The northeast Tennessee Spirituality and End of Life Issues Survey.

We developed the northeast Tennessee Spirituality and End of Life Issues Survey and randomly distributed it to 1,000 patients in our internal medicine practice. We received 568 surveys at least partially completed. Most of the participants demonstrated a spiritual interest and at least half believed it appropriate for their physician to share their diagnosis and prognosis with their spiritual leader. Only 0.9% of patients thought it was necessary for their physician to know about their spiritual heritage in order to serve their needs better. Less than 30% of respondents had a living will or durable power of attorney for health care. A large majority of patients did not want CPR (67.8%) or i.v. fluids (69%) or mechanical ventilation (74.5%) if their physician determined they were at the end of their life. This was true whether or not they could identify a house of worship or a spiritual leader. Less than one-third of patients who did not want terminal CPR or mechanical ventilation had a living will or durable power of attorney for health care.

Canadian nurses' views on assignment of publication credit for scholarly and scientific work.

A total of 184 Canadian nurses who were expected to publish scholarly and/or scientific work or whose roles provide for socialization of nurses in academic endeavours, research, and publication were asked to respond to 42 scenarios. This study replicated, with some modifications, surveys conducted in 1981, 1985, and 1987 to determine the views of American nurses on assignment of publication credit. The scenarios in the present survey required judgements about how authorship and footnote credit should be allocated among groups involved in research and academic writing; in some scenarios all the individuals were nurses (in both clinical and academic settings), while other scenarios featured collaboration between nurses and other health-care professionals or focused on interactions between nursing professors and students. While consensus of greater than 80% was achieved for only 7 of the 42 scenarios (modal responses), the respondents' written comments revealed 2 recurrent themes: that credit should be based entirely on contribution, rather than status; and that, as much as possible, authorship and footnote acknowledgement should be discussed and resolved before contentious issues arise. There was widespread agreement on these 2 principles. However, there was disagreement concerning collaborative academic work, particularly concerning the forms of collaboration that merit authorship credit and the forms that are sufficiently acknowledged through footnoting. Both the model responses and the areas of disagreement are discussed.

Moving toward policy development on assigning publication credit for oncology nurses' contributions to scholarly and scientific work.

The policy implications of a 1996 national nursing survey on the allocation of publication credit form of this paper. An earlier article (Butler & Ginn, 1997) describes and analyzes the outcome of the survey; the purpose here is to draw on that analysis, and on the relevant literature, to propose a starting place for discussion within the specialty of oncology and the nursing profession regarding assignment of credit for various contributions to collaborative scholarly work. After identifying the growing need for such a discussion and briefly highlighting the findings of the survey, the paper goes on to examine unacceptable practices in scholarly work and identify issues which should be resolved before collaborative work is undertaken. The final portion of the paper makes tentative suggestions as to principles and guidelines which might be applied to avoid disputes about the value of different contributions to a collaborative project. It is emphasized that the intention is not to advocate acceptance of the guidelines suggested here, but to create sufficient interest so that an approach to allocation of publication credit may be developed which will be consistent and relevant to the needs of the nursing profession.

Absence of acute cocaine interactions with the MAO-B inhibitor selegiline.

Selegiline, an irreversible monoamine oxidase-B (MAO-B) inhibitor, is under investigation as a treatment for cocaine relapse prevention. To evaluate its safety, human volunteers (n = 5) received intravenous cocaine (0, 20 and 40 mg, 1 h apart) following treatment with placebo or selegiline (10 mg, p.o.). Cocaine increased heart rate, blood pressure, pupil diameter and subjective indices of euphoria and craving. Selegiline produced no measureable effects, except for miosis, and did not alter the effects of cocaine. These data suggest that selegiline may be safely administered in combination with cocaine, and that selegiline is unlikely to increase reinforcing effects of cocaine.

Integration of information-seeking skills and activities into a problem-based curriculum.

