Animal-assisted interventions research: issues and answers

Animal visitation programs have been used in a wide variety of clinical settings with predominantly positive outcomes reported anecdotally. However, there is also a growing body of research investigating the effects of these interventions. Developing and conducting rigorous studies of animal interventions can be a complex and challenging process, The purpose of this article is to identify and discuss several issues arising with this type of research and to posit suggestions for avoiding pitfalls.     

Legal and ethical issues: questions and answers.

This article, in Question and Answer (Q&A) format, focuses on legal concerns raised by practicing school nurses across the country. In this Q & A edition, four questions submitted to the Section Editors by JOSN readers are included, with responses to each. The main topics of the questions are (a) the rights of emancipated and mature minors; (b) the "rights" of nonnurse supervisors to direct or assume the practice of school nursing; (c) the right of a school district to exclude a student from a fieldtrip (versus the right of the student to participate); and (d) the right of a school district to change the level of nursing care provided to a special education student.     

Clinical efficacy of heparin fractions: issues and answers

The recent development of heparin fractions and fragments for clinical use has created the prospect of some new agents at our disposal for the treatment of thrombotic disorders. The development of a drug that will block thrombosis but will not impair hemostasis now appears to be a possibility. Due to lack of understanding of all of the mechanisms of the pathology of thrombosis, we are not certain what the properties of the ideal anticoagulant should be. Of the heparins and heparin fractions, fragments, and heparinoids now available to us, we have yet to fully understand the mechanism of their pharmacologic activity. It has been amply demonstrated that decreasing the average molecular weight decreases the antithrombin activity while retaining the anti-Xa activity of heparin derivatives. Studies on animal models have proven the antithrombotic potency of some of these low molecular weight heparins to be equal to that of unfractionated heparin. There has been some evidence that these fractions are less likely than unfractionated heparin to cause hemorrhage in animal models as well as in at least one human clinical trial. A recently published human clinical trial revealed an unexpected incidence of hemorrhage following major surgery when a certain heparin fraction was given as prophylaxis against thrombosis. We are desperately in need of heparin derivatives, heparinoids or other anticoagulants that can be used in place of standard heparin in patients who are allergic to heparin or who have heparin-induced thrombocytopenia. Patients with these problems not infrequently require cardiopulmonary bypass surgery in which the use of heparin has been mandatory. There is now evidence from animal and human studies that such a procedure is possible with a heparin fraction or a heparinoid. This is true for hemodialysis as well. Studies in progress offer hope that a low molecular weight fragment with potent anti-Xa activity will not cause thrombocytopenia in patients with heparin-induced thrombocytopenia. Whether this agent, a pentasaccharide, will have sufficient antithrombotic potency for clinical use remains an important question. An important property of some of the newer heparin fractions is a prolonged duration of action which may permit fewer doses, thus reducing the cost as well as patient discomfort and inconvenience.     

Common issues, different approaches: strategies for community-academic partnership development

Communities around the United States face many challenging health problems whose complexity makes them increasingly unresponsive to traditional single-solution approaches. Multiple approaches have considered ways to understand these health issues and devise interventions that work. One such approach is community-based participatory research. This article describes the development of a new collaborative partnership between a school of nursing and an urban social service agency using community-based participatory research as a framework. We describe the partnership's evolution and process of data collection and analysis and evaluate the outcomes of both. We argue that community-based participatory research involves partnerships at its core whose members, both as individuals and part of the collaboration, must be committed and nimble in the face of shifting and challenging health and social problems, recognize common issues and concerns across the boundaries of community and academia, and respect each other's different approaches and expertise.