Social support in critically ill adults: a replication.

This study was designed to increase understanding of social support from the viewpoint of the critically ill adults. The authors investigated what the critically ill adults described as supportive behaviors, as well as the source of those behaviors. Open-ended interviews with 10 patients yielded rich data, which are presented in the article as cases illustrating the extremes of emotional support from physicians, nurses, hospital staff, family, and friends. The themes derived from the data stress the positive feelings of the participants when they believe they are being supported and the negative feelings when the patients believe they are not supported.

Joining education and service in exploring discharge needs.

Continuity of care beyond the walls of the acute hospital setting has always been a major emphasis in nursing. There is concern that the care needs of older adults at the time of discharge have been increased by shortened hospital stays. Yet little is known about the specific and changing health care needs of older adults during the early days at home following discharge from acute care, particularly those who are discharged without community referrals. To learn more about the experiences of this population, the College of Nursing at the University of Southern Maine, in collaboration with the Nursing Service Department at Maine Medical Center, conducted a demonstration project. This project involved follow-up home visits to older adults who were discharged to their homes from an acute care setting.

The latency-associated transcript gene of herpes simplex virus type 1 (HSV-1) is required for efficient in vivo spontaneous reactivation of HSV-1 from latency.

During herpes simplex virus type 1 (HSV-1) neuronal latency, the only viral RNA detected is from the latency-associated transcript (LAT) gene. We have made a LAT deletion mutant of McKrae, an HSV-1 strain with a very high in vivo spontaneous reactivation rate. This mutant (dLAT2903) lacks the LAT promoter and the first 1.6 kb of the 5' end of LAT. dLAT2903 was compared with its parental virus and with a rescued virus containing a restored LAT gene (dLAT2903R). Replication of the LAT mutant in tissue culture, rabbit eyes, and rabbit trigeminal ganglia was similar to that of the rescued and parental viruses. On the basis of semiquantitative PCR analysis of the amount of HSV-1 DNA in trigeminal ganglia, the LAT mutant was unimpaired in its ability to establish latency. In contrast, spontaneous reactivation of dLAT2903 in the rabbit ocular model of HSV-1 latency and reactivation was decreased to approximately 33% of normal. This decrease was highly significant (P < 0.0001) and demonstrates that in an HSV-1 strain with a high spontaneous reactivation rate, deletion of LAT can dramatically decrease in vivo spontaneous reactivation. We also report here that deletion of LAT appeared to eliminate rather than just reduce in vivo induced reactivation.

Significance of the insignificant.

This was an inductive descriptive study of supportive behaviors and sources of supportive behaviors in 20 critically ill, adult, pretransplant liver patients. Data were collected using a demographic tool and a semistructured interview schedule focusing on sources of support and supportive behaviors. Demographic data were analyzed by using frequencies, and interview data were analyzed utilizing content analysis. Participants were 28 to 68 years of age and considered themselves to be supported and critically ill. Family was mentioned most frequently as a support source. Supportive behaviors included visits, telephone calls, prayers, cards, and talking with the participants. Major themes from the interview data included family, spontaneous support, loss of supporters, encouragement, and the importance of the presence of someone else. Validation interviews were undertaken with a randomly drawn subset. Data underscore the differences in perception of important behaviors between health professionals and patients. Implications for practice are reviewed.

To cure, to care, or to heal.

Healing is an unfulfilled potential in the current healthcare system. Although illness is a ritual that necessitates the social support of natural networks and healers, the organization of hospitals impedes support and healing. In this article, the authors analyze the ritual of illness, the hospital as a technological bureaucracy, social networks, and social support, and make recommendations for action by nurses who identify themselves as healers.

Stress and social support in the experience of monitoring apneic infants.

This report focuses on 10 themes derived from a triangulated, longitudinal, descriptive study of highly stressed mothers who were monitoring apneic infants. The themes demonstrate the interplay between social support and interaction with network members. Such interconnection suggests intervention with a stressed population should include network members as well as the patient.

An in vitro study of ophthalmic antiviral agent toxicity on rabbit corneal epithelium.

