bluuebunny/crossref_metadata_2025 huggingface dataset:
Health Care Provider Satisfaction with Telephone Consultations Provided by Pharmacists and Physicians at the National HIV/AIDS Clinicians’ Consultation Center
Authors: Sherman Elizabeth M , Cocohoba Jennifer M , Neff Sarah E , Dong Betty J
Published: November 2011

Background:

The federally funded National HIV/AIDS Clinicians’ Consultation Center (NCCC) offers US health care providers expert telephone consultations for managing HIV/AIDS and occupational exposures to blood-borne pathogens through 3 telephone services: the National Clinicians’ Post-Exposure Prophylaxis Hotline (PEPline), the National HIV Telephone Consultation Service (Warmline), and the Perinatal HIV Hotline. Callers to the NCCC receive consultation from either a clinical pharmacist (PharmD) or a physician (MD) with HIV expertise.

Objective:

To compare the satisfaction of NCCC callers who received clinical consultations from clinical pharmacists and physicians with HIV expertise.

Methods:

We prospectively mailed 1256 satisfaction surveys to NCCC health care provider callers during a 7-month period. Survey recipients were not aware that satisfaction surveys compared PharmD and MD consultation services. Respondents rated their level of agreement with 8 statements about the quality of consultation, the quality of clinical information given, and future calls to the NCCC.

Results:

Survey return rates were 43% for PEPline and 40% for Warmline and Perinatal HIV Hotline combined. Overall, caller satisfaction with the telephone consultation service was extremely high (>4 in all categories on a 1–5 Likert scale). There was no significant difference in PEPline caller satisfaction ratings between PharmD and MD consultations. Callers to the Warmline and Perinatal HIV Hotline agreed with all 8 satisfaction statements. For the following 3 statements, however, satisfaction was higher when Warmline and Perinatal HIV Hotline consultation was provided by an MD: “Overall, I was pleased with the quality of my consultation” (p = 0.04); “I would use this service again” (p < 0.02); and “I am likely to recommend this service to my colleagues” (p = 0.02).

Conclusions:

Health care provider callers to the NCCC were highly satisfied with the information obtained from this HIV/AIDS telephone consultation service. By measuring callers’ survey response to PharmD and MD consultations, the importance of the clinicians’ contributions to this advanced HIV/AIDS consultation service is documented.
Emerging Biomarkers in Heart Failure
Authors: van Kimmenade Roland R J , Januzzi James L
Published: November 2011

BACKGROUND

Until recently, biomarker testing in heart failure (HF) syndromes has been viewed as an elective supplement to diagnostic evaluation of patients suspected to suffer from this condition. This approach to the use of biomarker testing contrasts with other cardiovascular diagnoses such as acute myocardial infarction, for which biomarkers are integral to disease process definition, risk stratification, and in some cases treatment decision making.

CONTENT

In this review we consider various perspectives on the evaluation of biomarkers in HF. In addition, we examine recent advances in the understanding of established biomarkers in HF (such as the natriuretic peptides), the elucidation of novel biomarkers potentially useful for the evaluation and management of patients with HF, and the growing understanding of important and relevant comorbidities in HF. We also review candidate biomarkers from a number of classes: (a) myocyte stretch, (b) myocyte necrosis, (c) systemic inflammation, (d) oxidative stress, (e) extracellular matrix turnover, (f) neurohormones, and (g) biomarkers of extracardiac processes, such as renal function.

Novel applications of established biomarkers of HF as well as elucidation and validation of emerging assays for HF syndromes have collectively led to a growing interest in the more widespread use of such testing in patients affected by the diagnosis.
Weed Control, Environmental Impact, and Economics of Weed Management Strategies in Glyphosate-Resistant Soybean
Authors: Stewart Christie L. , Nurse Robert E. , Van Eerd Laura L. , Vyn Richard J. , Sikkema Peter H.
Published: November 2011

With the number of glyphosate-resistant weed species increasing in North America and a lack of new herbicide chemistries being developed, growers are shifting toward using older herbicides that are more expensive and may be less environmentally friendly. Therefore, to determine which weed management strategies are most cost effective and have the lowest impact on the environment we evaluated the efficacy, environmental impact, and the profitability of several weed management strategies in glyphosate-resistant soybean over a 3-yr period (2007 to 2009) at three locations in southwestern Ontario, Canada. No visible injury to soybean was observed with the herbicide treatments evaluated. A sequential application of glyphosate consistently provided high levels of weed control (99 to 100%) at 56 d after treatment in comparison with one- or two-pass herbicide programs. Soybean yield did not differ between the two-pass herbicide programs and glyphosate applied early POST; however, a yield benefit was found with a sequential application of glyphosate or a PRE herbicide followed by glyphosate compared with glyphosate applied only at late POST. The two-pass herbicide programs had higher environmental impact (EI) (> 23) than the one-pass herbicide programs (< 15), except when imazethapyr was followed by or tank-mixed with glyphosate, which had an equivalent EI (∼ 14) to the one-pass herbicide programs. Not surprisingly because of the low purchase price of glyphosate, gross margins were highest for treatments that included glyphosate. However, to reduce the selection pressure on glyphosate-resistant weed biotypes, to reduce environmental impact, and to increase gross margins a combination of glyphosate with another mode of action would be most beneficial. In this study glyphosate + imazethapyr was the best alternative to a sequential two-pass glyphosate program.
Assessing and Visualizing Agricultural Management Practices: A Multivariable Hands-On Approach for Education and Extension
Authors: Smith Richard G. , Gareau Tara Pisani , Mortensen David A. , Curran William S. , Barbercheck Mary E.
Published: November 2011

