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PubMed2004

Second-impact syndrome.

Sports-related injuries are among the more common causes of injury in adolescents that can result in concussion and its sequelae, postconcussion syndrome and second-impact syndrome (SIS). Students who experience multiple brain injuries within a short period of time (hours, days, or weeks) may suffer catastrophic or fatal reactions related to SIS. Adolescents are particularly susceptible to the dangers of SIS, and current return-to-play guidelines may be too lenient to protect a student from SIS. Any student with signs of a concussion should receive medical evaluation and not be allowed to return to play in the current game or practice. The role of the school nurse includes being knowledgeable about management of head injuries and return-to-play guidelines, providing follow-up for athletes who have concussions, and providing education on prevention and management of head injuries.

Adolescent↗
PubMed2005

Intermediate care: for better or worse? Process evaluation of an intermediate care model between a university hospital and a residential home.

BACKGROUND: Intermediate care was developed in order to bridge acute, primary and social care, primarily for elderly persons with complex care needs. Such bridging initiatives are intended to reduce hospital stays and improve continuity of care. Although many models assume positive effects, it is often ambiguous what the benefits are and whether they can be transferred to other settings. This is due to the heterogeneity of intermediate care models and the variety of collaborating partners that set up such models. Quantitative evaluation captures only a limited series of generic structure, process and outcome parameters. More detailed information is needed to assess the dynamics of intermediate care delivery, and to find ways to improve the quality of care. Against this background, the functioning of a low intensity early discharge model of intermediate care set up in a residential home for patients released from an Amsterdam university hospital has been evaluated. The aim of this study was to produce knowledge for management to improve quality of care, and to provide more generalisable insights into the accumulated impact of such a model. METHODS: A process evaluation was carried out using quantitative and qualitative methods. Registration forms and patient questionnaires were used to quantify the patient population in the model. Statistical analysis encompassed T-tests and chi-squared test to assess significance. Semi-structured interviews were conducted with 21 staff members representing all disciplines working with the model. Interviews were transcribed and analysed using both 'open' and 'framework' approaches. RESULTS: Despite high expectations, there were significant problems. A heterogeneous patient population, a relatively unqualified staff and cultural differences between both collaborating partners impeded implementation and had an impact on the functioning of the model. CONCLUSION: We concluded that setting up a low intensity early discharge model of intermediate care between a university hospital and a residential home is less straightforward than was originally perceived by management, and that quality of care needs careful monitoring to ensure the change is for the better.

Aged↗
PubMed2006

Management of acute pancreatitis: current knowledge and future perspectives.

In recent years, a number of articles have been published on the treatment of acute pancreatitis in experimental models and most of them concerned animals with mild disease. However, it is difficult to translate these results into clinical practice. For example, infliximab, a monoclonal TNF antibody, was experimentally tested in rats and it was found to significantly reduce the pathologic score and serum amylase activity and also to alleviate alveolar edema and acute respiratory distress syndrome; however, no studies are available in clinical human acute pancreatitis. Another substance, such as interleukin 10, was efficacious in decreasing the severity and mortality of lethal pancreatitis in rats, but seems to have no effect on human severe acute pancreatitis. Thus, the main problem in acute pancreatitis, especially in the severe form of the disease, is the difficulty of planning clinical studies capable of giving reliable statistically significant answers regarding the benefits of the various proposed therapeutic agents previously tested in experimental settings.According to the pathophysiology of acute pancreatitis, the efficacy of the drugs already available, such as gabexate mesilate, lexipafant and somatostatin should be re-evaluated and should be probably administered in a different manner. Of course, also in this case, we need adequate studies to test this hypothesis.

Journal Article↗
PubMed2004

Object-oriented design tools for supramolecular devices and biomedical nanotechnology.

Nanotechnology provides multifunctional agents for in vivo use that increasingly blur the distinction between pharmaceuticals and medical devices. Realization of such therapeutic nanodevices requires multidisciplinary effort that is difficult for individual device developers to sustain, and identification of appropriate collaborations outside ones own field can itself be challenging. Further, as in vivo nanodevices become increasingly complex, their design will increasingly demand systems level thinking. System engineering tools such as object-oriented analysis, object-oriented design (OOA/D) and unified modeling language (UML) are applicable to nanodevices built from biological components, help logically manage the knowledge needed to design them, and help identify useful collaborative relationships for device designers. We demonstrate the utility of these systems engineering tools by reverse engineering an existing molecular device (the bacmid molecular cloning system) using them, and illustrate how object-oriented approaches identify fungible components (objects) in nanodevices in a way that facilitates design of families of related devices, rather than single inventions. We also explore the utility of object-oriented approaches for design of another class of therapeutic nanodevices, vaccines. While they are useful for design of current nanodevices, the power of systems design tools for biomedical nanotechnology will become increasingly apparent as the complexity and sophistication of in vivo nanosystems increases. The nested, hierarchical nature of object-oriented approaches allows treatment of devices as objects in higher-order structures, and so will facilitate concatenation of multiple devices into higher-order, higher-function nanosystems.

