Partnership caring

• ? ‘Partnership caring’ emphasizes the current paediatric practices and their importance in paediatric nursing Today.
• ? The importance in not compromising care in a rapidly changing health scene is described when shrinking resources and increasing constraints put pressure on the health services.
• ? Important concepts such as pre-admission programmes, creating the right environment for the child, family-centred care, parent participation, family accommodation and supporting services, nursing documentation, the rights of the child and family, specialist and community nursing services as well as children's out-patient services providing the vital link in the continuum of care are all emphasized. They show how these became ideas 5–6 years ago but are now firmly established in the philosophy of family-centred care.
• ? In the new health service today, paediatric nurses face new challenges which emanate from the children and parents served, but also from within new clinical directorate structures. ‘However, within our new world of clinical directorates and when the clinical director has the executive authority to make and influence decisions, and when segmentalization of paediatric services becomes a real threat (and in some places this is happening now!) paediatric nurses must remember the children. We must stand firm in our values and beliefs and above all we must not allow these changes to compromise the care we give to children and their families.’

     

Revisit the Cavernous Sinus from Fetus to Adult—New and Old Data

This article highlighted three advances in the study of the cavernous sinus: (1) the initial formation of the sinus reticulum in early development of the sphenoid bone before ossification (2) extension of reticulum of the sinus and connection with other venules, and (3) the cavernous sinus and the nerves evolved inside this sinus during gestation, for example, the trigeminal nerve already formed bundles of motor and parasympathetic components during fetal development. This ontogenetic study further confirmed the cavernous sinus is not a single or a dual set of sinuses, but a group of extensions of venous sinuses or sinusoids. These new insights were integrated with previous understandings of the cavernous sinus to form this review article. Anat Rec, 301:819–824, 2018. © 2017 Wiley Periodicals, Inc.     

Severe haemophilia A in a female resulting from two de novo factor VIII mutations

Summary. A 2-year-old girl is described with severe haemophilia A (factor VIII: C <0-01 units/ml). Both of her parents were phenotypically normal. Cytogenetic analysis on the proband demonstrated an interstitial X chromosome deletion encompassing Xq26-q28. Molecular studies with several polymorphic markers close to and within the factor VIII gene showed that the proband had inherited only the paternal factor VIII gene, indicating that the X chromosome deletion had occurred de novo in the maternal germ line. Further study of the factor VIII gene inherited by the proband from her father showed the presence of a de novo gene inversion mutation (a type 1, distal pattern inversion). Neither parent showed any evidence of the factor VIII inversion in their somatic DNA. The severe haemophilia A documented in this girl is therefore the result of two de novo mutations affecting the factor VIII gene, a maternally derived X chromosome deletion and a paternal factor VIII inversion mutation.     

Prognosis in Patients with Left Ventricular Dysfunction and Ventricular Tachycardia Following Programmed Ventricular Stimulation

We performed programmed ventricular stimulation on 69 patients with left ventricular ejection dysfunction (ejection fraction < 50%) and clinically recognized ventricular tachycardia including 28 patients with sustained ventricular tachycardia and 41 patients with nonsustained ventricular tachycardia. An inducible arrhythmia (> 6 beats ventricular tachycardia) was found in 74% of patients. Patients with clinically sustained arrhythmias were frequently inducible (89%) with a high incidence of inducible monomorphic ventricular tachycardia (82%). Patients with clinically nonsustained ventricular tachycardia had a lower rate of inducibility (63%) including a high incidence of inducible polymorphic ventricular tachycardia (27%). Inducible patients with left ventricular dysfunction and ventricular tachycardia had a low incidence of electrophysiologically demonstrated effective drug therapy (16%). However, if an effective drug was found, the prognosis was good. Empirical drug therapy was associated with a poor prognosis in inducible and noninducible patients. Finally, an unfavorable prognosis was associated with a clinically sustained arrhythmia, a lower ejection fraction, and the presence of a left ventricular aneurysm. An inducible arrhythmia did not predict an unfavorable course. Indeed, patients with noninducible ventricular tachycardia in this group of patients were still at risk for sudden cardiac death.     

The Effect of Posture on the Response to Atrioventricular Synchronous Pacing in Patients with Underlying Cardiovascular Disease

In order to determine whether the hemodynamic benefit of atrioventricular synchronous pacing is maintained in the upright position, 14 patients with dual chamber pacemakers were paced in VVI mode and DDD mode in both the supine and standing position. The hemodynamic response was assessed by measuring the velocity time integral derived from the pulsed-wave Doppler signal in the left ventricular outflow tract during VVI pacing and dual chamber pacing at three different AV delays (125, 200, 250 ms). In the supine position, the velocity time integral during VVI pacing was 14.6 ± 3.0 cm and this increased during DDD pacing at all three AV delays (17.7 ± 3.3, 17.9 ± 3,0, 17.5 ± 3.5 cm). In the upright position, the velocity time integral during VVI pacing was 12.9 ± 3.5 cm and this increased with DDD pacing (15.5 ± 3.3, 15. 1 ± 4.0, 15.1 ± 3.9 cm). It was concluded that although stroke volume decreases when assuming the upright position, the beneficial response to dual chamber pacing is maintained and equals that observed in the supine position.     

