Reasons for use of hormone replacement therapy in women undergoing coronary angiography.

The recommendation has been made that all women be counseled about the risks and benefits of hormone replacement therapy (HRT). Use of HRT among women undergoing coronary angiography was explored to assess whether patterns of use were similar to data drawn from community samples. Using a descriptive design, a convenience sample of 414 postmenopausal women was interviewed. Fifty-eight percent had never used HRT, 18.3% were past users, and 23.7% were currently using HRT. The primary reason given for ever using HRT was for symptoms of menopause. Less than 14% of women cited coronary heart disease (CHD) or osteoporosis as their primary reason for using HRT. The most common reasons for stopping HRT were side effects and fear of cancer. The most common reasons given for never having used HRT were that their healthcare provider had never talked about it and that they had never thought about it. Use of HRT among women undergoing coronary angiography is similar to that found in community samples. The challenge is to promote patient-provider interactions that include information about HRT based on the scientific model as well as attention to women's individual concerns.

Wolf-Hirschhorn syndrome and a split-hand malformation.

Ectrodactyly has not previously been reported in children with Wolf-Hirschhorn syndrome (WHS). Based on this premise and the identification of an unbalanced translocation between chromosomes 4p15 and 10q25 in a fetus with ectrodactyly and hemimelia, a second locus for dominantly inherited split hand/foot malformation (SHFM3) was mapped to chromosome 10q24-q25. We present the clinical findings of an infant with WHS and SHFM and suggest that the presence of additional loci on 4p which modify/cause SHFM cannot be excluded.

Syndromic ectrodactyly with severe limb, ectodermal, urogenital, and palatal defects maps to chromosome 19.

Congenital limb malformations rank behind only congenital heart disease as the most common birth defects observed in infants. Finding genes that cause defects in human limb patterning should be straightforward but has been limited, in part, by the bewildering spectrum of phenotypes, which are difficult to separate into etiologically distinct disorders. One approach to the identification of relevant genes is to take advantage of unique extended kindreds in which a defect in limb patterning is segregating. Recently, a large Dutch family with ectrodactyly, ectodermal dysplasia, cleft palate, and urogenital defects (EEC) was described by Maas et al. We have studied this kindred and localized a gene causing EEC to a locus on chromosome 19, in a region defined by D19S894 and D19S416. A second extended kindred with EEC does not map to this locus, indicating that EEC is a genetically heterogeneous disorder. Growth and patterning of the limbs, teeth, hair, and genitourinary system are mediated in part by epithelial-mesenchyme inductive interactions. The identification of both the gene causing EEC and its mutation may further elucidate the general signals mediating inductive mechanisms.

A variant of Freeman-Sheldon syndrome maps to 11p15.5-pter.

Distal arthrogryposis type 1 (DA1) and Freeman-Sheldon syndrome (FSS) are the two most common known causes of inherited multiple congenital contractures. We recently have characterized a new disorder (DA2B) with a phenotype intermediate between DA1 and FSS. We report the mapping of a gene that causes DA2B to chromosome 11p15.5-pter. Linkage analysis in a single kindred generated a positive LOD score of 5.31 at theta = 0 with the marker D11S922, and recombinants localize the gene to an approximately 3.5-6.5-cM region between the marker TH and the telomere. Analysis of additional families improves the LOD score to 6.45 at theta = 0 and suggests linkage homogeneity for DA2B.

Enrichment for gene targeting in mammalian cells by inhibition of poly(ADP-ribosylation).

Inhibition of poly(ADP-ribosylation) reduces random genomic integration of transfected DNA and mildly stimulates intrachromosomal homologous recombination in mammalian cells. We investigated the effect of inhibition of poly(ADP-ribosylation) on the efficiency of gene targeting in Chinese hamster ovary (CHO) cell line ATS-49tg. This cell line is hemizygous for a defective adenine phosphoribosyltransferase (aprt) gene and is hypoxanthine phosphoribosyltransferase (hprt) deficient. Plasmid pAG100 contains a portion of the CHO aprt gene sufficient to correct the defect in ATS-49tg cells via gene targeting; pAG100 also contains an Escherichia coli guanine phosphoribosyltransferase (gpt) gene. Following transfection of ATS-49tg cells with pAG100, selection for gpt-positive transfectants allowed recovery of cells that had randomly integrated pAG100 while selection for aprt-positive cells allowed recovery of cells that had undergone gene targeting at the endogenous aprt locus. Treatment of cells with 3 mM 3-methoxybenzamide (3-MB), an inhibitor of poly(ADP-ribose) polymerase, decreased random integration and gene targeting of electroporated pAG100 about 5-fold. In contrast, treatment with 3 mM 3-MB during calcium phosphate transfection could reduce random integration more than 150-fold while reducing gene targeting less than two-fold. Therefore, as much as a 100-fold enrichment for gene targeting was achieved with calcium phosphate transfection.

