Blood Pressure Regulation during Exercise

This brief review examines five problems concerning arterial blood pressure regulation during exercise. These are:

1. A history and summary of evidence that baroreflexes are, or are not, active during exercise.

2. What might be other “regulators” of blood pressure during exercise? The characteristics of a blood pressure-raising reflex from ischemic and active skeletal muscle (muscle chemoreflex) is reviewed along with a putative role for centrally generated motor command signals (central command).

3. How blood pressure is maintained during exercise. The importance of regional vasoconstriction, particularly in active skeletal muscle, is reviewed.

4. How well matched are cardiac output and total vascular conductance? Does demand for muscle blood flow outstrip cardiac pumping capacity?

5. Reflex control of blood pressure by both baroreflexes and muscle chemoreflexes. The importance of baroreflexes and evidence for resetting is reviewed. A new hypothesis is stated.     

A concept analysis of influence for nurse leaders

BackgroundTo shape priorities for health and health care outcomes, it is essential for nurse leaders to be influential. The application and impact of influence are readily recognized, but not its characteristics.PurposeThe purpose of this project was to conduct a concept analysis of influence relative to nurse leaders.MethodsThe Walker and Avant method of concept analysis was utilized.FindingsAttributes of influence include advocacy, communications skills, competency, confidence, credibility, and engagement. Antecedents of influence are authority, collaboration, integrity, and mentorship. Consequences of influence are action, change, commitment, compliance, decision-making, motivation, and resistance.DiscussionBy drawing upon a systematic understanding of the concept of influence, nurse leaders are urged to develop and leverage the attributes of influence to drive and achieve collective good for the future of health and health care in society.     

Implementation of selective prevention for cardiometabolic diseases; are Dutch general practices adequately prepared?

Objective: Current guidelines acknowledge the need for cardiometabolic disease (CMD) prevention and recommend five-yearly screening of a targeted population. In recent years programs for selective CMD-prevention have been developed, but implementation is challenging. The question arises if general practices are adequately prepared. Therefore, the aim of this study is to assess the organizational preparedness of Dutch general practices and the facilitators and barriers for performing CMD-prevention in practices currently implementing selective CMD-prevention.

Design: Observational study.

Setting: Dutch primary care.

Subjects: General practices.

Main outcome measures: Organizational characteristics.

Results: General practices implementing selective CMD-prevention are more often organized as a group practice (49% vs. 19%, p?=?.000) and are better organized regarding chronic disease management compared to reference practices. They are motivated for performing CMD-prevention and can be considered as ‘frontrunners’ of Dutch general practices with respect to their practice organization. The most important reported barriers are a limited availability of staff (59%) and inadequate funding (41%).

Conclusions: The organizational infrastructure of Dutch general practices is considered adequate for performing most steps of selective CMD-prevention. Implementation of prevention programs including easily accessible lifestyle interventions needs attention. All stakeholders involved share the responsibility to realize structural funding for programmed CMD-prevention. Aforementioned conditions should be taken into account with respect to future implementation of selective CMD-prevention.

• Key Points

• There is need for adequate CMD prevention. Little is known about the organization of selective CMD prevention in general practices.

• ??The organizational infrastructure of Dutch general practices is adequate for performing most steps of selective CMD prevention.

• ??Implementation of selective CMD prevention programs including easily accessible services for lifestyle support should be the focus of attention.

• ??Policy makers, health insurance companies and healthcare professionals share the responsibility to realize structural funding for selective CMD prevention.

     

People with disabilities as product innovators: a pilot study

Abstract

Purpose: The purpose of this study is to explore the rate of product innovation among persons with disabilities, how they are diffused and the general value of these developed solutions for persons without disabilities.

Materials and methods: A sample of participants (n?=?178) completed a self-administered questionnaire, which included information about their disability, disability burden, general unmet product needs, the impact of the developed solution on their quality of life and how solutions were diffused. We analyzed solutions both for their novelty and for their general value.

Results: Close to 45% of respondents reported having developed a solution, with 9.55% solutions judged as novel. Additionally, 6.8% of respondents developed a solution of general value to non-disabled users.

