Perturbations of model protein systems as a basis for the central and peripheral mechanisms of general anaesthesia. Protein perturbations associated with anaesthetic interactions are relevant to: (a) the central molecular mechanisms of general anaesthesia; (b) the molecular basis of physiological selectivity and anaesthetic specificity of the many 'side-effects' of anaesthesia; (c) the use of anaesthetic agents as selective hydrophobic probes for the study of protein structures and activities in detail. Small but specific protein perturbations have been studied with various nuclear magnetic resonance procedures with haemoglobin as a model protein to establish the 'ground-rules' for anaesthetic-macromolecule interactions. The correlation of one aspect of these perturbations with anaesthetic potency and hydrophobic solubility indicates that hydrophobic pockets in proteins can behave like bulk-lipid phases in terms of their solubility characteristics. Other aspects appear to depend on physical characteristics such as size, geometry, structure and composition of the individual agents. These data support the hypothesis that anaesthetic actions can be explained on a molecular basis by direct interactions with proteins in addition to lipid and aqueous effects.


Physical and chemical properties of lysozyme. The conformations of lysozyme in crystals and in aqueous solution are discussed and it is shown that the basic conformation is similar in the two states. Certain parts of the molecule have mobility. The reactions of lysozyme with protons, metal ions and some organic reagents are examined in the light of the conformations and their dynamics. The reactions considered are mainly those of tyrosyl, tryptophyl and carboxylate residues. The reactivity data are used in a discussion of the energy states of the reacting side-chains. In particular the reactivity of Glu-35 and its interaction with Trp-108 lead to suggestions for some new aspects in the hypothesis for the mechanism of action of lysozyme. In most respects the X-ray crystal diffraction and the nuclear magnetic resonance solution studies are in accord and complementary.


Dynamics of local conformation and enzyme function. Enzyme function is critically affected by gross changes in tertiary structure, but much less is known about the dependence of activity on localized conformational changes that might occur during the catalytic process. Such information is essential to the understanding and verification of enzyme mechanisms, and can only be obtained from systems in which the substrate binding and catalytic groups of the enzyme active centre are not only identified but also rendered appropriate probes of the catalytic reaction, that is they must signal changes in their mutual interactions at rates at least as fast as catalysis. It should then be possible to observe directly each of the dynamic events that result in catalysis. Time-averaged structural analyses can neither reveal the dynamics of catalysis nor describe the conformational details of molecules who structures-particularly of the active centre-are motile. Moreover, the three-dimensional structures of enzymes in crystals and solutions may not always be identical as evidenced by marked differences between the kinetic properties of crystalline and of dissolved enzymes (e.g. hexokinase, glycogen phosphorylase and carboxypeptidases A and B). Various experimental approaches have been devised to explore the relationship between structure and function of these and other enzymes. We have focused on the syncatalytic, spatial relationships of active-site residues as they bear on the mechanism of enzyme action using absorption, circular dichroism, magnetocircular dichroic, and resonance Raman spectroscopy as well as resonance energy transfer. Stopped-flow, pH and temperature jump methods quantitatively assess both the conformational and local structural features of the enzyme and reveal multiple, discrete conformational states that prove to have mechanistic significance. These and related data serve as a basis for a minimal model of the dynamic aspects of enzyme action.


To stabilize a transition state.

To stabilize a transition state. Inspection of the active sites of the many enzymes whose structures are known at high resolution leads to the unsurprising conclusion that an enzyme may provide an environment that exquisitely stabilizes the transition state for an elementary catalytic step that is expected to be difficult. In an effort both to mimic such an environment and to have the opportunity of investigating the thermodynamic and kinetic consequences of juxtaposing polar and non-polar loci in the same molecule, we have synthesized several specifically functionalized alpha-cyclodextrins. One of these is designed to stabilize the trigonal bipyramidal transition state for an in-line displacement at the phosphorus of a phosphate monoester. This cyclodextrin contains three symmetrically disposed ammonium groups on the 'top' (at C-6) of the hydrophobic cavity formed by the hexa-glucose torus and the remaining 15 hydroxy groups are methylated. The thermodynamic consequences of adjacent hydrophobic and hydrogen-bonding and/or electrostatic binding sites are investigated using several charged and uncharged ligands. The feasibility of building host species explicitly to stabilize reaction transition states is discussed.


Solvents, interfaces and protein structure. Mean packing densities in protein interiors are comparable to those of most organic solids but the variations between small regions may be substantial. Packing defects may be related to allowed structural fluctuations. Molecular surface areas can be correlated with free energies of transfer between different solvents. The proportionality factor will depend, in general, on the nature of the solute and both the solvents. The changes in solvent-protein interfacial area on chain folding are large and the implied changes in free energy from this solvent-squeezing effect are correspondingly large. The strong tendency to minimize surface area is reflected in the globular shape of most protein molecules or domains in larger structures. The formation of isolated units of secondary structure from an extended chain represents about one half of the eventual total area change. The tendencies of amino acids to form beta-sheets correlate well with the rank-ordered list based on non-polar area change for each residue type. The calculated area changes for helix and sheet formation are not identical in rank order. The rank-ordered list for alpha-helix formation correlates satisfactorily with the probability list prepared from actual structures if glutamic acid and tyrosine are removed. What special characteristics unrelated to surface area these two amino acids might have is not clear. Tertiary structure formation from preformed secondary structural units can be rank ordered on area change and possible nucleation sites can be identified. A prediction scheme for helix-helix interactions is proposed. The hydrophobic force begins to be felt when two helices are about 0.6 nm (6 A) from their final contact positions. Interfacial surface tension is a logical parameter to relate free energy and solvent contact area, but this macroscopic parameter must be used with great caution. It is suggested that water in the deep grooves, characteristic of the active sites of many enzymes, may have a substantially higher fugacity than bulk water as indicated, at least qualitatively, by the Kelvin equation based on surface curvature. Such water would be more easily displaced than its plane surface counterpart and could contribute significantly to ligand-binding energy. This factor would be in addition to the usual solvent entropic effects associated with surface area reduction on association.


Stereochemical studies of enzymic C-methylations. Samples of methionine carrying a chiral CHDT-group have been prepared from and degraded chemically to chiral acetic acid. With this powerful tool inversion mechanisms were detected for the methylations on sulphur, oxygen and carbon atoms in the biosynthesis of methionine, loganin and cyanocobalamin, respectively. Chirality of the methyl group of methionine is retained during formation of the C-24 methyl group in ergosterol biosynthesis. A stereochemical scheme for the unusual course of this reaction is presented and the current stage of experiments aimed at its verification is discussed.


Flexibility and rigidity in protein crystals. There is an increasing body of crystallographic evidence for disorder in parts of the main polypeptide chain of certain proteins. The zymogens of pancreatic serine proteinases and tyrosyl-tRNA synthetase are used as examples. It is suggested that reactivity and specificity are favoured by an appropriate rigid conformation, and that disorder may often be involved in some kind of control function.


[Neurological symptoms in a-beta-lipoproteinemia (author's transl)]. Abetalipoproteinaemia (Bassen-Kornzweig syndrome), an autosomal recessive inherited disease, up to now has been described in 53 instances in the world literature. Neurological symptoms were reported in 34 of them. Ataxia, loss of proprioceptive sensation, and areflexia characterize this disorder, resembling Friedreich's ataxia. Other signs, which may be inconstantly found, are weakness, diminution of cutaneous sensation, and in the later course an atypical retinitis pigmentosa. Laboratory examinations show acanthocytosis, lowered concentrations of serum cholesterol, triglycerides and phospholipids and as the pathognomonic feature of this disease absence of beta-lipoproteins. Reduced serum concentrations of fat soluble vitamin are secondary effects of this metabolic disorder. In a few cases there are connections to familial hypobeta-lipoproteinaemia, which is autosomal dominantly inherited. Therapeutic trials with a controlled dietary intake of fat may cause an improvement of clinical symptoms, additional doses of fat-soluble vitamin, if given during the early stages of the disease are said to prevent from retinopathy but do not seem to influence the development and course of neuropathy.


[Affective psychosis and month of birth (author's transl)]. Based on in parts extensive studies it is repeatedly indicated that patients with affective psychosis differ from the normal average population as to their month of birth. However, our studies concerning N = 6384 in-patients with affective psychosis demonstrate that they do not differ from the normal population in respect to their month of birth. Likewise the frequencies of male births agree vastly with those of female ones.


Brief sexual counseling during cardiac rehabilitation. Advances in the understanding and treatment of myocardial infarction have appeared over the past decade. One intervention technique receiving increasing emphasis is the development of multidisciplinary "rehabilitation teams" whose chief aim is to assist individuals in returning to former levels of medical and psychosocial functioning. Within the team approach, the mental health specialist clearly plays a significant role. Counselors can provide support and reassurance in the midst of the medical crisis and help to minimize stress related to rearrangements in family roles and routines. In this instance, brief sex counseling as part of an ongoing rehabilitation program serves to clarify misconceptions, reduce fears, and facilitate return to sexual activities after infarction. It is important to remember, however, that an accurate physiologic evaluation provides the foundation on which to base counseling efforts. Without adequate medical information, no amount of counseling expertise will succeed. Certainly the final decision to resume sexual behavior remains with the individual couple. The counselor's primary task is to emphasize that the myth of total abstinence is not applicable for most cardiac patients. In reality, it is possible and even highly beneficial for patient and spouse to return to their normal sexual relationship.


