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PubMed2003

Cancer gene therapy: an awkward adolescence.

At the Eleventh International Conference on Gene Therapy of Cancer (December 12-14, 2002, San Diego, CA) progress on using gene transfer technology to treat cancer was presented. Although there is as yet no cancer gene therapy being marketed, considerable progress has been made in defining likely strategies and likely targets for gene therapy of cancer. These strategies, including viral and non-viral delivery systems, and potential targets in cancer cells linked to our developing knowledge of cancer cell biology, are reviewed in this paper. Use of gene therapy to sensitize tumors to radiation and chemotherapy is one promising area of investigation. Some of the ancillary benefits of research on cancer gene therapy, including the development of public-private partnerships, recruitment of laboratory scientists into clinical research, and credentialing of potential cancer cell targets for therapies other than gene therapy, are noted.

Clinical Trials as Topic↗
PubMed2002

Telomerase as a universal tumor-associated antigen for cancer immunotherapy.

Although the search for pharmacologic inhibitors of telomerase activity represents a promising approach for telomerase-based anti-cancer therapy, the immunological properties of the telomerase reverse transcriptase hTERT suggest that the enzyme is also an attractive target for novel immunotherapies against cancer. Data from both human and murine systems demonstrate that cytotoxic T-lymphocytes (CTL) can recognize peptides derived from TERT and kill TERT-positive tumor cells of multiple histologies. Given the vast overexpression of hTERT in human tumors and its low-level expression in rare normal tissues, clinical trials have begun that test the credentials of hTERT as a broadly applicable target for immunotherapy of cancer.

Antigens, Neoplasm↗
PubMed2004

Variation at the IRF2 gene and susceptibility to psoriasis in chromosome 4q-linked families.

Evidence, largely from Irish pedigrees, indicates that a susceptibility locus for psoriasis maps to chromosome 4q. The gene encoding interferon regulatory factor-2 (IRF-2) maps to this region, and, as mice lacking IRF-2 exhibit a dermatologic phenotype resembling many aspects of human psoriasis, IRF-2 represents an attractive positional candidate. We set out to establish whether variation in IRF-2 sequence or expression was related to the development of psoriasis. First, the promoter, coding, and adjacent untranslated regions of IRF-2 were screened in individuals from 4q-linked families. Neither variant identified (IVS1A+29A/G; IVS3+729T/C), however, had functional credentials or statistical evidence supporting a susceptibility role. Second, in 62 Irish parent-offspring trios ascertained for psoriasis, we conducted a linkage-disequilibrium screen of the IRF2 region using a dense microsatellite map (covering 1.5 Mb from D4S1554 to D4S1540). Though there was nominal association for D4S1554/D4S2348 haplotypes (p=0.03) with one haplotype showing particularly skewed transmission to psoriatic offspring (p=0.0002, uncorrected), these markers lie some distance (500 kb) from IRF-2. Finally, we found no abnormalities of IRF-2 protein expression or distribution in skin biopsies from psoriatic individuals. These diverse lines of inquiry allow us to exclude variation in IRF2 as responsible for the 4q-linkage signal previously identified in Irish pedigrees.

Chromosome Mapping↗
PubMedDate not supplied

Public health nursing pioneer: Jane Elizabeth Hitchcock 1863-1939.

Jane Elizabeth Hitchcock was one of many distinguished nursing leaders of the 19th and early 20th centuries who attended a women's college before enrolling in a nurse training school. Like many of her contemporaries with equally impeccable family credentials, Hitchcock was something of an enigma to her family for choosing nursing over teaching, the most common acceptable career for women of her social class. Hitchcock's endowment of character, according to contemporary Lavinia Dock, exemplified the best of her Puritan roots. Her contributions to the evolution of public health nursing and the integration of public health nursing content into curriculums of training schools rivalled the achievements in higher education of her famous father, grandfather, and brother but garnered no comparable recognition. Her life presents an interesting case for analysis of an independent woman, a characteristic shared by many pioneers in the early years of public health nursing: 1893 to 1920.

History, 19th Century↗
PubMed1997

The primary holisms in nursing.

