{"title":"Diabetes and peripheral sensory neurons: what we don't know and how it can hurt us.","authors":"Jeannette M McHugh, William B McHugh","doi":"10.1097/00044067-200401000-00012","DOIUrl":"https://doi.org/10.1097/00044067-200401000-00012","url":null,"abstract":"The first purpose of this article is to examine general signaling transduction processes that become deranged in diabetes and the means by which they damage cells. However, among the cells that can be damaged by diabetes, the primary sensory neurons, also known as dorsal root ganglion (DRG) neurons, are uniquely sensitive. Damage to these cells results in diabetic peripheral neuropathy (DPN), one of the costliest and most common diabetic complications. Therefore, the second purpose of this article is to focus attention on factors that make these cells particularly vulnerable to hyperglycemic damage. Some clinical inferences are drawn from these considerations. Finally, limitations in our knowledge about the effects of diabetes on signaling in DRG neurons are illustrated in an overview of the basic research literature.","PeriodicalId":79311,"journal":{"name":"AACN clinical issues","volume":"15 1","pages":"136-49"},"PeriodicalIF":0.0,"publicationDate":"2004-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/00044067-200401000-00012","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24199501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maher M El-Masri, Karen M Williamson, Susan M Fox-Wasylyshyn
{"title":"Severe acute respiratory syndrome: another challenge for critical care nurses.","authors":"Maher M El-Masri, Karen M Williamson, Susan M Fox-Wasylyshyn","doi":"10.1097/00044067-200401000-00013","DOIUrl":"https://doi.org/10.1097/00044067-200401000-00013","url":null,"abstract":"<p><p>Severe acute respiratory syndrome (SARS) is a viral disease that may be contracted by exposure to a newly recognized form of the coronavirus. It often manifests through a set of common respiratory symptoms that include fever and nonproductive cough. To date, SARS has no vaccine or definitive treatment. Approximately 20% of SARS patients develop respiratory failure, which requires mechanical ventilation and close cardiopulmonary monitoring. Intensive care unit (ICU) nurses and other healthcare workers who care for SARS patients are at risk of contracting the disease. Thus, it is important that ICU nurses be familiar with the disease and its implications for critical care. This article provides critical care nurses with an update on the first SARS outbreak, its origin, case definition, clinical manifestations, diagnosis, relevant infection control practices, management, and recommendations for the role of ICU nurses in dealing with future outbreaks.</p>","PeriodicalId":79311,"journal":{"name":"AACN clinical issues","volume":"15 1","pages":"150-9"},"PeriodicalIF":0.0,"publicationDate":"2004-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/00044067-200401000-00013","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24199504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Insulin resistance and hyperglycemia in critical illness: role of insulin in glycemic control.","authors":"Lindsay E Robinson, Mary H van Soeren","doi":"10.1097/00044067-200401000-00004","DOIUrl":"https://doi.org/10.1097/00044067-200401000-00004","url":null,"abstract":"<p><p>Alterations in glucose metabolism, including hyperglycemia associated with insulin resistance, occur in critical illness. Acutely, such alterations result from normal, adaptive activation of endocrine responses, including increased release of catecholamines, cortisol, and glucagon and a reduced glucose uptake capacity. In prolonged critical illness, neuroendocrine changes lead to more extensive metabolic changes that may be associated with development of complications and poor prognosis. Until recently, hyperglycemia was not routinely controlled in intensive care units, except among patients with known diabetes mellitus. Studies have demonstrated that glycemic management in postmyocardial infarction in patients with diabetes is an effective practice. Recent investigation has extended this to demonstrate reduced morbidity and mortality in a surgical critically ill population with and without diabetes mellitus in later phases of critical illness. Although the mechanisms for improved patient outcomes need to be established, this novel approach to management of hyperglycemia in critical illness is a new and important concept for those working in critical care. This article reviews alterations in glucose metabolism which occur in critically ill patients and discusses potential mechanisms and mediators (e.g., hormones, cytokines) that may play a key role in hyperglycemia and insulin resistance during acute and prolonged phases of severe illness. The article addresses the application of insulin protocols and exogenous regulation of glucose concentration in critical illness based on a review of recent intervention studies.