BLOOD TRANSFUSION: A POSSIBLE RISK FACTOR IN RETROLENTAL FIBROPLASIA

ABSTRACT. Clark, C, Gibbs, J. A. H., Maniello, R., Outerbridge, E. W., and Aranda, J. V. (Department of Newborn Medicine, McGill University, Montreal Children's Hospital Research Institute, Montreal, Quebec, Canada). Blood transfusion: A possible risk factor in retrolental Fibroplasia. Acta Paediatr Scand, 70:535,.–The effect of blood transfusion on the occurrence of RLF was evaluated in 58 infants who weighed less than 1 001 g at birth (Group I) and 70 oxygen treated infants of various birth weights (Group 11). Although there was no significant difference between Group 1 infants with or without exchange transfusion as to birth weight, gestational age, duration of oxygen therapy, peak Po₂'s, or multiple births, there was a significantly increased incidence of pre-retrolental fibroplasia in transfused over non-transfused Group II infants. When Group II infants were stratified for prematurity and oxygen duration, this difference persisted in those not already at risk for RLF. This increased incidence of retinopathy in transfused infants suggests that blood transfusion may be a risk factor in the pathogenesis of RLF.     

Clinical leadership for high-quality care: developing future ward leaders

Aim This paper reports upon the development, delivery and evaluation of a leadership programme for aspiring Ward Leaders in one National Health Service Trust in England. Background The ward sister role is fundamental to quality patient care and clinical leadership, however the role is increasingly difficult to recruit to. A lack of formal preparation and skills development for the role has been widely acknowledged. Method An evaluation of a programme of education for leadership. Three cohorts (n = 60) completed the programme. Semi-structured questionnaires were completed by participants (n = 36: 60%) at the conclusion of the programme. Qualitative data from questionnaires was analysed using a thematic approach. Results Participants reported increased political, organizational and self-awareness, increased confidence, feelings of empowerment and the ability to empower others. Opportunities for networking with peers were valued within the action learning approach. For some participants, career intentions were clarified through reflection. Conclusion The majority of participants had benefited from the leadership programme and valued this development as an empowering preparation for future careers. Implications for nursing management Investment in leadership preparation for future ward sister roles is strongly recommended as part of a strategy designed to enhance quality improvement, career path development, workforce empowerment and retention.     

NURSING BEHAVIOUR, PROLACTIN AND POSTPARTUM AMENORRHOEA DURING PROLONGED LACTATION IN AMERICAN AND KUNG MOTHERS

In order to determine the effects of protracted nursing in American women, blood was collected hourly for 24 h and nursing periods recorded in 20 mothers, 10 amenorrhoeic, 3 3/4 to 17 1/4 months postpartum (PP), and 10 menstruating, 5 1/4 to 46 months PP. These data were compared to the daytime nursing behaviour and 1000-1100 h PRL of women among !Kung hunter-gatherers of Botswana, a non-contraceptive using population with a birth space interval of greater than 3 years. Intense nursing behaviour maintained amenorrhoea and hyperprolactinaemia for 1 to nearly 2 years PP in both American and !Kung mothers. Among Americans, 80 min of nursing per day, in conjunction with a minimum of six nursing episodes, was highly predictive of remaining amenorrhoeic up to 18 months PP. Amenorrhoea was always accompanied by hyperprolactinaemia, but delay in the onset of menses was related more to nursing behaviour than to a particular 24 h PRL level. The 1000-1100 h sample is equivalent to and about half of the 24 h mean in high and low intensity nursers, respectively. The !Kung women were similar to the high intensity nursing American women in 1000-1100 h PRL, percent amenorrhoeic, and the number of minutes of daytime nursing.     

Nutrition during treatment of head and neck cancer

The importance of nutrition during the treatment of head and neck cancers has been discussed in relation to oral health. The side effects of surgery, radiation therapy, and chemotherapy are described as well as their effects on nutrition. Common presentations of therapy-induced malnutrition are presented. Parameters for nutritional assessment are listed and an instrument is proposed to assist with the monitoring of nutritional status and to aid in organizing interventions that support adequate nutrition. The practitioner who is capable of recognizing and helps to prevent nutritional deficiencies in patients with head and neck cancers provides a valuable service that increases the comfort of the patient and improves the prognosis for successful therapy.     

