No abstract

The quality of instruction in the biomedical aspect of nursing education is relatively easily assessed. Caring is nurses' hidden work that may go unrecognized except when the caring behaviors are missed by the patients or their families.

This descriptive correlation study determined the attitudes and behaviors of obstetrics nurses toward breastfeeding and early lactation. Maternity nursing staff at 20 Midwestern hospitals, representing all levels of prenatal care in urban and rural settings, voluntarily answered a 19-item questionnaire. A total of 230 anonymous responses were received. Sixty-four percent of the nurses would recommend or actively encourage breastfeeding and were very interested in helping a woman learn how to breastfeed. Time factors, including shortened length of stay, and lack of knowledge were perceived to be the primary barriers for nurses in assisting mothers to breastfeed. Nurses who cited length of stay as a barrier had more years in obstetric nursing (p < .05). Level of nurses' education correlated positively to active encouragement and support of breastfeeding (p = .024), as well as personal breastfeeding experience (p = .02). The average discharge breastfeeding rate at the study hospitals was 40 percent, well below the national average of 56 percent. Both education and personal experience influence the nurse's attitudes and behaviors in the promotion of breastfeeding. These nurses perceived breastfeeding support as too time-consuming, which suggests that they have not fully adapted to shorter obstetric stays. Nurses need support and continuing education to identify personal bias and knowledge deficits which hinder breastfeeding promotion.

A phase III study was performed to compare the efficacy and safety of lamotrigine (Lamictal), desipramine (Norpramin), and placebo in the treatment of unipolar depression. Desipramine is extensively metabolized by cytochrome P450 2D6 (CYP2D6), and kinetics of this compound are altered in poor metabolizers. Genotyping was utilized to exclude poor metabolizers in order to increase subject safety and to eliminate the need to continuously monitor plasma desipramine levels. As part of screening, subjects were genotyped for the *3(A), *4(B), and *5(D) alleles, which identify approximately 95% of poor metabolizers. Extensive metabolizers were eligible for randomization to the lamotrigine, desipramine, or placebo arm. Follow-up genotyping for the *6(T) and *7(E) alleles was performed after study enrollment and was used to identify poor metabolizers who may have been incorrectly identified as extensive metabolizers upon initial three-allele screening. Of 628 subjects screened for *3(A), *4(B), *5(D) alleles, 590 (93.9%) were classified as extensive metabolizers. The remaining 38 (6.1%) subjects were poor metabolizers and excluded. Subsequent *6(T) and *7(E) testing revealed that two poor metabolizers had been enrolled, and the follow-up genotyping provided an explanation for the high desipramine plasma concentrations in one subject. No differences in phenotypic or allelic frequencies were found between the study population and literature populations. However, the frequency of poor metabolizers varied among clinical sites (0-15%). For a compound that is extensively metabolized by CYP2D6, prescreening subjects for *3(A), *4(B), *5(D), *6(T) and *7(E) alleles can increase subject safety and eliminate the need to continuously monitor drug plasma concentrations.

Patients (N = 71) from a sexually transmitted disease (STD) clinic in an urban setting were surveyed to determine their knowledge about acquired immune deficiency syndrome (AIDS) and attitudes toward condom use. Overall knowledge scores were high with a mean score of 22 on the 28-item true-false questionnaire. No statistical significance was found between AIDS-knowledge scores and condom-use behavior. The majority of subjects or their partners had STD symptoms and multiple partners within a 6-month period. Thirty percent of the respondents reported using condoms at least 25% of the time. In response to open-ended statements about condoms, 10 beliefs were mentioned most frequently. The majority of subjects reported protection against sexually transmitted disease and preventing pregnancy as the most important reasons for condom use. "Avoids getting AIDS" only ranked as the eighth most salient belief and few subjects with multiple partners in the previous 6-month period even cited this belief. Other significant beliefs about condom use included decreased feeling, worry about breakage, decreased pleasure for partner, uncomfortable, feeling safe, inconvenient, and not romantic. The most significant referent (normative belief) influencing condom-use decision making was "mother" in younger subjects and "sexual partner" for older subjects. The sexual partner had unfavorable attitudes toward condom use. These results indicate the need to incorporate attitudes and normative beliefs to change condom-use behavior.