Psychosocial responses to myocardial infarction. This paper has presented some psychosocial factors believed to contribute to the incidence of coronary artery disease. In addition to the recognized risks, Type A behavior was identified as particularly predisposing to the incidence of CAD. A pattern of psychosocial responses to MI, as a symptomatic manifestation of CAD, was discussed in relation to a specific patient and to the nursing interventions employed. These responses are not peculiar to individuals who suffer an MI, but are common human responses to threat by illness or injury, and as such present a challenge to nurses for appropriate therapeutic intervention.


Exercise stress testing in the patient with coronary artery disease. Part II. Cardiac exercise stress testing has both diagnostic and prognostic implications. ECG changes, hemodynamic responses, and symptoms during exercise are clues to the functional capacity, severity of coronary artery disease, and probability of future coronary events. The time and workload required for a positive response to exercise and the length of time the ECG changes persist during recovery are indicators of the degree of coronary disease and are useful in predicting future coronary events.


Management of the mechanically ventilated patient receiving pancuronium bromide. The use of the drug pancuronium bromide occasionally is necessary as a part of the treatment of mechanically ventilated patients. This article reviews the mechanism of drug action, the use of the drug, and the nursing care of the patient receiving pancuronium bromide.


The clinical importance of coronary arteriography after myocardial infarction. An analysis of 80 patients who had elective coronary arteriography within 6 months after hospital dismissal for acute myocardial infarction showed that approximately two-thirds had multivessel coronary disease. The study is consistent with others reported in the recent literature in suggesting that most patients who survive myocardial infarction have multivessel disease. High early and late post-myocardial infarction mortality is comparable to that described for patients with two- and three-vessel occlusive disease. Knowledge of specific coronary anatomy and left ventricular function is critical in assessing post-myocardial infarction prognosis. This information is also important in defining optimal medical or surgical treatment. Unfortunately, the severity of the subjective clinical syndrome does not correlate well with the degree of anatomic findings or the prognosis. Properly selected surgical intervention may be one approach to modifying the high post-myocardial infarction mortality, which has not changed materially in the past several decades.


Educating teachers of nursing: the contribution of pedagogical studies. This paper deals with the nature of pedagogical studies, starting with a discussion on aspects of the curriculum. This is followed by sections dealing with objectives, lesson presentation and teaching practice. The final sections deal with the assessment of learning and curriculum planning.


Teaching psychiatric nursing in the classroom. The practice in teaching psychiatric nursing to post registration student nurses at the Bethlem Royal & The Maudsley Hospital School of Nursing is described, showing the exclusive use of experiential teaching methods. Five distinct courses are conducted at present in this topic: 1 discussions based on written work; 2 discussions centring on set topics; 3 group dynamics discussions and projects; 4 psychodrama exercises; 5 supervision classes. The latter are conducted in a manner not previously described. The dependence of effective classroom teaching on the students' ward experience is demonstrated.


Nursing care in labour and patient satisfaction: a descriptive study. This study examined the subjective needs of labouring patients. A convenience sample of 80 postpartum patients was interviewed. They described the nursing care they had received, indicated the most helpful nursing measure received, and rated their satisfaction with their nursing care. These answers were categorized into types of nursing care. These were supportive care nursing, physical care nursing, medications and combinations of these three. X2 calculations done between these categories and satisfaction scores indicated a significant relationship between the type of care a patient received and her satisfaction scores. Patients found combined care very satisfying, but supportive care was the decisive factor in the way patients viewed their nursing care. The most frequently mentioned element in supportive care was the ability of the nurse to be a sustaining presence. The nurse's ability to assess and to meet the patient's need or non-need for her presence was major factor in patient satisfaction with nursing care in this sample. The relationship between congruency (agreement between time wanted and time spent by the nurse at the bedside) and satisfaction scores was highly significant. Thus the ability to recognize and respond to the patient's need or non-need for her presence was a crucial factor in patient satisfaction and in the way in which a nurse allocated her time. The relationships between numbers of nurses caring for a patient, parity, length of labour, presence of visitors, worries about the baby and patient satisfaction scores were examined. All were non-significant. However numbers of nurses caring for a patient was defined as a contributing factor to the delivery of supportive care nursing. More nurses contributed to more supportive care nursing being given, but was not the major factor in the delivery of supportive care nursing. Finally it was shown that the administration of syntocinon to patients in this sample decreased patient satisfaction with nursing care. Implications and possible reasons for these results are discussed.


Nurse-rating of psychotic behaviour.

Nurse-rating of psychotic behaviour. The aim of this study was to review six nurse-rating schedules to evaluate their suitability for a British psychiatric unit and current nursing practice. They were compared for their reliability, their concordance with psychiatric ratings and their acceptability to the nursing staff. It was found that psychiatric and nursing observations corresponded over a wide area of psychopathology: anxiety, tension, depression, hostility, preoccupation with hypochondriacal, grandiose and self-depreciatory ideas, hallucinosis, thought disorders, mannerisms, retardation, emotional withdrawal, hypomanic activity and uncooperative behaviour. These were adequately covered by two of the scales, the Brief Psychiatric Rating Scale (BPRS) and the Psychotic Inpatient Profile (PIP), which together took 7 1/2 minutes to complete. Another of the schedules studied, the Nursing Rating Scale (Hargreaves), also had relatively high reliability and a broad effective range.


The future nurse: selection and training; autonomy; should her health-care role by modified for future patient demands? This paper was presented in the context of an international interdisciplinary conference on Priorities in Health Care. The focus of the paper is the relationship between the nurse's role and the demands of patients, now and in the future. The incongruence between patients' needs and their demands is discussed and the question is raised as to whether the nurse's skills and knowledge currently acquired will be appropriate to meet patients' needs and demands in the future. Future patient needs and demands are not the only external pressures on changes in the nurse's role; advances in medical treatment and technology and changing roles of other health professionals are others. The paper highlights the dilemma between the profession having to give way to such external pressures or the risk of preparing nurses for irrelevant roles. A case is made for greater interchangeability of first level health care workers through a common portal of entry. It is suggested that diversion into the various professional fields should occur after the foundation course to health care and suitable counselling. Among the top level professionally qualified nurses should be both generalists and specialists. A speciality of nursing generalism, as a parallel with general medical practice, is advocated. A plea is made for a liberating rather than a restricting interpretation of professionalism so that necessary changes in the nurse's role can be initiated and directed by the profession rather than being forced upon it by external pressures.


Resistance to chloramphenicol and ampicillin Salmonella johannesburg in Hong Kong: observations over a five-year period 1973-1977. Salmonella johannesburg has been prevalent in Hong Kong since 1973 and most strains were resistant to a multiplicity of antibiotics. The susceptibility of S. johannesburg strains isolated in a 5-year period from 1973 to 1977 to eight antimicrobial drugs including ampicillin (A), streptomycin (S), tetracycline (T), chloramphenicol (C), Kanamycin (K), sulphadiazine (Su), trimethoprim (Tm) and gentamicin (G) was tested by the agar dilution method. The proportion of strains resistant to chloramphenicol and ampicillin increased steadily during the 5-year period while those resistant to tetracycline decreased dramatically. This change was associated with an alteration of predominant patterns of antibiotic resistance: strains with the resistance pattern A.S.T.C.K.Su predominated in years 1973, 1974 and 1975 while those with the resistance pattern A.S.C.K.Su predominated in years 1976 and 1977. Analysis of the resistance patterns of S. johannesburg strains isolated from the same cases showed that the resistance pattern A.S.C.K.Su was more stable, and changed less frequently to other patterns of resistance than strains with the resistance pattern A.S.T.C.K.Su. In donor salmonella strains with the A.S.T.C.K.Su resistance pattern, transmissible factors carrying resistance to A.S.T.C.K.Su in toto, to A.S.T.C.Su,A.T.C.K.Su and to A or T alone were demonstrated. In donor salmonella strains with the A.S.C.K.Su resistance pattern, transmissible factors carrying resistance to A.S.C.K.Su in toto and to A.S.K.Su were detected. The significance of the carriage of such transmissible resistance factors by this Salmonella is briefly discussed.


High-risk pregnancy screening techniques: a nursing overview. Procedures and indications for nonstress fetal monitoring, oxytocin challenge tests, 24-hour measurement of urine estriols, ultrasound, and amniocentesis, five of the most widely used diagnostic tools for monitoring the fetus at risk, are reviewed. While none of these tests is completely accurate by itself, selective use of these tests improves the ability to diagnose placental insufficiency and to predict the ability of the fetus to survive outside the uterus. Complications may threaten the life of the fetus, but delivery can be timed to minimize the complications associated with prematurity. Overall, skilled medical management of underlying problems remains most important, while tests of placental insufficiency add valuable, but supplementary guidelines for overall management of the high-risk patient.


Toward improvements in parenting: a description of prenatal and postpartum classes with teaching guide. A pilot program was developed at an urban community hospital in an attempt to enhance the educational preparation of new and expectant parents and to provide them with the opportunity to examine their values and expectations relating to parenthood. Forty-one couples attended prenatal and postpartum classes. Child development and parenting issues were the main topics of discussion. The effectiveness of the educational program and instructor performance were evaluated through questionnaires measuring parenting knowledge and emotional support. Also, a teaching guide was developed and published.


Culture and preventive health care.

Culture and preventive health care. Interviews were conducted with 85 Puerto-Rican-born women encountered in one urban community in the United States concerning their obstetrical and gynecological preventive health participation, modesty pattern, and feelings of being male dominated. Women who were living with partners were influenced in preventive health participation by their modesty pattern. The more modest woman participated less. Women no longer living with their partners participated in preventive health care independently of their modesty pattern. Women reporting to be more male dominated demonstrated no differences in their preventive health participation; however, women reporting to be less male dominated participated more in preventive health. The nurse should determine the degree of modesty and assess its probable influence on the woman's future participation in preventive health. The more modest woman will relate better to a female health provider in matters concerning her physical person, and particularly, in matters concerned with her sexuality. In some instances the nurse should determine the need to include the partner in preventive health education in order to encourage a more positive attitude toward and participation in preventive health care.


