Emergency Department Case-finding for High-risk Older Adults: The Brief Risk Identification for Geriatric Health Tool (BRIGHT)

Objective:  The objective was to test the ability of the Brief Risk Identification for Geriatric Health Tool (BRIGHT) to identify older emergency department (ED) patients with functional and physical impairment.
Methods:  This was a cross-sectional study in which 139 persons ≥75 years, who presented to an urban New Zealand ED over a 12-week period, completed the 11-item BRIGHT case-finding tool. Then, within 10 days of their index ED visit, 114 persons completed a comprehensive geriatric assessment. A "yes" response to at least 3 of the 11 BRIGHT items was considered "positive." Primary outcome measures were instrumental activities of daily living (IADL), cognitive performance scale (CPS), and activities of daily living (ADL).
Results:  The BRIGHT-identified IADL deficit (64% prevalence) with a sensitivity of 0.76, specificity of 0.79, and receiver operating characteristic (ROC) of 0.83 (95% confidence interval [CI] = 0.74 to 0.91, p < 0.01); cognitive deficit (35% prevalence) sensitivity of 0.78, specificity of 0.54, and ROC of 0.66 (95% CI = 0.55 to 0.76, p = 0.006); and ADL deficit (29% prevalence) sensitivity of 0.83, specificity of 0.53, and ROC of 0.64 (95% CI = 0.53 to 0.75, p = 0.020). Positive likelihood ratios (LR+) for the three outcomes of interest were 3.6, 1.7, and 1.8, respectively. Negative likelihood ratios (LR−) were 0.3, 0.4, and 0.3.
Conclusions:  The 11-item BRIGHT successfully identifies older adults in the ED with decreased function and may be useful in differentiating elder patients in need of comprehensive assessment.     

Safe Staffing for the Post Anesthesia Care Unit: Weighing the Evidence and Identifying the Gaps

Postanesthesia nursing care and standards are continually evolving. ASPAN has the professional responsibility to develop standards of nursing practice to promote a safe environment of care. Currently, ASPAN's recommended staffing ratios are based on the best available evidence: expert opinion and consensus. Our Society believes that these nurse-to-patient ratios have served to provide safe, quality patient care. In 2006, the ASPAN Safe Staffing Strategic Work Team was charged with conducting a national PACU Safe Staffing Evidence-Based Practice (EBP) project. The purpose of this EBP staffing project was to search the scientific staffing evidence in an attempt to validate ASPAN's staffing ratios. This expert panel critically weighed the nursing evidence on staffing ratios, workload intensity, patient acuity, nursing-sensitive outcomes, and nursing-sensitive indicators, including appropriate critical care studies because of the scarce number of postanesthesia studies. The outcome of this dynamic initiative revealed the need to develop nursing-sensitive perianesthesia indicators that can provide patient outcomes used to assess the effectiveness of staffing ratios. Finally, research gaps were identified and the next steps in the generation of knowledge needed to build safe staffing evidence were identified in ASPAN's Strategic Research Staffing Plan.     

Development of candidate rotavirus vaccines derived from neonatal strains in India

The need for a rotavirus vaccine in India is based on the enormous burden associated with the >100,000 deaths due to rotavirus diarrhea that occur annually among Indian children. Two rotavirus strains identified during nosocomial outbreaks of rotavirus infection in New Delhi and Bangalore, India, more than a decade ago are being developed as live oral vaccines. Infected newborns had no symptoms, shed virus for up to 2 weeks after infection, mounted a robust immune response, and demonstrated protection against severe rotavirus diarrhea after reinfection. The 2 strains are naturally occurring bovine-human reassortants. The New Delhi strain, 116E, is characterized as having a P[11],G9 genotype, and the Bangalore strain, I321, is characterized as having a P[11],G10 genotype. The strains have been prepared as pilot lots for clinical trials to be conducted in New Delhi. This unique project, which is developing a new rotavirus vaccine in India with the use of Indian strains, an Indian manufacturer, and an Indian clinical development program, aims to expedite introduction of rotavirus vaccines in India.     

Children with Behavioral/Mental Health Disorders and School Mental Health Nurses in Australia

TOPIC: This review of the literature addresses Australian school mental health nursing is an emergent field of practice. PURPOSE: Children with behavioral/mental health disorders present challenges to schools, teachers, and their families. They can be disruptive in class, inappropriate with their peers, and perform poorly academically. Often this group of children do not respond to the school's usual strategies to support appropriate behavior. When children with behavioral/mental health disorders do not receive specialized support based on their problems and needs, their problems can escalate over time and in adolescence their behavior may become more challenging, with increased aggression, substance use, contact with the criminal justice system, and school failure with or without dropout. CONCLUSION: Mental health nurses, working as case managers, could be effective in the support of children with behavioral/mental health disorders in schools. Mental health nurses, because of their professional education and clinical practice, work not only with the individual child but also with family members. They are well prepared to case manage in schools and support individual teachers and health and welfare services in their management of their clients with behavioral/mental health disorders.     

