Growing up in the hospital: Part II, Nurturing the philosophy of family-centered care.

This article is the second in a series that addresses the issues of "growing up in the hospital." Whereas the first article focused on the child and the complex growth and development issues surrounding indefinite hospitalization, this article will focus on the family, the philosophy of family-centered care, and how nursing practice can nurture this ideal when working with children who must "grow up in the hospital."

Growing up in the hospital: Part I, Let's focus on the child.

Major advances in medical research and technology have made it possible for many children with complex chronic illnesses to survive, including those who just a few years ago would have died (Hobbs & Perrin, 1985). One goal of health care professionals who care for these children is, and continues to be, discharge of the child to the family and community whenever possible. Complex medical and nursing care, elusive diagnoses, complicated psychosocial issues, and inconsistent community resources often mean discharge must be prolonged. Focusing on the creation of innovative methods for integrating the growth and developmental needs of these special children is a challenging and often overlooked aspect of our pediatric nursing practice. This article is one of a series that will address the issues of growing up in the hospital. What are the implications for the child, family, and professional nurse? What strategies can we devise to assist our patients through what may be a very lengthy and complex hospital course?

Extended day program: bringing preschool to the hospital.

Children who must grow up in a hospital setting due to complex medical and social conditions present health care professionals with unique challenges that include (a) providing an environment to facilitate growth and development, (b) normalizing life experiences, (c) strengthening children's positive self-concepts, (d) promoting independence and exploration, and (e) introducing opportunities for learning experiences. An Extended Day Program, designed by nurses and other professionals to promote optimal development and psychosocial care for long-term hospitalized children, can offer these benefits.

Protection of lambs against enteric colibacillosis by vaccination of ewes.

Pregnant ewes were vaccinated twice, seven weeks and three weeks before lambing, with a multivalent formalin-killed Escherichia coli vaccine containing an added K99, F41 antigen preparation. Lambs born to vaccinated and unvaccinated ewes were exposed to oral infection with E coli B44 (09:K30, K99, F41). All 10 lambs from vaccinated ewes were protected whereas all 10 control lambs developed severe diarrhoea and five died or were killed in extremis. In the following year, previously immunised ewes were given a single dose of the vaccine two weeks before lambing. Eleven of their 12 lambs were protected against a similar challenge, which caused the death of six of eight control lambs and severe diarrhoea in the two survivors. Higher levels of antibody to the K99, F41 preparation were detected by enzyme-linked immunosorbent assay in the serum and colostrum from vaccinated ewes and in the serum of their lambs when compared with similar samples from control ewes and lambs.

Development of a combined clostridial and Pasteurella haemolytica vaccine for sheep.

The efficacy of a multicomponent clostridial vaccine containing Pasteurella haemolytica antigens was tested in specific pathogen free or conventionally reared lambs exposed to experimental infection with P haemolytica serotypes A1, A2 or A6. In four experiments assessment was based upon the findings of clinical, pathological and bacteriological examinations. Three experiments carried out in conventionally reared lambs demonstrated protection against challenge infection with P haemolytica serotypes A1, A2 and A6 in vaccinated lambs. However, the inconsistency of the disease induced in these experiments emphasised the need to perform definitive studies in specific pathogen free conditions. The final experiment was carried out with specific pathogen free lambs and confirmed the efficacy of the multicomponent clostridial vaccine containing P haemolytica antigen in protecting against the effects of infection with P haemolytica serotype A6. In addition, this experiment indicated that the inclusion of several components in a vaccine did not affect the efficacy of an individual antigenic component.

Experimental immunisation of lambs against pneumonic pasteurellosis.

Methods of immunising lambs against pneumonic pasteurellosis, caused by several serotypes of Pasteurella haemolytica, were assessed in specific pathogen free lambs. Lambs were vaccinated intramuscularly with sodium salicylate extract (SSE) of P haemolytica, either alone or in combination with heat-killed organisms (HKO). SSE of P haemolytica type A1 protected vaccinated lambs against pneumonia resulting from challenge with the homologous serotype. SSE of type A2 also provided some protection but this was improved by vaccination with a combination of SSE and HKO.

Equine immunology 4: vaccines and antisera.

This paper attempts to relate the practicalities of vaccine development to the ideals which should be aimed for in a new vaccine. The type of immune response induced is dependent upon the nature of the antigen in the vaccine and the site and timing of its presentation to the immune system. In this respect the influence of age, maternal immunity and antigenic competition are discussed. The possible side effects associated with vaccination are defined and vaccines which are currently available for horses are reviewed. These vaccines are mostly for the prevention of respiratory disease. Finally, the possible uses for antisera are considered.

Cytotoxic effect of Pasteurella haemolytica on ovine bronchoalveolar macrophages in vitro.

Live Pasteurella haemolytica A1 was shown to have a cytotoxic effect on suspensions of sheep bronchoalveolar macrophages. Cytotoxic activity was also demonstrable in bacteria-free supernatants from suspensions containing P. haemolytica. Heat-killed and ultra-violet killed organisms of P. haemolytica and live Staphylococcus aureus were not toxic to sheep BAM. These results suggest that a bacterial cell-free cytotoxin is produced by metabolically active P. haemolytica. Guinea-pig peritoneal macrophages, McCoy and pig kidney epithelial cell suspensions were unaffected by live P. haemolytica and supernatant from P. haemolytica cultures, indicating that the cytotoxin may only affect phagocytic cells of ovine or bovine origin.

