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Health sciences. (Abstracts).

COPING WITH FEAR: ASSISTING NEWLY DIAGNOSEL) TERMINALLY DISEASED PERSONS ENCOUNTERING FEAR OF DYING. Olaf Bothe. University of Alabama School of Nursing, University of Alabama at Birmingham, Birmingham, AL. 35294-1210

Death and dying are issues rather put aside and not talked about, even in the medical community. This study examines the issue of fear as experienced by persons dying of a terminal disease. This is a qualitative descriptive study. Data will be collected in direct interviews about terminally diseased persons' fear of dying. state of acceptance, and their perception of the closing process. Subjects will be interviewed within a few weeks after being admitted to a hospice program. The goal of the study is to reveal patterns of strategies patients use or desire to overcome fear, accept, and come to a closing before dying. The relevance of the information is to help educate caregivers in end-of-life care in order to help with guidance through this most difficult process. Data collection for the study met with initial barriers in areas of census-age limitations and subject readiness to participate. These barriers are listed as preliminary results. Taking these results in consideration modifications were planned to c ontinue the study until saturation is accomplished. Data collection is still in progress. Final results are not yet available.

CRITICAL CARE NURSES' ATTITUDES AND KNOWLEDGE RELATED TO ORGAN DONATION. Jacqueline E. Ingram and Ann Rayburn, RN, BSN, CPTC University of Alabama at Birmingham, School of Nursing. Birmingham, Alabama 35294

Recently, organ donation has become an interest to the public and health care professionals. The need for organ transplant has nearly quadrupled in the past decade, but the number of organ donors has remained relatively constant. The critical care staff is referred to as the vital link in the organ donation process. They are responsible for referring potential donor cases to an organ procurement organization. making tire request for donation, responsible for the initiation of the organ donation process, and supporting the family through this process. This influence places nurses in a position to increase the supply of organs for donation. Data was collected OADQ-II from 69 critical care nurses working in private arid transplant hospitals in the southeast This study investigated the relationship of attitudes arid knowledge level in critical care nurses, The study's finding suggest that nurses are favorable of organ donation, and this is correlated with their knowledge about organ (p = < .001). The sturdy found that the majority of nurses' had overwhelmingly positive attitudes toward organ donation, but they failed to act on their beliefs. I would like to thank all those involved who willingly gave of their time arid have showed such great interest in this study. I am particularly indebted to Dr. Ellen Buckner, Stephen Hunt. RN, MSN, Linda Suther, RN, the Alabama Organ Center, Phillip Nolan, and all the nurses who participated in the study.

CURRENT INFECTIOUS DISEASE THREATS. Robert E. Pieroni, Dept. of Internal Medicine, Univ. of Ala., Tuscaloosa, AL 35487.

Bioterrorism has been the subject of considerable discussions because of the recent anthrax attacks. Although the mortality rate from inhaled anthrax has been less than previously predicted, it still hovers around 50%. Various other infectious agents, such as smallpox, as well as toxins, e.g. botulism, are also capable of including high mortality. I shall discuss characteristics of agents that might be used by bioterrorists, including possible routes of transmission, incubation times, illness duration, lethality, and vaccine efficacy. My experience from receiving of the above vaccines during the Gulf War and in evaluating potential side effects in numerous vaccines will be described, as will misconceptions concerning the use of these vaccines. Potential dangers of mass smallpox vaccination, and appropriate antibiotic use against possible anthrax exposure will also be discussed.

EXERCISE DURING PREGNANCY: A RETROSPECTIVE LOOK AT THE FEMALE ATHLETE'S MOTIVATION AND SUPPORT SYSTEM. Kelly M. McAfee, University of Alabama School of Nursing, University of Alabama at Birmingham, Alabama 35294-1210.

