Adverse effects from inappropriate medication administration via a jejunostomy feeding tube.

Numerous complications can arise when administering medications to patients receiving continuous enteral feeding. We report a case of a patient who could not be fed by mouth and was receiving continuous jejunal enteral feeding who had an adverse event associated with inappropriate administration of a medication via his jejunostomy tube. He had taken an extended-release niacin product before hospitalization for type IIb hyperlipidemia. The patient was inappropriately given a single dose of 750 mg of niacin as the short-acting tablets that were crushed and administered via the jejunostomy tube. He experienced severe cutaneous flushing, a feeling of warmth, itching, nausea, and emesis. He was noted to have "prickly heat" to the forehead, according to the nursing notes. A discussion of problems and guidelines for medication administration in adult patients receiving continuous tube feeding is provided.     

Comparison of changes in blood pressure measurements and antihypertensive therapy in older, hypertensive, ambulatory care patients prescribed celecoxib or rofecoxib

STUDY OBJECTIVE: To determine if changes in blood pressure and changes in class or dosing of antihypertensive drugs were significantly different in patients treated with celecoxib versus rofecoxib, two cyclooxygenase (COX)-2 inhibitors. DESIGN: Retrospective cohort study. SETTING: Thirty-one ambulatory care practices that shared an electronic medical record. PATIENTS: Nine hundred sixty men and women over age 55 years with stable hypertension. INTERVENTION: Patients had to have at least a 30-day supply of celecoxib or rofecoxib (any dose) prescribed between July 1, 1999, and June 30, 2000. MEASUREMENTS AND MAIN RESULTS: Patients were followed for 6 months, and logistic regression and survival models were used to compare outcomes between groups while adjusting for confounders. Baseline characteristics of 517 patients receiving celecoxib and 443 receiving rofecoxib were similar. No significant differences were observed, regardless of the COX-2 inhibitor prescribed, in the proportion of patients whose systolic blood pressure increased by 20 mm Hg, whose diastolic blood pressure increased by 15 mm Hg, or who were prescribed a new class of antihypertensive drug. Compared with patients taking celecoxib, those taking rofecoxib were significantly more likely (odds ratio 1.68, 95% confidence interval 1.09-2.60) to have had the dosage of their antihypertensive drug increased and also the dosage increased sooner (p<0.05). New-onset cardiac and renal comorbidity, number of physician visits, and changes in body weight and laboratory values were not significantly different between the groups. CONCLUSION: No significant differences in blood pressure changes or in the proportion of patients who were prescribed a new class of antihypertensive drug were found between rofecoxib- and celecoxib-treated patients. However, significantly more rofecoxib-treated patients had the dosage of their existing antihypertensive drug increased compared with those receiving celecoxib.     

Internet users becoming immersed in the virtual world. Implications for nurses

Worldwide, people are using the Internet for computer-mediated communication (CMC) in increasing numbers. Nurse researchers have begun to examine the use of this medium for communication, education, and support of their clients. Therefore, it is important to know the experiences and meanings of CMC if the Internet is to be used for nursing interventions. The purpose of this study was to examine the experiences and meaning of online communications for frequent Internet users and discuss implications for nursing practice. Four virtual focus groups consisting of a total of 32 individuals were included in this study. Their stories of everyday Internet use were analyzed by hermeneutic interpretation. Six related themes and 1 constitutive pattern emerged from the data: (1) Internet as a resource for communication, information, and entertainment; (2) Internet as appealing, drawing one into frequent use; (3) developing dependencies; (4) Internet as frustrating; (5) learning the rules; and (6) developing physical and psychosocial effects. The constitutive pattern is immersion into the virtual world. This knowledge can be used to identify the potential effects of integrating the Internet into nursing interventions. Nurses who plan Internet-based interventions need to understand the appeal of this medium as well as the limitations and barriers to use.     

