A complete and accurate patient assessment database is essential for effective communication, problem identification, planning and evaluation of patient status. When employed consistently for ...point-of-care documentation, information systems are associated with completeness and quality of documentation. The purpose of this paper is to report on the findings of a randomized, cross-over study conducted to evaluate the adequacy of a standard patient assessment module to support problem identification, care planning and tracking of nursing sensitive patient outcomes. The feasibility of wireless devices to support patient assessment data collection at the point-of-care was evaluated using wireless PDAs and tablet PCs. Seventy-nine (79) nurses from two patient care units at Massachusetts General Hospital (Boston, MA) were recruited into the study and randomized to complete patient assessment using wireless or paper devices. At the end of six weeks, nurses who where randomized to the paper assessment module were assigned to a device and those who used a device were assigned to paper for an additional six weeks. Impact was evaluated with regard to data capture, workflow implications and nurse satisfaction. Findings suggest that a standard patient assessment set promotes patient sensitive and quality data capture, which is augmented by the use of wireless devices.
Despite the common association of filarial infection with elephantiasis, the great majority of those infected are in fact clinically asymptomatic microfilariae carriers. The assumption has been that ...infection but not disease exists in these presymptomatic persons. In an area of Brazil where Wuchereria bancrofti is endemic, flow studies done with dynamic radionuclide lymphoscintigraphy were used to compare 30 limbs from asymptomatic microfilaremic subjects with 16 control limbs. Geometric mean values for T 1/2 (19.8 vs. 37.7 min; P < .001), appearance time (7.9 vs. 27.9 min; P < .001), percent uptake at the region of interest (0.67% vs. 0.14%; P < .001), and peak activity (62.6 vs. 2.6 cps; P < .001) each indicated an enhanced pattern of rapid, increased lymph flow in asymptomatic microfilaremic subjects. The abnormal lymphatic function in these subjects indicates that current passive intervention strategies may need to change if the debilitating sequelae of this parasitic infection are to be avoided.
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BFBNIB, NMLJ, NUK, PNG, SAZU, UL, UM, UPUK
Despite many millions of doses administered over the past 40 years, basic and crucial issues regarding the use, mode of action, and effectiveness of diethylcarbamazine (DEC) in many clinical ...situations remain unresolved. To directly investigate whether the well-known microfilaricidal and macrofilaricidal actions of DEC actually result in subsequent improvement in existing damage to lymphatic vessels or lymph nodes, 29 study subjects in Recife, Brazil were stratified into three groups according to the severity of clinical manifestations of lymphatic insufficiency. After baseline radionuclide lymphoscintigraphy was performed, subjects were treated with two courses of DEC separated by at least a six-month interval and then rescanned one year after the baseline scan. A side-by-side comparison of images obtained at baseline with those obtained at follow-up in 13 asymptomatic microfilaremic individuals, six individuals with filarial fever, and in 10 individuals with chronic pathology demonstrated essentially unchanged lymphatic morphology in all but one individual whose disease actually progressed in the face of therapy. We conclude that two 12-day treatment courses of DEC did not have a demonstrable direct or indirect effect on existing structural damage to the lymphatic system even in those individuals with preclinical disease.
The purpose of this column is to describe the implementation of an international multisite Roy adaptation model-based study of women’s perceptions of and responses to cesarean birth. The need for the ...study arose from the concern that women’s childbearing needs may not be met to their full satisfaction, especially if the infant is born by cesarean. Serendipity and networking played a part in the selection of four study sites in the United States (Boston, Milwaukee, Norfolk, Oklahoma City) and two in other countries (Finland, Australia). Data were collected by nursing students and staff nurses. Post-hoc consideration of the diversity of study sites revealed opportunities for examination of the influence of the contextual stimuli of culture and geographic region on the women’s adaptation to cesarean birth. Strategies used to foster integration of teaching, practice, and research are discussed.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