Teratology Study in Rats with Amsacrine, an Antineoplastic Agent

Teratology Study in Rats with Amsacrine, an Antineoplastic Agent.ANDERSON, J. A., PETRERE, J. A., SAKOWSKI, R., FITZGERALD, J.E., AND DE LA IGLESIA, F. A. (1986). Fundam. Appl. Toxicol.7, 214–220. Amsacrine, an acndinylamino derivative usedin the treatment of refractory leukemias, was evaluated forits teratogenic potential in pregnant rats. The compound wasgiven by intrapentoneal (ip) administration on Days 6 to 9 ofgestation to groups of 20 female CD rats at levels of 0.5, 1.0,and 2.0 mg/kg. Appropriate vehicle and untreated controls wereincluded. Dams given 2.0 mg/kg lost weight during and afterthe treatment period. Food consumption was comparable to controlsat all dose levels except for the high dose group in the post-treatmentperiod. Decreased litter size, increased postimplantation loss,and reduced fetal weights occurred with doses of 2.0 mg/kg.Significantly reduced fetal body weight and increased incidenceof stunting were the only adverse findings at 0.5 and 1.0 mg/kg,respectively. Two fetuses at 2.0 mg/kg, one at 1.0 mg/kg, oneat 0.5 mg/kg, and two vehicle control fetuses had gross abnormalities.Fetotoxicity, manifested by inhibition of osteogenesis and minorskeletal abnormalities, occurred with doses of 0.5 mg/kg ormore. The results indicate that amsacrine was embryolethal torats at doses of 2.0 mg/kg and embryotoxic at lower dose levels.Teratogenicity was not evident at doses which did not affectfetal survival.     

A Dietitian-Delivered Group Nutrition Program Leads to Reductions in Dietary Fat, Serum Cholesterol, and Body Weight: The Worcester Area Trial for Counseling in Hyperlipidemia (WATCH)

OBJECTIVE: To assess the effectiveness of a dietitian-based nutrition counseling and education program for patients with hyperlipidemia. DESIGN: A 4-session program implemented as a complement to a randomized physician-delivered intervention. SUBJECTS/SETTING: From 12 practice sites of the Fallon Clinic, 1,162 subjects with hyperlipidemia were recruited, 645 of whom had data sufficient for our primary analyses. INTERVENTION: Two individual and 2 group sessions conducted over 6 weeks. MAIN OUTCOME MEASURES: Total and saturated fat levels; serum low-density lipoprotein cholesterol levels; and body weight, measured at baseline and after 1 year. STATISTICAL ANALYSES: Multiple linear regression was used to evaluate changes in outcome measures. RESULTS: After 1 year, there were significant reductions in outcome measures for subjects attending 3 or 4 nutrition sessions vs subjects attending fewer than 3 sessions or those never referred to a nutrition session. Reductions (mean +/- standard error) in saturated fat (measured as percent of energy) were 2.7 +/- 0.5%, 2.1 +/- 0.5%, and 0.3 +/- 0.1%, respectively. These reductions correspond to roughly a 22% relative change from baseline in those attending 3 or 4 sessions. Corollary reductions were observed for total fat (measured as percent of energy): 8.2 +/- 1.4%, 5.0 +/- 1.4%, and 0.7 +/- 0.4%; low-density lipoprotein cholesterol: 0.48 +/- 0.11 mmol/L, 0.13 +/- 0.11 mmol/L, and 0.02 +/- 0.03 mmol/L; and body weight: 4.5 +/- 0.9 kg, 2.1 +/- 0.8 kg, and 1.1 +/- 0.2 kg. The specified changes were additive to those of the physician-delivered intervention. APPLICATIONS/CONCLUSIONS: This investigation provides empirical data demonstrating the effectiveness of a dietitian-delivered intervention in the care of patients with hyperlipidemia.     

Characterization of Sinoatrial Parasympathetic Innervation in Humans

INTRODUCTION: The response to sinoatrial parasympathetic nerve stimulation (shortened atrial refractoriness) was used to determine the atrial distribution of these nerve fibers in humans. We hypothesized that, in humans, parasympathetic nerves that innervate the sinoatrial node also innervate the right atrium and that the greatest density of innervation is near the sinoatrial nodal fat pad. METHODS AND RESULTS: Temporary epicardial wire electrodes were sutured in pairs in the sinoatrial nodal fat pad, high right atrium, and right ventricle by direct visualization during coronary artery bypass surgery in nine patients. Appropriate electrode placement was confirmed by electrically stimulating the fat pad in the operating room to prolong sinus cycle length by 50%. Experiments were performed in the electrophysiology laboratory 1 to 5 days after surgery. Programmed atrial stimulation was performed via an endocardial electrode catheter advanced to the right atrium. The catheter tip electrode was moved in 1-cm concentric zones around the epicardial wires by fluoroscopic guidance. Atrial refractoriness was determined in the presence and absence of sinoatrial parasympathetic nerve stimulation at each catheter site. In 8 of 9 patients, parasympathetic nerve stimulation reproducibly prolonged sinus cycle length by 50%. There was no effect on AV nodal conduction (no prolongation of PR interval) and no change in AV nodal refractoriness. Atrial effective refractory periods reproducibly shortened in response to parasympathetic nerve stimulation in 1-cm zones up to 3 cm surrounding the fat pad, by a mean (+/- SEM) of 26.6+/-4.3 msec (zone 1), 11.4+/-1.8 msec (zone 2), and 10.0+/-2.5 msec (zone 3), respectively (P = 0.0001). At distances > 3 cm from the fat pad, the effective refractory period did not shorten. CONCLUSION: Stimulation of parasympathetic nerves that innervate the sinoatrial node shortened atrial refractoriness in humans.