Chronic diseases: what are they? How are they inherited?

BACKGROUND: Chronic diseases (CD), miasms or reactional modes, remain one of the darkest concepts of homeopathy. They are supposed to be heritable and originate after suppression of other diseases. Besides this nothing is known about how they might produce the large number of diseases mentioned in homeopathic books. They have been described in a variety of terms, ranging from Kent and Gathak's spiritual or metaphysic conception; the biological-allergic by Paschero, and, Robert's materialist-nutritional point of view. Flores-Bejar et al have outlined an approach to CD from a cellular and bioenergetic point of view. RESULTS: Cellular pathology has led to an understanding of the basic repair mechanisms of every cell and tissue. These mechanisms exist in order to avoid necrosis or cell death. The main mechanisms are molecular repair, apoptosis and cell proliferation. Failure of these mechanisms leads to 'dysrepair'. Consequences of these 'dysrepair' mechanisms resemble the homeopathic reactional modes or miasms. These abnormal or 'dysrepair' mechanisms are probably the basis of miasms or reactional modes. A new interpretation of miasms is proposed: Psora corresponds to the dysmolecular reactional mode. Syphilis corresponds to dysapoptotic reactional mode. Sycosis corresponds to dysproliferative reactional mode.     

Internet-based patient information systems: what are they, why are they here, how will they be used, and will they work?

Web-based patient information systems are an emerging tool in the drive towards improving efficiency and effectiveness of health care. Providers and health plans may be able to achieve three key objectives with these systems: improve the health status of patients, improve marketing programs, and reduce costs. To discover what we know about these systems, we examine how they perform today, review the trends that are shaping their development, present a case study of a large East Coast HMO, and postulate future trends.     

Informal care providers for veterans with SCI: who are they and how are they doing?

Veterans with spinal cord injury (SCI) who received care at the Houston Department of Veterans Affairs Medical Center were interviewed about their use of formal and informal assistance to meet their daily physical needs. Informal caregivers were found to play an important role in the daily care of veterans with SCI, with 37% receiving some informal, unpaid assistance-with personal care. Primary informal caregivers were mostly women, had a mean age of 53, and provided an average of almost 12 hours of care a day. Nearly one-third of participants rated their primary caregiver as being only in fair or poor health, and one-fourth thought their caregiver was unlikely to be able to provide the same level of care 5 years from now. Of particular concern, more than half reported that they did not have anyone else willing and able to provide assistance if their primary family caregiver became permanently unable to care for them.     

Outcomes: are they a good thing?

One of the current buzzwords for health care these days is outcomes. Everyone, including payers, is attempting to evaluate the quality of care provided by the outcomes achieved. Outcomes can help the caregiver and the client determine if the appropriate care is being provided; identify if changes need to be made in the care plan; develop a mechanism to discuss effects of care that are understood by all health providers; demonstrate to the client the health care they have received, in a fashion that makes sense to them; and document nursing interventions that are most effective. Outcomes can be the basis for quality improvement and can assist in discharge planning. They also help in evaluating the organization's overall performance. As Martha Stewart would say, "It's a good thing."     

SGLT2 inhibitors: are they safe?

Sodium–glucose linked transporter type 2 (SGLT2) inhibitors are a relatively new class of antidiabetic drugs with positive cardiovascular and kidney effects. The aim of this review is to present the safety issues associated with SGLT2 inhibitors. Urogenital infections are the most frequently encountered adverse events, although tend to be mild to moderate and are easily manageable with standard treatment. Although no increased acute kidney injury risk was evident in the major trials, the mechanism of action of these drugs requires caution when they are administered in patients with extracellular volume depletion or with drugs affecting renal hemodynamics. Canagliflozin raised the risk of amputations and the rate of fractures in the CANVAS trial, although more data are necessary before drawing definite conclusions. The risk of euglycemic diabetic ketoacidosis seems to be minimal when the drugs are prescribed properly. Regarding other adverse events, SGLT2 inhibitors do not increase the risk of hypoglycemia even when co-administered with insulin, but a decrease in the dose of sulphonylureas may be needed. The available data do not point to a causative role of SGLT2 inhibitors on malignancy risk, however, these drugs should be used with caution in patients with known hematuria or history of bladder cancer. SGLT2 inhibitors seem to be safe and effective in the treatment of diabetes but more studies are required to assess their long-term safety.     

Mongolian spots: How important are they?

Mongolian spots (MS) are congenital birthmarks seen most commonly over the lumbosacral area. They are bluish-green to black in color and oval to irregular in shape. They are most commonly found in individuals of African or Asian ethnic background. Although these lesions resolve by one to two years of age, widespread, extrasacral and dark colored MS sometimes persist into adulthood. Aberrant MS over occiput, temple, mandibular area, shoulders and limbs may be confused with other dermal melanocytoses and bruises secondary to child abuse, thus necessitating documentation at birth. Although traditionally believed to be benign in nature, they have now been shown to co-exist with inborn errors of metabolism, most commonly GM1 gangliosidosis and mucopolysaccharidosis type I (Hurler’s disease), followed by mucopolysaccharidosis type II (Hunter’s syndrome), mucolipidosis, Niemann-Pick disease and mannosidosis. They have also been seen to co-exist with various vascular or other pigmented birthmarks like café-au-lait macules. Co-existing Mongolian spots and vascular birthmarks like nevus flammeus, nevus anemicus or nevus spilus is termed as phakomatosis pigmentovascularis. This review focuses on the important associations of Mongolian spots and stresses upon the importance of screening babies with extensive MS.     

