An audit of oral care practice and staff knowledge in hospital palliative care.

Mouth care is considered one of the most basic of nursing activities, and palliative care patients are especially vulnerable to oral problems (Macmillan Practice Development Unit, 1995). This article describes a project on developing oral care practice and staff knowledge, by nursing staff and Macmillan nurses at a hospital in central England. A baseline audit (audit I) was carried out to examine all aspects of current oral care practice and nursing knowledge, including assessment, implementation, prescribing and evaluation of care. Oral care guidelines and a programme of ward-based teaching were then introduced. Several months later a follow-up audit (audit II) was conducted. Results showed an improvement in all aspects of oral care and staff knowledge. Additional benefits of this process included improved professional relationships and the promotion of further audits in hospital palliative care. Recommendations include the need for further nursing research into oral care to build the evidence base further. Additionally, it is suggested that nurses must recognize their important and central role in improving this aspect of palliative care. Education and training is pivotal to this process.

A clinical pathway for endoscopy.

The purpose of this article is to describe the development and use of a clinical pathway in an endoscopy setting. The goal was to incorporate all of the established practices of each discipline--nursing, medicine, admissions, laboratory, radiology, and others--without changing their practice models. The clinical pathway is the framework for all the activities in the management and practice of the unit, including the nursing standard of care, nursing competency-based practice, hospital policy and procedures, quality improvement, risk management, and physician preference.

Genotoxic effects of 3-amino-1,2,4-benzotriazine-1,4-dioxide (SR 4233) and nitrogen mustard-N-oxide (nitromin) in Walker carcinoma cells under aerobic and hypoxic conditions.

As judged by alkaline elution, exposure of Walker cells to either 3-amino-1,2,4-benzotriazine-1,4-dioxide (SR 4233) or nitromin results in a dose-dependent increase in DNA damage due to single-strand breaks. With nitromin or SR 4233 there was little difference in the extent of DNA single-strand breaks between Walker cells incubated either hypoxically or aerobically. In contrast, there was a 24-fold enhancement in the differential hypoxic/aerobic response to SR 4233 in clonogenic studies. Following incubation of cells with nitrogen mustard, DNA cross-linking is observed. Bioreduction of nitromin would be expected to yield nitrogen mustard as the putative reactive metabolite. However, only DNA strand-breaks could be detected in Walker cells incubated with nitromin, suggesting that reduction of this pro-drug to nitrogen mustard was not a major activation pathway. In cells incubated under aerobic conditions, SR 4233 induces oxidative DNA damage, as indicated by the formation of 8-hydroxydeoxyguanosine, suggesting the involvement of futile redox cycling. In rats dosed with SR 4233 in vivo, significantly higher levels of 8-hydroxydeoxyguanosine could be detected in liver, compared to vehicle-dosed controls.

Durability of ceramic and novel man-made mineral fibers.

In vitro solubility testing is an important means of assessing the likely behavior of fibers that are respired and accumulate in the lung. The problem has been that such tests often do not mirror the dissolution and removal mechanisms seen in vivo. Comparison of iron and silica solubility values of various types of mineral fiber showed no obvious correlation. Treating a mineral fiber containing high levels of calcium with normal balanced salt solutions produces a precipitate of calcium phosphate on the fiber surface. This deposit was not seen in fibers isolated from the lung of exposed animals. New solutions have been developed and with variations in the methods of exposing fibers, results similar to those seen in vivo have been obtained. Suitable fluid phases have been examined in static and flow-through systems. The relationship of solubility to biological activity is discussed.

Colyte and Colyte-flavored (PEG-3350 & electrolytes) for oral solution for gastrointestinal lavage.

Colyte and Colyte-flavored are effective in preparing the bowel for endoscopic examination, particularly when used in combination with saline and stimulant laxatives, which may decrease the volume of Colyte required for optimal bowel cleansing.

Loss of seizure control associated with generic substitution of carbamazepine.

OBJECTIVE: We report two cases of lost seizure control associated with the generic substitution of carbamazepine, review pertinent literature, and discuss the impact of this substitution on patient care. DATA SOURCES: Case studies, abstracts, and research publications identified in MEDLINE and bibliographic review. DATA EXTRACTION: One author reviewed cases supplied by the other authors and abstracted information from published literature sources. DATA SYNTHESIS: The first case describes a 15-year-old boy who received valproic acid and carbamazepine for partial seizures. A change in government program policies caused him to receive generic carbamazepine. This resulted in loss of seizure control and a decrease in his serum carbamazepine concentration from 12.4 to 6.7 micrograms/mL. When his carbamazepine concentration returned to previous levels, seizure control was not reestablished. A second case involves a 21-year-old woman who substituted generic carbamazepine because of financial problems. After being seizure-free for at least five years on phenobarbital and carbamazepine, she experienced seizures related to the product change. Her carbamazepine concentration decreased from 11.8 to 8.5 micrograms/mL; she also became pregnant at that time. Seizure control was not reestablished. At least three other studies do not support these observations, but the tightly controlled conditions in these studies may not have simulated actual clinical practice. CONCLUSIONS: When generic substitution of carbamazepine is required, serum concentrations should be carefully monitored. The extra care required may negate the financial advantages of the substitution.

The incidence of monoclonal proteins during 7 years of screening in a District General Hospital.

The aim of this study was to assess the incidence of monoclonal proteins, during a 7-year period, in the population served by a typical District General Hospital. 183,300 sera were electrophoresed and 804 monoclonal proteins were detected. Various biochemical prognostic criteria, such as the concentration of monoclonal protein, incidence of Bence-Jones protein and the presence of reduced polyclonal immunoglobulins, were studied in an attempt to assess the benign or malignant nature of the monoclonal protein. In this study, 75% of the patients with monoclonal proteins fulfilled at least one of these criteria, demonstrating the importance of long-term monitoring.