Solar‐Powered Point‐of‐Care Sonography: Our Himalayan Experience

The benefits of sonography utilization in low‐resource communities has been thoroughly demonstrated in the literature.^1–3 As ultrasound units have become smaller and more portable, the feasibility of bringing these imaging devices into more remote areas is becoming a reality. One factor that limits ultrasound use in austere environments is battery life. Although solar power has been used for oxygen delivery^5,6 in resource‐limited settings, its use in sonography has not been previously described. This report describes the use of a Lumify (Philips; Amsterdam, Netherlands) for a month‐long trip into a remote Himalayan region of India powered exclusively with an Anker (Shenzhen, China) solar panel for the entirety of the trip. According to the Palmetto Health Institutional Review Board, this does not qualify as “research” as defined by the US Department of Health and Human Services and therefore does not meet the requirements for institutional review board review.     

Mn‐citrate and Mn‐HIDA: intermediate‐affinity chelates for manganese‐enhanced MRI

In this study we investigated two manganese chelates in order to improve the image enhancement of manganese‐enhanced MRI and decrease the toxicity of free manganese ions. Since both MnCl₂ and a low‐affinity chelate were associated with a slow continuous decrease of cardiac functions, we investigated intermediate‐affinity chelates: manganese N‐(2‐hydroxyethyl)iminodiacetic acid (Mn‐HIDA) and Mn‐citrate. The T₁ relaxivity values for Mn‐citrate (4.4 m m ^?1 s^?1) and Mn‐HIDA (3.3 m m ^?1 s^?1) in artificial cerebrospinal fluid (CSF) were almost constant in a concentration range from 0.5 to 5 m m at 37 °C and 4.7 T. In human plasma, the relaxivity values increased when the concentrations of these Mn chelates were decreased, suggesting the presence of free Mn²⁺ bound with serum albumin. Mn‐HIDA and Mn‐citrate demonstrated a tendency for better contractility when employed with an isolated perfused frog heart, compared with MnCl₂. Only minimal changes were demonstrated after a venous infusion of 100 m m Mn‐citrate or Mn‐HIDA (8.3 µmol kg^?1 min^?1) in rats and a constant heart rate, arterial pressure and sympathetic nerve activity were maintained, even after breaking the blood–brain barrier (BBB). Mn‐citrate and Mn‐HIDA could not cross the intact BBB and appeared in the CSF, and then diffused into the brain parenchyma through the ependymal layer. The responses in the supraoptic nucleus induced by the hypertonic stimulation were detectable. Therefore, Mn‐citrate and Mn‐HIDA appear to be better choices for maintaining the vital conditions of experimental animals, and they may improve the reproducibility of manganese‐enhanced MRI of the small nuclei in the hypothalamus and thalamus. Copyright © 2012 John Wiley & Sons, Ltd.     

Interruptions during nurses' work: A state‐of‐the‐science review

The purpose of this state‐of‐the‐science review was to examine empirical evidence from studies of interruptions conducted in acute care nurses' work environments. A total of 791 articles published from 2001 through 2011 were reviewed; 31 met the criteria to be included in the sample. Despite sustained multinational and multidisciplinary attention to interruptions during nurses' work, the current findings suggest that beliefs about the ill effects of interruptions remain more conjecture than evidence‐based. Pre‐existing beliefs and biases may interfere with deriving a more accurate grasp of interruptions and their effects. Future research would benefit from examinations of interruptions that better capture their complexity, to include their relationships to both positive and negative outcomes for both patients and health care workers. © 2012 Wiley Periodicals, Inc. Res Nurs Health 36:38–53, 2013     

