Use of individualized versus standard criteria to identify abnormal levels of heart rate or oxygen saturation in preterm infants.

Preterm infants' physiological indicators, such as heart rate, respiratory rate, and oxygen saturation levels, are routinely monitored by devices that can alert nurses to threatening changes in condition. Most Neonatal Intensive Care Units use standard criteria as alerting algorithms to determine when an alert should be issued, and these standard criteria have been adopted uncritically in studies of preterm infants. This article presents results from a study examining preterm infants' physiological responses to a gentle human touch (GHT) intervention in which we compared the use of standard and individualized criteria to define the percentages of abnormally low and high heart rates (HRs) and abnormally low oxygen saturation (O2 sat) levels before, during, and after periods of GHT. Results indicated that there were no differences in the percentages of abnormal HRs or O2 sat values between periods using standard criteria. However, using individualized criteria, there were significantly greater percentages of abnormally low heart rates and O2 sat levels during and after GHT periods as compared to baseline periods. The findings suggest that standard criteria may not be sensitive enough to detect subtle physiological responses to environmental stimuli such as touch. Moreover, consistent with the recognition of the value of individualized developmental care, these results suggest that the clinical effectiveness of individualized criteria for setting monitor alert limits merits further investigation.

Physiologic and behavioral effects of gentle human touch on preterm infants.

The purpose of this study was to evaluate the effects of a gentle human touch (GHT) intervention provided to 42 preterm infants (27-33 weeks gestational age), for 10 min, three times daily for 10 days. There was no significant difference in mean HR levels or in percent of abnormal heart rate (HR) or O2 saturation comparing 10-min baseline (B), GHT, and 10-min post-touch (PT) phases. There were significantly lower levels of active sleep, motor activity, and behavioral distress during GHT compared to B and P phases. There were no differences among the 42 infants in the GHT group and 42 infants in a randomly assigned control group on any outcome variable including weight gain, morbidity status, or behavioral organization. The findings suggest that GHT generally is a safe and soothing type of touch to provide to young preterm infants, but that individual infant responses to touch need to be continuously monitored by NICU staff and parents.

Factors associated with vagal tone responses in preterm infants.

The purpose of this study was to examine factors related to vagal tone (VNA) among preterm infants receiving a 10-minute gentle human touch (GHT) intervention three times daily for 10 days. VNA was measured continuously for 10 minutes before, during, and after each 10-minute GHT intervention. Findings indicated that there was a significant relationship between VNA and gestational age, although there were no relationships between VNA and measures of motor activity or behavioral distress. There was no difference in pattern of response to GHT or level of morbidity, average daily weight gain, or behavioral organization among infants with low, moderate, and high baseline VNA levels. There was no difference in VNA comparing infants in the GHT and control groups or during baseline, touch, and posttouch phases for infants in the GHT group. There is a need for further research to examine the usefulness of VNA as a measure of stress vulnerability among preterm infants.

Flirting with disaster.

Labor pain management has changed dramatically during the last 20 years, and recently the nurse's role with epidural analgesia and anesthesia has been called into question. Cost-cutting measures in hospitals and clinics have forced some RNs into roles typically, and advisedly, reserved for a certified anesthesia provider--sometimes to the mother and baby's peril.

Comparison of diagnostic studies in the pretreatment evaluation of stage Ib carcinoma of the cervix.

The results of our study highlight the need for change in the pretreatment workup of clinical stage Ib cervical cancer. The routine use of excretory urography, barium enema, cystoscopy,and sigmoidoscopy is not justified. MR evaluation is recommended in patients with lesions larger than 2 cm (the group with the greatest increase in predictive value). Although CT scanning is not recommended for the evaluation of parametrial invasion, both CT scanning and MR imaging provide similar positive and negative posttest probabilities for the evaluation of nodal disease.

Contraction of the guinea pig isolated, perfused trachea to purine and pyrimidine agonists.

