A procedure for the digital removal of faeces

This article describes the development of an evidence-based procedure for the digital removal of faeces (DRF) and the problems and barriers encountered--not least the absence of primary evidence. The procedure for DRF that evolved is based on the best evidence available. It sets out the criteria for performing DRF and directs the practitioner's actions, while still being adaptable to the individual patient's situation. It should help to ensure that nurses performing DRF do so within the remit of their professional and legal responsibilities, and that patients receive the most effective care grounded in the current state of knowledge.     

Improving tracheostomy care for ward patients

The number of patients with a tracheostomy being cared for in the ward setting has increased recently as intensive care clinicians use this procedure to aid early weaning from mechanical ventilation. As a result, ward staff are providing the specialist care required by patients with a tracheostomy more frequently. This article describes how the outreach team and the critical care practice development nurse in one trust collaborated to identify, develop and implement strategies to ensure that patients with a tracheostomy in the ward setting would be cared for by an educated and supported team of nurses.     

Effects of a high-fat diet on body composition in cancer patients receiving chemotherapy: a randomized controlled study

BACKGROUND: Patients with cancer are characterized by a profound impairment of glucose utilization, with lipids being the preferred metabolic fuel. In contrast, the energy needs of malignant tumors are almost entirely met by glucose. We therefore studied the effects of a high-fat diet, particularly on body composition. PATIENTS AND METHODS: Twenty-three moderately malnourished patients with gastrointestinal carcinomas were randomized to receive either a conventional diet supplying 35 nonprotein kcal and 1.1 g of protein/kg per day (group A, n = 11) or a fat-enriched artificial liquid diet (20 nonprotein kcal/kg per day) plus normal meals (group B, n = 12) for a period of eight weeks, i.e., from the first to the third chemotherapy cycle. The fat content of the artificial diet was 66% of the nonprotein calories. The day before the nutritional interventions, and again after four and eight weeks, body compartments were determined using bioelectrical impedance analysis, lymphocyte subpopulations were quantified using flow cytometry, and some aspects of the quality of life were rated using four linear analog self-assessment (LASA) scales. The statistical calculations were done as an exploratory data analysis. RESULTS: The consumption of non-protein calories did not differ significantly between the two patient groups. An average weight gain in group B contrasted with an average weight loss in group A after four (P < 0.01) and eight weeks (P < 0.05). Fat-free mass showed an intergroup difference in favor of group B after eight weeks (P < 0.05). Body cell mass was maintained throughout the study in group B, but declined significantly up to weeks 4 and 8 in group A (intergroup difference: P < 0.05 and 0.01, respectively). A decrease in the total lymphocyte count by 559 cells/mul occurred with the fat-enriched diet (P < 0.05). Several aspects of the quality of life were rated to be better in group B than in group A, although not all differences reached statistical significance. CONCLUSION: In patients with cancer, a high-fat diet may possibly support the maintenance of both body weight and body cell mass. However, monitoring the lymphocyte count is advisable.     

Stimulatory role for medical preoptic/anterior hypothalamic area neurones in growth hormone and prolactin secretion. A kainic acid study

The role of preoptic/anterior hypothalamic area (PO/AHA) neurones in the regulation of basal patterns of growth hormone (GH) and prolactin (Prl) secretion was investigated in unanaesthetized male rats prepared with chronic indwelling venous cannulae.PO/AHA injections of the neurotoxin kainic acid (KA) substantially reduced both GH and Prl secretion. Histological examination of tissue sections indicated that KA treatment had produced extensive neuronal loss and gliosis in the medial (m) but not the periventricular (p) PO/AHA.These findings suggest that m-PO/AHA neurones are facilitatory to the basal secretion of both GH and Prl. It is proposed that GH-facilitatory m-PO/AHA neurones provide an inhibitory input to the GH release-inhibiting factor neurones which are known to reside in the p-PO/AHA. Prl-facilitatory m-PO/AHA neurones may secrete, or stimulate the secretion of a Prl releasing factor.     

Influence of haloperidol on ACTH and beta-endorphin secretion in the rat

The injection of haloperidol, a dopamine receptor blocker, was followed by a large increase of plasma ACTH and beta-endorphin-like immunoreactivity (beta-EI) in the rat. This effect was prevented when the rats were previously treated with corticosteroids. These results suggest that catecholamines inhibit ACTH and beta-endorphin secretion in the rat.     

Studies on the stability of vitamin A in the stomach and small intestine

The instability of vitamin A alcohol relative to vitamin A acetate has been studied in vivo and in vitro.

Vitamin A alcohol is more unstable than vitamin A acetate in human gastric and duodenal juice and in rats' stomachs and intestines and is more marked at lower pH levels and in rats' stomachs.

Alpha tocopherol improved the absorption curve of vitamin A alcohol in man by protecting it in gastric and duodenal juice. This protective effect could not be demonstrated in the rat.