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AIM: With the emergence of a new virus and the associated pandemic, the ICU started to see a brand new kind of patient with severe ARD. As with any disease, sometimes the discontinuation of mechanical ventilation for any reason can be difficult. As a center specializing in weaning patients after prolonged mechanical ventilation, we wanted to compare our results with weaning patients who had prolonged mechanical ventilation for other reasons than those of patients who had prolonged mechanical ventilation due to SARS-CoV-2 infection. METHODS: We obtained our data from WeanNet register, the weaning register of the German Institute for Lung Research (ILF). In our analysis, we included only patient data from January until July 2020, which was recorded in our in-house study files. RESULTS: Our analysis included data on 28 patients; 11 were treated with prolonged mechanical ventilation due to SARS-CoV-2 pneumonia, 17 had no SARS-CoV-2 infection. 81.2 % of SARS-CoV-2 patients were successfully weaned from invasive ventilator therapy compared to 76.4 % of patients without SARS-CoV-2. Mortality in the SARS-CoV-2 group was 18.2 % compared to 11.8 % in the other group. Patients with SARS-CoV-2 infections were predominantly males with preexisting cardiovascular disease or a history of nicotine abuse. ARDS was the most common cause of respiratory failure which led to primary intubation. CONCLUSION: Even though we were only able to analyze a small number of patient histories due to the novelty of the disease, we were able to show that patients with prolonged mechanical ventilation after SARS-CoV-2 infection can be equally successfully weaned compared to patients with prolonged mechanical ventilation due to other diseases. Risk factors for prolonged mechanical ventilation after a severe case of SARS-CoV-2 infection seemed to be male gender, nicotine abuse and cardiovascular disease.

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The ecosystem service concept has emphasized the role of people within socio-ecological systems (SESs). In this paper, we review and discuss alternative ways of representing people, their behaviour and decision-making processes in SES models using an agent-based modelling (ABM) approach. We also explore how ABM can be empirically grounded using information from social survey. The capacity for ABM to be generalized beyond case studies represents a crucial next step in modelling SESs, although this comes with considerable intellectual challenges. We propose the notion of human functional types, as an analogy of plant functional types, to support the expansion (scaling) of ABM to larger areas. The expansion of scope also implies the need to represent institutional agents in SES models in order to account for alternative governance structures and policy feedbacks. Further development in the coupling of human-environment systems would contribute considerably to better application and use of the ecosystem service concept.

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The purpose of this study was to compare total capillary, total venous, risk ratio, high-density lipoprotein and low-density lipoprotein measures of cholesterol to determine whether total capillary cholesterol is a valid measure to use in cholesterol screening. An announcement and a registration form were distributed with employee paychecks announcing a cholesterol-screening programme. Capillary and venous samples were collected from screening participants (n=285). Results indicated false negatives in total capillary cholesterol in 17.21-34.4% of cases compared with other methods of cholesterol measurement. Due to the high number of misclassifications, health educators should not use total capillary cholesterol as a predictor of risk for heart disease, nor as a measure for referral during cholesterol screenings.

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Approximately 20%-30% of patients with acute promyelocytic leukemia (APL) who are treated with the current standard all-trans retinoic acid and anthracycline-based chemotherapy regimen suffer relapse. In the mid-1990s, studies from China reported the effective use of arsenic trioxide in achieving complete remission in patients with APL. In the United States, a multicenter trial of this agent in 40 patients with relapsed APL following conventional therapy confirmed the positive safety and efficacy outcomes of a smaller 12-patient pilot study. Common adverse events were hyperleukocytosis, APL differentiation syndrome, prolonged QT interval on electrocardiogram, skin rash, and hyperglycemia.

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Current advances in genetics have provided a better understanding of many diseases, including cancer, and will have an impact on oncology clinical practice in an unprecedented way. The molecular cytogenetic techniques of fluorescent in situ hybridization (FISH), comparative genomic hybridization (CGH), and spectral karyotyping (SKY) are providing tremendous insights into genetic information related to cancer by specifically illustrating chromosomal abnormalities that can occur in a patient's cancer cells. The application of these techniques allows for the development of molecular diagnostic tests may be applied to clinical material, which may help to improve the diagnosis and staging of a patient's tumor, particularly in small, premalignant lesions that often are equivocal and difficult to assess. An understanding of these genetic changes will provide a foundation of knowledge for oncology nurses that will lead to significantly improved detection methods, therapies, and disease prevention. As members of the healthcare team, oncology nurses must be knowledgeable about the rapid expansion of genetic information. Oncology nurses are in a unique position to translate this information to patients and their families and, ultimately, enhance comprehensive care through patient education and advocacy.