Baculoviridae↗
PubMed2004

Inhabitants' environmental perceptions in the city of Rome within the framework for urban biosphere reserves of the UNESCO programme on man and biosphere.

The article presents the main tenets of the UNESCO Programme on Man and Biosphere (MAB), launched by the United Nations at the beginning of the 1970s. The program aimed at supporting applied research and scientific knowledge for managing natural resources in a rational and sustainable way. The implication of the full ecological perspective, typical of the MAB, for promoting multidisciplinary and integrated approaches in the study of environmental issues is briefly outlined. In particular, we point out the role of the MAB, through the biosphere reserve concept, in supporting the collaboration between natural-biological and social-behavioral sciences when dealing with biodiversity conservation problems and with urban ecosystems. Then, the specific UNESCO-MAB Project on the city of Rome, launched at the end of the 1980s, is briefly presented, together with the recent project of the Department of the Environment of the Rome Municipality to propose Rome's urban and periurban green areas as a new UNESCO-MAB Biosphere Reserve. The results of the main research activities conducted therein are summarized. In particular, the specific research lines of the environmental psychology research group, involved in the MAB-Rome Project for approximately two decades, are presented. These research lines dealt with various aspects of residents' environmental perceptions and behaviors in the city of Rome. The practical implications of these results are also briefly discussed.

Attitude↗
PubMed1991

The effectiveness of a family asthma program for children and parents.

An evaluation of a Family Asthma Program revealed significant gains in relevant knowledge and management skills for parents, but not 4- to 12-year-old children with asthma. There were no significant differences between program group families and two other groups of families with asthmatic children at post-test time in regard to various characteristics of family stress and coping. Suggestions for the improvement of Family Asthma Programs are discussed.

Asthma↗
PubMed2006

The influence of variation in type and pattern of symptoms on assessment in pediatric asthma.

OBJECTIVE: We conducted a national, population-based survey to examine the asthma-related health burden of US children. METHODS: A telephone-based survey was conducted in 2004 of children 4 to 18 years of age with current asthma in the United States. In 41,433 households screened, 1089 children reported current asthma; 801 interviews were completed by parents of children aged 4 to 15 years and by children themselves aged 16 to 18 years. The survey included questions about symptoms, perceived level of control, activity limitations, health care use, medicines, disease management, and knowledge. Global asthma symptom burden, derived from the National Asthma Education and Prevention Program guidelines, was composed of 3 components: short-term symptom burden (4-week recall), long-term symptom burden (past year), and functional impact (activity limitation). RESULTS: The majority of children were classified with mild intermittent disease on the basis of recent daytime symptoms alone (80%); yet, when report of nighttime symptoms was included, the proportion of children classified as having mild intermittent symptoms decreased (74%). When asthma burden was assessed on the basis of the global symptom burden construct, only a minority (13%) of individuals was classified as having an asthma symptom burden consistent with mild intermittent disease; the majority (62%) was classified as having moderate/severe disease. In addition, the impact of asthma on the daily activities is substantial; avoiding exertion (47%) and staying inside (34%) are common approaches to improve control of asthma symptoms. CONCLUSIONS: The goals of therapy for asthma, based on the National Asthma Education and Prevention Program guidelines, have not been achieved for the majority of children. In addition, parents and children overestimate the child's asthma control and commonly restrict activities to control asthma symptoms. Deficiencies in the control of asthma may be related to the underestimation of the burden of disease.

Adolescent↗
PubMed1992

Preservation of renal function in chronic renal failure.

Mechanisms of progression of chronic renal failure (CRF) have been well documented in the rat but may not be relevant in man. Factors which may modify clinical CRF include underlying disease, diet, hypertension, intercurrent events, and adverse or beneficial effects of drug therapy. It has been argued that progression in many forms of renal disease is inexorable below a certain level of renal function. In other diseases, eg primary malignant hypertension, analgesic nephropathy, function frequently improves in both the short and long term with appropriate management. Thus knowledge of the nature of the underlying disease is essential in assessing progression. The value of diet in preserving renal function has been debated, particularly the relative roles of protein and phosphate control. In our own unit, a prospective randomized study showed a benefit of protein restriction. Development of accelerated hypertension is an important cause of progression of renal disease and clinical and experimental evidence supports the view that non-accelerated hypertension is also a factor in progression, amenable to treatment. Various intercurrent events may accelerate progression and function may be lost permanently following sepsis, urinary tract obstruction, renal arterial or venous obstruction, hypotension and in some cases pregnancy. Numerous drugs can have deleterious effects on the kidney. The possibility that converting enzyme inhibitors might preserve renal function is attracting attention but in view of their side effects their place in therapy should be determined by prospective controlled studies in which the above factors are carefully considered.

