Criteria used by nurses to evaluate practice-related information on the World Wide Web

Existing criteria used to evaluate information on the World Wide Web often are not related to nursing, especially in relation to clinical and evidence-based practice. Published criteria have been found orientated to the health-consumer, medicine, or general information. In this study, the process by which nurses evaluate practice-related information and the associated evaluative nursing criteria were investigated using a grounded theory approach. In the first stage of this ongoing investigation, semistructured interviews were used to collect data from UK postregistration nursing students. The findings from this initial study provided indications of the process and the criteria for evaluating information on the World Wide Web. Participating students identified intuition as part of the evaluative process. They identified some criteria similar to existing standards, but critically, with additional criteria that are nursing practice related. Because these new criteria are significant for evaluating nursing information, further refinement of these findings is being undertaken through the next stage of the research program.     

Selective inhibition of cyclooxygenase 2 induces p27kip1 and skp2 in oral squamous cell carcinoma

It has been shown that inhibition of cyclooxygenase 2 (COX-2) may cause growth arrest and reduced tumour formation in some human cancers; however, the mechanism is not fully known. In this study, we used an oral squamous cell carcinoma cell line to study growth inhibition and changes in critical cell cycle-regulating proteins induced by the selective COX-2 inhibitor celecoxib. Using cell viability assay, we established the optimal in vitro inhibitory dose of celecoxib and showed that inhibition of COX-2 markedly induces the expression of p27kip1, p21, waf1, and the F-box protein skp2. These results add new experimental data to our knowledge of the mechanism of cyclooxygenases on neoplastic cells.     

Duration of patency of laser-assisted tympanic membrane fenestration

BACKGROUND: Laser-assisted tympanic membrane fenestration (LTMF) provides intermediate-duration middle ear ventilation, which benefits selected children with acute otitis media (AOM) and otitis media with effusion (OME). OBJECTIVE: To evaluate clinical and technical factors that may affect duration of LTMF patency. DESIGN: Prospective clinical cohort effectiveness trial. SETTING: Four tertiary care children's hospitals. PATIENTS: Volunteer sample of 251 children (430 ears) followed up at 1, 2, 3, 4, 8, and 12 weeks; time to fenestration closure was evaluable in 201 ears, and assessment of cure at study conclusion was evaluable in 128 ears. INTERVENTIONS: Laser-assisted tympanic membrane fenestration for prospectively defined AOM or OME. The surgeon determined spot size, wattage, and concurrent adenoidectomy based on clinical judgment. MAIN OUTCOME MEASURES: Cure of AOM/OME with effusion at 90 days and duration of LTMF patency relative to spot size (1.8-2.8 mm), fenestration location on tympanic membrane, power (7-22 W), concurrent adenoidectomy, age, diagnosis (AOM vs OME), type of effusion, and preoperative tympanogram characteristics. Results are based on the number of ears that could be evaluated at each data collection interval. RESULTS: Fenestrations remained patent for 2 to 4 weeks (mean = 2.52, median = 2.0, SD = 1.4, n = 201); 97.4% were closed at 6-week follow-up. Spot sizes of 2.4 and 2.6 mm had a higher rate of patency than 2.0-mm spot size at 3 weeks following LTMF. Cure at 90 days was related to duration of patency for all patients combined and for patients treated for AOM and OME, but not for those undergoing adjunctive adenoidectomy. Cure at 90 days was related to larger spot size for all patients combined and those treated for AOM. Other investigated factors did not achieve statistical significance. CONCLUSIONS: Spot size of 2.4 mm or greater results in improved duration of LTMF patency, persisting for up to 3 weeks after LTMF, especially for treatment of AOM. Increased duration of LTMF patency correlates with greater incidence of cure of middle ear effusion at 90 days. Additional investigation is indicated to determine optimum spot size and optimum duration of patency for disease- severity-adjusted populations.     

Laboratory-based evaluation of a compression-bandaging system

Graduate external compression is a key factor in the successful treatment of venous leg ulcers, but can be damaging if used inappropriately. A new type of bandage has been designed to minimise the risk of tissue damage by controlling the amount of tension within the bandage during application. This laboratory study suggests that the bandage meets its design criteria, and highlights the importance of correct application to avoid excessive sub-bandage pressure.     

The efficacy of a local ascorbic acid-rich food in improving iron absorption from Mexican diets: a field study using stable isotopes

BACKGROUND: One potentially sustainable approach to improving iron status at the community level is to encourage the consumption of local ascorbic acid-rich foods, in conjunction with meals high in nonheme iron. OBJECTIVE: The study, conducted in rural Mexico, measured stable isotopes of iron to evaluate the effect on iron absorption of the addition of 25 mg ascorbic acid as agua de limón (limeade) to 2 typical meals per day for 2 wk. DESIGN: Fifteen nonpregnant, nonlactating, iron-deficient (ferritin < 12 microg/L) women (x +/- SD age: 28.3 +/- 7.7 y) fasted overnight and were brought to a community clinic. After an initial blood sample, subjects consumed 0.25 mg (57)Fe with both breakfast and lunch for 14 d. On day 29, another blood sample was taken, and a reference dose of 2.7 mg (58)Fe with 25 mg ascorbic acid was given. For the following 15 d, participants consumed 0.25 mg (57)Fe added to both breakfast and lunch with 25 mg ascorbic acid added to each meal as limeade. A final blood sample was taken on day 59. RESULTS: Iron absorption was calculated from recovery of isotopes in blood obtained 14 d after administration of each isotope. When 25 mg ascorbic acid as limeade was added to test meals twice a day for 2 wk, iron absorption increased significantly (P < 0.001) in every subject: the mean absorption rose from 6.6 +/- 3.0% to 22.9 +/- 12.6%. CONCLUSIONS: The consumption of 25 mg ascorbic acid as limeade twice daily with meals substantially improved iron absorption and may improve the iron status of nonpregnant, nonlactating, iron-deficient women.     