Self-care nursing model for patients experiencing radical change in body image. A description of the integration of concepts from other disciplines into the nursing self-care model is presented. Orem's model of the patient as a self-care, goal-directed, decision-making agent is applied to the care of a woman recovering from a radical vulvectomy. The model can be used in other nursing care situations in which the patient's body image is altered.


Comparison of the antiseptic effect of two Iodophor preparations on hand washing in a well-baby nursery. Two iodophor preparations, Betadine and Prepodyne, used as handwashing antiseptics in two well-baby nurseries, were compared. A total of 1,806 cultures were evaluated. They were taken a) from nurses' hands after washing with either of the products to determine the effectiveness in removing bacteria from the skin suface, b) from the babies' umbilicuses to assess the level of colonization of the infants' skin surfaces to which nurses were exposed during infant bathing, and c) from the nurses' hands immediately after completion of the babies' bathing routine. The results obtained indicated that the products are equally effective in eliminating bacteria in a routine handwashing procedure in similar circumstances. Both presented a comparable skin drying effect after repeated exposures and did not lead to any allergic reaction in the present trial.


Children of alcoholic parents: a neglected issue. Little attention has been focused on the children of alcoholic families, and the few studies that have been conducted indicate that these children are at grave risk for developing long-lasting psychosocial and educational problems. Their self-esteem suffers as a result of constant conflict, inconsistency, and role confusion in the home, and it is also known that academic performance and the ability to develop positive peer relationships are also greatly affected. In an effort to determine the scope of this problem, 51 Iowa school nurses attending an Annual School Nurse Conference were queried about: a) their awareness of the problem, b) who should be responsible for intervening with these children, and c) what the role of the school nurse is in working with these youngsters. Based on their responses as well as findings in the literature, suggestions regarding appropriate nursing interventions are offered.


Sixth graders can take blood pressures.

Sixth graders can take blood pressures. A curriculum guide entitled "Heart Health Curriculum Guide" was developed with and by teachers in Peabody Public Schools under a Massachusetts Public Health grant to the American Heart Association. The 67-page manual describes the format of the 12-hour teacher workshop, background physiology of heart/circulatory system, hypertension risk factors, a set of 20 lessons, and evaluating procedures. (Copies may be obtained for $3.00 by writing the corresponding author.) As a result of teaching this unit, sixth grade students in each school ran a Blood Pressure Screening Clinic for their parents and school staff.


Dental health knowledge tests: their development, implementation and evaluation. The present study discusses the development of dental health knowledge tests as part of an integrated dental health curriculum in the public school system of a rural community. It is part of a large project designed to test the effectiveness of a school-based dental health delivery system. Cognitive measures of dental health were designed to study the relationship of dental health knowledge to oral health behaviors. A review of the literature revealed no suitable dental health knowledge tests for grades K-6; new assessment measures were then developed by project staff. The tests consisted of 14 objectively scored tests--two parallel forms at each of the seven grade levels, K-6, and were administered four times to 1,942 students. Consistently, the tests have demonstrated high reliability estimates and low standard errors of measurement and indicate that the instruments are functioning as parallel forms and measuring the same dental concepts with equal precision.


Hyperactivity: pediatricians' and teachers' perspectives. Research of related literature indicated that disagreement existed among professionals as to the causes, diagnoses, treatments and descriptors of hyperactivity. A questionnaire was developed to compare the responses of a group of pediatricians, and a group of master's degree candidates in special education (79.18%) of whom were teachers with an average of 4.72 years of teaching experience) on four variables relating to hyperactivity diagnoses, etiology, treatments, and labels. Significant differences between the two groups were noted in their responses to the dependent measures.


Height/weight disproportion in elementary school children. This paper discusses the importance of studying physical growth patterns in children and presents the results of a survey of height and weight measurements collected on 1,953 children ages 5--11 from 12 schools in a city in the southeastern United States. Approximately 40% of the sample children had height/weight disproportion. Twenty-seven percent of the sample children weighed more than normal for their height. Physical and psychological consequences of childhood obesity are discussed as a basis for intervention with children. The investigators believe that the problems of elevated weight in childhood merits a great deal more study so that groups at risk can be predicted and more effective treatment programs developed. For persons who are overweight, control of weight requires a change in behavior which is essentially an educational process; therefore, it would appear appropriate to have such programs placed within the school setting.


Prenatal care for pregnant adolescents in a public high school. Two groups of pregnant adolescents enrolled in the St. Paul, Minnesota Maternal and Infant Care Project were involved in this study. A retrospective analysis of obstetrical summary sheets of delivered pregnant adolescents was conducted to demonstrate the relationship of the availiability of a comprehensive, interdisciplinary program of prenatal care in a regular public school setting to the achievement of early and continuous prenatal care and to the minimizing of obstetrical complications of the pregnant adolescents who were students in the school. A total sample of 36 students who received prenatal care in the school clinic (study group) from 1973 to 1976 was compared with a random sample of 36 adolescent patients (matched for race) who received care at a non-school clinic (comparison group). The data demonstrated that the study group initiated care earlier and had more total prenatal visits than did the comparison group. Also demonstrated were fewer obstetrical complications in the study group than in the comparison group. The comparison group had more low birth weight infants and more complicated deliveries than did the study group. Therefore, the results of this study support the initial objective and may have significance for educators and health personnel.


Interpreting a general index of subjective well-being. The complex and continuing problem of identifying the relationship between several subjective and objective measurements of health is explored through data from a national health survey. Statistical analyses show that sociodemographic variables among groups are less important than are psychological variables in interpreting subjective well-being.


Topical application of insulin in decubitus ulcers. When a pilot study provided evidence that insulin may increase the rate of healing of decubitus ulcers, this study attempted to answer the question: Is topical insulin therapy an effective treatment regimen for decubitus ulcers? The experimental study utilized a two-group, before-after design. Twenty-nine geriatric subjects were randomly assigned to either the experimental or the control group. The single independent variable was the topical application of ten units of regular insulin (U.S.P.) twice daily. The dependent variable was the surface area of the decubitus ulcer measured in square millimeters. Rate of healing was defined as decrease in surface area over time. Data were also gathered on extraneous variables believed to influence the healing process. The F test was used to test the research hypothesis that experimental subjects would have an increased rate of healing. When comparison of group means on day seven and day 15 revealed no significant differences, the research hypothesis was rejected. Pearson product moment correlation procedures were utilized to determine if there were differences between extraneous variables and the rate of healing. Females healed significantly (p less than .05) more slowly than males. Also, there was a direct correlation between the number of days of treatment and the rate of healing.


Situational stress and temporal changes in self-report and vocal measurements. Vocal stress levels (using the Psychological Stress Evaluator) the day before and eight days after final examination week for one group (I) of volunteer students were compared with levels of another group (II) without intervening examinations. Time intervals for both groups were identical. Vocal stress was also compared with self-rate anxiety. There was a significant (p less than 0.05) difference in vocal stress for group I when compared to group II, with group I showing a decrease. Mean changes in vocal stress paralleled mean changes (or lack thereof) in self-reported anxiety for both groups. This study suggested that vocal stress, as recorded by the PSE, does depict predictable and self-reported state anxiety which is significantly increased prior to and declines following college final examinations. Data further suggest that the PSE is useful for intervals of days rather than just in terms of minutes and that PSE measures may not be readily altered by acclimatization to the testing situation.


Nursing activities and acute confusional states in elderly hip-fractured patients. Confusion in 91 hospitalized patients over 60 years of age who had sustained hip fracture and undergone subsequent surgical repair was examined in seven hospitals in five states. The relationship of nursing activities, patient, surgical, and environmental variables to the extent of confusion apparent in the sample was explored. Data were gathered by record review, patient testing, observation, and interview. Patient testing and interview were carried out on the first, third, and fifth postoperative days; the patient's caregiver on those days was also interviewed. The major dependent variables used in multiple regression analysis were memory (immediate and recent), observed behavior, and patient's self-report of mental clarity. Results showed that the most consistent predictors of postoperative confusion were the presence of confusion on admission to the hospital or confusion during the preoperative period. Greater postoperative mobility and freedom from urinary problems resulted in less confusion. Being male and of increased age were risk factors. The presence of timepieces and patients' use of television were associated with higher levels of mental clarity. Patients in private rooms tended to do better on memory testing than patients in rooms shared with others. Nursing personnel's major action in response to patient confusion was that of conscious attention to orientation, explanation, or reassurance. Use of restraints was relatively frequent.


A study of older adults attending a program on human sexuality: a pilot study. This study attempted to ascertain if significant changes took place in older adults' knowledge and attitudes about human sexuality following a two-session course on the subject. Subjects were volunteers who attended a neighborhood center in Miami, Florida. Information was gathered immediately before the first session and after the second session by use of pencil-and-paper tests. Test items were adapted from the Sex Knowledge and Attitude Test and Attitude and Knowledge Assessment. At the first session, small-group discussions followed a large-group instruction period; the second session consisted of a 20-minute film on human sexuality, followed by group discussion. Of the 30 participants who took the pretest, only four completed the posttest, although most of the 30 attended the second session.


Effect of free time the day prior to mastery testing on nursing students' scores. This study compared mastery test score averages of 43 students who spent the day preceding the test in a seven-hour clinical laboratory with score averages of 36 students who had free time for study. The null hypothesis, that no significant difference would be found in the test means between the groups, was not rejected. Test score differences, it was assumed, resulted from chance.