Animals↗
PubMed2002

Assessment, measures and approaches to easing caregiver burden in Alzheimer's disease.

The reduction of caregiver burden for those caring for patients with Alzheimer's disease (AD) is especially important given the prevalence of AD as populations age. This paper reviews the complex nature of caregiver burden, how it is measured, and possible interventions that may affect caregiver burden. Caregiver characteristics as well as symptoms exhibited by patients contribute to burden. A number of specific quantitative measures which have been developed to better evaluate caregiver burden are discussed. Such measures are also useful in measuring the impact of interventions on caregiver burden. Pharmacological treatment of patients with AD through the use of acetylcholinesterase inhibitors has positively affected cognition, activities of daily living, and behavioural problems. These benefits significantly reduce caregiver burden. The same is true for psychosocial interventions for the caregiver. It has been suggested that combining both approaches should be utilised for optimal management. Our knowledge of caregiver burden has greatly increased over the past two decades with clear benefits for both patients and caregivers. However, many aspects still clearly require further research. Given the significance of caregiver burden, various aspects have been extensively studied including contributing and protective factors, quantitative assessment, and pharmacological and psychosocial intervention. It is important for clinicians to be aware of this knowledge so that they can effectively incorporate it into their treatment plans for those affected by AD.

Alzheimer Disease↗
PubMed2006

Vascular changes of the retina and choroid in systemic lupus erythematosus: pathology and pathogenesis.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder that affects multiple organ systems. When eyes are involved, the principle manifestations are hemorrhage, retinal cotton wool spots, microangiopathy and vaso-occlusion. Research in the past two decades has significantly contributed to our understanding about this disease in general and its therapeutic management, although knowledge about the mechanism of ocular involvement and pathogenesis in SLE is limited. This is an important issue, because the ocular symptoms in this disease could be potentially sight threatening in acute cases. Here, we present an overview of the clinical and histopathologic features of retinal and choroidal vascular changes, as seen in patients with SLE. We discuss the role of immune complex deposition in vascular pathogenesis in the eye. Reports indicated an involvement of antiphospholipid antibodies (APAs) in the retinal and choroidal vasculopathy in SLE, although their precise role in this process is uncertain. It is important to look for mechanisms of immune complex-mediated vasculopathy and role of inflammatory mediators in this process in SLE. For this, established animal models can be utilized in research to learn about the precise role of various autoantibodies and complements involved in disease pathogenesis. A clear knowledge about the immunopathogenesis is warranted, and the rationale for the future therapy should be based on reducing vascular inflammation as well as ameliorating autoimmunity in this disease.

Autoantibodies↗
PubMed2006

Food-supply veterinary medicine and veterinary medical education: an Australian perspective.

Food-supply veterinary medicine has been an essential part of veterinary degree programs in Australia since the first veterinary school opened in the late nineteenth century. Australian veterinary schools, like others internationally, are being challenged by the relevance of material in current curricula for modern food-supply veterinary medicine. Additionally, student aspirations are a major issue, as curriculum designers balance companion-animal training with the herd/flock-based issues that focus on productivity and profitability. One of the challenges is to examine the relative balance of education in generic skills (self-knowledge, change management, teamwork, leadership, negotiation) with more technically or scientifically based education. An ongoing process of curriculum review and renewal, which involves input from both external and internal stakeholders and allows regular review and assessment, is needed to ensure continuing curriculum relevance.

Australia↗
PubMed1994

Geropsychiatric nursing: essential curriculum content.

1. An incremental model should be used to determine what geropsychiatric content belongs at each level of educational programs in nursing. 2. Identifying teaching methods that will enable students to learn knowledge retrieval, management, and use skills--as well as to develop critical thinking and ethical decision making abilities--will become more important than identifying essential content. 3. With the increased emphasis on cost-effective primary care and autonomous role functioning within interdisciplinary teams, we must move toward an advanced practice role that combines attributes of the clinical specialist and nurse practitioner.

Curriculum↗
PubMed1990

Physiology of wound healing and risk factors that impede the healing process.

In the critically ill patient, wound repair can be impeded by processes inherent to the illness, its treatment, and the critical care environment. This vulnerability to wound complications increases patient morbidity and mortality as well as length of stay, resource consumption, and hospital cost. The physiology of wound healing and factors that impede wound repair are discussed. Those factors commonly seen in critical illness include advanced age, diabetes mellitus, compromised immunocompetence, inadequate perfusion, and oxygenation, infection, malnutrition, obesity, and preoperative illness. Knowledge of management of the physiologic factors that affect wound healing enables the nurse to maximize tissue repair and prevent wound complications.

