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Background: This study examined the role of glucocorticoids (GC) and interleukin-1 (IL-1) in regulating the production of brain prostaglandin E2 (PGE2) in response to surgical stress. Methods: Surgical stress was induced in rats by laparotomy or exploration of the carotid. PGE2 ex vivo production was measured in the frontal cortex or central amygdala of adrenalectomized rats, or of rats treated with either the GC type II receptor blocker (RU38486) or synthetic GC (dexamethasone). IL-1 involvement in mediating PGE2 response to surgical stress was examined in IL-1 receptor type I deficient (IL-1rKO) mice. Results: Surgical stress elevated serum corticosterone and increased PGE2 production by the frontal cortex and the central amygdala. A more pronounced PGE2 response was found in adrenalectomized rats and in rats treated with RU38486, whereas administration of dexamethasone inhibited stress-induced PGE2 production. IL-1rKO mice exhibited lower PGE2 production in the frontal cortex under basal condition and failed to increase PGE2 production in response to surgical stress. Conclusions: Surgical stress-induced production of brain PGE2 is specifically regulated by GC via the mediation of type II corticosteroid receptors. Normal IL-1 signaling is required for the production of brain PGE2 under basal conditions and in response to surgical stress.

Establishing a positive patient care environment is one of the most basic concepts of health care professional practice. Dress and personal address are aspects of this environment that are influenced by culture and express mutual respect within the patient-provider relationship. The Patient Sensitivity Questionnaire was administered to determine how 76 Israeli inpatients perceived forms of address and dress in their health care environment. Patients preferred that their health care providers wear formal dress and be addressed by their formal titles. Respondents did not object to being addressed by their first names. Based on these results, it would seem that this Israeli sample preferred to retain the traditional provider-patient environment.

Knowledge levels and attitudes of staff nurses in Israel towards complementary and alternative medicine Aims. The purpose of this study was to determine the knowledge level and attitudes of Israeli nurses towards complementary and alternative medicine and what factors are related to these variables. Background. Over recent years there has been increased interest among the lay public and health care professionals in complementary and alternative medicine (CAM). Previous studies have shown that several variables such as education, income, age, perceived health status and satisfaction with medical therapy are associated with use of CAM. Conflicting reports were found with respect to the relationship between health locus of control and the use of CAM. Israel is a small country comprised mostly of immigrants from vastly differing cultures with differing beliefs about health and health care. Nurses whose origins are similar to the general population are also caregivers who are used to integrating diverse therapies into the plan of care devised with the client. No study was found which investigated these issues among Israeli nurses. Design/methods. A systematic random sample of 369 staff nurses working at a major academic medical centre in Jerusalem, Israel were invited to participate in the study. Informed consent was obtained. Four self-administered, pencil and paper, questionnaires were distributed to the study participants: a questionnaire designed by the authors to determine the level of knowledge and attitudes towards complementary and alternative medicine; a questionnaire which measured satisfaction with the patient–physician relationship; a questionnaire which measured health locus of control; and a demographic questionnaire. Participants received a packet containing the questionnaire and a note explaining the study. The anonymous questionnaires were collected by the ward secretaries and sent in bulk to the researchers. Results. Results demonstrated that nurses in this sample perceived that they had little knowledge of complementary and alternative medicine but were very interested in learning more. Few used complementary and alternative medicine in their nursing practice but levels of personal use were similar to that of the general population. Nurses who used complementary and alternative medicine were satisfied with their care. Conclusions. In general, nurses tended to be wary of the use of complementary and alternative medicine. Nurses were also not satisfied with their relationships with their physicians. Those of middle age were more likely to use complementary and alternative medicine but no other demographic characteristics were associated with knowledge or attitudes towards complementary and alternative medicine. Nurses had higher levels of internal health locus of control which was associated with more positive attitudes and knowledge levels of complementary and alternative medicine.

