Assessing Psychotropic Medication Side Effects Among Children A Reliability Study

The Dosage Record Treatment Emergent Symptom Scale (DOTES) is a rating scale for measuring the presence and intensity of psychotropic medication side effects. Studies to evaluate its reliability have not been published. The purposes of this pilot study are to (1) develop a protocol for training raters to use the DOTES, (2) assess inter-rater agreement, 3) examine the reasons for disagreement among raters to clarify training procedures and symptom definitions, and (4) further refine this instrument for use in clinical and research settings.
Five nurses were trained to use the DOTES to rate the absence or presence and intensity of specific medication side effects. After training, Raters 1,2, and 3 watched a videotape of a nurse interviewing a 13-year-old child and completed the DOTES rating scale. There was agreement on the intensities of 6 (67%) of the 9 symptoms identified as present and agreement on 17 (89%) of the 19 symptoms identified as absent.
Process tracings were conducted on the ratings of Nurses 4 and 5 to elicit the criteria they used to determine their ratings. The results of the process tracings were used to identify ambiguities that led to disagreement among raters so that the training protocol and interview could be improved.     

Multiple peptide synthesis using a single support (MPS3)

An automated multiple peptide synthesis method to synthesize, cleave, and purify several peptides simultaneously in a single batch has been developed. The technique is based on the synthesis of multiple peptides on a single solid phase support and is easily adapted to manual or to automated methods. The approach relies on coupling of amino acid mixtures to the resin and it has been found that DCC/HOBt gives the best coupling performance. Fast Atom Bombardment Mass Spectrometry (FAB-MS) was used to rapidly and efficiently identify the peptides in each synthetic mixture which significantly assisted the purification process by HPLC. The method has been successfully applied to the synthesis of magainin 2 and angiotensinogen peptides.     

HIV-Seropositive Childbearing Women Nursing Management

With the implementation of the recommendation of the American College of Obstetricians and Gynecologists to screen all women who are at increased risk for HIV infection, more asymptomatic infected women will be identified. Obstetric and neonatal nurses who learn more about maternal and infant HIV infection can determine effective nursing interventions. Early planning is necessary to ensure that individualized, comprehensive care is available upon discharge.     

Effects of Defibrillation Shocks Delivered Directly Over a Major Coronary Artery

This study investigated the influence of defibrillator shocks delivered directly over a coronary artery, independent of ventricular fibrillation, on cardiac hemodynamics. Thirty-six open chest, halothane anesthetized pigs were randomized to receive six shocks at one of 5,0, 7.5, or 10.0 joules (J). Shocks were delivered between two mesh electrodes (Medtronic TX-7) sutured onto the epicardium, one over the left anterior descending coronary artery and the second directly opposite on the posterobasal ventricular surface. Shock delivery was synchronized to the R wave of the cardiac cycle, to reduce the risk of inducing fibrillation, with a 5-minute stabilization period between successive shocks. Pressure from the left ventricle, the left anterior descending coronary artery, distal to the mesh electrode and the left circumflex (control) artery and contractility in the regions perfused by both arteries were measured. The shocks invariably produced an immediate (2-second postshock), but transient, depression in systolic pressure of the same magnitude for the left anterior descending coronary artery, circumflex artery and the left ventricle that recovered by 5-minute postshock. There was no dose dependent relationship to energy. Also there was no clear difference in myocardial wall motion between the area perfused by the left anterior descending coronary artery and that perfused by the circumflex artery. These results suggest that shocks up to 10 J delivered over an epicardial artery do not cause arterial spasm and do not compromise coronary artery blood flow.     

Nursing Assessment and Responsibilities in Monitoring the Preterm Pregnancy

Evaluating women for pregnancy-related problems that may result in preterm birth frequently requires electronic fetal monitoring at early gestational ages. Caution is needed to interpret information correctly from the preterm fetal heart rate and uterine activity tracings. Interpreting fetal heart rate tracings from preterm fetuses requires knowledge of fetal physiologic development. Obtaining clear tracings of preterm uterine activity remains a challenge and heightens the importance of thorough nursing assessment, including inquiry about risk factors for pregnancy complications.     

Effects of Chronic Caffeine Consumption in Pregnant Monkeys (Macaca fascicularis) on Blood and Urine Clinical Chemistry Parameters

Pregnancy requires a variety of physiological adaptations tocreate an environment for the optimal development of the fetus.The widespread consumption of the methylxanthines especiallycaffeine and to a lesser extent theophylline by pregnant womensuggests that it is important to determine whether these methylxanthinesmay influence maternal physiology during pregnancy. Forty femalemonkeys (Macaca fascicularis), randomly divided into three groups,were exposed to caffeine in their drinking water (0, 0.15, or0.35 mg/ml) before, during, and after pregnancy. This exposureresulted in a dose-related increase in reproductive failurein the form of stillbirths, miscarriages, and decreased maternalweight gain. Blood and 24-hr urine samples were collected every2 weeks for clinical chemistry analysis. There were a numberof both pregnancy-related changes and treatment-related effectson the clinical chemistry measures. As expected, serum cholesteroland triglyceride levels declined during pregnancy for all dosegroups but there were no treatment-related effects. Serum andurine creatinine levels were increased in both treated groups.Serum glucose levels, which usually decline during pregnancy,remained elevated in the high-dose group. Serum estrogen levelsin the high-dose groups were depressed compared to those ofthe other two groups. These changes indicate that elevated serumlevels of caffeine and its metabolites, particularly theophylline,may influence maternal physiology during pregnancy in the monkey.     

