A case of neonatal dural sinus malformation: clinical symptoms, imaging and neuropathological investigations.

We report a case of neonatal dural sinus malformation already visible on antenatal ultrasound. This is a rare disease entity in infants and children. Clinical diagnosis was made by demonstrating a cranial murmur on auscultation; macrocrania and signs of progressive cardiac failure. Imaging studies as cerebral ultrasound, postnatal MRI scan and MR angiography demonstrated a large dural sinus malformation originating from the sagittal sinus with extensive arteriovenous fistulae. Due to the extent of the lesion, the existing ischemic brain damage and involvement of the torcular, no therapeutic options were available and the child died of irreversible cardiac failure. The diagnosis was confirmed with autopsy. We discuss the clinical presentation, imaging and neuropathological results and relate our findings to embryological data and the existing literature.

[Haemophilus influenzae type a as the causative agent of meningitis in an infant]. / Haemophilus influenzae type a als verwekker van meningitis bij een zuigeling.

A 6-month-old girl had been ill with a cold for several days and was increasingly drowsy. She had been fully vaccinated against Haemophilus influenzae type b and had meningitis due to H. influenzae type a. She made a complete recovery after treatment with ceftriaxone and amoxicillin. In the Netherlands, vaccination with the conjugated H. influenzae type b vaccine was started in 1993 and since then invasive infections caused by H. influenzae type b have almost disappeared. Vaccination may suppress carriership of H. influenzae type b. However, vaccination does not elicit cross-protective antibodies against other serotypes of H. influenzae. H. influenzae non-type b may profit from the vaccination state, resulting in a higher carrier rate and an increased incidence of invasive infections. In the Netherlands, H. influenzae type a as the causative agent of an invasive infection has been recorded for the first time since registration started in 1975 and since then five such cases have been reported. In the literature, 45 cases of infection with H. influenzae type a have been described up until now.

Chemoprevention research: implications for primary care practice.

The field of cancer prevention research is entering a time of growth and opportunity. This important research is identifying agents that are making a substantial difference by reducing cancer incidence in high-risk populations. Primary care providers are natural partners for this research because of their diversity, commitment to disease prevention, and long-term access to their patient population. Several national chemoprevention trials in breast and prostate cancer are open and seeking to affiliate with primary care providers. Information is provided on this research effort, the development of chemoprevention trials, and how to learn more.

National efforts to improve the informed consent process.

OBJECTIVES: To inform oncology nurses about several national efforts to improve the informed consent document and process. DATA SOURCES: A federally funded grant program to stimulate research of informed consent, an initiative from the National Cancer Institute to improve informed consent documents in cancer clinical trials, and a model consent document developed by the National Action Plan on Breast Cancer. CONCLUSIONS: These initiatives assist investigators and institutional review boards in presenting relevant and understandable information to potential clinical trial participants. IMPLICATIONS FOR NURSING PRACTICE: These national efforts will raise awareness of providing potential research participants with clear information to assist them in making an educated, informed decision.

Participants strengthen clinical trial research: the vital role of participant advisors in the Breast Cancer Prevention Trial.

Views regarding the rights and roles of participants in clinical trial research have changed extensively over the past several decades. Such changes have included moving from paternalistic views, in which human subjects often were totally uninformed of research participation, to a perspective that recognized certain rights of human subjects. In recent years, the consumer rights movement, a growing customer service perspective in health care, and the growth of a variety of advocacy groups have brought further change in attitudes and efforts to include consumer representatives and research participants in a variety of advisory roles. The BCPT PAB is a model for a way to involve research study participants in an expanded role. Members of the board initiate efforts to promote participation and inform potential participants about the trial. They help establish outreach efforts to recruit individuals from underrepresented populations. They serve as effective spokespersons for the trial to the media at both local and national levels, and they give highly useful guidance to the NSABP and the NCI regarding a variety of aspects of clinical trials. Beyond the formal responsibilities that were outlined when the board was established, the trial participants serving on the advisory board also have provided inspiration and motivation for other participants as well as for the clinicians, researchers, and administrators conducting the BCPT. The extensive contributions of the advisory board members confirm and add to the understanding of the variety of ways that clinical research participants can play a role in strengthening such research efforts. Further, the BCPT PAB may serve as a model strategy for drawing on the unique resource represented by the participants in clinical trial studies.

Women's health advocacy: its growth and development in oncology.

Women's health has become a topic of national importance. Advocacy initiatives by consumers, scientists, government officials, health care professionals, industry, and the media have played a role in helping to set this agenda. Much of the current interest in women's health is the result of the women's movement and its interaction with science, medicine, and health care. Emerging consumerism and increasing public knowledge of medical and scientific topics has led to the emergence of patients as individuals seeking to actively make decisions regarding health care options. Nurses should embrace the advocacy movement and, whenever possible, work with patients and their advocates toward their many shared goals.

Efforts to recruit the economically disadvantaged to national clinical trials.

Clinical trials are vital for the development of state-of-the-art cancer prevention and treatment. A goal for trial recruitment should be to have a representative sample of the total population by gender, race, culture, ethnicity, and socioeconomic status as appropriate. Increased sensitivity to the unique barriers and access to care issues required to achieve a representative sample are necessary. Knowledge and understanding of recruitment problems and strategies to resolve them are developing; however, much more is needed before we can fully address and resolve all of the relevant issues. Nurses have a key role in identification, education, and recruitment of special populations including the SED to clinical trials.

Strengthening the effectiveness of patient education: applying principles of adult education.

In spite of the recognized significance of patient education, many factors contribute to difficulties in providing effective patient teaching: diminished time from reduced hospital stays, the shortage of nursing personnel, and often, the patient's compromised physical and emotional status. With these constraints, teaching must be effective and efficient. In reviewing the literature, primary emphasis was found on providing sound clinical information with little attention to the techniques of effective methods for teaching adults. This article draws upon the principles of andragogy--the methods of teaching adults delineated by Malcolm Knowles--to provide a conceptual framework for developing effective patient education practice. Examples of both effective and ineffective practice are provided from the nursing literature. The information provided should assist nurses in understanding how adults learn and provide them with a structure to use in tailoring their teaching to meet the individual needs of their patients.