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PubMedDate not supplied

Advanced practice nursing outcomes: a review of selected empirical literature.

PURPOSE/OBJECTIVES: To review selected empirical literature examining outcomes of advanced practice nursing with a specific focus on the work of oncology advanced practice nurses (APNs). DATA SOURCES: Published articles (descriptive and data-based) and books. DATA SYNTHESIS: Well-designed, methodologically sound investigations offer clear and compelling evidence that APNs are effective in improving outcomes in diverse populations and settings. Data on outcomes of oncology APNs are more limited but do demonstrate statistically significant improvements in clinical outcomes in the homecare and ambulatory settings. The increase in oncology APNs and the evolution of viable roles for oncology APNs across cancer practice settings offer opportunities to further assess the outcomes of advanced practice nursing. CONCLUSIONS: Understanding the effects of oncology advanced practice nursing on clinical, cost, and satisfaction outcomes is critical. These data will help to explain how APNs can be used most effectively in the healthcare system to ensure the delivery of quality cancer care. IMPLICATIONS FOR NURSING: Assessing the outcomes of advanced practice nursing care has been identified as a priority by the Oncology Nursing Society. Expansion of APN roles in oncology creates myriad opportunities to investigate this issue. APNs should be cognizant of the work that has been done in this area and use this knowledge as a foundation from which to launch further investigations.

Humans↗
PubMed1992

Sleeping prone and the risk of sudden infant death syndrome.

OBJECTIVE: To critically analyze reports that show a relationship between sudden infant death syndrome (SIDS) and the prone sleeping position in infants. DATA SOURCES: Peer-reviewed articles, published letters, book chapters, and local and national health statistics were used, without time or language restrictions. These studies represented three races, four continents, and seven countries; none was published in North America. STUDY SELECTION: No studies were ignored, but only those with case controls were reviewed in detail; we regarded a recent cohort analytic (prospective) study as particularly strong, in addition to six before-and-after (intervention) trials. DATA EXTRACTION: Hill's criteria for decision making were used to assess the quality and validity of the data. DATA SYNTHESIS: Without exception, all studies demonstrated an increased risk for SIDS associated with the prone sleeping position. The published likelihood ratios (relative risk or odds ratio) for SIDS in the prone position compared with SIDS in any other position ranged from 3.5 to 9.3 in seven studies. Publicity against the use of the prone position has been associated with reduction of SIDS by 20% to 67%, paralleling the reduction in use of the prone position, with no increase in deaths from aspiration or in other diagnostic categories. CONCLUSIONS: We recommended avoidance of the prone sleeping position for infants in the first 6 months of life unless there is a specific medical indication for it. Reports from the Netherlands, Great Britain, Australia, and New Zealand indicate that avoiding the prone position for infants in the first 6 months of life could reduce the number of SIDS deaths by as much as 50%. Unfortunately, these findings have received little attention in North America. We offer here an analysis of these reports so that physicians can assess the evidence and advise parents accordingly.

Humans↗
PubMed2003

[Ambrosia, Franseria, Xanthium from the Bonaparte Herbarium].

Recently, French Association for Ragweed Study (AFEDA) founders published, in French, a book "Ambrosia, ragweed, biological pollutants". This association was founded in 1982. The authors referred to Bonaparte Herbarium set up in the Université Claude-Bernard Lyon 1. This herbarium is ranking second in France and seventh in the world. There were three aims for this work: to set up, for this herbarium, a complete list of different species of Ambrosia, Franseria and their pollen grains and to study with them Xanthium whose pollen grains look like Ambrosia, to establish a chronological order for Ambrosia that were collected in Europe and in some countries of the New World, to compare some pollen grains of Ambrosia and Xanthium (scanning electronic microscope). Good state plants in spite of about a century of conservation could be selected. They were photographied and some pollens so. The consultation of this herbarium brought a better morphological knowledge of different species of Ambrosia, Franseria and Xanthium, (plants and pollen grains). The authors were able to broadcast this knowledge to scientists and interested public through their book.

Ambrosia↗
PubMed2002

Splenectomy versus conservative management for acute sequestration crises in people with sickle cell disease.

