Medication administration: acquisition of knowledge and abilities required for a group of nurses

Nowadays, it is known that medication administration is a multidisciplinary process and requires constant updating from the professionals in charge. However, lack of knowledge, updating and in-service education permeate this theme area. Goals: analyze the educational needs of nurses working at a university hospital in the interior of S?o Paulo State, Brazil with regard to medication administration, as well as discuss about the need for this group of nurses to obtain the required knowledge and abilities. The Nominal Group Technique was used by means of the following question: "What else do you need to know in order to complete your knowledge on medication administration?" Eight categories of educational needs emerged: medication effect mechanisms, medication preparation and administration, information and knowledge acquisition, medication interactions, medication stability, specific and chemotherapeutic medication, side effects of medication and other aspects of medication administration. An updating course was proposed on the basis of the identified educational needs.     

Effect of pupillary dilation on retinal nerve fiber layer thickness measurements using optical coherence tomography

PURPOSE: To evaluate the effect of pupillary dilation on retinal nerve fiber layer thickness (RNFL) measurements using optical coherence tomography (OCT-3). METHODS: Randomly chosen eyes of healthy individuals were scanned before and after pupillary dilation by two trained operators (R.G.O., R.V.) using OCT-3 (Carl Zeiss Meditec, Inc., Dublin, CA). Fast and regular RNFL (256 A-scans) OCT-3 protocols (software version A1.1) were used in each scanning session. RNFL thickness measurements before and after dilation were compared. RESULTS: Ten eyes of 10 subjects (6 females, 4 males) were enrolled. Mean age was 32.0 +/- 11.2 years (range, 21 to 52 years). Mean pupillary diameter before and after dilation was 2.9 +/- 0.6 mm and 7.6 +/- 0.8 mm, respectively (P < 0.0001, paired t-test). There was no significant difference in RNFL thickness measurements before and after dilation using both fast and regular RNFL protocols (P > or = 0.05 for all comparisons, paired t-test). Mean coefficients of variation for mean RNFL thickness measurements were 15.3% before and 13.7% after dilation for operator 1; and 10.8% before and 12.7% after dilation for operator 2 for the fast RNFL protocol and 11.3% versus 10.4% and 12.9 versus 11.1%, respectively, for the regular RNFL protocol. CONCLUSION: Pupillary dilation is not necessary in all subjects to obtain reproducible RNFL thickness measurements using OCT-3.     

Molecular mechanisms of action and prediction of response to oxaliplatin in colorectal cancer cells

The platinum compound oxaliplatin has been shown to be an effective chemotherapeutic agent for the treatment of colorectal cancer. In this study, we investigate the molecular mechanisms of action of oxaliplatin to identify means of predicting response to this agent. Exposure of colon cancer cells to oxaliplatin resulted in G2/M arrest and apoptosis. Immunofluorescent staining demonstrated that the apoptotic cascade initiated by oxaliplatin is characterised by translocation of Bax to the mitochondria and cytochrome c release into the cytosol. Oxaliplatin treatment resulted in caspase 3 activation and oxaliplatin-induced apoptosis was abrogated by inhibition of caspase activity with z-VAD-fmk, but was independent of Fas/FasL association. Targeted inactivation of Bax or p53 in HCT116 cells resulted in significantly increased resistance to oxaliplatin. However, the mutational status of p53 was unable to predict response to oxaliplatin in a panel of 30 different colorectal cancer cell lines. In contrast, the expression profile of these 30 cell lines, assessed using a 9216-sequence cDNA microarray, successfully predicted the apoptotic response to oxaliplatin. A leave-one-out cross-validation approach was used to demonstrate a significant correlation between experimentally observed and expression profile predicted apoptosis in response to clinically achievable doses of oxaliplatin (R=0.53; P=0.002). In addition, these microarray experiments identified several genes involved in control of apoptosis and DNA damage repair that were significantly correlated with response to oxaliplatin.     

Endoscopic management of pancreatic fistula after pancreatic and other abdominal surgery

Post-operative pancreatic fistulae represent a challenge for all the actors in gastroenterology: for surgeons, because they want to prevent and treat conservatively this complication since re-operation is associated with high morbidity and mortality rates; for radiologists, because they have to provide the best staging and informations without any additional risk; and for endoscopists, because endoluminal treatment is emerging as a safe and effective procedure provided it is performed in highly experienced tertiary centres in the setting of a multidisciplinary approach. Herein, we review the definitions, the causes, the staging and the possible options to prevent or treat post-operative pancreatic fistulae. Special attention is paid to the endoscopic management of this complication: including the relief of ductal obstructions, the stenting of leakages and the drainage of bulging or non-bulging fluid collections. Practical problems and issues are clearly outlined as well as the need for future improvements in staging and management of the patients having such complications.     

