Use of complementary therapies, adherence, and quality of life in lung transplant recipients.

PURPOSES: The purpose of this study was to describe complementary and alternative medicine (CAM) use by lung transplant patients and to determine whether CAM users differ from nonusers with respect to health status, quality of life, or medical adherence. METHODS: A mailed survey seeking CAM, quality of life, and adherence information was sent to 145 lung transplant recipients, and 99 responded. RESULTS: The majority (88%) used at least 1 form of CAM (median, 2; range, 0-17). Prayer (68%), support groups (43%), and relaxation techniques (31%) were the most common. Only 44% of users reported discussing CAM with their providers. CAM users were adherent to their transplant regimen. Few differences were found between CAM users and nonusers. Education, high symptom burden, female sex, and depression symptoms were associated with various types of CAM use. CONCLUSION: Most lung transplant recipients are using CAM. Providers must explore potential for interaction or enhancement between CAM and standard therapy to optimize care.

Healing practices: trends, challenges, and opportunities for nurses in acute and critical care.

Florence Nightingale espoused a very holistic orientation in nursing. It was her belief that nursing should put the patient in the best possible condition for nature to restore or preserve health, to prevent or cure disease or injury. In other words, nurses should create environments in which healing can happen. Complementary therapies and healing practices offer nurses and patients an expanded array of options to improve health and healing. This article provides an overview of complementary therapies and healing practices and offers suggestions on how to incorporate these therapies when caring for critically ill patients.

The postsynaptic density protein PSD-95 differentially regulates insulin- and Src-mediated current modulation of mouse NMDA receptors expressed in Xenopus oocytes.

The NMDA subtype of glutamate receptor is physically associated with the postsynaptic density protein PSD-95 at glutamatergic synapses. The channel activity of NMDA receptors is regulated by different signaling molecules, including protein tyrosine kinases. Because previous results have suggested a role for protein kinase C (PKC) in insulin potentiation of NMDA currents in oocytes, the effects of coexpression of PSD-95 on insulin and PKC potentiation of NMDA currents from these receptors were compared. Another primary objective was to determine if PSD-95 could enable Src to potentiate currents from NR2A/NR1 and NR2B/NR1 receptors expressed in Xenopus oocytes. The results show opposite effects of PSD-95 coexpression on Src and insulin modulation of NR2A/NR1 receptor currents. Src potentiation of mouse NR2A/NR1 currents required PSD-95 coexpression. In contrast, PSD-95 coexpression eliminated insulin-mediated potentiation of NR2A/NR1 receptor currents. PSD-95 coexpression also eliminated PKC potentiation of NR2A/NR1 receptor currents. PSD-95 may therefore play a key role in controlling kinase modulation of NR2A/NR1 receptor currents at glutamatergic synapses.

How healthcare professionals contribute to hope in patients with cancer.

PURPOSE/OBJECTIVES: To explore whether healthcare professionals influence the level of hope in patients with cancer and, if so, how they influence their hope. DESIGN: Descriptive, qualitative design. SETTING: An adult hematology/oncology unit in the upper midwestern United States. SAMPLE: Thirty-two men and women receiving active or supportive treatment or palliative care for cancer. METHODS: Semistructured interviews conducted in the participants' hospital rooms. Ten investigators and two consultants transcribed and analyzed the interview data using content analysis. They identified themes and subthemes that described healthcare professionals' roles. MAIN RESEARCH VARIABLES: Healthcare professionals' contributions to hope as described by patients with cancer. FINDINGS: Healthcare professionals positively and negatively influenced hope in this sample. Hope was facilitated by being present, giving information, and demonstrating caring behaviors. Negative influences on hope primarily concerned the way in which healthcare professionals gave information. CONCLUSION: Healthcare professionals do influence patients' perceptions of their hope. Although most nursing actions are hope enhancing, nurses can reduce a patient's sense of hope if information provided or attitude toward the patient is insensitive or disrespectful. IMPLICATIONS FOR NURSING PRACTICE: Nurses can increase patients' hope by being present, taking time to talk, and being helpful. They must provide information and answer questions in a compassionate, positive, honest, and respectful manner. Caring behaviors such as thoughtful gestures, showing warmth and genuineness, and being friendly and polite also increase patients' hope.

Creating a healthy work environment in the midst of organizational change and transition.

In the midst of organizational change and transition, the need for a healthy work environment is greater than ever. Leaders may be in a position of leading staff on a journey they would rather not be on. Although there may not be a choice of destination, there are many decisions to be made along the way that will impact the health and quality of the journey. Creation of a healthy work environment does not occur overnight. It requires acknowledgment of the reality of the present environment, clear behavioral expectations and standards, systems, and structures to ensure the organizational changes are enduring and a means to assess continually the health of the work environment. Leaders have an opportunity and a responsibility to structure organizations in such a way that dignity, integrity, honesty, and compassion are preserved.

Legal aspects of child abuse: guidelines for the nurse.

Legislation provides certain mandates for the identification and treatment of child abuse and neglect. State intervention on behalf of the child occurs at the onset of suspected abuse or neglect. Court involvement may be necessary to ensure the protection of children through court-ordered provision of services to families. The implementation of legal mandates requires a multidisciplinary effort, so that nurses who work with children and families need to know the child abuse legislation of the state in which they practice. Because of their professional skills, nurses are in a vital position to identify and assist vulnerable children and families. Through effective reporting, record-keeping, and an understanding of the uses and benefits of court intervention, nurses can effect a positive impact upon the legal system in behalf of abused children and their families.

Improved surveillance of maternal deaths.

This study explains and verifies an apparent increase in the New Jersey resident maternal mortality rate from 1.7 per 10,000 live births by the state's traditional method to 3.1 per 10,000 live births by a new method of surveillance instituted in late 1974. In 1975, the maternal mortality rate by the traditional method was 1.5 per 10,000 and by the expanded method, 3.0 per 10,000. The traditional method compiled data from death certificates submitted to the State Vital Statistics Office. The expanded method found additional deaths by review of Annual Maternity Services Reports from hospitals and by close follow-up of individual reports of maternal deaths from medical examiners, physicians and hospitals.