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Purpose. The purpose was to compare three methods of predicting the gastric tube insertion length in children 1 month to 17 years of age: age-related, height-based (ARHB); nose-ear-xiphoid (NEX); and nose-ear-mid-umbilicus (NEMU). Design and Methods. The design was a randomized controlled trial. Children were randomly assigned to the ARHB, NEX, or NEMU groups. Tubes placed high were considered to be misplaced. Results. There were significant differences in percentages of correctly placed tubes, with ARHB and NEMU being more accurate than NEX. Practice Implications. NEX should no longer be used as a gastric tube insertion-length predictor. Either ARHB or NEMU should be used.

A 2007 survey of members of the Society of Gastroenterology Nurses and Associates identified a need for more evidence regarding sedation medications including propofol. Therefore, the Cochrane Database of Systematic Reviews, Cochrane Database of Randomized Clinical Trials, MEDLINE, CINAHL, EMBASE, and the National Guideline Clearinghouse (http://www.guideline.gov) databases were individually searched using the term propofol, limited to human, English, 2000-2009, review articles, and randomized clinical trials. A total of 46 resources contributed to this review, with emphasis on 16 studies ranging from retrospective chart reviews to double-blind, randomized controlled trials. Nonanesthesia personnel-administered propofol, including that administered by specially trained nurses under the supervision of an endoscopist, appears to be safe with minor, easily resolved, adverse events occurring in less than 1% of patients. These minor adverse events included four studies reporting hypoxemia requiring occasional intervention, three studies reporting hypotension, and two studies reporting bradycardia. No patients required tracheal intubation, and no deaths were reported.

PURPOSE To elucidate the experience of fathers living with a colicky infant. STUDY DESIGN AND METHODS Interpretive phenomenology using in-depth interviews with 10 fathers of colicky infants. Reiterative interview reading, repeated meaning unit sorting, going back to the literature, and discussions gave way to emerging themes. FINDINGS The overall experience is one of "falling into and arising from the crying abyss together as a family." Four themes emerged: (a) falling in, (b) hitting bottom, (c) weaving strands to make a rope, and (d) climbing out. CLINICAL IMPLICATIONS From their stories, fathers provide insight useful to nurses assisting families of colicky infants through a very difficult time. Nurses should talk to fathers directly about the possibility of colic, and teach both parents what it is, how long it usually lasts, and what can be done about it. Anticipatory guidance as well as discussion about colic during newborn health visits can help parents to vocalize their feelings, and learn what actions to take when the stress of colic becomes overwhelming.

Enteral feeding is desirable when the gastrointestinal tract is functional because it allows better use of nutrients, is safer, and is more cost-effective than parenteral nutrition. Feeding through a gastric tube, however, is often not feasible in severely ill adults and children because of gastric paresis leading to recurrent episodes of gastroesophageal reflux with the risk of subsequent aspiration. Feeding into the small intestine (duodenum or jejunum) through a nasointestinal tube, therefore, is preferred. Unfortunately, no method of enteral feeding is risk free. This literature review addresses the following 10 topics: (a) the reasons why nasointestinal tube feeding is better tolerated by some patients, (b) candidates for nasointestinal tube feeding, (c) options for selecting nasointestinal tubes, (d) recommended methods for predicting the distance to insert nasointestinal tubes, (e) recommended methods for placing nasointestinal tubes, (f) how promotility medications work and whether they facilitate nasointestinal tube placement, (g) nasointestinal tube placement error rate, (h) methods of determining the internal location of nasointestinal tubes, (i) complications associated with nasointestinal tube use, and (j) other pertinent issues surrounding feeding through nasointestinal tubes. The available research evidence is summarized and recommendations for future work are suggested.