Agroecosystems are inherently complex, and practices aimed at managing one component of the system can have unintended consequences for other components of the system. Management decisions, therefore, can be improved by assessing and understanding the multivariate nature of agricultural systems and the multifunctional character of particular agricultural management practices. The act of simultaneously assessing and evaluating multiple characteristics or functions in agriculture also can be a valuable education and extension activity, because it draws on active and experiential methods of learning and because the process effectively reveals important functions and tradeoffs associated with agroecosystems and their management. Here we introduce a tool (the spider plot) and present a case-study exercise in which we used this tool to evaluate the multiple characteristics and functions of different cover crops within a field day workshop format. We also provide examples of how this approach could be used to assess other management practices or properties of agroecosystems and communicate multivariate concepts within a weed science classroom or extension environment.
Potato Response to Simulated Glyphosate Drift
Authors: Felix Joel , Boydston Rick , Burke Ian C.
Published: November 2011

Field studies were conducted in 2008 in Ontario, OR and Paterson, WA to determine the effect of simulated glyphosate drift on ‘Ranger Russet’ potato, including visual injury, shikimic acid accumulation, and tuber yield. Glyphosate was applied at 8.5, 54, 107, 215, and 423 g ae ha−1; which corresponds to 0.01, 0.064, 0.126, 0.254, and 0.5 of the lowest recommended (846 g ha−1) single application dose for glyphosate-resistant corn and sugar beet. Glyphosate was applied when potato plants were at 10-cm height, stolon hooking, tuber initiation, or bulking stage. The greatest visual foliar injury was observed when glyphosate was applied at a dose of 54 g ha−1or greater and potato plants were at the hooking stage. The lowest foliar injury was observed when glyphosate was applied to potato plants at the bulking stage. TheI50glyphosate dose at 42 d after treatment (DAT) was estimated to be 167 g ha−1for potatoes sprayed at the hooking stage. The corresponding glyphosate dose to result in 50% injury for potatoes sprayed at tuber initiation, 10-cm height, and bulking stages were 129%, 338%, and 438%, respectively, greater than hooking stage. The U.S. No.1 potato yield was inversely related to vine injury and shikimic acid accumulation. Shikimic acid accumulation increased when glyphosate was applied at 107 g ha−1or greater. U.S. No.1 potato yield was reduced by 46% and 84% relative to the untreated control (55 and 76 T/ha) when glyphosate was applied at 107 g ha−1to plants in the hooking stage at Ontario and Paterson, respectively. Tuber yields at both sites were lowest when glyphosate was applied at hooking and tuber initiation stages.
Effect of Simulated Aminocyclopyrachlor Drift on Flue-Cured Tobacco
Authors: Lewis D. F. , Hoyle S. T. , Fisher L. R. , Yelverton F. H. , Richardson R. J.
Published: November 2011

Flue-cured tobacco is sensitive to foliar and soil residues of off-target synthetic auxin drift. Aminocyclopyrachlor is a newly developed synthetic auxin herbicide that may be used in right-of-way applications for broadleaf weed and brush control. Aminocyclopyrachlor is considered a reduced-risk alternative in rights-of-way compared with similar compounds because of its low application rate and volatility risk. However, no research is available on the response of field-grown, flue-cured tobacco to aminocyclopyrachlor drift exposure. Research was conducted in 2009 and 2010 at the Border Belt Tobacco Research Station in Whiteville, NC, to determine the response of ‘NC 71’ flue-cured tobacco to five simulated drift rates of aminocyclopyrachlor (0.31, 1.6, 3.1, 15.7, and 31.4 g ae ha−1) and one aminopyralid (6.1 g ae ha−1) simulated drift rates applied pretransplant incorporated, pretransplant unincorporated, 3 wk after transplant, and 6 wk after transplant. All herbicide rates and application timings caused significant visual tobacco injury, ranging from slight to severe with increasing herbicide drift rates. Tobacco plant heights and fresh weights were reduced at all application timings receiving ≥ 15.7 g ha−1aminocyclopyrachlor and the comparative aminopyralid rate.
Confirmation of Glyphosate-Resistant Italian Ryegrass (Lolium perennessp.multiflorum) in Arkansas
Authors: Dickson James W. , Scott Robert C. , Burgos Nilda R. , Salas Reiofeli A. , Smith Kenneth L.
Published: November 2011