BACKGROUND: Acute splenic sequestration crises are a complication of sickle cell disease, with high mortality rates and frequent recurrence in survivors of first attacks. Splenectomy and blood transfusion, with their consequences, are the mainstay of long term management used in different parts of the world. OBJECTIVES: To assess whether splenectomy (total or partial) to prevent acute splenic sequestration crises in people with sickle cell disease improved survival and decreased morbidity in patients with sickle cell disease, as compared with regular blood transfusion. SEARCH STRATEGY: We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group specialist trials register which comprises references identified from comprehensive electronic database searches, hand searching relevant journals and hand searching abstract books of conference proceedings Additional randomized controlled trials were sought from the reference lists of the studies found and reviews identified by the search strategy. Date of the most recent search: December 2001 SELECTION CRITERIA: All randomized or quasi-randomized controlled trials comparing splenectomy (total or partial) to prevent recurrence of acute splenic sequestration crises to no treatment or blood transfusion in people with sickle cell disease. DATA COLLECTION AND ANALYSIS: No trials of splenectomy for acute splenic sequestration were found. MAIN RESULTS: No trials of splenectomy for acute splenic sequestration were found. REVIEWER'S CONCLUSIONS: Splenectomy, if full, will prevent further sequestration and if partial, may reduce the recurrence of acute splenic sequestration crises but there is lack of evidence from trials that it improves survival and decreases morbidity in sickle cell disease. There is a need for a well-designed, adequately powered randomised controlled trial to assess the benefits and risks of splenectomy compared to transfusion programmes as a means of improving survival and decreasing mortality from ASS in people with sickle cell disease.

Acute Disease↗
PubMed2003

Inhaled bronchodilators for acute chest syndrome in people with sickle cell disease.

BACKGROUND: Bronchodilators are used to treat bronchial hyper-responsiveness in asthma. Bronchial hyper-responsiveness may be a component of the acute chest syndrome in people with sickle cell disease. Therefore, bronchodilators may be useful in the treatment of acute chest syndrome. OBJECTIVES: To assess the benefits and risks associated with the use of bronchodilators in people with acute chest syndrome. SEARCH STRATEGY: We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group trials register which comprises references identified from comprehensive electronic database searches, handsearching relevant journals and abstract books of conference proceedings. Additional searches were carried out on MEDLINE (1966 to 2002) and EMBASE (1981 to 2002).Date of the most recent search of the Group's haemoglobinopathies register: May 2002. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials. Trials using quasi-randomisation methods will be included in future updates of this review if there is sufficient evidence that the treatment and control groups are similar at baseline. DATA COLLECTION AND ANALYSIS: We found no trials investigating the use of bronchodilators for acute chest syndrome in people with sickle cell disease. MAIN RESULTS: We found no trials investigating the use of bronchodilators for acute chest syndrome in people with sickle cell disease. REVIEWER'S CONCLUSIONS: If bronchial hyper-responsiveness is an important component of some episodes of acute chest syndrome in people with sickle cell disease, the use of inhaled bronchodilators may be indicated. There is need for a well-designed, adequately powered randomised controlled trial to assess the benefits and risks of the addition of inhaled bronchodilators to established therapies for acute chest syndrome in people with sickle cell disease.

Acute Disease↗
PubMed2004

Progressive resistive exercise interventions for adults living with HIV/AIDS.

