The effects of infusion rate on platelet outcomes and patient responses in children with cancer: an in vitro and in vivo study.

PURPOSE/OBJECTIVES: To determine the influence of infusion rate on quality of transfused platelets and patients' physical and subjective responses. DESIGN: Linked in vitro and in vivo studies with repeated measures and crossover designs, respectively. SETTING: A 52-bed pediatric cancer center in the midsouthern United States. SAMPLE: In vitro: 12 randomly selected platelet units. in vivo: convenience sample of 26 children, ages 3-20 years, with cancer and thrombocytopenia requiring platelet transfusion. METHODS: Four infusion rates studied in vitro: two infusion rates studied in vivo. MAIN RESEARCH VARIABLES: Platelet count, morphology score, corrected count increment, and patients' physical and subjective responses. FINDINGS: No clinically significant differences were found in outcomes across the four rates in vitro. Similarly, no statistically significant differences were found between the two in vivo rates on objective or subjective outcomes. CONCLUSIONS: In this setting, the more rapid infusion rate is clinically preferable because it does not negatively affect platelet recovery or patient outcomes and it decreases the infusion time by half. IMPLICATIONS FOR NURSING PRACTICE: Findings provided a basis for altering platelet infusion rates at the study setting. Benefits of the faster infusion rate include more rapid correction of thrombocytopenia, decreased time that outpatients must remain in the clinic for transfusion. Increased time available for other parenteral infusions in the impatient setting, and substantial savings in nursing time and associated costs.

Virus-specific cytotoxic T lymphocytes as prophylaxis for Epstein-Barr virus lymphoproliferative disease in pediatric bone marrow transplant recipients.

Epstein-Barr virus lymphoproliferative disease (EBV LPD) is a well-recognized, life-threatening complication of bone marrow transplantation (BMT). The incidence of EBV LPD is increasing as more transplants are performed from mismatched and unrelated donors. Significant strides have been made in the diagnosis, prevention, and treatment of EBV LPD in marrow transplant recipients. Immunovirological assays can provide early identification of patients at risk for developing EBV LPD. Prophylaxis and treatment by the adoptive transfer of EBV-specific T cells and the subsequent long-term restoration of immunity against EBV-associated lymphoproliferation have provided positive outcomes in the management of this uniformly fatal complication of BMT. The purpose of this article is to provide a review of EBV LPD and to present a newly developed strategy for EBV LPD prophylaxis in pediatric BMT recipients.

The effects of infusion methods on platelet count, morphology, and corrected count increment in children with cancer: in vitro and in vivo studies.

PURPOSE/OBJECTIVES: To determine whether infusion method influences the quality of platelets transfused. DESIGN: Linked in vitro and in vivo study. Quasi-experimental design for in vitro and cross-over design with balanced randomization for in vivo. SETTING: Pediatric cancer center in the midsouthern United States. SAMPLE: Pheresed/pooled platelet units in vitro (n = 12). In vivo convenience sample of 26 children, ages 2-19 years, with cancer and thrombocytopenia who required platelet transfusion. METHODS: Two infusion pumps (IMED 980 and Gemini, IMED Corp., San Diego, CA) versus gravity flow for in vitro platelet infusion. Gemini infusion pump versus gravity flow for in vivo platelet transfusion. MAIN OUTCOME MEASURES: Platelet count, morphology score, and corrected count increment. FINDINGS: No significant differences noted in platelet count or morphology score among or across the three infusion methods in vitro. No significant differences noted between the two infusion methods in platelet count or corrected count increment in vivo. CONCLUSIONS: Although limited to a specific patient population, setting, and infusion device, findings revealed that the pump was clinically acceptable because it did not negatively affect platelet recovery. Replication of this study with other infusion devices is recommended. IMPLICATIONS FOR NURSING PRACTICE: Study findings validate the current nursing procedure for the administration of platelets at the study setting. Use of infusion pumps for platelet transfusions is time-efficient and energy-efficient for nurses because the pumps offer a well-controlled infusion rate, accurate volume measurement, and an alarm system for monitoring the infusion.