Using an in vitro system we measured the corneal epithelial cytotoxicity and the antiviral activity of the antiviral agents idoxuridine (IDU), trifluridine (TFT), ethyldeoxyuridine (EDU), and (E)-5-(2-Bromovinyl)-2'-deoxyuridine (BVDU). Confluent rabbit corneal epithelial cell cultures were established, and the antiviral agents were added for 5, 30, or 60 min at a range of concentrations including that used clinically (IDU 0.1%, TFT 1.0%, BVDU 0.1%, EDU 2.0%). Twelve hour [3H]thymidine incorporation then was measured and expressed as % inhibition of control cultures. In separate experiments confluent corneal epithelial cell monolayers were inoculated with 10(4) plaque forming units (PFU) of HSV type 1 (McKrae strain) for 1 h, and IDU 0.1%, TFT 1.0%, and BVDU 0.1% were added to the culture for determination of PFU inhibition. Significant dose-, but not time-dependent, toxicity was observed at the clinical concentrations of IDU, TFT, and EDU. Toxicity was absent for BVDU. TFT and IDU were the most toxic, and EDU was of intermediate toxicity. IDU, TFT, and BVDU showed significant antiviral activity in this corneal epithelial cell culture system (TFT greater than BVDU greater than IDU). The results of this in vitro study paralleled the findings of previous in vivo corneal epithelial toxicity studies of IDU, TFT, and BVDU. Our data, however, suggest that EDU has a potential for clinical toxicity and further studies are recommended. Our model may be useful in the future toxicologic study of new antiviral agents.

Development of oral HSV-1 infection model in mice. Evaluation of efficacy of 5'-amino-5-iodo-2',5'-dideoxyuridine.

We developed a new model of oral HSV-1 infection in mice. After oral inoculation, 100 percent of mice developed the clinical lesions at the inoculated area and latent HVS infection in their trigeminal ganglia without mortality. The antiherpetic efficacy of AIdUrd, an agent specifically activated by herpesvirus-encoded enzyme, has been evaluated in this animal model. Early topical or systemic treatment of AIdUrd notably reduced the development of clinical lesions and the virus content in the inoculated lips. However, the establishment of latent HSV infection in the sensory ganglia was not influenced by AIdUrd treatment.

Intraocular penetration of the soluble antiviral, Ara AMP.

Earlier studies on intraocular penetration of the antiviral drugs idoxuridine and vidarabine (formerly Ara A) reveal that either inactive metabolites from the former or very low levels of less active metabolites from the latter actually enter the aqueous. Additionally, to achieve therapeutic levels, systemically administered vidarabine must be given in large fluid volumes because of poor solubility. The present time-curve study on the intraocular penetration of the highly soluble nucleotide form of vidarabine, Ara AMP, reveals that, in rabbits, very high aqueous levels of the antiviral metabolite, Ara Hx, are achieved after intravenous does in small fluid volume. Moderately low levels are attained after subconjunctival injection, extremely low levels are attained after subconjunctival injection, and extremely low levels are present after topical administration. This indicates that intravenous and possibly subconjunctival injection may be useful in treatment of deep ocular herpetic disease.

Ara AMP- a highly soluble new antiviral drug.

While vidarabine (Ara A) is in several ways superior to idoxuridine (IDU) it still has the disadvantages of rapid inactivation and poor solubility. The monophosphate ester or vidarabine, Ara AMP, however, is metabolized very slowly in humans and is extremely soluble with good tissue penetrance. The present study indicates that Ara AMP drops are equipotent or superior to vidarabine ointment in treatment of type 1 and type 2 herpes simplex keratitis. While iritis was significantly less in all treated groups, a suspicion of chemical side effect was raised but could not be proven in subsequent toxicity tests.

Idoxuridine ocular insert therapy. Use in treatment of experimental Herpes simplex keratitis.

Therapy of acute Herpes simplex keratitis in rabbits with idoxuridine-releasing ocular inserts showed that an application rate of 30mug/hr gave significantly better results than conventional treatment with idoxuridine drops and ointment while exposing the eye to 40% less drug. Delivery rates lower than this were equal or not as effective as drop and ointment therapy and rates up to 100 mug/hr did not produce significantly better results than rates of 30mug/hr. Serial viral cultures demonstrated the persistence of virus beyond the period of clinical resolution of disease in all treatment groups, indicating that therapy should be continued longer than apparent resolution of disease.