BACKGROUND: Due to medical advancements, many people living with HIV infection in developed countries are living longer (Palella 1998). HIV infection can now present as a chronic illness with an uncertain natural disease history. The changing course of HIV infection has lead to a potential increase in the prevalence and impact of disability in people living with HIV infection. Exercise is one key management strategy used by health care professionals to address impairments (problems with body function or structure as a significant deviation or loss such as pain or weakness), activity limitations (difficulties an individual may have in executing activities such as inability to walk) and participation restrictions (problems an individual may experience in life situations such as inability to work) in this population (World Health Organization 2001). Exercise may also be used to address unwanted changes in weight and body composition in people living with HIV infection. Aerobic exercise has been associated with improvements in strength, cardiovascular function, and psychological status in general populations (Bouchard 1993). Results of a systematic review suggested that aerobic exercise interventions appeared to be safe and may lead to improvements in cardiopulmonary fitness for adults living with HIV/AIDS (Nixon 2002). But what are the effects of progressive resistive exercise (PRE) for adults living with HIV infection?A better understanding of the effectiveness and safety of progressive resistive exercise will enable people living with HIV and their health care workers to practice effective and appropriate exercise prescription, thus contributing to improved overall outcomes for adults living with HIV infection. OBJECTIVES: To examine the safety and effectiveness of progressive resistive exercise interventions on weight, body composition, strength, immunological/virological, cardiopulmonary and psychological parameters in adults living with HIV infection. SEARCH STRATEGY: To identify studies to be included in this review, we searched the following databases: MEDLINE, EMBASE, CINAHL, COCHRANE, SCIENCE CITATION INDEX, PSYCHINFO, SOCIOLOGICAL ABSTRACTS, SSCI, ERIC, DAI and HEALTHSTAR. We also reviewed both published and unpublished abstracts and proceedings from major international and national HIV/AIDS conferences such as the Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), the Conference on Retroviruses and Opportunistic Infections (CROI), the Infectious Diseases Society of America Conference (IDSA), and the International AIDS Conference (IAC). Reference lists from pertinent articles and books were reviewed, as well as Collaborative Review Group databases. Targeted journals were also hand searched for relevant articles. No language restriction was applied. The search strategy covered literature from 1980-August 2003. SELECTION CRITERIA: We included studies that were randomized controlled trials (RCTs) comparing progressive resistive exercise interventions with no progressive resistive exercise or another exercise or treatment modality, performed at least three times per week, and lasting at least four weeks among adults (18 years of age or older) living with HIV/AIDS. DATA COLLECTION AND ANALYSIS: Data collection forms were used by reviewers to abstract data pertaining to study design, participants, interventions, outcomes and methodological quality from the studies that met inclusion criteria. Whenever possible, meta-analyses were conducted on outcomes using RevMan 4.2.2 computer software. MAIN RESULTS: Seven studies met the inclusion criteria for this systematic review. Meta-analysis was limited due to the following differences among the studies: types of exercise interventions, inclusion of co-intervention groups, level of exercise supervision, baseline body composition and testosterone levels of participants, types of outcomes assessed, and methodological quality of the individual studies.Main results indicated that performing progressive resistive exercise or a combination of progressive resistive exercise and aerobic exercise at least three times a week for at least four weeks appears to be safe and may lead to statistically and possibly clinically important increases in body weight and composition. Results also indicate exercise interventions may lead to clinically important improvements in cardiopulmonary fitness. Individual studies included in this review suggest that progressive resistive exercise interventions with or without aerobic exercise also contribute to improvements in strength and psychological status for adults living with HIV/AIDS. Individual studies indicate that progressive resistive exercise or a combination of progressive resistive and aerobic exercise appears to be safe for adults living with HIV/AIDS who are medically stable as a result of no change seen in immunological/virological status. These results are limited to those who continued to exercise and for whom there were adequate follow-up data. REVIEWERS' CONCLUSIONS: Progressive resistive exercise or a combination of progressive resistive exercise and aerobic exercise appear to be safe and may be beneficial for adults living with HIV/AIDS. These findings are limited by the small number of studies that could be included in meta-analyses, small sample sizes and variable participant withdrawal rates among included studies. Future research would benefit from including participants at various stages of HIV infection, a greater proportion of female participants, and participants in a variety of age groups to increase the generalizability of results. Furthermore, future research would benefit from studies with larger sample sizes that conduct an "intention-to-treat" analysis (analysis of participants based on the groups to which they were originally allocated) to better understand outcomes of participants that withdraw from exercise interventions.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Treatment for avascular necrosis of bone in people with sickle cell disease.

