Mapping the Dutch SNOMED CT subset to Omaha System, NANDA International and International Classification of Functioning, Disability and Health.

BACKGROUND: Nurses register data in electronic health records, which can use various terminology and coding systems. The net result is that information cannot be exchanged and reused properly, for example when a patient is transferred from one care setting to another. A nursing subset of patient problems was therefore developed in the Netherlands, based on comparable and exchangeable terms that are used throughout the healthcare sector and elsewhere (semantic interoperability). The purpose of the current research is to develop a mapping between the subset of patient problems and three classifications in order to improve the exchangeability of data. Those classifications are the Omaha System, NANDA International, and ICF (the International Classification of Functioning, Disability and Health). METHOD: Descriptive research using a unidirectional mapping strategy. RESULTS: Some 30%-39% of the 119 SNOMED CT patient problems can be mapped one-to-one from the subset onto each separate classification. Between 6% and 8% have been mapped partially to a related term. This is considered to be a one-to-one mapping, although the meanings do not correspond fully. Additionally, 23%-51% of the patient problems could be mapped n-to-one, i.e. more specifically than the classification. Some loss of information will always occur in such exchanges. Between 1% and 4% of the patient problems from the subset are defined less specifically than the problems within the individual classifications. Finally, it turns out that 9%-32% of the terms from the subset of patient problems could not be mapped onto a classification, either because they did not occur in the classification or because they could not be mapped at a higher level. CONCLUSION: To promote the exchange of data, the subset of patient problems has been mapped onto three classifications. Loss of information occurs in most cases when the patient problems are transformed from the subset into a classification. This arises because the classifications are different in structure and in the degree of detail. Structural cooperation between suppliers, healthcare organisations and the experts involved is required in order to determine how the mapping should be used within the electronic health records, and whether it is usable in day-to-day practice.

[Amyloidosis despite normal ESR]. / Niet-verhoogde BSE, maar toch amyloïdose.

BACKGROUND: Amyloidosis is a clinical picture brought on by extracellular deposits of insoluble, non-degradable proteins. The clinical presentation of amyloidosis depends upon the type of protein and the organ afflicted. CASE DESCRIPTION: A 65-year-old woman had stiffness of the locomotor apparatus, recurrent carpal tunnel syndrome and problems with swallowing. Laboratory and urine investigations initially showed no abnormalities, but histopathological investigation of a synovial biopsy revealed amyloidosis with light-chain deposits. This turned out to be due to multiple myeloma. CONCLUSION: Amyloidosis can present with atypical symptoms, such as stiffness. Normal erythrocyte sedimentation rate (ESR) and normal urine analysis do not exclude this diagnosis. When there are clinical indications of amyloidosis further analysis for free-light chains should be performed, even when ESR is normal.

Performance Evaluations and Victim Satisfaction With State Compensation for Violent Crime: A Prospective Study.

Satisfaction with a particular good or service represents an affective state in response to an individual's evaluation of the performance of that good or service. This evaluation involves a comparison between perceived actual performance and prior expectations. The current study used this theoretical idea to study violent crime victims' levels of satisfaction with services provided by a Dutch state compensation scheme. One hundred and seventy-seven victims of violent crime who had applied for compensation from the Dutch Violent Offences Compensation Fund (DVOCF) participated in two brief telephone interviews: one before receipt of the fund's decision upon their request for compensation and one after receipt of that decision. Based on the theories of distributive and procedural justice, measurement of prior expectations was differentiated in expectations about receipt of compensation, treatment by fund workers, and information provision. Results suggested that satisfaction with the DVOCF depended on fulfillment of expectations about treatment by fund workers and information provision, but not on fulfillment of expectations about receipt of compensation. Other predictors of victim satisfaction were as follows: duration of the application procedure, approval upon request for compensation, and satisfaction assessed during the first interview. Results were discussed in light of theory, policy implications, study limitations, and future research.

Psychological distress following crime victimization: An exploratory study from an agency perspective.

