnosis should include objective evidence of airways obstruction and spirometry is recommended in guidelines and the general medical services contract in the UK. We assessed the impact of spirometry in general practice. METHOD: We determined by questionnaire the availability, staff training, use and the interpretation results of spirometry in 72% of general practices in Wales. We reviewed the diagnosis of COPD previously made in two general practices without spirometry. RESULTS: Most practices had a spirometer (82.4%) and used it (85.6%). Confidence in use and interpretation of results varied widely: 58.1% were confident in use and 33.8% confident in interpretation. Spirometry was performed more often if confident in use and interpretation (both P<0.001) and was related to greater training periods (P<0.001). Spirometric confirmation of COPD varied widely (0-100%, median 37%). Of the 125 patients previously diagnosed with COPD 61 had spirometric confirmation, while 25 had reversible obstruction (range 210-800 mls), 34 had normal and 5 had restrictive spirometry. CONCLUSION: Despite incentives to perform spirometry in general practice, lack of adequate training in use and interpretation suggests use is confounded and the diagnosis of COPD is likely to be made on imprecise clinical grounds.

Adult↗

Vaccinia (smallpox) vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2001.

These revised recommendations regarding vaccinia (smallpox) vaccine update the previous Advisory Committee on Immunization Practices (ACIP) recommendations (MMWR 1991;40; No. RR-14:1-10) and include current information regarding the nonemergency use of vaccinia vaccine among laboratory and health-care workers occupationally exposed to vaccinia virus, recombinant vaccinia viruses, and other Orthopoxviruses that can infect humans. In addition, this report contains ACIP's recommendations for the use of vaccinia vaccine if smallpox (variola) virus were used as an agent of biological terrorism or if a smallpox outbreak were to occur for another unforeseen reason.

Contraindications↗

Evidence-based practice and research utilization activities among rural nurses.

PURPOSE: To identify the extent to which rural nurses utilize evidence-based practice guidelines from scientific research in their practice; to describe both previous and current research utilization activities in which they have participated, and to identify the specific barriers they face in their practice settings. DESIGN AND METHODS: Data for this descriptive study were collected through questionnaires with open-ended questions focused on (a) current utilization of nursing research findings, (b) previous involvement in nursing research activities, and (c) participation in medical research activities. The participants were 106 nurses from various practice areas in six rural counties of a southwestern state in the United States. FINDINGS: Results revealed that only 20.8% of the participants stated they were currently involved in research utilization, and they were mostly nurses with bachelor's degrees. The two most common areas of current research utilization were pain management and pressure ulcer prevention and management. Barriers to research utilization, such as rural isolation and lack of nursing research consultants, were identified. CONCLUSIONS: The types of research utilization activities identified by these nurses indicate how much the facilities in which these nurses work in the rural areas are striving with the utilization of available scientific evidence. Rural nurses face unique barriers related to situational and geographic factors, with implications for nursing administrators, researchers, and educators.

Adult↗

Specificity and variability of practice with young children.

It has previously been suggested that paradigms investigating schema theory should include tests of the effects of variability of practice on tasks experienced during the acquisition of learning. The present aim was to test this effect using a sports-related task. Two groups of children (n = 13 each) aged between 3 and 5 yr. old were pretested on an aiming task. They then received ten practice trials per day for ten days. One group (designated the specific group) practised only at the specified target distance, while another group (designated the specific plus variable group) practised at the target distance and at distances around the target. At the end of the practice period both groups were again tested. The data were analysed for distance and lateral errors, using two-way (group x time) analyses of covariance with one repeated measure on the latter factor. The interaction of groups x time was significant for the distance errors, indicating that at the end of the practice period the specific plus variable group had improved more than the specific group. This finding extends previous work on a similar variability paradigm to a sports-related setting.

Child Development↗

A randomized comparison of the effect of four antihypertensive monotherapies on the subjective quality of life in previously untreated asymptomatic patients: field trial in general practice. The OCAPI Study Group. Optimiser le Choix d'un Anti-hypertenseur de Première Intention.

OBJECTIVE: To assess the equivalence of four antihypertensive treatments in patients with mild-to- moderate hypertension, and to compare the effects of those drugs on the subjective quality of life and clinical safety. DESIGN, SETTING AND PATIENTS: 653 patients aged > or = 18 years with untreated hypertension were randomly allocated to receive a combination of two diuretics (altizide and spironolactone), a beta-blocker (bisoprolol), a calcium antagonist (verapamil), or an angiotensin converting enzyme (ACE) inhibitor (enalapril). Follow-up lasted for 1 year. MAIN OUTCOME MEASURES: A composite outcome of the following measures was used to define success: attendance at the 12-month visit; at least nine supine DBP measurements during the study; and median supine DBP < 90 mmHg and a reduction of at least 10 mmHg compared with the baseline value. Failure was defined as one or more of those criteria not being fulfilled. Equivalence was concluded if the 95% confidence interval for the success rates differed between two groups by less than +/- 10%. Clinical safety and subjective quality of life were also assessed. RESULTS: No statistically significant differences in the change in DBP or systolic blood pressure were observed between the groups. The success rates were 43.9, 42.0, 32.5 and 43.9% in diuretic, beta-blocker, calcium antagonist and ACE inhibitor groups, respectively. Equivalence between the treatments could not be concluded, although analysis with a larger equivalence interval showed that some comparisons indicated equivalence. Significant improvement in satisfaction was observed for certain items for subjective quality of life at 1 month in the calcium antagonist treatment group, and significant differences in the responses to the clinical safety questionnaire were observed after 1-month follow-up in calcium antagonist and beta-blocker groups. Differences were no longer significant after 9 months. CONCLUSIONS: These results do not provide evidence on the basis of efficacy of blood pressure lowering or ability to increase short-term (1-year) safety and quality of life favouring any particular treatment among the studied drugs for newly diagnosed patients with mild-to-moderate hypertension.

Adolescent↗