The Ongoing Influence of Staff Training on the Performance of Radiofrequency Catheter Ablation

The aim of this study was to assess whether the performance of RF catheter ablations continues to improve by further staff training once an initial success rate of > 90% has been achieved. Two hundred and ninety-five procedures of SVT catheter ablation using RF energy were studied. Atrial tachycardia and atrial flutter substrate ablations were not included. The procedures were performed during a 4-year period by the same physician and nurse, who had previous training in these procedures. The 4-year period was subdivided into four consecutive 1-year periods in which 69, 72, 68, and 86 procedures were performed. The outcome, recurrence rate, and duration of the curative procedure were compared among the four periods. There was no significant difference in the initial success rate among the four periods. The recurrence rate decreased from 21.74% to 13.95% (P < 0.05). The duration of the curative procedure decreased from 93.7 ± 78.4 minutes to 39.1 ± 32.2 minutes (P < 0.001), and the fluoroscopic time decreased from 25.5 ± 22.3 minutes to 11.3 ± 8.2 minutes (P < 0.001). These results were similar when accessory pathway and selective AV nodal pathways ablations were separately evaluated. Following the initial staff training, during which the expected 80%-90% success rate is achieved, additional training will reduce the recurrence rate and the duration of the procedures at a similar level of success. (PACF 1997; 20[Pt. I]:1312-1317)     

Cumulative Effects of Amiodarone on Inducibility of Ventricular Tachycardia: Implications for Electrophysiological Testing

To determine whether the slow onset of action of amiodarone might result in a delayed effect on the inducibility of sustained ventricular arrhythmias, 45 patients with ischemic heart disease and inducible sustained monomorphic ventricular tachycardia were prospectively studied. Each patient had at least one initial repeat study on amiodarone and those with persistently inducible arrhythmias were rescheduled for further studies over the following 24 weeks. After 2-3 weeks of amiodarone therapy, nine patients no longer had inducible tachycardias, and tachycardia in another eight patients (18%) later became noninducible. Using life-table methods, analysis based on the results of the first re-study showed 18-month recurrence rates of 43% in the inducible vs 17% in the noninducible groups (p = 0.056). When the results of additional testing were then used to reclassify patients, the recurrence rates for these two groups were 50% and 17%, respectively (p = 0.004). Observation of blood pressure and level of consciousness during induced arrhythmias was also predictive of clinical tolerance in patients having recurrences; 16 of 19 patients experienced symptoms of similar severity to those produced during testing. We conclude: (1) early testing of amiodarone may result in misclassification of some patients as remaining inducible; (2) re-testing at a later time more accurately predicts tachycardia recurrence; (3) observation of hemodynamic response also provides important prognostic information.     

DO URINARY SYMPTOMS CORRELATE WITH URODYNAMIC FINDINGS?

PURPOSE: We determined whether urinary symptomatology correlates with video urodynamic findings. MATERIALS AND METHODS: A total of 115 women with complaints of urinary incontinence completed a 27-item questionnaire. Pelvic examination and video urodynamic study were performed. Subjective findings were scored from 0 to 5, with 5 representing the most severe symptomatology. Patients were divided into 5 subgroups based on etiology of incontinence, and analyzed by Student's t test with p < 0.05 considered statistically significant. RESULTS: Among the 115 patients 11% had normal studies, 38% proximal urethral hypermobility with stress urinary incontinence, 33% intrinsic sphincter deficiency, 11% significant pelvic prolapse and stress urinary incontinence, and 10% detrusor instability. Subjective complaints, such as incontinence during physical activity, were prominent in both stress urinary incontinence groups as well as the prolapse group with stress urinary incontinence. Questions about nocturia, frequency, urgency, urge incontinence, number of pads, number of vaginal deliveries and incomplete emptying were not statistically significant for any group. CONCLUSIONS: Subjective complaints were not helpful in differentiating the etiology of incontinence. Few questions were helpful in predicting which patients would have a normal video urodynamic study.     