Holistic thinking is so diverse that practically every theorist can claim holistic credentials. The challenge for nursing, then, is not whether holism but which holism? As a practice-centred discipline, nursing gives a central role to whole-person holism. In so far as nursing approximates medicine, it incorporates systemic holism. From its basis in biology, nursing imports organismic holism. The three holisms are, however, incompatible because the concepts of person, system and organism contrast in complex and interesting ways. Discussion of the contrasts reveals points of metaphysical, scientific and ethical incompatibility. A construct based on whole-person holism, but incorporating a partial synthesis of all three, reveals both promise and challenge for a unified holistic view in nursing.

Holistic Nursing↗
PubMed2000

Scoping practice issues in the Australian mental health nursing workforce.

This is the third of four articles on the scoping study of the Australian mental health nursing workforce conducted on behalf of the Australian and New Zealand College of Mental Health Nurses (ANZCMHN) for the Australian Health Ministers Advisory Council (AHMAC) National Working Group on Mental Health (NWGMH). Its purpose is to focus on factors that significantly affect mental health nursing practice. The issues of advanced practice, regulation of nursing, accreditation, credentialing and demarcation with other disciplines are addressed.

Australia↗
PubMed2002

Treatments for chronic fatigue syndrome and the Internet: a systematic survey of what your patients are reading.

OBJECTIVE: To evaluate the type, quality, and focus of patient information on the treatment of chronic fatigue syndrome on the Internet using simple search techniques. DESIGN: The search phrase 'chronic fatigue syndrome' was entered into nine common Internet search engines. The 25 most highly ranked pages identified by each of the nine search engines were analysed using a standardized pro forma. The following outcome measures were used: balance of content, consistency of content with evidence-based practice, declared authorship with credentials, information sources including the presence of references, the declaration of any potential conflict of interest, and the need to clarify information with an appropriate health professional. RESULTS: Two hundred and twenty-five websites were reviewed during a 2-week period in September 2000. A further 15 sites (6.3%) were inaccessible. Agreement between websites and systematic reviews of treatment for chronic fatigue syndrome ranged from 4 to 68%, the greatest agreement being for recommendations for graded exercise and the avoidance of prolonged rest. Most sites (64%) had a named author. Only a quarter to a third contained a declaration of interest, advised readers to clarify information with an appropriate health professional, or avoided inaccurate statements. CONCLUSIONS: The Internet contains a great deal of information on chronic fatigue syndrome that is neither balanced nor consistent with evidence-based practice. Doctors individually, and as a profession, should provide guidance on which Internet sites to trust.

Fatigue Syndrome, Chronic↗
PubMed2001

Virtual reality simulators for dermatologic surgery: measuring their validity as a teaching tool.

Surgical simulation is increasingly being considered for training, testing, and possibly credentialing in medicine and surgery. At the University of Washington we have been developing a virtual reality (VR) suturing simulator. In the course of development it must be realized that expensive new technologies should bear the burden of proof of their effectiveness and reliability before they are put into training programs. The purpose of this article is to define the concept of surgical skill and to discuss how it can be measured in the context of validating VR surgical simulators. Specific measures of validity and reliability are reviewed and discussed.

Computer Simulation↗
PubMed2002

Office surgical incidents: 19 months of Florida data.

BACKGROUND: In 1999-2000 a series of sensational articles were published in the lay media emphasizing the hazards of office surgery. Since then 31 state medical boards or legislatures have, or are in the process of drafting regulations restricting office procedures. OBJECTIVE: To determine the nature, incidence and scope of injuries and deaths resulting from office procedures. METHODS: Mandatory reporting by physicians to a neutral central agency of all office surgical incidents that resulted in death, serious injury, or transfer to a hospital in the State of Florida from February 2000 to September 2001. Telephone and Internet follow up to determine reporting physician board status, hospital privilege status, and office accreditation status. RESULTS: In 19 months there were 43 procedure related-complications and eight deaths. Liposuction under general anesthesia was the single most common cause of incidents and deaths. There were no injuries or deaths reported with liposuction with tumescent anesthesia. 50% of offices reporting incidents or deaths were accredited by an independent accrediting agency. There were no incidents or deaths reported due to the anesthesia when using conscious sedation anesthesia, or intramuscular sedation or analgesia 98% of physicians reporting incidents or deaths had hospital privileges and were board certified. Anesthesiologists or nurse anesthetists provided all general anesthesia, and deep sedation. There were no physicians performing procedures outside their scope of specialty training. CONCLUSION: Liposuction under general anesthesia deserves closer scrutiny. Office accreditation is not associated with fewer patient injuries and deaths. Restrictions on tumescent liposuction, conscious sedation and intramuscular sedation and analgesia would not yield any saved lives or fewer injuries since these modes of anesthesia resulted in no injuries or deaths. Board certification and hospital privilege requirements for office practice would have very little effect since the vast majority of reporting physicians already had these credentials. These data do not show an emergent hazard to patients from office surgery This data strongly contradicts the lay media portrayal of the dangers of office procedures. Mandatory reporting of office incidents should be strongly supported, and this data should be available for analysis after protecting patient confidentiality.