PURPOSE To describe the experience of families with previously colicky infants. STUDY DESIGN This qualitative, descriptive study explored parents' perspectives of the lasting effects of infant colic on their children's development and on their family relationships. METHODS Through in-depth interviews, the parents had the opportunity to share what they remembered most about this experience. Participants volunteered by accessing the Infant Colic Study Web site advertised on numerous search engines. Forty-four participants, all of whom had an infant with colic at some time in the past, answered open-ended questions regarding their feelings about the colicky period and how their children developed later. Data were analyzed from a phenomenologic perspective. RESULTS The majority of participants reported no later problems in their previously colicky children. Some did believe, however, that family relationships had been affected by the colic experience, and that communication and support had been impaired. Most described feelings about the colic experience that were negative. CLINICAL IMPLICATIONS Continued support needs to be provided to families of colicky infants throughout their growth and development at a primary care level. Nurses need to recognize that the experience of infant colic may have residual effects on the entire family unit. These families need to be provided with the support and resources to enable them to successfully care for their children and to engage in nurturing relationships.

Approximately 1 million enteral tubes are placed through the nose or mouth in adults and children in the United States annually. Previous studies found gastric tube placement errors to be common. A primary issue in ensuring safe and effective gastric feeding by tube is achieving optimal tube position on insertion. The purpose of this study is to use 24 variables to develop a clinical prediction rule for gastric tube insertion distance in adults, using the internal-nares-to-distallower esophageal-sphincter distance. A three-variable model using gender, weight, and nose-umbilicus-flat was selected. This new model, validated using nonparametric bootstrap cross-validation, correctly predicted gastric tube insertion distance 85.3% of the time. This new model is compared to two other methods, one evidence based and one commonly used in practice, and was found to be superior. Two nomograms, one for each gender, are drawn to make this new model easier to use.

Infant colic is prolonged hard crying for no apparent reason in an otherwise healthy infant. The purpose of this study was to describe the parents' experiences of caring for their infants with colic. This qualitative study employed a multiple case study design using a descriptive approach through indepth interviews. Five of the interviews were conducted in person, and 10 were conducted via e-mail. One or both parents of 15 colicky infants were interviewed about their recent experiences of living with colicky infants. Three themes--crying, emotions (anger, frustration, worry, and guilt), and feelings (hopeless, helpless, isolated, and unloved) were identified. This study adds the rich description that was missing from the previous two qualitative studies of infant colic. It also adds fathers' perspectives of the experience of living with a colicky infant. Lastly, this study demonstrates that indepth interviews can be conducted via e-mail as well as in person.

An abdominal radiograph is considered the "gold standard" for determining the position of flexible small-bore nasogastric/orogastric tubes. However, placement must be checked frequently while a tube is in place, and the summative radiation risk of multiple radiographs, as well as their expense, make the development of adequate bedside placement-locating methods imperative. Several methods of detecting tube placement have been investigated in adults, including: aspirating gastric contents and measuring the pH, bilirubin, pepsin, and trypsin levels; examining the visual characteristics of aspirate; placing the proximal end of the tube under water and observing for bubbles in synchrony with expirations; measuring the carbon dioxide level at the proximal end of the nasogastric/orogastric tube; auscultation for a gurgling sound over the epigastrium or left upper quadrant of the abdomen; and measuring the length from the nose/mouth to the proximal end of the tube. Many researchers have already concluded simple auscultation is not a reliable method to assess tube position because injection of air into the tracheobronchial tree or into the pleural space can produce a sound indistinguishable from that produced by injecting air into the gastrointestinal tract. In adults, only pH and bilirubin of aspirate have been shown both to reliably predict tube position and to have inexpensive simple bedside tests. In children, only pH of aspirate has been shown to be reliable. Research on gastric tube placement in children is relatively new because children are challenging to study in that they are considered a vulnerable population. This review of the literature includes results of both adult and pediatric studies. Tube placement error rates varied from 1.9% to 89.5% in adults and between 20.9% and 43.5% in children.

