Beyond the significance test in administrative research and policy decisions.

PURPOSE: To describe confidence interval (CI) analysis and show how it can be used in administrative decisions. ORGANIZING CONSTRUCT: Statistical significance testing should be supplemented, if not replaced, by effect size (ES) estimation and confidence interval analysis. Hypothesis testing based on the statistical significance test is the dominant paradigm in statistics; however, this approach has inherent problems which can ultimately diminish the usefulness of research for operational decisions. After identifying major difficulties with significance testing, the authors use hypothetical examples to demonstrate how ES and CI analysis provide more informative answers to nursing administrative research questions. CONCLUSIONS: CI analysis provides the basis for both improving the interpretation of findings from individual studies and for facilitating the analysis of cumulative evidence. By clarifying the meaning of results, CI analysis can increase the relevance and usefulness of research for health care executives and practitioners.

Sources of satisfaction in hospital nursing practice. A guide to effective job design.

OBJECTIVE: As the healthcare system restructures, changes are being made that appear to influence nurses' jobs and satisfaction, yet little is known about effects on job characteristics and related outcomes. The authors present findings from a research project designed to identify links between specific aspects of hospital staff nurse (SN) practice and perceived job characteristics and psychological states, thought to have motivational consequences. BACKGROUND: The Job Characteristics Model (JCM) is the dominant paradigm in contemporary job design theory and research. Although generally well-supported, the JCM has limitations that constrain its usefulness: first, the Job Diagnostic Survey used to assess perceived characteristics does not indicate the specific aspects of activities that lead to these perceptions, and second, the JCM, based primarily on manufacturing research, does not include interpersonal job characteristics that seem important in human service jobs. METHODS: Two studies were conducted using a similar methodology. Focus groups of SNs were held to identify links between specific activities and characteristics and sources of satisfaction in SNs' job content. The Staff Nurse Job Characteristics Index (SNJCI) was developed to assess the presence of certain elements and activities in a nurse's job. An initial sample of 63 and a second sample of 146 SNs from Medical/Surgical and Coronary Care units completed the SNJCI, the JDS, and a demographic form through a mail survey. RESULTS: Internal consistency reliabilities (Cronbach's alpha) for eight of the nine SNJCI scales were acceptable. Correlation analysis indicates that job characteristics are meaningfully related to psychological states and job satisfaction. Findings support the hypothesis that specific aspects of SNs' jobs are reliably related to characteristics. CONCLUSIONS: Aspects of SNs' jobs important to their satisfaction include continuity in nurse-patient relationships, authority to initiate independent nursing actions, individual accountability for clinical outcomes, and regular performance feedback from managers.

Modulating radiation cataractogenesis by hormonally manipulating lenticular growth kinetics.

There is considerable evidence that the lens epithelium is the primary site of injury leading to the development of cataracts following radiation exposure. That the damaged cells of the epithelium are the progenitors of the aberrantly differentiating fibers associated with the cataract is indisputable. So too is the observation that post-radiation proliferative activity in the lens epithelium is required for cataracts to develop. The natural hormonal regulation of lens epithelial mitotic activity in the frog offers the opportunity to alter the cell cycle of the lens epithelium in vivo, thus enabling the direct examination of the role of lenticular mitosis in the cytopathomechanism of radiation-induced cataracts. The cell cycle of the lens epithelium of northern leopard frogs was manipulated by hypophysectomy (to halt mitotic activity) and pituitary hormone administration (to stimulate baseline mitosis and reverse hypophysectomy-induced mitotic suppression). Animals were hypophysectomized, irradiated and injected with pituitary hormone replacement. Irradiated animals, irradiated animals + hormone replacement and irradiated hypophysectomized animals served as controls. Cataract development was evaluated by slit-lamp biomicroscopy and correlated with histologic determinations of mitotic index and meridional row disorganization on lens epithelial whole mounts. In another study, hypophysectomized-irradiated animals received varying concentrations of replacement hormone in an attempt to quantitatively modulate lens epithelial mitotic activity and determine the effect on cataractogenesis. It was found that irradiated-hypophysectomized (mitosis halted) frogs failed to develop opacities, while those with hormonal replacement (mitosis reinstated) developed cataracts.(ABSTRACT TRUNCATED AT 250 WORDS)

A comparison of pulmonary functions and oxygenation following local, spinal or general anaesthesia in patients undergoing inguinal hernia repair.

