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Background: We evaluated a cohort of 35 children diagnosed with long QT syndrome, catecholaminergic polymorphic ventricular tachycardia, hypertrophic cardiomyopathy, or arrhythmogenic right ventricular cardiomyopathy with regard to physical and psychosocial well-being., Material and Methods: Patients wore an accelerometer to record their time involved in moderate- to vigorous-intensity physical activity and completed the Pediatric Quality of Life Inventory and the Pediatric Cardiac Quality of Life Inventory. Parents were also asked to describe if their child had changed their physical activity because of their diagnosis and how difficult and upsetting it was for the child to adapt to the physical activity recommendations., Results: Patients were involved in less moderate- to vigorous-intensity physical activity per day (35 min/day versus 55 min/day) and had lower Pediatric Quality of Life Inventory total health scores (79 versus 84) compared to normative data. Overall, 51% of the cohort modified their physical activity in some way because of their diagnosis and changing physical activity was associated with lower Pediatric Quality of Life Inventory and Pediatric Cardiac Quality of Life Inventory scores., Conclusion: Our cohort was involved in less moderate- to vigorous-intensity physical activity and had lower Pediatric Quality of Life Inventory total health scores compared to normative paediatric data. Modifying one's physical activity was associated with worse health-related quality of life scores, highlighting a vulnerable sub-group of children. These findings are useful for families and healthcare professionals caring for children who are adjusting to a new cardiac diagnosis of an inherited arrhythmia or cardiomyopathy.

Background: Historically, individuals diagnosed with an inherited arrhythmia or cardiomyopathy have been advised to avoid participating in competitive sports. Consequently, these individuals may be more susceptible to weight gain and obesity., Methods: A retrospective longitudinal chart review was performed for a population of children with a genetic or clinical diagnosis of the long-QT syndrome, catecholaminergic polymorphic ventricular tachycardia, hypertrophic cardiomyopathy, or arrhythmogenic right ventricular cardiomyopathy. We recorded the physical activity recommendation, postdiagnosis sports participation, and body mass index (BMI) over time., Results: A total of 109 charts were reviewed. Some level of physical activity restriction was documented for the majority of phenotype-positive children (80%) but was less common for phenotype-negative children (37%) (P < 0.001). Overall, 38% ( n = 41) of the study population were reportedly participating in a moderate or high dynamic sports following their diagnosis. Nonetheless, the BMI did not differ over time based on physical activity restriction or sports participation, and the proportion of overweight and obese children at follow-up was consistent with that seen in the Canadian pediatric population., Conclusion: Physical activity restriction was recommended for the majority of phenotype-positive children with an inherited arrhythmia or cardiomyopathy. However, many children continue to participate in competitive sports. Children prescribed physical activity restriction appear to face similar concerns relating to obesity as other Canadian children. This study highlights the need to further assess the effectiveness of physical activity recommendations and its impact on the cardiovascular health., (© 2018 Wiley Periodicals, Inc.)

Predictive genetic testing in minors should be considered when clinical intervention is available. Children who carry a pathogenic variant for an inherited arrhythmia or cardiomyopathy require regular cardiac screening and may be prescribed medication and/or be told to modify their physical activity. Medical genetics and pediatric cardiology charts were reviewed to identify factors associated with uptake of genetic testing and cardiac evaluation for children at risk for long QT syndrome, hypertrophic cardiomyopathy or arrhythmogenic right ventricular cardiomyopathy. The data collected included genetic diagnosis, clinical symptoms in the carrier parent, number of children under 18 years of age, age of children, family history of sudden cardiac arrest/death, uptake of cardiac evaluation and if evaluated, phenotype for each child. We identified 97 at risk children from 58 families found to carry a pathogenic variant for one of these conditions. Sixty six percent of the families pursued genetic testing and 73% underwent cardiac screening when it was recommended. Declining predictive genetic testing was significantly associated with genetic specialist recommendation (p < 0.001) and having an asymptomatic carrier father (p = 0.006). Cardiac evaluation was significantly associated with uptake of genetic testing (p = 0.007). This study provides a greater understanding of factors associated with uptake of genetic testing and cardiac evaluation in children at risk of an inherited arrhythmia or cardiomyopathy. It also identifies a need to educate families about the importance of cardiac evaluation even in the absence of genetic testing.