BACKGROUND: Avascular necrosis of bone is a frequent and severe complication of sickle cell disease and its treatment is not standardised. It is therefore important to gather evidence about the safety and effectiveness of different interventions. OBJECTIVES: To determine the impact of surgery compared to non-surgical management on both the short- and the long-term outcomes (efficacy, safety, and adverse events) for people with sickle cell disease-related avascular necrosis. SEARCH STRATEGY: We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group trials register, which comprises references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings. Additional randomized controlled trials were sought from the reference lists of the trials found and reviews identified by the search strategy. Date of the most recent search: April 2004. SELECTION CRITERIA: All randomized or quasi-randomized controlled trials (published or unpublished). DATA COLLECTION AND ANALYSIS: One ongoing clinical trial has been identified but no data are available for inclusion in the review. MAIN RESULTS: Five trials were identified by the searches. Four trials were not eligible for inclusion and one is an ongoing clinical trial. REVIEWERS' CONCLUSIONS: We were unable to find any evidence from completed randomized controlled trials assessing treatments for avascular necrosis in people with sickle cell disease. We await the results of an ongoing clinical trial to assess the benefits and risks of a surgical approach compared to a non-surgical approach as a means of improving survival and quality of life for people with sickle cell disease-related avascular necrosis of bone.

Anemia, Sickle Cell↗
PubMed1999

Hemoglobin and red cell indices correlated with serum ferritin concentration in late pregnancy.

OBJECTIVE: To study the correlation between third-trimester serum ferritin concentration and hemoglobin and red cell indices to select the best hematologic characteristic to identify women who need iron therapy. METHODS: In a prospective study, blood was drawn from pregnant women with hemoglobin above 10 g/dL, and thalassemia trait excluded at booking, at 28-30 weeks' gestation to study the correlation (Spearman p value) between serum ferritin concentration and hemoglobin level, mean corpuscular volume, mean cell hemoglobin, mean cell hemoglobin concentration, and hematocrit. The best relationship was identified using receiver operating characteristic (ROC) curves. RESULTS: Serum ferritin concentration correlated significantly with hemoglobin (p = .211), mean corpuscular volume (p = .332), mean cell hemoglobin (p = .304), and hematocrit (p = .199). The area under the ROC curve was largest for hemoglobin. CONCLUSION: Serum ferritin concentration at the early third trimester correlated best with hemoglobin level. If a hemoglobin level of 11 g/dL or below (25% of all patients) was used as the cutoff, 64% of women who needed iron therapy were identified.

Adult↗
PubMed1993

Selective surveillance for nosocomial infections in a Brazilian hospital.

OBJECTIVE: To devise a system for surveying the frequency of nosocomial infections in a tertiary care hospital in a developing country. DESIGN: Prospective selective surveillance by nurses of the charts of patients at high risk for nosocomial infections, as identified by a form completed by resident physicians. The sensitivity, specificity, and predictive value of this method of selective surveillance were compared with those for total prospective chart review by two infectious disease specialists. SETTING: A university hospital in northeastern Brazil. PATIENTS: All patients hospitalized for more than 72 hours with an identified risk factor for nosocomial infection. RESULTS: The ratio of nosocomial infections to 100 discharges was 13.4 and the incidence density was 11.2/1,000 patient days. The surveillance method demonstrated a sensitivity of 74% and a specificity of 99.7%. Positive predictive value was 93%, negative predictive value was 99%, and overall accuracy was 98%. CONCLUSIONS: This method of selective surveillance for nosocomial infections based on risk factors identified by physicians demonstrated excellent predictive value and overall accuracy and may be of use to other hospitals that lack a nursing care plan book such as the Kardex. The relative frequency of nosocomial infections significantly exceeded the rates reported from hospitals in developed countries.

Brazil↗
PubMed1999

Chance favors the prepared genome.

Most descriptions of mutation have emphasized its negative consequences, and randomness with respect to biological function. This book seeks to balance the discussion by emphasizing mechanisms that both diversify the genome and increase the probability that a genome's descendants will survive. This chapter provides a framework for, and overview of, the diverse contributions to this book; these contributions will be stimulating companions, well into the 21st Century, as we work to comprehend the information contained in genomic databases. Genomes that encode "better" amino acid sequences are at a selective advantage. Genomes that generate diversity also are at an advantage to the extent that they can navigate efficiently through the space of possible sequence changes. Biochemical systems that tend to increase the ratio of useful to destructive genetic change may harness preexisting information (horizontal gene transfer, DNA translocation and/or DNA duplication), focus the location, timing, and extent of genetic change, adjust the dynamic range of a gene's activity, and/or sample regulatory connections between sites distributed across the genome. Rejecting entirely random genetic variation as the substrate of genome evolution is not a refutation, but rather provides a deeper understanding, of the theory of natural selection of Darwin and Wallace. The fittest molecular strategies survive, along with descendants of the genomes that encode them.

