Descriptions of comfort by substance-using and nonusing postpartum women.

OBJECTIVE: To compare definitions of comfort held by a group of postpartum substance users with those of a group of nonusers. SETTING: The postpartum unit of a large university hospital. PARTICIPANTS: The convenience sample constituted 36 postpartum women; half were substance users and half denied substance use. The nonusing participants were matched to the users according to age, race, type of delivery, and parity. DESIGN: Qualitative, descriptive. MAIN OUTCOME MEASURES: Data were collected through semistructured, individual interviews. Patients defined comfort and described the characteristics and patterns of comfort during the postpartum period. RESULTS: Data were analyzed into three categories of themes. Attributes of comfort were resolution of pain, resolution of fatigue, satiation of hunger, resolution of individual irritants, and relaxation. Interventions for comfort were standard therapy, supportive presence, and caring nursing approach. Modifiers of comfort were individualized comfort patterns, environmental ease, and maternal concern. CONCLUSIONS: Comfort is more than the absence of pain. A supportive presence and a caring nursing approach were the most helpful interventions.

The concentration of lipopolysaccharide on individual root surfaces at varying times following in vivo root planing.

Material with endotoxin activity has been detected in extracts prepared from pooled, periodontally involved teeth, and it has been shown that root planing in vivo reduces the level of such material. However, questions concerning the concentration of endotoxin on the diseased surfaces of individual teeth and questions concerning how rapidly individual root planed tooth surfaces retoxify in vivo have not been addressed previously. Citric acid extracts were prepared from individual, periodontally diseased teeth that had been extracted either from the oral cavity without prior root planing or at varying times up to 12 weeks following root planing. Using a chromogenic Limulus Amebocyte Lysate (LAL) assay, we were able to quantitate the amount of endotoxin associated with diseased root surfaces of individual teeth. We concluded that the extracted material contained endotoxin since it activated LAL and since the LAL-activation was heat-stable, acid-stable and neutralizeable by polymyxin B. The levels of endotoxin found on the root surfaces of these individual, periodontally involved teeth at varying times following in vivo root planing support the following conclusions: the concentration of endotoxin present on diseased root surfaces is markedly reduced, but not eliminated, by in vivo root planing, significant retoxification of root planed surfaces occurs within a relatively short time period after root planing and biological responses to such toxification conceivably may lead to subsequent phases having reduced levels of endotoxin.

Increased platelet arachidonic acid metabolism in diabetes mellitus.

Platelets obtained from some diabetic patients show enhanced in vitro platelet aggregation. This study sought to determine if platelet obtained from insulin-dependent diabetic subjects synthesize increased quantities of the labile aggregating substance, thromboxane A2 (TXA2), and if it may play a role in the enhanced platelet aggregation. Arachidonic acid (1 mM)-stimulated TXA2 synthesis, as determined via radioimmunoassay of its stable metabolite TXB2, was significantly greater (P less than 0.01, N = 12) in platelet-rich plasma obtained from diabetics compared with matched controls. Arachidonic acid-stimulated TXB2 synthesis in the diabetic platelet-rich plasma was positively correlated with the ambient fasting plasma glucose (r = 0.61, P less than 0.02, N = 15). Platelet aggregation induced by arachidonic acid (0.4-0.8 mM) was inhibited significantly less by 13-azaprostanoic acid (P less than 0.04, N = 14), a competitive antagonist of the actions of prostaglandin H2 or TXA2 on platelets, compared with matched controls. The results support the notion that platelets obtained from some insulin-dependent diabetic subjects manifest increased synthesis of TXA2, which may contribute to the enhanced platelet aggregation.