Conclusions: Our results suggest that people with disabilities are actively involved in product development and that their solutions have a positive impact on their lives. Furthermore, many reported solutions also provide value for non-disabled persons, suggesting that persons with disabilities may be an important source of innovation.

• Implications for Rehabilitation

• Persons with disabilities are frequently engaged in developing solutions that meet their unmet product needs.

• Most solutions are not diffused beyond their immediate social circle.

• Solutions have a significant impact on the self-reported quality of life of participants.

     

Bone formation in calvarial defects by injectable nanoparticular scaffold loaded with stem cells

Objective: Calcium phosphates are one of biomaterials that are used for bone regeneration. In this study, calcium phosphate nanoparticles such as hydroxyapatite (HA)/fluorapatite (FA),with chitosan gel filled with unrestricted somatic stem cells (USSCs) were used for healing calvarial bone in rat model.

Methods: The healing effects of these injectable scaffolds, with and without stem cells, in bone regeneration were investigated by computed tomography (CT) analysis and pathology assays after 28 days of grafting.

Results: The results of CT analysis showed that bone regeneration on the scaffolds, and the amounts of regenerated new bone for USSC scaffold were significantly greater than the scaffold without cell and untreated controls.

Conclusion: Therefore, the combination of scaffold especially with USSC could be considered as a useful method for bone regeneration.     

Suitability of Nintendo Wii Balance Board for rehabilitation of standing after stroke

Abstract

Background: Normal standing requires ongoing postural adjustments while performing a variety of everyday tasks. Reduced muscle strength and dexterity affect the ability to stand after stroke. Biofeedback has been shown to be effective in training lower limb activities in people with stroke. Nintendo Wii, Nintendo Wii Balance Board, and Nintendo Wii Fit Plus are potentially useful devices for providing feedback to train standing after stroke.

Objectives: What specific Nintendo Wii Fit Plus games are suitable for rehabilitation of standing in patients with stroke?

Method: A criteria-based review of the Nintendo Wii Fit Plus was carried out to determine the movements required, feedback provided, demands upon the patient, difficulty of and instruction provided by the Nintendo Wii Fit Plus games in the context of stroke rehabilitation. Seventy-five Nintendo Wii Fit Plus games were reviewed and 20 were included for in-depth review.

Major findings: The games require movements of the centre of mass in different directions, provide feedback in different ways and place additional physical and cognitive demands upon the patient. Only five games are suitable for people who have severely impaired ability to stand. Six games are suitable for people with moderately impaired standing and nine games are suitable only for people with mildly impaired standing ability. Game goals and the position of the patient can be modified to make the games target physiotherapy goals.

Conclusions: Enough suitable games exist to make the Nintendo Wii and Nintendo Wii Fit Plus an appropriate biofeedback device for rehabilitation of standing after stroke.     

Prognostic and therapeutic molecular markers in the clinical management of esophageal cancer

ABSTRACT

Introduction: Esophageal cancer is a deadly disease with high mortality. Treatment with chemotherapy, radiation, and surgery continues to leave many patients with disease progression and recurrence. Novel treatments are needed for this patient population. The development of molecular markers are important for identifying therapeutic targets, as well as prognosis.

Areas covered: This review evaluates three molecular markers in esophageal cancer: HER2, PD-L1, and MSI. The fundamentals of these markers, diagnosis, and rates of occurrence in esophageal cancer are explored. The prognostic potential of these markers is based on existing literature as well as application in clinical trials. Key trial findings pertaining to the therapeutic targets for HER2 and PD-1 as well as the role of MSI are discussed.

Expert commentary: Molecular markers are changing the practice for esophageal cancer. Therapeutic targeting for HER2 and PD-L1 have shown positive results in recent clinical trials. Trials evaluating immunotherapy as first-line agents are currently underway.     