In 2007, populations of Italian ryegrass were observed surviving applications of glyphosate under field conditions in southeast Arkansas. At least 10 reports of Italian ryegrass escaping glyphosate applications followed in subsequent years in Arkansas. These were unconfirmed reports of resistance from county agents, consultants, and farmers. The objectives of this research were to confirm resistance to glyphosate in a suspected resistant population collected in 2007 (Desha 2007) and to determine the level of resistance of a putative glyphosate-resistant population collected in 2009, both from Desha County, AR. Other objectives were to determine the resistance frequency in these populations, to determine whether the 2009 population was also acetolactate synthase (ALS) or acetyl-CoA carboxylase (ACCase-resistant), and to determine the effect on plant size as it relates to dose–response to glyphosate. The Desha, AR, 2007 population exhibited a low level of resistance to glyphosate. The estimated glyphosate dose that would control this population 50% was 1,260 g ae ha−1, compared with 190 g ae ha−1for the susceptible check. In 2009, a population of Italian ryegrass (Des03) was identified that survived a glyphosate application of 1,740 g ae ha−1made in the field, which is twice the commercial use rate for glyphosate. Dose–response experiments determined that an estimated 3,890 g ae ha−1glyphosate was required to obtain 50% biomass reduction of Des03; this was 23 times that of the susceptible standard. Neither growth stage nor glyphosate rate evaluated affected the level of resistance observed in the Des03 population. This population was determined to be more than 70% resistant at the levels reported. In addition to glyphosate, Des03 was also resistant to diclofop, a commonly used herbicide in wheat in Arkansas and other areas. As a result, alternative management strategies for Italian ryegrass are currently being explored.
Use of Imazosulfuron in Herbicide Programs for Drill-Seeded Rice (Oryza sativa) in the Mid-South United States
Authors: Riar Dilpreet S. , Norsworthy Jason K.
Published: November 2011

Research was conducted in 2009 and 2010 to evaluate influence of imazosulfuron rate and application timing on weed control in drill-seeded rice at Stuttgart, AR, and to evaluate imazosulfuron-containing herbicide programs in drill-seeded rice at Keiser and Stuttgart, AR. Weed species evaluated included barnyardgrass, broadleaf signalgrass, hemp sesbania, and yellow nutsedge. Imazosulfuron applied at 224 and 336 g ai ha−1during PRE, early POST (EPOST), or preflood (PREFLD) growth periods provided similar control of all weeds. Imazosulfuron applied EPOST or PREFLD controlled hemp sesbania and yellow nutsedge ≥ 93% both years at 5 and 7 wk after planting (WAP), except in 2009 when hemp sesbania control was ≤ 79% at 7 WAP. In 2010, because of inadequate rainfall, hemp sesbania and yellow nutsedge control with PRE-applied imazosulfuron was ≤29% at 5 and 7 WAP. Imazosulfuron plus clomazone PRE followed by (fb) quinclorac plus propanil EPOST and imazosulfuron plus quinclorac EPOST fb thiobencarb plus propanil PREFLD programs controlled hemp sesbania and barnyardgrass (in at least two site-years), and yellow nutsedge and broadleaf signalgrass (in at least one site-year) greater than or equal to clomazone plus quinclorac PRE fb propanil plus halosulfuron PRELD (standard program). No rice injury was observed with any herbicide program. Rice yield with all imazosulfuron-containing herbicide programs (6,630 to 8,130 kg ha−1) was similar to the standard herbicide program (7,240 kg ha−1). Imazosulfuron in mixture with clomazone, propanil, or quinclorac can be incorporated into herbicide programs of mid-South rice production for the control of broadleaf weeds and sedges.
Neonatal HIV Infection
Authors: Katz Anne
Published: November 2011

The purpose of this article is to describe the pertinent issues related to mother-to-child transmission of HIV infection. Significant success has been achieved in developed countries to reduce the incidence of this devastating disease in neonates through screening of pregnant women, maternal antiretroviral therapy to reduce transmission, and cesarean section for delivery. Prophylaxis continues for the first six weeks of the newborn’s life with antiretroviral therapy and careful monitoring of clinical well-being. Antiretroviral therapy offers significant reduction in the rate of mother-to-child transmission, and this is presently the cornerstone of therapy for the HIV-infected pregnant woman. Clinical studies of treatment modalities continue to offer new hope to prevent transmission of the virus to the fetus. Care for the HIV-infected newborn is highly complex and constantly evolving. All neonatal nurses should be aware of these issues so that they can be partners in the identification of new cases and the ongoing treatment of babies who are infected.
Determination of Positional Skin-Surface Pressures in Premature Infants
Authors: Marcellus Lenora
Published: November 2011

Purpose:To describe the skin-surface pressure distributions and points of maximal pressure that are generated by healthy premature infants in the supine, prone, and right side–lying positions.

Design:A descriptive, repeated-measures design.

Sample:Four medically stable premature infants of 34 weeks postconceptional age. The mean weight was 2,180 gm, and the mean age was 24.5 days.

