A pilot study to assess the use of megesterol acetate to promote weight gain in frail elderly persons residing in long-term care.

OBJECTIVE: The purpose of this pilot study was to determine the effectiveness of megesterol acetate (MA) for increasing body weight of frail older persons residing in long-term care settings. DESIGN: A retrospective study. SETTING: Two long-term care facilities in a large city in the southwestern US. PARTICIPANTS: Six white residents (five female, one male, mean age 87.8 years) of the facilities who had a sustained weight loss of 5% in 1 month or 10% in 6 months or longer. MEASUREMENTS: Weight gain or loss of participants receiving 480 milligrams of megesterol acetate for a minimum of 28 consecutive days. RESULTS: Five of the six subjects gained weight over a 2-month period after taking 480 milligrams of MA for 1 month or more. There was a delayed effect of non-fluid weight gain that was statistically significant 2 months after the end of treatment. One woman with diagnoses of stroke, arthritis, and hypertension lost weight despite taking MA continuously for 84 days. CONCLUSIONS: Results suggest that MA has been underutilized by geriatric health professionals as an intervention to ameliorate or reverse anorexia of aging after other nutritional efforts have failed. Using MA to prevent unintentional weight loss and malnutrition may significantly improve the health status of older patients. A prospective study using a larger sample and based on ideal weight should be carried out to evaluate the benefit of MA, with particular attention to weight gain that persists after 2 months. Future studies should also take into account the high dropout rate of participants and consider earlier intervention with MA.

Research & clinical practice. Building a nursing research culture.

The internalization of clinical nursing research values, norms, and attitudes via orientation and research development, along with the introduction of research tools (artifacts), constitutes the birthing phase of the acculturation process. The development of unit and individual research agendas and the implementation of research rounds illustrates a "bonding phase," in that nurses are bonding or weaving research into the fabric of their clinical practice. The final phase, stabilization, occurs when clinical nursing research is core to clinical nursing practice as illustrated by rewards or sanctions via performance evaluations, and provisions for release time for research participation.

Family violence. Development of a master's level specialty track in family abuse.

Family violence is a societal reality. It will not disappear if society closes its eyes and fails to recognize its existence. When this is done, the abusive cycle is perpetuated. The specialty track described in this article was the nation's first graduate nursing educational program in the area of Family Violence. This program demonstrates nursing's potential contribution to the development of competent professionals with the expertise necessary to intervene in the abusive cycle.

Nutritional changes in nonhuman primates during mechanical ventilation.

To characterize the baseline nutritional changes occurring in healthy baboons receiving an acute lung injury, we prospectively evaluated serial nutritional changes in eight adult baboons that received oleic acid (0.08 mL/kg) and then required mechanical ventilation for a period of 8 d. The animals were given hypocaloric feeding. Nutritional assessment included the measurement of changes in muscle mass and changes in visceral protein concentration and plasma lipids. Both serum protein and albumin concentrations decreased for 3 d after mechanical ventilation began but then remained stable. The animals exhibited a marked increase in bronchoalveolar lavage fluid (BALF) protein concentrations after receiving oleic acid. We conclude that previously healthy baboons receiving only dextrose infusion during mechanical ventilation have marked decreases in serum albumin occurring after the lung injury. Decreases in albumin occur very early and may represent pooling of albumin in the lung after the oleic acid injury.