Infant colic affects about 20% of all infants and the cause remains elusive. Healthcare providers typically view infant colic as a minor inconvenience that is harmless to the thriving infant and will go away with time; however, parents view caring for a colicky infant as a crisis situation. The purpose of this feasibility study conducted via the internet was to examine the feasibility of implementing kangaroo care at the beginning of colicky episodes. Mothers of colicky infants began the study by completing the on-line Infant Colic Scale and recording in a baseline state-of-arousal diary for 3 days. Next, they implemented kangaroo care at the beginning of as many episodes of colic as possible for 2 weeks while recording in a second state-of-arousal diary. Then, they stopped kangaroo care for 2 days while continuing to record in the second state-of-arousal diary, and lastly they were asked how kangaroo care worked for them.Seventy-five parents of colicky infants consented to participate in this study; however, only five of them actually did. Three of these completed only the baseline state-of-arousal diary, and two completed all parts of the study. This dropout rate showed that conducting such an intervention via the internet is not a feasible approach. Because kangaroo care for infants with colic is a promising intervention and because there are no other effective treatments for most of these infants, another feasibility study is warranted using different methods. Then if results are promising, a larger clinical trial should be conducted.

In February 2001, President Clinton’s Information Technology Advisory Commission reported that information technology has the potential to advance biomedical research. As nursing research via the Internet expands, important ethical and legal issues need to be addressed. The purpose of this article is to report one researcher’s journey in attempting to conduct ethical and legal nursing research via the Internet. The ethical and legal issues needing attention are discussed. Potential guidelines are provided for researchers wanting to use Internet technology.

Novice researchers, when confronted with a clinical problem they want to study, are admonished by more experienced researchers to search the literature for an instrument that already has established reliability and validity, fits the problem of study, or that can be easily adapted. Sometimes, however, there is no such instrument available so the researcher has to develop a new instrument. The purpose of this article is to describe the steps required to develop and psychometrically test a new instrument. A new instrument, the Infant Colic Scale, is used as an example.

Inflammation of the liver is known as hepatitis. Six or seven viruses, hepatitis viruses A through G, are responsible for most cases of viral hepatitis. In this second of a series of three articles, current knowledge regarding hepatitis C, E, F, G, and non-A-G is reviewed. Up to 80% of patients infected with hepatitis C progress to chronic liver disease. Hepatitis E is an enteric hepatitis that is endemic in Asia. Hepatitis F may be a mutant hepatitis C. Hepatitis G is a posttransfusion hepatitis. Non-A-G hepatitis consists of all of the hepatitis viruses awaiting identification. Up-to-date information regarding each of these types of hepatitis viruses is presented herein, because every phase of patient care improves when health care professionals are knowledgeable regarding the illnesses of their clients.

PURPOSE The purpose of this study was to determine the prevalence of feeding tube placement errors in children. DESIGN AND METHODS The hospital records of 201 children having both an enteral tube and at least one radiograph showing tube placement were retrospectively reviewed. Chart review was also used to determine the risk factors associated with these errors. Tube placement error was defined as tube tip or orifices in the esophagus or intestine (if the tube was supposed to be in the stomach) or tip or orifices in the esophagus or stomach (if the tube was supposed to be in the intestine.) RESULTS On the first day, a radiograph documenting tube placement showed that 32 of the 201 children (15.9%) had tube placement errors. Overall, 53 tube placement errors were evident during the 385 observation days on which radiographs were obtained (13.8%). Of the 201 children, 42 (20.9%) had experienced tube placement errors at some time during the period reviewed. Over all radiograph days, activity level was independently related to radiographic tube placement (p = < 0.02), with more errors among active children. Also, classification regression tree analysis showed that age, level of consciousness (alert or comatose versus semicomatose), abdominal distention, vomiting, and orogastric tubes were associated with more tube placement errors. NURSING IMPLICATIONS Nurses need to be especially careful in assessing tube placement if the pediatric client has one or more of the identified risk factors. Health care providers need to carefully weigh the benefits and risks of feeding by nasal or oral enteral tubes versus the benefits and risks of feeding by endoscopically or surgically placed enteral tubes.