Deficits in recognition of suffering play a significant role in the etiology of psychological distress in crime victims. However, given the preliminary status of the literature, it seems necessary to take other factors into account as well. Starting from an agency perspective, this study explored three such factors: negative self-attributions, peritraumatic distress, and early posttraumatic emotions. More specifically, this study explored whether the association between recognition deficits and posttraumatic stress disorder (PTSD) symptoms observed in other studies could be replicated and, if so, whether this association was mediated by negative self-attributions and would decrease in strength when taking into account the adverse roles of peritraumatic distress and early posttraumatic emotions. To address these questions, we used prospective data from 201 victims who had reported a crime to the Dutch police. Recognition deficits, negative self-attributions, peritraumatic distress, and early posttraumatic emotions were assessed within 1 month after the crime report and PTSD symptoms 1 month later. Results indicated that the association between recognition deficits and PTSD symptoms was partly mediated by negative self-attributions and that the strength of this association decreased when controlling for peritraumatic distress and early posttraumatic emotions.

Use of detergent extracts of Brucella abortus RB51 to detect serologic responses in RB51-vaccinated cattle.

Serologic responses to the newly introduced rough Brucella abortus vaccine strain RB51 have been determined in a dot-blot format using gamma-irradiated RB51 cells as the antigen. Because gamma-irradiated cells are not easily prepared and the signal from cells was not always reliable, an alternative antigen was sought. Detergent extracts of B. abortus RB51 were prepared using zwittergent 3-14, Triton X-100, and sodium dodecyl sulfate (SDS) and examined in a dot-blot format. Zwittergent 3-14 extracts and gamma-irradiated RB51 cells gave the same titers. Unlike gamma-irradiated RB51 cells, zwittergent 3-14 extracts produced signals consistently, and the signals were easily interpreted. Triton X-100 extracts interfered with signal development, and SDS extracts resulted in a high background signal. Western blot analyses revealed several outer membrane proteins in the zwittergent 3-14 extract. The major antigens in the extract had apparent molecular weights of <20,000.

Olfactory receptor neurons express D2 dopamine receptors.

The role of the dopamine (DA) in the olfactory bulb (OB) was explored by determining which of the potential target cells express dopamine receptors (DARs). Previously, it was reported that D2-like DAR (D2, D3, and D4 subtypes) radioligand binding is restricted to the outer layers of the OB. The neuronal elements present only in these layers are the axons of the olfactory receptor neurons (ORNs) and the juxtaglomerular (JG) neurons of the glomerular layer. Based on this pattern of D2-like ligand binding, it was suggested that D2-like receptors might be located presynaptically on ORN terminals. The present study was undertaken to investigate this hypothesis. In the outer bulb layers of rats in which the ORNs were destroyed by nasal lavage with ZnSO(4), D2-like radioligand binding was reduced severely. The receptor subtype D2 mRNA, but not D3 mRNA, was detected in adult rat olfactory epithelial tissue. By using in situ hybridization, this D2 mRNA was located preferentially in epithelial layers that contain ORN perikarya. D2 mRNA was eliminated after bulbectomy, a manipulation known to cause retrograde degeneration of the mature ORNs. Taken together, the surgical manipulations indicate that mature ORNs express D2 DARs and are consistent with the hypothesis that functional receptors are translocated to their axons and terminals in the bulb. This suggests that dopamine released from JG interneurons could be capable of presynaptically influencing neurotransmission from the olfactory nerve terminals to OB target cells through the D2 receptor.

Electrophysiological characterization of the olfactory bulb during recovery from sensory deafferentation.

Axonal transection results in degeneration of the olfactory sensory neurons (OSNs). Replacement OSNs reinnervate the olfactory bulb. To document reinnervation, lateral OSN fibers were stimulated while bulb negative evoked potentials (NEPs) were recorded. For control adult hamsters and at 20, 30, and 120 days after transection, lateral fibers were connected to the lateral more than the medial bulb. The percentage of lateral bulb positions with NEPs was similar to control at 30 and 120 days, but NEP amplitude did not reach control level.