Symbiosis: nursing and the bioengineer.

Symbiosis: nursing and the bioengineer. At this time, bioinstrumentation is the product of the possible as modified by what is practical. The bioengineer offers both the possible and the practical from an engineering and ideal model. The nurse, in contrast, speaks to the ideal possible from a confining practical clinical model. Symbiosis of nursing and bioengineering will combine the important attributes of each discipline for the betterment of patient care. In truth, the machine becomes an instrument of humanity.


Attitudes and intentions of baccalaureate nursing students toward the elderly. The primary purpose of this study was to develop instruments that reliably measure belief and behavioral intentions toward the elderly with control for social desirability set within the belief measure. Related purposes involved evaluation of the impact of a gerontologic nursing course on beliefs and behavioral intentions of nursing students toward the elderly. Data were collected over a three-month period from 153 volunteers in a baccalaureate nursing program. One group was tested both before and immediately after a gerontologic nursing course; three other groups were tested immediately, one, and two years after the course. A paired-comparison type belief scale and a multiple-act behavioral intention scale were developed and used in the study. The Kogan Old People and Marlowe-Crowne Social Desirability scales served as outside criteria. Both new instruments were found to be highly reliable. An association between beliefs and behavioral intentions above the .30 level was found between scores on the behavioral intention and Kogan scales, but not between behavioral intention and belief scores.


Professional development of nurse practitioners as a function of need motivation, learning style, and locus of control. This study assessed the relationship of loci of control, learning styles, and motivational needs of 53 graduates of the Wichita State University Nurse Clinician Program to amounts and types of professional activities performed in a clinical setting. A self-appraisal was also considered in the analyses. Motivational needs assessed included the needs for achievement, affiliation, and power. Findings revealed that nurse clinicians with moderate need for achievement, high need for affiliation, and moderate need for power performed significantly (p less than .03) more professional activities than nurses with high need for achievement, low need for affiliation, and high need for power. Other findings showed a significant (p less than .04) negative relationship between chance locus of control and self-appraisals. Amounts and types of professional activities performed were not significantly related to loci of control or to learning styles.


Bioinstrumentation in the care of the neonate. There are many things to consider when deciding upon the various instruments to use to monitor a newborn. The availability of these monitoring devices should be considered a boon both to the care of the sick newborn and to the nurse, for the data collection process is greatly enhanced in efficiency and accuracy. Nurses have assumed increasing responsibility for data collection, and with the aid of a variety of monitoring systems they will be better able to perform this task. They will also be left with more time for data synthesis and other aspects of patient care. The small amount of time that is necessary to check the machines for safety and functioning is well compensated for by the amount of data derived. The data contribute vastly to the maintenance of homeostasis and the early detection of problems in the neonate.


Antecedents of nursing school attrition: attitudinal dimensions. In an attempt to identify attitudinal orientations that might be used as indicators of attrition, demographic, academic performance, and attitudinal data on 261 students enrolled in the Woodruff School of Nursing at Emory University, Atlanta, between 1968 and 1972, were studied. Traditional measures of scholastic aptitude were not found to be good indicators. The higher the father's educational attainment, the more likely attrition was to occur. The higher the mother's occupational status, the less likely attrition was to occur. Attitudinal measures used in the study seemed to have little direct impact on attrition.


The bioinstrumentation of hemodialysis.

The bioinstrumentation of hemodialysis. This paper is designed to introduce the nondialysis nurse to the world of the hemodialysis patient through an overview of its bioinstrumentation. The aim of this paper is not to make a dialysis specialist of all who read it, but rather to assist the nurse--through an understanding of the basic principles of dialysis, the artificial kidney machine, and its component parts--to feel comfortable around the dialysis machine. The outcome will be to improve the quality of care given to the patient who is receiving hemodialysis.


Bioinstrumentation: twentieth century slave. Instrumentation represents an extension of human ability to sense, to monitor, and to record data for interpretation. The devices can supplement failing physiologic functions. They are the products of fertile imaginations, tedius and fastidious development, and scientific and technologic knowledge. As such, the devices have infiltrated health care. The time is ripe for nursing actively to take advantage of the capacities and potentials of these tools, which slavishly and untiringly carry out tasks and relay information that can contribute to the well-being of patients and the advancement of nursing.


Influence of group process on the unit milieu. The purpose of this paper has been to discuss one clinical phenomenon, that of the group process, the determination of which facilitates the provision of nursing care on an inpatient psychiatric unit. Both the phenomena that engender a stressful group process and the cues to determining a group process were discussed.


Multiple family group therapy with a tri-therapist team. In summary, we attempt to minimize personal and professional factors that may hinder the group or be deleterious to the tri-therapists' working relationship. With such contract variables in mind, it is hoped that other co-therapists would find similar approaches that will make co-therapy a satisfying experience.


Use of systemic antibiotics in the burned patient. A diagnosis of clinical sepsis is the primary indication for administration of systemic antibiotics. Choices of antibiotics for sepsis, where cultures are unavailable, requires a knowledge of current strains in the unit where the patient resides and coverage for both Staphylococcus aureus and Pseudomonas. Dosage requirements are increased in burned patients and serum antibiotic levels must be monitored for maximal effectiveness and minimal toxicity. Localized foci of infection must be identified and eradicated with regional antibiotic therapy or surgery when possible. Gram-negative pneumonia in the patient with an inhalation injury poses special difficulties in therapy. Resistance to antibiotics must be constantly guarded against and isolation procedures followed to avoid its propagation in the burn unit. Combination drug regimens and plasmid-directed therapy may in the future slow down the acquisition of further antibiotic resistance and lead to improved salvage of severely burned patients.


[Kinetics of specific (codon-dependent) binding of aminoacyl-tRNA to the 30S ribosomal subunit under different medium conditions]. It was shown that the increase of Mg2+ ions concentration in the medium from 0,01 M to 0,03 M speeds up the formation of a codon-dependent complex between 14C-Phe-tRNA and the 30S ribosomal subparticle. Under high MgCl2 concentration (0,02 M) the increase of NH4Cl concentration also accelerates the specific binding of 14C-Phe-tRNA to the 30S subparticle. In the presence of 0,005 M MgCl2 0,5 M urea significantly decreases the rate of the specific binding. 0,5 M ethanol does not have any noticeable effect on the kinetics of the reaction.


[Functional role of aminoacyl phosphatidylglycerols in the lamellar system of chloroplasts]. The role of 14C-aminoacyl-tRNAs in the formation of aminoacyl phosphatidyl glycerols in isolated chloroplasts of haricot bean leaves was studied. The formation of 14C-aminoacyl-tRNAs was more intensive in the case when 14C-aminoacyl phosphatidyl glycerols were the source of amino acids. On incubation of lamellae with 14C-aminoacyl phosphatidyl glycerols, 14C-amino acids proved to be incorporated intensively in protein of the lamellae. Membrane-bound chloroplast ribosome-like particles were observed on the outermost thylakoid membranes of the grana stacks as well as on the stroma thylakoids. It is concluded that aminoacyl phosphatidyl glycerols play an important role in lateral transport of amino acids within the chloroplasts lamellar system.


Planning drug abuse treatment: critical decisions. This paper identifies and discusses certain key issues which must be recognized and resolved as part of the process of planning drug abuse treatment efforts. It is emphasized that the approach which is ultimately adopted must be tailored to the specific needs which prevail in a particular locale, at a particular time. It is urged that the addict population be viewed as the most significant of all critics in assessing the appropriateness of the therapeutic services which are provided.


Nonexistence of N-acetylseryl-tRNA in rat liver. Reports of the existence of N-acetylseryl-tRNA in rat liver were reinvestigated. Methods were developed to permit recovery of N-acetylserine in a yield of 30--40% from N-acetylseryl-tRNA added to liver homogenates and cell-free incubations. [14C]Serine and [3H]acetate were injected into rats pretreated with iron and into rats after partial hepatectomy, and aminoacyl-tRNA was isolated from their livers. The amount of radioactivity associated with N-acetylserine in the amino acids released by hydrolysis from the aminoacyl-tRNA was negligible. No formation of N-acetylseryl-tRNA could be observed in incubations of acetyl CoA and seryl-tRNA or tRNA with enzyme fractions from liver of rats pretreated with iron. It is concluded that previous reports of the existence of N-acetylseryl-tRNA in rat liver are erroneous.


Effects of cannabis resin on learning by repetition in the rat. Studies were made of the effects of cannabis resin in differing doses on a type of learning by repetition, using the water-filled maze technique, and on the conditioned avoidance reflex in the rat. When administered at a dose corresponding to 0.5 mg of delta9-THC per kg, the resin led to improved learning in both the types of test employed; opposite effects were observed with the higher dose (corresponding to 5 mg of delta9-THC per kg). These effects are probably attributable to complex reciprocal action between the active constituents of the resin, particularly THC, and the metabolisms of the cerebral monoamines and c-AMP.


Vibrio cholerae hybrid sex factor that contains ampicillin transposon Tn1. The ampicillin resistance transposon Tn1 was translocated from the R plasmid RP4 to the Vibrio cholerae conjugative plasmid, P. The hybrid sex factor P::Tn1 was highly transmissible and expressed the biological activities of the P factor. In addition, P::Tn1 facilitated transfer of RP4 to V. cholerae recipients. Physical studies of P::Tn1 indicated that the Tn1 transposon was added to the otherwise unaltered P plasmid.