In order to compare the pulmonary effects of various anaesthetic techniques, 49 otherwise healthy patients needing inguinal hernia repair were randomized to general, spinal or local anaesthesia. Blood gases were drawn and spirometry performed pre- and postoperatively at fixed intervals. Results showed a superior ventilation and oxygenation pattern for local anaesthesia (p < 0.05). No statistically significant differences were found between the groups with respect to forced vital capacity (FVC) or forced expiratory volume per second (FEV1) but patients who had spinal anaesthesia performed worse, and for the group as a whole there was a significant reduction compared to preoperative values. We conclude that local anaesthesia is less detrimental to pulmonary function in inguinal hernia operations than spinal or general anaesthesia.

Unilateral ureteral obstruction secondary to rupture of liver echinococcal cyst.

We report a case of ureteral obstruction by reactive retroperitoneal fibrosis secondary to rupture of a liver echinococcal cyst after minimal blunt flank trauma. The patient presented initially with a cyst-cutaneous fistula and was treated with mebendazole, since surgery was refused. Unilateral ureteral obstruction due to reactive dense retroperitoneal fibrosis developed 2 years later, which presumably was initiated by intense inflammatory reaction to the cyst content. Diagnosis was established by excretory urography, ultrasonography and computerized tomography, and was histologically confirmed. Hydronephrosis and hydroureter resolved following ureterolysis. This complication is anticipated to be encountered more frequently with the use of the new potent anthelmintic agents, which may successfully prevent daughter cyst formation but fail to abolish reactive retroperitonitis.

Acute symptomatic hernia.

Acute symptomatic hernia is a clinical entity characterized by the coexistence of acute incarceration of an abdominal wall hernia together with an acute abdominal disease. Thirteen such cases are described. Increased awareness of this entity, both pre- and intraoperatively, is probably the basis for the improved rate of correct diagnosis (60%) and the decreased mortality (7%).

[Rupture of hepatic echinococcal cyst by minimal blunt abdominal trauma].

Hepatic echinococcosis is endemic in Israel, with about 90 new cases diagnosed each year. Although many are asymptomatic for years, 40% develop complications. We describe a man of 37 and women aged 22 and 35, respectively, in whom rupture of an echinococcal cyst followed minimal, blunt abdominal trauma. In each patient the rupture led to complications consisting of massive intra-abdominal bleeding in 1, diffuse peritonitis in another and cystocutaneous fistula with ureteral obstruction due to reactive retroperitoneal fibrosis in the third. All 3 underwent surgery to resolve the immediate complication, with no mortality. A striking feature was the disproportion between the stormy clinical presentation and the relatively innocent nature of the trauma. In only 1 of our cases was the correct preoperative diagnosis made, which in this condition depends primarily on a high index of suspicion.

Clinical effects of photodynamic therapy on recurrent laryngeal papillomas.

Thirty-three patients with moderate to severe recurrent laryngeal papillomatosis underwent photodynamic therapy at our institution. All received 2.5 mg/kg of dihematoporphyrin ether intravenously either 48 or 72 hours prior to photoactivation with an argon pump dye laser system. Photosensitivity was the only side effect seen. Statistical analysis showed a significant decrease, by approximately 50%, in the average rate of laryngeal papilloma growth following treatment. The response was especially pronounced in patients with the worst disease. In addition, three patients have now remained free of disease for extended periods following photodynamic therapy. Latent infection with human papillomavirus continues to persist in clinically normal tissue following photodynamic therapy. The results and potential of this exciting new therapy for laryngeal papillomatosis are described.