Enteral nutrition, given through feeding tubes to patients with intact gastrointestinal tracts who are unable to eat enough orally to sustain themselves, remains an important component of supportive care. Feeding by a soft, small-bore tube passed through the nose or mouth is a more cost-effective means of providing enteral nutrition than either percutaneously or surgically placed gastrostomy tubes or central venous catheters. However, tube feeding is not without problems. The prevalence of tube placement errors reported in the literature varies from 1.3% to 50% in adults. Transpyloric tubes are difficult to place initially and correct positioning is also difficult to maintain. All types of small-bore tubes dislocate easily, frequently with no outward sign that the dislocation has occurred. Risk factors found to be related to feeding tube misplacement on insertion in adults include altered level of consciousness, altered swallowing mechanisms, and upper airway intubation. Those related to spontaneous tube displacement include altered level of consciousness, upper airway intubation, coughing, tracheal suctioning, and restlessness.

The purpose of this study was to identify barriers and facilitators to children's use of speech-generating devices (SGD).Interviews with 14 mothers were analyzed with content analysis to identify barriers and facilitators to SGD use.This study identified a number of specific barriers and facilitators to successful and sustained SGD use by children with complex communication disorders.Nurses can use the list of barriers and facilitators provided here as a springboard to discuss the families' experiences with device use.

Disinfectant surveys from responding members of the American Society of Postanesthesia Nurses were divided into two groups based on whether or not they considered themselves to be exposed to disinfectants in their work environment. Their survey responses were then compared with those obtained previously from members of the Society of Gastroenterology Nurses and Associates, Inc., who were regularly exposed to 2% alkaline glutaraldehyde in the work setting. There were significant differences among the groups in the percentage of respondents who reported having headaches, eye irritations, respiratory problems, shortness of breath, rashes, memory loss, mood swings, and fatigue. These findings support the association of these complaints with 2% alkaline glutaraldehyde exposure. In contrast, there were no significant differences among the groups in the percentage of respondents who reported having asthma, rhinitis, chest pain, nausea, diarrhea, muscle/joint pain, visual disturbances, or dermatitis.

The purpose was to compare three methods of predicting the gastric tube insertion length in children 1 month to 17 years of age: age-related, height-based (ARHB); nose-ear-xiphoid (NEX); and nose-ear-mid-umbilicus (NEMU).The design was a randomized controlled trial. Children were randomly assigned to the ARHB, NEX, or NEMU groups. Tubes placed high were considered to be misplaced.There were significant differences in percentages of correctly placed tubes, with ARHB and NEMU being more accurate than NEX.NEX should no longer be used as a gastric tube insertion-length predictor. Either ARHB or NEMU should be used.

Abdominal radiographs are used to determine the location of the tip of a newly placed nasogastric tube. The precise location of the gastroesophageal junction has not been well described in the radiology literature. To improve interpretation of radiographs taken to evaluate the location of the tip of a nasogastric tube. Using UGI barium studies, we determined the anatomical location and variability of the position of the gastroesophageal (GE) junction and the pylorus We reviewed 200 upper gastrointestinal barium studies (50 in each of 4 age groups). We measured the vertebral levels and distance of the gastroesophageal junction and the pylorus from the spine, the vertical distance of the gastroesophageal junction from the dome of the diaphragm and the distance from the gastroesophageal junction to the pylorus. There is a constant location of the GE junction with no significant variation between age groups. There is a moderately constant location of the pylorus. The other measurements were very variable. The location of the GE junction is very constant, irrespective of age. Tube tips below the level of the vertebral disc between the 11th and 12th thoracic vertebra and/or more than 16 mm from the left side of the spine lie in the stomach and not the lower esophagus. Our results should help in accurate radiographic description of the location of the tip of an NG tube.

The sedative-hypnotic propofol (2,6-diisopropylphenol) is being increasingly used for sedation during painful diagnostic and therapeutic procedures in adults and children. The purpose of this article is to present a general overview of the use of propofol for endoscopic sedation. Advantages and disadvantages of using propofol for sedation, as well as its pharmacokinetics, preparation for use, dosing for endoscopic sedation, auxiliary sedative and analgesic medication options, methods of administering, adverse effects with interventions, recovery, and patient-physician satisfaction are discussed. Finally, next steps necessary to optimize future use of propofol are suggested.