Critical Care↗
PubMed2006

[The social meaning of medical professionalism].

This essay looks into the meaning of today's professionalism and the apparent inconsistency between its growing status and a context of profound changes and dissatisfaction with medical practice. The cultural climate of our times is reviewed, as the framework for understanding changes in the social organization of medicine. One of the critical traits of professions has been their power to manage specialized knowledge under their own standards, without external control. The limits of this self regulation of expertise have faded, representing an important threat for professionalism. Together with the fundamental changes and tensions of work conditions for professionals, however, the appeal of professionalism is on the rise. Because of its ability to submit devastating individualism to collective interests, professionalism can contribute to the stability of social systems, as a third logic, between the market and public organizations. In medicine, professionalism as a value based system and ideology, also emerges as a response to the challenges posed to its practice. It represents reflection and preservation of traditional values inspiring a practice of excellence, which will undoubtedly restore and enhance public confidence in medicine.

Humans↗
PubMed2006

Diagnosis and management of chronic pancreatitis: current knowledge.

This paper reviews the current literature on chronic pancreatitis (CP). Despite marked progress in diagnostic tools, predominately imaging methods, no consensus has been reached on the nomenclature of CP, ie diagnosis, classification, staging, pathomechanisms of pain and its optimal treatment. A major problem is that no single reliable diagnostic test exists for early-stage CP except histopathology (rarely available). This stage is characterised typically by recurrent acute pancreatitis +/- necrosis (eg pseudocysts). Acute pancreatitis is a well-defined condition caused in 80% of cases by gallstones or alcohol abuse. Alcoholic pancreatitis, in contrast to biliary pancreatitis, progresses to CP in the majority of patients. However, a definite CP-diagnosis is often delayed because progressive dysfunction and/or calcification, the clinical markers of CP, develop on average 5 years from disease onset. The progression rate is variable and depends on several factors eg aetiology, smoking, continued alcohol abuse. Repeated function testing eg by the faecal elastase test, is the best alternative for histology to monitor progression (or non-progression) of suspected (probable) to definite CP. The pathomechanism of pain in CP is multifactorial and data from different series are hardly comparable mainly because insufficient data of the various variables ie diagnosis, classification, staging of CP, pain pattern and presumptive pain cause, are provided. Pain in CP is rarely intractable except in the presence of cancer, opiate addiction or extra-pancreatic pain causes. Local complications like pseudocysts or obstructive cholestasis are the most common causes of severe persistent pain which can be relieved promptly by an appropriate drainage procedure. Notably, partial to complete pain relief is a common feature in 50-80% of patients with late-stage CP irrespective of surgery and about 50% of CP-patients never need surgery (or endoscopic intervention). The spontaneous "burn-out" thesis of CP is in accordance with this observation although precise data of this phenomenon are scarce. Recent observations indicate that the progression to late-stage CP is markedly delayed in non-alcoholic compared to alcoholic CP. Therefore, spontaneous pain relief is also delayed but it occurs in close association with severe exocrine insufficiency suggesting that aetiology has a major impact on the duration of early-stage CP and that the "burn-out" thesis appears valid both in uncomplicated alcoholic and nonalcoholic late-stage CP. For treatment of steatorrhea and diabetes the reader is referred to recent reviews. Mortality and survival are closely related to aetiology with an increased death rate of about 50% within 20 years from onset in alcoholic CP compared to a markedly better prognosis in hereditary and idiopathic "juvenile" CP. The risk of pancreatic cancer is increased particularly in nonalcoholic CP based on the longer survival, whereas the risk of extra-pancreatic (smoking-related) cancer is about 12-fold higher in alcoholic CP.

Alcoholism↗
PubMed1981

Retrolental fibroplasia today.

The incidence of retrolental fibroplasia (RLF, retinopathy of prematurity) is increasing, as more premature infants of lower birth weight are surviving. Currently, about 17% of premature neonates at risk will develop this condition, although in 85% of these cases it will undergo spontaneous resolution. This paper reviews our current knowledge and management of RLF, and aims to remind us that sophisticated monitoring techniques have not eliminated the problems of hyperoxia.

Diagnosis, Differential↗
PubMed1996

Hypertension and heart disease.

Peripheral blood pressure and heart disease are closely linked. Hypertension is not only associated with, but also a cause of, heart disease and evidence is mounting that treating hypertension reduces cardiac events. The knowledge and management of blood pressure is a key element of cardiac care.

Heart Diseases↗