Individuals affected by restrictive cardiomyopathy (RCM) often develop heart failure at young ages resulting in early heart transplantation. Familial forms are mainly caused by mutations in sarcomere proteins and demonstrate a common genetic etiology with other inherited cardiomyopathies. Using next-generation sequencing, we identified two novel missense variants (p.S1624L; p.I2160F) in filamin-C (FLNC), an actin-cross-linking protein mainly expressed in heart and skeletal muscle, segregating in two families with autosomal-dominant RCM. Affected individuals presented with heart failure due to severe diastolic dysfunction requiring heart transplantation in some cases. Histopathology of heart tissue from patients of both families showed cytoplasmic inclusions suggesting protein aggregates, which were filamin-C specific for the p.S1624L by immunohistochemistry. Cytoplasmic aggregates were also observed in transfected myoblast cell lines expressing this mutant filamin-C indicating further evidence for its pathogenicity. Thus, FLNC is a disease gene for autosomal-dominant RCM and broadens the phenotype spectrum of filaminopathies., (© 2015 WILEY PERIODICALS, INC.)

The FoodChek™ - Salmonella assay is an immunomagnetic lateral flow assay for the rapid detection (shorter than 24 h) of the most frequently isolated Salmonella (groups B-E) in eggs, egg-derivative products, and environmental surfaces. The FoodChek - Salmonella assay correctly identified 99.6% (239/240) of the samples tested in the matrix studied, and the statistical analysis of the method comparison study results demonstrated that it performs as well as U.S. culture-based reference methods. Ninety-nine percent of the 103 Salmonella strains tested belonging to serogroups B-E were detected during the inclusivity study. Concerning the exclusivity, 31 nontarget strains were tested. No cross-reactivity was observed in FoodChek - Salmonella assay enrichment conditions. In addition, the assay shows strong robustness, good stability, and consistency among lots. The present study proves that the assay is an effective tool for the rapid detection of Salmonella spp. in whole liquid eggs, liquid egg white (liquid egg albumen), shell eggs, dried whole eggs, dried egg yolks, and environmental surfaces as stainless steel, plastic, rubber, ceramic tiles, and sealed concrete.

ACTERO Listeria Enrichment Media (ACTERO Listeria) is a selective medium developed for a single-step recovery and enrichment of Listeria spp. from environmental samples. Robustness testing of the ACTERO Listeria medium demonstrated good performance when minor changes were introduced to the incubation temperature and time. All 54 Listeria strains tested, representing the most frequently isolated Listeria species from food (L. monocytogenes, L. ivanovii, L. seeligeri, L. welshimeri, and L. grayi), were successfully enriched in ACTERO Listeria. None of the 30 nontarget strains tested in the exclusivity study was recovered after incubation in ACTERO Listeria. Recovery of Listeria was consistent across three independently produced lots of the ACTERO Listeria, and the prepared medium was stable for 45 days when stored at 4 degrees C in the dark. Matrix studies performed with environmental sponge samples from plastic and stainless steel surfaces demonstrated similar recovery of Listeria spp. in a single-step enrichment using ACTERO Listeria from plastic, and significantly better recovery from stainless steel surfaces when compared to the U.S. Department of Agriculture-Food Safety and Inspection Service reference method. The results of this study prove that ACTERO Listeria Enrichment Media can be effectively used in replacement of the two-step enrichment suggested by the reference method without affecting the recovery of Listeria spp. from environmental samples.

Background: The genetics of congenital heart disease (CHD) remain incompletely understood. Exome sequencing has been successfully used to identify disease-causing mutations in familial disorders in which candidate gene analyses and linkage mapping have failed., Methods: We studied a large family characterized by autosomal dominant isolated secundum atrial septal defect (ASD) (MIM No. 612794). Candidate gene resequencing and linkage analysis were uninformative., Results: Whole-exome sequencing of 2 affected family members identified 44 rare shared variants, including a nonsynonymous mutation (c.532A>T, p.M178L, NM&#95;005159.4) in alpha-cardiac actin (ACTC1). This mutation was absent from 1834 internal controls as well as from the 1000 Genomes and the Exome Sequencing Project (ESP) databases, but predictions regarding its effect on protein function were divergent. However, p.M178L was the only rare mutation segregating with disease in our family., Conclusions: Our results provide further evidence supporting a causative role for ACTC1 mutations in ASD. Massively parallel sequencing of the exome allows for the detection of novel rare variants causing CHD without the limitations of a candidate gene approach. When mutation prediction algorithms are not helpful, studies of familial disease can help distinguish rare pathologic mutations from benign variants. Consideration of the family history can lead to genetic insights into CHD., (Copyright © 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)