Adverse Drug Reaction Reporting Systems↗
PubMedDate not supplied

Coordination of care in disease management: opportunities and financial issues.

Patients with end-stage renal disease (ESRD) and pre-ESRD require higher utilization of health care resources. Current reimbursement modalities contribute to the fragmentation of care, and inadequate financial information obscures the fiscal impact disease management's coordination of care can have for this population. Ignoring the extreme costs of the first 3 months of hemodialysis underestimates costs by as much as 16%. Potential areas of coordination and the financial benefits are discussed. In each venue of the care settings of a patient with chronic renal failure (CRF) they may receive excellent service. Too often there is not optimal coordination of care between these venues, and in fact the fragmentation of care can cause unnecessary wear and tear on the patient, and increases the overall expense to a health care system. Understanding sources of fragmentation, reimbursement effects, and potential corrections will enhance the patient's voyage through the system. This article provides some examples of the discoordination that presently exists and financial implications especially during the transition onto dialysis. In patients with end-stage renal disease (ESRD), each arena of care has criteria established to quantitate quality. None of the settings, whether it is the dialysis unit, the hospital, the skilled nursing facility, or the physician's office, exists in the absence of regulations. These may be state or federal, National Council on Quality Assurance (NCQA), Health Plan Employer Data and Information Set (HEDIS), water standards, Occupational Safety and Health Administration (OSHA), fire codes, physician peer review, Medicare billing, Health Care Finance Administration (HCFA), the ESRD networks, credentialing, health maintenance organization (HMO) insurance requirements, pharmacy benefits and formularies, safe harbors, "antikickback," or National Kidney Foundation Dialysis Outcomes Quality Initiative (NKF-DOQI) guidelines. For all the providers of care, the other critical component is the ability to have adequate income to stay in business, and make a profit. Each becomes very astute at working within the confines of the regulatory restrictions to provide good care. However, the continuity of care cannot be the overwhelming issue for many of the providers. The only person that is involved in every arena is the patient. The only provider that currently crosses over most arenas is the nephrologist. But the other element that exists in each arena is a payer.

Continuity of Patient Care↗
PubMedDate not supplied

Validity and community-health-nursing sensitivity of six outcomes for community health nursing with older clients.

A survey research design was used to assess the importance, sensitivity to nursing interventions, and content validity of six client outcomes from the Nursing Outcomes Classification (NOC)). Outcomes relevant for elderly community residents and caregivers were included in a questionnaire mailed to American Nurses Credentialing Center-certified expert community health nurses. Two hundred thirty-nine experts rated specific indicators of the six outcomes for their importance in determining the outcomes and the contribution of nursing to their achievement. Outcomes also were rated for their importance for community health nursing clients and responsiveness to community health nursing intervention. Results strongly support the content validity and nursing sensitivity of outcomes and specific indicators. Experts judged all six outcomes to be important and 90% of indicators as important in determining the outcome. All outcomes and 78% of indicators were judged to be responsive to community health nursing intervention. Recommendations include the testing of NOC outcomes in community health nursing clinical practice and inclusion in community health nursing curricula. Areas for further research include development and validation of community-level outcomes, validation of outcomes with rural and home health nursing experts, and exploration of the community health nursing-sensitivity of one study outcome.

Activities of Daily Living↗
PubMed2003

ED screening to identify abdominal aortic aneurysms in asymptomatic geriatric patients.