Role of the locus coeruleus in the prolactin secretion of female rats

Since locus coeruleus (LC) lesion blocks preovulatory prolactin surge, the aim of this study was to determine if this lesion would also block prolactin surges induced by steroids in ovariectomized rats and would modify basal prolactin secretion. To determine the time of the steroid-induced prolactin surges, ovariectomized rats treated with estradiol (OVE) or estradiol and progesterone (OVEP) were cannulated at 08:00 h and blood samples were collected hourly between 14:00 and 18:00 h. Ovariectomized rats treated with oil (OV-Oil) were used as control. Prolactin peaked at 16:00 h in OVE rats and at 15:00 h in OVEP. In a second experiment, male rats, cycling rats, OVE, OVEP, and OV-Oil groups were cannulated at 08:00 h, followed by LC lesion or sham-surgery. Blood samples were withdrawn at times of basal and peak prolactin levels. LC lesion blocked afternoon prolactin surges of OVE, OVEP and proestrus rats. However, the low levels observed at 16:00 h in OV-Oil, diestrus and male rats as well as at 11:00 h in OVE, OVEP, estrus, and proestrus rats were not modified by LC lesion. The high prolactin levels observed on estrus afternoon were dramatically reduced by LC lesion. Data suggest that LC neurons are important for steroid-induced prolactin surge genesis, but not for prolactin basal secretion.     

Upregulation of CB1 receptors and agonist-stimulated [35S]GTPgammaS binding in the prefrontal cortex of depressed suicide victims

Endogenous and exogenous cannabinoids (CBs) acting through the CB(1) receptors have been implicated in the regulation of several behavioral and neuroendocrine functions. Modulation of endocannabinoidergic system by ethanol in mouse brain, and the association of suicide and mood disorders with alcoholism suggest possible involvement of the cannabinoidergic system in the pathophysiology of depression and suicide. Therefore, the present study was undertaken to examine the levels of CB(1) receptors and mediated signaling in the dorsolateral prefrontal cortex (DLPFC) of subjects with major depression who had died by suicides (depressed suicides, DS). [(3)H]CP-55,940 and CB(1) receptor-stimulated [(35)S]GTPgammaS binding sites were analyzed in membranes obtained from DLPFC of DS (10) and matched normal controls (10). Upregulation (24%, P<0.0001) of CB(1) receptor density (B(max)) was observed in DS (644.6+/-48.8 fmol/mg protein) compared with matched controls (493.3+/-52.7 fmol/mg protein). However, there was no significant alteration in the affinity of receptor (DS; 1.14+/-0.08 vs control; 1.12+/-0.10 nM). Higher density of CB(1) receptors in DS (38%, P<0.001) was also demonstrated by Western blot analysis. The CB(1) receptor-stimulated [(35)S]GTPgammaS binding was significantly greater (45%, P<0.001) in the DLPFC of DS compared with matched controls. The observed upregulation of CB(1) receptors with concomitant increase in the CB(1) receptor-mediated [(35)S]GTPgammaS binding suggests a role for enhanced cannabinoidergic signaling in the prefrontal cortex of DS. The cannabinoidergic system may be a novel therapeutic target in the treatment of depression and/or suicidal behavior.     

Fiber order of the normal and regenerated optic tract of the frog (Rana pipiens)

In the normal frog, axons from the peripheral retina arising at the temporal pole course superficially in the middle stream of the diencephalic optic tract. Axons from the nasal pole course in two streams running in the opposite margins of the tract, dorsonasal axons ventrally, ventronasal axons dorsally. Axons from the dorsal and ventral poles of the retina occupy the intervals between the aforementioned middle and marginal streams. Axons from more central regions of the retina tend to occupy deeper levels of the optic tract. The regenerated optic tract does not regain its normal organization, e.g., axons of peripheral nasal origin are spread out widely over the entire width of the tract. However, axons from the temporal pole of the retina do return approximately to their original location in the middle stream. The concentration of temporal axons in the middle stream of the optic tract after regeneration may now be understood in terms of the expression pattern of the ephrin-A class of receptor tyrosine kinase ligands in the cellular matrix of the optic tract. The ephrin-As, which have a repellent effect on growing temporal retinal axons, are concentrated in and along the margins of the diencephalic optic tract and essentially absent from its middle stream. It is proposed here that peripheral temporal axons may be forced into this middle region by their avoidance of the higher levels of ephrin-A expression in the tract margins. In contrast, the growth pattern of regenerating peripheral nasal axons would not be affected by the ephrin-A gradient in the optic tract.