Challenges in postgraduate research supervision in nursing education: Integrative review

AimThe aim of this study was to investigate challenges associated with postgraduate research supervision in nursing education and possible implications for improvement efforts.BackgroundPostgraduate research-based programs in nursing education are particularly new compared to other professions. Anecdotal notes from nursing education stakeholders indicate that postgraduate research supervision encounters numerous challenges, with negative consequences for the nursing profession and for society.MethodIntegrative review that combines empirical and theoretical evidence was used to obtain a comprehensive picture of challenges in the supervision of postgraduate research.Data sourcesEBSCOhost; Science Direct; Google Scholar.Review methodsThe quality of included studies was appraised using the Mixed Method Appraisal Tool for quantitative, qualitative and mixed-method studies. Two reviewers extracted data and did quality appraisal.AnalysisInductive content analysis was used to analyse extracted data from included studies.ResultsSeven studies were included. Three main categories of challenges associated with (a) institutional context, (b) research supervisors, and (c) postgraduate students.DiscussionInstitutional context challenges were lack of clear guidelines for nursing schools, limited pool of appropriate research supervisors, and recruitment of many postgraduate students leading to mismatch, confusion and limited support. Research supervisors are insufficiently prepared, predominantly use traditional face-to-face method, and provide inconsistent feedback. Postgraduate students are inadequately prepared and are mostly full-time employed.ConclusionMany challenges continue to beset postgraduate research supervision in nursing discipline, with negative consequences for the quality of graduates and the quality of their research output.The implication for nursing policyTo generate useful knowledge and increase the number of motivated nursing scholars, challenges associated with postgraduate research supervision need to be addressed, with emphasis on formal training for research supervisors and development of clear guidelines for postgraduate research supervision and for recruitment of postgraduate students.     

磁共振弥散张量成像图像后处理

目的 探讨医学图像处理方法在磁共振弥散张量成像后处理中的应用。方法 通过医学图像处理的方法,对弥散张量成像主要进行了图像变形纠正、标量图计算、体绘制生成、纤维束追踪的后处理。结果 实验证明弥散张量成像图像后处理方法有效、可靠。结论 医学图像后处理的方法能够有效提取原始数据信息,提高图像质量,方便诊疗。     

The role of integrin antagonists in the treatment of inflammatory bowel disease

Introduction: Ulcerative colitis (UC) and Crohn’s disease are chronic inflammatory diseases of the bowel associated with complex inflammatory cascades within the mucosal lining of the gut.

Areas covered: INTEGRINS and their use as therapies in UC and Crohn’s.

Expert Opinion: The anti-adhesion molecules are a welcome addition to the armamentarium of medical therapies for inflammatory bowel disease.     

Pharmacologic Management of Cancer Pain

ObjectiveTo provide an overview of the pharmacologic management of cancer pain.Data SourcesPeer-reviewed articles, textbooks, Internet.ConclusionMedications are the mainstay of cancer pain management. Evidence exists for multimodal use of opioids, non-opioids, and co-analgesics to optimally manage cancer pain.Implications for Nursing PracticeOncology nurses are the front line of pharmacologic pain management for patients. Patient education regarding analgesic administration and potential side effects is paramount to optimizing safe and effective pain management.     

磁共振弥散张量成像图像几何变形的原理分析

目的讨论磁共振弥散张量成像图像几何变形的原因。方法以T1加权图像为基准,对1.5T与3.0T磁共振弥散张量成像的图像进行回顾,分析图像变形产生的主要原因以及参数优化对图像质量的影响。结果磁共振弥散张量成像的图像序列均存在变形,变形的大小主要取决于组织磁敏感性的差异与梯度磁场的非线性;通过参数优化可以适当提高图像质量。结论磁共振弥散张量图像几何变形主要是由于组织磁敏感性差异与涡流导致的梯度磁场的非线性造成。     

Method specific second-trimester reference intervals for thyroid-stimulating hormone and free thyroxine

ObjectiveTo determine second trimester reference intervals for TSH and FT4.DesignSamples from 3102 subjects were tested for TPO and Tg antibodies.MethodsElecsys E170 reference intervals for TSH and FT4 were determined using antibody-negative samples.ResultsSecond trimester reference intervals for TSH and FT4 were 0.18–4.07 mIU/L and 9.5–15.8 pmol/L, respectively. The Elecsys E170 TSH results were positively biased compared to ARCHITECT i2000_SR results for these same samples.ConclusionsMethod-specific reference intervals are required for TSH and FT4.     

