Nurses' attitudes and practices in sickle cell pain management

Professional objectivity should be the primary focus of patient care. Health care professionals are at times reluctant to give opioids out of fear that patients may become addicted, which would result in the undertreatment of pain. The influence of nurses' attitudes on the management of sickle cell pain was studied. The variables of age, education, area of practice, and years of active experience were considered. Of the respondents, 63% believed addiction was prevalent, and 30% were hesitant to administer high-dose opioids. Study findings suggest that nurses would benefit from additional education on sickle cell disease, pain assessment and management, and addiction. Educational recommendations are discussed.     

Localized immediate early gene expression related to the strength of song learning in socially reared zebra finches

Recent evidence showed that exposure of tape-tutored zebra finch (Taeniopygia guttata castanotis) males to the tutor song involves neuronal activation in brain regions outside the conventional 'song control pathways', particularly the caudal part of the neostriatum (NCM) and of the hyperstriatum ventrale (CMHV). Zebra finch males were reared with a live tutor during the sensitive period for song learning. When, as adults, they were re-exposed to the tutor song, the males showed increased expression of Fos, the protein product of the immediate early gene c-fos, in the NCM and CMHV, compared with expression in two conventional 'song control nuclei', high vocal centre (HVC) and Area X. The strength of the Fos response (which is a reflection of neuronal activation) in the NCM (but not in the other three regions) correlated significantly and positively with the number of song elements that the birds had copied from the tutor song. Thus, socially tutored zebra finch males show localized neural activation in response to tutor song exposure, which correlates with the strength of song learning.     

Localized brain activation specific to auditory memory in a female songbird

Song acquisition in songbird males is a prominent model system for the study of the brain mechanisms of memory. Male zebra finches (Taeniopygia guttata) learn their songs from an adult conspecific tutor early in life. Previous work has shown that exposure of males to their tutor song leads to increased expression of immediate early genes (IEGs) in the caudomedial nidopallium (NCM) and in the caudomedial mesopallium (CMM). In addition, IEG expression in the NCM correlates significantly with the strength of song learning. Interpretation of these findings is complicated, as males both learn the characteristics of tutor song and learn to produce a similar own song. Female zebra finches do not sing, but nevertheless they learn the characteristics of a song to which they were exposed when young, and form a preference for it. Here, adult zebra finch females reared with their fathers showed a significant preference for their father's song. Females that were later reexposed to their father's song showed significantly greater expression of Zenk, the protein product of the IEG ZENK, than controls that were exposed to a novel song, in the CMM, but not in the NCM or hippocampus. These results suggest that in female zebra finches the CMM may be (part of) the neural substrate for the representation of the memory of their father's song.     

Effects of N-acetylcysteine on dense cell formation in sickle cell disease

The extent to which dense and irreversible sickle cells (ISCs) contribute to vaso-occlusive episodes in sickle cell disease remains unclear. N-Acetylcysteine (NAC) inhibits dense cell and ISC formation in sickle erythrocytes in vitro and restores glutathione levels toward normal. A phase II double-blind randomized clinical trial was completed to determine the efficacy of NAC in decreasing dense cell and ISC formation, and vaso-occlusive episodes in sickle cell disease. Twenty-one subjects with a history of at least two vaso-occlusive episodes per year and 6% dense cells were enrolled. Four treatment groups were analyzed; NAC at a dose of 2,400 mg per day decreased the percent dense cells from 20.1 +/- 2.9 to 12.6 +/- 2.1 (P < 0.05) and increased red cell glutathione levels from 292.8 +/- 74.5 to 576.7 +/- 155.1 (P < 0.05). In addition, we observed a decrease in vaso-occlusive episodes from 0.03 to 0.006 episodes per person-days and a decreased in relative risk to R = 0.39. Although NAC did not significantly decrease the number of ISCs, there was a downward trend at all doses tested. In summary, NAC inhibited dense cell formation, restored glutathione levels toward normal, and decreased vaso-occlusive episodes at a well-tolerated dose of 2,400 mg per day. To determine the long-term efficacy and safety of NAC, a multicenter phase III clinical trial is required.     