Results:Similar regions of increased skin-surface pressures were identified for the four infants. Within areas of peak pressure, some sensor cells reached 28–32 millimeters of mercury, which is considered to be the critical compressive pressure for obstruction of nutritive flow to the underlying body tissues. These descriptive results may be a starting point for development of research studies to determine positioning strategies to optimize the skin integrity of premature infants while minimizing unnecessary handling.
An Update on ECMO
Authors: Tulenko Dina
Published: November 2011

Extracorporeal membrane oxygenation (ECMO) is essentially a heart-lung bypass machine that can be used to support certain critically ill neonates. ECMO therapy reached a peak in usage in the mid to late 1980s. At that time, ECMO was most often used for severe complications of persistent pulmonary hypertension, meconium aspiration, congenital diaphragmatic hernia, and sepsis. Since that time, the use of ECMO has decreased, due largely to newer medical advances that have improved the course of these neonates. Whether a nurse works in a Level III ECMO center or a Level I, II, or III NICU, ECMO treatment has become less familiar than it once was. But even though ECMO is used less often, there are times when nothing can take its place. It is important to stay informed so that families of those critically ill newborns who do need ECMO can be educated and supported. This article defines ECMO, discusses when it should be incorporated into the plan of care, describes advances in the NICU that have resulted in the dramatic reduction in the use of ECMO, and provides information and communication strategies to better support the family of a very sick newborn.
The Story of Nitric Oxide: From Rascally Radical to Miracle Molecule
Authors: Bell Susan Givens
Published: November 2011

ONCE CONSIDERED AN environmental nuisance at best and a dangerous poison at worst, nitric oxide (NO) has been discovered to be an important biologic messenger, sending a shock wave through the scientific community. This article briefly reviews the discovery of NO as a regulator of vascular muscle tone and describes important events on its road to fame. The application of inhaled NO (iNO) for the treatment of hypoxic respiratory failure in neonates is discussed.
Magnetic Energy
Authors: Simons Sherri Lee
Published: November 2011

ONE OF THE GREATEST CHALLENGES facing the manager of a neonatal intensive care unit is to retain qualified professional nurses. During the current national nursing shortage, most organizations are having difficulty providing adequate professional staffing. Studies of organizations that have received the American Nurses Credentialing Center’s Magnet designation illuminate leadership and environmental characteristics that help attract and retain good nurses.1–4 By incorporating these characteristics into the NICU, the manager can create an environment that will serve as a “magnet” to professional nurses.
Selecting and Using Research Instruments
Authors: Davis Deborah Winders
Published: November 2011

FOR MOST, THE WORD RESEARCH evokes an image of something that is rigid, with very strict and specific rules. We think that there is a right and a wrong way to study any given phenomenon. In reality, however, the design and implementation of every study involve a series of compromises. Although the researcher aims always to employ scientific rigor, she must be practical because resources are limited. Being practical does not necessarily detract from the scientific rigor of a study as long as the choices are made with thoughtful consideration. This column examines some of the practical issues that commonly arise in relation to research. The scientific rationale for various data collection methods will be discussed in a future column.
Happy Thanksgiving
Authors: Askin Debbie Fraser
Published: November 2011

AS I WRITE THIS, IT IS THANKSGIVING MONDAY IN Canada. As you read this, it will soon be Thanksgiving in the U.S. Of course, as we should once in a while, I had some time to think this long weekend. Two hours and thirty minutes to be exact, as I drove back to the city from my parents’ farm where the harvest was in full swing. That there were four kids in the back of the van happily watching a movie didn’t detract more than a little from my thinking time. Both personally and professionally, it was time to think about giving.
The Pharmacology of Palliative Care
Authors: Bell Susan Givens
Published: November 2011

THE VERB PALLIATE COMES FROM the Late Latin palliatus, past participle of palliare, to cloak, conceal. Merriam-Webster Online defines palliate as “to reduce the violence of (a disease)” or “to moderate the intensity of” something.1 Understanding the features of palliative care can challenge NICU staff, whose focus is primarily promotion of the neonate’s survival and healing. Many staff members may be ill prepared to assist the family of a newborn who is dying.2
Kudos to Our Volunteers
Authors: Rait Suzanne
Published: November 2011

VOLUNTEERISM IS AN ESSENTIAL COMPONENT OF modern society. Without volunteers, the daily operations of many institutions on which we rely, would come to a screeching halt. Volunteers have become an integral part of our world, the most noticeable volunteers presently being the men and women serving in the military in Iraq and other parts of the world. Certainly, we are grateful that these men and women have chosen to volunteer to defend our country.
Data Collection and Study Implementation
Authors: Davis Deborah Winders
Published: November 2011

IN PREVIOUS COLUMNS, I HAVE covered the following topics: types of study designs (September/October 2003), study reliability and validity (January/February 2004), instrument reliability and validity (May/June 2004), and selection and use of research instruments (September/ October 2004). The focus of this column is issues and methods related to data collection and study implementation. The confines of a column make an exhaustive treatment of this subject impossible. Suggestions for additional reading are provided in the bibliography for those desiring more extensive coverage.
Heparin-Induced Thrombocytopenia in Neonates
Authors: Martchenke Julie , Boshkov Lynn
Published: November 2011