Effects of fibrin glue on injured rabbit ureter

BACKGROUND AND OBJECTIVE: Fibrin glue is used as a hemostatic agent, has potential as a tissue adhesive, and may promote tissue healing. The histologic effects of fibrin glue on the ureter have not yet been fully investigated. We studied the effect of fibrin glue on the thickness of various layers of injured and uninjured ureters and its effect on vessel density in the rabbit model. MATERIALS AND METHODS: Rabbits were divided into two groups. The ureters were exposed using a midline abdominal incision. In the study group, one of the ureters was crushed, and fibrin glue was instilled around both ureters. In the control group, one of the ureters was crushed, but no fibrin glue was instilled. The animals were sacrificed at 6 weeks and the ureters examined histologically. Using NIH Image Analysis solftware, the thickness of the urothelium, muscular, and adventitial layers and the cross-sectional area of the ureters were measured. The vessel density of the ureters was also assessed. RESULTS: Whereas the thickness of the epithelium was increased in the crushed ureters treated with fibrin glue (20.7 microm v 15.3 microm), the thickness was reduced in the uncrushed ureters treated with fibrin glue compared with controls (16.3 microm v 19.8 microm). There was no statistically significant difference in the thickness of the muscular or adventitial layers in the study and control groups. There was a reduction in the cross-sectional area of the uncrushed ureters treated with fibrin glue compared with controls (7,095 microm2 v 9,409 microm2). In addition, the vessel density in the crushed ureters was reduced in ureters treated with fibrin glue compared with controls (0.00067/microm2 v 0.00108/micro2). In the uncrushed ureters, the difference was not statistically significant. CONCLUSIONS: Fibrin glue has potential as an adhesive agent in the ureter and may promote healing. It may affect epithelial layer thickness and vessel density of the ureter, but these effects were variable. Fibrin glue does not appear to have significant effects on the ureteral muscular and adventitial layers or on the overall cross-sectional area of all three layers. These results indicate that fibrin glue does not appear to have a detrimental effect on the ureter.     

The outcome of 369 ECT consultations

OBJECTIVE: The components of a pre-ECT consultation have been well-described, but the outcome has not been described. We describe the outcome of 369 consecutive ECT consultations. METHODS: We performed a retrospective review of ECT consultations performed at Wake Forest University School of Medicine between January 23, 1992, and October 22. 1998. Each consultation was coded as either recommending against ECT, unenthusiastic about ECT, or recommending ECT. RESULTS: Thirteen percent of the patients at their first consultation needed clarification of their capacity to consent to ECT. Additional testing was recommended in 34%, and additional medical consultation was recommended for 11% of the patients. The ECT consultation recommended against ECT for 4% of patients, was unenthusiastic for an additional 15% of patients, and was enthusiastic for 81%. Likelihood of receiving ECT was strongly influenced by the consulting physician's level of enthusiasm for ECT. Enthusiasm for ECT, in turn, was highly related to diagnosis. CONCLUSIONS: The recommendations from an ECT consultation appeared influential in the likelihood of receipt of ECT. The consultation's enthusiasm for ECT, in turn, was related to the patient's diagnosis. Furthermore, the consultation revealed the need for additional testing, medical consultation, or clarification of capacity to consent in a substantial number of patients.     

Traumatic wound care

The scope and importance of traumatic wound care, assessment, debridement, pre and postoperative management, and subsequent skin care during the course of treatment cannot be over-emphasized, and indeed, are the most important considerations for functional and cosmetic outcome. Care begins in the emergent phase and continues through acute and convalescent phases. Efforts are directed at methods and techniques which prevent infection, facilitate wound healing, promote comfort, and at the same time, maintain optimal function and minimize deformities.     

2,3,7,8-Tetrachlorodibenzo-p-dioxin inhibition of 17 beta-estradiol-induced increases in rat uterine epidermal growth factor receptor binding activity and gene expression

Treatment of immature female Sprague-Dawley rats with 17 beta-estradiol (5 micrograms/animal) resulted in an increase in uterine epidermal growth factor (EGF) receptor binding activity. Moreover, in a separate study it was also shown that 17 beta-estradiol increased steady-state levels of rat uterine EGF receptor mRNA as determined by Northern analysis. In contrast, 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) caused a dose-response decrease in constitutive rat uterine EGF receptor binding activity and this was paralleled by a decrease in steady-state levels of uterine EGF receptor mRNA. Cotreatment of the animals with both TCDD (16 nmol/kg) and 17 beta-estradiol (5 micrograms/rat) gave results which showed that TCDD significantly inhibited the estrogen-induced increases in rat uterine EGF receptor binding activity and EGF receptor mRNA levels. These results further extend the range of antiestrogenic properties of TCDD and suggest that the inhibition of growth factor expression may play a role in the growth-inhibiting properties of TCDD in estrogen-responsive tissues or cells.