Although more than 5% of the geriatric male population is thought to have an abdominal aortic aneurysm, no study has evaluated the ability of ED physician sonographers to screen for this condition. The purpose of this study was to evaluate whether a screening program to sonographically identify abdominal aortic aneurysms would result in increased identification of this potentially lethal disease. This prospective clinical study used a convenience sample and was performed in a community teaching hospital ED. Hemodynamically stable male patients > or = 65 years of age presenting for reasons other than back, flank, or abdominal pain were eligible. After obtaining informed consent, patients underwent bedside ultrasound of the abdominal aorta by EPs. All participating physician sonographers met SAEM credentialing recommendations for performing sonography. The maximal transverse diameter of the aorta was measured at each of three locations: proximal, mid, and distal aorta. All patients with aortic diameters > or = 3.0 cm were confirmed by formal ultrasound in the radiology department. Over a 12-month period, 103 subjects were enrolled in the study. ED physician sonographers identified eight patients with abdominal aortic diameters > or = 3.0 cm. Abdominal aortic aneurysm was confirmed in 6 of 8 subjects, yielding a positive predictive value of 75%. An EP sonographic screening program can identify abdominal aortic aneurysms in asymptomatic men older than 65 years of age.

Aged↗
PubMed2001

Trends in pathology graduate medical education.

Comprehensive data show trends in graduate medical education in pathology with regard to the numbers of accredited programs, persons certified from those programs, and demographics of the population of first year-trainees in pathology. Experience with US seniors and foreign-trained physicians in the PGY match process for pathology from 1991 through 2000 is presented, along with data on the types of medical schools generating pathology trainees for the PGY-1 year and the top medical schools of origin of US medical graduates who completed the program and became certified in pathology between 1995 and 1999. The impact of reimbursement of the credentialing year is also addressed through data collected from the PRODS Survey 2000, and those results are reviewed. Finally, turnover rates among pathology program directors of combined AP/CP programs and subspecialty programs since 1994 are presented. An analysis of these trends is provided, along with suggestions to improve both the perception of careers in pathology and the actual choice of a career in pathology.

Accreditation↗
PubMed1998

Prevention of infection in the immunocompromised host.

The Association for Professionals in Infection Control and Epidemiology, Inc, is accredited as a provider of continuing education in nursing by the American Nurses Credentialing Center's Commission on Accreditation. This learner-paced study package is designated for 1.1 contact hours. APIC's California nursing provider number is CEP 7146. This continuing medical laboratory education activity is recognized by the American Society of Clinical Pathologists as meeting the criteria for 1 CMLE credit hour. ASCP CMLE credit hours are acceptable to meet the continuing education requirements for the ASCP Board of Registry Continuing Competence Recognition Program. (See the instructions and examination at the end of the article.)Infectious diseases represent a major cause of morbidity and mortality in immunocompromised patients. Infectious complications are often predictable and may be preventable. This article is an overview of practical considerations in the care of immunocompromised patients. Recognizing the compromised host, identifying and correcting risk factors in advance, and reducing sources of infection all play a role in prevention. Topics were chosen to include the areas of care that differ from the immune competent patient, such as diet, pet therapy, handwashing, immunizations, augmentation of host resistance, prevention of pneumonia, and antibiotic prophylaxis. National practice guidelines are cited when possible; evidence-based literature review and experience are applied to situations lacking consensus statements. Treatment decisions are made in areas for which information is often incomplete. A systematic approach to care of the immunocompromised host, tailored to the individual patient's needs, should reduce the risk of infection.

Cross Infection↗
PubMed2003

Rationale and status of randomized controlled clinical trials in carotid artery stenting.

Efficacy for carotid artery stenting (CAS) has not been confirmed by randomized clinical trial methodology. Although carotid endarterectomy (CEA) is considered the preferred method for carotid revascularization in the management of patients with asymptomatic and symptomatic extracranial carotid occlusive disease, comparisons between CAS and CEA are now underway. In North America, the CREST (Carotid Revascularization Endarterectomy versus Stent Trial) protocol is now completing credentialing cases as randomization of cases is initiated. In Europe, the CAVATAS (Carotid and Vertebral Artery Transluminal Angioplasty Study) and SPACE (Stent Protected Angioplasty versus Carotid Endarterectomy) trials are recruiting symptomatic patients for randomization between CEA and CAS. It is anticipated that these trials will publish definitive results within the next 1-3 years and help guide the referral of patients for CAS and CEA in the future.