Aminoacyl-tRNA synthetase mutants degrade protein at a normal rate. The stability of both rapidly and slowly degraded proteins in wild type CHO cells is similar to that in three ts aminoacyl-tRNA synthetase mutants at both permissive and non-permissive temperatures, although the degree of tRNA charging in the synthetase mutants differs considerably with temperature. These results indicate that the altered rate of protein breakdown seen under a variety of physiological conditions in eukaryotic systems is not mediated by uncharged tRNA.


Carbenicillin for treatment of Bacteroides fragilis infections: why not penicillin G? Carbenicillin has been advocated for treatment of infections caused by Bacteroides fragilis and other anaerobic bacteria. Wide-scale use of the drug in this setting could result in a substantial increase in carbenicillin-resistant Pseudomonas aeruginosa, an effect that would have serious implications. Thirty-four strains of B. fragilis, one-half from bacteremic infections, were tested in vitro, and penicillin G was found to be twice as active as carbenicillin on an equal weight basis; 94% of the strains were inhibited by 32 microgram of penicillin/ml, a level easily achieved therapeutically. Penicillin killed B. fragilis organisms as rapidly as carbenicillin. In two subjects given equivalent doses (100 mg/kg intravenously) of carbenicillin and aqueous penicillin G, the bactericidal activity of serum against B. fragilis after administration of each drug was the same. Controlled clinical trials of treatment of anaerobic bacterial infections with penicillin G in high dosage, carbenicillin (or closely related ticarcillin), clindamycin, and chloramphenicol should be undertaken. Carbenicillin (and ticarcillin) for the present would seem better reserved for P. aeruginosa infections.


Outcome criteria: a process for validation at the unit level. This study reports the development of a process for the validation of sets of outcome criteria. The process can be simply and inexpensively utilized at the unit level by staff nurses. It was tested by the investigators and did serve to differentiate between valid and invalid outcomes of nursing care.


The "cooling out" process in a complex organization. In a sequence of events described as the "cooling out" process, an administrative conflict snowballed to an irrevocable stage resulting  in an employee's dismissal. Such scapegoating reduces friction in the organization structure, but does not identify and resolve problems.


The clinical nurse specialist: implementing the role in a hospital setting. The introduction of a clinical nurse specialist into a functioning patient care setting represents a major institutional change, and implementation of the role should involve all affected staff members. The authors describe how one nurse unilaterally negotiated her role using an exchange theory approach. They make recommendations to help nursing service administrators aid in role negotiation.


Writing for publication: a survey of nursing journal editors. Nursing administrators have exciting programs, thoughts, and experiences that can benefit the nursing community. Suggestions and advice offered by editors, representing seven nursing journals with a readership of nearly 200,000, are presented for those preparing to publish in the professional literature.


Consequences of prenatal exposure to diethylstilbestrol. Exposure to the drug diethylstilbestrol (DES) during the first 18 weeks of prenatal life can have many results ranging from benign misconfigurations of the reproductive organs to adenocarcinoma. Since the drug was routinely administered to pregnant American women from 1940 to 1970, a large population of Americans are involved. The key factor is early awareness to the exposure and careful follow-up. Since many of those exposed are unaware that they received DES, the health care profession must be attuned to the signs and symptoms predisposed by the exposure and be able to provide adequate follow-up and education concerning this medical problem.


Relieving parental anxiety a booklet for parents of an infant in NICU. The transfer of a sick newborn infant to a Newborn Intensive Care Unit evokes an acute emotional crisis for the parents. In order to help the family master this crisis, the authors have developed a parent booklet entitled, "A Sign of Hope." This pamphlet introduces the parents to Newborn Intensive Care even before the transfer of the baby to the regional hospital. By merely changing a few words, telephone numbers, and maps, this brochure can be adapted for use at most Level II or III Newborn Special Care Units.


School nurse certification with a health education minor option. Undergraduate nursing students, graduate nurses and practicing school nurses may enter a program of study at the University of Wisconsin-Madison leading to eligibility for certification as a school nurse. The option of attaining a minor in health education and certification eligibility as a teacher of health is available in conjunction with the school nurse program. The program and potentials are described and discussed.


Non-health professionals and the school-age child: early intervention for behavioral problems. A methodology is described to utilize dormitory parents in direct care activities for the early intervention of behavioral problems of the school-age child. Specific information gathering, assessment, treatment, referral and follow-up tasks were defined and incorporated into a problem-solving protocol which served to guide the dormitory parents through the defined problem-solving process, to promote early identification of students with a behavioral problem, and to expedite referral to a professional for students with more severe problems. The methodology was pilot-tested in a large American Indian boarding school and demonstrated the feasibility and efficacy of dormitory parents in a therapeutic role as one component of a team approach to the management of behavioral problems. The pilot study resulted in a significant reduction in the rates of alcohol abuse and school dropouts and deserves application in a variety of settings.


The "other" venereal diseases: herpes simplex, trichomoniasis and candidiasis. Although the term venereal disease has been synonymous with gonorrhea and syphilis, the Center for Disease Control now states that the new cases of herpes simplex type - 2, trichomoniasis and candidiasis are rapidly approaching and, in certain instances, have surpassed the annual cases of syphilis and gonorrhea. Trichomoniasis and candidiasis are at times unbearable to millions of women. In relation to genital herpes, the circumstances are much more serious. It is rapidly approaching epidemic proportions, it has no cure, and it can be detrimental to the unsuspecting pregnant woman. It is imperative that, as health professionals, we broaden our teaching efforts to include these "other" venereal diseases and help our students to do what they can within the total framework of their own knowledge and behavior to avoid and treat venereal infections. Traditionally the term "venereal disease" has been thought of as being synonymous with only gonorrhea and syphilis because of their high incidence rates. The Center for Disease Control estimates that there are 3 million new cases of trichomoniasis and 300,000 to 1 million cases of herpes genitalis, compared to one million cases of gonorrhea and about 20,000 cases of syphilis each year. These incidence rates certainly indicate a need for our educational programs to include trichomoniasis and herpes simplex, as well as the traditional coverage of gonorrhea and syphilis, in our health education classes. But what are these other common, sexually transmitted diseases? What are their causes, symptoms and complications, and most important, how can they be prevented or at least treated?


Involuntary deviance: schooling and epileptic children. There exists in schools an unwritten set of presuppositions defining "normalcy." Students going beyond these boundaries of normalcy are encouraged (sometimes punitively) to change their behaviors. However, there is a growing awareness that not all children going beyond normalcy do so willingly. The phenomenon here termed "involuntary deviance" represents a way of perceiving and dealing with special students. An example, the case of children with epilepsy, is presented to illustrate the need for health educators and other educators to be familiar with such medical problems and, among their students, to help decrease the social stigma attached to some of these conditions. This need will become more urgent as the practice of mainstreaming students becomes increasingly prevalent.


Measuring the quality of medical care: process versus outcome. The controversy over appropriate and efficient ways to measure the quality of medical care continues. Many experts call for increased attention to assessment of the outcome of care. Others maintain that process measurements are more direct and practical. But both measurement techniques are of questionable validity, and each obscures important problems of the differences among patients, disease severity, and medical performance.


Alternative physician payment methods: incentives, efficiency, and National Health Insurance. Physicians are the dominant group in our health care system. Their decisions often influence the ways by which society's resources are used to achieve and maintain health. But physicians are also social and economic beings; their behavior is, in part, determined by the way they are reimbursed. Reimbursement methods and physician preferences interact on important medical care variables: utilization of services; treatment setting; practice location and specialty choice; and the efficiency of an individual physician's practice.


Control, participation, and the British National Health Service. The experience of Britain's National Health Service since 1948 suggests that there is a conflict between different social values and policy aims, and that progress toward achieving more community or worker control is constrained by the pursuit of other desired objectives. The egalitarian ideology of the NHS emphasizes central control to achieve a nationally equitable distribution of resources. Emphasis on coordination between the NHS and other social services limits freedom of action. Democracy as accountable policy-making on a national scale may therefore be incompatible with democracy as direct control, whether by community or workers. To encourage participation means accepting diversity in the provision of health care and the multiplication of small, self-governing units. Similarly, worker control is professional autonomy writ large and may therefore conflict with community control.


Estrogen and alternative therapy of the menopausal patient. Estrogen therapy is indicated for the vasomotor, genitourinary, and menstrual changes of the climacteric woman. Estrogens should be prescribed to relieve these symptoms specifically, and in the lowest dosage for the shortest time. Vaginal estrogens are appropriate in the treatment of genitourinary symptoms and may be given until sexual activity ceases. Vaginal ointments may be given even to patients in whom oral therapy may be contraindicated. Alternative therapy is helpful in the treatment of vasomotor symptoms, vulvitis, and breast tenderness. Appropriate therapy for all women includes a complete history and physical examination, and a thorough discussion of the physiologic and psychological changes of menopause. Appropriate studies include tests for estrogen effect to monitor therapy. They assist in treatment of the complexity of the menopause.


Tonsillectomy and adenoidectomy.

Tonsillectomy and adenoidectomy. Tonsillectomy and adenoidectomy is the definitive treatment for chronic tonsillitis and adenoid hypertrophy. It is most important to determine if the patient has chronic tonsillitis--a diagnosis that can only be made between acute attacks when the patient is clinically well. Decisions regarding the need for a tonsillectomy and adenoidectomy should be made only at this time and never during an episode of acute tonsillitis. Frequency of acute attacks should not by itself be the indication for surgery. The family physician who performs tonsillectomy and adenoidectomies has an opportunity to correlate the preoperative and postoperative clinical course of the patient with the findings at the time of surgery. In my experience, patients carefully selected for tonsillectomy and adenoidectomy on the basis of these criteria do benefit from the surgery, and the clinical improvement is sustained in the long-term follow up of these patients.


