Nutrition screening tool development and utilization for home care patients.

Caring for individuals with nutritional problems is a part of nursing practice. Nurses often struggle with how to categorize nutrition-related maladies. Signature Home Care (now a subsidiary of Integrated Health Services) modified an existing tool to assist nurses in their assessment of nutrition status. This article describes the process of adapting the Nutrition Screening Initiative and implementing the screening tool.

Inhibition of PAF-induced human platelet aggregation by antithrombotic nipecotomides.

Nipecotamides (piperidine-3-carboxamides) are potent inhibitors of platelet aggregation induced by a variety of agonists in vitro and in vivo. The inhibitory effects of six structural types of nipecotamides on human platelet aggregation induced by platelet-activating factor (PAF) in vitro, are studied. Evaluation of 15 racemates and stereoisomers of two nipecotamides showed that bis-nipecotoyl alkanes were more active than their mono congeners. Mono- and bis-nipecotoyl decanes were more potent than the corresponding hexanes. Lipophilicity was found to play a significant role in the antiplatelet activity of these compounds. The stereoselectivity in the PAF-antagonist potential of nipecotamides was less pronounced than that resulting from their action on ADP- or collagen-induced aggregation. Oxidation of the two benzylic carbon atoms of alpha, alpha'-bis[3-(N,N-diethylcarbamoyl)piperidino]-p-xylene.2HBr (A-1) to form 1,4-bis[3-N,N-diethylcarbamoyl) piperidino]benzenedicarboxamide (A-40K), which has a second set of carbonyl oxygens but lacks basic N atoms, resulted in a remarkable loss of ADP-antagonist potency while retaining PAF-antagonist activity. It is suggested that in addition to their membrane effects, nipecotamides act at other sites, including the PAF receptor. Double reciprocal plots of PAF binding to gel-filtered platelets (GFP) in the presence and absence of a typical nipecotamide (A-1C) were indicative of competitive inhibition (Ki = 19.28 microM). Scatchard analysis of 3H-PAF binding to GFP suggested the presence of high, intermediate (I) and low affinity binding sites, of which the I site gave a KD/app of 0.332 nM with an estimated 564 sites/platelet. Key interactions of nipecotamides with the PAF receptor appear to be the following (i) electrostatic interactions of the two amide oxygens with a primary set of electropositive areas spaced at 5-7 A, (ii) in the case of appropriate compounds, electrostatic interactions of the two amide oxygens spaced at 10-12 A with corresponding secondary receptor sites carrying positive electrostatic potential, (iii) a hydrophobic moiety fitting into a hydrophobic pocket in the receptor, and (iv) the cationic piperidine N+ (at pH 7.4) interacting with a counterion, probably aspartic acid.

In vitro and in vivo activities of the novel antiplatelet agent alpha,alpha'-bis[3-(N,N-diethylcarbamoyl)piperidino]-p-xylene dihydrobromide.

In an effort to develop compounds with high antithrombotic activity and minimal toxicity, our laboratory has synthesized a number of nipecotamides. The effectiveness of one of these compounds, alpha,alpha'-bis[3-(N,N-diethylcarbamoyl)piperidino]-p-xylene dihydrobromide (A-1), in inhibiting both in vitro and in vivo platelet aggregation is reported here, along with its acute toxicity. The IC50 of A-1 in in vitro ADP- and PAF-induced platelet aggregation was 44.5 microM and 21.2 microM, respectively. Suppression of intraplatelet [Ca2+] is suggested as a likely mediator of the aggregation-inhibitory properties of A-1, since both the release of cytosolic Ca2+ and the influx of extracellular Ca2+ were decreased. The ED50 of A-1 in protecting mice against thromboembolism induced by a collagen-epinephrine challenge was 164 mumol/kg. The measurement of the acute toxicity of this compound as the LD50 was 691 mumol/kg, with the therapeutic index being 4.2. These data indicate that compounds in this family hold promise as clinically effective antithrombotic agents.

Molecular determinants of the platelet aggregation inhibitory activity of carbamoylpiperidines.