Heparin-induced thrombocytopenia (HIT), an immune-mediated response to heparin administration, has been recognized in adults for some time, but only recently recognized in neonates and children. HIT Type I is a mild, self-limiting condition. HIT type II is a severe immune reaction to heparin that leads to thrombocytopenia and often thromboembolic complications. The incidence of HIT Type II is 2–5 percent in adults on heparin products and may be as high in neonates and children. The mortality rate from HIT in adults is 7–30 percent and is unknown but potentially high in newborns as well. The cardinal sign of HIT is a drop in platelet count by 50 percent or platelet counts below 70,000–100,000/mm3. This drop usually occurs five to ten days after the first exposure to heparin. Treatment is immediate cessation of all heparin therapy and initiation of alternative anticoagulants, especially the direct thrombin inhibitors lepirudin and argatroban. This article reviews the literature on HIT and presents a case of neonatal HIT following heart surgery.
Sound Level Exposure of High-Risk Infants in Different Environmental Conditions
Authors: Byers Jacqueline , Waugh W. Randolph , Lowman Linda
Published: November 2011

Purposes:To provide descriptive information about the sound levels to which high-risk infants are exposed in various actual environmental conditions in the NICU, including the impact of physical renovation on sound levels, and to assess the contributions of various types of equipment, alarms, and activities to sound levels in simulated conditions in the NICU.

Design:Descriptive and comparative design.

Sample:Convenience sample of 134 infants at a southeastern quarternary children’s hospital.

Main Outcome Variable:A-weighted decibel (dBA) sound levels under various actual and simulated environmental conditions.

Results:The renovated NICU was, on average, 4–6 dBA quieter across all environmental conditions than a comparable nonrenovated room, representing a significant sound level reduction. Sound levels remained above consensus recommendations despite physical redesign and staff training. Respiratory therapy equipment, alarms, staff talking, and infant fussiness contributed to higher sound levels.

Conclusion:Evidence-based sound-reducing strategies are proposed. Findings were used to plan environment management as part of a developmental, family-centered care, performance improvement program and in new NICU planning.
A Note from the Publisher on Neonatal Network’s 25th Anniversary
Authors: Rait Charles
Published: November 2011

ANNIVERSARIES ARE A TIME OF CELEBRATION. They are markers of hard work, of dedication, of making it through tough times and of good times. During the past twenty-five years, we have been fortunate that we have tapped into the heart of neonatal nursing. That heart beats strongly in the nurses who are driven to provide the best nursing care they can. It is those nurses who we celebrate and who have made it possible for us to publish Neonatal Network® and reach this milestone.
Immunomodulation, Part II: Granulocyte Colony-Stimulating Factors
Authors: Bell Susan Givens
Published: November 2011

IN A RECENT STUDY OF LATE-ONSET SEPSIS in very low birth weight (VLBW) neonates, the National Institute of Child Health and Human Development Neonatal Research Network found that, of 6,215 infants who survived beyond three days, 1,313 (21 percent) had experienced at least one episode of blood culture–proven sepsis. Not only does sepsis increase the length of stay in the NICU, but VLBW neonates with sepsis are significantly more likely to die than uninfected infants (18 percent vs 7 percent).1The most recently published statistics on sepsis-related neonatal mortality reveal that early neonatal mortality from sepsis declined from an average of 24.9/100,000 live births between 1985 and 1991 to an average of 15.6/100,000 live births between 1995 and 1998. During the same time period, the rate of late neonatal mortality from sepsis increased from 14.8/100,000 live births between 1985 and 1991 to 16.2/100,000 live births between 1995 and 1998.2The immaturity of bactericidal mechanisms, including the production and function of neutrophils, is one factor in this high rate of sepsis and related mortality.3
NRP 2006: What You Should Know
Authors: Zaichkin Jeanette
Published: November 2011

In spring 2006, the American Academy of Pediatrics (AAP) and the American Heart Association (AHA) will introduce revised materials for the Neonatal Resuscitation Program (NRP). These revisions affect the practice of neonatal resuscitation as well as the administrative components of the NRP. This article cannot address every program revision. Instead, it summarizes what prompted the program changes and then introduces the reader to guideline revisions that affect practice, as well as to changes in NRP tools and resources.

The fifth edition of the Textbook of Neonatal Resuscitation is currently in press. The AAP granted permission to use material from the forthcoming edition in this article.
Writing for Publication: Supporting the Neonatal Nurse Practitioner Student
Authors: Trotter Carol , Rasmussen Lynn
Published: November 2011

THE QUESTION POSED TO PARTICIPANTS AT THE International Academy of Nurse Editors (INANE) was “Why don’t nurses write for publication?” The answer that surfaced throughout the discussions was because nurses never learned why and how to write professional manuscripts.1It is our belief that authorship should be part of the curriculum of every advanced practice nursing (APN) program. Four articles published in this issue ofNeonatal Network® were written by University of Missouri-Kansas City (UMKC) Neonatal Nurse Practitioner (NNP) students as part of their required course work.Neonatal Network® has chosen to highlight these student writers in an effort to encourage all neonatal nurses to consider this opportunity and to encourage faculty to incorporate this activity into their curricula for APNs. Sharing one’s knowledge and expertise is an essential element of advanced nursing practice and provides the opportunity to enhance the science of nursing practice. By writing for publication, students work toward achieving the following recently published Acute Care NP Competencies:2

• Integrates research to promote evidence-based practice for patients with acute, critical, and chronic illness.

• Participates in formal and informal education provided to other health care professionals to promote positive outcomes during complex acute, critical, and chronic illness.

• Contributes to the knowledge base of the health care community through research, presentations, publications, and involvement in professional organizations.