Aim: To evaluate the prevalence of hypertension and/or left ventricular hypertrophy (LVH) in children with a diagnosis of obstructive sleep apnea (OSA)., Methods: A cross-sectional case series of consecutive, otherwise healthy children aged > 4 years, with polysomnography-proven OSA [apnea hypopnea index (AHI) > 1.5/h] is described. Echocardiography was performed on all subjects and left ventricular mass was calculated. Study subjects underwent additional investigation with 24-h ambulatory blood pressure (BP) monitoring., Results: Thirty children (21 males) were studied. Mean age was 8.9 years. Mean body mass index was 19.87 kg/cm(2). Mean AHI was 14.3/h. 10/30 (33%) of the study population met criteria for pre-hypertension (n = 3) or masked hypertension (n = 7) based on standard ambulatory monitoring criteria. All 10 children had systolic hypertension throughout the night with 5 of these also having elevated daytime systolic readings. There was a relationship between AHI and BP showing an increase of 1.162 percentile units in mean diastolic night BP (age, gender and height specific) per unit increase in AHI (P = 0.018). There were no subjects with LVH and/or right ventricular hypertrophy., Conclusion: In our population of otherwise healthy Caucasian children, there was a high prevalence of hypertension that would not have been identified using standard office/clinic protocols.

A methodology for working with children and adolescents with disruptive behavior is presented. This program has been in use since 1998 in a boarding home for boys in Buenos Aires. A common issue in this sample is the presence of non-functional families with high levels of violence between their members.

We report an extremely premature infant with Noonan syndrome who developed rapidly progressive obstructive hypertrophic cardiomyopathy, which contributed to the death of the infant. The complications of prematurity combined with progressive, severe hypertrophic cardiomyopathy associated with Noonan syndrome lead to a poor prognosis.

Objective: The objective of this study was to evaluate the effect of the timing of surgical repair of nonductal dependent coarctation on the short-term outcome., Methods: The medical records of 76 patients, diagnosed and treated for a nonductal dependent mild-to-moderate coarctation at a tertiary care institute over a 20-year period, were retrospectively reviewed with the age at repair compared against outcome measures. Multiple logistic regression was performed to assess the timing of repair, the presence of congestive heart failure or associated cardiac defects on the outcome measures., Results: The mean age of surgery for the mild-to-moderate coarctation repair was 3.1 years (range: three days to 12 years). The most common cause for referral to a pediatric cardiologist was the clinical finding of a cardiac murmur. The timing of surgical repair was not found to be a predictor of morbidity or mortality. There was no significant difference in outcome measures defined as residual hypertension, residual coarctation gradient, persistent cardiomegaly, postoperative neurological sequelae, the requirement for a second surgery or the need for balloon dilatation for residual postoperative coarctation and the need for antihypertensive medications within five years postsurgery., Conclusion: The timing of surgical repair in the setting of nonductal dependent, mild-to-moderate coarctation of the aorta, does not adversely affect the short term (less than 20 years) outcome in children.

Background: Systemic lupus erythematosus (SLE) is an autoimmune disorder with various systemic and cutaneous manifestations. Nail abnormalities, including onycholysis, red lunulae, pitting, and ridging, have been seen in patients with the disorder. To our knowledge, however, pincer nail deformity has yet to be reported coincident with the onset of SLE., Objective: We report a case of pincer nail deformity subsequent to the development of SLE and describe surgical treatment of the deformed nails. This is followed by a review of the literature., Conclusion: Acquired pincer nail is a dystrophy with numerous reported causative associations, including psoriasis, tumors of the nail apparatus, tinea ungium, ss-blocker usage, and now SLE. Pain from the resulting constriction can interfere greatly with daily activities and can be debilitating to the extent of requiring therapy.

Aortopulmonary septal defect and tetralogy of Fallot is a rare combination. We report a case of tetralogy of Fallot, non-confluent pulmonary arteries with the left arising from the arterial duct, and a large aortopulmonary septal defect diagnosed by echocardiogram and confirmed by cardiac catheterization.

Most nurses' first attempt at research will be a quality assurance or performance improvement project. Unfortunately, these terms do not even appear in the indexes of most nursing research textbooks. The limitations and common pitfalls of this type of research is covered in this paper.