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Historically, a low supply of physical and occupational therapists existed in the home care marketplace. Home care agencies have had to contract with private practices and accept therapists who could only provide two or three visits a week to keep up with the demand. However, cutbacks have occurred at the acute, sub-acute, and rehabilitation levels of inpatient care. Now, many therapists who would not have considered home care employment in the past are asking for interviews. For once, many home care agencies have the opportunity to carefully select the therapists they hire.

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OBJECTIVES: To provide information on the assessment and management of the nutritional needs of patients with severe neutropenia. DATA SOURCES: Textbook chapters, research articles, and review articles. CONCLUSIONS: Malnutrition is a common result of high-dose chemotherapy treatment. Clinical outcomes are directly related to careful assessment, early intervention, and ongoing evaluation and monitoring in the severely neutropenic population. IMPLICATIONS FOR NURSING PRACTICE: Early assessment, management, and psychological support are essential in meeting the needs of this patient population.

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The relationship of sex composition of class and instructor's sex to Physical Self-efficacy has yielded conflicting results in several studies. This study examined the relationship of sex composition of class and instructor's sex to scores on Physical Self-efficacy, Perceived Physical Ability, and Physical Self-presentation Confidence of 80 male students enrolled in one of four sections of a strength training class. Analysis indicated no significant difference on Physical Self-efficacy between male students who were enrolled in all male classes or in coeducational classes; improvements in scores on Physical Self-efficacy were not specific to the sex composition of the class or sex of the instructor and no significant difference on Perceived Physical Ability and Physical Self-presentation Confidence between male students who joined an all male class or a coeducational class. Perceived Physical Ability improved from the pretest to the posttest in all classes; and no improvement in scores for Physical Self-presentation Confidence was found in all classes. In conclusion, the analysis showed sex composition of the class and sex of the instructor were not significantly related to scores for self-efficacy.

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The Oncology Nursing Society's (ONS's) position on quality cancer care states that "quality cancer care incorporates the individual with cancer (and the family) as fully informed partners and decision makers" (ONS, 1997). Patients diagnosed with breast cancer are inundated with information, and oncology nurses help these patients receive quality cancer care by providing and explaining information related to their diagnosis and treatment. This information allows patients to participate in meaningful collaborative decision making. Prognostic tumor markers have provided information that can determine the natural history of breast cancer, identify women with high-risk or aggressive tumors, and help to establish a disease prognosis.

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Anemia is not an uncommon problem. Knowledge of a few common laboratory tests can be helpful when caring for patients with anemia. By reviewing approaches to classifying, evaluating, and managing patients with common anemias, nurses will be prepared to care for patients with an anemia more confidently.

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Anemia is a significant issue in clinical practice. Reducing anemia can improve quality of life. Advanced practice nurses are critical to the diagnostic evaluation of anemia. The key to effective treatment is establishment of the anemic etiology. This can be done through a straightforward diagnostic approach utilizing the traditional history and physical, and standard laboratory assessment. The diagnostic process must be based on an understanding of demographics, normal physiology, and the pathophysiologic processes of the different anemias. Nurse practitioners are uniquely educated to assess anemia in a holistic manner, incorporating components of the history, physical exam, and laboratory evaluation into an appropriate diagnosis. Once the diagnosis is established, this same holistic assessment can be utilized to create a specific, patient-focused plan of care and follow-up.

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Oprelvekin (Neumega, Genetic Institute Co., Cambridge, MA) is a thrombopoietic growth factor approved by the U.S. Food and Drug Administration for the prevention of severe thrombocytopenia following myelosuppressive chemotherapy in patients with nonmyeloid malignancies. The most common side effects are edema, dyspnea, tachycardia, and conjunctival redness. Patient-care concerns include appropriate timing of administration, patient selection, dosing and administration issues, and the early identification and management of side effects.