Physical activity and congenital heart disease.

With advances in the diagnosis and management of congenital heart disease (CHD), the need has arisen for the assessment and counseling of patients as to appropriate physical activity levels through adulthood. Considerations to be evaluated before making exercise and athletic activity recommendations to the patient with CHD are outlined. Recommended guidelines of the American Heart Association are presented for recreational and occupational activities. Selected congenital heart defects are reviewed to address potential negative effects of incorrect recommendations.

Nursing considerations for the neonate awaiting heart transplantation for the hypoplastic left heart syndrome.

This article discusses the congenital heart lesion identified as hypoplastic left heart syndrome (HLHS) and the pretransplant management of the neonate born with this defect. Discussion of pretransplant management includes hemodynamic, ventilatory/pharmacological, immunologic, ethical, and economic considerations. An increased knowledge of these early management principles is a necessity, not only for nursing staff working with this population of heart transplant patients, but also for nursing staff in any center that may identify and need to stabilize an infant with this defect. Relevant nursing considerations are presented to assist nurses in supporting the neonate and his or her parents during the time when decisions about heart transplantation must be made.

Recurrent sepsis from retained endocardial electrode in children: successful removal with cardiopulmonary bypass.

Infection remains a significant problem in patients undergoing permanent cardiac pacemaker implantation, and removal of all components is usually required. The transvenous system carries minimal morbidity at implantation, but the development of infection is more life-threatening than in the epicardial system. Although the evolution of the tined porous endocardial lead reduced the incidence of wire displacement, the development of a serious infection is still a problem and may require major surgery for removal. We experienced this problem in a 15-month-old child who developed recurrent sepsis. Attempts at removal of the retained tined porous electrode through the neck incision proved dangerous and unsuccessful. Removal was carried out using cardiopulmonary bypass and infection was promptly controlled.

Comparison of the sutureless and suture-type epicardial electrodes in pediatric cardiac pacing.

Fourteen consecutive patients with the suture-type electrode (Group 1) were compared with the previous 14 patents having the sutureless electrode (Group 2). five patients in Group 1 had had failure with the sutureless electrode, for a total of 23 patients. In Group 1, no exit block was encountered. One patient had sensing problems corrected simply by increasing the pacer rate. One patient had generator failure and another, lead fracture. In 5 patients in Group 2, exit block developed early (less than 6 months after implantation); 3 patients had the problem twice, making a total of eight early failures. Two patients had late exit block (more than 6 months after implantation). Improved results with the suture-type electrode can probably be explained by its smaller head, larger surface area, ease of placement in a small space, and control of direction and depth of implantation.

Effect of ambient temperature and humidity on urine output in sheep.

Urine output, respiratory rate, water intake, plasma and urine osmolalities, and PCV of 6 sheep exposed to 4 weeks of each of hot-humid, hot-dry, and cool-humid environments alternated with 3 weeks each of cool-dry control environments were determined. Compared with urine output during the control environment, urine output increased during hot-humid, hot-dry, and cool-humid exposure, but was 70% greater during the hot-humid environment than during hot-dry exposure. Water intake increased 37% to 45% during hot-dry exposure but decreased 35% during the first 2 weeks of cool-humid exposure. Urine osmolality decreased 38%, 22%, and 44% during hot-humid, hot-dry, and cool-humid exposure, respectively, whereas plasma osmolality values only increased 3% during hot-dry exposure. Respiratory rates increased on exposure to both hot environments, but decreased during cool-humid exposure. The PCV decreased 3% after 1 week of hot-humid exposure, 8% after 4 weeks of hot-dry exposure, and 5% after 4 weeks of cool-humid exposure. Urine output, and probably plasma volume, increased during these periods because evaporative heat loss was reduced due to the lack of adequate air convection and mobility. Heat loss through increased urine output was not significant (P less than 0.2). Enclosed sheep should be kept with short fleeces and should be maintained in conditions of low temperature and adequate convection if representative physiologic, biochemical, and pharmacologic assessments are desired.