United Kingdom national paediatric bilateral project: Results of professional rating scales and parent questionnaires.

OBJECTIVES: This fourteen-centre project used professional rating scales and parent questionnaires to assess longitudinal outcomes in a large non-selected population of children receiving simultaneous and sequential bilateral cochlear implants. METHODS: This was an observational non-randomized service evaluation. Data were collected at four time points: before bilateral cochlear implants or before the sequential implant, one year, two years, and three years after. The measures reported are Categories of Auditory Performance II (CAPII), Speech Intelligibility Rating (SIR), Bilateral Listening Skills Profile (BLSP) and Parent Outcome Profile (POP). RESULTS: Thousand and one children aged from 8 months to almost 18 years were involved, although there were many missing data. In children receiving simultaneous implants after one, two, and three years respectively, median CAP scores were 4, 5, and 6; median SIR were 1, 2, and 3. Three years after receiving simultaneous bilateral cochlear implants, 61% of children were reported to understand conversation without lip-reading and 66% had intelligible speech if the listener concentrated hard. Auditory performance and speech intelligibility were significantly better in female children than males. Parents of children using sequential implants were generally positive about their child's well-being and behaviour since receiving the second device; those who were less positive about well-being changes also generally reported their children less willing to wear the second device. CONCLUSION: Data from 78% of paediatric cochlear implant centres in the United Kingdom provide a real-world picture of outcomes of children with bilateral implants in the UK. This large reference data set can be used to identify children in the lower quartile for targeted intervention.

United Kingdom national paediatric bilateral project: Demographics and results of localization and speech perception testing.

OBJECTIVES: To assess longitudinal outcomes in a large and varied population of children receiving bilateral cochlear implants both simultaneously and sequentially. METHODS: This observational non-randomized service evaluation collected localization and speech recognition in noise data from simultaneously and sequentially implanted children at four time points: before bilateral cochlear implants or before the sequential implant, 1 year, 2 years, and 3 years after bilateral implants. No inclusion criteria were applied, so children with additional difficulties, cochleovestibular anomalies, varying educational placements, 23 different home languages, a full range of outcomes and varying device use were included. RESULTS: 1001 children were included: 465 implanted simultaneously and 536 sequentially, representing just over 50% of children receiving bilateral implants in the UK in this period. In simultaneously implanted children the median age at implant was 2.1 years; 7% were implanted at less than 1 year of age. In sequentially implanted children the interval between implants ranged from 0.1 to 14.5 years. Children with simultaneous bilateral implants localized better than those with one implant. On average children receiving a second (sequential) cochlear implant showed improvement in localization and listening in background noise after 1 year of bilateral listening. The interval between sequential implants had no effect on localization improvement although a smaller interval gave more improvement in speech recognition in noise. Children with sequential implants on average were able to use their second device to obtain spatial release from masking after 2 years of bilateral listening. Although ranges were large, bilateral cochlear implants on average offered an improvement in localization and speech perception in noise over unilateral implants. CONCLUSION: These data represent the diverse population of children with bilateral cochlear implants in the UK from 2010 to 2012. Predictions of outcomes for individual patients are not possible from these data. However, there are no indications to preclude children with long inter-implant interval having the chance of a second cochlear implant.

Furosemide reverses multidrug resistance status in bladder cancer cells in vitro.