The effects of antidiuretic hormone on urine flow and composition in the chronically-cannulated ovine fetus. The fetuses of nine pregnant ewes were chronically cannulated between 86 and 130 days with cannulae in one carotid artery, one jugular vein, the fetal bladder and the amniotic cavity. The effects of infused AVP on fetal urine flow rate and composition were studied. A dose of 35 pmol. h-1 always caused an increase in urine osmolality and a decrease in flow rate and free water clearance without change in blood pressure. Higher doses (140 pmol.h-1) were significantly pressor and caused increased excretion of sodium, chloride, urea and creatinine. Although this dose always caused an increase in urine osmolality, in five experiments the flow rate also rose. It is concluded that the ovine fetus has the ability to control its own urine flow and composition, and possibly also amniotic fluid volume and composition.


The effect of intravenous hypertonic saline infusion on renal function and vasopressin excretion in sheep. Conscious Merino ewes were given an intravenous hypertonic sodium chloride load of 4 mmol.min-1 for 100 min. This resulted in increases in urine flow, sodium and potassium excretion and plasma sodium concentration and osmolality. Urinary vasopressin output and solute-free water reabsorption increased and plasma renin activity declined. Renal plasma flow and glomerular filtration rate (GFR) rose, as did the solute clearance. The change in urinary osmolality was related to the initial urine osmolality such that when the initial urine osmolality was high the urine became more dilute, and vice versa. Tubular sodium reabsorption increased but the fractional reabsorption rate fell. It is suggested that the increase in GFR was at least partly due to the increase in AVP and that the electrolyte loss can be accounted for by the increase in GFR without necessarily involving AVP or other hormonal effects at the tubular level.


The breathing pattern after breath-holding: the influence of chest position and the drive to breathe. The pattern of breathing following the breaking-point of sixty breath-holds has been studied in five healthy adults and compared with the pattern during recovery from CO2-rebreathing. The volume and direction of the first respiratory movement, and the VT, V relation for the first four complete breaths was measured. Only when breath-holds were terminated with an inspiration was the accumulated drive to breathe reflected in an increased volume of the first respiratory movement: terminating expirations simply returned the chest to the resting respiratory level. The volume of the first inspiration was not influenced by the intervention of a terminating expiration, suggesting that expiratory movements do not dissipate the non-chemical component of the drive to breathe. In three of the five subjects the tidal volumes for given levels of ventilation were greater following breath-holding than following rebreathing. This altered pattern of breathing has been interpreted in terms of an insiratory-augmenting reflex.


Portal circulations and their relation to counter-current systems. We have reviewed the distribution of portal circulations throughout the animal body; they are commoner than is generally supposed. Most portal circulations consist of two serial capillary beds connected by one or more larger vessels. We have called these 'convergent' portal circulations: examples are hepatic portal, placental, hypophysial, renal, ovarian and testicular circulations, as are parts of the lymphatic circulation. A second type of portal circulation, which is less common, consists of two serial capillary beds that are not connected by larger vessels. These we have called 'continuous' portal circulations: adrenal and pancreatic circulations are examples of this type. When a countercurrent concentrating mechanism exists in the body it is always part of the primary or secondary bed of a convergent portal circulation, though some convergent portal circulations are not associated with countercurrent mechanisms.


Serum enzyme levels during experimental hypothermia in man. Deep surgical and accidental hypothermia cause elevations in serum enzyme levels, probably because of ultrastructural cell damage. Many variables hinder work on this problem in the clinical situation and the mechanism is obscure. Accordingly, enzymes and other physiological parameters were monitored in four subjects cooled four times, under controlled conditions in the laboratory, to a mean auditory canal temperature of 35.0 degrees C. Mild hypovolaemia and acidosis is occurred. Serum enzyme levels did not change significantly and it is concluded that elevations due to hypothermia cannot be studied in laboratory experiments on healthy volunteers who can only safely be cooled to 35 degrees C.


Iron metabolism in pigeons.

Iron metabolism in pigeons. Several haematological parameters such as haemoglobin concentration, haematocrit, erythrocyte number, reticulocyte concentration, plasma iron and total iron binding capacity were determined in 118 urban pigeons of both sexes. No statistically significant sex differences among these parameters were found. In 36 specimens (23 males and 13 females), the plasma iron turnover was determined using 59Fe. The results obtained in this species, expressed per 100 ml-1 blood. day-1 and Kg-1 body weight. day-1, were compared with those of turkeys, ducks and chickens calculated from earlier papers. The highest values versus body weight were observed in pigeons. Organ (liver, spleen, tibia, heart, leg muscle, ribs, sternal keel, gonads and blood) distribution of 59Fe intravenous injection was analyzed during a period from 5 min up to 120 days (19 different times) in groups of 4 pigeons. At the 6 h period, the organs retained the highest dose (20% of total Fe injected), but by the 2nd day period, the radioiron in the blood represented about 98% of the total injected. A fast iron uptake by the circulatory blood was checked and compared with that of other species (domestic fowl, ducks and turkeys). The reticulocyte count in pigeons normally ranged from 4 to 12%, which was consistent with these results. A linear decreasing radioactivity in blood, with an inflexion point on the 40th day was observed. An inverse correspondence between blood and liver was found. Content in other organs decreased uniformly with time, except the heart where the iron content was practically constant during the whole time. Ribs and sternal keel are erythropoietic organs in young pigeons.


HR 756, a highly active cephalosporin: comparison with cefazolin and carbenicillin. HR 756, a new parenteral cephalosporin, was compared with cefazolin and carbenicillin for activity against a total of 264 strains of Pseudomonas aeruginosa, Escherichia coli, Klebsiella spp., Proteus mirabilis, Proteus spp. (indole positive), Enterobacter spp., Salmonella typhi, Serratia marcescens, Providencia stuartii, and Staphylococcus aureus. In every comparison, except that with the last organism, HR 756 was clearly more active than cefazolin and carbenicillin. All three compounds had similar activity against penicillin-susceptible staphylococci; against penicillin-resistant strains, HR 756 and cefazolin were equally active and superior to carbenicillin. HR 756 was compared with penicillin for activity against strains of Streptococcus pyogenes, Lancefield group D streptococci, and Neisseria gonorrhoeae; with ampicillin against Haemophilus influenzae; and with cefoxitin against Bacteriodes fragilis. HR 756 was clearly more active than the respective reference compounds in all of these comparisons, except those involving the streptococci. HR 756 and penicillin were essentially equally active against S. pyogenes; against Lancefield group D, penicillin was 32 times as active as HR 756. HR 756 not only compared favorably with the reference compounds with respect to relative activity, but also effected growth inhibition of essentially all test organisms (P. aeruginosa and group D streptococci excepted) at remarkably low concentrations ranging from 0.015 to 2.0 mug/ml. A series of seven transfers of selected strains of E. coli, Klebsiella spp., S. aureus, and P. aeruginosa through medium containing HR 756 led to emergence of strains with significant levels of resistance to the agent. Resistance to HR 756 was retained for at least seven transfers through plain medium.


Comparative evaluation of piperacillin in vitro. The minimal inhibitory concentrations of piperacillin and seven other betalactam antibiotics were determined against 407 bacterial isolates. Piperacillin was found to be more active than ampicillin against susceptible gram-negative bacilli and more active than either carbenicillin or ticarcillin against Pseudomonas aeruginosa and streptococci. Although piperacillin was active against Klebsiella pneumoniae, this activity was less than that of the cephalosporins. Piperacillin was not active against penicillin-resistant Staphylococcus aureus and Enterobacteriaceae that were resistant to the other test antibiotics.


Effect of modeccin on the steps of peptide-chain elongation. Modeccin inhibits polypeptide-chain elongation catalysed by Artemia salina (brine shrimp) ribosomes by inactivating the 60 S ribosomal subunit. Among the individual steps of elongation, peptide-bond formation, catalysed by 60 S peptidyltransferase, is unaffected by the toxin, whereas the binding of EF 2 (elongation factor 2) to ribosomes is strongly inhibited. Modeccin does not affect the poly(U)-dependent non-enzymic binding of either deacylated tRNAPhe or phenylalanyl-tRNA to ribosomes. The inhibitory effect of modeccin on the EF 1 (elongation factor 1)-dependent binding of phenylalanyl-tRNA is discussed, since it is decreased by tRNAPhe, which stimulates the binding reaction. The analysis of the distribution of ribosome-bound radioactivity during protein synthesis shows that modeccin consistently inhibits the radioactivity bound as long-chain peptides, but depending on the experimental conditions, can leave unchanged or even greatly stimulates the radioactivity bound as phenylalanyl-tRNA and/or short-chain peptides. It is concluded that, during the complete elongation cycle, modeccin does not affect the binding of the first aminoacyl-tRNA to ribosomes, but inhibits some step in the subsequent repetitive activity of either EF 1 or EF 2. The results obtained indicate that the mechanism of action of modeccin is very similar to that of ricin and related plant toxins such as abrin and crotin.


Tumor-associated phenylalanyl transfer RNA found in a wide spectrum of rat and mouse tumors but absent in normal adult, fetal, and regenerating tissues. RPC-5 chromatography was used to examine the phenylalanyl transfer RNA (Phe-tRNA) of 25 normal rat and mouse tissues including adult, fetal, and regenerating liver; whole embryos; and other adult organs. Only a single major isoaccepting Phe-tRNA was found in every case. Phe-tRNA's from 25 transplantable rat tumors and 33 transplantable mouse tumors were similarly examined. Seventeen rat tumors and 10 mouse tumors, of a wide spectrum of histological types, were found to have an additional, tumor-associated Phe-tRNA isoacceptor. This tumor-associated Phe-tRNA was not found in the livers of animals bearing tumors that contained this isoacceptor. Differences in chromatographic behavior between the rat and mouse tumor-associated Phe-tRNA's strongly suggest that they have different structures. Our data suggest that these differences result from different degrees of incompleteness of posttranscriptional modification, most likely at the normally very hypermodified Wye (formerly called Y) base.


