Integrating Nursing Care into Systems of Care for Children with Emotional and Behavioral Disorders

PROBLEM: Recent developments in providing care to children with emotional and behavioral disorders, especially those with serious emotional disturbance, have included the establishment of systems of care. Guided by a set of principles and values, these systems of care have organized and delivered services to children and families with complex needs. To date, nurses have not had a salient role in systems of care. RESULTS: It is estimated that 20% of American children and adolescents have an emotional or mental disorder. As many as two thirds of these children are not receiving services. Systems of care have been funded to provide services for these children, particularly for the most severely affected. To date, nursing has not had a prominent role in these systems of care. CONCLUSIONS: Based on their knowledge, skills, and holistic approach to care, nurses could better integrate nursing care into systems of care. Possible roles as case managers, primary therapists, in-home interventionists, and in educational programs are suggested.     

PR01“A PICTURE SPEAKS A THOUSAND WORDS”– THE USE OF DIGITAL PHOTOGRAPHY AND THE INTERNET IN MONITORING FREE TISSUE TRANSFER

Purpose Post operative monitoring is crucial for the success of microsurgical free tissue transfer. Sophisticated and expensive methods are available for monitoring. We propose a novel technique using digital photography and the internet as a reliable and cost effective method to monitor free tissue transfers. Methods 163 micro‐vascular procedures were monitored using this technique over 8 months. Serial photographs taken to show flap color. Capillary refill time, pin prick‐ bleed time and color and hand held Doppler signal was recorded in the movie mode of a standard 5 mega pixel camera with duration of 15 seconds. Data was sent to the surgeon at regular intervals and or as deemed necessary. Results Analysis of the 67 cases is presented. 5 re‐explorations were done. The early diagnosis of venous congestion was possible using this technique. Timely intervention contributed to the success of the re‐explorations and these flaps could be salvaged. The file size of images was in the range of 1 MB–6 MB. The file size of an entire set of images ranged about 7 MB–9 MB. These were sent across the ADSL internet lines. Conclusion The use of the digital images and the internet allow reconstructive surgeons to have a reliable picture of the state of their free tissue transfers. This permits decrease in observer error and saves valuable time which otherwise needs to be spent to verify situations of doubt and offers an ideal solution to the logistic problem of having to visit the patient in case of doubt.     

实时双平面超声心动图初步临床应用研究

目的　探讨实时双平面超声心动图的临床应用价值。方法　对 83例受检者进行实时双平面超声 (BP)检查 ,其中男 46例 ,女 3 7例 ,平均年龄 2 0 92± 19 16岁。正常人 10例 ,先天性心脏病 44例 ,心瓣膜病 2 6例 ,其他心脏病变3例。结果　实时双平面超声有助于理解心脏立体解剖 ;能通过有限的声窗获得更多的切面 ,并可显示常规经胸超声不易得到的切面 ;多切面显示心脏瓣膜及其病变 ,有利于获得瓣膜狭窄或关闭不全的最佳观察平面 ;多切面显示房、室间隔缺损 ,便于寻找缺损的最佳显示切面以及与毗邻结构的关系。房、室间隔缺损BP、2DE测值与手术测值均有良好相关性 ;室间隔缺损BP测值与手术测值无显著性差异 ;BP、2DE均有低估房间隔缺损大小的倾向。实时双平面超声能同时显示复杂先心病的多种解剖畸形 ,有利于确定房室连接 ;辨认主、肺动脉。结论　实时双平面超声有其独特的优势 ,可为心血管疾病的准确诊断提供更多的信息。     

End-of-life Models and Emergency Department Care

Many people die in emergency departments (EDs) across the United States from sudden illnesses or injuries, an exacerbation of a chronic disease, or a terminal illness. Frequently, patients and families come to the ED seeking lifesaving or life-prolonging treatment. In addition, the ED is a place of transition-patients usually are transferred to an inpatient unit, transferred to another hospital, or discharged home. Rarely are patients supposed to remain in the ED. Currently, there is an increasing amount of literature related to end-of-life care. However, these end-of-life care models are based on chronic disease trajectories and have difficulty accommodating sudden-death trajectories common in the ED. There is very little information about end-of-life care in the ED. This article explores ED culture and characteristics, and examines the applicability of current end-of-life care models.     

DNA damage from polycyclic aromatic hydrocarbons measured by benzo[a]pyrene-DNA adducts in mothers and newborns from Northern Manhattan, the World Trade Center Area, Poland, and China.