Thirty-six parents of colicky infants participated in this randomized, placebo-controlled clinical trial conducted via the Internet. Parents recorded a baseline state-of-arousal diary for 3 days using their usual feeding methods, and then they used six study-provided bottles for 2 weeks while recording a second state-of-arousal diary. Infants being fed with placebo bottles significantly spent more time crying (rho=.010) and fussing (rho=.002) on average than infants using Dr. Brown's Natural Flow Baby Bottles. Because these bottles decreased the time the infants spent crying and fussing, use of these bottles may be recommended for colicky infants who receive any bottle feedings.

In this study, the internal position of a nasogastric/orogastric tube was determined in 72 children, prior to an abdominal radiograph, by measuring CO2 and pH and bilirubin of tube aspirate. Fifteen of the 72 tubes (20.8%) were incorrectly placed on radiograph. Using the suggested adult cutoff of pH 5, pH of aspirate correctly predicted misplacement outside the stomach in 7/28 (25%) of children and correctly predicted correct placement in the stomach in 34 of 40 children (85%). Using the suggested adult cutoff of bilirubin ≥ 5 mg/dL, bilirubin monitoring failed to identify either of two incorrectly placed tubes. In this study, using an algorithm of assuming stomach placement if the pH of aspirate is ≤ 5 and obtaining an abdominal radiograph when either no aspirate is obtained or the pH is >5 would have resulted in 92% accuracy. Alternatively, obtaining an abdominal radiograph would result in nearly 100% accuracy.

The ancient Greeks were the first to mention infant colic in recorded history; yet in 2002, the cause of infant colic is still unknown. Review of the infant colic literature suggests there are at least five possible explanations-cow's milk/soy protein allergy or intolerance; immature gastrointestinal system; immature central nervous system; difficult infant temperament; and parent-infant interaction problems consisting of either the transfer of parental anxiety to the infant or the inability of the infant to give clear cues about needs to the caregiver. It is likely the cause of infant colic is multifactorial because it has proven to be so elusive. One or more of the above explanations (or as yet an undiscovered explanation) is likely to play a role in the development of colic in a given infant. Determining the most probable explanation for each infant and then selecting interventions based on this explanation is likely to be more successful in preventing or decreasing the length or frequency of episodes than the various trial-and-error approaches to treatment currently recommended by healthcare providers. Infant colic is an important clinical problem that is amenable to nursing intervention.

The purpose of this article is to introduce practicing nurses to qualitative research. Qualitative research terms are defined, philosophy of science is briefly discussed, and several types of qualitative research studies are described. A hermeneutic phenomenological study of infant colic is described as an example of qualitative research useful in gastroenterology nursing. Finally, suggested criteria for evaluating a qualitative study are introduced.

Autoimmune hepatitis (AIH) is a necro-inflammatory disease that, untreated, carries a 3-year mortality rate of approximately 50%. In this last of a series of three articles, current knowledge regarding AIH is reviewed. The mode of presentation of AIH is variable: insidious onset with few if any symptoms, presenting with symptoms indistinguishable from that of any acute viral hepatitis, or onset with fulminate hepatitis. In AIH, hepatocytes become injured by various agents (such as a viral infection) and become antigenic, leading to a self-perpetuating antigen-antibody response with subsequent chronic liver disease. AIH is the only type of hepatitis that is responsive to corticosteroids. Occasionally, AIH develops after liver transplantation.

Inflammation of the liver is known as hepatitis. Six or seven viruses, hepatitis A-G, are responsible for the majority of cases of viral hepatitis. All of the types of hepatitis present with the same flu-like symptoms. In this first of a series of three articles, current knowledge regarding hepatitis A, B, and D will be reviewed. Fifty percent of hepatitis cases are due to hepatitis A. Hepatitis B is considered a sexually transmitted disease. Hepatitis D is an incomplete virus found accompanying Hepatitis B. Every phase of patient care improves when health care professionals are knowledgeable regarding their clients' illnesses. This article presents our current scientific understanding of hepatitis A, B, and D viruses.