Views of the Israeli public on expanding the authority of nurses

Aim To explore the views of the Israeli public on expanding the authority of nurses and identify factors affecting these views. Background New advanced nursing roles are currently being introduced and nursing is undergoing dynamic change. Public views on expanding the authority of nurses and factors affecting public views await investigation. Method In a correlational study, a questionnaire was administered to 200 male and female Israelis aged 18 and older treated at a hospital or healthcare clinic at least once over the past year. Results Most respondents are in favour of expanding the authority of nurses, considered vital for patients. In addition, the public is in favour of certifying clinical nursing specialists in all fields. Influential factors were ethnicity, personal acquaintance with nurses, income and religiosity. Conclusions The public has a positive perception of expanding the authority of nurses, and major determinants are familiarity with nursing, ethnicity, income and religiosity. Implications for nursing management Understanding public views on expanding the authority of nurses in Israel will help policymakers adjust their actions according to social perceptions and needs. This will help nursing managers further the process of expanding nurse authority, to the satisfaction of both nurses and the public they serve.     

Twelve Weeks of Endurance Exercise Training does not Affect Iron Status Measures in Women

Objective This study examined the effects of 12 weeks of endurance exercise training on iron status measures in previously inactive women and compared the effects of weight-bearing endurance exercise training and non-weight-bearing endurance exercise on iron status measures.Design Randomized, experimental study.Subjects Thirty-one healthy, inactive women (aged 23 to 43 years) with apparently normal iron stores (serum ferritin concentration ≥20 μg/L) were recruited from the local area by newspaper advertisements and campus mailings. Twenty-one subjects completed the study (mean±standard deviation for age=32±5 years, for body mass index=23.1±4.9, and for maximum oxygen consumption [Vo₂max]=33.8±6.3 mL/kg per minute).Intervention Subjects were randomly assigned to one of three groups: an inactive control group, a walking/running group, or a cycling group. Subjects in the two exercise groups trained three to four times per week at 80% Vo₂max for 12 weeks. Exercise training sessions were monitored and energy expenditure increased from 150 kcal per session (week 1) to 375 kcal per session (weeks 9 to 12). Subjects in the inactive control group were instructed to maintain their normal activity patterns for the duration of the study. All subjects were instructed to maintain their normal dietary habits.Main outcome measures Serum ferritin concentration, serum iron concentration, percentage saturation of transferrin, total iron-binding capacity, serum haptoglobin concentration, and other selected hematologic variables were measured at baseline and at weeks 2, 4, 8, and 12.Statistical analyses Repeated measures analysis of variance was used to examine group × time interactions in changes in iron status measures. Statistical significance was reached at P<.05.Results Analysis of variance indicated that serum ferritin concentration did not change significantly (P=.59) during the 12 weeks in the walking/running group (mean±standard deviation from 41.28±14.22 to 27.41±9.74 μg/L) or the cycling group (from 65.81±37.62 to 41.06±26.38 μg/L) compared with the control group (from 47.55±15.87 to 31.56±10.57 μg/L). Values for serum iron, total iron-binding capacity, percentage saturation of transferrin, and haptoglobin also did not change significantly (P>.30) in the walking/running or cycling groups compared with the control group.Applications/conclusions Results of this study suggest that participation in 12 weeks of moderate-intensity endurance exercise training (walking/running or cycling) is not associated with negative effects on selected measures of iron status in healthy, previously untrained women with normal iron stores (serum ferritin ≥20 μg/L). J Am Diet Assoc. 1997;97:1116–1121.     

Relationship of Diet, Abdominal Obesity, and Physical Activity to Plasma Lipoprotein Levels in Asian Indian Physicians Residing in the United States

Objective To examine the relationship of total fat, saturated fat, carbohydrate and energy intake, leisure-time activity, waist-to-hip ratio (WHR), and body mass index to the prevalence of atherogenic plasma triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C) levels in Asian Indians living in the United States. High plasma TG and low HDL-C levels have been documented in Asian Indians worldwide.Design This exploratory study examined medical history, demographics, anthropometries, plasma lipids levels, food intake frequency, and self-reported leisure-time activity.Subjects 153 Asian Indian male physicians (mean age=47 years) were recruited at two annual national conferences of the American Association of Physicians from India, with free medical assessments as incentives.Statistical analyses performed Correlational and multiple regression analyses were performed.Results Subjects’ diets averaged 56% energy from carbohydrate, 32% from total fat, and 8% from saturated fat. High total fat intake was associated with high WHR (r=.2l, P<.01) and high total carbohydrate intake (grams per day) was associated with high TG level (r=.24, P<.05). Leisure-time activity averaged 136 minutes/week and negatively correlated with total plasma cholesterol level (r=−.22, P<.01) and low-density lipoprotein cholesterol level (r=−.25, P<.001).Applications Dietitians should recommend moderate dietary carbohydrate intake and meal patterns with energy distributed throughout the day, in addition to decreasing fat consumption, to Asian Indian clients at risk for coronary artery disease. High carbohydrate intake and uneven diurnal distribution (no breakfast and large evening meals) are associated with high TG and low HDL-C levels in this population. J Am Diet Assoc. 1996; 96:257-261.     