Drug‐induced aseptic meningitis: a mini‐review

Aseptic meningitis associates a typical clinical picture of meningitis with the absence of bacterial or fungal material in the cerebrospinal fluid. Drug‐induced aseptic meningitis (DIAM) may be due to two mechanisms: (i) a direct meningeal irritation caused by the intrathecal administration of drugs and (ii) an immunologic hypersensitivity reaction to a systemic administration. If the direct meningeal irritation allows a rather easy recognition, the immunologic hypersensitivity reaction is a source of challenging diagnostics. DIAM linked to a systemic treatment exerts typically an early onset, usually within a week. This period can be shortened to a few hours in case of drug rechallenge. The fast and spontaneous regression of clinical symptoms is usual after stopping the suspected drug. Apart from these chronological aspects, no specific clinical or biological parameters are pathognomonic. CSF analysis usually shows pleiocytosis. The proteinorachia is increased while glycorachia remains normal. Underlying pathologies can stimulate the occurrence of DIAM. Thus, systemic lupus erythematosus appears to promote DIAM during NSAID therapy, especially ibuprofen‐based one. Similarly, some patients with chronic migraine are prone to intravenous immunoglobulin‐induced aseptic meningitis. DIAM will be mainly evoked on chronological criteria such as rapid occurrence after initiation, rapid regression after discontinuation, and recurrence after rechallenge of the suspected drug. When occurring, positive rechallenge may be very useful in the absence of initial diagnosis. Finally, DIAM remains a diagnosis of elimination. It should be suggested only after all infectious causes have been ruled out.     

Concept Analysis: Nurse‐to‐Nurse Lateral Violence

PURPOSE. The purpose of this paper is to examine the concept of nurse‐to‐nurse lateral violence (LV). SOURCE. Published literature—LV among nurses is significant and results in social, psychological, and physical consequences, negative patient and nursing outcomes, and damaged relationships. An extensive review of literature through Health Source, Cumulative Index to Nursing and Allied Health Literature (CINAHL), ProQuest health, and Medical Complete was used to determine agreement and disagreement across disciplines and emerging trends. CONCLUSION. This concept analysis demonstrates that nurse‐to‐nurse LV is nurse‐to‐nurse aggression with overtly or covertly directing dissatisfaction toward another. Origins include role issues, oppression, strict hierarchy, disenfranchising work practices, low self‐esteem, powerlessness perception, anger, and circuits of power. The result of this analysis provides guidance for further conceptual and empirical research as well as for clinical practice. Organizations must learn how to eliminate antecedents and provide nurses with skills and techniques to eradicate LV to improve the nursing work environment, patient care outcomes, and nurse retention.     

Adenosine‐sensitive Wolff‐Parkinson‐White: Longer time across the atrioventricular groove

1 Background

Successful ablation sites in Wolff‐Parkinson‐White syndrome (WPW) are characterized by short atrioventricular (AV) intervals. Approximately 15% of patients with WPW have adenosine‐sensitive accessory pathways (APs). We sought to determine if local AV intervals of adenosine‐sensitive APs are different from those of adenosine‐insensitive APs in patients with WPW.

2 Methods

Patients ≤21 years with WPW and adenosine‐sensitive APs who underwent successful ablation over a 9‐year period were included. Patients with WPW and adenosine‐insensitive APs were matched by age and weight in a 1:2 case‐control design. AP location, antegrade and retrograde conduction properties, supraventricular tachycardia (SVT) inducibility, local AV interval, interval from delta wave onset to local ventricular activation (del‐V), and time to loss of preexcitation were reviewed.

3 Results

Fourteen patients with adenosine‐sensitive APs and 28 with adenosine‐insensitive APs were included. Patients with adenosine‐sensitive APs had minimum 1:1 antegrade AP conduction at a longer median paced cycle length (380, interquartile range [IQR] 295 to 585 ms vs 290, IQR 250 to 330 ms, P = 0.046), were less likely to have inducible SVT (35.7% vs 75.0%, P = 0.035), and had a longer median local AV interval (40.5, IQR 30.8 to 58.3 ms vs 32.0, IQR 29.3 to 37.8 ms, P = 0.029) when compared to those with adenosine‐insensitive APs.

4 Conclusion

Patients with WPW and adenosine‐sensitive APs have 1:1 antegrade AP conduction at longer cycle lengths, lower likelihood of SVT induction, and longer local AV intervals when compared to those with adenosine‐insensitive APs. In patients with WPW, it may be important to consider adenosine response when selecting appropriate ablation targets.