Polycyclic aromatic hydrocarbons (PAH), of which benzo[a]pyrene is a representative member, are combustion-related environmental pollutants and include known carcinogens. Laboratory animal studies indicate that the dose of PAHs to the fetus is on the order of a 10th that to the mother and that there is heightened susceptibility to PAH-induced carcinogenesis during the fetal and infancy periods. Carcinogen-DNA adducts, a measure of procarcinogenic genetic damage, are considered a biomarker of increased cancer risk. Here we compare the levels of benzo[a]pyrene-DNA adducts as a proxy for PAH-DNA damage measured in maternal blood and newborn cord blood obtained at delivery in four different populations of mothers (total of 867) and newborns (total of 822), representing a 30-fold range of exposure to ambient PAHs. The populations include residents in Northern Manhattan, participants in a study of the effects of the World Trade Center disaster, residents in Krakow, Poland, and residents in Tongliang, China. Mean adduct concentrations in both maternal and cord blood and the proportion of samples with detectable adducts, increased across the populations [Northern Manhattan < World Trade Center (WTC) < Krakow < Tongliang], consistent with the trend in estimated ambient exposure to PAHs (P < 0.001). For mothers, the means in the respective populations were Northern Manhattan (0.21 adducts per 10(8) nucleotides), WTC (0.23 adducts per 10(8) nucleotides), Krakow (0.28 adducts per 10(8) nucleotides), Tongliang (0.31 adducts per 10(8) nucleotides); the corresponding means in the newborns were Northern Manhattan (0.23), WTC (0.24), Krakow (0.29), Tongliang (0.31). The percentage of mothers with detectable levels of adducts in the respective populations were Northern Manhattan (36.8%), WTC (57.5%), Krakow (72.9%), Tongliang (73.4%); the corresponding percentages among the newborns were Northern Manhattan (42.4%), WTC (60.6%), Krakow (71.1%), Tongliang (79.5%). Despite the estimated 10-fold lower PAH dose to the fetus based on laboratory animal experiments, the adduct levels in the newborns were similar to or higher than in the mothers. This study suggests that the fetus may be 10-fold more susceptible to DNA damage than the mother and that in utero exposure to polycyclic aromatic hydrocarbons may disproportionately increase carcinogenic risk. The data support preventive policies to limit PAH exposure to pregnant women and children.     

International Family-planning Training for Nurse Practitioners

Since the mid-1970s, the Margaret Sanger Center of Planned Parenthood of New York City has prepared nurses and nurse midwives from less developed countries to be family-planning nurse practitioners. These nurse practitioners then provide services to patients, train other staff, and manage integrated family-planning clinics. More than 120 nurses and nurse midwives have arrived in groups of 10 at the Sanger Center, with 72 attending since 1981. Each course lasts 10 weeks. The core curriculum provides trainees with skills in women's health care including contraception, in training and advocacy, and in management of clinics. Whether, in the current period of scarce resources, cross-cultural training programs of this type remain a worthwhile investment, and if so, which of their components are most important to this success, is assessed.     

Focus cleaning using mini-thoracotomy for cavitary pulmonary tuberculosis or pulmonary tuberculoma: case study of 18 human subjects

Zusammenfassung GRUNDLAGEN: Das Ziel dieser Untersuchung war, die Machbarkeit und Wirksamkeit der Fokus-Sanierung via Mini-Thorakotomie zur Therapie einer kavernösen Lungentuberkulose zu prüfen. METHODIK: Der Mini-Thorakotomie-Zugang wurde in 18 Patienten angewendet (Alter, 25–75 Jahre; median, 47,5 Jahre). Die Patienten hatten eine kavernöse Lungentuberkulose oder ein Lungentuberkulom nach tuberkulostatischer Therapie oder waren Patienten, die auf diese Therapie nicht angesprochen haben. 8 Patienten mit chronischer kavernöser Lungentuberkulose und 10 Patienten mit Tuberkulom haben sich der Fokus-Sanierung, Spülung und Faltnaht unterzogen. ERGEBNISSE: Es gab keine operative Mortalität. Alle Patienten waren klinisch saniert, hatten keinen Nachweis für Bakterien im Sputum, im Röntgen hatten die Lungenschatten abgenommen. Die Dauer der Operation betrug 30–120 min (median, 75 min), der intraoperative Blutverlust war 100–200 ml (median, 153 ml). Der postoperative Spitalsaufenthalt betrug 21–42 Tage (median, 30 Tage). Das Follow-up nach 1–4 Jahren (median, 2,5 Jahre) zeigte keine Komplikation und kein Rezidiv der Grunderkrankung. SCHLUSSFOLGERUNGEN: MTFC ist eine sichere und technisch machbare Methode zur Therapie der Lungentuberkulose oder des Tuberkuloms bei Schonung der Lungenfunktion.