Recent trends in medical education include a shift from the traditional, didactic, lecture-oriented approach to a more student-driven, problem-based approach to learning. This trend provides librarians with an opportunity to develop programs to teach information-gathering skills that support and are integrated into problem-based learning (PBL). In 1992, the University of Pittsburgh School of Medicine implemented the initial phase of a curriculum revision that emphasizes PBL. Since that time, Falk Library of the Health Sciences has provided a large-scale, intensive program integrating information-seeking skills and activities into the first-year Patient-Doctor Relationship course, a sequence that initiates medical school. A multimodal approach to information seeking and sources is emphasized, utilizing print and audiovisual materials, computerized resources, and subject experts. The Falk Library program emphasizes the gathering and use of information as central to both PBL and student skills development. An informal, post-course evaluation was conducted to gauge which information resources were used and valued most by students. This article presents evaluation results, including data on the use of information sources and services, and student perceptions of the librarian's role in the PBL sessions.

Cardiopulmonary resuscitation. Not for all terminally ill patients.

Where there are clear clinical indications that a patient suffering from a terminal illness would not benefit from cardiopulmonary resuscitation, there is no legal or ethical requirement that CPR be discussed with the patient as a treatment option or that CPR be administered if the patient stops breathing or suffers cardiac arrest.

Genetic analysis of alpha 2-adrenergic receptors and blood pressure using Dahl salt-sensitive rats.

OBJECTIVE: To evaluate the role of alpha 2-adrenergic receptors in genetic hypertension by cosegregation analysis using Dahl rats. DESIGN: Inbred Dahl salt-sensitive (SS/Jr) rats were crossed with inbred Dahl salt-resistant (SR/Jr) rats; also, SS/Jr rats were crossed with several control strains, and large F2 populations were subsequently produced from each cross. All F2 populations were raised on a high-salt diet. The rats were genotyped, where possible, at the loci for three different subtypes of alpha 2-adrenergic receptors designated as classes I, II and III. The blood pressures of the rats classified by genotype at each alpha 2-adrenergic receptor subtype locus were compared using analysis of variance. METHODS: Genomic clones of three classes of alpha 2-adrenergic receptors were isolated from genomic lambda-phage libraries of SS/Jr or SR/Jr rat strains, or both, by screening with complementary DNA for human alpha 2-adrenergic receptors. Fragments of the rat genomic clones obtained were used for genotyping by restriction fragment length polymorphism. Also, cloned genomic DNA flanking the alpha 2-adrenergic receptors and containing microsatellites was sequenced; genotyping at informative microsatellite markers was performed using the polymerase chain reaction. Two of the three classes of rat alpha 2-adrenergic receptors were localized to rat chromosomes by linkage analysis or using a panel of mouse-rat hybrid somatic cell lines. RESULTS: Rat alpha 2-adrenergic receptor classes I and III genes were assigned to rat chromosomes 14 and 3, respectively. These correspond to alpha 2-adrenergic receptor genes on human chromosomes 4 and 2, respectively. Extensive cosegregation analysis, involving five alleles in six segregating populations for class I alpha 2-adrenergic receptors, yielded no evidence of an effect of these loci on blood pressure. Classes II and III alpha 2-adrenergic receptors could each be tested in only one population and there was no evidence for an effect of either receptor gene on genetic differences in blood pressure. The dopamine-1B receptor was closely linked to the class I alpha 2-adrenergic receptor on rat chromosome 14. Thus, the negative cosegregation of the class I receptor with blood pressure applies equally to the dopamine-1B receptor. CONCLUSIONS: Genetic analysis in segregating populations involving crosses of inbred Dahl salt-sensitive rats with five other strains provides no evidence for a genetic effect of class I alpha 2-adrenergic receptors, or of the dopamine-1B receptor, on blood pressure. Classes II and III alpha 2-adrenergic receptors also failed to cosegregate with blood pressure but, because only limited testing was possible with the classes II and III receptors, this negative result is not definitive.

Providing medical care to methadone clinic patients: referral vs on-site care.

