Preoperative hair removal: a case report with implications for nursing

• ? Preoperative hair removal has been a practice since the beginning of this century. Research in the 1970s and 1980s provide support for the contention that the procedure is unnecessary for wound asepsis and may increase the rate of surgical site infections (Seropian & Reynolds, 1971; Hamilton et al., 1977; Cruse & Foord, 1980; Court-Brown, 1981; Alexander et al., 1983; Winfield, 1986; Fairclough et al., 1987). However, some hospitals have continued routine preoperative hair removal long after dissemination of recommendations against it. This begs the question, ‘Why is it that so often research findings are not applied in practice’.
• ? In Stroud v. General Hospital Corp. and Pollett (1993), a man died of sepsis resulting from cuts he gave himself after he was asked by a nurse, in complete violation of the hospital's preoperative skin preparation protocol, to clip hair from his abdomen. The court held the hospital liable for the nurse's negligent breach of its protocol. The case clearly supports findings in the literature that preoperative hair removal is potentially dangerous. It reinforces the importance of strict adherence to hospital protocols which have been put in place to protect patients' safety.

     

Effects of Propylene Oxide on Nasal Epithelial Cell Proliferation in F344 Rats

In chronic inhalation studies, propylene oxide (PO), widelyused in the chemical and food industries, induced nasal tumorsin F344 rats. Nonneoplastic findings of the chronic studiessuggest a strong cytotoxic and proliferative component in themechanism of PO carcinogenicity. A 4-week cell proliferationstudy was conducted to establish a no-observed-adverse-effectlevel (NOAEL) for non neoplastic changes in the nasal epitheliumof rats. Male F344 rats were exposed to 0, 10, 20, 50, 150,or 525 ppm PO vapor for up to 4 weeks with up to 4 weeks ofrecovery. Histopathology showed that the incidence and severityof respiratory epithelial hyperplasia increased with exposuretime and regressed after termination of exposure with completerecovery after 4 weeks. Similarly, cell pro liferation, as determinedby bromodeoxyuridine incorporation into replicating cells, waselevated following 1 and 4 weeks of exposure, but decreasedto control values after 1 week of recovery. Degenera tion ofthe olfactory epithelium was found after 4 weeks of expo surewith a decrease in incidence and severity after terminationof exposure. Cell proliferation at this site was elevated duringthe 4-week exposure period and 1 week postexposure with returnto control values after 4 weeks of recovery. Based on the cytotoxlcand proliferative findings, the NOAEL for PO in nasal epitheliumis 50 ppm     

Evidence for localization of the myotonic dystrophy protein kinase to the terminal cisternae of the sarcoplasmic reticulum

Myotonic dystrophy is an autosomal dominant multisystem disease primarily affecting skeletal muscle and is characterized by the presence of an amplified trinucleotide repeat in the 3–2; untranslated region of the myotonic dystrophy protein kinase gene. In this study, the subcellular localization of the myotonic dystrophy protein kinase in muscle tissues has been investigated at both morphological and biochemical level, by using antibodies against the myotonic dystrophy protein kinase. Immunofluorescence studies and Western-blot analysis were carried out with antibodies raised against both a synthetic peptide and a recombinant fusion protein fragment specific for the myotonic dystrophy protein kinase. The kinase is localized both to the surface membranes, and within the skeletal fibres in the region of the A-I band boundary. Consistent with the A-I location of the kinase is that Western-blot analysis of purified fractions from sarcoplasmic reticulum show that triads and sarcoplasmic reticulum terminal cisternae are immunoreactive for two myotonic dystrophy protein kinase proteins of different molecular weight (85 and 54 kDa). The relative amount of these two proteins is different in relation to the muscle type, the 85 kDa protein being more evident in skeletal than in cardiac fibres. In addition, immunofluorescence studies of cardiac muscle reveal a heavy concentration of DM-PK localized to the intercalated discs, as well as a weaker reaction in the sarcoplasm. These results taken together suggest that multiple isoforms of the DM-PK may exist and that they may be differentially located in muscle tissues     