The Cryopreserved Homograft Valve in the Pulmonary Position: Early Results and Technical Considerations

Since September, 1985, 20 patients have undergone implantation of a homograft valve in the pulmonary position (16 pulmonary, 4 aortic). There were 11 primary operations and 9 reoperations. In 7 of 11 primary operations the homograft valve was utilized as a composite conduit with a short Dacron extension. In four of five reoperations for a failed porcine valved conduit, a composite homograft conduit was used. Four patients underwent implantation of a free homograft in a previously repaired right ventricular outflow tract (RVOT). Age ranged from 15 days to 22 years. There was one operative death (5%), a seven-week-old infant with truncus arteriosus. Long-term follow-up ranges from 1 to 30 months. Clinical performance has been satisfactory in 18 of 19 patients. One patient undergoing free implantation of a pulmonary valve in the RVOT required replacement at 18 months with a porcine valve. In this patient, pulmonary insufficiency was caused by distortion of the annulus secondary to dilatation and pulmonary hypertension. Nine of 18 survivors do not require medication. Eleven of 18 have trivial to mild pulmonary insufficiency murmurs without symptomatology. The homograft valve is extremely useful in reconstruction of the right heart, however, early insufficiency murmurs have been noted. Distortion of the valve annulus may contribute to the early onset of a benign insufficiency murmur. Residual distal obstruction or pulmonary hypertension may be a contraindication to the use of a free homograft in the orthotopic position.     

Vegetables, Fruits, and Legumes: Effect on Urinary Isoflavonoid Phytoestrogen and Lignan Excretion

Objective To compare the effect of vegetable, fruit, and legume consumption on urinary isoflavonoid phytoestrogen and lignan excretion.Design After 4 days of data collection, during which subjects consumed their habitual diets, subjects were randomly placed on four 9-day controlled experimental diets with each subject receiving each diet in a random order.Subjects Seven men and three women, aged 20 to 35 years, were recruited from the University of Minnesota Twin Cities community.Interventions All subjects consumed four experimental diets in an assigned random order: a controlled basal diet, a legume/allium diet (containing garbanzo beans, garlic, and onions), and diets low or high in vegetables and fruits (containing apples, pears, potatoes, and carrots).Main outcome measures Urine samples that were collected while subjects consumed their habitual diets and during the last 3 days of each feeding period were analyzed for isoflavonoid and lignan content using isotope dilution gas chromatography-mass spectrometry.Statistical analysis performed The effect of vegetable and fruit intake on urinary isoflavonoid and lignan excretion was analyzed using the general linear model procedure. Post hoc comparisons were made using Duncan's multiple range test.Results Subjects excreted more of the lignan enterodiol on the high vegetable/fruit diet compared with the basal and legume/allium diets (P=.03); more of the isoflavonoids O-desmethylangolensin (O-DMA), genistein, and sum of isoflavonoids on the legume/allium diet compared with the other controlled diets (P<.05); and more of the isollavan equol on the basal and legume/allium diets compared with the high vegetable/fruit diet (P<.01). Subjects who excreted higher levels of equol on the basal and legume/allium diets also consumed more of the milk-based pudding provided as part of the controlled diets.Conclusions Urinary lignan and isoflavonoid excretion changed in response to alterations in vegetable, fruit, and legume intake under controlled dietary conditions. J Am Diet Assoc. 1995; 95:769-774.     

Temporal drinking patterns and variation in social consequences

Temporal drinking patterns and their associated social consequences are described for a sample of US adults aged IS years and over who drank at least 12 drinks in the preceding year and did not restrict their drinking to special occasions (n= 16 086). The earliest time of day when these current regular drinkers reported usually drinking was between 6 a.m. and II a.m. for 1.2%, between 11 a.m. and 3 p.m. for 7.3%, between 3 p.m. and 6 p.m. for 31.2%, and after 6 p.m. for 60.3%. Less than one-tenth (7.7%) reported any drinking (not necessarily their earliest drinking) between midnight and 6 a.m. Characteristics associated with above-average rates of both early (6 a.m.–3 p.m.) and late-night (midnight–6 a.m.) drinking included male gender, black race, low education and income and heavy quantity of ethanol intake per drinking day. Early drinking was also characteristic of the elderly and daily drinkers. Prior to adjusting for background variables and quantity and frequency of intake, early drinking was associated with a two- to nine-fold increase in the risk of alcohol-related interpersonal problems, hazardous use, job/school problems and legal problems, and late-night drinking was associated with a three- to eight-fold increase in their prevalence. After adjusting for these factors in multiple logistic regression models, early drinking was associated with a 54% increase in the odds of interpersonal problems, a 39% increase in the odds of hazardous use and a 52% increase in the odds of legal problems. The association between early drinking and job/school problems fell just short of statistical significance. After adjusting for other factors, late-night drinking retained a significant association with all of the outcomes except legal problems. The magnitude of its association was greater than that of early drinking but varied substantially (i.e. interacted) with quantity of intake, race, ethnicity and gender.