Best practices for perioperative nursing care for weight loss surgery patients

OBJECTIVE: To describe the unique nursing responsibilities involved in providing nursing care to severely obese weight loss surgery patients and to develop evidence-based guidelines for safe patient care. RESEARCH METHODS AND PROCEDURES: We performed a systematic review of the scientific literature using MEDLINE and CINAHL. A specific search of nursing journals from 1985 to 2004 identified 134 articles; 16 were found to be pertinent. These were reviewed in detail and used in the context of this report. The quality of the evidence was graded according to a system derived from established evidence-based models. Recommendations were developed from published evidence and expert opinion. RESULTS: This Task Group found that safe and competent nursing care requires assessment of, and provision for, the complex physical and psychological needs of weight loss surgery patients. We developed evidence-based guidelines for preoperative, perioperative, and postoperative care that address risk factors unique to severely obese patients. We also addressed issues related to the use of proper body mechanics and positioning to avoid on-the-job injury to nursing staff. DISCUSSION: We found that patient safety is best served when nurses are specifically trained to deal with the physical, medical, and psychosocial needs of severely obese patients and when they play an integral role in the multidisciplinary healthcare team. This role should start with a patient's first contact with the system and continue through discharge and follow-up. Special attention needs to be paid to the widespread bias and discrimination that severely obese individuals often experience.     

The importance of place of residence in predicting late-stage diagnosis of breast or cervical cancer

We tested whether inner-city women were at significantly increased risk of late-stage cancer diagnosis because they resided in extremely poor and socially isolated neighborhoods or in neighborhoods meeting the federal definition of a medically underserved area (MUA). Cancer registry data on women in three American cities were matched to Census data. Using logistic regression we found that residence in economically and socially distressed or medically underserved neighborhoods tended to increase the likelihood of late-stage cancer diagnoses. Further, we found that not all areas that are economically and socially distressed receive the federal MUA designation. Consequently, we argue that economically and socially distressed neighborhoods should be automatically designated as MUA.     

Synthesis and evaluation of cryptolepine analogues for their potential as new antimalarial agents.

The indoloquinoline alkaloid cryptolepine 1 has potent in vitro antiplasmodial activity, but it is also a DNA intercalator with cytotoxic properties. We have shown that the antiplasmodial mechanism of 1 is likely to be due, at least in part, to a chloroquine-like action that does not depend on intercalation into DNA. A number of substituted analogues of 1 have been prepared that have potent activities against both chloroquine-sensitive and chloroquine-resistant strains of Plasmodium falciparum and also have in common with chloroquine the inhibition of beta-hematin formation in a cell-free system. Several compounds also displayed activity against Plasmodium berghei in mice, the most potent being 2,7-dibromocryptolepine 8, which suppressed parasitemia by 89% as compared to untreated infected controls at a dose of 12.5 mg kg(-1) day(-1) ip. No correlation was observed between in vitro cytotoxicity and the effect of compounds on the melting point of DNA (DeltaT(m) value) or toxicity in the mouse-malaria model.     

Development of taxane resistance in a panel of human lung cancer cell lines.

Using a selection process designed to reflect clinically relevant conditions, a panel of taxane-selected variants were developed to study further the mechanisms of resistance in lung cancer. Unlike continuous or pulse exposure to high concentrations of chemotherapeutic drugs which yield high resistance and often cross resistance, most variants developed here displayed low level resistance to the selecting drug with slight cross-resistance. Pulsing with taxol resulted in more highly resistant clones (up to 51.4-fold). Analysis of taxol and taxotere in the four major lung cancer cell types showed the taxanes to be more effective against NSCLC (with the exception of SKMES-taxane selected variants) than against the SCLC. Comparison of taxol and taxotere shows that taxol induces higher levels of resistance than taxotere. Further, in taxotere-selected cell lines, the cells are more resistant to taxol than taxotere, suggesting that taxotere may be a superior taxane from a clinical view. Taxol treatment resulted in increased cross-resistance to 5-FU in all classes of lung cancer except DMS-53. The high levels of Pgp in the DMS-53 and selected variant suggests this mechanism is not related to Pgp expression. Analysis of the Pgp and MRP-1 status by combination inhibitory assays and Western blotting showed no consistent relationship between expression of the membrane pumps Pgp or MRP-1 and resistance. However, where high level resistance was seen, the parent cell line expressed Pgp or MRP-1 and was accompanied by increased levels in the variants. Overall we found that the clinically relevant models used here are useful for investigating mechanisms of taxane resistance.     

Human herpesvirus 8-encoded interleukin 6 activates HIV-1 in the U1 monocytic cell line.

OBJECTIVE: Human herpesvirus 8 (HHV-8) encodes a viral interleukin 6 (vIL-6) which is structurally and functionally similar to human interleukin 6 (hIL-6). Since hIL-6 has been shown to upregulate the expression of HIV-1, the objectives of this study were to examine the ability of vIL-6 to upregulate HIV-1, and to determine the interactions of this virokine (viral cytokine) with the components of the interleukin 6 (IL-6) receptor complex. DESIGN AND METHODS: Recombinant HHV-8 vIL-6 (rvIL-6) was assayed for bioactivity in the IL-6-dependent cell line MH60.BSF2. HIV-1 p24 production by the U1 monocytic and ACH-2 T-cell lines, which are chronically infected with HIV-1, was used to assess the ability of vIL-6 to affect HIV-1 expression. hIL-6 and vIL-6 receptor utilization was determined by quantifying HIV-1 p24 production after neutralization of components of the IL-6 receptor complex, CD126'IL-6R' and CD130'gp130', on U1 cells with blocking antibodies. RESULTS: HHV-8 rvIL-6 was seen to have IL-6-like bioactivity in MH60.BSF2 cells, and readily upregulated HIV-1 p24 production in U1 monocytic cells, but not in ACH-2 T cells. The vIL-6 appeared to utilize the IL-6-specific component of the IL-6 signaling complex, CD126'IL-6R', in U1 cells. CONCLUSIONS: HHV-8 vIL-6 clearly has the potential to upregulate HIV-1 expression in monocytic cells, and therefore may play a role in AIDS pathogenesis in individuals infected with both viruses.     

Technical considerations in pectoralis major transfer for treatment of the paralytic elbow

Modification of pectoralis major transfer as originally described by Clark in 1946 have not addressed concerns such as diminished strength and excursion of the transfer, along with obligatory supination of the forearm. Postoperative scarring from the long oblique chest incision further compounds the psychological impairment that accompanies brachial plexopathy. One hundred forty-three brachial plexopathies were seen over a five-year period. Seven pectoralis major transfers were done to restore elbow flexion in patients with C5-6 and C5-6-7 cord injuries. Mean age and follow-up were 26 years and 25 months respectively. The modifications of this transfer we use improve strength and range of motion by preserving dual innervation of the muscle, by tubularization of the transfer, and by restoration of the transverse aponeurosis as a fascial pulley. By transfer of the pectoralis insertion to the acromion, further anterior shoulder stability may be obtained. Aesthetics can also be improved by use of selected midline and deltopectoral incisions, along with preservation of the remaining pectoralis major and minor.