Paediatric arterial ischaemic stroke: functional outcome and risk factors

Aim To study functional outcome in children aged 1 month to 18 years after paediatric arterial ischaemic stroke (PAIS) and to identify risk factors influencing their quality of life. Method In a consecutive series of 76 children (35 males 41 females, median age at diagnosis 2y 6mo, range 1mo–17y 2mo; median length of follow‐up 2y 4mo, range [7mo–10y 6mo]) with PAIS diagnosed at the Erasmus Medical Centre Sophia Children's Hospital between 1997 and 2006, we collected clinical, biochemical, and radiological data prospectively. In 66 children surviving at least 1 year after PAIS, functional outcome could be evaluated with the World Health Organization’s International Classification of Impairments, Disabilities and Handicaps. Results Significant risk factors at presentation for a poor neurological outcome were young age, infarction in the right middle cerebral artery territory, and fever at presentation. Fifty‐four % of children had severe neurological impairments at 12 months after PAIS, and at last follow‐up more than half needed remedial teaching, special education, or institutionalization. Health‐related quality of life (HRQOL) questionnaires showed a significantly lower HRQOL in all age groups. Children with a longer follow‐up had a lower HRQOL in the cognitive functioning domain. Interpretation Our study shows significant morbidity and mortality and a reduced HRQOL after PAIS depending on age, fever at presentation, and infarction in the right middle cerebral artery territory.     

Community pharmacists' views and experiences of counter-prescribing in pregnancy

Objective — To ascertain the sources of community pharmacists' knowledge base for counter-prescribing in pregnancy, whether sufficient additional information was readily accessible and, if not, to discover pharmacists' areas of concern. Method — A structured telephone interview of community pharmacists by a single researcher using a pre-piloted questionnaire to obtain both quantitative and qualitative data. Questions covered previous education about counter-prescribing in pregnancy, reference sources used, and satisfaction with available reference sources. Respondents were also asked to cite examples where they would or would not recommend a medicine in pregnancy. Setting — A random sample of 50 community pharmacies in Scotland. Key findings — From the high response rate (43 pharmacists, 86 per cent) the topic was demonstrably important to community pharmacists, most of whom perceived their knowledge base for counter-prescribing in pregnancy to be experience-gained. Thirty-four pharmacists (79 per cent) agreed there was a need for more information to be available. Ten pharmacists (23 per cent) highlighted complementary therapies as an area where they found available information inadequate. Examples of requests from pregnant women and the action taken by the pharmacist are reported. Conclusion — There is a need for an accurate, current and comprehensive data source for counter-prescribing in pregnancy. The field of complementary medicines and therapies is of particular concern to many community pharmacists. More research is required into GP referrals.     

Evidence for a glycoconjugate form of glutathione S-transferase pI

The anionic form of glutathione S-transferase from human (GST) and rat (GSTYp) sources has been shown to exist in multiple forms which have similar molecular weights but different isoelectric points (pIs). Treatment with endoglycosidase H caused the acidic forms of GST Yp to be converted to proteins with more basic pIs as compared to the untreated control mixtures, suggesting that an N-linked mannose moiety containing acidic residues had been removed. Inability to detect these carbohydrates by techniques requiring unsubstituted vicinal hydroxyls further suggested acidic substitutions on the sugar moiety. GST/Yp carbohydrate modifications were also identified by differential staining procedures. These data represent the first indication that glycosylation of GST can occur. Additionally, this may offer an explanation for the often seen microheterogeneity within a class of GST isozymes.     

Traditional midwives in Botswana: strengthening links between women

Since the mid-1970s, mother and child health (MCH) servicesin Botswana have expanded dramatically to become among the bestin the African region. A review carried out in 1984 recommendedthat, to further improve MCH care, efforts should be made toincrease the percentage of women who deliver their babies inclinics and hospitals. At present almost 40% of deliveries inBotswana take place at home under the care of untrained, elderly,female kin. This paper looks at the role and practices of thesetraditional midwives. There is then a discussion of the potentialvalue of mobilizing them to take part in primary health careas a link between women in the villages and the formal healthcare services. Finally the paper outlines a strategy for implementingsuch a policy of cooperation.     