Costly regional variations in primary health care test utilization in Sweden

Abstract

Objective: Laboratory tests are used increasingly in primary health care and they are thus associated with rapidly growing costs. Variations in clinical practice, an important determinant of expenditure for laboratory tests, could further increase the financial burden. The study's threefold objective was to determine the presence and extent of regional variations in test ordering between eight counties in Sweden, to investigate the influence on these variations by factors earlier described in the literature as explanatory, and to calculate the achievable savings that could be realized through optimized test ordering. Design: A retrospective study using test request data. Setting: A total of 223 primary health care centers in eight counties in Sweden. Main outcome measures: Thirteen ratios of commonly used laboratory tests, demographic data and the number of ordered tests per 1000 inhabitants served as the basis of comparison. The total savings per 100,000 inhabitants that could be achieved through optimized test ordering was estimated. Results: Large variations were found between all studied counties for all investigated ratios. However, none of the demographic variables investigated seemed to be able to explain the full extent of the variations. The range of achievable yearly savings per 100,000 inhabitants was €14,000–€185,000. Conclusion: The inter-county variations in Sweden are large and the savings associated with optimized test utilization are substantial. The investigated factors previously described as explaining the variations in test ordering only seem to explain a small part of the variation, and the variations are likely influenced by regional habits and traditions.     

Reimagining the role of nursing education in emissions reduction

BackgroundThe healthcare sector is a significant producer of emissions globally and yet paradoxically cares for those who are most impacted by climate change.PurposeThis rapid review examined the role of the nurse in reducing emissions within the hospital setting.MethodsLiterature meeting inclusion criteria were identified from 2009 to 2021, resulting in 11 primary research papers being reviewed.FindingThe review found that nurses, the largest profession within the healthcare workforce, are in a unique position to influence emissions reduction in the hospital setting.ConclusionWhilst nurses have not reached their full potential in influencing emissions reduction, education, setting policy direction, and undertaking research are pivotal for the nursing profession to reduce emissions within the hospital setting.     

Alemtuzumab and multiple sclerosis: therapeutic application

Importance of the field: The cause and cure for multiple sclerosis (MS) remain unknown. Immunomodulatory agents are only partially effective and many patients do not tolerate the side effects or fail them. Immunosuppressive agents act non-specifically and are associated with serious complications. An emerging group of biologic agents with great potential for treatment of immune-mediated disorders such as MS are monoclonal antibodies. A review of alemtuzumab in MS is presented.

Areas covered in this review: Mechanisms of action of alemtuzumab and the results of Phase II clinical trials in MS.

What the reader will gain: Alemtuzumab is a humanized mAb, which targets the surface molecule CD52 on all T cell populations and other cellular components of the immune system such as thymocytes, B cells, and monocytes. Alemtuzumab, which is administered intravenously, depletes T as well as B lymphocyte populations for extended periods. Adverse effects in MS patients such as thyroid disorders and idiopathic thrombocytopenic purpura are discussed.

Take home message: Alemtuzumab may hold great promise for treatment of MS patients and serve as an option for patients refractory to immunomodulatory therapies. Due to its unique mechanism of action and profound effect on MS disease activity it enhances our knowledge about pathogenic mechanisms of MS.     

Consultation with users,carers and staff in order to improve local palliative care services – how to do it and views on current services

Abstract

Objective: To learn about the quality of local services and develop an appropriate methodology for future consultation.

Methods: Tape recordings were made of patient and carer consultations using semi-structured interviews and staff focus groups using semistructured questioning. These were then transcribed and analysed.

Results: The majority of feedback was positive. Continuity of care is very important and complex when a large range of agencies are involved in an individual package of care. Many staff expressed concern that expectations of patients are beyond what they are able to deliver. Participants wanted to have choice in the way that they were consulted. It is difficult to enable staff to support the consultation process whilst meeting constraints imposed by ethical considerations. The consultation work must demonstrate a difference in order to encourage enthusiasm from staff or patients/carers for projects in the future.

Conclusions: Users of palliative care services are a particularly hard group to access and consult with; we must demonstrate that their contribution is likely to lead to change.