Quality of life in children and adolescents with cancer

Quality of life for children and adolescents who have cancer is a personal, subjective experience that is influenced by the individual's internal, immediate, and institutional environments. Quality of life is most accurately assessed on an individual basis with each child or adolescent serving as his/her own standard.     

Exposure of firefighters to diesel emissions in fire stations

Personal sampling techniques were used to evaluate firefighter exposure to particulates from diesel engine emissions. Selected fire stations in New York, Boston and Los Angeles were studied. Firefighter exposure to total particulates increased with the number of runs conducted during an 8-hr period. In New York and Boston where the response level ranged from 7 to 15 runs during an 8-hr shift, the resulting exposure levels of total airborne particulates from diesel exhaust were 170 to 480 micrograms/m3 (TWA). Methylene chloride extracts of the diesel particulates averaged 24% of the total. The authors' findings suggest that additional research is necessary to assess fire station concentrations of vehicle diesel exhaust that may have adverse health consequences to firefighters.     

Developing nursing care guidelines for children with Hodgkin''s disease

Oncology patients are generally treated on therapeutic research protocols that detail medical treatment. Nursing care is not clearly defined in these protocols; therefore, the need to develop a set of guidelines specifically for nursing care was identified. To further enhance the specialized care that our pediatric oncology patients receive, we developed nursing care guidelines to accompany specific protocols. One of our most highly accruing protocols is designed to treat patients diagnosed with Hodgkin's disease. In an effort to increase understanding of this clinical trial, decrease potential for errors, and improve overall quality of patient care, nursing care guidelines were created. To develop the nursing care guidelines, nurses created a seven-step process: (1) studied the therapeutic protocol, established ongoing interactions with the principal investigator (brainstorming), reviewed benchmarking, (2) created the first draft of the guidelines, compared the formatting of this particular set of guidelines with those previously developed at this setting (drafting), (3) field tested guidelines, (4) revised the guidelines and subjected them to additional field testing, (5) examined the guidelines for implications related to teaching tools, (6) implemented the guidelines through in-services, and (7) developed an evaluation plan with pre- and post-tests that indicated improved disease and treatment knowledge among participating nurses. Potential contributions from implementing nursing care guidelines that parallel therapeutic protocols include more accurate and complete research data collection and a more defined role for nurses in the protocol development process. The guidelines also offer a useful, detailed resource to deliver complex protocol-directed care.     

Reversible tetraplegia due to polyneuropathy in a diabetic patient with hyperosmolar non-ketotic coma

Critical illness polyneuromypathy has not previously been reported as a complication of diabetic coma. We describe a patient with hyperosmolar non-ketotic coma (HONK) complicating gram-negative sepsis in whom persistent coma and profound tetraplegia caused considerable concern. Although, initially, it was feared that the patient had suffered a central neurological complication such as stroke or cerebral oedema, a diagnosis of critical illness motor syndrome (CIMS) was subsequently confirmed neurophysiologically. Profound limb weakness associated with HONK is not necessarily due to a catastrophic cerebral event, rather it may be a result of CIMS, which has an excellent prognosis for full neurological recovery. Received: 4 June 1999 Accepted: 22 September 1999     

Development and testing of the Role-related Meaning Scale for Staff in Pediatric Oncology

The purpose of this study was to develop and test the Role-Related Meaning Scale for Staff in Pediatric Oncology (RRMS) to determine the internal consistency and the content and construct validity of this two-phase instrument. During phase 1 (item generation, content validation, and initial field testing), 23 nurses from two cancer centers participated, and during phase 2 (instrument testing), 89 nurses from one pediatric research center participated. The nurses completed either the RRMS only (phase 1) or six instruments including the RRMS (phase 2) to assess the following research variables: role-related meaning, group cohesion, organizational commitment, work satisfaction, and intent to leave. The RRMS was revised after phase 1 because the results yielded a ceiling effect and three overlapping items. The Cronbach alpha for the phase 2 total RRMS was.83, and four of the five hypothesized relations were confirmed (P =.04). Therefore, the RRMS was concluded to be an internally consistent instrument that has content validity and beginning construct validity. Future studies will examine whether the RRMS adequately measures the change in meaning brought about by interventions designed to increase role-related meaning among nurses.     