</p>","PeriodicalId":79311,"journal":{"name":"AACN clinical issues","volume":"15 1","pages":"45-62"},"PeriodicalIF":0.0,"publicationDate":"2004-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/00044067-200401000-00004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24200158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Nutritional modulation of neonatal outcomes.","authors":"William L Diehl-Jones, Debra Fraser Askin","doi":"10.1097/00044067-200401000-00007","DOIUrl":"https://doi.org/10.1097/00044067-200401000-00007","url":null,"abstract":"<p><p>In humans, growth and development continues until early adulthood when bone, muscle, and nervous tissue reaches final stages of maturity. Adequate levels of nutritional intake and utilization are critical to optimize ongoing growth. The goal of nutritional therapy for premature or ill neonates has been to provide sufficient nutrients to allow growth to continue at rates seen in utero. Functional immaturity of the gut in the premature infant makes absorption and utilization of nutritional substrates difficult. Premature infants are at risk for developing necrotizing enterocolitis, a potentially lethal bowel disorder. The etiology of necrotizing enterocolitis is not well understood, and a number of theories of causation have been proposed. Breast milk, the optimal source of nutrition for the neonate, is believed to confer some protection against necrotizing enterocolitis. A number of breast milk components have been credited with antiinflammatory properties. Breast milk is recognized for its benefits, yet for preterm infants breast milk alone does not promote adequate growth. A number of breast milk supplements have been investigated to facilitate growth and development and to prevent necrotizing enterocolitis. This article addresses development of the fetal gastrointestinal system, focusing on the biological mediators for normal function and the role of human breast milk and its additives in optimizing neonatal growth. The possible etiologies of necrotizing enterocolitis are discussed in terms of the relationship between this disease and enteral feeding practices.</p>","PeriodicalId":79311,"journal":{"name":"AACN clinical issues","volume":"15 1","pages":"83-96"},"PeriodicalIF":0.0,"publicationDate":"2004-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/00044067-200401000-00007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24199502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
DaiWai M Olson, Dennis J Cheek, Joel C Morgenlander
{"title":"The impact of bispectral index monitoring on rates of propofol administration.","authors":"DaiWai M Olson, Dennis J Cheek, Joel C Morgenlander","doi":"10.1097/00044067-200401000-00005","DOIUrl":"https://doi.org/10.1097/00044067-200401000-00005","url":null,"abstract":"<p><p>The purpose of this article is to examine the efficacy of Bispectral Index (BIS) monitoring as a tool for adjusting the amount of propofol patients receive to maintain a safe and adequate level of sedation in a neurocritical care setting. The BIS monitor is utilized as an adjunct for anesthesia monitoring in the operating room setting and is currently being investigated as a tool for objective sedation monitoring in the critical care setting. 1-6 Sedation is discussed in terms of patient safety and comfort. A secondary data analysis was used to test the hypothesis that BIS monitoring provides a more objective form of sedation assessment that will lead to a decrease in overall rates of propofol administration and fewer incidences of oversedation. Data were abstracted from a quality improvement study of propofol use adjusted to BIS values in patients whose sedation levels were previously adjusted to a goal Ramsay score. The results suggest that there are potential benefits to incorporating BIS into routine sedation assessment in the neurocritical care setting.</p>","PeriodicalId":79311,"journal":{"name":"AACN clinical issues","volume":"15 1","pages":"63-73"},"PeriodicalIF":0.0,"publicationDate":"2004-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/00044067-200401000-00005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24200159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Inactivity and inflammation: selected cytokines as biologic mediators in muscle dysfunction during critical illness.","authors":"Chris Winkelman","doi":"10.1097/00044067-200401000-00006","DOIUrl":"https://doi.org/10.1097/00044067-200401000-00006","url":null,"abstract":"<p><p>Muscle dysfunction leads to activity intolerance, prolonged hospitalization, and additional days of mechanical ventilation. The etiology of muscle dysfunction in the critically ill patient is multifactoral. Inactivity and inflammation, common phenomena to patients in the intensive care unit, are associated with myopathy and muscle dysfunction. Cytokines are small biological active molecules that regulate inflammation and have a direct effect on muscle wasting. The purpose of this article is to describe selected cytokines (ie, interleukin-1, interleukin-6, interleukin-10, and tumor necrosis factor), explain their role in muscle dysfunction, and explore the role of therapeutic activity as a moderator of muscle dysfunction and cytokine-mediated muscle damage.