Catchers in the Rye: Treatment Foster Parents as a System of Care

PROBLEM: Similar to the children in J. D. Salinger's novel, The Catcher in the Rye, youth in foster care face the specter of "going over the cliff." METHODS: The empirical basis for "treatment foster care" is reviewed, concluding that treatment foster care is both a clinically and cost-effective form of community-based treatment. FINDINGS: Treatment foster parents prevent the fall of foster youth into the chasm of school failure, involvement with juvenile justice, and dependent living as adults. CONCLUSION: Treatment foster care is an evidence-based approach that is less restrictive and offers troubled youth an opportunity to engage and grow within a family setting.     

The role of white cells in the transmission of Yersinia enterocolitica in blood components

The mechanism for the transmission of Yersinia enterocolitica in blood components has been studied experimentally. One hypothesis is that, during a Yersinia infection in the blood donor, bacteria are phagocytosed by white cells (WBCs), but are not killed. After collection of blood from such a donor and component production, the bacteria are present in WBCs for some time, during which the unit appears sterile. Later, when the WBCs disintegrate, the bacteria are released and multiply in the unit. Aliquots of whole blood and buffy coat were inoculated with 100 colony-forming units (CFU) per mL of a Y. enterocolitica strain of type O:3 and left at room temperature for 5 hours. Some aliquots were then WBC-reduced by filtration, while others retained their WBC contents. All aliquots were kept at 4 degrees C for 6 weeks. Meat extract broth culture medium was used as a control. Growth in the range of 2000 CFU per mL was obtained in the broth control by 24 hours, whereas the whole blood and buffy coat units appeared sterile for the first days of storage. After 1 week, a trace of bacteria and, after 4 weeks, massive growth were found in the WBC-containing units but not in the WBC-reduced units. The likely explanation is that the bacteria had been phagocytosed by the WBCs and were thereby hidden and not available for bacterial culture during the first phase of storage. When the WBCs spontaneously disintegrated, bacteria were released and multiplied in the blood units.(ABSTRACT TRUNCATED AT 250 WORDS)     

Granulocyte transfusion therapy in a child with chronic granulomatous disease and multiple red cell alloantibodies

A 7-year-old, 17-kg child with chronic granulomatous disease and nocardial pneumonia and osteomyelitis did not respond to antibiotic therapy and developed multiple red cell (RBC) alloantibodies (anti-c, -E, and -Jka). To provide daily granulocyte concentrates, a method was devised to reduce the number of incompatible RBCs per transfusion. Leukapheresis was done with hydroxyethyl starch, and the apheresis product was allowed to sediment by gravity in a plasma expressor for 90 minutes. The leukocyte-rich plasma was separated from the sedimented RBCs by transfer to a satellite bag, and the volume of the product was reduced by centrifugation to approximately 80 ml. RBC content was reduced from 29 +/- 7 to 2.5 +/- 1.0 ml (n = 22, p less than 0.01) and was accompanied by a 70 percent recovery of white cells (range, 49-90%). The final product contained 1.6 +/- 1.0 X 10(10) granulocytes. There were no clinical or laboratory signs of hemolysis during the course of 46 granulocyte transfusions, 37 of which were derived from c-, E-, or Jka-positive donors. The size of most apheresis donor pools is insufficient to provide phenotypically matched granulocyte concentrates daily for patients with RBC alloimmunization. The rapid, simple method described here may allow daily therapy with mismatched concentrates to be administered safely to such patients.     

Introduction: Ethical issues in the daily practice of cancer nursing

Cancer nurses face ethical issues daily in their clinical practice. Most issues are resolvable, and the patient is provided with the best treatment option for his individual situation. Ethical dilemmas will continue to exist throughout time, raising more questions than providing concrete answers. Dilemmas force us to examine all possible alternatives and to include the patient in the decision-making process. The articles in this issue provide a broad overview of the ethical issues that cancer nurses face.