In the present study, we examined the mechanisms involved in the activation of the adrenocortical axis following surgical stress. Adult male rats underwent surgical laparotomy or craniotomy under ether anesthesia while control rats were only ether-anesthetized. Four hours following laparotomy or craniotomy, serum adrenocorticotropin (ACTH) and corticosterone (CS) were significantly increased and returned to almost basal levels after 24 h. Laparotomy also caused a significant depletion of corticotropin-releasing hormone (CRH-41) in the median eminence (ME). Pretreatment with dexamethasone 50 μg/kg completely abolished the pituitary-adrenal response while pretreatment with type II corticosteroid receptor antagonist caused a significant hypersecretion of both ACTH and CS and inhibited the effect of dexamethasone. The response to laparotomy was markedly attenuated in rats injected with 6-hydroxydopamine into the paraventricular nucleus (PVN) which significantly depletes norepinephrine (NE) PVN content. Intracerebroventricular injection of interleukin-1 receptor antagonist (IL-1ra) also inhibited the pituitary-adrenal response to laparotomy. The results suggest that (1) surgical stress activates the hypothalamo-pituitary-adrenal (HPA) axis via a mechanism which involves the release of CRH from the ME and NE input to the PVN; (2) the adrenocortical response is sensitive to the negative feedback of glucocorticoids via the mediation of type II glucocorticoid receptors, and (3) central IL-1 may be a mediator in the HPA axis response to surgical stress.

It has been shown that the hypothalamic-pituitary-adrenal (HPA) axis responses to immune-derived stimuli in particular can be modulated by nitric oxide (NO). In the present study we examined the effect of endogenous and exogenous NO on the HPA axis responses to neural stimuli which are not related to immune functions. Intracerebroventricular injection of NOR-3, a donor of NO, had no effect on basal HPA axis activity but significantly attenuated the secretion of median eminence (ME) CRH-41 as well as the serum ACTH and corticosterone (CS) in response to acute photic stimulation in a dose-dependent manner. Intracerebroventricular administration of N-ω-nitro-L-arginine methyl ester (L-NAME), a general NOS inhibitor, significantly enhanced ACTH and CS responses to this stress but did not change the basal levels of these hormones. On the other hand, i.c.v. injection of aminoguanidine, an inhibitor of inducible NO synthase (NOS) but not of neuronal NOS, did not affect the HPA axis responses to photic stimulation. These results suggest that: (1) NO is involved in modulation of the HPA axis responses to neural stimuli which are not dependent on immune factors, (2) the effect of NO is mediated by inhibition of hypothalamic ME CRH-41 secretion, and (3) this effect is probably mediated by neuronal NOS and not by inducible NOS.

A relationship begun in 1985 between the University of Pennsylvania School of Nursing and the Henrietta Szold Hadassah/Hebrew University has included a student exchange program and a faculty mentoring partnership. The student exchange focused on maternal-child nursing and led to the development of the faculty mentoring program. The goals of the latter program are to increase the expertise of the Israeli nursing faculty in the development of grant applications, publications, and abstracts and to develop a National Institutes of Health-supported research project with an Israeli nursing faculty as principal investigator.

The purpose of this study was to try to elucidate a possible biobehavioral mechanism associated with decreased immune function in trauma patients by determining whether there is an interaction between the effects of ACTH, a stress hormone, and TGF beta, a cytokine, on peripheral blood lymphocyte proliferation. Peripheral mononuclear lymphocytes (PMLs) from healthy donors were preincubated with varying concentrations of ACTH for 24 hr, stimulated with concanavalin A and increasing concentrations of TGF beta, and incubated for 72 hr. Proliferation was assayed by tritiated thymidine incorporation. A parallel aliquot of PMLs were incubated in the presence of ACTH to determine the direct effect of ACTH on mononuclear cell TGF beta production. While harvested supernatant from cells incubated in the presence of ACTH did not contain any detectable TGF beta, ACTH as well as TGF beta were found to significantly decrease cellular proliferation independent of one another. An even greater decrease in cellular proliferation was found when both ACTH and TGF beta were used, compared to either ACTH or TGF beta alone. These results suggest a biobehavioral interaction between ACTH and TGF beta at the cellular level and that interactions to relieve stress may assist in improving function and recovery from trauma.