It is often the assignment of the perianesthesia nurse to critique a research article to evaluate a suggested procedure or instrument for implementation the patient care area. Although details of what should appear in each section of the research article have appeared in past reports in this series, this article will present an outline for critiquing the entire research manuscript.

This manuscript presents some of the basic concepts of science and scientific reasoning. Whether you are reading research or planning to do a Master's thesis, understanding these concepts will be important. How theories differ from beliefs and their ultimate practicality are discussed.

The American public is being overwhelmed with scientific sounding claims for products to be ingested and/or applied to the body that have no research support. To protect ourselves and our patients from potential harm or unnecessarily wasting their resources, we need to be aware of the problem. In addition we need to apply the standards we have learned for critiquing research to the claims made by the purveyors of these products.

Surveys are essential for discovering the incidence, distribution, and inter-relationship of variables within a population. As such, it is important that we are able to critically read published surveys. This manuscript is the second of two dealing with survey research. This manuscript deals with the advantages and disadvantages of different types of surveys and what the reader should be looking for when reading survey research.

Surveys are essential for discovering the incidence, distribution, and interrelationship of variables within a population. As such, it is important that we are able to critically read published surveys. This manuscript is the first of two dealing with survey research. Sampling and external validity are covered in this manuscript.

The research design is the overall plan or structure of the study. The goal of a good research design is to insure internal validity and answer the question being asked. The only clear rule in selecting a design is that the question dictates the design. Over the next few issues this column will cover types of research designs and their inherent strengths and weaknesses. This article discusses ex post facto research.

The readers of this journal are frequently confronted with statistical analysis that includes analysis of variance (ANOVA) and multivariate analysis of variance (MANOVA). This article discusses what the authors are really telling you when they use these techniques.

This manuscript presents the beginning portions of a research project as well as a critique of the design and methods. Although it is not a complete proposal, this article may given those readers who are thinking of doing research some idea of how easy it is to make fatal flaws in the design of a project. Suggestions for how a research novice might avoid these classic mistakes are made.

The discussion section of a research manuscript is the last thing we read and often the section that leaves the most lasting impression. It is important to know what to reasonably expect to be in the discussion section. This article presents the areas that are usually covered. Over-interpretation of the results of a research project occurs all too often. This article will help you avoid being taken in by this problem.

The article explains what to look for when an investigator compares data from two distinct groups. The most common statistical methods of doing these evaluations are the chi-square test and the t test. Both tests are explained.

The goal of research is to discover new knowledge to improve patient care. Research is essential because of its ability to establish causal relationships. This article discusses the minimum requirements a research report must meet to establish a causal relationship.

This article presents issues to be considered when planning to conduct research, specifically ways to avoid critical errors in writing the research proposal. It concludes with an outline for writing research proposals.

Multiple regression is an analysis tool used much more frequently than bivariate regression analysis in the research we are reading. This article is designed to help the reader understand multiple regression analysis and confidence intervals.

Regression is an analysis tool used in much of the research we read, and the terminology can be daunting. In reality, bivariate regression analysis is simply an extension of correlational analysis. This article was written to help the reader understand bivariate regression analysis.

This series of articles to date has discussed points that readers should be looking for when reading and critiquing a researcher article. This article presents a brief report of a research project investigating the reliability and validity of the infrared tympanic thermometer (ITT) in afebrile subjects. Using four subjects and 40 temperature diads, the ability of the ITT to predict the subjects' temperatures obtained with a mercury thermometer was very poor (regression coefficient = .39). Test-retest reliability using the same data set resulted in an equally poor correlation coefficient (r = .19). A critique of the methodology of the study is provided as a learning experience.

Statistical tests you have heard of, designed primarily to characterize relationships between and among variables within a data set, are correlations and regressions. Tests designed to analyze the difference among groups on a particular variable are the chi-squared test, the Student's t Test, and the analysis of variance. This article will explain the interpretation of simple relationships in research data, specifically correlations.

Nurses in PACUS as well as other areas of nursing are increasingly being asked to incorporate research into their clinical practices. Unfortunately, many nurses have limited formal education in research and are not adequately prepared to critically analyze the quality of the research they are reading. This is especially true when it comes to the statistical analysis section of the published research report. This article lays the foundation for understanding the statistical analysis most commonly seen in results sections of research publications in nursing journals.

Accurate measurement of research variables is necessary so that research consumers can trust that it is the research intervention that affected the change in the outcome variable, not some extraneous error component. Reliability is the accuracy with which the research instruments measure the variable that they are designed to measure. A number of known threats to instrument reliability should be anticipated by the researcher and looked for the consumer. These threats are presented in this article.

