Skill set requirements for nurses deployed with an expeditionary medical unit based on lessons learned.

Based in Kuwait 3 years apart, the authors recount how nurses and corps staff, along with their physician counterparts, came together to form well-run medical facilities under adverse circumstances. Their respective hospitals became competent organizations because of specific formulas for success, along with preparation, identification of required skill sets, and making improvements based on experience. This article describes the training of medical, nursing, and corps staff, the facilities and resources required for managing casualties, and some of the more commonly encountered combat injuries and conditions.     

Combined heart-lung transplantation for end-stage Eisenmenger's syndrome

Between May, 1981, and December, 1984, thirteen combined heart-lung transplants were performed in 12 patients for the treatment of Eisenmenger's syndrome. The age range of the recipients was 22 to 42 years. Two patients had undergone previous open cardiac operations; in addition, one had had closure of a persistent ductus arteriosus, one an open lung biopsy, one a pulmonary artery banding, and one patient received a second heart-lung transplant after 3 years. Four recipients died before hospital discharge, one at operation and three at 4, 10, and 33 days after operation. Early symptomatic results and cardiopulmonary function were excellent in all of the survivors. Two patients died 14 and 15 months after transplantation of accelerated graft arteriosclerosis and respiratory failure, respectively, and six remain alive 7 to 44 months after transplantation. Four of these surviving patients and the two patients who died late subsequently had major pulmonary complications. Symptoms included progressive breathlessness, cough (often productive), and fever with physical signs of diffuse crepitations and expiratory rhonchi. Serial pulmonary function tests showed progressive obstructive physiology in all six patients with superimposed restrictive defects in four. Histologic examination of tissue from open lung biopsy or autopsy displayed bronchiolitis obliterans in five of these patients, one of whom required retransplantation. It is possible that these late changes are the result of rejection, since similar changes in one other patient have now been reversed with augmented immunosuppression. Further understanding of the causes and manifestations of late pulmonary deterioration should improve the late functional results of this operation for Eisenmenger's syndrome.     

Inhibition of intercellular communication in Chinese hamster V79 cells by fractionated asphalt fume condensates

Asphalt fume condensate is a skin carcinogen in mice, yet this complex mixture contains relatively low levels of known carcinogenic initiators. Consequently, its biological activity has been attributed to the presence of cocarcinogenic or tumor-promoting agents. One of several proposed mechanisms of tumor promotion is inhibition of intercellular communication. In an attempt to determine if asphalt fume has tumor-promoting potential inhibition of intercellular communication was measured in V79 cells exposed to fractionated asphalt fume condensate. Fume from air-blown Arabian crude asphalt was trapped and separated into five fractions by preparative-scale high-pressure liquid chromatography. The parent fume condensate and the five fractions inhibited intercellular communication in a concentration-dependent fashion, with a minimum effective concentration of 2.5 microgram/ml for the most potent fraction. Cytotoxicity assays were performed at the same time and concentrations as the metabolic cooperation assays. Cytotoxic responses paralleled the inhibition of intercellular communication.     

Acculturation and self-reported health among Hispanics using a socio-behavioral model: the North Texas Healthy Heart Study

Background  

Acculturation is a continuous, firsthand contact with other cultures functioning at both group and individual levels and is reflected in our culturally diverse society, calling for a greater understanding of the environmental and cultural impact on health. Self-reported health (SRH), a robust and well validated predictor of future mortality for all racial/ethnic groups, has been differentially reported by Hispanics compared to whites, especially based on their acculturation status. This study investigated the relationship between acculturation and SRH among Hispanics. An adapted Andersen framework was used to develop logistic regression models to assess for an association between acculturation and general health status.     

Spread of squamous cell carcinoma to the nonirradiated edentulous mandible—A preliminary report

The changes in the mandible and in its relationship to surrounding soft tissue structures after loss of the teeth are described; the regular presence of deficiencies in the cortical bone along the line of the occlusal ridge is emphasized. Resection specimens of squamous carcinoma of the oral cavity not treated by radiotherapy were examined where there was mandibular involvement by tumor, and showed that the main route of tumor entry into the bone was through the occlusal ridge. Subsequent perineural spread along the inferior alveolar nerve has been found to be a regular occurrence.     

The Behavior Problems Inventory: Reliability and Factor Validity in Institutionalized Adults with Intellectual Disabilities

Background The aim of this study was to reevaluate the reliability (internal consistency, inter‐rater and re‐test) and the factor structure of the Behavior Problems Inventory (BPI‐01) with adults with intellectual disabilities who resided in a state‐run developmental centre. Methods BPI‐01 was administered to informants who had known participants for a minimum of 6 months. For study 1, data were collected in two samples: 100 residents who were selected based on the challenging behaviour targeted in their behaviour treatment plan and 325 randomly selected residents. Results The internal consistencies of the BPI‐01 subscales were in the good to excellent range. Overall, the inter‐rater and test–re‐test reliability of the subscales and items were adequate with relatively lower reliability found for the Stereotypy subscale and items. For study 2, the data of the 425 participants from study 1 were used in a confirmatory factor analysis, which indicated that three a priori BPI‐01 subscales (Self‐Injurious Behavior, Stereotyped Behavior and Aggression/Destruction) were a reasonable fit. Conclusions The current study provides additional support to the reliability and factor structure of the BPI‐01 in adults with intellectual disabilities.     

Facilitating involvement in Alcoholics Anonymous during out-patient treatment: a randomized clinical trial

Aim   This study evaluated two strategies to facilitate involvement in Alcoholics Anonymous (AA)—a 12-Step-based directive approach and a motivational enhancement approach—during skills-focused individual treatment.
Design   Randomized controlled trial with assessments at baseline, end of treatment and 3, 6, 9 and 12 months after treatment.
Participants, setting and intervention   A total of 169 alcoholic out-patients (57 women) assigned randomly to one of three conditions: a directive approach to facilitating AA, a motivational enhancement approach to facilitating AA or treatment as usual, with no special emphasis on AA.
Measurements   Self-report of AA meeting attendance and involvement, alcohol consumption (percentage of days abstinent, percentage of days heavy drinking) and negative alcohol consequences.
Findings   Participants exposed to the 12-Step directive condition for facilitating AA involvement reported more AA meeting attendance, more evidence of active involvement in AA and a higher percentage of days abstinent relative to participants in the treatment-as-usual comparison group. Evidence also suggested that the effect of the directive strategy on abstinent days was mediated partially through AA involvement. The motivational enhancement approach to facilitating AA had no effect on outcome measures.
Conclusions   These results suggest that treatment providers can use a 12-Step-based directive approach to effectively facilitate involvement in AA and thereby improve client outcome.