Pain related to tracheal suctioning in awake acutely and critically ill adults: a descriptive study.

The purpose of this secondary data analysis of findings from a larger procedural pain study was to examine several factors related to pain during tracheal suctioning. In addition to tracheal suctioning, other procedures studied included turning, wound drain removal, femoral catheter removal, placement of a central venous catheter, and wound dressing change. A total of 755 patients underwent the tracheal suctioning procedure that was performed primarily in intensive care units (93%). A 0-10 numeric rating scale, a behavioural observation tool, and a modified McGill Pain Questionnaire-Short Form were used for pain assessment. Pain intensity scores were significantly greater during the tracheal suctioning procedure (M=3.96, S.D.=3.3) than prior to (M=2.14, S.D.=2.8) or after (M=1.98, S.D.=2.7) tracheal suctioning. Few patients received analgesics prior to or during the procedure. Surgical, younger, and non-white patients reported higher pain intensities. Although mean pain intensity during tracheal suctioning was mild, almost the half of the patients reported moderate-to-severe pain. Individualized pain management must be performed by healthcare providers in order to respond to patients' needs as they undergo painful procedures such as tracheal suctioning.     

Interaction of duration of homelessness and gender on adolescent sexual health indicators.

PURPOSE: The purpose of this analysis was to determine the effects of duration of homelessness and gender on personal and social resources, cognitive-perceptual factors, and sexual health behaviors among homeless youth. DESIGN: Cross-sectional analysis of data collected at baseline from 461 homeless adolescents who participated in a sexual health intervention study was done. METHOD: Data were collected via laptop computers from homeless adolescents (mean age=19.52+1.91 years) in both comparison and intervention groups before the initiation of the intervention. FINDINGS: Significant interaction effects were found for personal and social resources F (4, 426)=2.83, p<.05. Male participants who had been homeless<6 months had significantly higher scores on social connectedness than did male participants who were homeless>1 year. Univariate analysis of variance (ANOVA) indicated that both boys and girls who had been homeless>1 year had greater AIDS knowledge, F (1, 441)=7.91, p<.01, reported significantly more sexual risk-taking behaviors, F (1, 396)=9.93, p<.05, and engaged in fewer safe-sex behaviors, F (1, 396)=12.05, p<.05, than did those who had been homeless<6 months. Univariate ANOVA indicated that female participants had significantly lower levels of perceived health status, F (1, 429)=12.08, p<.01, significantly greater sexual self-care behaviors, F (1, 396)=16.29, p<.01, and significantly higher levels of assertive communication F (1, 396)=4.03, p<.05 than did male participants, regardless of duration of homelessness. CONCLUSIONS: The duration of homelessness and gender has both direct and interaction effects on cognitive-perceptual and behavioral outcomes associated with sexual health. CLINICAL RELEVANCE: Nurses and other healthcare providers working with homeless youth recognize the need to develop brief interventions that address health-risk behaviors. Findings from this study indicate that gender-specific interventions should be provided to youth soon after they become homeless.     

A survey of treatment modalities for convergence insufficiency.

BACKGROUND: Convergence insufficiency (CI) is a common and distinct binocular vision disorder. However, there is a lack of consensus regarding the treatment most appropriate for Cl. Possible treatment modalities include base-in prism, pencil pushup therapy (PPT), reading glasses, home-based vision therapy/orthoptics (HBVT), and office-based vision therapy/orthoptics (OBVT). The purpose of this study was to investigate the care process for Cl by surveying eyecare professionals regarding the most common treatment modalities used by both optometrists and ophthalmologists across the United States. METHODS: Surveys requesting doctors to indicate which treatment(s) they prescribed and believed to be most effective for symptomatic CI patients were mailed to 863 optometrists and 863 ophthalmologists in the United States. RESULTS: Fifty-eight percent of the optometrists responded to the survey; the most common treatment prescribed was PPT (36%) followed by HBVT (22%) and OBVT (16%). For the ophthalmologists (who had a 23% response rate), the most common treatment prescribed was PPT (50%) followed by HBVT (21 %) and base-in prism (10%). CONCLUSIONS: This survey suggests that most eyecare practitioners prescribe PPT as the initial treatment for CI.     

Morphine pharmacokinetics in early infancy

The pharmacokinetics of morphine in ten infants less than or equal to 10 weeks of age who were receiving morphine infusions were determined. Infants 1-4 days of age (newborns) showed longer elimination half-lives than the older infants (6.8 vs. 3.9 h). Clearance in the newborns is less than one-half that found in older infants (6.3 vs. 23.8 ml X min-1 X kg-1). The combination of lower clearance and longer elimination half-life in newborns (0-7 days) may well explain a prolonged duration of action for morphine in very young infants, but other etiologies are needed to explain the respiratory sensitivity believed to persist in older infants.     

Impaired fasting glucose as a treatment target in diabetes management

Impaired fasting glucose (IFG) contributes to microvascular and macrovascular complications and increased cardiovascular disease risk. Although type 2 diabetes is largely considered to occur as a result of IFG, understanding of physiologic and associated management targets is uniformly lacking among health care professionals. Once definitions are standardized, diagnostic criteria and screening tools may help to identify individuals at risk sooner, thereby minimizing the rapid deterioration that often results. To counter the rising pandemic of obesity and diabetes, it is important to understand the vascular risk of IFG and impaired glucose tolerance in patients at risk.     

Cellular and in vivo activity of a novel PI3K inhibitor, PX-866, against human glioblastoma

The phosphatidylinositol-3-kinase (PI3K)/Akt oncogenic pathway is critical in glioblastomas. Loss of PTEN, a negative regulator of the PI3K pathway or activated PI3K/Akt pathway that drive increased proliferation, survival, neovascularization, glycolysis, and invasion is found in 70%–80% of malignant gliomas. Thus, PI3K is an attractive therapeutic target for malignant glioma. We report that a new irreversible PI3K inhibitor, PX-866, shows potent inhibitory effects on the PI3K/Akt signaling pathway in glioblastoma. PX-866 did not induce any apoptosis in glioma cells; however, an increase in autophagy was observed. PX-866 inhibited the invasive and angiogenic capabilities of cultured glioblastoma cells. In vivo, PX-866 inhibited subcutaneous tumor growth and increased the median survival time of animals with intracranial tumors. We also assessed the potential of proton magnetic resonance spectroscopy (MRS) as a noninvasive method to monitor response to PX-866. Our findings show that PX-866 treatment causes a drop in the MRS-detectable choline-to-NAA, ratio and identify this partial normalization of the tumor metabolic profile as a biomarker of molecular drug action. Our studies affirm that the PI3K pathway is a highly specific molecular target for therapies for glioblastoma and other cancers with aberrant PI3K/PTEN expression.