Meaningful measurement of events in a research study depends on the use of valid and reliable measurement tools. This article discusses the nature of validity, types of validity, and how researchers demonstrate the validity of their instruments to the reader.

Statistical significance pertains to the probability that a finding of difference between two groups in a study has occurred by chance. Unfortunately, statistical significance often is confused with significance. This article discusses the meaning of statistical significance, how it differs from significance, and when it can be misleading.

Internal validity refers to the extent to which it is possible to attribute the change in the dependent or outcome variable in a study to manipulation in the independent variable. This article will discuss the frequent threats to internal validity and how to recognize them.

Postanesthesia nurses are being asked to incorporate research into their clinical practices. Unfortunately, many nurses are not adequately prepared to critically analyze the quality of the research they are reading. This article, which provides hints for reading review of the literature, is the first of a series regarding reading research critically.

This study compared time required to rewarm, incidence of shivering, and nurses' preferences in hypothermic postoperative cardiac surgery patients treated with a forced air warmer (Bair Hugger) or a noninfrared radiant heater (Thermal Ceiling). Data were collected on 38 subjects and 6 nonsubjects treated with warm blankets. Average minutes to rewarm were: forced air, 100.3; radiant heat, 99.3; and warm blankets, 188.2. The warm air subjects had significantly higher skin temperatures, lower incidence of shivering, and less severe afterdrop, suggesting that rewarming in these patients resulted from heat gained from the environment. Nurses preferred the forced air warmer to the noninfrared radiant heater.

This study was designed to assess factors associated with afterdrop, the fall in core temperature following completion of cardiac surgery, and determine the validity of noninvasive measures of temperature to predict core temperature in the severely hypothermic patient. Twenty-five postcardiac surgery patients served as subjects. Core temperature was measured using the pulmonary artery, bladder, and esophageal sites. The less invasive measures included a tympanic membrane thermometer, oral and axillary electronic thermometers, and a forehead surface temperature indicator. Temperatures were recorded every 10 minutes for 2 hours. End-of-surgery temperatures ranged from 30.3-38.3 degrees C (86.5-100.9 degrees F) with a mean of 36.02 degrees C (96.84 degrees F). Temperature change over the next hour ranged from a rise of 2.5 degrees C (4.5 degrees F) to a fall of 4.1 degrees C (7.2 degrees F). Factors associated with afterdrop included age, end-of-surgery temperature (both positively) and body mass (negatively). No noninvasive measure appeared to be a valid indicator of core temperature in these hypothermic patients.

This study was designed to determine if the forced warm air system is more effective than warmed cotton blankets or radiant heat lamps for rewarming postoperative patients. PACU admission temperatures were taken on 370 adult patients. The study population of 90 patients with admission temperatures of 35 degrees C (95 degrees F) or less was randomly assigned to one of three intervention groups: (b) warmed cotton blankets, (L) radiant heat lamps, or (A) forced warm air. Oral or axillary temperatures were monitored every 15 minutes and the warming intervention continued until the patient reached the discharge criteria of 36 degrees C (96.8 degrees F). The three groups were comparable for sex, age, admitting temperature, OR time, and OR fluid. The mean rewarming times for patients who shivered were similar for all groups. For those patients who did not shiver, those treated with forced warm air rewarmed significantly faster than patients in the other groups. Nonshivering patients treated with forced warm air were ready for discharge somewhat sooner than those treated with either of the other two interventions.

1. Needlestick injuries are the most common type of occupational injury experienced by nursing personnel. Sixty percent to 90% of needlestick injuries in medical centers are incurred by nurses. 2. Future increases in patient acuity and more advanced technology are likely to increase the risk of nurses experiencing accidental needlesticks. 3. Needle devices that require disassembly of equipment, especially those related to intravenous piggybacks and prefilled cartridge syringes, are placing nurses at an increased risk for injury. 4. Needle-less devices or devices which keep the needle recessed except during intended use have been designed. The assessment instrument can identify needlestick injury incidence and trends and can be used to evaluate and justify the increased costs of purchasing new safety equipment.