Unlike methacholine and histamine, ATP and uridine 5'-triphosphate (UTP) are more potent contractile agonists when they are applied to the mucosal (intraluminal, IL) surface of the guinea pig perfused trachea than when they are applied to the serosal (extraluminal, EL) surface. The relative contractile activities of a series of purine and pyrimidine compounds were assessed. The order of EL activity was: [2-methythio ATP (2 MeSATP) = adenosine 5'-diphosphate (ADP)] > [adenosine 5'-O-(2-thiodiphosphate) (ADP beta S) = ATP = adenosine 5'-O-(3-thiotriphosphate) (ATP gamma S)] > [(beta, gamma-imido ATP) (APPNP) = alpha, beta-methylene ATP (APCPP)] > [UTP = uridine 5'-diphosphate (UDP) = inosine 5'-triphosphate (ITP)] > [xanthosine 5'-triphosphate (XTP) beta, gamma-methylene ATP (APPCP)]. EL adenosine, adenosine 5'-monophosphate, uridine 5'-monophosphate and uridine were weak or inactive. The EL order of activity, therefore, shares some characteristics of P2Y receptors. The order of IL activity was: (ATP = UTP = ITP) > (ATP gamma S = ADP = APPNP = 2 MeSATP) > (UDP = ADP beta S = XTP) > APCPP; the other compounds were weak or inactive. The IL order of activity, therefore, resembled that for P2U or "nucleotide receptors." ATP, APPNP, UTP, UDP, ITP and XTP were more active when added to the IL than after administration to the EL bath; the remaining compounds were similarly active EL and IL, or were more active EL than IL. Greater IL than EL activity of agonists was a property associated with preference for P2U-receptors.(ABSTRACT TRUNCATED AT 250 WORDS)

Campus attitudes toward alcohol and drugs in a deep southern university.

In our zeal to deal with alcohol and drug abuse, we may have a distorted picture of what the majority of college students actually think about alcohol and drug use. Students in this study done at a public university located in the Deep South report being generally intolerant of substance abuse.

The quantity and frequency of drinking among undergraduates at a southern university.

This study examines patterns of alcohol use among undergraduates at a moderate-size university in the deep South. The results reveal that 84% of the students consumed alcohol and that Infrequent, Light, and Moderate drinking was the rule. However, 14% of the students were Heavy Drinkers, who were primarily White males, from each academic level, and fraternity members. The drinking circumstances and the complications which resulted from use varied between the drinking types. Heavy drinkers began to drink at the elementary and middle school age levels, and were introduced to alcohol outside the home. Moreover, the greater the quantity and frequency of alcohol consumption, the greater the likelihood of experiencing alcohol-related problems regardless of an individual's sex, race, or year in college.

Meaning of serum free-thyroxin values in nonthyroidal illnesses: seven methods compared.

Serum free thyroxin (FT4) was determined in 40 patients with various nonthyroidal illnesses. We studied seven methods: (1) a free thyroxin index calculated from total T4 and triiodothyronine resin uptake; (2) a free T4 index determined by enzyme inhibitor assays (Abbott's "Tetrazyme" and "Thyrozyme"); (3) a free T4 index calculated from total T4 and thyroxin-binding globulin; (4) free T4 by equilibrium dialysis; (5) Amersham's free T4 RIA; (6) Clinical Assays' one-step free T4 RIA; and (7) Clinical Assays' two-step free T4 RIA. Approximately half of the free T4 results were in the euthyroid range and the other half in the hypothyroid range by methods 1, 2, 5, and 6. Results for free T4 by methods 3 and 7 were similar to those by equilibrium dialysis (method 4), the percentages of patients with results in the euthyroid range being 68%, 65%, and 76%, respectively.

Clinical evaluation of two direct procedures for free thyroxin, and of free thyroxin index determined nonisotopically and by measuring thyroxin-binding globulin.

We have investigated the clinical utility of two direct radioimmunoassays for free thyroxin, an enzyme-inhibition immunoassay, and a direct measurement of thyroxin-binding globulin (TBG) by radioassay. All assay methods correctly identified greater than or equal to 90% of euthyroid, hyperthyroid, and hypothyroid patients who had normal TBG concentrations. In patients with altered TBG concentrations, none of the assays correctly classified all categories of patients. However, the direct assays of free thyroxin concentrations were able to classify correctly more patients with altered TBG concentrations than did the free thyroxin index methods. The free thyroxin index methods evaluated may be acceptable for routine use, if the concentration of thyroxin and the measurement of TBG capacity are reported along with the index value. Patients with altered TBG concentrations included a group of euthyroid pregnant patients. Significant decreases in free thyroxin in the third trimester were detected by all the assays studied. For patients in the first and second trimester, the mean free thyroxin concentration measured varied with the assay method.