Focus group interviews: assessment of continuing education needs for the advanced practice nurse

This article reports the use of focus group interviews to promote the development of continuing education programs that meet the needs of advanced practice nurses (APNs). The three major needs identified were: a) enhancement of clinical practice skills and knowledge in specialty areas, b) education about future changes in the APN role, and c) education in management strategies for the changing health care delivery system. A summary of the investigation and implications for continuing nursing education departments are also presented.     

New iodinated progestins as potential ligands for progesterone receptor imaging in breast cancer. Part 1: Synthesis and in vitro pharmacological characterization

Five putative iodinated progesterone receptor (PR) binding ligands were synthesized and evaluated as potential imaging agents for PR-positive human breast tumours. Two compounds (E- and Z-17-hydroxy-21-iodo-19-nor-17alpha-pregna-4,20-dien-3-one; E- and Z-IPG1) were previously described, but are re-evaluated. The other three were novel compounds: two nortestosterone analogues derived from ORG 3236 (E- and Z-13-ethyl-17-hydroxy-21-iodo-11-methylene-18,19-dinor-17alpha-pre gna-4,20-diene-3-one; E- and Z-IPG2) and one norprogesterone analogue derived from ORG 2058 (21-[4-iodophenoxy]-16alpha-ethyl-19-norpregn-4-ene-3, 20-dione; IPG3). The E-iodovinyl nortestosterone compounds were obtained by a new route of synthesis. Competitive binding studies were performed to determine their binding affinities for the PR in three types of tissue (human MCF-7 breast tumour cells and rat uterine and mammary tumour tissue) and for the androgen receptor (AR) in human MCF-7 breast tumour cells, as well as for the sex hormone-binding globulin (SHBG) and corticosteroid-binding globulin (CBG) in human plasma. All four 17alpha-iodovinyl nortestosterone derivatives displayed high binding affinity for the human PR, that of Z-IPG1 and E- and Z-IPG2 being even higher than that of ORG2058. Their affinities for the rat PR were somewhat lower, especially those of both E-isomers. The affinity of IPG3 was lower for both the human and rat PR. The nortestosterone derivatives also showed AR binding, the relative binding affinities ranging from 4.3 to 17.0% as compared with 5alphaDHT. Additionally, neither of these steroids displayed any significant binding to either SHBG or CBG in human plasma. We conclude that the in vitro binding properties of all four 17alpha-iodovinyl nortestosterone derivatives warrant evaluation of the distribution characteristics of their 123I-labelled analogues to determine their usefulness as PR imaging agents.     

Complex refractive errors in pediatric patients: cause, management, and criteria for success

BACKGROUND: Uncorrected refractive error in children is an important contributor to permanent neurological visual impairment (amblyopia). Spectacles are often inadequate for certain refractive errors that occur in the pediatric population. Therefore, the purpose of this paper is to present the diagnostic and therapeutic considerations of infants and children referred to a hospital specialty contact lens practice during a 30-month period. METHODS: A retrospective cohort design was used to study patients 12 years or younger referred to a hospital-based contact lens service and cared for by the author. Sixty patients were first examined during the enrollment period. Follow-up data were collected after a period of no less than 3 years from the initial visit. Success with the prescribed therapy was assessed by comparing the final method of optical correction with that prescribed at the initial presentation. RESULTS: Aphakia and trauma were the two most common causes for referral, representing 57% of the patients younger than age 12. Contact lenses were prescribed for 51 of the 60 patients (85%) at presentation. Seventy-five percent of patients with unilateral aphakia attributable to congenital cataract were wearing a contact lens at the most recent follow-up examination. This was reduced to 60% with aphakia after trauma and just 50% with bilateral aphakia. The frequency of a visual acuity of 20/40 or better was 67% for bilateral aphakia, 47% after trauma with aphakia, and 25% for unilateral aphakia. CONCLUSIONS: The results presented here suggest that patients with unilateral aphakia attributable to congenital cataract have the most consistent contact lens wear, followed by patients with unilateral aphakia attributable to trauma. Patients with bilateral aphakia were more likely to have changed to spectacle lens wear. Patients wearing contact lenses at the most recent follow-up examination were more likely to have good visual acuity.     

Ictal and interictal technetium-99m-bicisate brain SPECT in children with refractory epilepsy

Identification of epileptogenic foci in patients with refractory epilepsy remains a significant diagnostic challenge. Magnetic resonance imaging studies frequently fail to reveal an anatomic origin for the seizures, and scalp electroencephalography is often limited to identification of the involved hemisphere. Functional imaging modalities such as PET and SPECT are more promising tools for this application because they reflect the functional pathology associated with the seizure. These changes are more pronounced ictally, but until recently, no radiopharmaceutical was available that could be used routinely for ictal SPECT. The present study was therefore undertaken to determine whether 99mTc-bicisate could be used in ictal SPECT in pediatric patients with refractory epilepsy, to compare the patterns of ictal and interictal blood flow in these patients and to compare the localization information provided by ictal SPECT with that available from other techniques. METHODS: Technetium-99m-bicisate/SPECT was compared prospectively with scalp EEG for its ability to identify a possible seizure focus in pediatric patients with refractory epilepsy. Ictal and interictal SPECT studies were performed in 10 patients (3-19 yr old, mean age 10.9 +/- 4.3 yr; 7 female, 3 male) in whom MRI scans revealed no lesions that might be responsible for the seizures. RESULTS: Ictal SPECT was performed in all patients, and all ictal studies revealed focal perfusion abnormalities. By comparison, four of the interictal SPECT studies showed regional hypoperfusion that corresponded to the regions of hyperperfusion in the ictal studies, and three showed regional hyperperfusion corresponding to the hyperperfused regions in the ictal studies. Three interictal studies revealed no abnormal perfusion. Scalp EEG provided localization information in five patients. CONCLUSION: These initial results suggest that ictal SPECT with 99mTc-bicisate is a more promising tool for the identification of epileptogenic foci than interictal SPECT or scalp EEG in patients without focal abnormalities on MRI.     

Benign postpartum pleural effusion

The conditions of labour appear to favour the development of pleural effusion. The frequency of postpartum pleural effusion was investigated in this study using thoracic ultrasonography. Thirty one postpartum and 22 healthy nonpregnant women of the same age-group were examined, both supine and seated, via an intercostal approach. Seven of the 31 (23%) postpartum women had pleural effusion within 1-24 h of normal delivery. None of the nonpregnant women had pleural effusion. No correlation was found between postpartum pleural effusion and age, weight-gain during pregnancy, duration of labour, use of intravenous fluid, or oxytocin administration. Pleural effusion seems to be a common finding postpartum, but of no clinical significance.