Physiology of wound healing

Despite the emphasis placed on skin care, hospitalized infants often experience injury to their skin. Although skin injuries vary, they have a common innate mechanism for repair and healing. Wound healing is a physiologic process that involves a series of sequential yet overlapping stages. The first stage, hemostasis, occurs immediately at the time of injury. During hemostasis, a provisional matrix seals the injury site and initiates the process of wound healing. The second stage, inflammation, is triggered by a variety of mediators released from injured tissue cells and capillaries, activated platelets and their cytokines, and the by-products of hemostasis. During the third stage, the wound surface is covered with new skin and vascular and structural integrity are restored as granulation tissue fills the defect. The final stage, remodeling, is responsible for maturation of the granulation tissue into mature connective tissue and/or scar. A thorough understanding of wound healing physiology is an important prerequisite to providing care that optimizes wound healing and prevents unnecessary complications. Many of the current wound care practices are based on tradition rather than scientific knowledge. As the interface between the infant and the environment, nurses are in an ideal position to evaluate the soundness of these wound care practices. Physiologic-based care strategies to enhance wound healing are proposed. Copyright © 2001 by W.B. Saunders Company     

Comparison of three preverbal scales for postoperative pain assessment in a diverse pediatric sample

The purposes of this study were to compare the reliability and validity of three pain measurement scales for assessing pain in preverbal and nonverbal children and to determine which of the scales was mos tappropriate in a clinical setting to evaluate pain for infants and young children regardless of developmental stage or cognitive or physical disability. Pain scales tested were revised versions of the Riley Infant Pain Scale (RIPS), the Nursing Assessment of Pain Intensity (NAPI), and the Postoperative Pain Score (POPS). Purposive sampling of 391 postoperative infants and children was used for evaluation of pain in a midwestern children's hospital. Four assessments with each scale were done 1 hr apart by trained observers blinded to pain medications. Data analyses supported high inter-rater reliability, satisfactory discrimination between pain and no-pain observations, and suggested acceptability for all three scales with lower caregiver burden for RIPS and NAPI.     

Randomized controlled trial of a self‐efficacy enhancement program for the cardiac rehabilitation of Thai patients with myocardial infarction

This study examined the effects of a self‐efficacy enhancement program for the cardiac rehabilitation of Thai patients who had a myocardial infarction. Sixty‐six hospitalized patients of various ages and both genders were randomly assigned to either an experimental or a control group. Participants in the experimental group took part in three individualized in‐hospital education sessions and three weekly sessions of telephone counseling. The control group primarily engaged in a supervised exercise and activities of a daily living performance regimen, and received education in this regard. Self‐efficacy and functional status were measured via questionnaire. Four weeks after discharge, the experimental group was found to have significantly higher total self‐efficacy and functional status scores than the control group. In addition, the experimental group exhibited significantly higher subscale scores on social activity, household tasks, occupation, and exercise self‐efficacy than the control group. These results indicate that the program is effective in improving the self‐efficacy and functional status of Thai patients who have had a myocardial infarction.     

Characterization and NMR solution structure of a novel cyclic pentapeptide inhibitor of pathogenic hantaviruses

Hantavirus-induced diseases such as hantavirus cardiopulmonary syndrome and hemorrhagic fever with renal syndrome are a global health concern. Hantavirus cardiopulmonary syndrome caused by Sin Nombre virus lacks specific therapy and its high mortality makes Sin Nombre virus a potential bioweapon agent. Sin Nombre virus entry into susceptible cells requires expression of alpha(v)beta(3) integrin. We recently reported the sequence of a cyclic nonapeptide that inhibited Sin Nombre virus entry into Vero E6 cells at a level comparable to ReoPro, a Fab fragment of the anti-beta(3) antibody c7E3. Here, we refine the parental peptide, cyclo-[CPFVKTQLC], using alanine scanning and amino acid deletions, by optimizing for viral inhibition. The IC(50) of the resulting peptide, cyclo-[CPFVC], was 267 microM compared with 263 microM for the parental peptide. The solution structure of cyclo-[CPFVC] was determined by two-dimensional nuclear magnetic resonance spectroscopy, revealing the Phe ring in an extended conformation stacked against the Pro ring and containing a beta-turn encompassing Val-4 through Cys-1. As an initial step in identifying interactions between cyclo-[CPFVC] and its target cellular receptor, the refined peptide structure was docked into the ReoPro binding site of integrin beta(3). This structure will provide the basis for designing more potent peptidomimetic therapeutics to prevent Sin Nombre virus entry and treat hantavirus cardiopulmonary syndrome.     

Research on women and health care: Influence of sociocultural factors

Sociocultural factors and medical science have shaped the basic ideas about the female role and her place in society. This paper discusses the influence of these ideas on current thinking about women and their health and raises design and methodological questions about past research. Additionally, current research emphasis in the field of women's health is explored.     

Conceptual and theoretical approaches to patient care: associate versus baccalaureate degree prepared nurses

The purpose of the study was to determine if there is a relationship between types of entry-level preparatory nursing programmes in which a nurse receives basic nursing education and conceptual and theoretical approaches to patient care. A secondary purpose of the study was to determine if there is a relationship between entry-level basic preparatory nursing education and nursing leadership, the ability to make nursing diagnosis, and implementation, as well as evaluation of the nursing process. Three nursing practice categories were identified and included: professional, all-nurse and technical. Useable data collected by short-essay questionnaire from 343 out of 344 sample subjects were computed to determine the relationship, if any, between basic preparatory nursing education and conceptual and theoretical approaches to patient care. Decisions about three null hypotheses were made at the 0.05 level of significance utilizing analysis of covariance and the 0.01 level of significance utilizing chi-square analysis. For Hypothesis 1, the main effect for degree work when covaried with Verbal Scholastic Aptitude Test scores, Quantitative Scholastic Aptitude Test scores, time and age indicated a significance of 0.001 for all item associations in the professional, all-nurse and technical categories utilizing analysis of covariance, and 0.001 utilizing chi-square analysis. For Hypotheses 2 and 3, the main effect for degree work when covaried with the aforementioned variables indicated a significance of 0.001 utilizing analysis of covariance, and 0.001 utilizing chi-square analysis. In conclusion, the findings from the study suggest that graduates of baccalaureate degree programmes do vary in conceptual and theoretical approach to nursing care in specific nursing care situations.(ABSTRACT TRUNCATED AT 250 WORDS)