The extent, nature, and precipitating factors of nurse assault among three groups of registered nurses in a regional medical center.

INTRODUCTION: This study investigated nurse perceptions of the incidence and nature of verbal and physical assault or abuse by patients and their family members or visitors. METHODS: A survey was given to ED, ICU, and general floor nurses in a 770-bed acute care north Florida medical center. RESULTS: The response rate was 68.8% (86 out of 125). Large percentages of nurses reported being victims of verbal assault or abuse and physical assault by patients and family members or visitors; 88% reported being verbally assaulted and 74% reported being physically assaulted while at work in the past year. ED nurses reported the highest rates of these incidences, with 100% reporting verbal assault and 82.1% reporting physical assault within the past year. Assaults were most commonly perpetrated by patients with cognitive dysfunction (79.1%), patients with substance abuse (60.5%), and persons who were angry because of the patient's condition (55.8%). Surprising information: the most common causes of assault by family members and visitors were anger related to enforcement of hospital policies (58.1%), anger related to the patient's condition/situation (57%), anger related to long wait times (47.7%), and anger related to the health care system in general (46.5%). DISCUSSION: Nurses were confused about what legally constitutes "assault" and "abuse"; nurse rights versus patient rights; and policies and procedures for reporting assault or abuse incidences. Our results indicate that nurses are experiencing abusive and assaultive behavior from family members and visitors just as often as they are from patients, and ED nurses are at higher risk. Nurses perceive a lack of institutional support and an institutional emphasis on patient rights and satisfaction and do not feel safe in the workplace.     

A faith-based screening/education program for diabetes, CVD, and stroke in rural African Americans

The purpose of this study was to examine the effectiveness of a faith-based health screening/education program to ultimately reduce risk factors for diabetes (DM), cardiovascular disease (CVD), and stroke (CVA) in a southern, rural, African-American population. Over 120 parishioners from four rural African-American churches attended health education/screening programs offered as a part of their Bible Study. The majority of participants were female, married, with a mean age of 45 years. The program included education about prevention of cardiovascular disease (CVD), diabetes (DM), and stroke (CVA) followed by health screening, individual counseling, and healthy snacks. Pre/post test surveys for health knowledge were given. While the pre/post health knowledge scores showed some improvement, they were not statistically significant indicating the need for more than one program. Participants under age 30 and over age 60 years had the least knowledge on the pretest about these illnesses compared to the middle-age group. Almost 50% were found to have high blood pressure, and 14% had high blood sugar levels of which they were unaware. Participant and pastor feedback was positive and supported the feasibility of ongoing faith-based screening/ education programs as one way to meet the health needs of a rural African-American population.     

Multiple comparisons model-based clustering and ternary pattern tree numerical display of gene response to treatment: procedure and application to the preclinical evaluation of chemopreventive agents

Microarray technology has greatly aided the identification of genes that are expressed differentially. Statistical analysis of such data by multiple comparisons procedures has been slow to develop, in part, because methods to cluster the results of such comparisons in biologically meaningful ways have not been available. We isolated and analyzed, by Northern blot and GeneChip, replicate liver RNA samples (n = 4/group) from rats fed with control diet or diet containing one of three chemopreventive compounds, selected because their pharmacological activities, including RNA expression response, are relatively well understood. We report on a classification tree, based on the results of nonparametric multiple comparisons, which results in the bipolar hierarchical clustering of genes in relation to their response to treatment. In addition to identifying treatment-responsive genes, application of this procedure to our test study identified the known pharmacological relationships among the treatment groups without supervision. Also, small treatment-specific subsets of genes were identified that may be indicative of additional pharmacophores present in the test compounds.     