A series of alpha,alpha'-bis[3-(N,N-dialkylcarbamoyl)piperidino]-p- xylenes were synthesized and tested for their inhibitory activity on ADP-induced aggregation of human platelets. A parabolic curve was obtained when log 1/C (activity) was plotted against log P (octanol/water partition coefficient). Using this as a model, a new analogue, alpha,alpha'-bis-[3-(N-methyl-N-butylcarbamoyl)piperidino]-p-xylen e (3g), was synthesized with a predicted IC50 of 25 microM. When this compound was subsequently evaluated, the IC50 was 22.1 +/- 5.5 microM, demonstrating the applicability of this model. The amide oxygen of the carbamoyl substituent appeared necessary for activity. Thus, for example, when the amide carbonyl group of 3a (IC50 = 44.5 microM) was reduced to CH2, the resulting compound 4 had a dramatically reduced activity, IC50 = 1565 microM. Compound 3a was resolved into (+) and (-) enantiomers and a meso (0) diastereomer using fractional crystallization, diastereomeric tartrate formation, and chiral HPLC. Compared to (-)-3a, the (+) isomer was 15 times more potent when ADP was the agonist and 19 times more active when collagen was used as the agonist. Molecular modeling of R,R- and S,S-3a using the SYBYL program was used to examine their interactions with phosphatidylinositol (PI). There was a better fit between PI and the R,R-3a with the energy of interaction being 17.6 kcal/mol less than that of the S,S-3a/PI complex. Although the absolute stereochemistry of individual enantiomers is not known, this study shows that R,R-3a interacts more favorably with PI than does S,S-3a and that (+)-3a is a more potent inhibitor of human platelet aggregation than (-)-3a. It is postulated that because of their lipophilicity, these compounds penetrate the platelet membrane and are then protonated at the pH of the cytosol. The protonated N then neutralizes the anionic charge on the membrane phosphoinositides, thereby rendering them less susceptible to hydrolysis by phospholipase C. Thus, the determinant parameters for optimum antiplatelet activity in 3-carbamoylpiperidines are (1) the amide carbonyl, (2) appropriate stereochemistry of the 3-substituent and (3) a log P value of about 4.5.

Insulin-like growth factor-binding protein-3 proteolysis is induced after elective surgery.

The insulin-like growth factors (IGFs) are bound to several binding proteins (IGFBPs) that appear to regulate IGF transport, receptor binding, and action. The concentrations of these peptides are altered by catabolic conditions. To determine if IGF-I and IGFBP levels change after surgery, sera were obtained from 16 patients before and after cholecystectomy. Immunoreactive IGF-I measured in plasma samples from which IGFBPs had been extracted did not change postoperatively. In contrast, IGF-I determined in unextracted samples increased roughly 3-fold postoperatively, presumably due to changes in IGFBPs. Two days postoperatively, IGFBP-3 levels, determined by ligand blot, averaged 36% of preoperative values, whereas levels of IGFBP-2 and a 24,000 mol wt IGFBP did not change significantly. Similarly, by immunoblot, intact IGFBP-3 was decreased 84.2 +/- 20.2%, and a 31,000 mol wt IGFBP-3 fragment increased 57.5 +/- 47.4% postoperatively. Coincubation of postoperative, but not preoperative, sera with control sera resulted in a significant decrease in IGFBP-3 and production of proteolytic fragments. IGFBP-3 proteolytic activity in postoperative sera was markedly inhibited by antipain, Na-p-tosyl-L-lysine chloromethyl ketone, phenylmethylsulfonylfluoride, aprotinin, o-phenanthroline, and EDTA, but not by leupeptin or N-tosyl-L-phenylalanine chloromethyl ketone. This pattern of inhibition is consistent with a metal-dependent trypsin-like serine protease. We speculate that proteolysis of IGFBP-3 may alter tissue uptake of IGF-I and thereby help to counteract the catabolic state caused by surgery.

Cytosolic ionized calcium in human platelets: the influence of collagen and a novel antiplatelet agent.

Two phases of calcium mobilization were observed when aequorin-loaded human platelets, suspended in a nominally calcium-free medium containing 0.1 mM EGTA, were stimulated with collagen. The first phase coincided with platelet shape change, and the second phase corresponded to aggregation. On the other hand, only one [Ca2+]i peak was found in systems containing 1.0 mM Ca, or 1.0 or 2.0 mM EGTA. A novel antiplatelet compound alpha,alpha'-bis [3-(N,N-diethylcarbamoyl)piperidino]-p-xylene dihydrobromide, inhibited both [Ca2+]i peaks. It is suggested that inhibition of the mobilization of intraplatelet calcium stores as well as the blocking of transmembrane calcium flux may be responsible for the platelet aggregation-inhibitory action of this compound.

