Kay Weiler

Onset of action, efficacy, and safety of fexofenadine 60 mg/pseudoephedrine 120 mg versus placebo in the Atlanta allergen exposure unit

BACKGROUND Second-generation antihistamine-decongestant combinations are often used to treat seasonal allergies. However, onset of action and efficacy data for these agents in a controlled setting are limited. OBJECTIVE Determine onset of action of fexofenadine-pseudoephedrine (Allegra-D, Aventis, Bridgewater, NJ) for treating moderate-to-severe seasonal allergies in an allergen exposure unit. METHODS This single-dose, double-blind, placebo-controlled study was conducted during the fall ragweed allergy season. Qualifying subjects attended one to two priming visits; those with sufficient symptom scores returned for treatment and were initially exposed to ragweed pollen for 90 minutes. Symptomatic subjects received fexofenadine-pseudoephedrine or placebo and recorded symptoms for 6 hours postdose. Efficacy variables were major symptom complex (MSC; sneezes, itchy nose, runny nose, watery eyes, itchy eyes, itchy ears/throat, stuffy nose), total symptom complex (nose blows, sniffles, postnasal drip, cough, plus all MSC symptoms), and all individual symptoms as well as headache. Onset of action for each efficacy variable was calculated as the earliest time at which a consistent, significant decrease was seen for fexofenadine-pseudoephedrine versus placebo. RESULTS Of 571 screened subjects, 298 were randomized. Onset of relief for fexofenadine-pseudoephedrine (n = 148) was 45 minutes postdose (MSC, P = 0.0127; total symptom complex, P = 0.0380). All individual symptoms were reduced to a greater extent with fexofenadine-pseudoephedrine than with placebo (P < 0.05, not adjusted for multiple comparisons). Decrease in headache with fexofenadine-pseudoephedrine versus placebo began 45 minutes postdose (P = 0.0425). Incidence of treatment-related adverse events was 1.4% for fexofenadine-pseudoephedrine and 3.3% for placebo. CONCLUSIONS Fexofenadine-pseudoephedrine was safe and effective in treating a broad range of allergy symptoms, with a rapid onset of action at 45 minutes.

Special care units for people with Alzheimer's disease. Only for the privileged few?

The number of Special Care Units (SCUs) for people with Alzheimers disease (AD) in nursing homes have increased dramatically in the past 10 years. Despite the rapid increase in number of SCUs and the concern that most SCUs report higher costs than traditional nursing home units where residents with AD are integrated with cognitively intact residents, the evaluation of costs has been largely unsystematic and noncomparative. Studies are urgently needed to assess comparative costs so that administrators and policy makers can make informed decisions. This article reviews studies that examine the costs of care in SCUs and presents cost-related data comparing the outcomes of care for residents with AD on a SCU and on traditional units in one long-term care setting.

Responsibilities of Nursing Education: The Lessons of Russell v Salve Regina.

In August 1985 Sharon Russell was dismissed from Salve Regina College just before her senior year of nursing education. The reasons given for her dismissal focused on Russells obesity and her inability to lose weight. The issues raised by this case pose important questions that nursing programs and nurse educators must address. This article explores the questions raised by Russell: (1) What constitutes substantial compliance with both academic and nonacademic performance criteria in a contract between a student and an educational institution? (2) What duties to preserve the privacy interests of students may be imposed on programs and educators? Ms Russells case has been settled. She established that she had met the terms of the contract and substantially complied with the academic and nonacademic criteria of the nursing curriculum. She was awarded monetary damages for the colleges breach of contract in nonperformance of an agreement to educate. She did not prevail in her claims of intentional infliction of emotional distress or invasion of privacy. She did, however, put nursing education programs on notice that colleges and universities are not immune from these contractual challenges and must demonstrate respect and consideration for students personal concerns.

Efficacy and safety of clemastine-pseudoephedrine-acetaminophen versus pseudoephedrine-acetaminophen in the treatment of seasonal allergic rhinitis in a 1-day, placebo-controlled park study

BACKGROUND Allergic rhinitis afflicts more than 40 million people in the United States and is a leading cause of reduced productivity at work and in school. Patients with allergic rhinitis have a wide range of symptoms that are often treated with oral combination products that contain antihistamines, decongestants, and analgesics. OBJECTIVE To evaluate the onset of action and the extent of efficacy and safety of a combination (CPA) of clemastine (0.68 mg), pseudoephedrine (60 mg), and acetaminophen (1,000 mg) versus a combination (PA) of pseudoephedrine and acetaminophen versus placebo in the treatment of seasonal allergic rhinitis (SAR). The primary goal was to evaluate the benefit of adding clemastine to the PA combination product to treat the symptoms of SAR. METHOD A 1-day, multicenter, double-blind, double-dummy, randomized, parallel-group park study was organized, and medication was given at 9:00 AM and 3:00 PM. RESULTS A total of 298 subjects participated at two outdoor facilities. The primary efficacy outcome was the major symptom complex score averaged over the period of 2 to 5 hours after each dose. Mean absolute and percentage reduction in major symptom complex averaged over the period of 2 to 5 hours in the CPA group was significantly superior to those of either the PA (P < 0.01) or placebo (P < 0.03) groups. Somnolence, fatigue, and nausea were the most common volunteered adverse events; only somnolence was significantly greater after CPA than after either PA or placebo. CONCLUSIONS Treatment with CPA was safe and highly effective in reducing symptoms associated with SAR. It was more effective than either PA or placebo over most of the postdose observation period.