Smoking,physical activity and breakfast consumption among secondary school students in a southwestern Ontario community

OBJECTIVES: To determine the prevalence of smoking, low levels of physical activity, and missing breakfast among students (n=318) in grades 9 through 12 in three schools in southwestern Ontario; to see if these behaviours were associated; and, whether there were gender differences. METHODS: A self-administered survey was conducted in grade 10 English classes. RESULTS: The response rate was 87.1%. The prevalence of smoking was 36.2%; there was no gender difference. Only 42.8% of students ate breakfast daily; 48.8% of boys and 36.1% of girls (chi2 = 5.2; p<0.05). A higher proportion of boys (77.1%) were active for at least 30 minutes > or = 3 times/week compared to girls (66.0%) (chi2 = 4.8; p<0.05). Students who were active > or = 3 times/week were more likely to eat breakfast daily and, among boys, 60.4% of non-smokers ate breakfast daily compared to 31.9% of those currently smoking (chi2 = 13.3; p<0.001). There were no differences among girls. More girls (63.9%) were concerned about gaining weight compared to boys (36.1%) (chi2 = 37.7; p<0.001). Among girls, a higher proportion of those who were concerned about gaining weight were less likely to engage in physical activity or smoke, and more likely to skip breakfast compared to those who were not concerned. DISCUSSION: Weight concern was not associated with frequency of physical activity, smoking, or breakfast consumption among boys. The high prevalence rates for these behaviours suggests that interventions in high schools should include daily physical activity, promotion of breakfast eating (either at home or in the school), and encouragement to quit smoking.     

A randomized comparison of propofol and methohexital as general anesthetics for vacuum abortion

The objective of this study was to determine whether propofol and methohexital differ in their efficacy, acceptability, cost and side effects when used as the single anesthetic agent for inducing general anesthesia in first-trimester vacuum abortion. We randomized 400 unpremedicated American Society of Anesthesiologists grade I-II women to receive 1% propofol or 1% methohexital by intravenous bolus infusion during abortion. No ancillary anesthetic or adjunctive drugs were used. Visual analogue scale scores were used to grade preoperative patient anxiety and the quality of the anesthetic experience. All personnel outside the operating suites, except the data analyst, were blinded. Chi2, median, analysis of variance and Student's t-tests were used, as appropriate. There were no statistically significant differences in age, gravidity, parity, spontaneous and induced abortion, body mass index or gestational age. Mean total operating time and total drug dose were similar. Propofol use resulted in a significant reduction in the incidence of postoperative nausea (11.5% vs. 17.5%) or vomiting (3.5% vs. 7.0%) with a combined p (mean difference) = 0.002 (95% confidence interval of the mean difference 1.8%, 17.2%). Both the nursing and patient appraisals of the quality of the anesthetic experience favored propofol, but only the nursing scores reached statistical significance (p < 0.001). The cost differential was more than twofold greater for propofol patients, 9.51 dollars vs. 4.42 dollars. In our population of midwestern patients in a major urban area, propofol use had modest advantages over methohexital when used as single agents as judged by first recovery charge nurses, but patients found them equally acceptable.     

Combined Phacoemulsification, Intraocular Lens Implantation and Trabeculectomy for Chronic Angle Closure Glaucoma

Purpose: To investigate the results of combined phacoemulsification, intraocular lens implantation and trabeculectomy in Asian patients with chronic angle closure glaucoma (CACG). Methods: This was a retrospective non-comparative case series of 55 consecutive patients (57 eyes) who underwent phacoemulsification, posterior chamber intraocular lens implantation and trabeculectomy for CACG at the Singapore National Eye Centre between 1997–1998. The surgical outcome was assessed in terms of intraocular pressure (IOP), the incidence of complications and the visual acuity at last follow-up. Success was defined as final IOP 21 mmHg without medication and qualified success as final IOP 21 mmHg with medication. Patients with final IOP > 21 mmHg who required further glaucoma surgery, lost light perception or became pthisical, were classified as failures. The eyes were further categorized into two groups according to whether single-site or separate-sitesurgery was performed. The outcome was also compared among eyes in which per-operative antimetabolites were applied to the trabeculectomy site and those without antimetabolites. Results: The mean follow up was 22.0 ± 5.6 months (mean ± SD). Success was achieved in 46 (81%) eyes, qualified success in 10 (17%) eyes, and failure in 1 (2%) eye. In terms of IOP outcome, the success rate was similar in the two surgical groups (single-site or separate-site).There was no significant difference in IOP outcome among eyes in which per-operative antimetabolites were used and eyes with no per-operativeantimetabolites use. Forty-one eyes (72%) had 6/12 or better vision. There were no cases of intraoperative complications and the incidence of postoperative complications was low. Conclusions: Combined phacoemulsification, intraocular lens implantation and trabeculectomy is associated with good intraocular pressure control and visual outcome in patients with CACG.