Can. J. Chem. 58, 1372 (1980. Thermodynamic parameters for the self-association of N-methylformamide and N-methylacetamide in CCI, solvent have been determined by infrared spectroscopy. The pure base calorimetric method was used to determine the enthalpy of hydrogen bond complex formation of N-methylformamide and N-methylacetamide with N,N-dimethylformamide, N,N-dimethylacetamide, ethyl acetate, and dioxane. Comparison of the calorimetric and spectroscopic results show that the dimers of N-methylformamide and N-methylacetamide are linear with hydrogen bond enthalpies of -2.9 and -3.9 kcal mol-' respectively. The carbonyl group of N-methylacetamide was found to be a better proton acceptor than the carbonyl of N-methylformamide in agreement with theoretical predictions. N-methylacetamide was found to be a better proton donor than N-methylformamide in disagreement with theoretical predictions. The dimer self-association constants appear to be larger than previously reported.
Frequent guidewire changes of single-lumen (SLC) and triple-lumen (TLC) catheters have been proposed to decrease catheter sepsis. We placed TLC in 126 patients needing total parenteral nutrition (TPN) and multiple venous access, prospectively randomizing them to two groups: group I received a guidewire change every 3 days, and group II received guidewire changes for mechanical or septic complications only. Tips were cultured at each line change and tips and blood for each septic episode. Catheter sepsis was defined by the criteria of the Association for Practitioners in Infection Control (APIC). There were 67 positive cultures in 52 patients, but most produced very few colonies or grew the same organisms in other infection sites. Forty-seven% of all cultures grew Staphylococci, and 23% grew Candida. APIC-defined catheter sepsis was detected in 12.7% of group I and 15.9% of group II. Although we observed no statistically significant difference in the two techniques, if we assume that a 20% difference in the incidence of catheter-induced sepsis would be important to detect, the probability of failing to detect such a difference is 0.24 with an 0.05 level of significance (two-sided). Prophylactic guidewire changes did not alter the incidence of catheter sepsis in patients with TLC who required TPN. The high rate of sepsis and Candida infection may be due to the critical illness of the immunocompromised population studied.
Nurses practicing in long-term care facilities were surveyed on the adequacy of their nutrition education, nutrition knowledge, and general attitudes about the diet of elderly residents. While 78% of the 95 responding nurses reported taking a required nutrition course during their training, only 61% indicated the quantity of their nutrition education was sufficient and 66% indicated the quality of their education was sufficient. The mean nutrition knowledge score was 60% correct with 51 subjects scoring at this level or less. Since the nurse is such an important caregiver for the institutionalized elderly it is recommended that more emphasis be placed upon nutrition of the elderly in the nurses' education as well as the provision of more inservice training for practicing nurses utilizing the registered dietitian.
A prospective, randomized study compared the use of Opsite and standard gauze/tape dressings in 261 patients receiving parenteral nutrition. Eighty-four patients had a source of external drainage and were evaluated as a separate group. Catheter-related sepsis was assessed by blood culture, catheter tip culture, clinical sepsis, and clinical defervescence of fever after catheter removal. Although no statistically significant difference between Opsite and standard dressings could be identified, Opsite-treated patients consistently had increased parameters of catheter-related sepsis in all comparisons. As used here, Opsite is probably not a suitable catheter dressing system for parenteral nutrition.
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