Assertiveness and caring: are they compatible?

Background. Findings from numerous assertion studies suggest that nurses are generally non‐assertive. This study examines the role of caring as an important determinant of adaptive assertive behaviour. Aim and objectives. The aim of the investigation was to explore the relationship between assertion and caring skills. Two study objectives sought to determine whether both positive and negative assertive behaviours were related to caring skills. Design. Correlational and cross‐sectional study. Method. The Caring Assessment Instrument (Care Q – Questionnaire Version) and the assertion inventory were used to collect self‐report data from a convenience sample of 94 subjects. Behavioural data were obtained by directly sampling 50 nurses’ responses within role‐play situations. Results. One significant result between the various assertion measurements and caring skill scores was noted, highlighting a relationship between negative assertion and the caring ‘accessible’ subscale. Conclusion. Overall the findings of the study suggest that positive and negative assertive behaviours are not related to caring skills. Relevance to clinical practice. The current findings suggest that the presence of caring attributes cannot be offered as a possible reason for non‐assertion in nurses.     

National service frameworks: what are they?

This article describes policy developments surrounding the creation of national service frameworks. The national service framework for mental health is used as an example to highlight the content of the framework and the way it has been received.     

Clinical prediction rules: What are they and what do they tell us?

QUESTION: Clinical prediction rules are research-based tools that quantify the contributions of relevant patient characteristics to provide numeric indices that assist clinicians in making predictions. Clinical prediction rules have been used to describe the likelihood of the presence or absence of a condition, assist in determining patient prognosis, and help the classification of patients for treatment. The recent rapid rise in the use of clinical prediction rules raises questions about the conditions under which they may be used most appropriately. What is the potential role of clinical prediction rules in physiotherapy practice and what are the strategies by which clinicians can determine their appropriate use for a given clinical setting? CONCLUSION: Clinical prediction rules use quantitative methods to build upon the body of literature and expert opinion and can provide quick and inexpensive estimates of probability. Clinical prediction rules can be of great value to assist clinical decision making but should not be used indiscriminately. They are not a replacement for clinical judgment and should complement rather than supplant clinical opinion and intuition. The development of valid clinical prediction rules should be a goal of physiotherapy research. Specific areas in need of attention include deriving and validating clinical prediction rules to screen patients for potentially serious conditions for which current tests lack adequate diagnostic accuracy or have unacceptable cost and risk, and to assist in classification of patients for treatments that are likely to result in substantially different outcomes in heterogeneous groups of patients.     

Blood cell microRNAs: what are they and what future do they hold?

The advent of blood component storage revolutionized health care by allowing for a managed supply of transfusion quality blood products. During storage, blood components undergo a series of physiological changes that affect the product quality, which ultimately can interfere with the safety and efficacy of such products after transfusion. Despite continuous improvements in blood component quality and safety, it is still desirable to have in vitro standard markers of measurable characteristics that predict blood component safety and efficacy in vivo following their transfusion. Over the last decade, research on the feasibility of using microRNAs as biomarkers for various clinical manifestations and cellular pathologies has exploded. Here, we review the literature on blood cell microRNAs and discuss the potential of these molecules to act as measurable characteristics (product biomarkers) for stored blood component quality and safety.     

Nurse prescribers: who are they and how do they perceive their role?

AIMS: This paper reports a study to elicit background data from recently qualified nurse prescribers and explore aspects of their work. BACKGROUND: Nurse prescribing has been introduced quite recently in the United Kingdom. Although a certain amount of information is available about the characteristics of nurse prescribers, relatively little is known about their professional backgrounds, their reasons for choosing to become nurse prescribers and their perceptions of their emerging role. More information is needed to inform the selection, education and support of nurse prescribers. METHOD: All nurses who undertook a nurse prescribing course in one university in the West Midlands during 2003-2004 were invited to participate in the study. A 40-item questionnaire was used to gather data on demographics, expectations of nurse prescribing, personal and professional development and perceived education needs. FINDINGS: Respondents considered that, despite initial problems, the nurse prescribing initiative would ultimately prove to be a cornerstone of improved service delivery for service users. The majority of nurses were already heavily involved in prescribing 'by proxy' and the course merely formalized what they were currently doing. Potentially, prescribing could advance the professional development of nurses, improve communication between professionals and patients, and make the experience of patients more beneficial. However, some concerns were expressed about how supportive the current climate in health care could be, given the multiple demands on time and energy required by so many other innovations. CONCLUSIONS: Respondents appeared balanced in their perceptions of this innovation and what it could realistically achieve. They were not indifferent to the many short and long-term problems that need to be resolved before it can be claimed to have become embedded in practice. The success of non-medical prescribing may depend on organizational support, coupled with a robust continuing professional development strategy for all nurse prescribers.