Teaching the teachers: creating an effective critical care preceptor program.

Staff nurse preceptors are integral members of effective critical care orientation programs. Much of the success of the orientation experience and orientee satisfaction depends on them. A critical care preceptor workshop containing a review of the orientation program and the application of educational principles in critical care settings has been found to be an effective method for assisting preceptors and for enhancing our orientation program.

Preserving the mission. Sponsors and lay leaders must collaborate to maintain the Church's presence in healthcare.

As the number of women and men religious involved in healthcare decreases, the Church faces the task of sustaining and expanding its institutional presence in the healthcare world. Both the Gospels and Church teaching support the claim that the Church should be involved in social institutions such as healthcare. Documents such as the Second Vatican Council's Pastoral Constitution on the Church in the Modern World stress the Church's concern with the impact of God's kingdom on all dimensions of human life. Pope Paul VI's Evangelization in the Modern World clearly affirms that the Gospel cannot be complete until it is interrelated with social life. Jesus' ministries of teaching and humble service are also paradigmatic for Catholic healthcare. To preserve and extend its institutional presence, Catholic healthcare will have to meet a number of challenges in the coming years. Catholic healthcare facilities must be prepared to relinquish their autonomy and work with others, providers will have to become attuned to what is distinctively Catholic about their facilities, and the Church must commit itself to preparing lay leaders for the Catholic healthcare ministry.

Analysis of gait patterns in normal school-aged children.

The continuing development of gait in 60 children aged 7-16 years was studied with plantar surface-attached transducers to describe the time pressure profiles of foot segments during stance. Decreased pronation/supination of the subtalar and midtarsal joints was shown by simultaneous onset and simultaneous peak on medial and lateral heel sensors. The resultant midstance showed a rapid lateral-to-medial loading of the forefoot. The foot-flat position with decreased rotation about the longitudinal axis of the foot persists even after the temporal parameters of gait attain mature values.

Platelet inhibitors and hydroxyethyl starch: safe and cost-effective interventions in coronary artery surgery.

This study evaluated the cost-effectiveness and clinical safety of utilizing hetastarch in pump prime solutions and for colloid replacement postoperatively in conjunction with the platelet inhibitors, aspirin and Persantine (dipyridamole). Sixty-four adult patients undergoing a coronary artery bypass operation were divided into two groups. Group 1 (N = 32) received only Persantine (75 mg three times a day) on the day prior to operation. Group 2 (N = 32) received the same Persantine dose plus aspirin (325 mg). In both groups, aspirin and Persantine were continued postoperatively and hetastarch was used as the colloid of choice. All patients were evaluated for blood loss, coagulation profiles, cost of blood and colloid replacement, and clinical course. Group 2 patients demonstrated significantly greater blood loss (p less than 0.05) but the same postoperative coagulation profiles as Group 1. The transfusion requirement (3.6 units versus 1.3 units) and cost basis ($252 versus $91) for patient care were higher in Group 2. Hetastarch had no effect on blood loss and was not associated with any adverse clinical reactions. Annual institutional savings based on utilization of hetastarch were calculated at $33,500 to $40,500 per 500 patients. We conclude that preoperative administration of aspirin (325 mg) is associated with increased perioperative blood loss and higher patient costs, two variables not demonstrable with Persantine only. Use of hetastarch combined with postoperative platelet inhibition was clinically safe and was a cost-effective method of colloid replacement.

The public debate on social justice and health care: an opportunity for evangelization.

The most difficult moral choices arise at the point where social justice questions and medical-moral questions intersect. In an age of increasing technological advances and government intervention, Catholic health care facilities ought to shape a coherent moral policy that affirms human dignity and conforms to the Church's moral teaching.