Animals↗
PubMed1994

Knowing the form.

This study set out to discover if midwives need to complete the antenatal record form (ANR) in its entirety, or if women could complete part of the form themselves. The study involved 33 pregnant women and eight midwives. Questionnaires were used for both the women and the midwives. In addition, a structured interview was employed for the participating women. These methods gave both qualitative and quantitative data. Thirty women (94%) completed the selected parts of the ANR form, either mostly or in full. Twenty-four women (67%) stated that they had completed this form by themselves. Midwives completed a questionnaire for each woman they booked. For 21 cases (62%) midwives found it useful when the woman completed part of the ANR form. Offering women the opportunity to complete part of the ANR form was considered to be advantageous by 19 (57%) mothers participating in the study. The conclusion is that midwives do not always need to complete the antenatal record form in its entirety.

Female↗
PubMed1997

Evaluation of a protocol for selective empiric treatment of fever without localising signs.

A protocol for management of young febrile children at risk for bacteraemia has been used at Westmead Hospital, a university based hospital in the western Sydney region, since early 1994. Implementation of the protocol was retrospectively evaluated for the 12 month period 1 June 1994 to 31 May 1995, using the emergency department log book as the primary data source. Altogether 498 children, aged from 3 months to 3 years, with a fever > or = 39.5 degrees C were identified over this period, of whom 291 were admitted to hospital because of evidence of sepsis or identified focal infection and 207 children without focal infection were observed in the short stay annexe of the emergency department. Fifty children, considered at high risk of bacteraemia because of a total white cell count > or = 20 x 10(9)/1 received empiric antibiotic treatment with ceftriaxone, of whom 19 subsequently had proved bacteraemia and another 10 had focal infection identified during observation in the short stay annexe. Bacteraemia was due to Streptococcus pneumoniae in 16 cases and Haemophilus influenzae type b in three. No adverse events occurred at follow up. Use of a management protocol and selection on higher white cell count criterion than previously recommended by US centres resulted in restriction of empiric antibiotic treatment to a small proportion of young febrile children presenting to a busy emergency department of whom 38% were bacteraemic.

Bacteremia↗
PubMed2000

Cranial irradiation for preventing brain metastases of small cell lung cancer in patients in complete remission.

BACKGROUND: Prophylactic cranial irradiation halves the rate of brain metastases in patients with small cell lung cancer. Individual randomized trials conducted on patients in complete remission were unable to clarify whether this treatment improves survival. OBJECTIVES: This study aims to test whether prophylactic cranial irradiation prolongs survival of patients with small cell lung cancer in complete remission. SEARCH STRATEGY: Published and unpublished trials were eligible. Electronic databases, reference lists of trial publications, review articles and relevant books were used to identify potentially eligible trials. The search was also guided by discussions with investigators and experts, and the examination of meeting proceedings and of the Physician Data Query clinical trial registry. SELECTION CRITERIA: Randomized trials comparing prophylactic cranial irradiation with no prophylactic cranial irradiation in patients with small cell lung cancer in complete remission. DATA COLLECTION AND ANALYSIS: Meta-analysis based on updated individual data. The main endpoint was survival. MAIN RESULTS: The relative risk of death in the treatment group compared to the control group was 0.84 (95% confidence interval=0.73 to 0.97, P=0.01), corresponding to a 5.4 percent increase in the 3-year survival rate (from 15.3 percent in the control group to 20.7 percent in the treatment group). Prophylactic cranial irradiation also increased disease-free survival (relative risk=0.75, 95% confidence interval=0.65 to 0.86, P<0.001) and decreased the risk of brain metastases (relative risk=0.46, 95% confidence interval=0.38 to 0.57, P<0.001). Increasing doses of irradiation decreased the risk of brain metastases when four groups (8 Gy, 24-25 Gy, 30 Gy, 36-40 Gy) were analyzed [trend test, P=0.02], but the effect on survival did not differ significantly according to the dose. We found a trend (P=0.01) for a decrease in the brain metastasis risk in favour of earlier administration of cranial irradiation after the initiation of induction treatment. REVIEWER'S CONCLUSIONS: Prophylactic cranial irradiation significantly improves survival and disease-free survival for patients with small cell lung cancer in complete remission. Further clinical trials are needed to confirm the potential greater benefit on brain metastasis rate suggested when cranial irradiation is given earlier or at higher doses.

