Dialysance and clearance measurements during clinical dialysis-a plea for standardization.

Mass transfer and dialysance measurements were determined using (1) whole blood solute concentrations with blood flow rates, (2) plasma solute concentrations with plasma flow rates, and (3) plasma solute concentrations with whole blood flow rates by standard formulas during 30 clinical hemodialyses. Resulting values by these three methods were compared for potassium, urea, and creatinine. The three techniques yield significantly different values and, accordingly, the type of measurement must be specified before such clinical measurements of solute transport are interpretable. Multiple mechanisms to account for the differences are suggested and include minimal or no immediate effect of a single coil blood transit on intracellular solute concentrations for all solutes studied.     

Audit on nuchal translucency thickness measurements in Flanders, Belgium: a plea for methodological standardization.

OBJECTIVES: To audit nuchal translucency thickness (NT) measurements for fetal aneuploidy screening in Flanders, and to estimate the impact of small variations in NT measurement on the screening result of two first-trimester screening algorithms: maternal age + NT (Algorithm A), and maternal age + NT + pregnancy associated plasma protein-A + free beta-human chorionic gonadotropin (Algorithm B). METHODS: We used the database of first-trimester combined screening, as collected by the General Medical Laboratory AML in Antwerp, Belgium, between 1 January 2001 and 1 April 2004. Audit was performed by establishing a delta-NT distribution curve for one trainee of The Fetal Medicine Foundation (FMF) and for a group of 263 other sonographers, in comparison with the FMF reference values. Risks for fetal aneuploidy were calculated at a cut-off value of 1 : 300 for Algorithm A and 1 : 150 for Algorithm B. These risks were recalculated in both algorithms after a modeled increase of all NT values by 0.1 or 0.2 mm. RESULTS: In a total of 592 measurements performed by the FMF trainee, the 5th, 50th and 95th percentiles of delta-NT measurements were at -0.41, +0.03 and +0.68 mm, respectively. These values were close to the FMF reference values. The screen-positive rate for this set of data was 4.4% (26/592) in both algorithms. For the 12 555 measurements of the 263 other sonographers, the 5th, 50th and 95th percentiles of delta-NT were at -0.81, -0.14 and +0.73 mm, respectively, which clearly indicates underestimation of NT in the lower range. In this set of data the screen-positive rate was 3.5% for both algorithms (439/12 555 for Algorithm A and 436/12 555 for Algorithm B). Also in this group, 5% (59/1186) of negative screening results at maternal age > or = 35 years in Algorithm A became positive after a modeled 0.1-mm increase in NT, whereas this was only in 1.2% (134/11 369) of tests at maternal age < 35 years (P < 0.0001). The overall increase of screen-positive rate in Algorithm A after an NT modification of +0.1 mm was 1.2% (152/12 555), significantly more than in Algorithm B (86/12 555; 0.7%) (P < 0.0001). CONCLUSION: In Flanders, there is a systematic underestimation of NT in comparison with the FMF reference range. Attempts to change these measurements according to the FMF criteria are crucial. This will mainly influence the screening results of women at advanced maternal age and of NT-based algorithms without the use of other parameters.     

NANDA's definition of nursing diagnosis: a plea for conceptual clarity.

A working definition of nursing diagnosis was adopted by the North American Nursing Diagnosis Association (NANDA) Biennial Business Meeting in March 1990. Because of the working nature of the definition, members and nonmembers of the Association were invited to judge the merits and faults of the definition and to recommend areas needing further debate, analysis, or modification. The purpose of this article is to apply principles and rules of definition to an analysis of the working definition of nursing diagnosis as adopted by the NANDA General Assembly. In presenting this analysis, concerns and questions regarding the conceptual, logical, and grammatical clarity of essential elements (e.g., clinical judgment; individual, family, or community responses; actual or potential health problems; and actual or potential life processes) in the definition are posed; and, where appropriate, suggestions for clarification are offered. Further debate, research, and clinical testing is requested in an attempt to improve NANDA's very important contribution to the development of nursing practice theory.     

Breast biopsy technique: a plea for cosmesis

Breast cancer is the leading cause of cancer death among American women. Early detection and treatment greatly increase long-term survival rates, but many women delay seeking treatment of suspected lesions out of fear of mutilation. Unfortunately, this fear is compounded by the fact that although 60% to 80% of all biopsies prove benign, many women are left with unsightly scars from the biopsies themselves. The great majority of these avoidable scars result from the use of radial biopsy incisions, which are unnecessary in virtually all cases. Most lesions can be reached via periareolar incisions and even those few that require incisions away from the areola can be reached through incisions that follow Langer's lines circumferential to the breast. Even total subcutaneous mastectomy and reconstruction can often be done via periareolar incisions, with minimal scarring, less likelihood of keloid formation, no deformity, and less emotional trauma for the recovered patient.     