THE EVOKED HEART RATE RESPONSE DURING SLEEP

Heart rate responses evoked by a 3-sec auditory stimulus were averaged within stages of sleep for five subjects. Although there were some individual differences, the evoked HR response is generally diphasic, with the peak of the acceleratory component occurring on the fourth post-stimulus beat and the trough of the deceleratory component occurring on the 10th post-stimulus beat. Unlike other variables, which are depressed during the rapid eye movement (REM) stage, the HR response tends to be larger during the REM stage than during other stages of sleep. The size of the response is not appreciably affected by time of night, since HR is non-habituating during sleep, but is affected by the respiratory cycle phase, being largest when the stimulus occurs during inspiration or the period immediately prior to inspiration, and smallest when the stimulus occurs during the expiratory phase.     

Neuronal activation related to auditory perception in the brain of a non-songbird, the ring dove

In songbirds, parrots, and hummingbirds, which need to learn their songs, exposure to conspecific song leads to increased expression of the immediate early gene (IEG) ZENK in a number of forebrain regions, including the caudomedial nidopallium (NCM) and the caudomedial mesopallium (CMM). Here we investigated the pattern of IEG expression in response to auditory stimulation in the brain of the ring dove (Streptopelia risoria), a non-songbird that does not need to learn its vocalizations. Ring dove males were exposed to conspecific vocalizations (coos), to heterospecific vocalizations (zebra finch song) or they were kept in silence. IEG expression was investigated by means of immunocytochemical analysis of the distribution of the ZENK protein product Zenk. In all three groups there was Zenk expression in several forebrain regions including the NCM and the CMM, similar to earlier findings in song-learning species. Quantitative analysis of the NCM, the CMM, and the hippocampus revealed significantly greater Zenk expression in birds exposed to conspecific vocalizations than in birds kept in silence, in the CMM only. These results show that there is substantial Zenk expression in the forebrain of a non-song-learning bird, comparable to that in avian song-learning taxa. These findings suggest that there is IEG expression specific to conspecific auditory stimulation in the CMM in both songbirds and non-songbirds.     

AUTONOMIC CORRELATES OF EYE MOVEMENT BURSTS DURING STAGE REM SLEEP

During stage REM sleep, eye movements were found to be distributed in discrete bursts of rapid eye movement (REM-bursts). REM-burst time averaged approximately 10 percent of stage REM sleep and the rate within a subject was consistent from epoch-to-epoch and night-to-night. Consistent subject biases in eye movement direction were also found. Within subject correlations were obtained between REM-burst time and autonomic activity. Significant positive correlations were found for respiration rate and number of finger pulse responses. There were positive but insignificant correlations with electrodermal activity, heart rate and decreases in respiration amplitude. Autonomic variability was not significantly associated with REM-burst time.     

A primary care provider's guide to preventive and acute care management of adults and children with sickle cell disease

Purpose: To familiarize primary care providers (PCPs) with the pathophysiological processes, diagnostic evaluation, and medical management of sickle hemoglobinopathies and their complications. Current standards of care, clinical research advances, and new treatment options will also be addressed to assist PCPs in the management of sickle cell disease (SCD).
Data sources: A selective search and review of the current literature on SCD and the authors' experience.
Conclusions: Management of individuals with SCD is very complex, requiring a multidisciplinary approach that includes the patient or parent, PCP, specialist, nurse, and social worker. More patients living with SCD are relying on PCPs in nonspecialty practices for comprehensive disease management.
Implications for practice: Newborn screening detects new cases of SCD annually. The median life expectancy has more than doubled for individuals with sickle cell anemia. Healthcare providers are now in an era of increased routine screening, assessment, and management of chronic complications from this illness not previously seen in the care of adults with SCD.