The purpose of this study was to compare the prevalence of Helicobacter pylori (HP) seropositivity among gastroenterology nurses and technicians with that of the general population. Nurses attending the 1996 Indiana Society of Gastroenterology Nurses and Associates Spring and Fall Education Courses were asked to complete a checklist regarding employment, current symptoms, and use of universal precautions, and to have 3 ml blood drawn. These 138 blood specimens as well as 112 serum samples from generally age- and sex-matched blood donors (representing the general population) underwent qualitative HP antibody testing. Results showed that the prevalence of seropositivity for immunoglobulin G (IgG) antibody for HP among the gastroenterology nurses and technicians was 19 of 138 (13.8%), which was less than that of the blood donor control group, whose seropositivity was 20 of 112 (17.9%). However, this difference failed to reach statistical significance. Seropositivity tended to increase with age, but there was no association between clinical symptomatology and seropositivity. Likewise, there was no difference in seropositivity between nurses assisting with endoscopic procedures for more than 10 years and those assisting for less than 10 years. Although the differences were not significant, these findings refute those of an earlier study in which the researchers found 122 gastroendoscopists and endoscopy nurses significantly more likely to be positive for HP antibodies. Therefore, the findings reported here provide important information.

Developing a new data collection scale is a time- and labor-intensive process. Initially, the items may be developed from a review of the appropriate literature, clinical expertise of the developer, in-depth interviewing of potential subjects, or any combination of these techniques. Next, evidence of the validity (content-related, construct-related, and criterion-related), internal consistency reliability, and reliability of the scale must be established. The new scale may be administered to one or two small samples (pilot studies) before it is ready for use with a larger group. Gathering evidence regarding the scale's validity and reliability with different groups and consequent revision are ongoing processes. In this article, the authors describe how this process was followed in developing the Vulnerability Scale.

Vitamin E sufficiency was assessed in 19 children with chronic cholestasis by determining both erythrocyte peroxide hemolysis (EPH) and serum alpha-tocopherol (alpha-T) levels. Eight had normal alpha-T (1.19 +/- 0.67 mg/dl; normal greater than 0.5). The mean EPH in this group was 13.1 +/- 14.3% (normal less than 20%). The remaining 11 patients had low alpha-T levels (0.25 +/- 0.15 mg/dl) and elevated EPH (83.9 +/- 17.1%). Children found to be vitamin E deficient received either oral alpha-T (50-100 IU/kg per day) or parenteral alpha-tocopherol acetate in sesame oil every 2-4 wk (200-300 mg). This permitted serial monitoring of EPH and alpha-T. We found that normalization of the EPH was uniformly accompanied by normalization of the alpha-T level. However, normal alpha-T levels occurred with elevated EPH (between 20% and 80%) on 11 occasions. EPH greater than 80% correctly identified vitamin E deficiency in all cases. Hence, EPH is a satisfactory screening test of vitamin E sufficiently. When the EPH is less than 20%, the patient is vitamin E sufficient. Conversely, when the EPH is greater than 80%, the patient is vitamin E deficient. Serum alpha-T measurements are needed to determine vitamin E sufficiency when the EPH is greater than 20% and less than 80%.

Background A systematic literature review was conducted to (a) identify the most frequently used health-related quality of life (HRQOL) models and (b) critique those models. Methods Online search engines were queried using pre-determined inclusion and exclusion criteria. We reviewed titles, abstracts, and then full-text articles for their relevance to this review. Then the most commonly used models were identified, reviewed in tables, and critiqued using published criteria. Results Of 1,602 titles identified, 100 articles from 21 countries met the inclusion criteria. The most frequently used HRQOL models were: Wilson and Cleary (16%), Ferrans and colleagues (4%), or World Health Organization (WHO) (5%). Ferrans and colleagues’ model was a revision of Wilson and Cleary’s model and appeared to have the greatest potential to guide future HRQOL research and practice. Conclusions Recommendations are for researchers to use one of the three common HRQOL models unless there are compelling and clearly delineated reasons for creating new models. Disease-specific models can be derived from one of the three commonly used HRQOL models. We recommend Ferrans and colleagues’ model because they added individual and environmental characteristics to the popular Wilson and Cleary model to better explain HRQOL. Using a common HRQOL model across studies will promote a coherent body of evidence that will more quickly advance the science in the area of HRQOL.