Breastfeedilzg Support Services in the Neonutd Intensive-Care Unit

Objective: To describe a model for providing breastfeeding support in the neonatal intensive-care unit (NICU).
Design: Naturalistic, participant observation.
Setting: Suburban Level III NICU.
Patients: One hundred thirty-two mother-infant pairs over 1 year. Infants were hospitalized In the NICU, and mothers had initiated lactation efforts.
Interventions: Investigators provided breastfeeding interventions for the mother-infant pairs, based on identified problems, the research literature, or both.
Main Outcome Measures: Percentage of mothers who were breastfeeding at the time of discharge from the NICU.
Results: Interventions were classified into jive categories: expression and collection of mothers' milk, gavage feeding of expressed mothers' milk, in-hospital breastfeeding sessions, postdischarge breastfeeding management, and additional consultation.
Conclusions: This model was effective In preventing breastfeeding failure for this population. The model can provide the basis for NICU breastfeeding standards of care, protocols, and chart records, or for reimbursement purposes. The model also provides a framework for studying a specific category or breastfeeding intervention.     

The evolution and value of bleeding assessment tools

Summary. A personal history of excessive mucocutaneous bleeding is a key component in the diagnosis of a number of mild bleeding disorders, including von Willebrand disease (VWD), platelet function disorders (PFD), and coagulation factor deficiencies. However, the evaluation of hemorrhagic symptoms is a well‐recognized challenge for both patients and physicians, because the reporting and interpretation of bleeding symptoms is subjective. As a result, bleeding assessment tools (BATs) have been developed and studied in a variety of clinical settings. This work has been pioneered by a group of Italian researchers, and the resultant ‘Vicenza Bleeding Questionnaire’ stands as the original BAT. In this review, we will discuss the modifications of the Vicenza Bleeding Questionnaire that have taken place over the years, as well as the validation studies that have been published. Other BATs that have been developed and published will be reviewed, as will the special situations of assessing pediatric bleeding as well as menorrhagia. Lastly, the clinical utility of BATs will be discussed including remaining challenges and future directions for the field.     

Low expression of MSH2 DNA repair protein is associated with poor prognosis in head and neck squamous cell carcinoma

Objective

This study aimed to investigate the expression of the MSH2 DNA repair protein in head and neck squamous cell carcinoma (HNSCC) in order to analyze its association with clinicopathologic factors and overall survival of patients.

Material and Methods

Clinical data and primary lesions of HNSSC were collected from 55 patients who underwent surgical resection with postoperative radiotherapy in Montes Claros, state of Minas Gerais, Brazil, between 2000 and 2008. Immunohistochemical reactions were performed to analyze MSH2 protein expression.

Results

Bivariate analysis showed no significant correlation or association between MSH2 expression and clinicopathologic parameters by Mann-Whitney and Kruskal-Wallis tests. Patients with locoregional metastatic disease (OR=4.949, p<0.001) and lower MSH2 immunohistochemical expressions (OR=2.943, p=0.032) presented poorer survival for HNSCC by Cox regression models.

Conclusions

Our data demonstrated that lower MSH2 expression might contribute to a higher clinic aggressiveness of HNSCC by promoting an unfavorable outcome.     

Empowerment, engagement and perceived effectiveness in nursing work environments: does experience matter?

Aims  We examined the impact of empowering work conditions on nurses' work engagement and effectiveness, and compared differences among these relationships in new graduates and experienced nurses.
Background  As many nurses near retirement, every effort is needed to retain nurses and to ensure that work environments are attractive to new nurses. Experience in the profession and generational differences may affect how important work factors interact to affect work behaviours.
Methods  We conducted a secondary analysis of survey data from two studies and compared the pattern of relationships among study variables in two groups: 185 nurses 2 years post-graduation and 294 nurses with more than 2 years of experience.
Results  A multi-group SEM analysis indicated a good fit of the hypothesized model. Work engagement significantly mediated the empowerment/effectiveness relationship in both groups, although the impact of engagement on work effectiveness was significantly stronger for experienced nurses.
Conclusions  Engagement is an important mechanism by which empowerment affects nurses feelings of effectiveness but less important to new graduates' feelings of work effectiveness than empowerment.
Implications for nursing management  Managers must be aware of the role of empowerment in promoting work engagement and effectiveness and differential effects on new graduates and more seasoned nurses.     

ANALYSIS OF ETHANOL AND ACETALDEHYDE RECOVERY FROM PERCHLORIC ACID-TREATED BLOOD

Recovery of acetaldehyde (0–20 µM) or ethanol (0–50mM) added to blood and subsequently treated with perchloricacid (PCA) was evaluated using head-space gas chromatographyand compared with controls. Using blood from five dogs, <100%of acetaldehyde and ethanol was recovered from PCA-treated samples.Mathematical models of putative binding mechanisms indicatedacetaldehyde partitioned simply between supernatant and PCA-inducedprecipitate and occupied <1% of acetaldehyde binding siteson precipitate; ethanol partitioned simply between supernatantand precipitate and occupied >62% of ethanol binding sites.The mathematical model also indicated acetaldehyde binding is2500-fold stronger than ethanol binding. These results indicateas much as 46.4% of acetaldehyde may be bound to PCA-inducedprecipitate formed in whole blood. This loss of acetaldehydeis 3- to 4-fold greater than acetaldehyde loss caused by evaporationfrom PCA-treated blood.