BACKGROUND: Multidrug resistance (MDR) has a potentially serious influence on cancer treatment and should be taken into consideration in the design and application of therapeutic regimens. It is mediated through the activity of cellular pumps. AIM: To investigate whether furosemide, itself a pump-blocker, reverses MDR in an in vitro model. MATERIALS AND METHODS: An MDR bladder cancer cell line (MGH-u 1R) and its parental (drug sensitive) clone were exposed to epirubicin and furosemide, with the concentration of one drug fixed and that of the other serially diluted in a 96-well plate format. Both drugs formed the variable component in separate experiments. After a 1-h exposure, the cells were washed and replenished with fresh medium. To examine the toxicity of epirubicin and furosemide separately and in combination, monotetrazolium-based assays were carried out. Intracellular epirubicin distribution was assessed by confocal microscopy as a second index of resistance status after in vitro exposure. RESULTS: MGH-u 1R cells incubated with furosemide showed distribution of drug similar to that in the parental cells (MGH-u 1 sensitive). Controls (without furosemide) continued to show a resistant pattern of fluorescence. In cytotoxicity assays furosemide appeared substantially non-toxic. Resistant cells in the toxicity titration experiments showed increased resistance to levels of furosemide over 500 mug/ml. Parental cells were made only marginally more sensitive against increased background toxicity. CONCLUSION: Furosemide is effective in reversing MDR status in bladder cancer cell lines in vitro. It may also have an increment of intrinsic cytotoxicity, but only at higher concentrations. We propose a potential for further investigation of furosemide as an adjunct to chemotherapy for superficial bladder cancer.

Workshop 1 (synthesis): systems for sustainable urban water services.

The systems approach is absolutely essential to secure sustainability in urban water services. The financing dimension is critical; fragmented institutions are a great barrier, hindering a systems approach; recycling of water and nutrients is vital for food production and livelihood improvements; effective knowledge transfer about innovative approaches to sanitation is essential to share success stories and failures.

Perioperative assistants are a new resource.

In the current health care environment, buzzwords such as redesign, reengineering, restructuring, right-sizing, customer service, diversity, quality, multiskilled workers, and unlicensed assistive personnel conjure up many notions about how perioperative nurses can meet the needs and wants of their patients. Unlicensed assistive personnel are becoming commonplace in our hospitals and have assumed a variety of positions and functions. This article describes a project that one hospital undertook to create unlicensed, multiskilled workers in the perioperative area.

It is time to move from the nursing process to critical thinking.

As we reflect on the concept of critical thinking in perioperative nursing practice, we should ask ourselves whether we think critically. If not, we must learn the principles of critical thinking and apply them in our clinical practice settings. Our perioperative nurse managers and directors must demonstrate critical thinking in leading other nurses in the delivery of quality, cost-effective, service-oriented patient care. They also must identify peers who use critical thinking skills to support and sustain them in their quest.

Preparing for the future: perianesthesia orientation.

A comprehensive orientation for RNs to perianesthesia nursing is essential for nurses who are new to the area because of the specialized skills and knowledge required. A massive restructuring of the existing orientation was undertaken to better prepare nurses for these challenges and to reduce costs. A competency-based orientation program was developed by the educator, the supervisors, and the preceptors. The concept of competency-based education is explored. The program development, implementation, and evaluation phases are highlighted. The results have been positive and rewarding with an improved outcome: a competent new perianesthesia care nurse.

Competency-based orientation for registered perioperative nurses.

A comprehensive orientation is essential for new nurses who plan to practice in the perioperative area. The traditional perioperative orientation program at our hospital was not effective, so we developed a competency-based orientation program to improve patient care, decrease costs, and increase new nurses' confidence and perioperative skills. Program results have been positive and rewarding and have provided many new perioperative registered nurses whose practice is based on sound principles.

Crossword puzzles: a teaching strategy for critical care nursing.

Crossword puzzles are an effective teaching and learning tool in critical care education. They are especially effective for teaching details that need to be memorized. The positive outcomes are well worth the creative efforts of the educator.

Games in nursing staff development.

Adult learners have different learning styles and needs. To facilitate learning in a mixed group, various strategies must be used. Games have proven to be effective in basic and continuing nursing education. Educational games are gaining popularity in nursing staff development. This article discusses games in nursing staff development.

Care of the infant in a Pavlik harness.

Congenital hip dysplasias, a common orthopaedic problem in children, can be treated effectively if diagnosed early. One such valuable tool in treating this disorder is the Pavlik Harness. These authors describe their child's experience with the Pavlik Harness along with the personal needs of the child and family.

Patient education: theory and practice.

Patient education is an important component of quality nursing care. Nurses must be prepared to teach their patients in the promotion of health and recovery from illness. This article addresses the theories and practices of patient education. An example of a patient education program is described.