The natural connection: the clinical nurse specialist and bedside nursing research.

The educational preparation and consistent clinical focus of CNSs position them ideally for conducting research at the bedside and helping staff nurses see the relevance of such research. Our research studies have identified a new category of clinical nursing research termed bedside nursing research. Like its parent category of clinical nursing research, the function of bedside nursing research is to generate new knowledge or validate and expand previously generated knowledge. Characteristics that distinguish bedside nursing research from other forms of clinical nursing research are: focus, idea stimulus and setting, originator of the research question, relationship with theory, sensitivity to changing technology in health care, and impact on nursing practice. To illustrate the nature and outcome of this type of research, we describe three bedside nursing research studies conducted by CNSs in a pediatric oncology setting. These studies assessed: (1) the effects of chest tube stripping on the incidence of pain, fever, and pulmonary complications; (2) the relative safety and efficacy of techniques for blood sampling from Hickman catheters; and (3) the effects of infusion method on quality and survival of transfused platelets. The impact of these studies of hospital practices is reviewed.

Bedside nursing research. A new category of research?

A new category of clinical nursing research, labeled "bedside nursing research," is proposed and described in this article. Justification for this research category is based on its particular characteristics, such as its narrow focus on direct care procedures that have well-defined parameters and the patient outcomes of those procedures. Findings from this type of research have high clinical relevance and can directly influence nursing practice at the study site.

Establishing pediatric cancer nursing research priorities: a Delphi study.

The purpose of this study was to have pediatric oncology nurses identify and rate topic priorities for clinical nursing research in the specialty and to determine if nurses in a pediatric cancer center identified different priorities than did nursing colleagues in other settings. The sample consisted of 44 nurses from a comprehensive pediatric cancer center and 43 nurses attending the 12th Annual APON Conference. A decision-making method, the classical Delphi technique, was used. Three rounds of soliciting opinions by questionnaires were completed, and data from each round were reviewed and categorized by a research team of six nurses until group consensus was achieved. The majority of priorities identified by both groups concerned nursing procedures, the pediatric oncology patient, and the specialty itself. The least number of priorities were in the categories of care delivery systems and families. One difference between the two groups was that professional issues dominated the cancer center sample, whereas psychosocial issues were more prominent in the APON sample.

Presenile dementia with Lewy bodies and neurofibrillary tangles.

A 55-year-old man showed progressive mental deterioration over a five-year period along with a syndrome of "normal pressure hydrocephalus." At autopsy the main finding was the presence of two age-related neurocellular changes, the neurofibrillary tangle and the Lewy body, in limbic structures and in the pigmented nuclei of the brain stem. Cortical changes were mild, and senile plaques were not present. Electron microscopy occasionally showed an intimate relationship between the paired helical filaments of the neurofibrillary tangle and Lewy bodies in nerve cell processes in the hypothalamus. The findings suggest a closer relationship between Lewy bodies and neurofibrillary tangles than usually suspected. We also speculate that the presence of one type of age change in the brain may accelerate or predispose to other age changes.

Ultrastructure of Lewy bodies in the stellate ganglion.

The Lewy body, a characteristic nerve cell inclusion in idiopathic parkinsonism, was examined by electron microscopy in the stellate ganglion, obtained from 9 patients at autopsy. Three main forms of Lewy bodies or Lewy body-related structures were demonstrated: A.Rare filamentous Lewy bodies, similar to Lewy bodies in the central nervous system. B. Granular Lewy bodies in nerve cell processes. C. Abnormal nerve cell processes, filled with heterogenous material. Large dense core vesicles were prominent in the last 2 forms. None of these abnormalities were found in 2 control groups consisting of 9 parkinsonism cases without central nervous system Lewy bodies, and 17 cases without parkinsonism. The filamentous Lewy body (type A) was found in the perikaryon and was surrounded by neuromelanin, whereas the other forms (type B and C) were seen in nerve cell processes. Mitochondrial inclusions, present mainly, but not exclusively, in neuromelanin-containing cells, were not related to Lewy body formation or to parkinsonism.