Neonatal hearing screening with otoscopy, auditory brain stem response, and otoacoustic emissions

A study was performed to investigate the relationship between external and middle ear factors and hearing screening results by auditory brain stem response (ABR) and transient evoked otoacoustic emissions (EOAEs). The ears of 200 well newborns aged 5 hours to 48 hours underwent screening by ABR and EOAEs, followed by otoscopic examination. The pass rates for ABR and EOAE screening were 88.5% and 79%, respectively. On otoscopic examination, 13% (53 of 400) ears had occluding vernix obscuring the view of the tympanic membrane. Cleaning of vernix was attempted in ears that failed ABR or EOAE screening. Seventeen ears that failed ABR were cleaned, and 12 (71%) of them passed repeat ABR. Thirty-three ears that failed EOAE screening were cleaned, and 22 (67%) of them passed repeat emissions testing. Cleaning vernix increased the pass rates for ABR and EOAE screening to 91.5% and 84%, respectively. Decreased tympanic membrane mobility was found in 9% of ears that could be evaluated otoscopically. Increased failure rates for both ABR and EOAE screening were found in infant ears with decreased tympanic membrane mobility, but significance testing could not be performed because of inadequate sample size. Prevalence of occluding external canal vernix and middle ear effusion as a function of increasing infant age were studied. Implications for newborn hearing screening are discussed. (Otolaryngol Head Neck Surg 1997;116:597-603.)     

Isolation and primary culture of rat Kupffer cells

The aim of this study was to describe a reproducible method for the isolation, purification and primary culture of rat Kupffer cells. Kupffer cells were isolated following sequential pronase/collagenase digestion of the liver and enrichment of a non-parenchymal cell fraction by a single-density gradient centrifugation step using 30% metrizamide. Kupffer cells were isolated and further purified from this cell fraction by centrifugal elutriation. Kupffer cells were isolated at 1017 g at 48–110 mL/min. All Kupffer cell fractions exhibited phagocytosis of 3 μm latex beads. Kupffer cell fractions isolated at 48 and 60 mL/min were predominantly ED2 negative while later fractions (80–110 mL/min) were ED2 positive. Kupffer cells were adherent in culture after 2 h. This method for Kupffer cell isolation resulted in a yield of 80–120 times 10⁶ Kupffer cells per liver.     

Neurological pupillary noise in narcolepsy

SUMMARY Pupillometry has a long but inconclusive history as a means of measuring human alertness. Spontaneous pupillary oscillations in narcoleptics and the sleep deprived are a recognized but quantitatively elusive indication of alertness. Stimulation of the pupillary light reflex (PLR) has provided contradictory or confusing indications of alertness levels. Results from 10 diagnosed narcoleptics and 10 control subjects in which the PLR system was stimulated and a reliable (90%) discriminator derived for classifying narcoleptics and controls was reported. Random pupillary oscillations, which is called pupillary noise to distinguish these oscillations from spontaneous ones, were estimated from continuous pupil diameter recordings using a recursive least squares method applied to a subject–specific PLR system model. Pupillary noise sum of squares indicate that narcoleptics have significantly (P < 0.005) less PLR noise than controls. This difference was attributed to supranuclear inhibition of randomly active Edinger-Westphal neurons long hypothesized to be the source of random papillary oscillations. This inhibition also has been suggested as a cause of PLR sensitivity to nocturnal sleep quality so it may be that these findings apply to the sleep deprived and not just specifically to narcoleptics.     

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.’