Impetigo contagiosa--etiology in Iraq.

Impetigo contagiosa--etiology in Iraq. Two hundred cases of impetigo contagiosa were studied bacteriologically. Along with the usual staphylococci and streptococci, gram-positive diplococci were isolated in pure cultures in thirty-seven cases. Ninety-six cases were submitted for sensitivity tests to several antibiotics; the results are discussed.


Endocarditis due to strain of Cardiobacterium hominis resistant to erythromycin and vancomycin. Endocarditis caused by Cardiobacterium hominis was observed in a penicillin-allergic patient with a prosthetic cardiac valve who had received prophylactic therapy with erythromycin for dental extractions. The organism was resistant to erythromycin and vancomycin, with minimal inhibitory concentrations of 12.5 microgram/ml and 25 microgram/ml, respectively, but was sensitive to penicillin G, tetracycline, cephalexin, and cefaclor. This case suggests that currently recommended antibiotic prophylactic therapy for endocarditis, especially in penicillin-allergic patients, may be inadequate for unusual pathogens such as C hominis.


Antibacterial activity and synergy, in vitro and in vivo, of a combination of amoxycillin and flucloxacillin. The antibacterial activity of a combination of equal parts of amoxycillin and flucloxacillin was compared in vitro and in vivo with that of amoxycillin and flucloxacillin against a range of gram-positive and gram-negative bacteria. The combination generally showed additive effects against bacteria sensitive to the individual penicillins and there was no evidence of antagonism, but synergistic effects were observed between amoxycillin and flucloxacillin against certain amoxycillin-resistant gram-negative bacilli. The extent of synergism varied according to the particular bacterial species under test and synergy was observed only against bacteria with chromosomally-mediated beta-lactamases and not against bacteria with R-factor-mediated beta-lactamases. In general, amoxycillin + flucloxacillin demonstrated activity against experimental mouse infections in good agreement with demonstrated activity against experimental mouse infections in good agreement with its in vitro activity, and synergy was produced against a range of gram-negative bacilli in vivo. The data suggest that clinical trial with amoxycillin + flucloxacillin in the treatment of selected infections including those due to some amoxycillin-resistant bacteria may well be justified.


In vitro susceptibility of pseudomonas to four beta-lactamantibiotics (ampicillin, cephalothin, carbenicillin, piperacillin), to four aminoglycosides (kanamycin, amikacin, gentamicin, tobramycin) and to colimycin. Of 97 well-defined strains of Pseudomonas, isolated from sputum of patients with cystic fibrosis (CF), the minimum inhibitory concentration (MIC) of several antibiotics was determined with a broth dilution method. The majority of the strains were resistant to ampicillin and cephalothin, moderately susceptible to carbenicillin (70% to 100 microgram/ml) and highly susceptible to piperacillin (100% to 25 microgram/ml, 88% to 6.25 microgram and 60% to 3.12 microgram/ml). If the pharmacological properties of piperacillin are comparable with those of carbenicillin, it can be expected that the sputum level of this drug will be adequate to treat Pseudomonas pulmonary infections. At the lowest concentration tested (0.78 microgram/ml) 3% of the strains were susceptible to kanamycin, 85,5% to amikacin, 95% to gentamicin, 98% of tobramycin, and 80% to colimycin. With regard to clinically attainable concentrations, 98.9% of the strains were susceptible to gentamicin and tobramycin 97.9% to amikacin, 96.9% to colimycin, 88.6%  to piperacillin, 38% to carbenicillin, 25.7% to kanamycin, 12.3% to ampicillin, and 1% to cephalothin.


[Cognitive and learning theory aspects of anxiety (author's transl)]. The learning model of anxiety by Mowrer and Miller has significantly influenced the development of theories in clinical psychology and psychosomatic medicine as well as the development of behavioral therapies. This concept, however, is insufficient in explaining factors effective in psychophysiological conditioning experiments, behavioral therapies, and in animal experiments of anxiety conditioning. This study discusses new learning theoretical concepts intending to explain the development and persistence of anxiety states. Therewith the various effects of cognitive, psychobiological, and situational factors on each other are of special significance. Therefore in studying the causes of anxiety states in clinical psychology the different components of anxiety dealt with in these theories have to be considered.


[Highly located transverse lesion of the cord with quadriplegia caused by giant cell arteritis (author's transl)]. This is a report of a 64 years old patient who experienced a transverse lesion of the spinal cord with quadriplegia caused by giant cell arteritis. It is stressed that giant cell arteritis not only affects the temporal arteries but on principle any other artery of the body. The giant cell arteritis generally is accompanied with similar humoral findigns as a malignant neoplasm. Therefor in a few cases with high spinal cord lesion suspected to be caused by a malignant tumour the giant cell arteritis may be the real cause, if a spinal mass is excluded. In order to prevent irreversible paralytic defects a cortisone therapy has to be started with as early as possible. It must be carried on for a long period to prevent a restarting of the inflammatory process.


Endocarditis caused by coagulase-negative staphylococci. Sixteen patients with coagulase-negative staphylococcal endocarditis were treated at the University of Minnesota Hospitals between January 1970 and September 1977. In six patients, endocarditis developed after prosthetic valve surgery; among the other ten patients (the medical group), eight had known antecedent valvular disease. The skin was thought to be the source of infection in eight patients, suggesting that prompt treatment of skin infections and avoidance of injections in patients with valvular disease are important measures in the prevention of this disease. Patients with prosthetic valve endocarditis were infected with antibiotic-resistant organisms and had a higher mortality than those in the medical group (83% versus 20%). Bacterial isolates from three patients with prosthetic valve endocarditis were resistant to methicillin, and two of these three isolates also were resistant to cephalothin by quantitative susceptibility testing. The only patient with prosthetic valve endocarditis to survive was operated upon early in the course of his illness. These observation, coupled with the high mortality in this series and in others, has prompted us to advocate early surgery in prosthetic valve endocarditis.


Extracorporeal membrane oxygenation (ECMO): a team approach in critical care and life-support research. ECMO may be used clinically in selected cases to provide life support when all other modes of therapy have been exhausted. Survival of moribund patients has been demonstrated. Results might be improved if the severity of the disease is recognized and defined early in the clinical course to prevent the development of irreversible complications. ECMO requires a large, fully trained team to interface with the attending physicians and nursing staff in providing complete life support. The ECMO team provides continued evaluation of the status and treatment of the patient, detection of complications, and correction of any minor or major emergency. It also conducts laboratory and clinical research programs in pulmonary insufficiency as an adjunct to clinical life-support research.


The patient with left heart assist device: nursing management. When prolonged use of adjuvant therapy (positive inotropic agents, ventricular or atrial pacing), including intra-aortic balloon counter-pulsation, fails to achieve separation of patients with poor ventricular performance from CPBP the use of LHAD should be considered. The left heart assist device is a means of diverting a moderate portion of the systemic blood flow around the left ventricle. It provides hemodynamic stability until the left ventricle regains is effectiveness and capability as a pump. Nursing care of these patients requires the highest competence in clinical assessment based on a sound knowledge of the interrelatedness of body system and technical support devices. Nursing responsibilities include: careful observation of patient's clinical appearance and behavior, interpretation of data obtained from monitoring equipment, early recognition of physiologic deviations, and prompt initiation of appropriate nursing interventions.


Use of sodium nitroprusside and dopamine hydrochloride in the postoperative cardiac patient. Effective postoperative nursing care of the cardiac surgery patient receiving combined drug infusion of dopamine HCl and SNP requires awareness of many critical factors. Among these are: (1) understanding of cardiac physiology with emphasis on the concepts of myocardial oxygen consumption vs. availability; (2) basic pharmacologic functions of dopamine HCl and SNP, both singly and combined; (3) importance of maintaining intravascular volume at optimum levels; and (4) awareness that constant nursing observations and reassessments are essential.


Continuing education for coronary care nurses. Coronary care nurses were surveyed to determine their perceptions of their initial training and ongoing continuing education. Eighty-one per cent (162 of 200) completed formal training, 65 per cent (105 of 162) felt this training adequately prepared them, but only 42 percent (84 of 200) successfully passed a test of competency prior to beginning work. Nurses' perceptions of their abilities were compared to actual performance of physical assessment and no significant differences were noted. Continuing education programs were ongoing for 57  per cent (114 of 200) of the nurses but physician participation was rare. Physician involvement in the overall management of CCUs was satisfactory for only 40.5 per cent of nurses (81 of 200). In view of these data, physicians and nurses have been remiss in the training and evaluation of coronary care nurses and must work together to define educational objectives and institute evaluation mechanisms. It is through this type of joint cooperation that the quality of care will improve as will morale.


Shifting pleural effusions.

Shifting pleural effusions. The patient's position in bed may cause repositioning of free pleural fluid, which can track to paravertebral, subpulmonary, and paramediastinal planes. Awareness of this situation aids the clinician's recognition of the nature of the lesion on chest roentgenograms.


