Observation of nurse-patient interaction in oncology: review of assessment instruments

The aim of this review is to identify assessment instruments that can be used for analyzing sequences and can be applied to research into nurse-patient communication in cancer care. A systematic search of the literature revealed a variety of methods and instruments applicable to studies recording nurse-patient interaction. The studies that were qualitative in nature offered valuable information on observational research in general, on procedures relating to informed consent and observational arrangements in nursing practice. The quantitative studies provided an insight into the content and structure of the interaction by describing communication concepts or by frequency counts of previously determined behaviours. Systematic research into interaction sequences was not found. However, some of the quantitative instruments identified could be adapted for this purpose. The complexity and time-consuming nature of observational research highlight the need for efficiency. For instance a combination of quantitative and qualitative instruments could be considered.     

Parental and child factors associated with inhalant and food allergy in a population-based prospective cohort study: the Generation R Study

The prevalence of allergic diseases in children is markedly increasing to epidemic proportions. The aim of this study is to describe the presence and examine associated parental and child characteristics of allergic sensitization and physician-diagnosed allergy in Dutch children at age 10 years. This study among 5471 children was performed in a population-based prospective cohort from fetal life onwards. Allergic sensitization was measured by skin prick tests. Physician-diagnosed allergy and parental and child characteristics were collected by questionnaires. In children aged 10 years, inhalant and food allergic sensitization was present in 32.2% and 7.1%, and physician-diagnosed inhalant and food allergy in 12.4% and 2.3%. Maternal and paternal history of allergy, eczema or asthma was associated with increased risks of physician-diagnosed inhalant allergy (aOR (95% CI) 1.44 (1.23–1.70) and 1.59 (1.30–1.94), respectively), but not with food allergy. Asthma and eczema ever at age 10 years were associated with increased risks of physician-diagnosed inhalant allergy (4.60 (3.55–5.96) and 2.42 (1.94–3.03), respectively). Eczema ever at age 10 years was associated with an increased risk of physician-diagnosed food allergy (5.78, 3.04–9.52), with the highest risk of cashew (7.36, 3.20–16.94) and peanut (5.58, 3.08–10.10) food allergy.

Conclusions: We found strong effects of parental history of allergy, eczema or asthma on the presence of physician-diagnosed inhalant allergy in children at age 10 years. Eczema ever at age 10 years was a strong risk factor for the development of physician-diagnosed inhalant and food allergy.

Plasma concentrations and haemodynamic effects of nimodipine in patients resuscitated after cardiac arrest

Summary As the pharmacokinetics of a drug may be altered in haemodynamically compromised patients, the plasma concentrations and haemodynamic effects of the calcium entry blocker nimodipine have been examined in patients resuscitated after out-of-hospital cardiac arrest.In 7 patients nimodipine was infused at increasing rates up to 30 µg·kg^–1·h^–1. The plasma concentrations increased with increasing dose; at the highest dose a mean steady-state plasma concentration of 22.1 ng·ml^–1 was obtained, and the mean plasma clearance was 1.4 l·kg^–1·h^–1. There were no marked changes in mean arterial blood pressure or heart rate.In 9 other patients nimodipine was given as a bolus infusion of 10 µg·kg^–1 over 3 min, followed by a continuous infusion of 30 µg·kg^–1·h^–1. A mean steady-state plasma concentration of 17.6 ng·ml^–1 was obtained and the mean plasma clearance was 1.9 l·kg^–1·h^–1. Heart rate did not change significantly, but the mean arterial blood pressure fell.The data indicate that in patients resuscitated after cardiac arrest, the pharmacokinetics of nimodipine are not markedly different from patients with other conditions, e.g. subarachnoid haemorrhage. However, if a loading dose is given to obtain a steady-state concentration sooner, there will be a fall in arterial blood pressure.     

Addition of nitrous oxide to fentanyl anesthesia does not induce myocardial ischemia in patients with ischemic heart disease

Although nitrous oxide is commonly administered to patients with ischemic heart disease, recent reports suggest that it may induce myocardial ischemia in these patients. The authors compared the effects of nitrous oxide on segmental left ventricular (LV) function and the ST segment of the electrocardiogram with the effects of an equal concentration of nitrogen (crossover design) before the start of surgery in 18 patients who required coronary-artery bypass grafting. The patients studied did not have valvular or LV dysfunction. Anesthesia was induced and maintained with intravenous fentanyl. After endotracheal intubation and 20 min of ventilation with 100% oxygen, either 60% nitrous oxide or 60% nitrogen (randomly assigned) was added to the inspired gas mixture of each patient for 10 min. This was followed by 10 min of 100% oxygen, and then 10 min of 60% nitrous oxide or 60% nitrogen, whichever had not been administered previously. Patients were monitored for myocardial ischemia using a standard 12-lead electrocardiogram and trans-esophageal two-dimensional echocardiography. Surgery did not begin until the study was concluded. No patient experienced an ST segment change greater than 1 mm during the study, and none developed a new segmental wall motion abnormality during inhalation of either nitrous oxide or nitrogen. The authors conclude that nitrous oxide does not induce myocardial ischemia when used as an adjunct to fentanyl anesthesia in patients who have severe coronary-artery disease accompanied by well-preserved valvular and LV function.     

