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T he d ig ita l a g e has re v o lu tio n iz e d h o w in d iv id u a ls in te ra c t. The n u m b e r o f c o m p u te r users has increased e x p o n e n tia lly , a lo n g w ith e x p a n d in g local a n d g lo b a l n e tw o rk s a n d o p p o rtu n itie s f o r le a rn in g , e n te rta in m e n t, an d s u p p o rt. M o s t recently, cyb e r c o m m u n ic a tio n is b e c o m in g a n im p o r ta n t p a rt o f fa c e -to -fa c e social w o r k p ra c tic e as an a d m in is tra tiv e a n d th e ra p e u tic e xch a n g e b e tw e e n p ra c titio n e rs a n d clie n ts , w ith b o th b e n e fits a n d ch a lle n g es.T he p u rp o s e o f th is a rtic le is t o p re s e n t results o f a s tu d y th a t used g ro u n d e d th e o r y t o e x p lo re th e a p p lic a tio n a n d a d a p ta tio n o f in fo rm a tio n a n d c o m m u n ic a tio n te c h n o lo g y (ICT) in tra d itio n a l c lin ic a l social w o r k p ra c tic e w ith in o rg a n iz a tio n s a n d p riv a te p ra ctice . T he o v e rw h e lm in g fin d in g w a s th a t it is n o lo n g e r po ssib le n o t t o e n g a g e in th e use o f ICT. W e discuss im p lic a tio n s f o r p ra ctice , in c lu d in g clin ica l, p ra c tic a l, a n d e th ic a l b e n e fits a n d issues o f ICT. IMPLICATIONS FOR PRACTICE• F ind in g s s h o w th a t p ra c titio n e rs o rie n te d clie n ts re g a rd in g ICT in tre a tm e n t, used in fo rm e d co n se n t, d e fin e d b o u n d a rie s , a n d e d u c a te d clie n ts a b o u t th e ir p o te n tia l v u ln e ra b ility ; th e se d iffe r fro m re c o m m e n d a tio n s in th e lite ra tu re t h a t social w o rk e rs e d u c a te th e m se lve s o n ICTth ro u g h tra in in g a n d a p p ly in g p ra ctice -b a se d research.

Granulocytopenic patients with an intravascular catheter are at increased risk for infection with Staphylococcus epidermidis. During the intervals when the catheters are not being used for infusions, it is customary to maintain patency of the catheter lumen with a solution containing heparin. We show that heparin does not inhibit the growth of S. epiderinidis isolated from the catheter of an infected patient. A 20-mg/ml solution of disodium EDTA, a chelating agent which effectively anticoagulates blood at this concentration, was shown to be bactericidal for an initial inoculum of 103 CFU of staphylococci per ml in 24 h. Vancomycin, an antibiotic which is often employed to treat Staphylococcus infections, was also bactericidal for initial inocula of 103 CFU/ ml at doses of 6.7 ,ug/ml, a drug concentration in the therapeutic range. When 103 staphylococci per ml were cultured in the presence of catheter segments and disodium EDTA or vancomycin, subcultures of the catheters showed minimal or no growth, respectively. In contrast, when cultured with heparin alone, subcultures showed abundant growth. In view of its low cost, effectiveness as an anticoagulant, and bactericidal activity, EDTA should be studied as a replacement for heparin solutions for the maintenance of intravenous catheters in granulocytopenic patients.Hickman and Broviac catheters offer long-term venous access for the treatment of patients who are seriously ill (2, 7). They are typically maintained by twice-daily injections of a heparin flushing solution. Reports of complications associated with the use of these catheters focus on thrombosis and infection (9,10,16). Among the latter, Staphylococcus epidermidis has emerged as the most significant opportunistic pathogen, especially in patients who are granulocytopenic (1, 19). Christensen et al. have shown that microbial colonization of Hickman lines is dependent upon the production of a slime coat by the bacteria (3). Recent studies suggest that this glycocalyx contributes to S. epidermidis virulence by protecting the organism from the bactericidal effects of empiric antibiotic therapy (4, 5).Numerous approaches to infection prophylaxis have yielded inconclusive results. Pizzo and Schimpff report that total protected isolation of granulocytopenic patients reduces but does not eliminate completely the incidence of catheter-related sepsis (11). Similarly, the efficacy of systemic antimicrobial prophylaxis or selective suppression of alimentary flora is counterbalanced by the emergence of resistant bacteria, fungal superinfections, and drug-induced organ toxicity (11).We address the issue of infection prophylaxis from the standpoint that bacterial adherence and colonization of Hickman catheters are prerequisite to S. epidermidis septicemia. Our model is based upon disodium EDTA, a chemical well known for its chelating properties in vivo and which has been used as an anticoagulant in vitro. EDTA has also been used as a topical antiseptic in gram-negative infections and more recently, in combination with ot...

The effect of the 44-amino-acid peptide human pancreatic GH releasing factor (hpGRF-44) upon the secretion of GH was studied in control and hypothyroid adult male rats. In animals rendered hypothyroid by ingestion of propylthiouracil (PTU), basal and hpGRF-44-stimulated secretion of GH was depressed in vivo. Administration of T4 together with PTU prevented the decline in basal and hpGRF-provoked GH secretion in vivo. HpGRF-44-stimulated release of rat GH was also impaired in vitro, an effect partially reversed by administration of low doses of T4 in vivo. The depressed in vitro secretion of GH could not be restored in hypothyroidism pituitaries by incubation of the glands with T3. Thus, hypothyroidism blunts hpGRF-44-stimulated secretion of GH in vivo and in vitro in the hypothyroid adult male rat.

Growth hormone (GH) and the thyroid hormones interact in the hypothalamus, pituitary and peripheral tissues. Thyroid hormone exerts a permissive effect upon the anabolic and metabolic effects of GH, and increases pituitary synthesis of this protein hormone. GH depresses the secretion of thyrotropin and the thyroid hormones and increases the peripheral conversion of thyroxine to triiodothyronine. In the adult male rat experimental hypothyroidism produced by ingestion of propylthiouracil depresses the GH secretory response to GH-releasing hormone in vivo and in vitro, reflecting the lowered pituitary stores of GH in the hypothyroid state. Short term administration of large amounts of thyroxine with induction of the hyperthyroid state does not affect the in vivo GH secretory response to GH-releasing hormone in this animal.

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Hospitalized patients require venous access for procedures, treatments, or therapies. The use of lidocaine for pain relief during central vascular access device (CVAD) insertion is a standard of practice. Lidocaine buffered with sodium bicarbonate has been shown to provide significantly more pain relief in the sensation of pain upon injection. Shortages of lidocaine with bicarbonate provided an opportunity to explore other options to provide pain relief during CVAD insertion. The PICO question for this project was: In adult patients requiring CVAD insertion, how does lidocaine buffered with bicarbonate compare with lidocaine buffered with saline in minimizing pain with lidocaine injection? This study assessed how lidocaine buffered with bicarbonate compares with lidocaine buffered with saline in minimizing pain with lidocaine injection. Sixty patients received the buffered lidocaine before having a peripherally inserted central catheter inserted. Thirty patients received lidocaine buffered with bicarbonate and 30 patients received lidocaine buffered with saline. Pain and vasoconstriction were the 2 outcomes monitored during the project. Although the trial was only 2 wk due to the urgency of the rollout, the pilot was able to offer clinicians the opportunity to compare the 2 products. The saline-buffered lidocaine provided comparable pain relief compared with the lidocaine buffered with bicarbonate. The clinicians also measured the amount of vasoconstriction caused by the 2 products with similar outcomes.