Needs of relatives of critically ill patients: a descriptive study. Relatives of critically ill patients were able to identify their needs during the intensive care phase of hospitalization. The universal need identified as very important was the need for hope. Other important needs were concerned with receiving adequate and honest information and feeling that the hospital staff members were concerned about the patient. Although several of the needs appeared to be of great concern to relatives, all the needs were considered very important by at least one relative. The majority of needs were perceived as being met consistently. Various resources were used by the relatives to meet their needs; however, specific needs were expected to be met by physicians and nurses. Since many relatives have similar needs, the use of a group process to deal with them should be investigated. A group process allows for sharing and support among the relatives and also allows one  staff member to work with several relatives. The relatives perceived the role of health care personnel to be patientcentered only. If the patient is a member of a family, then the family and staff should recognize that the health care personnel are helping relatives because it is a crucial part of total patient care. This area in providing total patient care needs to be studied carefully. The relatives of critically ill patients have important needs in this crisis period. By recognizing these needs and evaluating how they are being met, total patient care will involve the family. Such involvement is essential to the care of the critically ill patient.


Neisseria sicca endocarditis: report of a case and review of the literature. A rare case of bacterial endocarditis caused by Neisseria sicca is reported. Review of the literature revealed only five other cases where sufficient data existed to confirm this particular organism as the etiological agent of bacterial endocarditis.


A joint practice council in action.

A joint practice council in action. A nurse/physician joint practice council, patterned after the activities and recommendations of the National Joint Practice Commission, was developed at a community hospital to provide a forum for nurse-physician dialogue regarding roles and practice issues. Clear objectives, good communications, utilization of resource persons, and equal physician and nurse representation and critical elements of the council's success. In operation, the council's focus is evolving from conflict resolution to a medium for planning and implementing change.


Nurses' stress factors in the intensive care unit. To identify the origins to stress as preceived by ICU nurses, stressful situations in the intensive care unit were identified and ICU nurses were asked to rank order them. Situations pertaining to the physical workload, death of a patient, and communication problems with physicians and nursing administrators were ranked most highly stressful. Nursing educators and nursing administrators can make changes and adjustments to lessen these stressors.


A health education model for ambulatory care. Nurses in this ambulatory care center recognized a need for a systematic, planned approach to health education, and developed a health education model. The nurses on the committee serve as inhouse consultants to help other nurses develop, implement, and evaluate health education programs.


A regional cardiac care program: planning & development. Five hospitals in northeastern Massachusetts joined together to provide a cardiac care nursing educational program for staff nurses. Their mutual effort reduced costs for each hospital and maximized the use of human and material resources. The endeavor has been successful, based upon a number of evaluation factors.


A computerized scheduling system with centralized staffing. Personnel costs make up approximately 70 percent of the operating expense of a hospital, and nursing service accounts for a large percentage of those personnel costs. It is imperative that nursing personnel be appropriately scheduled so that patient care units are properly staffed while personnel budgets are maintained. This hospital's centralized staffing function, supported by a computerized scheduling system, successfully handles all staffing situations with minimal involvement of professional nurses.


The use of supplemental nurses: why, where, how? The use of nurses from labor pool agencies is one way of dealing with the ever present problem of maintaining adequate staffing. Although there are benefits in using supplemental nurses, there are also problems which directors of nursing services need to be aware of in order to assure quality nursing care. The author reports the results of a statewide survey of the use of nurses from supplemental staffing agencies.


A systematic approach to leadership selection. This article introduces a system for selecting nursing leaders that recognizes personal aspiration as the motivating force behind successful leadership. The nursing administrator relinquishes sole responsibility and asks others to share in the selection process. An objective and subjective assessment examines every aspect of the candidates' potential.


[Urinary uropepsin activity in patients with encephalomalacia as an index of the activity of the hypothalamo- hypophyseal-adrenal axis]. The determinations were carried out in 25 patients with thrombotic encephalomalacia. The changes in 24-hour urine uropepsin activity were studied after administration of metopirone and dexamethasone. The uropepsin activity in a sample of 24-hour urine was determined by the method of West, Ellis and Scott. A statistically significant fall of uropepsin activity was observed in 24-hour urine after metopirone, with a rise in the activity of this enzyme after dexamethasone administration.


Functionally impaired tRNA from ethionine treated rats as detected in injected Xenopus oocytes. Treatment of rats with ethionine was found to cause severe impairment in the aminoacylation capacity of tRNA. This effect was only observed when assayed in injected oocytes, while invitro assays of aminoacylation failed to detect differences between normal tRNA and tRNA from ethionine treated animals. The effect of ethionine on the tRNA population was not uniform and differed for various amino acid specific tRNAs. Thus liver tRNA from ethionine treated rats showed a decreased capacity for phenylalanine aminoacylation, while no change was found in the case of leucine. On the other hand, the level of histidine aminoacylation was higher for tRNA from ethionine treated animals. An even more complex response was observed with methionine aminoacylation where tRNA from ethionine treated animals showed an initially faster rate than control tRNA. With more prolonged incubation periods, the methionyl-tRNA from ethionine treated animals was deacylated at an accelerated rate while the level of normal methionyl-tRNA remained almost constant. In addition to the aminoacylation reaction, the participation of aminoacyl-tRNA in protein synthesis was severely impaired. In this case, both the injected oocyte system and the cell-free wheat germ assay revealed these differences which were manifested with various mRNA and viral RNA preparations.


Effect of positioning on discomfort from intramuscular injections in the dorsogluteal site. An intramuscular injection into a relaxed muscle is believed to result in less discomfort than an injection into a contracted muscle. When the femur is internally rotated, the gluteus maximus muscle is relaxed. The hypothesis that a dorsogluteal injection with the femur internally rotated will cause less discomfort than when the femur is externally rotated was tested in 44 surgical patients who received two injections of preoperative medication. Each patient received an injection of a narcotic medication and one of diazepam. All possible combinations of the factors--position (internal and external rotation), order of injection (first or second injection), and medication (narcotic or diazepam)--were determined, and patients were randomly assigned to one of these conditions. Patients rated their perceived discomfort after each injection on a five-point scale. The hypothesis was supported by discomfort ratings from injections of both types of medications, although diazepam injections caused significantly more discomfort than injections of narcotics. Older patients tended to report less discomfort from diazepam injections than younger patients. Sex, order of injection, and nurse administering the injection did not significantly influence discomfort ratings.


Promoting creativity in nursing education. Shortly after the University of Iowa implemented a new, integrated curriculum in 1974, a study of creativity was initiated because one goal of the process curriculum is to foster creativity. Hypotheses of no difference between beginning and graduating students and between old and new curriculum students were tested by means of Student's t test with Activities 5, 6, and 7 of Verbal Form A, Torrance Tests of Creative Thinking used as the criterion measure. The null hypotheses were rejected in favor of the beginning students and the old curriculum students, respectively (p less than .05). Hypotheses of no relationship between creativity and American College Testing scores and admit grade point average were tested by computing Pearson product moment correlation coefficients. All values of r were nonsignificant. Further research on a number of aspects of creativity in nursing is suggested.


Information structures: an analysis of nursing performance. This study demonstrated a methodology of measuring information content and manipulation of nursing subject matter and suggested features of information processing nurses may use to determine the condition of patients. Subjects included 23 associate degree nurses (experts) and 37 first-year AD nursing students (novices) who sorted 59 data elements of a simulated client problem into categories. As a result, 12 categories of patient problems were identified, which were subjected to a latent partition analysis to identify common categorization. Subjects then were asked to decide on appropriate patient interventions. The two groups--experts and novices--were compared re: mean number of data elements requested, mean number of elements requested by LPA category, t test of the mean weights for each category, and rank order correlations of category emphasis. The 12 protocols were then tested for conformity to experience by nine judges. Experts were found to address more problems than novices; they placed more emphasis on current vital signs, pain, and neurological check.


Effectiveness of a comprehensive health program for the well-elderly by community health nurses. Effectiveness of three nursing approaches used in providing health care for the well-aging was tested experimentally by selecting three matched groups among a well-aging population of 195 who lived in three housing units for the elderly. The approaches differed in extensiveness of physical and psychosocial assessment and in involvement of residents in screening, counseling, and health education sessions. Health status was measured before and after one year of implementation by specific observations and structured interviews. Residents who received the extensive nursing program: reported increases in their positive perceptions of their own health, learned to respond effectively to health screening programs, and showed increases in the number who were under primary care. The data supported study hypotheses that predicted higher levels of health for persons who had the opportunity of extensive and specific nursing interventions.


Factors related to foreign nurse graduates' test-taking performance. The essential problem in the immigration of foreign nurse graduates (FNGs) to the United States is their poor incidence of success in meeting state licensure requirements. Factors responsible for the low success rate include nonfamiliarity with multiple-choice format in tests, lack of English proficiency, and anxiety. This study gathered information regarding FNGs' experience in taking state board examinations and demonstrated relationships between factors identified above and scores obtained by FNGs on achievement tests developed according to the American Nurses' Association Blueprint for Licensing Examination for R.N. Licensure.


The language of touch.

The language of touch. A conceptual framework is discussed from which to consider the meaning of touch in nursing research and practice. The impact of interpersonal touch is examined through a review of literature that demonstrates the relationship of touching to human development. The importance of acknowledging the physiologic foundations of touch is reinforced, with considerations as to dangers in accepting all forms of touch as therapeutic. Existing research into the physiologic and psychosocial bases of tactile interaction is explored, and qualitative symbols for a language of touch are presented. These qualitative symbols create the foundations for discussing a construct of tactile arousal.


Cross-cultural study of initial visits to psychiatric outpatient clinics. This descriptive and comparative study explored issues involving initial visits to psychiatric outpatient clinics. Seventy patients in an Irish clinic and 51 patients in a United States clinic were interviewed and 100 medical records in each clinic were reviewed to examine data on five variables: presenting complaints, critical incidents, referral processes, patient expectations, and reactions to treatment plans. Commonalities and differences between clinics were cited.