• Promotes valuing lifelong learning and evidence-based practice while continually acquiring knowledge and skills needed to address questions arising in practice to improve patient care.
National Institues of Health Recommends the Routine Use of H2 Blockers in Preterm Infants be Carefully Evaluated
Authors: Pulsifer-Anderson Elizabeth , Guillet Ronnie
Published: November 2011

ARETROSPECTIVE ANALYSIS OF data from 11,000 preterm infants in neonatal intensive care units (NICUs) in the U.S. found that infants receiving H2 blockers such as Zantac, Tagamet, Pepcid, and Axid were more likely to develop necrotizing enterocolitis (NEC).1 The study was funded by the National Institutes of Health (NIH). As a result of the findings of this study, Elias A. Zerhouni, MD, Director of the National Institutes of Health, issued a press release in February, 2006, stating, “This study strongly suggests that the current practice of prescribing H2 blockers to prevent or treat acid reflux in premature infants needs to be carefully reevaluated by all concerned in light of these new findings.”2
Congenital Diaphragmatic Hernia: Two Case Studies with Atypical Presentations
Authors: Puckett Barbara
Published: November 2011

Congenital diaphragmatic hernia (CDH) affects 1 in every 2,000 to 4,000 live births. Many infants with this condition are diagnosed antenatally through routine ultrasound screening. Nearly 90 percent present at delivery with severe respiratory distress requiring intubation. Many of these infants develop persistent pulmonary hypertension of the newborn due to hypoplasia of the affected lung. The survival of infants with CDH is limited by the degree of pulmonary hypoplasia and requires sophisticated medical technology such as high-frequency ventilation and inhaled nitric oxide. Some infants also require treatment with extracoporeal membrane oxygenation. This article gives details of two cases of CDH in which the presentation was atypical. The more subtle presentation is discussed, as well as the embryology and pathophysiology of CDH and the possibility of associated anomalies. Clinical management and impact on the family are outlined.
Evidence-Based Review of Oral Sucrose Administration to Decrease the Pain Response in Newborn Infants
Authors: Leef Kathleen
Published: November 2011

Pain assessment and management are important issues for the neonatal nurse today. Clinicians have gradually come to acknowledge that newborn infants (term and preterm) are capable of responding to painful stimuli. This article reviews the evidence regarding the safety and efficacy of oral sucrose administration, to help answer the clinical question of how to manage an infant’s pain response to minor invasive procedures that are everyday occurrences in the NICU. This review included information on 1,077 infants enrolled in 16 studies. The evidence presented in the 16 studies reviewed here shows the safety and efficacy of sucrose in decreasing term infants’ pain response to a single procedure. In regard to preterm infants, there is insufficient evidence to recommend the use of sucrose as a routine comfort measure. More research is needed to determine the safety and efficacy of repeated doses of oral sucrose given for multiple procedures in preterm infants.
Caring for the Newborn with an Omphalocele
Authors: McNair Carol , Hawes Judy , Urquhart Heather
Published: November 2011

An omphalocele, a ventral defect of the umbilical ring resulting in herniation of the abdominal viscera, is one of the most common congenital abdominal wall defects seen in the newborn. Omphaloceles occur in 1 in 3,000 to 10,000 live births. Associated malformations such as chromosomal, cardiac, or genitourinary abnormalities are common. Postnatal management includes protection of the herniated viscera, maintenance of fluids and electrolytes, prevention of hypothermia, gastric decompression, prevention of sepsis, and maintenance of cardiorespiratory stability. A primary or staged closure approach may be used to repair the defect. Some giant omphaloceles require a skin flap or nonoperative management approach, however. Immediate postoperative complications, usually related to significant changes in intra-abdominal pressures, include compromise of interior venous blood return and hemodynamic and respiratory instability due to diaphragmatic elevation. Complications occur more frequently with giant defects. Potential short-term complications include necrotizing enterocolitis, prolonged ileus, and respiratory distress. Long-term complications include parenteral nutrition dependence, gastroesophageal reflux, parenteral nutrition– related liver disease, feeding intolerance, and neurodevelopmental delay. Overall, advances in surgical therapies and nursing care have improved outcomes for infants with omphaloceles; survival rates for those with isolated omphaloceles are reported at 75 to 95 percent. Infants with associated anomalies and giant omphaloceles have the poorest outcomes.
Partnering with Parents: Establishing Effective Long-Term Relationships with Parents in the NICU
Authors: McAllister Mary , Dionne Kim
Published: November 2011

Advances in health care have led to unprecedented innovation in the care provided to critically ill newborns. One outcome of this new reality is that newborn intensive care units have become “homes” for fragile infants who require long-term hospitalization. Clearly, NICUs were never so envisioned; thus, this reality has resulted in challenges for families and health professionals alike. As the duration of hospitalization increases, relationships between families and health care professionals become increasingly important. Parents of hospitalized newborns face fear, anxiety, and frustration as they struggle to cope with an ill child while developing their parental role. The quality of relationships established between families and health care professionals is crucial to their coping and adaptation. This article addresses challenges faced by families whose infants experience extended hospitalization, applies a model to help health care professionals understand parent perspectives, and proposes strategies to promote effective partnerships and alliances with families.
Octreotide
Authors: Stajich Gregory , Ashworth Laurel
Published: November 2011

