Mental health nurses' PRN psychotropic medication administration practices.

PRN psychotropic medications (medications given with the aim of changing the patient's mental state on an 'as needed' basis) are frequently prescribed and administered in mental health facilities. Their administration is largely an autonomous nursing role. However, little research has explored this important area of nursing practice in any detail and therefore the use of this intervention by mental health nurses is not fully understood. A descriptive project was undertaken to explore the factors involved in the administration of PRN psychotropic medications. It utilized a retrospective chart audit, conducted at one regional and one urban setting in Queensland, Australia. The results indicate a lack of clarity surrounding psychotropic PRN medication administration practices, confusion surrounding decision-making processes related to this intervention, and poor documentation practices. The study found a high incidence of PRN psychotropic medication administration when compared to similar studies, and an excessive reliance on the use of typical antipsychotics over benzodiazepines. This practice is not supported by contemporary literature. As a result of our findings, we recommend further studies in areas of related importance, in order to increase our understanding of the complexities surrounding this important nursing intervention, and an investigation into documentation practices in inpatient mental health settings.

[Value of combined electro- and vectorcardiography in the estimation of left ventricular mass in the elderly]. / Valor del electro y vectorcardiograma combinados en la estimación de la masa ventricular izquierda en la tercera edad.

Electro- and vectorcardiographic methods describe left ventricle increases only when it has attained a significantly high magnitude, but even in such circumstances the exactitude of such methods is substantially lower than that of echocardiogram (ECHO). On the other hand, in comparison to other age groups, there have been relatively few reports relating electrocardiogram (ECG), vectorcardiogram (VCG) and ECHO with left ventricular mass (LVM) in healthy elderly subjects where increases of the left ventricle mass, if present, would be small or moderate. In this paper LVM as well as LVM index (iLVM) from a group of healthy subjects belonging to a physical training program for elderly, was studied by means of ECHO and computerized ECG and VCG. From ECG, voltage indexes and other LVM associated parameters were extracted; from VCG, planar maximum vectors, areas within VCG loops and maximal spatial magnitude of QRS (SM), were measured. Results of LVM (221 +/- 37.9, g) were higher than figures reported for others groups. Voltage indexes showed normal values, but QRS duration was somewhat prolonged. The best simple linear regression, combining variables from VCG and ECG was maximum horizontal vector (Vmax-Hor) vs Sokolow-Lyon index (SOK) and combining ECHO with ECG or VCG, LVM vs Area inside horizontal loop (AreaHor). A model for estimation of LVM from electrical variables was obtained by multiple linear regression; combining five variables from ECG and VCG. The best model included Sokolow-Lyon index and variables from horizontal and sagittal planes of VCG and spatial magnitude of QRS: LVM = 4.8 SOK-186 VmaxHOR-80 VmaxSAG + 126SM + 340 AreaH + 175.(ABSTRACT TRUNCATED AT 250 WORDS)

Regulation of growth hormone secretion from human fetal pituitaries: interactions between growth hormone releasing factor and somatostatin.

Using an explant culture system, we have demonstrated that human somatotropes respond to growth hormone releasing factor (GRF) and somatostatin (SRIF) from as early as 9.5 weeks of fetal age. Responsiveness to GRF increases significantly as a function of age up to midgestation while SRIF inhibition of basal growth hormone (GH) release does not change. SRIF has little effect on GRF-stimulated GH secretion from early gestation pituitaries, but its ability to block GRF stimulation gradually increases with fetal age from 9.5 to 16 weeks. The response to GRF remains predominant throughout this developmental period: 100 times more SRIF than GRF must be added to the cultures in order to block the GRF stimulatory effect and maintain GH secretion at basal (control) levels. Finally, adding SRIF 30 min prior to the GRF does not increase the inhibitory activity of SRIF. Our data suggest that the mechanisms that permit an interaction between GRF and SRIF are developing, but slowly, in the early to midgestation human fetal somatotrope and that GRF stimulatory pathways predominate. This may help to explain the very high levels of GH in fetal serum during the first half of gestation.

Oral amiodarone in high-risk ventricular arrhythmias.

Oral amiodarone was evaluated in 24 patients with complex forms of ventricular premature depolarizations (VPD) by means of ECG monitoring and measurement of systolic time intervals. The patients received 800 mg daily for 3 days, 600 mg daily for 7 days and 400 mg daily thereafter. Follow-up lasted from 6 to 17 months. Advanced forms of VPD were abolished and the VPD rate was reduced in 98% of patients. After 10 days repetitive VPD were absent in more than 80% and after 4 months more than 70% were completely free from arrhythmia. ECG changes revealed heart rate reduction and prolongation of PR, QRS and QTc intervals. Left ventricular performance was not influenced. After 6 months of treatment, 10 randomly selected patients received placebo instead of amiodarone in a single blind fashion until arrhythmia reappeared; the latter was again abolished by reinstituting amiodarone, The most frequent side effect were corneal microdeposits which were reversible and did not impair vision. It is concluded that amiodarone is effective and well tolerated in patients with high-risk VPD.