High impact activity during pregnancy is a topic that is questioned by the general public and underestimated in terms of the effects it has for the athletic woman. High impact activity includes high mileage running, swimming, biking, teaching step acrobics or a combination of these, resulting in high intensity training. The purpose of this study is to evaluate the motivation support system responded to her exercise levels. This qualitative study includes data obtained by questionnaires form 13 postpartum athletes who continued their exercise regime throughout all 3 trimesters of pregnancy. The support system (a total of 26 husbands, mothers, friends and others) also responded via questionnaire to the athlete's decision to continue exercise during gestation. Athletes reported underlying motivations such as maintenance of body image, quicker postpartum recovery, stress relief, remaining healthy and desire for easier delivery. Most support system members were supportive and encouraging although some expressed co ncern and anxiety. Husbands (9/13) were identified as the program athlete's biggest advocate. Perceived benefits from exercise were numerous and varied, and all athletes reported exercise having a positive effect on labor and/or the recovery period.

METHYLATION INHIBITION BY PERIODATE-OXIDIZED ADENOSINE ENHANCES ARSENIC DEVELOPMENTAL TOXICITY IN MICE. Carol A. Lammon, Capstone College of Nursing, & Ronald D. Hood, Dept. of Biological Sciences, University of Alabama, Tuscaloosa, AL 35487.

Inorganic arsenic, given by injection to pregnant laboratory animals, can induce malformations. Arsenic methylation, which appears to be a detoxification step with respect to toxicity and teratogenicity, can be inhibited by periodate-oxidized adenosine (PAD). Severe human health effects from chronic arsenic exposure have mainly been reported in populations with significant levels of malnutrition, which may compromise arsenic methylating capacity. Our study sought to determine the effect of inhibition of arsenic methylation on the developmental toxicity of arsenic. PAD (100 [micro]M/kg, ip) was given to pregnant CD-1 strain mice 30 mm prior to 7.5 mg/kg sodium arsenite [As(III)j, ip, or 17.9 mg/kg sodium arsenate [As(V)], ip, on gestation day (GD) 8 (plug = GD 0). Control dams received As(III), As(V), or PAD alone or were untreated. Dams were killed on GD 17, and their litters were examined for mortality and gross and skeletal defects. Pretreatment with PAD prior to either arsenical resulted in increased mater nal toxicity, lower fetal weights, and higher prenatal mortality. Significant increases in the incidences' of exencephaly, ablepharia, and anomalies of the vertebral centra, sternebrae, and ribs were also caused by PAD pretreatment. These results demonstrate that the developmental toxicity of inorganic arsenic can be enhanced by PAD, possibly due to inhibited methylation of arsenic. Supported in part by a grant from Sigma Theta Tau International, Epsilon Omega chapter.

NUTRITIONAL ASSESSMENT IN HOSPITALIZED PATIENTS. Mary Green, L Ferguson, K. Logan, J. Roy, S. Gaskins, J. Lipscomb, B. Wilhite, S. Copeland, M.A. Murdock, R. E. Pieroni, DCII Regional Medical Center, Tuscaloosa, AL 35401.

Malnutrition, unfortunately, still occurs, all too frequently in both acute- and long-term care facilities and is related to increased morbidity and mortality. Since prevention is paramount, assessment of early markers of nutritional status continues to be extremely important. Prealbumin (PA). a negative phase transport protein, has been shown to be a sensitive and early indicator of the adequacy of nutritional support. However, its levels are affected by acute phase reactions such as sepsis and a variety of pathological and inflammatory states. Since C-Reactive Protein (CRP) increases during stressful conditions, a negative correlation between PA and CRP would be expected. We evaluated results of sequential monitoring of both PA and CRP in over 300 patients receiving parental nutrition for an average of 12 days. Such measurements were found to be extremely helpful in assessing adequacy of nutritional support, and in interpreting non-rising PA levels, especially during septic states. The results demonstrated that monitoring PA and CRP offers the practitioner an additional marker for assessing effectiveness of nutritional support--an area of vital concern for all health care providers.