A CHYLOTHORAX IS CHARACTERIZED BY AN ACCUMULATION OF pleural fluid having a turbid or milky white appearance due to a high lipid and triglyceride content. This continuously draining fluid, called chyle, contains lymphocytes, proteins, and immunoglobulins. Besides incurring respiratory compromise, the loss of fluid through excessive chyle drainage may lead to nutritional, electrolyte, and immunologic complications and is associated with high morbidity and prolonged hospitalization.1Chylothoraces may be acquired from trauma secondary to intraoperative disruption of either the thoracic duct lymph or its lymphatic tributary or from nontraumatic causes such as malignancies.
How to Reduce DEHP in Your NICU: A Plan of Simple Steps to Promote Change
Authors: Pak Victoria , Briscoe Valerie , McCauley Linda
Published: November 2011

IN THEIR EFFORTS TO IMPROVE THE health outcomes of neonates and infants in the Neonatal Intensive Care Unit (NICU), neonatal nurses should understand the potential for harm that plastic medical devices pose to infants. Di(2-ethylhexyl) phthalate (DEHP) is a plasticizer used to soften polyvinylchloride (PVC) that can leach from the plastic into the fluid or gas being delivered to the neonate. DEHP can harm the developing reproductive system. The U.S. Food and Drug Administration (FDA) has issued a public health notification recommendation that DEHP- free devices be considered for use in NICU patients.1 There are alternatives available. The purpose of this column is to inform neonatal nurses of the risk of DEHP exposure among infants and to make it simpler for them to implement change in reducing DEHP in their institution.
Building a Case for Neonatal Palliative Care
Authors: Romesberg Tricia
Published: November 2011

The concept of palliative care, well recognized in the adult population, has not been fully implemented in the pediatric population. Yet there is an urgent need to define and provide excellence in end-of-life care for infants and their families. Beneficent end-of-life care for the dying neonate includes efforts directed at comfort care, assistance with end-of-life decision making, and bereavement support. Through research and education, the challenges to implementing neonatal palliative care programs can be overcome. This article describes the components of neonatal palliative care, identifies the challenges associated with the implementation of such programs, and proposes strategies for addressing these challenges.
Full Disclosure When Bad Things Happen
Authors: Simons Sherri Lee
Published: November 2011

SINCE THE RELEASE OF THE Institute of Medicine report “To Err Is Human: Building a Safer Health System,” much attention has been focused on redesigning health care systems and implementing safer practices.1 At the same time, health care providers continue to grapple with the ways in which institutions and caregivers respond when preventable injuries occur.2–5
Surgical Retrieval of a Transected Umbilical Artery Catheter
Authors: Mitchell Roderick Thomas , Thompson Richard , Thomas Sumesh
Published: November 2011

UMBILICAL ARTERY catheters (UACs) are commonly used in neonates and particularly in premature babies. They are crucial in enabling accurate blood pressure monitoring, blood gas analysis, and blood sampling. There is a relatively low rate of major complications with these catheters; however, complications may result from fracture or transection of the catheter.1,2Complications of retained UACs include hemorrhage and thromboembolic events. Long-term sequelae have also been described, including limb abnormalities as a result of ischemia and recurrent umbilical infection following unrecognized retained UACs.2,3We report a case of accidental transection of a UAC and subsequent migration of the catheter into the arterial circulation. This resulted in the premature baby requiring a laparotomy to retrieve the catheter. We describe the events leading to the transection, present its operative management, and offer suggestions for preventing this complication.
News of The Academy of Neonatal Nursing
Authors: Brott Shirley
Published: November 2011

Did you receive the premiere issue of Academy Connection in your e-mail inbox? With just a click of a mouse, ANN members can now stay up to date on hot nursing topics and educational opportunities. Membership renewals and recruitment reimbursements couldn’t be easier or faster. Designed to keep members current without crowding your mailbox or your time, Academy Connection is easy to navigate, interesting, and helpful.
Safety and Efficacy of Ibuprofen versus Indomethacin for the Treatment of Patent Ductus Arteriosus in the Preterm Infant: Reviewing the Evidence
Authors: Donze Ann , Smith Joan Renaud , Bryowsky Kristina
Published: November 2011

THE DUCTUS ARTERIOSUS IS a vascular shunt that exists before birth to enable blood flow to bypass the lungs, which are not yet functional, and direct it instead to the systemic circulation and to vital organs such as the kidney and the gastrointestinal (GI) tract. In the term infant, this shunt should start to close within the first few hours after birth; it should close functionally within 72 hours and anatomically within 2 weeks after birth.1 In the preterm infant, functional and subsequent anatomic closure frequently does not take place. Failure of ductal closure occurs in as many as 60 percent of all infants who are less than 28 weeks gestation at birth.1 Causes for patency of the ductus arteriosus in preterm infants include decreased smooth muscle fibers in the duct and continued responsiveness of the ductus arteriosus to prostaglandins produced within it.
Roles of Long-Chain Polyunsaturated Fatty Acids in the Term Infant: Developmental Benefits
Authors: Mitmesser Susan Hazels , Jensen Craig
Published: November 2011