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PURPOSE/OBJECTIVES: To review the drug profile and nursing implications associated with the new lipid amphotericin preparations. DATA SOURCES: Published articles, abstracts, professional communications, drug manufacturer prescribing information, and personal experience. DATA SYNTHESIS: Three lipid amphotericin B (AmB) preparations have been approved by the U.S. Food and Drug Administration (FDA). The first agent, amphotericin B lipid complex (Abelcet, Liposome Co., Princeton, NJ), a ribbon-like structure, was approved in November 1995 for the treatment of aspergillosis in patients who are refractory to or intolerant of conventional amphotericin B therapy and for invasive fungal infections. In November 1996, amphotericin B cholesteryl sulfate complex for injection (Amphotec, Sequus Pharmaceuticals, Menlo Park, CA), a second preparation composed of a disc-like structure, received FDA approval for the treatment of invasive aspergillosis in patients in whom renal impairment or unacceptable toxicity precludes the use of conventional AmB therapy and in patients in whom prior AmB therapy has failed. Amphotec frequently is referred to as amphotericin B colloidal dispersion (ABCD). The third formulation, a liposomal preparation composed of vesicles, liposomal amphotericin B or L-AmB (AmBisome, Fujisawa USA, Inc., Deerfield, IL, and Nexstar Co., Boulder, CO) recently received FDA approval for three indications. All of these preparations accumulate in organs of the reticuloendothelial system as opposed to the kidneys. Further studies of lipid AmB are needed to help clarify the usefulness of each AmB preparation. The most common side effects of lipid AmB preparations are chills and fever. CONCLUSIONS: Lipid-based AmB preparations are well-tolerated treatments with mild to moderate side effects. These preparations have some advantages over conventional AmB. IMPLICATIONS FOR NURSING PRACTICE: Nurses in clinical settings can focus on staff and patient education, including identification and management of side effects associated with the lipid-based AmB preparations. Patient-care concerns include appropriate patient selection, dosing and administration issues, and the prevention, early identification, and management of toxicities.

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PURPOSE/OBJECTIVES: To discuss dose-intensive chemotherapy and the associated toxicities to the nervous, pulmonary, and cutaneous systems. DATA SOURCES: Published articles, book chapters, and personal experience. DATA SYNTHESIS: Because of the discovery of the protective effect of colony stimulating factors, a renewed emphasis has been placed on dose-intensive chemotherapy in an attempt to affect both survival and cure rates with chemotherapy. As a result, increased toxicities have been seen in other organ systems. CONCLUSIONS: Toxicities to the nervous, pulmonary, and cutaneous systems are increasing. Meticulous medical and nursing care are critical to ensure patient survival and to minimize these effects. IMPLICATIONS FOR NURSING PRACTICE: Goals of care include a through knowledge of potential toxicities, recognition of signs and symptoms of toxicity, and appropriate nursing interventions once such deficits occur to decrease the toxic effects of chemotherapy and improve patient function.

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CT- or MRI-guided stereotactic procedures should be a standard in a modern neurosurgical unit. Analysing 71 cases the indications and results of stereotactic neurosurgery are presented. In 53 patients stereotactic serial biopsies of different intraaxial lesions were performed, in 5 patients a spontaneous haemorrhage of the basal ganglia was removed by lysis with r-tPA. In 3 patients suffering from hydrocephalus due to diencephalic cysts a cystventricular shunt device was implanted. In 3 patients an intracerebral abscess was aspirated and drained. A stereotactic guided craniotomy and excision of small deep-seated lesions was performed in 6 cases. The accuracy of stereotactic tumour biopsies was 88.7% in our series, in accordance to other authors. The stereotactic aspiration and drainage of an intracerebral abscess provides accurate localization and minimal cortical damage and offers the possibility of intracavitary application of antibiotics. The stereotactic internal shunt implantation seems to be an alternative approach in the treatment of diencephalic cysts due to its minimal invasiveness and low operative risk. The aspiration of basal ganglia haematomas with insertion of an external drainage allows the lysis of the haematoma with r-tPA or urokinase. With stereotactic guidance small, deep-seated intraaxial lesions can be well localized and removed.

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The results of Deep Brain Stimulation in deafferentation pain syndromes, in particular in thalamic pain, indicate that excellent long-term pain relief can hardly ever be achieved. We report 7 cases using Motor-Cortex-Stimulation for treating severe trigeminal neuropathic pain syndromes, i.e., dysaesthesia, anaesthesia dolorosa and postherpetic neuralgia. The first implantation of the stimulation device for precentral cerebral stimulation was performed in June 1993, the last in September 1995. In all but one case the impulse-generator was implanted after a successful period of test stimulation. Successful means a pain reduction of more than 50% as assessed with a Visual Analogue Scale. Excluding one case, in whom a prolonged focal seizure resulting in a postictal speech arrest occurred during test stimulation, there have been no operative complications and the postoperative course was uneventful. In all the other patients the pain inhibition appeared below the threshold for producing motor effects. Initially these patients reported a good to excellent pain relief. In three of 6 patients a good to excellent pain control was maintained for a follow-up period of 5 months to 2 years. In the remaining three patients the positive effect decreased over several months.