PAIN PERCEPTION IN NURSING I HOME PATIENTS. Robert F. Picroni, Dept. of Internal Medicine, Univ. of Ala. luscaloosa, AL 35487.

In both acute-- and long--term care facilities pain is frequently unaddressed, undocumented and unrelieved. This is especially true of older, demented patients who can experience pain from a variety of sources. Management of pain is an important indication of a facility's quality of care. Demented patients often display markedly atypical pain behaviors which may be unrecognized by inexperienced and/or inadequately trained health care workers. Untreated pain can result in physical and mental alterations through a variety of mechanisms involving numerous organ systems. It can also result in considerable increase in morbidity and even mortality. I shall discuss common myths concerning pain control especially the frequently unwarranted concern about addiction from the use of narcotic analgesics. Pain assessment tools, such as the "Assessment of Discomfort in Dementia" (ADD) protocol will be discussed, as will appropriate measures to alleviate, to the extent possible, pain and discomfort in patients who frequently cannot verbalize extremely painful situations.

THE RELATIONSHIP BETWEEN SELECTED VARIABLES AND EXERCISE PATICIPATION IN FIREFIGHTERS IN BIRMINGHAM. ALABAMA. Yotaka Pakapong and Michael Weaver Sch Nursing, Univ of Ala, Birmingham, 35205 James Hilyer, The Birmingham, Fitness Center, Birmingham, AL, 35205.

The benefits of exercise have been widely recognized. However, only 20% of people in the United States exercise regularly Physical fitness is essential for firefighters to perform required job tasks and reduce risk for chronic diseases and workplace injury (Hilyer, et at 1999, Sorensen, 2000; Weaver, et at, 2001) Regular exercise at moderate intemit for 30 min/session at least 3 days a week can enhance and improve physical and mental fitness. Many studies have examined factors that influence exercise participation, but few studies have specifically examined firefighters. This study sought to determine the relationship between a set of demographic and Theory of Reasoned Action (TRA) -- derived variables and exercise behaviors in firefighters in Birmingham, Alabama

This study used a non-experimental, correlational design with a convenience sample of 246 participants. All participants completed a questionnaire containing questions about demographics, exercise behaviors, attitudes, subjective norms, and intention to exercise. Correlation analysis was used to test the relationship between exercise participation and selected TRA and demographic variables. The results of this study suggest that Age, Physical Health, Attitude, & Intention have a significant positive relationship with exercise participation. However, only a small amount of exercise behavior variability was explained by each variable. Further study incorporating (a) a multi-variable approach, (b) variables in addition to those in the TRA, or (c) use of a different theoretical framework may produce higher levels of explanation In addition, exmination of these associations in a more heterogeneous sample may result in improved explanatory power

SCHOOL SCREENING OF SCOLIOSIS: ARE THE COSTS JUSTIFIED? Tom E. Denton, Dept. of Biology, Auburn University at Montgomery. Montgomery, AL 37 117.

The U.S. Preventive Services Task Force released its findings almost 10 years ago concerning the disadvantages of school screening for scoliosis. Reliability, predictability, and costs of screening procedures were challenged. The American Academy of Pediatrics. The American Academy of Orthopedic Surgeons, and the Scoliosis Research Society have refuted many of the USPSTG interpretations. Screening costs are difficult to determine because of the various methods used by any of the 33 states that require annual examination of school children. T he Adams forward bending test is the simplest screening method and it is also the most economical. Costs amount to pennies per student because trained health nurses or physical education personnel can complete tests and transmit results for hundreds of students in less than a day. However, this method is also the least accurate. Costs escalate as technological procedures are used to improve reliability. Moire analysis and radiology can cost up to $60 per child. Radiology constitutes the gold standard of methods but these tests are both invasive and potentially harmful. This lack of a low cost and reliable scoliosis screening standard speaks to the problems cited by the USPSTG. In the meantime, the Adams test should not be abandoned. Without economical school screening, many children, especially those from low income families, will be disadvantaged by not having examinations during a time when their spines are undergoing rapid developmental changes.

