The effect of high-dose enteral glutamine on the incidence and severity of mucositis in paediatric oncology patients.

BACKGROUND/OBJECTIVE: The study was conducted to determine if enteral glutamine, 0.65 g kg(-1) daily for 7 days, is effective in reducing the incidence and severity of mucositis in paediatric oncology patients when given alongside chemotherapy. The study was carried out at St James's University Hospital, Leeds, UK. SUBJECTS/METHODS: This was a randomized study using the patients as their own controls. Seventy-six patients undergoing treatment for paediatric malignancy having at least two identical courses of chemotherapy and at risk of developing mucositis participated in the study. Patients received one course of chemotherapy with glutamine and an identical course without. Alternate patients were allocated to have glutamine with course 1 or with course 2. The severity of symptoms of mucositis and the duration of enteral and parenteral nutrition were recorded. Daily ammonia levels were measured. RESULTS: Fifty patients completed the study. No statistical significance with regard to symptoms of mucositis was found. Fewer children receiving glutamine required parenteral nutrition (P=0.049), and the duration of parenteral nutrition was less (P=0.023). No adverse effects attributed to taking the glutamine were observed. CONCLUSIONS: The study showed that high-dose enteral glutamine did not reduce the incidence and severity of oral mucositis as determined by subjective toxicity measurements, but did show a significant reduction in parenteral nutrition usage. No adverse cumulative effect of this oral glutamine dose was observed.

Oral glutamine in paediatric oncology patients: a dose finding study.

OBJECTIVE: The purpose of this study was to determine the most appropriate dose of oral glutamine to use in a further clinical study in paediatric oncology patients. DESIGN: This was a phase I, pharmokinetic study. SETTING: The study was carried out at The Yorkshire Regional Centre for Paediatric Oncology and Haematology, St James's University Hospital, Leeds, UK. SUBJECTS: Thirteen patients undergoing treatment for paediatric malignancy participated in this study. All 13 completed the study. INTERVENTIONS: The most appropriate dose was determined by patient acceptability and by plasma glutamine and ammonia levels measured at timed intervals after ingestion of a single glutamine dose. RESULTS: Doses of 0.35, 0.5 and 0.65 g/kg were well tolerated with no untoward plasma glutamine and ammonia levels. One patient was recruited to a higher dose of 0.75 g/kg, but the plasma glutamine and ammonia levels peaked at 2601 and 155 micro mol/l, respectively. The ammonia level was greater than the acceptable upper limit. It was difficult to disperse the glutamine adequately at this dose, resulting in the suspension being found to be unpalatable and therefore no further patients were recruited at this dose. CONCLUSION: It was concluded that 0.65 g/kg is a safe dose of glutamine to use in a clinical study in paediatric oncology patients.

Regional Examination for Nurse Registration, Commonwealth Caribbean.

In 1990, a Regional Examination for Nurse Registration was approved by the Conference of Ministers Responsible for Health in the Commonwealth Caribbean. The examination allows for standardization and improvement of nursing education, as well as reciprocity and ease-of-movement for Registered Nurses among the countries of the region. A Planning Committee and a Blueprint Committee were established to develop the examination process. Committee membership included the Principal/Chief Nursing Officers, Nurse Tutors, and General Nursing Council representatives of each country, as well as educators from the two universities of the region. The accepted model, based on mutually agreed competencies for the Registered Nurse to practice in the region, forms the basis for the elaboration of the blueprint and the administrative manuals. The treatment of test items, assembling and conducting the examinations, which consist of four papers, as well as scoring the examination results, and notifying students of the results, are the responsibility of each General Nursing Council. The 13 General Nursing Councils with responsibility for Schools of Nursing meet annually as a regional committee to prepare the examinations, using a different country for each meeting; countries are rotated alphabetically. There is no permanent site for the administration of the examination. Membership to the regional committee, known as the Regional General Nursing Councils (RGNCs), is for 3 years. This staggering of membership allows for continuity.

Problems of infertility following cancer therapy in childhood and adolescence.

Hormones regulate ovarian and testicular function. These are produced by the anterior lobe of the pituitary gland, the hypothalamus and by the sex organs. Impaired gonadal function may result from damage to any of these structures and the toxic effects of chemotherapy and radiotherapy can cause this damage. This paper will discuss the effects these treatments can have on adults who have survived a childhood cancer, and describe the subsequent implications for clinical practice.

Nursing education trends in the Caribbean.

Today, the professional nurse must be educated to respond to and manage the present and forecasted advances in the health system. They must be innovative, analytical and articulate, which cannot be taught using the traditional apprenticeship methods. Nursing workforce development must of necessity be broad in scope to encompass the socioeconomic, political and health system changes. These changes and trends significantly affect nursing generally, and nursing education specifically.

Human resources in nursing: determining requirements and skills.

Beset with feeble economies and debt servicing obligations, many countries have had no recourse but to impose stringent structural adjustment policies, particular in the nonproductive social sectors such as health and education. Below, a look at the effects of these restraints on the health services and on nursing and some recommendations on how nurses should respond, particularly in planning human resources.

An economic model for nurse manpower planning in the Caribbean: Part II--Strategies.

Figure 5 illustrates the key ingredients of manpower planning. Whatever model or framework that have or will be considered for the Region must be based on cost containment necessitated by the scarcity of resources. Since the health sector is labour intensive, health manpower is critical for its successful functioning. Approximately 65-70% of the Ministries of Health's recurrent budget is allocated for health personnel. Budgetary restrictions as a result of economic downturn have therefore impacted severely on the manpower resources resulting in a decreased supply of all categories of health workers in the health service. Even the most minimum level of services is therefore jeopardized. Most countries of the Region are at present suffering from a net loss in most of the health professional groups and some countries are without auxiliary groups. In providing quality care, certain questions need to be answered. In the light of decreasing economic resources and accompanying decreasing nurse manpower resources: 1. What degree of substitutability between categories of health manpower generally and specifically, between different categories of nurses will affect their efficient use and provide quality care? 2. What are the least cost combinations of nurse manpower that will ensure greater productivity and quality care? 3. What are the policy restrictions that may hinder substitutability? 4. What are the market forces that affect the demand and supply of nurses? In all of the above, it is necessary to understand that the basis of any nurse manpower policy and plan and the economic analysis of these is guided by the demand for health care and services as well as economics within a given country.

An economic model for nurse manpower planning in the Caribbean--Part 1: The issues.

Below is a noneconomist's view on economic issues impacting on nurse manpower development in the Commonwealth Caribbean. The issues however are of an international nature and are therefore pertinent to all those interested in nurse manpower development. The main objective is to present a model for economic analysis and planning.

Home care after surgery for scoliosis.

Parents are normally highly motivated to learn how to give care to their children. Adolescents convalescing after Harrington instrumentation and spinal fusion need to actively participate in decisions concerning their care. As much effort as possible should be made to allow them to follow a normal routine, within the limits of the surgeon's instructions. Both parents and patients need teaching, support and reinforcement from the nurse. They need to know how they are coping. The parents need to be supported and reinforced in their performance of home care and in their acceptance of the patient within the family life-style. Adolescents need to be supported in their independence and adjustment to their new and temporary immobility. Assessment of the home and an informative teaching program on home care needs to be initiated as soon as possible after surgery.