Brain Neoplasms↗
PubMed1991

Can ethnopharmacology contribute to the development of anti-fertility drugs?

China, one of the developing countries with approx. one-fifth of the world population, has been making great efforts in controlling her population size. One of the efforts being stressed is to look into the practicability of employing Chinese herbal medicine for fertility control. The rich ethnopharmacological descriptions in the ancient books of herbal remedy and those scattered in the folklore medicine contribute the possibility of this approach. After a discussion concerning the facets of antifertility drugs linked with male or female fertility regulation, several selected examples are presented, which include yuehchukene (isolated from Murraya paniculata), pseudolarix acids A and B (from Pseudolarix kaempferi), mardekoside A (from Mardenia koi), gardenic acid and gardenodic acid A (from Gardenia jasminoides) as early pregnancy terminating agent, for fertility regulation in females; whereas gossypol (from cottonseed oil) and total glycosides of Tripterygium wilfordii (GTW) as antispermatogenic agent for fertility regulation in males. Further research and development strategies of antifertility drugs from herbal medicines have also been discussed based on a collective research data in this field worldwide.

Animals↗
PubMed1988

Estimation of genetic trend in racing performance of thoroughbred horses.

Thoroughbred horses have been bred exclusively for racing in England since Tudor times and thoroughbred horse racing is now practised in over 40 countries and involves more than half-a-million horses worldwide. The genetic origins of the thoroughbred go back largely to horses imported from the Middle East and North Africa to England in the late seventeenth and early eighteenth centuries. Since the establishment of the Stud Book in 1791, the population has been effectively closed to outside sources, and over 80% of the thoroughbred population's gene pool derives from 31 known ancestors from this early period. Despite intense directional selection, especially on the male side, and the generally high heritabilities of various measures of racing performance, winning times of classic races have not improved in recent decades. One possible explanation for this is that additive genetic variance in performance may have been exhausted in the face of strong selection. To test this, we have estimated the genetic trend in performance over the period 1952-77 using TIMEFORM handicap ratings which are based entirely on the horse's own performance, and express its racing merit as a weight in pounds which the compilers believe the horse should carry in an average free-handicap race. These ratings take into account such factors as the firmness of the ground, the distance and the level of the competition. Our results indicate that the failure of winning times to improve is not due to insufficient genetic variance in the thoroughbred population as a whole.

Animals↗
PubMedDate not supplied

Utilization of approved health facilities for delivery in Ile-Ife, Osun State, Nigeria.

This was a cross-sectional population survey carried out to determine utilization of approved health facilities for delivery by mothers in Ile-Ife and factors influencing the observed utilization. A total number of 117 mothers who had delivered once or many times were selected using the systematic sampling method. Information was collected using pretested structured interview administered questionnaire. Data collected was analyzed using frequency tables and statistical test of significance. Of the 117 mothers interviewed, 70 (59.8%) booked in approved health facilities while 51 eventually delivered in the approve health facilities. The prominent reasons given for non utilization of health facilities were time of occurrence of labor, difficulty with transportation, fear of surgical operation, husband/family influence and delivery assistance by TBA's and relatives. Educational status of the mother, religious beliefs, distance from approved health facilities more than 5 km and attitude of health workers were amongst factors significantly influencing choice of place of delivery by the mothers.

Adolescent↗
PubMed1994

The pros and cons of transdermal nicotine therapy.