Effect of short‐term intensive insulin therapy on quality of life in type 2 diabetes

Rationale, aims and objectives Short‐term intensive insulin therapy (IIT) early in the course of type 2 diabetes can improve pancreatic beta‐cell function and even induce normoglycemia that persists post‐therapy. In spite of this benefit, insulin is often delayed until late in the course of disease partly because of its perceived negative impact on quality of life (QOL). Therefore, we sought to examine the effect of early implementation of short‐term IIT on patient‐reported QOL and treatment satisfaction. Methods A total of 34 patients with type 2 diabetes (5.9 ± 6.6 years duration, on zero to two oral antihyperglycaemic agents) underwent 4–8 weeks of IIT consisting of basal detemir and pre‐meal insulin aspart. Patient‐reported QOL, treatment satisfaction and symptom distress were assessed at baseline and post‐IIT using the Medical Outcomes Study 36‐item Short‐Form Health Survey (SF‐36), Diabetes Quality of Life Measure (DQOL), and Diabetes Symptoms Checklist‐Revised (DSC‐R). Results There was a significant improvement in glycated haemoglobin post‐IIT (mean 6.5% vs. 7%; P < 0.001). All 34 patients tolerated IIT well with no severe hypoglycaemia. Following IIT, the SF‐36 showed a significant improvement compared to baseline in reported physical functioning (mean 88.2 vs. 83.3, P = 0.009), general health (69.4 vs. 65.6, P = 0.03), and general mental health (85.2 vs. 82.2, P = 0.04). The DQOL demonstrated a significant improvement in global health perception (P = 0.02), diabetes worry (P = 0.006) and treatment satisfaction (P = 0.007). The DSC‐R revealed a significant improvement in the diabetes‐related total symptom score (P = 0.01). Conclusions Contrary to popular perception, a short course of IIT resulted in significant improvements in QOL and treatment satisfaction, demonstrating the patient acceptability of early insulin therapy.     

A transformation-associated complex involving tyrosine kinase signal adapter proteins and caldesmon links v-ErbB signaling to actin stress fiber disassembly

The avian erythroblastosis viral oncogene (v-erbB) encodes a receptor tyrosine kinase that possesses sarcomagenic and leukemogenic potential. We have expressed transforming and nontransforming mutants of v-erbB in fibroblasts to detect transformation-associated signal transduction events. Coimmunoprecipitation and affinity chromatography have been used to identify a transformation-associated, tyrosine phosphorylated, multiprotein complex. This complex consists of Src homologous collagen protein (Shc), growth factor receptor binding protein 2 (Grb2), son of sevenless (Sos), and a novel tyrosine phosphorylated form of the cytoskeletal regulatory protein caldesmon. Immunofluorescence localization studies further reveal that, in contrast to the distribution of caldesmon along actin stress fibers in normal fibroblasts, caldesmon colocalizes with Shc in plasma membrane blebs in transformed fibroblasts. This colocalization of caldesmon and Shc correlates with actin stress fiber disassembly and v-erbB-mediated transformation. The tyrosine phosphorylation of caldesmon, and its association with the Shc–Grb2–Sos signaling complex directly links tyrosine kinase oncogenic signaling events with cytoskeletal regulatory processes, and may define one mechanism regulating actin stress fiber disassembly in transformed cells.     

Indomethacin uptake into poly(2-hydroxyethyl methacrylate-co-3,9-divinyl-2,4,8,10-tetraoxaspiro [5.5]-undecane) network: In vitro and in vivo controlled release study

Networks based on poly(2-hydroxyethyl methacrylate-co-3,9-divinyl-2,4,8,10-tetraoxaspiro [5.5]-undecane), synthesized through radical dispersion polymerization, were used as template for indomethacin (INN) as model drug. The copolymers were characterized by swelling studies at three pH values (2.4, 5.5 and 7.4) and two temperatures (room temperature 24 °C and physiological temperature 37 °C). Fourier transform infrared (FTIR) spectroscopic analysis was used to sustain the copolymer structures. Scanning electron microscopy (SEM) and thermogravimetric (TG) investigations were used to examine microstructure and appreciate the thermal stability of the polymer samples. The studies of the INN drug release from the copolymer networks were in vitro performed. The in vivo study results (biocompatibility tests, somatic nociceptive experimental model (tail flick test) and visceral nociceptive experimental model (writhing test)) are also reported in this paper.     

Warfarin Bioavailability With Feeding Tubes and Enteral Formula

Background: Earlier literature showed reduced efficacy of warfarin when co‐administered with enteral nutrition formulas through feeding tubes. This study used an in vitro model for gastric administration of warfarin through a feeding tube to evaluate potential causes for reduced warfarin absorption when administered through feeding tubes. Methods: There were 2 phases of the study. The first phase used an artificial stomach model with or without the infusion of enteral nutrition formula. Warfarin was added to the contents either directly into the vessel or passed through a feeding tube. Warfarin tablet dissolution was compared to the injectable formulation, which served as a control. The second phase used chopped feeding tube material added to beakers containing warfarin in increasing amounts. Results: Warfarin injection and tablet formulations showed decreased solubility when combined with acid. The warfarin solubility was higher when enteral formula was added. Warfarin concentration dropped by 35% when the drug was passed through a feeding tube, as opposed to added directly to the flask. In the second study, the warfarin levels were lower in the beakers containing feeding tubes. Doubling the amount of warfarin added did not raise levels to that of the initial dissolved. Doubling the amount of feeding tube material further reduced the concentration dissolved. Conclusions: Feeding‐tube administration compromises the total amount of warfarin reaching patients. It appears, from this in vitro study, that the mechanism of the interaction of warfarin may be a result of direct binding to the feeding tube.