The national glycohemoglobin standardization program: a five-year progress report.

BACKGROUND: The Diabetes Control and Complications Trial (DCCT) and the United Kingdom Prospective Diabetes Study (UKPDS) demonstrated conclusively that risks for complications in patients with diabetes are directly related to glycemic control, as measured by glycohemoglobin (GHB). In 1994, one year after the DCCT results were reported, the American Diabetes Association (ADA) set specific diabetes treatment goals. However, 1993 College of American Pathologists (CAP) Survey results indicated a lack of comparability of GHB test results among methods and laboratories that represented a major obstacle to meaningful implementation of the ADA guidelines. Thus, an AACC subcommittee was formed in 1993 to develop a standardization program that would enable laboratories to report DCCT-traceable GHB results. This program was implemented in 1996 by the National Glycohemoglobin Standardization Program (NGSP) Steering Committee. APPROACH: We review the NGSP process and summarize progress in standardization through analysis of CAP data. CONTENT: Since 1996, the number of methods and laboratories certified by the NGSP as traceable to the DCCT has steadily increased. CAP GH2-B survey results reported in December 2000 show marked improvement over 1993 data in the comparability of GHB results. In 2000, 90% of surveyed laboratories reported GHB results as hemoglobin A(1c) (HbA(1c)) or equivalent, compared with 50% in 1993. Of laboratories reporting HbA(1c) in 2000, 78% used a NGSP-certified method. For most certified methods in 2000, between-laboratory CVs were <5%. For all certified methods in 2000, the mean percent HbA(1c) was within 0.8% HbA(1c) of the NGSP target at all HbA(1c) concentrations.     

CCATT: a military model for civilian disaster management.

When major disasters incapacitate hospitals and definitive care facilities-as Hurricane Katrina did in 2005-a crisis point is rapidly reached. Critical care services are often the first to be overwhelmed. Personal experiences and regional disaster plans were examined in the wake of Hurricane Katrina to uncover shortfalls in delivery of care and resources. A search was undertaken for a viable model for delivering critical care services in the immediate post-disaster period. Such a model already exists in the US Air Force's (USAF) Critical Care Air Transport Teams (CCATT). These teams have functioned well during recent military conflicts by providing both ground critical care and transport of high-risk, severely injured patients. The need for augmented critical care and transport resources in the face of overwhelming casualties in the civilian environment does not require a de novo construct. The USAF's CCATT model should be easily adaptable to the civilian disaster scenario.     

Herbal medicine development: a plea for a rigorous scientific foundation

Science, including rigorous basic scientific research and rigorous clinical research, must underlie both the development and the clinical use of herbal medicines. Yet almost none of the hundreds or thousands of articles that are published each year on some aspect of herbal medicines, adheres to 3 simple but profound scientific principles must underlie all of herbal drug development or clinical use. Three fundamental principles that should underlie everyone's thinking about the development and/or clinical use of any herbal medicine. (1) There must be standardization and regulation (rigorously enforced) of the product being studied or being used clinically. (2) There must be scientific proof of a beneficial clinical effect for something of value to the patient and established by rigorous clinical research. (3) There must be scientific proof of safety (acceptable toxicity) for the patient and established by rigorous clinical research. These fundamental principles of science have ramifications for both the scientist and the clinician. It is critically important that both the investigator and the prescriber know exactly what is in the studied or recommended product and how effective and toxic it is. We will find new and useful drugs from natural sources. However, we will have to learn how to study herbal medicines rigorously, and we will have to try to convince the believers in herbal medicines of the wisdom and even the necessity of a rigorous scientific approach to herbal medicine development. Both biomedical science and practicing physicians must enthusiastically accept the responsibility for searching for truth in the discovery and development of new herbal medicines, in the truthful teaching about herbal medicines from a scientific perspective, and in the scientifically proven clinical use of herbal medicines.     

It's a disaster: emergency departments' preparation for a chemical incident or disaster

Nurses in the Accident & Emergency (A&E) Department have a significant role to play in the treatment and resuscitation of victims of a chemical disaster. Chemical disasters are unique because casualties are contaminated. Nursing staff triage casualties and they have direct contact with contaminated patients, before and during decontamination. Consequently they require adequate personal protective equipment and information regarding isolation and decontamination. The use of chemicals has increased since the turn of the century. Hazardous chemical emergencies arise from accidents in production, storage, transportation and the disposal of chemical substances. Their illegal manufacture and use by terrorists makes the likelihood of a chemical disaster with mass casualties in Australia very real. Emergency departments are ill-prepared to deal with this scenario, and very few disaster plans include a comprehensive decontamination component. To achieve an effective response with the best utilisation of resources, it is vital for emergency services personnel and A&E departments to be prepared.