The Affective Outcomes of Course Work on Computer Technology in Nursing

At the University of Iowa, nursing students are introduced to computer technology as one unit in a course designed to explore nursing as a profession. A single group, pretest/posttest design was used to evaluate changes in attitudes associated with the course work. Relationships of attitudes scores and eight background variables were studied. Posttest attitudes scores were significantly higher than pretest scores. The attitudes scores were positively related to skills scores at a statistically significant level of .05, with no significant relationship between attitudes scores and knowledge base scores. Four of the eight background factors were related to the attitudes scores at a statistically significant level of .05.

Aid-in-Dying: Issues and Implications for Nursing

A debate format describes questions arising from the Model Aid-in-Dying Act, drafted at the University of Iowas College of Law, and the implications for nurses. The Act allows patients or their named surrogates to demand or request active aid-in-dying. The Act requires nurses and other health care providers to comply with the qualified patients demand unless the health care provider is a registered conscientious objector.

Abuse among rural mentally ill

Each American adult has the right to make individual decisions. These decisions include preferences in lifestyle, occupation, diet, housing, health-care treatment, and allocations of financial resources. The right to autonomous decision making is not limited to young or middle-aged adults, nor is it limited to those occasions during which the individual has the capacity to personally participate in the decisions (US Congress, 1987). The right also applies to elderly, incapacitated, mentally ill, or dependent adults. Because of this autonomy, no individual must suffer physical, psychological, or financial coercion. Based on these rights, all 50 states have enacted statutes to protect dependent adults and to authorize government intervention in cases of suspected adult abuse (Hunzeker, 1990). Iowa is one of the states that has enacted dependent adult abuse legislation, and in 1988, health-care practitioners in Iowa became mandatory reporters of adult abuse (Iowa Code, 1992). As mandatory reporters, all nurses who treat, counsel, examine, or attend dependent adults must observe the physical status and interpersonal relationships of their clients and significant others to identify potential conflict or injury. Categories of abuse recognized by the Iowa law include physical, sexual, and financial abuse, neglect by self, and neglect by another (Figure).

Financial Abuse of the Elderly: Recognizing and Acting on It

1. Within a trust situation, one party (the trustee) holds the title and control of property, but has a responsibility to use the property for the benefit of another (the beneficiary). 2. A durable power of attorney is a written document in which one person (the principal) has granted another person (the agent or attorney-in-fact) the authority to act for him and the delegation of authority continues even if the principal becomes incapacitated. 3. A representative payee is a person or organization who receives payment as a substitute for the beneficiary. 4. A joint tenancy is a form of co-ownership in which two or more persons hold a single interest in property and each co-owner has the right of survivorship.

Use of substitute decision makers by the mentally ill rural elderly: an issue of concern for mental health nurses

In 1986, the Abbe Center for Community Mental Health implemented a nurse-led elderly outreach program (EOP) designed to identify and treat elderly rural residents in need of mental health care. Because some EOP clients evidenced a lack of or limited decision-making capacity, a record review was conducted to answer the following questions: Do any of the clients have a legal substitute decision maker? What are the forms of substitute decision making? Is there a familial relationship between the elderly client and the substitute decision maker? Is there evidence that any of the named legal substitute decision makers have abused the elder? Almost half the clients who had a substitute decision maker used a power of attorney. Adult children were the most frequent family members named as substitute decision makers. Four records indicated that an adult child had been given a power of attorney and that the child had potentially abused the parent. Implications for mental health nurses dealing with this vulnerable population are set forth.

A comparative study: guardianship petitions for adults and elder adults

1. The appointment of a guardian is the result of a court proceeding that transfers to another an individuals authority to make personal decisions. 2. Gerontological nurses may be asked to assist clients and families in the resolution of problems concerning personal and health care treatment decisions. 3. This study showed that adults younger than 65 years old needed a guardian due to mental retardation, mental illness, or accidental injury. Adults over 65 years old needed a guardian because they had mental retardation, alcoholism, dementia, or other physical disabilities. 4. Immediate family members were most often the individuals to serve as guardians.