The frequency of high-grade intraepithelial neoplasia in anal/perianal warts is higher than previously recognized.

A retrospective review of the prevalence of intraepithelial neoplasia (IN) in surgically removed perianal/anal warts from December 1995 to December 2004 was undertaken in patients referred to the Sexual Health Clinic at Royal Perth Hospital. Data were analysed from 115 men and 38 women, 29 of whom had HIV infection (27 men and two women). Perianal/anal IN within the warts was found in 78% (52% high grade) of men with HIV infection. In men without HIV infection, the overall rate of IN within warts was 33% (20% high grade). The IN rate was 8.3% for HIV-negative women (2.8% high grade). Rates of IN within perianal/anal warts in men with or without HIV infection are higher than previously reported, and suggest the likelihood of a substantial increase in the future incidence of anal cancer. The association between IN and genital warts needs to be further studied.

An open-label phase II pilot study investigating the optimal duration of imiquimod 5% cream for the treatment of external genital warts in women.

Our objective was to determine the optimal duration of treatment with imiquimod for external genital warts over 4, 8, 12 or 16 weeks. A total of 120 women with a history of genital warts for a median of 3-6 months and prior alternative treatments in 73% were evaluated for total clearance rates. There was no statistically significant difference in complete clearance rates after 16-week follow-up across treatment groups: four weeks (40.0%), eight weeks (48.4%), 12 weeks (39.3%) and 16 weeks (51.6%). Imiquimod was well tolerated, and in those treated for four weeks there was a lower incidence of local skin reactions such as erythema and erosion, and no incidences of pain. These preliminary results suggest that a four-week treatment course of imiquimod applied thrice weekly for women with external genital warts may provide a reasonable approach with comparable efficacy and compliance, and minimal adverse events, drug costs and clinic visits.

Comparative analyses of multi-species sequences from targeted genomic regions.

The systematic comparison of genomic sequences from different organisms represents a central focus of contemporary genome analysis. Comparative analyses of vertebrate sequences can identify coding and conserved non-coding regions, including regulatory elements, and provide insight into the forces that have rendered modern-day genomes. As a complement to whole-genome sequencing efforts, we are sequencing and comparing targeted genomic regions in multiple, evolutionarily diverse vertebrates. Here we report the generation and analysis of over 12 megabases (Mb) of sequence from 12 species, all derived from the genomic region orthologous to a segment of about 1.8 Mb on human chromosome 7 containing ten genes, including the gene mutated in cystic fibrosis. These sequences show conservation reflecting both functional constraints and the neutral mutational events that shaped this genomic region. In particular, we identify substantial numbers of conserved non-coding segments beyond those previously identified experimentally, most of which are not detectable by pair-wise sequence comparisons alone. Analysis of transposable element insertions highlights the variation in genome dynamics among these species and confirms the placement of rodents as a sister group to the primates.

Use of the nursing interventions classification by critical care nurses.

A survey of 111 critical care nurses was carried out to determine the frequency with which they perform each of the 336 interventions in the NIC. Forty-nine interventions were used at least daily, indicating a set of core interventions unique to critical care practice. These findings have implications for critical care practice, education, and research.

The dimensional structure of nursing interventions.

The derivation and description of the embedded structure undergirding nursing interventions are provided in this study. To determine the dimensions of nursing interventions, multidimensional scaling was used to analyze similarity ratings among classes of interventions. Kruskal's stress formula indicated that the embedded structure is composed of three dimensions. To describe the dimensions, each intervention class was rated on a 16-attribute pair semantic differential scale. Subsequent factor analysis and correlations of the factors with the dimensions resulted in the delineation of three dimensions: intensity of care, complexity of care, and focus of care.

Nurses' use and delegation of indirect care interventions.

One hundred seventy one nurses were surveyed about their use of 26 indirect care interventions. They indicated that they would not delegate to others the majority of the interventions. Their estimations of the time to perform each intervention were, for the most part, the same, regardless of size of hospital, shift work, and illness level of the patient. The results demonstrate the importance of defining the nurse's indirect care, or role as manager of the care environment role. The indirect care interventions in this study are included in the second edition of the Nursing Interventions Classification (NIC).

Nursing Interventions Classification: a standardized language for nursing care.

Although nurses constitute the largest single group of healthcare providers in the United States, confusion exists about what nurses actually do. This article provides an overview of the Nursing Interventions Classification (NIC), which is the first comprehensive classification of nursing treatments. Quality management professionals will find the NIC useful in designing quality management programs, meeting Joint Commission standards, and planning redesign initiatives.

Using the Nursing Interventions Classification to implement Agency for Health Care Policy and Research guidelines.