OBJECTIVES: Intravenous drug users are at high risk for medical illness, yet many are medically underserved. Most methadone treatment programs have insufficient resources to provide medical care. The purpose of this study was to test the efficacy of providing medical care at a methadone clinic site vs referral to another site. METHODS: Patients with any of four target medical conditions were randomized into an on-site group offered medical care at the methadone treatment clinic and a referred group offered medical care at a nearby clinic. Entry to treatment and use of medical services were analyzed. RESULTS: Of 161 intravenous drug users evaluated, 75 (47%) had one or more of the target medical conditions. Fifty-one were randomized. In the on-site group (n = 25), 92% received medical treatment; in the referred group (n = 26), only 35% received treatment. CONCLUSIONS: Providing medical care at a methadone treatment program site is more effective than the usual referral procedure and is a valuable public health intervention.

Estimate of the genetic divergence between inbred Dahl salt-sensitive and salt-resistant rats.

OBJECTIVE: The genetic divergence of inbred Dahl salt-sensitive (SS/Jr) rats from inbred Dahl salt-resistant (SR/Jr) rats and various other inbred strains was measured. DESIGN: Structural differences in DNA between strains were evaluated. METHODS: Genetic variants were sought (1) by restriction fragment length polymorphism (RFLP) analysis, using 19 DNA probes, (2) by the polymerase chain reaction around microsatellites and (3) by DNA sequencing. RESULTS: It was estimated that 1 in 1532 bases of DNA were different between the SS/Jr and SR/Jr strains. In comparing SS/Jr and SR/Jr rats, it was also observed that one DNA probe in 10 will yield multiple RFLP, presumably as the result of large insertion/deletion events. A comparison of SS/Jr rats with seven other inbred strains showed that the percentage of loci that carry alleles different from SS/Jr rats varies from about 23% for Albino Surgery rats to 71% for Brown Norway rats. CONCLUSIONS: Although the SR/Jr strain is an appropriate contrasting strain for the genetic analysis of hypertension in SS/Jr rats, a genetic analysis involving crosses of SS/Jr rats and unrelated inbred strains is also likely to be useful in identifying genes that cosegregate with blood pressure because more informative genetic markers will be available than in a cross of SS/Jr with SR/Jr rats.

Quality filtering of the clinical literature by librarians and physicians.

A study was conducted at the University of Pittsburgh to determine the effectiveness of the selection process by clinical medical librarians and to identify the criteria used by librarians and physicians to select relevant articles. The study analyzed the similarity between librarian and physician selections, the decision-making processes used by librarians and physicians, and the utility of librarian selections versus those of physicians. No significant difference in utility between librarian and physician selection was found, suggesting that librarians can recognize and select useful articles as effectively as physicians. Both librarians and physicians based selection decisions primarily on article title, abstract, and journal title. Librarians were more likely to focus on Medical Subject Headings (MeSH) descriptors, while physicians focused on clinical applicability or similarity to a specific case. Journal selection data indicate that the principle internal medicine journals were the most frequently selected sources. The study demonstrates that librarians can effectively serve a quality filtering function in the clinical environment, and they should consider extending quality filtering activities to other arenas.

Inhibition of rotavirus in vitro transcription by optimal concentrations of monoclonal antibodies specific for rotavirus VP6.

Three monoclonal antibodies (MAbs) obtained from inoculation of mice with either a serotype 1 human rotavirus or rotavirus SA11 (serotype 3) inhibited the in vitro transcription of rotavirus SA11. Two of the MAbs exhibited a biphasic inhibitory response. Removal of antibody from MAb preparations by adsorption with Sepharose-Protein G reduced the inhibitory activity completely for all three MAb preparations. Analysis by radioimmunoprecipitation and Western blotting indicated that all three MAbs reacted with VP6. All MAbs also reacted with four group A rotavirus serotypes by ELISA, but did not cross-react with reovirus type 1, poliovirus type 2 or MA-104 cell lysates. Transcription of four rotavirus serotypes as well as epizootic diarrhoea of infant mice rotavirus was inhibited when tested with two of the MAbs. Transcription of both purified single-shelled virus and purified heat-activated double-shelled SA11 rotavirus was inhibited by purified MAb. Our results indicate that these MAbs can be used effectively to study the events associated with rotavirus transcription.