Bilirubin,a new therapeutic for kidney transplant?

In patients with end-stage renal disease, kidney transplantation has been associated with numerous benefits, including increased daily activity, and better survival rates. However, over 20% of kidney transplants result in rejection within five years. Rejection is primarily due to a hypersensitive immune system and ischemia/reperfusion injury. Bilirubin has been shown to be a potent antioxidant that is capable of potentially reversing or preventing damage from reactive oxygen species generated from ischemia and reperfusion. Additionally, bilirubin has several immunomodulatory effects that can dampen the immune system to promote organ acceptance. Increased bilirubin has also been shown to have a positive impact on renal hemodynamics, which is critical post-transplantation. Lastly, bilirubin levels have been correlated with biomarkers of successful transplantation. In this review, we discuss a multitude of potentially beneficial effects that bilirubin has on kidney acceptance of transplantation based on numerous clinical trials and animal models. Exogenous bilirubin delivery or increasing endogenous levels pre- or post-transplantation may have therapeutic benefits.     

Motivational forces affecting participation in post-registration degree courses and effects on home and work life: a qualitative study

Motivational forces affecting participation in post-registration degree courses and effects on home and work life: a qualitative study ¶ Over the past decade, pre- and post-registration education for nurses and midwives in the United Kingdom has undergone major change, creating an atmosphere where continuing professional development is a matter of priority for individual health care staff. Against this context of change, and as part of a larger study of continuing education and training in the National Health Service, a cohort of participants in a part-time health studies degree course were interviewed using a semi-structured schedule. Twenty-nine nurses, midwives and allied professional staff described their motives for participation in the course and its effects on their professional and personal lives. Data collected in interviews were analysed using qualitative methods and revealed that participation was encouraged by both professional and personal factors. For many staff participation was prompted by negative feelings about themselves and their professional status. Participation in the course was associated with (largely negative) changes in home and family life and most participants faced additional financial burdens. The findings of the study have implications for policy relating to the funding of continual professional education for nurses and other health care staff. Health care staff are receiving mixed messages about continuing education from policy makers and employers. Dependence on willingness and ability to pay for post-registration degree-level studies is unlikely to be an efficient or equitable means of ensuring lifelong learning for healthcare staff.     

The role of extracellular matrix composition in structure and function of bioengineered skeletal muscle

One of the obstacles to the potential clinical utility of bioengineered skeletal muscle is its limited force generation capacity. Since engineered muscle, unlike most native muscle tissue, is composed of relatively short myofibers, we hypothesized that, its force production and transmission would be profoundly influenced by cell-matrix interactions. To test this hypothesis, we systematically varied the matrix protein type (collagen I/fibrin/Matrigel) and concentration in engineered, hydrogel-based neonatal rat skeletal muscle bundles and assessed the resulting tissue structure, generation of contractile force, and intracellular Ca(2+) handling. After two weeks of culture, the muscle bundles consisted of highly aligned and cross-striated myofibers and exhibited standard force-length and force-frequency relationships achieving tetanus at 40?Hz. The use of 2?mg/ml fibrin (control) yielded isometric tetanus amplitude of 1.4?±?0.3?mN as compared to 0.9?±?0.4?mN measured in collagen I-based bundles. Higher fibrin and Matrigel concentrations synergistically yielded further increase in active force generation to 2.8?±?0.5?mN without significantly affecting passive mechanical properties, tetanus-to-twitch ratio, and twitch kinetics. Optimized matrix composition yielded significant cellular hypertrophy (protein/DNA ratio?=?11.4?±?4.1 vs. 6.5?±?1.9?μg/μg in control) and a prolonged Ca(2+) transient half-width (Ca(50)?=?232.8?±?33.3 vs. 101.7?±?19.8?ms). The use of growth-factor-reduced Matrigel, instead of standard Matrigel did not alter the obtained results suggesting enhanced cell-matrix interactions rather than growth factor supplementation as an underlying cause for the measured increase in contractile force. In summary, biomaterial-based manipulation of cell-matrix interactions represents an important target for improving contractile force generation in engineered skeletal muscle.