Does platelet aggregation play a role in the reduction in localized intimal proliferation in normolipidemic pigs with fixed coronary artery stenosis fed dietary fish oil?

In order to investigate the effect of fish oil on intimal proliferation of coronary arteries with a fixed stenosis normolipidemic piglets received a basic diet to which either 9% (w/w) lard (L, n = 8) or 4.5% (w/w) lard and 4.5% (w/w) mackerel oil (ML, n = 8) was added for 4 months. Stenosis was applied by implanting a 4.0 X 2.0 mm (i.d.) Teflon constrictor around the left anterior descending coronary artery (LADCA) (o.d. 2.7 +/- 0.1 mm). During the dietary period ADP-induced platelet aggregation in whole blood was higher in L than in ML. Partial replacement of 20:4 n - 6 by 20:5 n - 3 fatty acids in the platelet membranes of ML may have altered platelet aggregation by changes in eicosanoid synthesis. The plasma cholesterol and triglyceride levels did not change in L, but decreased in ML. At the end of the 4-month dietary period the animals were again anesthetized and regional myocardial perfusion (radioactive labelled microspheres) and systolic segment length shortening (SLS) were measured while the hearts were paced at 160 pulses/min. Perfusion and SLS of non-LADCA nourished segment were similar for L and ML. However, transmural flow to the LADCA perfused myocardium was impaired in both groups, but the deficiency in endocardial perfusion was considerably larger in L than in ML, resulting in a larger loss of SLS in the former. Remote (2-3 cm from the site of the constrictor) luminal encroachment was minimal (less than 2%) in both groups, but at the site of the constrictor there was significant encroachment in both groups which was higher in L (62 +/- 7%) than in ML (11 +/- 4%). It is thought that in these normolipidemic pigs the reduction in platelet aggregation may play a role in the smaller intimal proliferation of the fish oil-fed animals.     

The distribution of infectivity in blood components and plasma derivatives in experimental models of transmissible spongiform encephalopathy

BACKGROUND: The administration of blood components from donors who subsequently develop Creutzfeldt-Jakob disease has raised the issue of blood as a possible vehicle for iatrogenic disease. STUDY DESIGN AND METHODS: We examined infectivity in blood components and Cohn plasma fractions in normal human blood that had been "spiked" with trypsinized cells from a scrapie-infected hamster brain, and in blood of clinically ill mice that had been inoculated with a mouse-adapted strain of human transmissible spongiform encephalopathy. Infectivity was assayed by intracerebral inoculation of the blood specimens into healthy animals. RESULTS: Most of the infectivity in spiked human blood was associated with cellular blood components; the smaller amount present in plasma, when fractionated, was found mainly in cryoprecipitate (the source of factor VIII) and fraction I+II+III (the source of fibrinogen and immunoglobulin); almost none was recovered in fraction IV (the source of vitamin-K-dependent proteins) and fraction V (the source of albumin). Mice infected with the human strain of spongiform encephalopathy had very low levels of endogenous infectivity in buffy coat, plasma, cryoprecipitate, and fraction I+II+III, and no detectable infectivity in fractions IV or V. CONCLUSION: Convergent results from exogenous spiking and endogenous infectivity experiments, in which decreasing levels of infectivity occurred in cellular blood components, plasma, and plasma fractions, suggest a potential but minimal risk of acquiring Creutzfeldt-Jakob disease from the administration of human plasma protein concentrates.     

Near continuous cardiac output by thermodilution

A new thermodilution method for frequent (near continuous) estimation ofcardiac output, without manual injection of fluid into the blood, was tested.The method utilizes a pulmonary artery catheter equipped with a fluid filledheat exchanger. The technique is based on cyclic cooling of the blood in theright atrium and measurement of the temperature changes in the pulmonaryartery. Using this technique, a new estimate of cardiac output can be obtainedevery 32 s. Cardiac output estimates, obtained for a running mean of threemeasurements with this method, were compared to the mean of three conventionalthermodilution measurements. The measurements were obtained during shortperiods of stable respiration and circulation.In six pigs, we made 46 paired measurements of conventional thermodilution(TD) and near continous (TDc) thermodilution. The cardiac output(CO TD) ranged from 2.4–13.7 l/min (mean 5.4 l/min). Thebest linear fit through the paired data points was CO TDc =–0.57 + 1.01 CO TD. The mean difference between themethods was –0.50 l/min (S.D. = 0.39). The mean coefficient of variationof repeated measurements with the near continuous thermodilution was3.6%.Considering changes of more than 0.25 l/min to be significant, all changes incardiac output measured by conventional thermodilution were followed by therunning mean of three near continuous thermodilution estimates.This study demonstrates the feasibility of the new method to monitorcardiac output, and to detect all changes greater than 0.25 l/min.     

Clients Served and Services Provided by Academic Nurse-Managed Centers

Currently, no national database for academic nurse-managed centers (ANMCs) exists. These primary care services remain somewhat invisible in the policy and reimbursement areas of the American primary care system and, consequently, are undersupported. The purpose of this article is to describe client and service data from a national study of ANMCs. A cross-sectional survey design was used to collect data from ANMC directors. Usable data were received from 64 centers. ANMCs in the sample were relatively small in terms of patients and volume. Client and service profiles demonstrated variation, which seemed to be reflective of needs relative to populations and communities served. Nearly half of the ANMCs responding served clients of all ages, with services representing the breadth of primary care (i.e., health maintenance and management of minor acute and common chronic illnesses). Evidence of community-focused care was also noted. The reported use of standardized nursing language was low. Standardized medical taxonomies were more commonly used, with International Classification of Diseases, Ninth Revision being the most common. ANMCs provide a small but substantial amount of primary care services in communities served. Findings indicated a need for ANMCs to improve the documentation of their contributions through the use of standardized taxonomies to provide aggregated reporting for policy and research purposes.     

Clinical Care Costing Method for the Clinical Care Classification System™

PURPOSE: To provide a means for calculating the cost of nursing care using the Clinical Care Classification System (CCCS). DATA SOURCES: Three CCCS indicators of care components, actions, and outcomes in conjunction with Clinical Care Pathways (CCPs). DATA SYNTHESIS: The cost of patient care is based on the type of action time multiplied by care components and nursing costs. CONCLUSIONS: The CCCM for the CCCS makes it possible to measure and cost out clinical practice. IMPLICATIONS FOR PRACTICE: The CCCM may be used with CCPs in the electronic patient medical record. The CCPs make it easy to track the clinical nursing care across time, settings, population groups, and geographical locations. Collected data may be used many times, allowing for improved documentation, analysis, and costing out of care.