BUILDING THE FOUNDATION OF EXCELLENCE IN HEART FAILURE NURSING

This column contains the presidential address presented during the Third Annual Meeting of the American Association of Heart Failure Nurses on June 28, 2007, in San Diego, California, titled "Building the Foundation of Excellence in Heart Failure Nursing."     

Chlordiazepoxide alters intravenous cocaine self-administration in rats

This investigation was designed to examine the effects of benzodiazepines on intravenous cocaine self-administration in rats. Pretreatment with low doses of the benzodiazepine receptor agonist, chlordiazepoxide (0.3 to 1.0 mg/kg, IP), resulted in small but nonsignificant increases in drug intake with 0.5 mg/kg cocaine, while higher doses (10 mg/kg, IP) significantly decreased drug intake in all rats tested. The effects of chlordiazepoxide on self-administration were attenuated when the concentration of cocaine was increased to 1.0 mg/kg, suggesting that chlordiazepoxide was opposing rather than augmenting the pharmacological actions of cocaine. Pretreatment with the benzodiazepine receptor antagonist, Ro 15-1788 (1.0 to 10 mg/kg, IP), had no effect on self-administration, suggesting that the reinforcing properties of cocaine do not result from direct interactions with benzodiazepine receptors. The result of this investigation demonstrate that chlordiazepoxide alters intravenous cocaine self-administration in rats. Although additional research will be necessary to confirm these data, the results of this investigation suggest that chlordiazepoxide may decrease the reinforcing efficacy of cocaine through indirect actions on dopaminergic neuronal activity potentially mediated through GABAergic mechanisms via benzodiazepine receptor activation.     

A cluster of cases of streptococcal necrotizing fasciitis in Gloucestershire.

We describe the first cluster of cases of necrotizing fasciitis (NF) in this century in the United Kingdom (UK). Between 1 January and 30 June 1994 there were six cases (five confirmed, one probable) of Streptococcus pyogenes NF in west Gloucestershire, population 320,000. Two cases died. The first two patients probably acquired their infections during the course of elective surgery performed in the same operating theatre, possibly from a nasopharyngeal carrier amongst the theatre staff. The remaining infections were community-acquired. Of 5 S. pyogenes isolates there were 2 M1 strains, 1 M3, 1 M5 and 1 M non-typeable strain. S. pyogenes NF had not been recorded in west Gloucestershire in the preceding 10 years and the incidence of S. pyogenes bacteraemia in England and Wales had not risen in the past 5 years. The two presumably theatre-acquired infections raised several issues. The need for detailed bacteriological investigation of all cases of post-surgical NF was confirmed. Clusters of S. pyogenes infection following surgery should be managed by closure of the operating theatre until all staff have been screened for carriage. Closure of an operating theatre and screening of staff following a sporadic case is probably not justified because of the infrequency of surgical cross-infection with S. pyogenes. Regular, routine screening of theatre staff is neither practical nor necessary.     

Effects of negative pressure wound therapy on fibroblast viability, chemotactic signaling, and proliferation in a provisional wound (fibrin) matrix

Vacuum Assisted Closure brand Negative Pressure Wound Therapy (V.A.C. NPWT) has been shown to be an effective therapeutic option for the treatment of recalcitrant wounds; however, the mechanism of action at the cellular level remains to be elucidated. Here, we examined the effects of negative pressure wound therapy, manifolded with two different dressings, on fibroblast viability, chemotactic signaling, and proliferation in a fibrin clot matrix. Fibroblasts were grown in a three-dimensional fibrin matrix and were treated for 48 hours with either V.A.C. NPWT and GranuFoam Dressing, or with gauze under suction, or as static controls without negative pressure or dressings. Cells treated by gauze under suction showed significantly greater cell death and stimulated less migration and proliferation than static and V.A.C. NPWT-treated cells (p<0.05). Apoptosis was also significantly higher in gauze under suction than in static treatments. These results indicate that the dressing material has a significant effect on cell response following negative pressure wound therapy. The ability to support cell growth, stimulate chemotaxis, and proliferation without increasing apoptosis may provide an insight into the mechanisms of action of V.A.C. NPWT.     