The mandate for establishing guidelines for assessing effectiveness has been given to the Agency for Health Care Policy and Research (AHCPR). This agency has published 10 practice guidelines for practitioners to use. The present task for practitioners is to establish how effectively use these guidelines. Nurse researchers at the University of Iowa have provided a practical standardized language of nursing interventions that will help nurses demonstrate and communicate current nursing practice. This Nursing Interventions Classification (NIC) will allow nurses to implement the guidelines, demonstrate nursing input for patient care, and make nursing visible to consumers and other health care providers.

Construction and validation of a taxonomy of nursing interventions.

As the nursing profession evolves, it is becoming increasingly evident that standardized languages are needed for nursing diagnoses, nursing interventions, and nursing sensitive patient outcomes. Such classifications will make explicit what is now largely implicit about the nature of nursing practice. These classifications are needed so nursing can enter both the computer world of health information systems and national databases used for health policy planning. A large and diverse research team at the University of Iowa has been working since 1987 on the construction and validation of a classification of nursing interventions. In 1990, the National Center for Nursing Research (NCNR) funded the Iowa Intervention Project team with a three-year (R01NR02079) grant and in 1993 awarded a four-year continuation grant. In June 1992, Nursing Interventions Classification (NIC) (Iowa Intervention Project, 1992) was published, representing the work of the Iowa group to date. The purpose of this paper is to describe NIC and the on-going efforts at Iowa to develop a standardized language to describe nursing treatments.

Nursing interventions classification (NIC).

The Nursing Interventions Classification (NIC) is the first comprehensive classification of treatments that nurses perform. It is a standardized language of both nurse-initiated and physician-initiated nursing treatments. An alphabetical listing of 336 interventions was published in a book in May 1992 [Iowa Intervention Project, McCloskey, J. C., & Bulechek, G. M. (eds). Nursing Interventions Classification (NIC). St. Louis: Mosby-Year Book]. Each NIC intervention is composed of a label, a definition, a set of activities that a nurse does to carry out the intervention, and a short list of background readings. NIC interventions include: the physiological (e.g., Acid-Base Management, Airway Suctioning, Pressure Ulcer Care) and the psychosocial (e.g., Anxiety Reduction, Preparatory Sensory Information, Home Maintenance Assistance); illness treatment (e.g., Hyperglycemia Management, Ostomy Care, Shock Management), illness prevention (e.g., Fall Prevention, Infection Protection, Immunization/Vaccination Administration), and health promotion (e.g., Exercise Promotion, Nutrition Management, Smoking Cessation Assistance); and those used for individuals and those for families (e.g., Family Integrity Promotion, Family Support). Most recently, indirect care interventions (e.g., Emergency Cart Checking, Supply Management) have been developed. Research methods used to develop the classification include content analysis, expert survey, focus group review, similarity analysis, and hierarchical cluster analysis. The research, conducted by a large team of investigators at the University of Iowa and supported by the National Institute of Nursing Research, is ongoing. Since the 1992 publication, approximately 50 additional interventions have been developed, a taxonomic structure has been constructed and validated, a feedback and review system has been established and implemented, NIC interventions have been linked to nursing diagnoses, and five clinical agencies are serving as field sites to study the implementation process of NIC in nursing information systems. A numerical coding system for the interventions will be available in 1995. A second edition of the NIC book is in early preparation and will be available from Mosby-Year Book in early 1996. NIC facilitates the implementation of a Nursing Minimum Data Set. The use of NIC to plan and document care will facilitate the collection of large databases that will allow us to study the effectiveness and cost of nursing treatments. The use of standardized language provides for the continuity of care and enhances communication between nurses and other providers. NIC provides nursing with the treatment language that is essential for the computerized health care record. The domains and classes provide a description of the essence of nursing. NIC is helpful in representing nursing to the public and in socializing students to the profession. The coded interventions can be used in documentation and in reimbursement. For the first time in the history of nursing, nurses have a language which can be used to describe their treatments. The language is comprehensive and can be used by nurses in all settings and in all specialties. poster, giving an overview of the development of NIC, will be accompanied by a display of books and publications about NIC and its use.

Toward a standardized language to describe perioperative nursing.

The Nursing Interventions Classification (NIC) is a standardized language that identifies all interventions performed by nurses. Each nursing intervention has a label name, a conceptual definition, and a set of defining activities. The NIC provides a standardized nomenclature for automated databases, describes and measures nursing's contribution to health care, facilitates nursing education, supports clinical decision making, plans resource allocation, and facilitates nursing research. Perioperative nurses can use the NIC to describe and document their contributions to surgical patients' outcomes.