What do nurses do to promote population's health?

It is interest of the profession to theorize on this matter to direct and to reorganize the education. This article describes the phase of study developed up to today.     

Pharmacological interventions for spinal cord injury: where do we stand? How might we step forward?

Despite numerous studies reporting some measures of efficacy in the animal literature, there are currently no effective therapies for the treatment of traumatic spinal cord injuries (SCI) in humans. The purpose of this review is to delineate key pathophysiological processes that contribute to neurological deficits after SCI, as well as to describe examples of pharmacological approaches that are currently being tested in clinical trials, or nearing clinical translation, for the therapeutic management of SCI. In particular, we will describe the mechanistic rationale to promote neuroprotection and/or functional recovery based on theoretical, yet targeted pathological events. Finally, we will consider the clinical relevancy for emerging evidence that pharmacologically targeting mitochondrial dysfunction following injury may hold the greatest potential for increasing tissue sparing and, consequently, the extent of functional recovery following traumatic SCI.     

Which type of observation for patients with high-risk mild head injury and negative computed tomography?

OBJECTIVE: Current guidelines suggest hospital admission followed by home monitoring for high-risk patients with mild head injury and negative computed tomography scan. We tested early home monitoring under the care of a competent observer. METHODS: A total of 1480 patients with mild head injury and negative computed tomography scan were prospectively studied. Based on clinical status and available home caretakers, patients were managed by in-hospital observation (n = 646) or early home monitoring (n = 834). Outcome measures were: (1) the detection of previously undiagnosed post-traumatic intracranial injury; (2) neurosurgical intervention; and (3) unfavourable outcome (death, permanent vegetative state or severe disability). RESULTS: In the in-hospital arm, nine cases (1.4%) developed intracranial injuries (in three after discharge). In the early home-monitoring arm, six patients (0.7%) had a previously undiagnosed lesion after re-admission (P = 0.773 versus in-hospital arm). No patients with previously undiagnosed intracranial injuries had a neurosurgical intervention. After 6 months, five patients had died in the home monitoring arm (0.8%) versus eight (1.0%) in the in-hospital arm (P=0.785). No permanent disability or vegetative state was observed. CONCLUSION: Early home monitoring may be safely proposed to selected "high-risk" patients, with an early negative computed tomography scan, normal clinical examination and feasible home monitoring.     

How do general practitioners in Denmark promote physical activity?

Abstract Objective. The primary objective of this study was to quantify the frequency of advice given on type, frequency, duration, and intensity of exercise during physical activity (PA) promoting sessions by general practitioners. Second, to find GP characteristics associated with high quality of PA counselling. Design. A cross-sectional questionnaire survey. Setting and subjects. General practitioners in two Danish municipalities in central Copenhagen, Denmark. Results. 56.3% (223/396) of GPs returned the questionnaire. 95.5% (127/223) of the respondents reported giving advice on PA at least weekly. PA promotion included advice on type of exercise, duration, frequency, and intensity in 80% (interquartile range 60 to 90), 70% (50-80), 70% (50-90), and 60% (40-80) of the consultations, respectively. Length of consultation (minutes) was positively associated with increased chance of advice on type of exercise (OR 1.08; 95% CI 1.02-1.13), frequency (OR 1.09; 95% CI 1.03-1.16), and intensity (OR 1.06; 95% CI 1.01-1.11). Having attended a course on exercise promotion was associated with increased information on frequency (OR 1.94; 95% CI 1.05-3.60) and duration (OR 1.81; 95% CI 1.02-3.21). Conclusion. While GPs report frequently providing PA counselling, this often lacks specific advice on how to perform the exercise. GPs who have received training on PA promotion more often report providing advice on duration and frequency of exercise compared with GPs who have not received training on PA promotion.     

Biomarkers for acute kidney injury: is NGAL ready for clinical use?

The RIFLE (Risk, Injury, Failure, Loss, and End-stage kidney disease) criteria were introduced in 2004, defining the clinical stage of acute kidney injury (AKI) and outcome measures based on serum creatinine, glomerular filtration rate, and urine output. However, a growing body of evidence suggests that these markers are insufficient in drawing an accurate illustration of kidney injury. Indeed, mortality and morbidity remain high in AKI, suggesting that accuracy and speed of patient evaluation are lacking. A great deal of evidence indicates that neutrophil gelatinase-associated lipocalin (NGAL) is a sensitive and specific early marker of various etiological classes of AKI and would be highly valuable in conjunction with existing markers of AKI for better classifying renal injury as well as dysfunction (kidney attack). Improvements in diagnosis, risk identification, stratification, prognosis, and therapeutic monitoring will benefit clinical decision-making in the individualized bundling of therapies and ongoing patient management. In particular, kidney protection and AKI prevention may become feasible if an earlier and more accurate diagnosis is made for AKI. Here, we discuss the opportunity to consider whether NGAL is ready for routine clinical use in a number of etiologies of AKI.     

Why do children vomit after minor head injury?

Objective—To determine factors associated with vomiting after minor head injury in a paediatric population with the intention of defining the role of vomiting in management decisions.

Methods—A prospective study of all patients presenting with minor head injury to the Royal Hospital for Sick Children, Edinburgh, between 1 May and 30 June 1997. Information regarding basic demographics, features of the head injury and past and family history was noted on a proforma. This included mechanism of injury, site of impact, presence or absence of scalp haematoma, skull fracture or brain injury and intrinsic factors such as age, family history of migraine and a personal history of migraine, its childhood variants and associated conditions. The relation between vomiting and these features was analysed using χ² and Fisher's exact tests.

Results—563 children aged from birth to 13 years presented with minor head injury. Complete data were obtained on 463 patients. Some 15.8% vomited after minor head injury. Comparing vomiters with non-vomiters the only associated factors that could be identified were a past history of recurrent vomiting or motion sickness (p= 0.0035, p=0.036 respectively).

Conclusions—Vomiting after minor head injury seems to be related to individual intrinsic factors rather than specific features of the head injury and its role in management decisions needs to be explored further.

     

Why do children vomit after minor head injury?

OBJECTIVE: To determine factors associated with vomiting after minor head injury in a paediatric population with the intention of defining the role of vomiting in management decisions. METHODS: A prospective study of all patients presenting with minor head injury to the Royal Hospital for Sick Children, Edinburgh, between 1 May and 30 June 1997. Information regarding basic demographics, features of the head injury and past and family history was noted on a proforma. This included mechanism of injury, site of impact, presence or absence of scalp haematoma, skull fracture or brain injury and intrinsic factors such as age, family history of migraine and a personal history of migraine, its childhood variants and associated conditions. The relation between vomiting and these features was analysed using chi2 and Fisher's exact tests. RESULTS: 563 children aged from birth to 13 years presented with minor head injury. Complete data were obtained on 463 patients. Some 15.8% vomited after minor head injury. Comparing vomiters with non-vomiters the only associated factors that could be identified were a past history of recurrent vomiting or motion sickness (p= 0.0035, p=0.036 respectively). CONCLUSIONS: Vomiting after minor head injury seems to be related to individual intrinsic factors rather than specific features of the head injury and its role in management decisions needs to be explored further.