Angiography↗
PubMed2000

Tell me a story: a walk down ASPAN's memory lane.

Happy Birthday ASPAN! Our Society celebrates its 20th birthday this year. This anniversary issue of the Journal of PeriAnesthesia Nursing, and the 20th National Conference in Boston, 2001, will culminate a year of celebration for ASPAN. In the Breathline (November/December 1999), an article was printed requesting narratives or stories from perianesthesia nurses who are ASPAN members. The invitation was extended to share in the celebration of our success. Over 70 stories were sent in, some quite lengthy and detailed, and others with bulleted information of selected memorabilia. All share the heart and soul of ASPAN and of perianesthesia nursing. The heart of ASPAN is its membership-the memories we share about thefounding of our Society and its meaning in our lives are poignant. The excerpts included in this article are taken from perianesthesia nurses' stories. The member voices are heard, the passion is stirred, and the pride is evident. The stories were displayed at the ASPAN National Conference in Kansas City, MO, in April 2000, during ASPAN's kickoff birthday celebration, Walk Down Memory Lane, sponsored by the ASPAN Foundation through a grant from Stryker, Inc. The Conference was a perfect opportunity to stir the passion of perianesthesia nurses, to remember how we got started, and celebrate what we have become. Milestones, such as this anniversary, are significant events as we consider the past, the roots worth nourishing, and the years ahead. The stories are placed in 1 of 4 themes: Historical Perspective, Regional Pride, Personal Meaning and Passion, and National Conference. Expect to see several other themes emerge as well. Professionalism, mentoring, nursing friendships, focus on patient advocacy, and certification are frequently repeated. As individuals, ASPAN members share their own accomplishments with humility, surprise, and delight. The power and dignity of volunteer efforts and of our specialty Society are palpable. ASPAN thanks each author who took the time and effort to relate theirpersonal memories. Individual credentials for each writer are listed at the end of the article.

History, 20th Century↗
PubMedDate not supplied

Specialist nurses in Australia: the ICN and international regulation.

This article focuses on the relationship between specialist nurses in Victoria (Australia) and the International Council of Nurses (ICN). A major consideration is whether international standards can be applied across international boundaries. The ICN has represented the worldwide nursing community for the past 100 years. In 1997 the Royal College of Nursing (Australia) gained membership to the ICN and to its Regulation Network. With growing interest about internationalization, a key question is whether Australian nurses will accept the Council recommendations on regulation. In a report on specialist nurse education in Australia, recommendations were made that included the adoption of the ICN definition for specialist practice. A survey of the opinions of 75 nurses practicing in Victoria, toward a selection of recommendations from the report, showed strong agreement on definition and much less agreement on minimum credentials. Findings from the survey are discussed in relation to the international profile that is now expected of specialist nurses in Australia and a potential future role for professional organizations.

Analysis of Variance↗
PubMed2002

The ethics of applying new medical technologies.

Medical technology itself, including minimally invasive surgery, has no morals; our morality revolves around when and how we use technology. This often involves the individual clinician's assessment of their own abilities and an awareness of two aspects of the technology: its proven efficacy and its safety. Is technology outpacing knowledge? Or do physicians adopt new technologies in a responsible way with good motives? No one knows for sure. Technological progress in medicine has been a mixed blessing. The only ethical element involved in the use of new technologies over which individual medical practitioners have control, is that of user proficiency with the device, procedure, or drug, and the related information they provide to their patients when obtaining their consent for its use. New technologies fall into two broad categories: evolutionary, the most common, and revolutionary, which occur sporadically and may completely change the face of medical care. The learning curve for all new technologies can be steep. So, when should physicians be permitted to use these new technologies without supervision? Who is responsible for setting and monitoring standards for new technologies? With the moving target of medical technological innovation, individual practitioners are primarily responsible for the ethical use of new (to them) technologies. It is physicians' ethics that govern their use of new technologies, being certain that they have the requisite training and experience to use the modality, and that the intervention is safe for their patients. Institutional practitioner credentialing at the local level, despite its faults, will often be the primary control over a technology's use. What will ultimately govern the use of new technologies is the ethics (if they exist) of healthcare institutions and individual practitioners, as well as patient need. This is simply another reason why ethics education is vital for physicians-and other health practitioners and healthcare administrators.

Attitude of Health Personnel↗