This article describes and discusses trends in trauma nursing research from 1988 to 1993, and provides a basis for evaluating this type of research. Trauma nursing research is divided into several topics: trauma prevention, prehospital care, acute care, outcome and rehabilitation, trauma systems and health policy, and trauma nursing education and administration. Variables specific to trauma, such as the trauma score, are identified and described. The contents of a research article and a means of evaluating each section of such literature are discussed.

Surgical stress is the combined result of tissue injury, anesthesia, and postoperative pain. It is characterized by elevated levels of adrenocorticotropin (ACTH), corticosterone (CS), and elevated levels of prostaglandin E2 (PGE2) in the periphery and in the spinal cord. The present study examined the effects of perioperative pain management in rats undergoing laparotomy on serum levels of ACTH, CS, and on the production of PGE2 in several brain regions, including the amygdala. The amygdala is known to modulate the pituitary-adrenal axis response to stress. We, therefore, also examined the effects of bilateral lesions in the central amygdala (CeA) on laparotomy-induced activation of the pituitary-adrenal axis in rats. In the first experiment, rats either underwent laparotomy or were not operated upon. Half the rats received preemptive analgesia extended postoperatively, the other received saline. ACTH, CS serum levels, and ex vivo brain production of PGE2 were determined. In the second experiment, rats underwent bilateral lesions of the CeA. Ten days later, rats underwent laparotomy, and ACTH and CS serum levels were determined. Laparotomy significantly increased amygdala PGE2 production, and CS and ACTH serum levels. This elevation was markedly attenuated by perioperative analgesia. Bilateral CeA lesions also attenuated the pituitary-adrenal response to surgical stress. The present findings suggest that the amygdala plays a regulatory role in mediating the neuroendocrine response to surgical stress. Effective perioperative analgesia attenuated the surgery-induced activation of pituitary-adrenal axis and PGE2 elevation. The diminished elevation of PGE2 may suggest a mechanism by which pain relief mitigates pituitary-adrenal axis activation.

The purpose of this research was to compare the experience of social support of Israeli and Chinese husbands of women with breast cancer. Social support was examined from three different sources: wives, friends and family, and the healthcare team. This study is part of a larger descriptive comparative study investigating the husbands' adjustment to their wives' diagnosis of cancer. A convenience sample of 50 husbands from each cultural framework was selected. Support from family and friends and the healthcare team was measured by items from the Social Support Questionnaire (SSQ), the Psychosocial Adjustment to Illness Scales (PAIS) and questions developed by the authors. Israeli husbands reported significantly higher levels of support in all three areas. Chinese husbands were significantly more interested in joining a support group. The results of this study show that culture has an impact on spousal responses to their wives' illness. In developing appropriate breast cancer nursing, nurses need to practice sensitivity and awareness of the cultural differences in order to provide culturally sensitive family oriented nursing care. This study is an ongoing effort of collaboration between nursing professionals from the far east and the middle east.

Psychoneuroimmunology is the study of the interactions among behavior, neural, and endocrine functions and the immune system. The purpose of this review is to briefly summarize the evidence concerning interactions among behavior, the neuroendocrine system, and the immune system, and to show how this evidence relates to critical care patients. It has been shown that the immune function of many patients in the intensive care unit is suppressed as a result of trauma, sepsis, or profound physiologic and psychological stress. Three of the most common stressors among patients in the intensive care unit are pain, sleep deprivation, and fear or anxiety. Findings have shown each of these stressors to be associated with decreased immune functioning. Nurses have an important responsibility to protect their patients from infection and promote their ability to heal. Several actions are suggested that can help the nurse achieve these goals. It is hoped that nurses would keep these interactions in mind while caring for their patients in the intensive care unit.

There is a concern among healthcare providers regarding the use of gloves in non-mandated clinical situations and its impact on patient sensitivities. A convenience sample of 76 Israeli hospital inpatients were surveyed to measure patients' attitudes towards the use of gloves by healthcare providers. The Patient Sensitivity Questionnaire (PSQ) was developed and used to collect the data. Overall, patients were found to have a positive attitude towards the use of gloves in most patient care situations. Significant differences in patient attitudes towards glove use were found based on country of origin and number of hospital admissions in the previous year. The study concluded that hospitalized patients, in general, support healthcare providers' use of gloves. In addition, subjects agreed with the (American) Occupational Safety and Health Administration regulations regarding glove use.