Child,family, and system outcomes of intensive case management in New York State

New York State’s Children and Youth Intensive Case Management (CYICM) was implemented in 1988 as one of several community-based initiatives for children with serious emotional disturbance (SED). Underlying this program is the goal of maintaining children with SED in the least restrictive environment appropriate to their needs. This paper presents CYICM child, family, and system outcomes over six years, describes program refinements, and explores continuing research efforts. Data are supportive of the positive outcomes associated with intensive case management for children with SED. Associated with enrollment in CYICM are a decrease in symptoms, improvement in functioning, and fewer hospitalizations in state-operated psychiatric centers, which translates into cost savings and a possible reduction in hospital beds.     

POLICE INVOLVEMENT WITH CLIENTS HAVING INTELLECTUAL DISABILITIES: A PILOT STUDY IN SOUTH LONDON

Following the increasing trend for de-institutionalisation of people with learning disabilities, community services are increasingly being utilised to support those who also display challenging behaviours. Where severely challenging behaviours are involved community service providers may require additional support from die police service. The authors undertook a retrospective pilot study among two major community care providers in South London, and looked at the reasons for calling the police, the frequency with which die police were called; staff expectations in calling the police and the outcomes for die clients in terms of further involvement with the criminal justice system. The authors note that the police were generally used as additional support when clients became too difficult for the immediate service providers to manage. It is also noted that police action on behalf of victims was generally low and that the police were never called in response to clients with learning disabilities reporting having witnessed crime. The authors note that further research is required.     

Morphometric analysis of the pineal complex of the golden hamster over a 24-hour light: Dark cycle: I. The superficial pineal in untreated and optically enucleated animals

Morphometric analysis of the superficial pineal gland of intact and blinded golden hamsters was conducted at both the light and electron microscopic level. The volume of the superficial gland was estimated to be 151 × 10⁶ μm³, comprising 90–94% of the total pineal parenchymal tissue. Analysis of structural rhythms in animals maintained under a 14:10 L:D cycle showed significant 24-hr variations in values for pinealocyte nuclei, nucleoli, rough and smooth endoplasmic reticulum, Golgi bodies, dense bodies, and dense-cored vesicles. Peak values for these structures generally occurred at the light:dark interface. These results provide morphological correlates for known rhythmic variations in the synthesis of pineal-gland products. Superficial pineals examined 8 weeks following optic enucleation exhibited a decrease in the volume of pinealocyte nuclei and cytoplasm, while nucleolar size and the amounts of smooth and rough endoplasmic reticulum, Golgi bodies, dense bodies and dense-cored vesicles were enhanced. The latter changes are interpreted as indications of increased synthetic activity by the superficial pineal gland in response to light deprivation.     

Reovirus-like agent (rotavirus) from lambs.

Rotavirus particles were demonstrated by electron microscopy in the feces of lambs with diarrhea. Rotavirus antigen was synthesized in cell cultures infected with filtrates of the diarrheic feces, but the virus was not adapted to grow serially in cell cultures. An antigenic relationship between rotaviruses from lambs, pigs, and calves was demonstrated by immunofluorescence. Colostrum-deprived lambs were infected with the lamb rotavirus, and the virus was passaged in lambs. Viral replication occurred in the villous epithelial cells of the small intestine, and the virus was excreted in the feces up to 78 h postinfection. Diarrhea was not observed in the experimentally infected lambs.     

Electrophoretic variation of avian rotavirus RNA in polyacrylamide gels

Five different sorts of RNA profiles (electropherogroups 1 to 5) were recognised when avian rotavirus RNAs were electrophoresed in polyacrylamide gels. These could be distinguished from the RNAs of mammalian group A, B and C rotaviruses. Viruses belonging to electropherogroups 1, 2/3 and 4 were detected in chickens and viruses belonging to electropherogroups 1, 2, 3 and 5 were detected in turkeys. A minimum of three electropherogroups was recognised in each of four longitudinal surveys of broiler chicken flocks. On examination of rotaviruses from different clinical outbreaks of diarrhoea and from different longitudinal surveys minor differences involving almost all the RNA segments were observed when rotaviruses from the same electropherogroup were compared. Detailed RNA analysis in two of the surveys detected up to three electropherotypes within each electropherogroup.