Docosahexaenoic acid (DHA) and arachidonic acid (ARA) are two long-chain polyunsaturated fatty acids (LCPUFAs) found naturally in human milk. DHA and ARA have been receiving increased attention from health care professionals and the public. Research suggests that DHA intake and status have a significant impact on visual and cognitive development in breastfed infants. For formula-fed infants, studies have shown mixed results from DHA or DHA plus ARA supplementation. There are several important differences among LCPUFA studies with term infants that may contribute to the differing results, including levels of LCPUFA added to the formula, variations in test methods, ages of infants evaluated, and sources of LCPUFA. Nevertheless, several expert groups recommend that infant formulas be supplemented with DHA and ARA. Recommendations for term infants for DHA and ARA range from 0.2 percent to 0.4 percent and from 0.35 percent to 0.7 percent of the fatty acids, respectively.
Letters
Authors: Clark Roberta
Published: November 2011

My name is Roberta Clark and I have subscribed to your journal for many years as well as published in it. I was recently reading an article in the March/April 2007 issue entitled “Potassium and Sodium Homeostasis in the Neonate,” and have a few questions. On page 127, Table 1 lists the common therapies for hyperkalemia, and the first question I have is what reference(s) did the author use to extrapolate that data? The formula for the insulin glucose infusion is very vague. It states that one should start insulin 0.2 unit/kg/hour with glucose 0.5 gm/kg/hour, and I am uncertain as to what this actually means. First of all, how does one calculate gm/kg/hour on a glucose infusion when the formula doesn’t give a specific concentration of glucose, or is this variable? Then I am curious about whether this is a supplemental infusion or included in the total glucose load for the patient. I retrieved articles number 4 & 12, as referenced in the section “Treatment of K+ Imbalance,” and found no information dealing with a specific gm/kg/hour rate of glucose infusion to be used with the initiaition of insulin for hyperkalemia.
The Role of the NNP in Facilitating Family-Centered Care
Authors: Bowen Nicole
Published: November 2011

THE NEONATAL NURSE practitioner (NNP) has come a long way since the 1970s. A profession that was once educated in certificate programs is now one in which each nurse practitioner is master’s prepared. The practitioner role has evolved from one of limited scope to its form as originally intended—an effective part of the collaborative team. The neonatal nurse practitioner collaborates not only with a physician, but with the entire NICU staff and family members. NNPs are excellent examples of the health care team approach that combines educated, research-based care with compassionate family-centered objectives.
Peripheral Intravenous Extravasation: Nursing Procedure for Initial Treatment
Authors: Thigpen Janet
Published: November 2011

Tissue extravasation resulting from intravenous (IV) infiltration can occur as a complication of neonatal intensive care with varying degrees of morbidity. Serious extravasation can result in pain, infection, disfigurement, prolonged hospitalization, increased hospital costs, and possible litigation. Although most infiltrates resolve spontaneously after the IV catheter is removed, IV extravasations and tissue sloughing do occur in NICU patients. Specific therapies are based on assessment of the degree of the injury. The goal in managing tissue damage after IV extravasation is to improve tissue perfusion and prevent progression of tissue necrosis. This article presents an initial approach to nursing care for peripheral IV infiltrations to guide clinicians in management of this complication. The approach is based on clinical experience, descriptive studies, and reports from expert committees.
News of The Academy of Neonatal Nursing
Authors: Brott Shirley
Published: November 2011

This year, for the first time, the 5th National Advanced Practice Neonatal Nurses Conference is seeking abstracts for podium presentations related to the conference theme, “Building the Evidence: Supporting the Practice.” Two topics have been selected for 20-minute presentations: (1) Ventilation: How do you ventilate very low birth weight infants to optimize lung volume and prevent lung injury? (2) Nutrition: How do you feed low birth weight infants? Posters addressing clinical and research issues and case studies are also welcome. Abstracts are due February 15, 2008. For guidelines and submission forms, please see pages 49–51 or go to academyonline.org or neonatalnetwork.com.
Conscientious Objection: A Potential Neonatal Nursing Response to Care Orders That Cause Suffering at the End of Life? Study of a Concept
Authors: Catlin Anita , Volat Deborah , Hadley Mary Ann , Bassir Ranginah , Armigo Christine , Valle Elnora , Gong Wendy , Anderson Kelly
Published: November 2011

This article is an exploratory effort meant to solicit and provoke dialog. Conscientious objection is proposed as a potential response to the moral distress experienced by neonatal nurses. The most commonly reported cause of distress for all nurses is following orders to support patients at the end of their lives with advanced technology when palliative or comfort care would be more humane. Nurses report that they feel they are harming patients or causing suffering when they could be comforting instead. We examined the literature on moral distress, futility, and the concept of conscientious objection from the perspective of the nurse’s potential response to performing advanced technologic interventions for the dying patient. We created a small pilot study to engage in clinical verification of the use of our concept of conscientious objection. Data from 66 neonatal intensive care and pediatric intensive care unit nurses who responded in a one-month period are reported here. Interest in conscientious objection to care that causes harm or suffering was very high. This article reports the analysis of conscientious objection use in neonatal care.