Histological assessment of pre‐transplant kidney biopsies is reproducible and representative

Snoeijs M G J, Boonstra L A, Buurman W A, Goldschmeding R, van Suylen R J, van Heurn L W E & Peutz‐Kootstra C J
(2010) Histopathology 56, 198–202 Histological assessment of pre‐transplant kidney biopsies is reproducible and representative Aims: Histological examination of pre‐transplant renal biopsy specimens can be used to select grafts from older donors after cardiac death (DCD) with a satisfactory transplant outcome. The aim was to determine whether such biopsy specimens can be reproducibly scored between pathologists and are representative of the whole kidney. Methods and results: In renal biopsy specimens from DCD aged ≥60 years (n = 44), globally sclerosed glomeruli, vascular narrowing, tubular atrophy and interstitial fibrosis were scored by three independent pathologists according to the Pirani scoring system. Interobserver agreement on the sum of scores improved considerably with the introduction of a combined tubulo‐interstitial scoring system (intraclass correlation coefficient increased from 0.38 to 0.64). In small needle biopsy specimens (n = 144) obtained at autopsy, estimates of the proportion of globally sclerosed glomeruli were more precise with increasing sample size. Reasonably precise estimates may be obtained from specimens with at least seven glomeruli. Conclusions: It is feasible to implement pre‐transplant renal biopsy specimen analysis as a selection criterion in clinical practice in order to accept kidneys from marginal donors for transplantation.     

Mumps outbreak in a highly vaccinated student population,The Netherlands, 2004

In September 2004 a mumps outbreak occurred at an international hotel school in The Netherlands. We investigated this outbreak to identify risk factors for mumps. There were 105 mumps cases (overall mumps attack rate (AR) 12% (95% CI: 10–15%)). The AR for Dutch vaccinated and unvaccinated participants was 12% (95% CI: 10–15%) and 15% (95% CI: 3–42%), respectively. Independent risk factor was mumps contact. Explanations for the relatively high AR among vaccinated participants include primary vaccine failure, waning immunity and incomplete vaccine-induced immunity in the context of high mumps virus exposure in a school party and a crowded boarding school.     

Clinical evaluation of the Bentley Univox membrane oxygenator

This paper reports a clinical evaluation of Bentley's new Univox membrane oxygenator (Bentley Laboratories, Irvine, California). In this new device, the blood flow path is outside the fibre, the incorporated heat exchanger consists of a 22-channel stainless-steel bellows, and the polypropylene fibres are woven into fibre ribbons and wound into each of the bellows channels. In this way, heat and gas transfers take place simultaneously. The priming volume has been reduced to 220ml and the membrane has an effective surface area of 1.6m 2. A BMR 1900 collapsible reservoir (Bentley Laboratories, Irvine, California) was used as a venous reservoir. Ten consenting patients undergoing elective coronary artery bypass surgery were perfused with this new oxygenator. BSA was between 1.7 and 2.11m 2; mean BSA was 1.81. Minimum priming was 1200 ml. The blood-gas results were all within or close to the normal range used in our institution. Acid-base management was performed using alpha-stat regulation and no problems occurred in this series of patients. Average pO 2 was 155mmHG+/-53 with a mean O 2 transfer of 90.7ml and a maximum of 185ml. The heat exchange performance was very good, with a mean coefficient of heat exchange of 0.54+/-0.11 and a maximum of 0.87.     

Changes in Circulating Levels of 25-hydroxyvitamin D3 in Breast Cancer Patients Receiving Chemotherapy

Cancer treatments, toxicities and their effects on lifestyle, may impact levels of vitamin D. The aim of this study was to determine serum 25-hydroxyvitamin D3 (25(OH)D₃) levels before, directly after and 6 months after chemotherapy in breast cancer patients (n?=?95), and a comparison group of women (n?=?52) not diagnosed with cancer. Changes in 25(OH)D₃ levels over time were compared using linear mixed models adjusted for age and season of blood sampling. Before start of chemotherapy, 25(OH)D₃ levels were lower in patients (estimated marginal mean 55.8?nmol/L, 95% confidence interval (95%CI) 51.2–60.4) compared to the comparison group (67.2?nmol/L, 95%CI 61.1–73.3, P?=?0.003). Directly after chemotherapy, 25(OH)D₃ levels were slightly decreased (–5.1?nmol/L, 95%CI –10.7–0.5, P?=?0.082), but ended up higher 6 months after chemotherapy (10.9?nmol/L, 95%CI 5.5–16.4, P?<?0.001) compared to pre-chemotherapy values. In women without cancer, 25(OH)D₃ levels remained stable throughout the study. Use of dietary supplements did not explain recovery of 25(OH)D₃ levels after chemotherapy. We reported lower 25(OH)D₃ levels in breast cancer patients, which decreased during chemotherapy, but recovered to levels observed in women without cancer within 6 months after chemotherapy. Suboptimal 25(OH)D₃ levels in the majority of the participants highlight the relevance of monitoring in this vulnerable population.