Reactions to Aquaphor®: Is Bisabolol the Culprit?

Abstract:  Bisabolol is a sesquiterpene alcohol compound derived from the German chamomile plant, a member of the Compositae family. Only two case reports of adults with allergic contact dermatitis to this chemical exist in the literature, and we describe three more cases of children with recalcitrant atopic dermatitis found to have potential allergic contact dermatitis to bisabolol- a component of the Aquaphor^® emollient they were using to treat their atopic dermatitis. Of note, Compositae dermatitis has been shown to have a higher prevalence in children with atopic dermatitis, so it is important for physicians to be aware of the potential allergens (like bisabolol) in products they are recommending as first line treatments.     

Substitution of aromatic and nonaromatic amino acids for the Phe3 residue in the δ-selective opioid peptide deltorphin I: Effects on binding affinity and selectivity

Deltorphins I and II (Tyr-D-Ala-Phe-Asp-Val-Val-Gly NH₂ and Tyr-D-Ala-Phe-Glu-Val-Val-Gly NH₂) display a high degree of 6-opioid receptor selectivity. Since they lack the intervening Gly3 residue found between the Tyr and Phe aromatic moieties in pentapeptide enkephalins, deltorphins I and II resemble a previously described series of cyclic tetrapep-tides based on Tyr-c[D-Cys-Phe-D-Pen] (JOM-13). With the goal of development of structure-activity relationships for deltorphins and comparison with that of the cyclic tetrapep-tides, ten analogs of deltorphin I were synthesized in which Phe³ was replaced with specific aromatic and nonaromatic amino acids with varying physicochemical properties. Results indicated that analogs containing the bicyclic aromatic amino acids 3-(l-naphthyl)-L-alanine [1-Nal; K_i(μ) = 767 nM, K_i(§) = 7.70 nM], 3-(2-naphthyl)-L-alanine [2-Nal; K_i(μ)= 1910 nM, K_i(§) = 49.2 nM], tryptophan [K_i(μ)= 1250 nM, K_i(§) = 23.9nM], and 3-(3-benzothienyl)-L-alanine [Bth; K_i(μ)= 112nM, K_i(§) = 3.36 nM] were fairly well tolerated at μ- and §-receptors, though affinity was compromised to varying degrees relative to deltorphin I. Shortening the Phe side chain by incorporation of phenylglycine (Pgl) was detrimental to both μ (K_i= 4710 nM) and § (K_i= 15.6 nM) binding, while extension of the side chain with homophenylalanine (Hfe) enhanced μ binding (K_i= 67.8 nM), leaving § affinity unaffected (K_i= 2.64 nM). Substitution with nonaromatic amino acids valine and isoleucine led expectedly to poor opioid binding [K_i(μ) =≥ 10000 nM for each, K_i(§) = 160 and 94.7 nM, respectively], while peptides containing cyclohexylalanine (Cha) and leucine surprisingly retained affinity at both μ (K_i= 322 and 1240 nM, respectively) and § (K_i= 10.5 and 12.4 nM, respectively) sites. In general, these trends mirror those observed for similar modification in Tyr-c[D-Cys-Phe-D-Pen].     

Should opiate addicts be involved in controlling their own detoxification? A comparison of fixed versus negotiable schedules

This study compares the responses of opiate addicts at a London drug treatment centre to two outpatient methadone-based detoxification programmes. These involved either a fixed (non-negotiable) dose reduction schedule or a flexible, negotiable withdrawal schedule. In the negotiable condition, subjects were less likely to complete the detoxification programme and the mean reduction in dose achieved by the subjects in the negotiable condition was less than that in the fixed group. There was no difference between groups in programme retention at 6 weeks though subjects who remained in treatment in the negotiable group tended to extend their detoxification period beyond this point. The overall response of subjects in both groups was unsatisfactory. Only 13% of the subjects initially allocated to detoxification or 28% of those who actually started detoxification completed treatment; urine screening showed that heroin abuse was a continuing problem during treatment. The implications of these results for detoxification and drug treatment services are discussed.     

Partnerships in Neonatal Care: A Model in Reverse Neonatal Transport

An agreement between a pediatric tertiary-care center and a community hospital provides a model of a program that has facilitated appropriate, cost-effective, high-quality care for high-risk neonates through reverse transport. This agreement has established trust between the professionals at both hospitals, increased communications to ensure continuity of care and psychosocial support for families, and obtained supplemental financia1 resources for families of high-risk neonates.