<Emphasis Type="Italic">S</Emphasis>-adenosylhomocysteine hydrolase deficiency: two siblings with fetal hydrops and fatal outcomes

This paper reports the clinical and metabolic findings in two sibling sisters born with fetal hydrops and eventually found to have deficient S-adenosylhomocysteine hydrolase (AHCY) activity due to compound heterozygosity for two novel mutations, c.145C>T; p.Arg49Cys and c.257A>G; p.Asp86Gly. Clinically, the major abnormalities in addition to fetal hydrops (very likely due to impaired synthetic liver function) were severe hypotonia/myopathy, feeding problems, and respiratory failure. Metabolic abnormalities included elevated plasma S-adenosylhomocysteine, S-adenosylmethionine, and methionine, with hypoalbuminemia, coagulopathies, and serum transaminase elevation. The older sister died at age 25 days, but the definitive diagnosis was made only retrospectively. The underlying genetic abnormality was diagnosed in the second sister, but treatment by means of dietary methionine restriction and supplementation with phosphatidylcholine and creatine did not prevent her death at age 122 days. These cases extend the experience with AHCY deficiency in humans, based until now on only the four patients previously identified, and suggest that the deficiency in question may be a cause of fetal hydrops and developmental abnormalities of the brain.     

Correlation between Rotator Cuff Tears and Repeated Subacromial Steroid Injections: A Case-Controlled Study

INTRODUCTION

Concern exists regarding potential damage to the rotator cuff from repeated corticosteroid injections into the subacromial space.

PATIENTS AND METHODS

In this retrospective, case-controlled study, 230 consecutive patients presenting to three orthopaedic units with subacromial impingement and investigated as an end-point with magnetic resonance imaging (MRI) of the shoulder were divided into groups having received less than three or three or more subacromial injections of corticosteroids.

RESULTS

With no significant difference in age and sex distribution, analysis by MRI showed no significant difference between the two groups in the incidence of rotator cuff tear (P < 1.0).

CONCLUSIONS

This suggests that corticosteroid use in patients with subacromial impingement should not be considered a causative factor in rotator cuff tears.     

Taking the pressure off type 2 diabetes mellitus: implementing hypertension guidelines

Successful treatment of hypertension in patients with type 2 diabetes mellitus increases life expectancy and reduces the risk of many of the complications associated with diabetes, such as heart disease, stroke, and retinopathy. Controlling blood pressure also protects against advancing renal disease, with several recent studies having clearly shown the advantage of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in slowing the progression of renal disease. Here, the authors review current guidelines for the management of hypertension in patients with type 2 diabetes mellitus and explore ways in which nurse practitioners can improve care for these patients.     

Effects of 5,6-benzoflavone, indole-3-carbinol (I3C) and diindolylmethane (DIM) on chemically-induced mammary carcinogenesis: is DIM a substitute for I3C?

The abilities of 5,6-benzoflavone (5,6-BF, a synthetic flavonoid), indole-3-carbinol (I3C, a plant derived product) or diindolylmethane (DIM, a condensation product of I3C) to alter the induction of mammary cancers induced by the carcinogens 7,12-dimethylbenzanthracene (DMBA) or N-methyl-N-nitrosourea (MNU) were evaluated. Interestingly, the first two agents act as aryl hydrocarbon receptor (AhR) agonists, while DIM does not. The agents were initially examined for their ability to inhibit DMBA-induced mammary carcinogenesis. Agents were administered for 14 days starting 7 days prior to a single dose of the carcinogen. Evaluated over an extensive range of doses (165, 550 and 1650 ppm in the diet), 5,6-BF caused a dose-dependent decrease of mammary cancers. In addition, 5,6-BF at doses of 1650 and 165 ppm in the diet blocked the induction of DMBA-induced DNA adducts in the mammary gland by approximately 85% and 45%, respectively. In contrast, DIM (180 or 20 mg/kg BW/day) failed to block induction of DMBA tumors. The effect of these agents on the promotion/progression phase of carcinogenesis using the MNU mammary cancer model was also determined. 5,6-BF (1650 or 165 ppm in the diet), I3C (180 or 60 mg/kg BW/day administered by gavage), or DIM (180 or 60 mg/kg BW/day by gavage) were initiated 5 days after the administration of MNU, and continually thereafter. 5,6-BF decreased MNU- induced mammary tumor multiplicity by 40-60%. I3C reduced tumor multiplicity at the high dose, while DIM at either dose had minimal effects on tumor multiplicity. Thus, 5,6-BF and I3C were highly effective against initiation of DMBA-induced mammary carcinogenesis, and were also effective against MNU-induced tumors during the promotion/progression phase of carcinogenesis. In contrast, DIM had minimal effects in either model; arguing that administration of DIM is not analogous to administration of I3C.