Stationary radiation cataracts: an animal model.

The restitution of normal fibergenesis that occurs in stationary radiation cataracts provides a unique opportunity to study the cytopathomechanism of radiocataractogenesis. Previous attempts at investigating this phenomenon have been limited by the lack of an appropriate animal model. This report describes the induction of stationary radiation cataracts in postmetamorphic bullfrogs following ocular irradiation with a 10 Gy (1 Gy = 100 rads) dose of X-rays. The eyes of non-irradiated animals and animals irradiated with 25 Gy (an established dose known to induce progressive cataracts in frogs) served as controls. Animals were followed biomicroscopically and histopathologically over 79 weeks. As previously described, the cataracts developed in a dose-dependent manner. The 25 Gy irradiated lenses rapidly progressed to complete opacification (4+) by 26 weeks, while lenses exposed to 10 Gy advanced to the 2.5+ stage by 35 weeks and progressed no further. In the lower dose lenses, transparent cortex began to appear anteriorly and posteriorly between the capsule and opaque fibers at 45 weeks. As the clear fibers accumulated, the disrupted region came to occupy increasingly deeper cortex. Histologically, opacities in both groups were preceded by disorganization of the bow cytoarchitecture, meridional row disorganization, and the appearance in the lens epithelium of nuclear polymorphism, fragmented nuclei, micronuclei, clusters of nuclei, and abnormal mitotic figures. In the lenses exposed to the 25 Gy dose, this damage continued to worsen, so that the 4+ stage was characterized by extensive epithelial cell death, absence of the lens bow, degenerated fiber masses, and liquefied substrata. In contrast, prior to the appearance of transparent cortex in the 10 Gy group, the lens epithelial aberrations, are of the bow, and meridional row disorganization were all observed to improve. Further, by 69 weeks, the lens epithelium appeared as a largely homogeneous population, and the meridional rows and the are of the bow had become reestablished. The details of these observations and their possible relationship to the cytopathomechanism of radiation cataract formation are discussed.

A comparison of growth regulation of mammalian with amphibian lens epithelium.

In frogs hypophysectomy causes cell proliferation in lens epithelium to subside entirely, with better than 95% of the cells arresting in G1. The phenomenon has been traced to the action of insulin-like growth factors (IGFs) whose synthesis depends on anterior pituitary hormones, most notably GH. Both GH and purified somatomedin C can reinitiate mitosis in the lenses of hypophysectomized frogs. The present studies were done to determine if growth of rat lenses is controlled as is that of amphibia. It appears this may not be so because hypophysectomy has no effect on division in the rodent system. Protein calorie malnutrition (PCM) reduced the mitotic index and this effect is much enhanced by pituitary ablation. Of interest too, were the observations that the glucocorticoid, dexamethansone, is inhibitory in frog; the effect in rat is uncertain. Injection of bovine pituitary powder has no influence on rat while stimulating the amphibian material. It is therefore possible to modify growth of rat lens epithelium in vivo but the regulating mechanism(s) appears to be distinct from that operating in frogs. Whether the difference(s) is inherent in the cells themselves or is to be sought in the access routes through which they are reached by blood borne factors (e.g. permeability of blood-aqueous barriers) is, at present, unclear.

Duodenostomy revisited.

Four patients were admitted to the Surgical Ward because of massive bleeding from a duodenal ulcer. In three the ulcer was induced by non-steroid anti-inflammatory drugs. On operation, following pylorotomy and suture of the bleeding artery, neither drainage nor stump closure could be affected safely. Partial gastrectomy with vagotomy, or high subtotal gastrectomy with gastroenterostomy were performed. The duodenum was dealt with by means of a tube duodenostomy. There was no mortality among these patients. Morbidity was related mainly to the extent of preoperative bleeding and associated pathology (e.g. perforation). Patient data is presented in Table I.

The use of laser in rectal surgery.

