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As the complexity of care increases for hospitalized older adults, the clinical nurse specialist is essential for ongoing development of nursing practice and care standards. This article describes the Acute Care of the Elderly (ACE) model for interdisciplinary management of older adults and clinical specialist responsibilities within this interdisciplinary team. Within the model, clinical care specialists utilize clinical expertise and consultation skills reflecting three spheres of practice related to care of high-risk community-dwelling older adults admitted an acute medical unit. The goal for this patient group is to achieve medical stability while preserving maximum functioning. The Acute Care of the Elderly team members include primary nurses (staff nurses), physicians, clinical care specialists, therapies, social workers, dietitians, pharmacists, and a discharge planner. Under the leadership of the primarily nurse, the team develops a comprehensive care and discharge plan, implemented across a care continuum. Using protocols and working together, the team delivers cost-effective, coordinated care that promotes process improvement resulting in practice that is in alignment with current standards of care.

Background: Although advances have been made in modulation of host inflammatory response in periodontal therapy, it is important to control the bacterial challenge to the host immune system through conventional therapy and improvement of personal oral hygiene. Although toothbrushing is generally performed, interdental cleaning is not as common. This study compared the use of dental floss to a toothpick holder in the improvement of gingival health., Methods: Participants were examined and those with clinical gingivitis or slight chronic periodontitis were included in the study. O'Leary plaque, interproximal plaque index (IPI), and Eastman interdental bleeding index scores (EIBI) were recorded at baseline and following appointments. Forty-two females and 13 males ranging from 18 to 50 years in age were randomly divided into either a dental flossing group or toothpick holder using group. Each was given instructions in the use of the oral hygiene device and examined 2, 6, and 12 weeks following baseline. At 12 weeks, 27 floss users and 20 toothpick-holder users completed the study., Results: Plaque scores were reduced in both groups as the study progressed. Mean O'Leary plaque scores decreased significantly for both methods from baseline to week 12 (P < 0.05). The EIBI and IPI scores decreased in mean scores over time for each method (P < 0.05). A correlation was found between the O'Leary plaque index and the IPI scores (P < 0.05)., Conclusion: The results of this study found that the use of dental floss or toothpick holder resulted in no significantly different effect in the improvement of gingival health.

Salaries and benefits are a major concern for dental hygienists and their employers. In 1998, the University of Tennessee Dental Hygiene Department conducted a survey of dental hygienists licensed to practice in Tennessee. Objectives included (1) to determine the current salary range and benefits of practicing dental hygienists, (2) to determine the factors which influence salaries and benefits, and (3) to compare the salaries and benefits of dental hygienists across the state. Results revealed an average compensation of $175.00 per day. While most full-time dental hygienists receive paid vacation, only 33 percent receive health care benefits. There were various factors influencing salaries and benefits, including the method of compensation, region of the state in which one practices, years of experience, and ethnic background.

The normal aging process brings about inevitable and irreversible changes in physical, psychosocial, and spiritual health. These normal changes are partially responsible for the increased risk of developing health-related problems in the hospitalized elder population. The Acute Care for Elders (ACE) model provides an effective, proactive, inexpensive framework for addressing the complex health needs of older adults. When ACE principles are used for the clinical management of clients with orthopaedic problems, interdisciplinary conferences provide the structure for maintaining the continuity of care. Mobility as well as independent functioning, comfort level, mental status, depression, skin health, nutrition, and response to treatment, are discussed and nurse initiated guidelines for preventive and restorative interventions are implemented. Follow-up phone calls and/or home visits are important indices of thorough discharge planning. The theory of comfort is used to assure that holistic needs are addressed. Nurses who practice the ACE model are excited about demonstrating the highest level of competency in geriatric nursing, whereby patient functioning is maximized, comfort and dignity are promoted, functional decline is prevented, and patients are successfully returned to their homes.

The interdisciplinary team process of care combines the principles of geriatric assessment with guidelines for optimal medical and nursing care of patients in an interdisciplinary environment. Strong evidence suggests that this method of care can help prevent functional decline, restore function, and provide efficient and coordinated continuity of care for older patients who are hospitalized for acute medical illness. The loss of functional independence is not an inevitable consequence of acute illness and hospitalization among older patients.

The patient centered "Acute Care of the Elderly Unit" is a multifaceted process of care that combines optimal geriatric nursing and medical care of elders within an interdisciplinary model. Although functional decline has been previously assumed to be an inevitable consequence of hospitalization, preliminary findings suggest that a patient centered multidisciplinary model of geriatric care prevents functional decline of hospitalized elders. In addition, the "low tech" interventions and cost savings outcomes suggests the feasibility of implementing this model of care in hospitals serving a variety of patient populations.

A full-length cDNA clone encoding carbonic anhydrase was isolated from an Arabidopsis thaliana (Columbia) leaf library. Comparison of the derived amino acid sequence obtained from this clone with those of pea and spinach reveals a considerable degree of identity. The carbonic anhydrase cDNA was used to probe the level of RNA encoding this protein in the leaves of plants grown in elevated CO2 (660 ppm). We have found that under these conditions the steady-state level of carbonic anhydrase mRNA was increased in comparison with control plants grown in normal atmospheric concentrations of CO2 (330 ppm). This raises the intriguing possibility that there exists in higher plants a mechanism for perceiving and responding to changes in environmental CO2 concentrations at the genetic level.

Adoptive immunotherapy using lymphokine-activated killer (LAK) cells and interleukin-2 (IL-2) offers the possibility of a new treatment for patients with malignant glial tumors. In a clinical trial, the effectiveness of a 5-day treatment cycle of direct intratumoral administration of both LAK cells and IL-2 via a reservoir/catheter system in patients with recurrent malignant gliomas was studied. Ten patients were entered into the study, nine of whom were treated with 15 cycles of LAK cells (0.9 to 21.0 x 10(9) cells) and IL-2 (49 to 450 x 10(3) U/kg). The 10th patient in the study was not treated because of the onset of severe neurological deficits prior to beginning immunotherapy. Of the nine patients treated, one had a partial tumor response to immunotherapy as documented by computerized tomography. Neurological side effects occurred in all patients undergoing treatment and were related to increases in cerebral edema that appeared to be mediated by the immunotherapy. This report demonstrates the present limitations of regional adoptive immunotherapy with LAK cells and IL-2 in the treatment of human glial tumors.