Teaching symptom management in end-of-life care: the didactic content and teaching strategies based on the end-of-life nursing education curriculum.

Relief of symptoms for patients and families throughout the illness trajectory requires that palliative care practitioners have knowledge and skill, both in assessment and use of pharmacologic and complementary therapies. This article presents the didactic content of symptom assessment and management, and the experiential experiences used in a nondrug laboratory within the End-of-Life Nursing Education Consortium (ELNEC) curriculum.     

Balancing Engagement/Detachment in AIDS-related Multiple Losses

The process gay persons use to manage the multiple losses and cumulative grief from losing lovers, friends, colleagues and clients to AIDS was explored. Interviews with gay individuals (n=19) in a large urban area in the West provided data for conceptual coding and comparative analysis. Balancing engagement and detachment was identified as the basic social-psychological process that described how gay individuals struggled to reach an optimal balance in their involvement in the needs of individuals and the community. Four conceptual categories were identified: dysfunctional engagement, functional engagement, functional detachment and dysfunctional detachment. These four categories occur within the contexts of previous life style and redefinition of personal values.     

Alcohol drinking and high blood pressure: data from a 1980 national cardiovascular survey of Japan.

Many epidemiological cross-sectional studies have confirmed that alcohol drinking is related to high blood pressure. However, the impact of alcohol drinking on high blood pressure in the general population including older people has only been reported on in a few studies. The association between alcohol drinking and blood pressure or the prevalence of hypertension was examined using cross-sectional data of 4795 men and 6102 women aged 30-94, randomly selected from the Japanese population in 1980. The response rates were 74 and 84% for men and women, respectively. The prevalence of hypertension adjusted for body mass index (BMI, kg/m2) was significantly higher in everyday male drinkers than in male non-drinkers from the youngest age group (30-39 years) to oldest age group (70 years and over). A relationship between alcohol and blood pressure was found only in the youngest age group (30-39 years) of female drinkers. In each 10-year age-group of men, the BMI-adjusted systolic and diastolic blood pressures in everyday drinkers were 7-10 and 4-6 mmHg higher than those in non-drinkers. The relationship between alcohol and blood pressure in men was confirmed by multiple regression analysis adjusting for age and BMI in both younger (30-59 years) and older (60-94 years) people. The impact of alcohol drinking on blood pressure in men should be taken into account in the primary prevention of blood pressure related diseases and in the treatment of hypertension in both younger and older people.     

Experimental study on the pathogenesis of acute ulceration in obstructive jaundice--with reference to gastric mucosal blood flow

We prepared obstructive jaundice models in rats in order to study the mechanism of acute ulceration in obstructive jaundice centering on impediments to gastric wall blood flow and changes in gastric mucosal NA and PGE2 when the rats were subjected to water immersion restraint stress. The results were: In the obstructive jaundice 2 weeks group, when subjected to water immersion restraint stress, gastric mucosal NA reached a dried up stage from the incipient stage, causing gastric mucosal impediments at the same time, showing a significant decrease of gastric mucosal PGE2. Intragastric pH was at a similar level of excessive acidity in all groups; gastric acid is believed to be a secondary factor promoting ulceration. Gastric mucosal PGE2 showed a significant decrease coinciding with the increase in ulceration index, being a possible factor of ulceration; it is also presumed to regulate gastric wall blood flow alternatively with gastric mucosal NA. Pre-treatment with PGE2 prior to loading stress resulted in a decrease in gastric wall blood flow being significantly controlled. The administration of PGE2 brought about an improvement in gastric wall blood flow and a consequent increase in gastric mucosal NA, being judged effective for acute ulceration in obstructive jaundice.     

Large French-Canadian family with Lewy body parkinsonism: exclusion of known loci.

The identification of rare, large families with Parkinson's disease (PD) has provided important clues that have contributed to our understanding of this complex disorder. We have identified a large French-Canadian kindred that spans five generations consisting of more than 90 individuals. A total of 65 individuals now have been examined, had venous blood drawn, and DNA extracted. Two-point and multipoint linkage analysis was performed to assess linkage to known PD genes or loci. Within the third and fourth generations of this family there are 10 living, plus 3 deceased members with well-documented levodopa responsive parkinsonism. Autopsy results on 1 member demonstrated the loss of pigmented neurons in the substantia nigra and the presence of alpha-synuclein positive Lewy bodies. Four of the PD patients have prominent postural and kinetic tremors that preceded their parkinsonism by up to 10 years. Two other individuals within the family have prominent isolated postural and kinetic tremors without parkinsonism. The alpha-synuclein(4q21.3-23), Parkin(6q25.2-27), PARK3 (2p13), PARK4, and ubiquitin carboxy terminal hydrolase-L1 (4p14-16.3) and PARK6 and PARK7 (1p35-36) loci were excluded in this kindred using closely linked markers. The clinical and pathological features of this family are consistent with the diagnosis of PD. This family further demonstrates the known genetic heterogeneity in PD and is large enough that a genome-wide screen has been undertaken in an effort to identify a novel PD gene.     

I.v. fentanyl decreases the clearance of midazolam

We have examined the effect of fentanyl on the pharmacokinetics of midazolam in patients undergoing orthopaedic surgery. Thirty patients were allocated randomly to receive fentanyl 200 micrograms and midazolam 0.2 mg kg-1 (fentanyl group, n = 15) or placebo and midazolam 0.2 mg kg-1 (placebo group, n = 15) in a double-blind manner for induction of anaesthesia. Anaesthesia was maintained with nitrous oxide and isoflurane. Systemic clearance of midazolam was decreased by 30% (P = 0.002) and elimination half-time was prolonged by 50% (P = 0.04) in the fentanyl group compared with the placebo group. There were no differences in the distribution half-time or volume of distribution at steady state between the two groups. These findings indicate that elimination of midazolam was inhibited by fentanyl during general anaesthesia.      

Deaths: leading causes for 2001.

OBJECTIVES: This report presents final 2001 data on the 10 leading causes of death in the United States by age, race, sex, and Hispanic origin. Leading causes of infant, neonatal, and postneonatal death are also presented. This report supplements the annual report of final mortality statistics. METHODS: Data in this report are based on information from all death certificates filed in the 50 States and the District of Columbia in 2001. Causes of death classified by the International Classification of Diseases, Tenth Revision are ranked according to the number of deaths assigned to rankable causes. RESULTS: In 2001, the 10 leading causes of death were (in rank order) Diseases of heart; Malignant neoplasms; Cerebrovascular diseases; Chronic lower respiratory diseases; Accidents (unintentional injuries); Diabetes mellitus; Influenza and pneumonia; Alzheimer's disease; Nephritis, nephrotic syndrome and nephrosis; and Septicemia and accounted for nearly 80 percent of all deaths occurring in the United States. Differences in the rankings are evident by age, sex, race, and Hispanic origin. Leading causes of infant death for 2001 were (in rank order) Congenital malformations, deformations and chromosomal abnormalities; Disorders related to short gestation and low birth weight, not elsewhere classified; Sudden infant death syndrome; Newborn affected by maternal complications of pregnancy; Newborn affected by complications of placenta, cord and membranes; Respiratory distress of newborn; Accidents (unintentional injuries); Bacterial sepsis of newborn; Diseases of the circulatory system; and Intrauterine hypoxia and birth asphyxia. Important variation in the leading causes of infant death is noted for the neonatal and postneonatal periods.