In this study, the use of physiologic variables is described in research reports published 1989-1993 in four broad-based research journals. The National Institute for Nursing Research (NINR) emphasizes the need for more physiologically based nursing research. This analysis documents the current number and proportion of such research reported in four journals during a 5-year period. Each report was evaluated for the population sampled, type of physiologic variable, type of study, definitions, and reporting of reliability and validity measures. Among the 763 reports, 114 (15%) examined physiologic variables. The most frequently studied physiologic variables were blood pressure, heart rate, and body temperature. The majority of studies posed and answered a clinical nursing question, and the study populations sampled were adults. Theoretical and operational definitions were included in most reports. Evidence of reliability and validity analysis were in 36% and 60% of the reports respectively. Although most nursing research focuses primarily on psychosocial aspects of care, several conceptual and psychometric issues were also addressed in studies that examined physiologic variables.

The financial realities of the current health care arena make it imperative that deliverers of trauma care initiate programs that reduce the cost of trauma. Triage can be one process that attempts to attain this goal. Once patients are assigned to a Level I trauma center, it is possible to triage patients again to complement field triage. A two-tiered, inhospital trauma response system was developed in which different team responses are initiated depending on the patient status. This tiered, in-house response system differs with respect to human and material resources. Personnel, operating room, laboratory work, and protective wear savings account for approximately $1,042 per code patient, yielding an annual $629,404 institutional savings. [DeKeyser FG, Paratore A, Seneca RP, Trask A: Decreasing the cost of trauma care: A system of secondary inhospital triage. Ann Emerg Med April 1994;23:841-844.]

Objective: To examine job satisfaction among trauma surgeons. Design: Cross-sectional mail survey. Setting: Hospital-based trauma care. Participants: Trauma surgeons in the United States and Canada. Main Outcome Measures: A 20-item Likert satisfaction questionnaire, three open-ended questions, and demographic data. Results: Survey respondents were slightly dissatisfied with providing trauma care. The greatest sources of dissatisfaction were extrinsic, such as poor hours, low pay, and interference with a daily schedule. The major sources of satisfaction were personal, such as the challenging and rewarding nature of operative trauma care. Satisfaction was not statistically related to most aspects of the work environment or personal characteristics. Conclusions: Survey respondents strongly affirmed that operative trauma care was satisfying and that saving lives was challenging and rewarding. However, 40% of these respondents were seriously considering withdrawing from the trauma call roster. (Arch Surg. 1996;131:627-631)

Three nursing positions were created to effectively manage the Trauma Nurse Coordinator (TNC) role and responsibilities: Trauma Director, Clinical Nurse Specialist and Trauma Researcher. By using this innovative approach, the quality of trauma care improved as shown by decreased complication rates, lengths of stay, and trauma costs. In addition, trauma referrals, research and education increased.

Purpose: To provide this second 10-year review of nursing research on blood pressure (BP) and to focus attention on incorporating biopsychosocial factors affecting BP in nursing research. Organizing Construct: Blood pressure is a dynamic, multidimensional, cardiovascular indicator of a person's state rather than a one-dimensional static measurement. Methods: This 10-year literature review 1990–1999 included 54 nursing research articles with BP as an outcome measure. Four nursing research journals were reviewed to identify all nurse-authored articles investigating BP as an outcome variable in adult populations. Inclusion of individual characteristics, environmental factors, dynamic nature of blood pressure, and interpersonal aspects of blood pressure were assessed for each article. Findings: Age, gender, and health status were mentioned consistently in both decades. Reporting of socioeconomic, occupational, educational, activity, and martial status remained low. Descriptions of environments increased, and automated devices were the most common method for BP assessment. Less than half of the articles included a description of the person measuring the BP. Measurement of BP under multiple conditions increased, but measurement within conditions did not. Conclusions: Advances in technology and data analysis have increased knowledge of the dynamic nature of BP, but recognition of the complex nature of BP has not progressed rapidly over the last 2 decades.