Dans cet article, nous présentons une étude sur l'expérience des conducteurs d'applis, menée au premier semestre 2020, pendant les mois de verrouillage dus à la pandémie de Covid19. Dans un premier ...temps, nous développons une brève revue de la littérature sur les transformations du monde du travail, puis une étude préliminaire sur la structure professionnelle brésilienne basée sur les statistiques disponibles de l'Institut brésilien de géographie et de statistique (IBGE). Au Brésil, le taux de chômage a augmenté ces dernières années, et avec lui, l'informalité a également augmenté, c'est-à-dire que le nombre de travailleurs sans contrat de travail signé a augmenté, et donc, sans la garantie des droits du travail. Nous pouvons observer au cours des trois dernières années une augmentation significative du nombre de conducteurs et de coursiers d'apps. Cette catégorie, pour ne pas avoir de droits du travail, est confrontée à la précarité, car elle travaille pour des entreprises multinationales qui profitent beaucoup, sans aucun lien d'emploi. Cette réalité est devenue encore plus évidente en période de crise, comme dans le cas de la pandémie de coronavirus, lorsque ces travailleurs ne pouvaient pas respecter les règles d'isolement, car s'ils ne travaillent pas, ils ne peuvent pas subvenir aux besoins de leur famille. La recherche vise à contribuer à la compréhension des changements dans les relations de travail causés par l'avancement des outils numériques qui facilitent l'échange de services. Pour ce faire, trois objectifs spécifiques ont été fixés : i) cartographier le débat dans la littérature spécialisée sur les relations de travail médiées par la popularisation des applications de prestation de services ; ii) explorer les statistiques disponibles auprès de l'Institut brésilien de géographie et de statistique (IBGE) sur le sujet et présenter une étude exploratoire sur le profil des moteurs d'application. Les statistiques publiques sur la population économiquement active seront examinées et des informations sur les trajectoires professionnelles des prestataires de services seront collectées. Une discussion plus approfondie est attendue sur la façon dont ces outils de prestation de services sont liés au travail et comment ils modifient ces relations à partir du moment historique, économique et politique. Ils permettront également de contribuer à la production d'informations socio-démographiques sur ces travailleurs, sur lesquels nous ne disposons pratiquement d'aucune statistique.
To determine the nephron segment distribution of tubular epithelial damage and regeneration and the proliferative activity of various nephron segments in human acute tubular necrosis (ATN) with an ...antibody to proliferating cell nuclear antigen (PCNA) and to compare the findings in native kidneys with ATN with those in transplant kidneys with ATN, archival tissues from 12 native and 21 transplant kidney biopsy specimens and nine transplant nephrectomy specimens were collected that all showed obvious morphological signs of ATN. Nineteen patients with transplant kidneys with ATN were immunosuppressed with cyclosporine and 11 were immunosuppressed with prednisone and azathioprine. There was a predominance of “regenerating” tubules (tubules with thin epithelium) in the distal nephron in native kidneys with ATN; in the transplant kidneys this was less conspicuous. The number of Tamm-Horsfall protein (THP)-positive tubules was decreased in all kidneys with ATN compared with normal human kidneys. In contrast, the number of THP-positive casts was much higher in all kidneys with ATN than in the normal kidneys. In transplant kidneys with ATN the number of THP-positive casts was substantially lower than in native kidneys with ATN. The macula densa appears to maintain its morphological integrity in kidneys with ATN. Both regenerating and normal appearing tubules expressed vimentin and HLA-DR. The proliferation index (PI; ie, percentage of PCNApositive nuclei) of the renal tubular epithelium in normal control kidneys varied between 0.22 and 0.33, depending on the tubule segment. The highest PI was noted in the transplant kidneys with ATN not treated with cyclosporine (8.0), followed by the native kidneys with ATN (4.4) and the transplant kidneys with ATN treated with cyclosporine (4.3). We did not find any significant difference in the PI between the regenerating (5.0) and normal appearing (5.6) tubules. Proximal tubules (8.7) showed significantly higher PI values than distal tubules (3.5) in transplant kidneys with ATN. Our results show substantial differences between native kidneys and transplant kidneys with ATN. Tubular epithelial cell proliferation in human ATN is prominent and appears to correlate with the severity of ATN. Light microscopically normal appearing tubules and regenerating tubules participate equally in the regeneration of injured tubules. Cyclosporine may have an inhibitory effect on cell regeneration (proliferation) in human transplant kidneys with ATN.
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IJS, IMTLJ, KILJ, KISLJ, NUK, SBCE, SBJE, UL, UM, UPCLJ, UPUK
We have carried out a retrospective, multicentre, chart-review trial, in which all the patients meeting pre-established inclusion criteria and treated in the three participating centres with either ...splenectomy or low-dose splenic irradiation were enrolled. Inclusion criteria were: long-lasting, symptomatic, severe thrombocytopenia (<25 x 10 super(9)/l), refractory to previous treatments (zidovudine; corticosteroids; vincristine; danazol; high-dose intravenous IgG; high-dose dexamethasone or IFN- alpha ) and a CD4 cell count higher than 50 x 10 super(6)/l. Exclusion criteria were: reduced bone marrow megakaryocytes; liver cirrhosis; granulocytes lower than 3 x 10 super(9)/l or haemoglobin lower than 110 g/l; allergy to pneumococcal vaccine or to cephalosporins. Patient records were analysed for a follow-up of 6 months by independent reviewers.
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