HIV, substance use and related behaviour of gay and bisexual men: an examination of the talking sex project cohort

This paper reports on the substance use of 612 gay and bisexual men who participated in an HIV risk reduction project. Use/non-use, level of substance use, and reported frequency of use prior to sexual activity were examined in relation to number of sexual fanners, sexual activities, HIV antibody test seeking behaviour and known HIV status. The use of substances among the study cohort appear to be higher than in a comparable heterosexual male group. An association was found between substance use, and both number of sexual partners and sexual activities. However, no significant difference was found in substance use between men participating in protected versus unprotected anal sex. Similarly, no significant difference was found in the reported frequency of substance use prior to sex by those participating in protected and unprotected anal intercourse. Greater drug use was reported among those who were known to be HIV antibody pisitive. These findings raise issues for further research. The high use of alcohol and drugs by gay and bisexual men may pose significant health risks for this group of men.     

Enhanced cytotoxic function of natural killer and natural killer T‐like cells associated with decreased CD94 (Kp43) in the chronic obstructive pulmonary disease airway

Background and objective: Natural killer (NK) and natural killer T (NKT)‐like cells represent a small but important proportion of effector lymphocytes that we have previously shown to be major sources of pro‐inflammatory cytokines and granzymes. We hypothesized that these cells would be increased in the airway in chronic obstructive pulmonary disease (COPD), accompanied by reduced expression of the inhibitory receptor CD94 (Kp43) and increased expression of cytotoxic mediators granzyme B and perforin. Methods: We measured NK and NKT‐like cells and their expression of CD94 in the blood of COPD patients (n = 71; 30 current and 41 ex‐smokers), smokers (16) and healthy controls (25), and bronchoalveolar lavage fluid (BALF) from a cohort of subjects (19 controls, 12 smokers, 33 COPD). Activation was assessed by measuring CD69 in blood and the cytotoxic potential of NK cells by measuring granzymes A and B, and using a cytotoxicity assay in blood and BALF. Results: In blood in COPD, there were no significant changes in the proportion of NK or NKT‐like cells or expression of granzyme A or NK cytotoxic potential versus controls. There was, however, increased expression of granzyme B and decreased expression of CD94 by both cell types versus controls. The proportion of NK and NKT‐like cells were increased in BALF in COPD, associated with increased NK cytotoxicity, increased expression of granzyme B and decreased expression of the inhibitory receptor CD94 by both cell types. Conclusions: Treatment strategies that target NK and NKT‐like cells, their cytotoxicity and production of inflammatory mediators in the airway may improve COPD morbidity.     

Importance of Heart Rate During Exercise for Response to Cardiac Resynchronization Therapy

Background: Cardiac resynchronization therapy (CRT) is an established therapy for patients with severe heart failure and mechanical dyssynchrony. Response is only achieved in 60–70% of patients.
Objectives: To study exercise-related factors predicting response to CRT.
Methods: We retrospectively examined consecutive patients in whom a CRT device was implanted. All underwent cardiopulmonary exercise testing prior to implantation and after 6 months. The occurrence of chronotropic incompetence and heart rates exceeding the upper rate of the device, thereby compromising biventricular stimulation, was studied. Response was defined as a decrease in LVESV of 10% or more after 6 months.
Results: We included 144 patients. After 6 months 86 (60%) patients were responders. Peak VO₂ significantly increased in responders. Chronotropic incompetence was more frequently seen in nonresponders (21 [36%] vs 9 [10%], P = 0.03), mostly in patients in SR. At moderate exercise, defined as 25% of the maximal exercise tolerance, that is, comparable to daily life exercise, nonresponders more frequently went above the upper rate of the device (13 [22%] vs 2 [3%], P < 0.0001), most of whom were patients in permanent AF. Multivariate analysis revealed heart rates not exceeding the upper rate of the device during moderate exercise (OR 15.8 [3.3–76.5], P = 0.001) and nonischemic cardiomyopathy (OR 2.4 [1.0–5.7], P = 0.04) as predictive for response.
Conclusions: Heart rate exceeding the upper rate during moderate exercise is an independent predictor for nonresponse to CRT in patients with AF, whereas chronotropic incompetence is a predictor for patients in SR.