The present research was designed to describe the character, severity, and factors associated with postoperative pain following total hip replacement (THR) and total knee replacement (TKR) surgery, and to identify amounts of opioid required to relieve that pain. It was the investigators' intention to investigate the impact of age on severity of pain and amount of opioid required after surgery. Complete data were obtained on 29 white subjects, 16 of whom were men. Subjects' ages ranged from 27 to 88 years (mean, 66). The mean age for the men was 61 years and the mean age for the women was 72 years. Twelve subjects underwent THR and 17 underwent TKR. Eight patients received general anesthesia and 21 received spinal anesthesia. Pain was described using the McGill Pain Questionnaire-Short Form and quantified using a visual analogue scale. Amount of opioid required to relieve pain over 24 hours was recorded using a patient-controlled analgesia pump. Data analysis indicated that most patients do not report their pain as being controlled when discharged from the PACU, and that patients who receive spinal anesthesia require more postoperative opioid to control pain than patients who receive general anesthesia. In general, patients who undergo TKR experience more pain than patients who undergo THR. Pain was described as moderate to severe aching. As age increases, patients self-administer less postoperative opioid, but they do not report less postoperative pain.

Amphotericin-B is the only parenteral agent currently available to treat systemic fungal infections. Pyrogenesis, accompanied by severe shivering, is a distressing side effect. Possible risk factors of developing this reaction have not been reported. A case series was developed to document the occurrence and duration of shivering in patients who received amphotericin-B and to investigate whether these responses were associated with a diagnosis of diabetes mellitus, receipt of insulin or beta blockers, the amount of body fat content, an immunocompromised state, age, and gender. Medical records were reviewed and abstracted for patients who received 20 milligrams or more of amphotericin-B per day for at least 10 consecutive days between January 1, 1984, and September 1, 1988. Results indicated that a diagnosis of diabetes, insulin therapy, and advancing age were inversely associated with the amphotericin-B-induced rigors response. Shivering was noted to occur first at the test dose, with the percentage of patients who shivered increasing with each successive dose (this peaked at the fifth therapeutic dosage). Of the factors under study, only advancing age appeared to be related to the duration of shivering. It is possible that identification of the descriptive characteristics of amphotericin-B-induced rigors will facilitate the nursing care of patients who receive this treatment; it also may be an important first step in the identification of risk factors for this clinical complication.

The goal of this study was to assess the accuracy of the axillary site as an indicator of core body temperature. Data from 30 core body temperatures, 30 electronic axillary temperatures, and 30 mercury-in-glass axillary temperatures in nonpostoperative intensive care unit patients are reported. Core and axillary temperatures were simultaneously measured in each patient. The correlation between core and axillary-mercury was r = 0.90. The mean difference between core and axillary-mercury was 0.35 degrees F (0.19 degrees C). The correlation between core and axillary-electronic was r = .87. The mean difference between core and axillary-electronic was 0.6 degrees F (0.33 degrees C). Only three, or 5%, of the 60 core-axillary pairs met the expected 2 degrees F (1.2 degrees C) difference. These findings support the accuracy of axillary temperature measurement as a reflection of core body temperature measurement in nonpostoperative patients. These researchers suggest that mercury thermometers be used in cases where small differences in temperature are clinically meaningful.

The purpose of this study was to determine the validity of the axillary site for temperature measurement in the postoperative patient. Axillary electronic, axillary mercury, rectal mercury, and core body temperatures were obtained in 18 postoperative patients. Rectal temperatures correlated extremely well with core temperatures, r = .98, but on average were .5 degrees C higher than core. Mercury axillary left in place for 10 minutes had the next highest correlation, r = .96, but on average were .2 degrees C lower than core. Electronic axillary were the poorest indicator of core temperature, r = .92, and were on average .6 degrees C lower than core. The correlation of -.64 between age and postoperative core temperature suggests that the elderly are most susceptible to hypothermia in a surgical setting.

Though therapeutic advances have been made in the treatment of ovarian carcinoma, success at achieving a cure in women with advanced disease has been elusive. Since advanced ovarian carcinoma is frequently confined to the peritoneum, the use of intraperitoneal (IP) chemotherapy is being studied. Dose-limiting toxicity and extended nausea and vomiting associated with intraperitoneal chemotherapy are problems with several of the drugs under study. The most beneficial drug for intraperitoneal use would be one that offers the maximum pharmacologic value without toxicity. An investigation at the Dartmouth-Hitchcock Medical Center in New Hampshire is exploring the use of alpha interferon in treating advanced ovarian carcinoma. This case report describes an individual's course of treatment and the challenges in managing the administration of the IP immunotherapy, anticipating problems, and identifying interventions necessary to achieving optimal patient comfort during this Phase I-II investigation.