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The objective of our study was to examine the relation of the intracranial pressure (ICP), cerebral perfusion pressure (CPP), regional cerebral blood flow (rCBF), and vasomotion in the acute phase in rats after having induced subarachnoid haemorrhage (SAH). The experiments were carried out on a total of 21 Wistar rats by means of neuroleptanalgesia and controlled mechanical ventilation. In 16 animals SAH was induced according to the method described by Solomon et al. with a fractionated application of 0.5 ml autologous blood into the cisterna magna. In a control group 0.5 ml of physiological saline solution was injected under identical conditions. The parameters were registered continuously before, during and at least 3 hours after the bolus application. The rCBF and vasomotion were recorded by laser-doppler fluxmetry. The ICP and the systemic arterial blood pressure were registered simultaneously. In the course of the experiment blood gas analyses were carried out regularly for documentary reasons of normoventilation. Our results show that the Cushing-response-after having induced SAH-led to a deterioration of the cerebral perfusion. In the control group however an increase in ICP and rCBF was recorded. The frequency and amplitude of the oscillations of Doppler signals, described as vasomotion, were significantly reduced in the SAH group as compared to the control group (p = 0.0004) during the course of the experiment. After having induced SAH an impairment of the cerebral autoregulation becomes apparent which seems to manifest itself on the level of microvascular structures as a suppressed behaviour pattern of vasomotion. Although basal vessels may constrict distal parenchymal vessels tend to dilate after SAH. The dilation-described as a reduction of vasomotion-could also be measured in clinical situations by means of laserdoppler fluxmetry.

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OBJECTIVE: This preliminary study was designed to determine whether occupational therapists involve patients and their families in a goal-setting process and, if so, to identify the methods used. METHOD: Thirty registered occupational therapists practicing in adult physical rehabilitation settings were audiotaped during an initial evaluation. Researchers reviewed corresponding documentation and interviewed each subject. Twenty-three patient and family involvement criteria were generated from standards developed by accreditation commissions and health care professions. RESULTS: Data revealed that although subjects did involve patients and families in a goal-setting process, a number of criteria were not attempted, thus much potential for involvement was unrealized. Subjects with scores above and below one standard deviation from the mean were identified to determine which patient participation criteria had the highest discrepancies. Discrepancies included (a) verbal preparation of the patient and family for initial and ongoing treatment, purposes and procedures of evaluation and treatment, and potential outcomes of treatment, (b) attempts to elicit the patient's concerns, and (c) collaboration with the patient to establish treatment goals. CONCLUSION: Factors that might have influenced subjects' use of a patient participation approach included the application of a specific theory or technique, time constraints, patient's age, and assumptions about the patient's cognitive status.

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BACKGROUND AND PURPOSE: Because the timing and strategy of surgical intervention in massive cerebellar infarction remains controversial, we report our experience with the management of 52 such patients. METHODS: Case records, computed tomographic scans, surgical reports, and angiograms of 52 patients with space-occupying cerebellar infarction defined by computed tomographic criteria were reevaluated with regard to clinical course, etiology, therapeutic management, mortality, and functional outcome. RESULTS: In most cases clinical deterioration started on the third day after stroke, and a comatose state was reached within 24 hours. Sixteen patients were treated medically, and 30 by suboccipital craniectomy (22 plus ventriculostomy, 12 plus tonsillectomy). Ten patients primarily had ventriculostomy, which in 4 patients was supplemented by craniotomy because of continuing deterioration. Twenty-nine patients made a good recovery, 15 remained disabled, and 8 died. Even comatose patients had a 38% chance of a good recovery with decompressive surgery. Age older than 60 years (P = .0043) and probably initial brain stem signs (P = .0816) and a late clinical stage (P = .0893) were linked with a fatal or disabling outcome. CONCLUSIONS: Decompressive surgery should be the treatment of choice for massive cerebellar infarction causing progressive brain stem signs or impairment of consciousness.

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