OBJECTIVE: To review current knowledge of the efficacy, safety and cost of transdermal nicotine therapy for smoking cessation. DATA SOURCES AND STUDY SELECTION: 1. Published and unpublished reports of randomised, double-blind trials of at least 12 weeks' duration, in smokers motivated to cease smoking, identified by a search of the MEDLINE database, article and book bibliographies, Current contents, and by a request to the Medical Department of Ciba-Geigy (Australia) Ltd. 2. A clinical trial of 1500 smokers using transdermal nicotine (S Gourlay, unpublished data). DATA SYNTHESIS: Transdermal nicotine more than doubles the success rates of smoking cessation attempts in motivated subjects who smoke at least 10-15 cigarettes per day (odds ratio 12 months after quitting, 2.3; 95% confidence interval, 1.6-3.4). Application site reactions are not uncommon (erythema or burning < or = 16%, transient itch < or = 50%) and cause discontinuation of therapy in up to 10% of subjects. Sleep disturbance due to nocturnal nicotine absorption occurs in up to 13% of subjects when patches are worn overnight. Smoking or nicotine chewing gum used concurrently with transdermal nicotine could raise peak nicotine levels but is unlikely to adversely affect individuals with established tolerance to nicotine. Smoking and (theoretically) nicotine replacement therapies should be avoided in pregnancy or patients with unstable coronary artery disease. In such patients, the risk-benefit ratio of nicotine replacement therapies may be favourable for nicotine-dependent smokers unable to cease smoking by alternative methods. CONCLUSIONS: Transdermal nicotine is an effective smoking cessation therapy for motivated, nicotine-dependent smokers. As most smokers can cease smoking on their own, and the patches are costly, they should be recommended only for smokers who are unable to quit by simpler means and those likely to suffer severe nicotine withdrawal symptoms.

Administration, Cutaneous↗
PubMed1999

Selective inhibition of inducible nitric oxide synthase: effects on hemodynamics and regional blood flow in healthy and septic sheep.

OBJECTIVES: To investigate the effects of S-ethylisothiourea (S-EITU) on hemodynamics, oxygen transport, and regional blood flow in healthy and septic sheep. DESIGN: Prospective, randomized, controlled experimental study with repeated measures. SETTING: Investigational intensive care unit at a university medical center. SUBJECTS: Eleven healthy, female adult sheep of the Merino breed, divided into a control group (n = 5) and into a group treated with S-EITU (n = 6). INTERVENTIONS: All sheep were chronically instrumented. After a 5-day recovery period, they were randomly assigned to either control or S-EITU groups. While control sheep received only saline, S-EITU was administered in increasing doses of 1, 3, and 9 mg/kg/hr over 1 hr each (nonseptic phase). After 2 days of recovery, a continuous infusion of live Pseudomonas aeruginosa (2.5 x 106 colony-forming units/min) was started in all sheep and maintained for the remainder of the experiment. After 24 hrs of sepsis, the sheep again received their assigned treatment (septic phase). In both the nonseptic and septic phases, the sheep received colored microspheres through a left atrial catheter to allow analysis of regional blood flows. All animals were autopsied at the end of the experiments, and organ probes were removed for blood flow analyses. MEASUREMENTS AND MAIN RESULTS: The administration of S-EITU caused a dose-dependent vasoconstriction in the nonseptic phase. After 24 hrs of Pseudomonas infusion, all sheep developed a hyperdynamic circulatory state, with increased cardiac indices and reduced arterial pressures and systemic vascular resistances. Oxygen extraction decreased significantly, preventing an increase in oxygen consumption, despite an increased oxygen delivery. The hyperdynamic circulation was dose dependently reversed by S-EITU, causing an increase in arterial pressure by peripheral vasoconstriction. Sheep in the control group showed a continuation of the hyperdynamic circulation. The effects of S-EITU on hemodynamics and regional blood flows were comparable under septic and nonseptic conditions. CONCLUSIONS: With the inducible form of nitric oxide synthase expressed under septic, but not under nonseptic conditions, S-EITU was expected to have vasoconstrictive properties only in the septic phase. It produced a comparable vasoconstriction during the nonseptic phase of the experiment. Thus, either S-EITU does not selectively block the inducible nitric oxide synthase in sheep, or other vasodilators besides nitric oxide play an important role in septic vasodilation.

Animals↗