The stability of mesna in beverages and syrup for oral administration.

We evaluated the stability of the aqueous formulation of mesna during storage in syringes and after dilution in beverages and syrups. Measurements of the concentrations of mesna showed that the undiluted formulation was stable for at least 9 days in standard polypropylene syringes at 5 degrees, 24 degrees, and 35 degrees C. There was no detectable oxidation of mesna to dimesna over the course of at least 1 week when mesna was diluted 1:2 and 1:5 in syrups and incubated at 24 degrees C in capped tubes. Concentration changes were clinically negligible for 1:2, 1:10, and 1:100 dilutions of mesna in six carbonated drinks, two juices, and milk after incubation for 24 h at 5 degrees C. Thus, the aqueous mesna formulation is stable when diluted and stored in a variety of beverages and syrups under conditions suitable for oral administration.

Enteral feeding in the hypoalbuminemic patient.

Previous studies have correlated intolerance of isotonic, intact protein enteral solutions with hypoalbuminemia. The purpose of this retrospective study was to determine whether the level of serum albumin (SA) influenced tolerance of such an enteral nutrient solution (ENS). All patients who received Entrition during 1987 for a minimum of 48 hr were studied for the first 10 days of enteral feeding. Documentation included SA, medications, stool frequency, gastric residuals (GR), and daily caloric intake. ENS intolerance was defined as greater than 3 stools/day for greater than 48 hr or GR greater than twice the hourly infusion rate for greater than 48 hr. Patients were categorized into two groups: those with SA greater than or equal to 2.5 g/dl (group I) and those with SA less than 2.5 g/dl (group II). Of 88 patients studied, 48 (86%) in group I and 28 (88%) in group II tolerated the ENS. Eight (14%) in group I and 4 (12%) in group II experienced ENS intolerance. There was no statistically significant difference in the frequency of ENS intolerance between these two groups (p less than 0.05). Also, 97% of all those with a SA less than 2.5 g/dl were fed 80% or more of their estimated caloric requirements. We concluded that ENS tolerance was not affected by the SA level and patients with hypoalbuminemia (SA less than 2.5 g/dl) could be fed enterally.

Age differences in the temporal continuity of gratings as a function of their spatial frequency.

This study compared young and elderly observers on the continuity of sinusoidal grating-pairs as a function of interstimulus interval (ISI) and spatial frequency (.5, 1.0, 2.0, 4.0, 8.0, and 12.0 c/deg). Consistent with prior research, the maximum ISI over which pattern continuity was maintained increased with spatial frequency. In addition, among older observers, grating continuity occurred at significantly longer ISI's at the two lowest spatial frequencies; no age difference was observed at the higher spatial frequencies. These results could not be attributed to an age difference in retinal illumination associated with pupillary miosis. However, they do indicate an age-related decline in detecting visual offset and are consistent with the hypothesis of a decline in the effectiveness of the transient visual channels.

Modification of protein synthetic components by aflatoxin B1.

Molecular sites of perturbation by the hepatocarcinogen aflatoxin B1 (AFB1) in the protein synthesis initiation complex were assessed using isolated hepatocytes and a cell-free activating system containing microsomes and cytoplasmic ribonucleoprotein complexes (cRPC). Ribosomal proteins showed no detectable modification by the toxin in either system. With hepatocytes, initiation factors demonstrated only slight modification by AFB1. RNAs from both hepatocytes and the cell-free system with microsomes and cRPC were modified, with poly(A)-containing RNA exhibiting at least a 5-fold higher modification than poly(A)-lacking RNA. The poly(A)-lacking RNAs were modified in the order 28S rRNA greater than 18S rRNA greater than 5-6S rRNA greater than 4S tRNA. Guanine was the target base of AFB1, but only 10% of the AFB1-GMP adducts were on guanines located in a poly(G) region. These results suggest that guanine modification in RNAs may be responsible for the observed inhibition of translational initiation by AFB1 to a greater extent than modification of either ribosomal intrinsic or associated proteins.

Effects of elaboration and relational distinctiveness on sentence memory.