Ten patients with rectal tumors were treated by surgical excision of the tumor using a CO2 laser Sharplan 733 CO2 laser, Laser Industries Ltd., Israel. The laser permitted sharp excision, evaporization, or fulguration of tissue. Good hemostasis was achieved. Anesthesia was unnecessary in cooperative, calm patients. There was no mortality or morbidity related to the procedure. In five patients with villous adenoma the tumor was resected with one recurrence as yet (followup 4-16 months). Five patients with inoperable carcinoma were treated for palliation with good results. Our preliminary results indicate that the CO2 laser can be a useful asset in rectal tumor surgery, especially in elderly, moribund patients and in the definite treatment of benign tumors of the rectum.

Gender differences in schizophrenia.

Lewine (Psychol. Bull., 90: 432-444, 1981) has proposed sex differences, specific to schizophrenics, in age at first psychiatric hospitalization, age at first reported symptoms, and premorbid social competence. To evaluate Lewine's hypothesis we collected data on 64 schizophrenic and 30 nonschizophrenic psychiatric outpatients. As no interaction between sex and diagnostic groups was found, our data failed to demonstrate sex differences specific and unique to schizophrenia. It is possible that Lewine's evidence is due to a cultural artifact.

Studies on corneal endothelial growth and repair. IV. Changes in the surface during cell division as revealed by scanning electron microscopy.

Changes in the surface morphology of regenerating rabbit, rat and frog corneal endothelial cells in vivo have been investigated by scanning electron microscopy. In adult tissue these cells do not normally divide unless given a stimulus, such as injury. Surfaces of quiescent rabbit and rat cells are devoid of microvilli but display globular projections and surface pits up to 300 nm in diameter. However, regenerating endothelia are characterized by the appearance of microvilli which attain their greatest length when the cells are rounded. At this stage, cells also possess filopodia and broad processes. In cytokinesis, the microvilli have shortened and blebs and ruffles appear for the first time. In contrast to rabbits and rats, frog endothelial cells of noninjured tissue are covered by microvilli and smaller surface pits of 60-70 nm diameters. During regeneration, these cells have reduced numbers of microvilli and extensive foldings of the membrane. Neither blebs nor filopodia occur during the mitotic cycle and ruffles are not detected until cytokinesis.

Radiation cataractogenesis in the amphibian lens.

This report describes a reproducible and characteristic sequelae for radiation cataractogenesis in the amphibian. The development of lens opacification was investigated as a function of dose and time after X-irradiation of the eye of postmetamorphic bullfrogs. It was found that the development of radiation cataracts in frogs is both age and dose dependent. It was also determined that, far from being radiation resistant, frog lenses are sensitive to doses that are moderately cataractogenic for mammals.

In situ demonstration of actin in normal and injured ocular tissues using 7-nitrobenz-2-oxa-1,3-diazole phallacidin.

The fluorescent derivative of the actin-binding toxin phallacidin, 7-nitrobenz-2-oxa-1,3 diazole phallacidin, has been used to cytologically demonstrate the presence of actin in lens epithelium, corneal endothelium, and retinal pigment epithelium. In these noninjured tissues, no stress fibers are observed and fluorescence is confined mainly to an area at or near the cell membrane, although some diffuse cytoplasmic staining can also be seen. However, following injury to either the lens epithelium or corneal endothelium of rats and frogs, stress fibers are detected, but only in those cells that migrate into the wound area. Cells on the periphery of each tissue do not partake in would repair and thus maintain their normal appearance. After the tissue has regenerated, stress fibers disappear, and those cells involved in the injury response return to their normal morphology. When rabbit corneal endothelium is placed in tissue culture, stress fibers are observed as the cells migrate away from the initial explant. Upon reaching confluency, these cells spread out and each is surrounded by thick actin-containing bands. Furthermore, they exhibit some stress cables within their cytoplasm. This is in contrast to their appearance in vivo where stress fibers are absent and fluorescence is limited to a region near the cell membrane.