</p>","PeriodicalId":79311,"journal":{"name":"AACN clinical issues","volume":"15 1","pages":"74-82"},"PeriodicalIF":0.0,"publicationDate":"2004-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/00044067-200401000-00006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24200160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The role of nutrition in the prevention of breast cancer.","authors":"Alison M Duncan","doi":"10.1097/00044067-200401000-00011","DOIUrl":"https://doi.org/10.1097/00044067-200401000-00011","url":null,"abstract":"<p><p>Nutrition has been widely studied as a leading environmental factor in the prevention of breast cancer (BC). Despite the challenges in relating consumption of specific nutrients to BC risk, particularly in the context of a total diet, many investigators have contributed valuable information. Dietary fat has received the most attention and also created the most uncertainty. Specific types of fat, particularly monounsaturated fat and the ratio of omega-3 to omega-6 fatty acids, demonstrate more potential to influence BC risk. A wide variety of other dietary factors have been studied in relation to BC including total energy, dietary fiber, alcohol, micronutrients, phytochemicals, specific foods, and food constituents. Results of epidemiological studies relating consumption of these dietary factors to BC have increased the knowledge base that provides rationale for various nutritional strategies to contribute to BC prevention.</p>","PeriodicalId":79311,"journal":{"name":"AACN clinical issues","volume":"15 1","pages":"119-35"},"PeriodicalIF":0.0,"publicationDate":"2004-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/00044067-200401000-00011","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24199497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Biological markers in diagnosing, monitoring, and treating asthma: a focus on noninvasive measurements.","authors":"Lisa C Cicutto, Gregory P Downey","doi":"10.1097/00044067-200401000-00008","DOIUrl":"https://doi.org/10.1097/00044067-200401000-00008","url":null,"abstract":"<p><p>Asthma is a major concern for society, healthcare professionals, and individuals and families directly affected by asthma due to rising morbidity rates and costs associated with the disease. The pathological hallmark of asthma is airway inflammation that is considered to be a major cause of exacerbations and persistent structural alterations of the airways. Assessing airway inflammation is important for investigating the underlying mechanisms of the disease and possibly for following the progression and resolution of the disease. The presence and type of airway inflammation can be difficult to detect clinically, and may result in delays in initiating appropriate therapy. The purpose of this article is to review noninvasive methods for assessing biological markers of airway inflammation and their potential role in the future for diagnosing, monitoring, and treating asthma. The article reviews the noninvasive measurements of induced sputum and exhaled nitric oxide as indicators of airway inflammation.</p>","PeriodicalId":79311,"journal":{"name":"AACN clinical issues","volume":"15 1","pages":"97-111"},"PeriodicalIF":0.0,"publicationDate":"2004-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/00044067-200401000-00008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24199505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Deborah Brinker, Jerelen DeChatelet Hancox, Stephen O Bernardon
{"title":"Assessment and initial treatment of lacerations, mammalian bites, and insect stings.","authors":"Deborah Brinker, Jerelen DeChatelet Hancox, Stephen O Bernardon","doi":"10.1097/00044067-200311000-00002","DOIUrl":"https://doi.org/10.1097/00044067-200311000-00002","url":null,"abstract":"<p><p>Millions of wounds are seen in emergency rooms across the United States each year. The goals of wound care for all ages are to avoid infection and achieve an esthetically pleasing and functional scar. This article reviews the care needs associated with acute traumatic wounds. Information presented includes anatomy and physiology of skin and wound healing, and assessment and care of lacerations, bites, and sting wounds.</p>","PeriodicalId":79311,"journal":{"name":"AACN clinical issues","volume":"14 4","pages":"401-10"},"PeriodicalIF":0.0,"publicationDate":"2003-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/00044067-200311000-00002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24055645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Role of Vernix caseosa in the neonate: potential application in the adult population.","authors":"Kathleen A Haubrich","doi":"10.1097/00044067-200311000-00006","DOIUrl":"https://doi.org/10.1097/00044067-200311000-00006","url":null,"abstract":"<p><p>Vernix caseosa is a naturally occurring fetal barrier film produced in late pregnancy as a result of sebaceous and epidermal lipids combined with desquamation of maturing fetal corneocytes. Vernix lacks desmosomal interconnections between corneocytes as demonstrated in adult stratum corneum and is, therefore, referred to as a \"mobile phase\" stratum corneum. Vernix is proposed to have multiple fetal/newborn overlapping biological functions: moisturization, anti-infective, antioxidant, wound healing, and waterproofing. Patients with altered skin integrity due to burn injuries lack the protective qualities necessary for wound healing. Emerging research suggests that Vernix applied to skin cultures may enhance wound healing. Application of the fetal/neonatal skin science findings to the adult burn population offers the potential for a clinically relevant homologous substitute for impaired tissue integrity.</p>","PeriodicalId":79311,"journal":{"name":"AACN clinical issues","volume":"14 4","pages":"457-64"},"PeriodicalIF":0.0,"publicationDate":"2003-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/00044067-200311000-00006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24055649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}