Protective immunity and specificity of antibody responses elicited in cattle by irradiated Trypanosoma brucei.

The level and specificity of antibody responses elicited in cattle by irradiated non-infective Trypanosoma brucei were examined and related to the development of protective immunity. These responses were compared with those induced by infection and by inoculation with purified variable surface glycoprotein (VSG) in adjuvant. It was found that 10(7) or more irradiated trypanosomes inoculated intravenously into cattle conferred complete protection against challenge with 10(3) homologous trypanosomes 14 days later. Animals immunized with 10(6) organisms showed partial protection. Of the assays used for detection of antibody, neutralization of infectivity was slightly more sensitive than either the Farr assay or the immunofluorescence test which were both more sensitive than solid-phase radioimmunoassay (RIA). Detection of specific antibody correlated with immunity, in that all animals inoculated intravenously with 10(6) or more trypanosomes developed neutralizing activity in their sera. The antibody responses after intravenous inoculation were consistently superior to those induced by the subcutaneous route. By carrying out blocking assays, most of the antibody elicited by irradiated trypanosomes was found to be specific for antigenic determinants on the VSG exposed on the surface of live trypanosomes. A similar specificity was found for the antibody induced during infection with T. brucei. Conversely, a large component of the antibody induced by purified VSG in adjuvant appeared to be directed against determinants on the VSG which are not exposed on live trypanosomes and are probably not involved in protective immunity.

Equine immunology 3: immunopharmacology--anti-inflammatory and antihypersensitivity drugs.

This article reviews anti-inflammatory and antihypersensitivity drugs under these 4 headings: Functional or physiological antagonists; Selective pharmacological inhibitors; Broad spectrum anti-inflammatory drugs; Miscellaneous inhibitors. The compounds considered include sympathomimetic amines, anticholinergic drugs, antihistamine drugs, tryptamine antagonists and dopamine antagonists, glucocorticosteroids and non-steroidal anti-inflammatory drugs, disodium cromoglycate and diethylcarbamazine citrate. The relationship of the pharmacological actions of these compounds is considered in the context of clinical conditions. The potential for immunomodulatory pharmacology is discussed using levamisole as an example.

Interference in the establishment of superinfections with Trypanosoma congolense in cattle.

To examine the influence of an established infection on subsequent challenge with another unrelated trypanosome serodeme, cattle were subjected to two challenges, 5 to 6 wk apart, with unrelated isolates of Trypanosoma congolense. The primary infection inhibited the establishment of the second infection despite the initial absence of detectable antibody to the trypanosomes used for the second challenge. This was true whether the second challenge consisted of bloodstream forms of the parasite or metacyclics from infected Glossina m. morsitans. Rechallenge with bloodstream forms resulted in a slight antibody response, which was only detectable by immunofluorescence and was much less than in the challenge controls. Although animals subjected to the second challenge by tsetse flies showed no appreciable increase in parasitemia and, in most instances, no chancre reaction at the site where the tsetse bit, they developed readily detectable neutralizing antibody to the metacyclic trypanosomes. That this interference effect was not the result of specific immunity and required an active infection was confirmed by the finding that when infected animals were treated with Berenil prior to rechallenge, they were fully susceptible to the infection.

Immunization of cattle with a variant-specific surface antigen of Trypanosoma brucei: influence of different adjuvants.

Nine different adjuvants were examined for their ability to potentiate the humoral and cell-mediated immune responses of cattle to a soluble glycoprotein antigen prepared from Trypanosoma brucei. Serological responses as measured by the Farr assay were best augmented by the oil-based adjuvants and saponin. Cell-mediated immunity, as assessed by specific lymphocyte transformation in vitro, was enhanced by all oil-based adjuvants at different intervals after immunization. Results from a challenge infection of immunized cattle with the homologous clone of T. brucei and from neutralization tests indicated that protection against infection was better correlated with specific antibodies than with cell-mediated responses. From these considerations, and the absence of tissue reactions at the site of inoculation, saponin was considered more practical than the oil-based or bacterial adjuvants for the elicitation in cattle of antibodies to purified soluble antigens.

Equine immunology 2: immunopharmacology--biochemical basis of hypersensitivity.

In general, 4 types of hypersensitivity reactions can be defined according to their immunological basis and clinical appearance. The differing mechanisms of these responses are described with particular reference to chemical mediators which through their pharmacological actions contribute to the clinical manifestations of hypersensitivity. Chemical mediators may exert their influence locally or systemically through their action on effector, tissues or organs and in addition, may be involved in the recruitment of cells of specific type to the site of the reaction. The possible role of these mediators in hypersensitivity in the equine species is discussed to provide a background for a subsequent paper which will be concerned with the therapy of hypersensitivity conditions.

Equine immunology: an introductory review.

This article attempts to relate some of the more recently accepted concepts of immunology to an understanding of the mechanisms of immunity in the horse. The cellular mechanisms involved in the immune response are outlined, with an indication of their likely role in humoral and cell-mediated immunity. In describing the humoral immune response, the structure and function of the different equine immunoglobulins are reviewed. The significance of humoral and cell-mediated immune responses are considered in relation to actively and passively acquired immunity.