Memory for normal and distinct target sentences in elaborated and isolated contexts was examined in two experiments. Distinctiveness was operationalized as the uniqueness of the stated relation among the elements (words) of the sentence. In both experiments distinct target sentences were recalled significantly better than normal target sentences. Robust elaboration effects emerged only in Experiment 2, however, when care was taken to construct elaborations that were causally related to the target sentences. Further, the positive mnemonic effects of elaboration in Experiment 2 combined additively with the distinctiveness effects. These results demonstrate that text manipulations emphasizing both relational distinctiveness and causal elaboration facilitate memory performance. Several possible theoretical mechanisms underlying this facilitation are outlined.

The role of the nutritional support team in preventing and identifying complications of parenteral and enteral nutrition.

As the technology of parenteral and enteral nutrition advances, a multidisciplinary nutritional support team (NST) can be used to assure quality care. NST functions include developing and using standard protocols and solutions, monitoring patients, and preventing complications. Interventions by NSTs can save money for the hospital as well. Examples from Truman Medical Center (Kansas City, Missouri) illustrate how the NST can perform these functions.

Foveal and parafoveal processing of asynchronous Stroop stimuli.

Two experiments are presented which used a form of the Stroop colour-word task to study the processing of target and distractor information under changing conditions of temporal and spatial proximity. Experiment 1 focused on the marked empirical discrepancies in previous research reported in the recent literature. A coloured target and a distractor (neutral, facilitative or interfering) that were separated by variable onset asynchronies were presented foveally to observers. The findings of this study indicate strong distractor effects on response latency at the intermediate stimulus onset asynchronies (SOAs) (around 0 ms) and a clear monotonic decrease in reaction time for colour naming at extreme positive and negative SOAs. Experiment 2 used this same task but presented targets parafoveally and distractors foveally. This manipulation resulted in the same general pattern of processing as found in Expt 1. In addition, a laterality effect was found when the target and distractor were incongruent; the left visual field/right hemisphere showed significantly greater interference as indicated by longer reaction times. These results are discussed in terms of current models of information processing of compound stimuli.

Age differences in target identification as a function of retinal location and noise level: examination of the useful field of view.

Foveal and peripheral target detection were compared in young adults (M age = 22 years) and older adults (M age = 66 years) who were optically corrected for the viewing distance. In a two-alternative, forced-choice task, target letters were presented at 0 degree to 10.5 degrees from fixation. Targets were presented alone, flanked on each side by one noise element (i.e., nontarget letter), or embedded in a horizontal row of 19 noise elements. An Age X Noise Level X Location interaction was obtained, wherein age differences were largest for peripheral targets presented in noise. Slope analyses of latency data showed that the performance of young adults in the high-noise condition was most similar to that of older adults in the low-noise condition. At the functional level, results indicated that aging is associated with a restricted useful field of view. In addition, the data suggest that age differences in search can be described by a model in which older adults take smaller perceptual samples from the visual scene and scan these samples more slowly than do the young adults.

Sepsis from triple- vs single-lumen catheters during total parenteral nutrition in surgical or critically ill patients.

We prospectively studied the infection rates for 59 triple-lumen (TLC) and 68 single-lumen (SLC) subclavian catheters during the administration of total parenteral nutrition (TPN) to surgical or critically ill patients. A standard protocol was used for catheter insertion and maintenance. The infection control committee determined independently whether patients had catheter-related sepsis, an infected insertion site only, or no catheter infection. The TLCs had an increased incidence of catheter sepsis (19%) compared with the SLCs (3%). Low rates (5% for TLCs and 3% for SLCs) of infected catheter sites only indicated that the catheter care was comparable for both groups. The patients in the two groups were similar but not identical; those with TLCs appeared to be sicker and, therefore, at greater risk to develop catheter sepsis than patients with SLC. However, since TLCs were involved in six times more catheter sepsis than were SLCs, limiting the use of a subclavian catheter to giving TPN only and strict adherence to a TPN protocol are necessary to minimize the risk of catheter sepsis.

Distance, duration and blur effects on the perception of pseudoisochromatic stimuli.

Two experiments are reported that examine the effects of viewing distance, viewing duration, and stimulus clarity on performance with three popular versions of the pseudoisochromatic tests of colour deficiency. With a large sample of colour-normal observers, highly significant effects of these viewing conditions are found. In addition, large differences in sensitivity to these conditions are obtained among the three tests employed (The American Optical Corporation test, the Dvorine test, and the Ishihara test). Results are discussed in terms of practical implications for test administration and in terms of likely processes, in addition to colour discrimination, assessed by these tests.