TEACHING INTERNAL MEDICINE: A RURAL PRECEPTORSHIP. E. Ray Stewart, John R. Wheat, M.D., MPH, Robert E. Pieroni, M.D. The University of Alabama Department of Rural and Community Medicine, Tuscaloosa, AL.

Throughout the state of Alabama, there are a considerable number of medically underserved communities. The lack of physician access, locations of hospitals, and geographical isolation all play major roles in creating this situation. The University of Alabama in conjunction with the University of Alabama at Birmingham (UAB) has developed a number of programs designed to infuse primary care physicians into rural and underserved areas of the state. For the most part, each of these programs focuses primarily on training family practice physicians. Family practice is a valuable, much needed component of primary care in rural areas. However, the programs in place need to be expanded to address the lack of internists in underserved areas. Rather than developing a new method of training students in rural internal medicine, it was decided that existing programs should be reviewed. The review was conducted through a literature search, personal interviews and e-mail. In addition, it is important to garner an understandi ng of the rural communities in the state of Alabama to determine possible sites of community-based training. Through the knowledge gained from program reviews, it will be possible to address the issues and concerns surrounding the development of a rural internal medicine preceptorship for the state of Alabama.

THROMBOCYTOPENIA AND IRON DEFICIENCY ANEMIA IN A YOUNG MALE: AN UNUSUAL PRESENTATION. Salih Faldon. Robert E. Pieroni Internal Medicine, Univ. of Ala., Tuscaloosa, AL 35487.

A 23-year-old male with a past history of "blood not clotting properly" presented to our emergency department (ED) with complaints of sinusitis and epistaxis. His hemoglobin and platelets were decreased; oilier coagulation studies were normal. Available records indicated that lie had experienced several bleeding episodes requiring RBC and platelet transfusions. Bleeding was First noticed after circumcision and he was diagnosed as having "Glanzmann's syndrome" which is a thrombasthenia ("weak clot") in which the bleeding time is prolonged because platelets fail to aggregate properly due to of a platelet membrane defect. Unlike our patient, the platelet count is usually normal. Shortly after his initial ED visit the patient bleed profusely. Hemoglobin decreased from 7.2 to 4.9 and lie required immediate transfusion of 3 units of packed cells. The bleeding was felt secondary to erosive gastritis for which he was treated. In view of his marked iron deficiency lie was placed on parenteral iron. Several published r eports indicate that severe iron depletion can lead to thrombocytopenia, which we feel explains the atypical nature of his Glanzmann's syndrome, i.e. both qualitative and quantitative platelet abnormalities.


Nurses at every level need to speak with knowledge, confidence, and poise. The ability to communicate in a manner that influences others to achieve goals is key to personal and professional success. In today's expanded role of nurse managers (NM) and chief nurse executives (CNE), the ability to manage across disciplines is critical. As primary spokespersons for clinical practice, the NM and CNE must communicate at the conference table with multidisciplinary teams to establish collaborative relationships and foster shared outcome accountability. My teaching strategy of video recording student presentations in nursing administration graduate courses is a result of my studies of shift reports videotaped in the clinical setting. These studies indicate that specific behaviors either promote or hinder information exchange and a collegial environment. The framework for this teaching approach is Chinn's art of criticism, that is, the use of feedback to impart positive messages that provide an interpretation to the ot her or the self of which the person(s) may not have been aware. The classroom videotaping of students' presentations is done in conjunction with self-assessments of their verbal and nonverbal behaviors in sequential courses. This method provides formative and summative benchmarks for the instructor and students. During the courses and following graduation, students have found that videography is a helpful educational intervention, noting that it lets them see where they need to modify their actual behavior patterns to achieve the behavior standards they set for themselves.
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Publication:Journal of the Alabama Academy of Science
Date:Apr 1, 2002
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