Is there a future for clinical laboratories? Experience in the Marche Region, Italy

The government of the Marche Region has approved an Act called the "Regional Health Plan" establishing rules for the organization and development of healthcare. The main aim of the general plan is to rationalize the activities of medical laboratories first by making up an inventory of existing facilities and tests performed, and by classifying laboratories on the basis of their specialization and the complexity of tests that they perform.Moreover, the possible role of point-of-care testing and the need for clinical advice by laboratory professionals has also been debated.     

Is there a glycemic threshold for mortality risk?

OBJECTIVE: To determine whether there are thresholds for fasting and for 2-h glucose above which the risk of death from all causes and from coronary heart disease (CHD) increases. RESEARCH DESIGN AND METHODS: We studied 23-year mortality data from the Paris Prospective Study of the 7,018 men, aged 44-55 years, who were not known as diabetic at the baseline examination. The effect of glucose concentrations on mortality was studied using the observed relative risks and an age-adjusted Cox proportional hazards model. RESULTS: For all causes of death, there were J-shaped relationships with both fasting and 2-h glucose concentrations, and the lowest observed death rates were in the intervals centered on 5.5 mmol/l for fasting glucose and 5.0 mmol/l for 2-h glucose. The death rates for CHD were low in this population: for fasting glucose, the hazards ratio was best modeled by a positive linear relationship; for 2-h glucose, it was modeled by a J-shaped curve and the lowest observed death rate was in the interval centered on 6.0 mmol/l. CONCLUSIONS: In the Paris Prospective Study, there were no clear thresholds for fasting or 2-h glucose concentrations above which mortality sharply increased; in the upper levels of the glucose distributions, the risk of death progressively increased with increasing fasting and 2-h glucose concentrations.     

Is there a scientific basis for pet therapy?

Purpose.?Pet therapy is a non-pharmacological intervention, but its scientific value is still undefined.

Methods.?The first step to identify the papers of interest was the access to the MEDLINE library from 1960 until June 2007 and the Cochrane controlled trials registry.

Results.?At present there is consistent evidence of the protective effect against cardiovascular risk, mainly through the moderate exercise prompted by walking a dog. Indeed, walking a dog may contribute to a physically active lifestyle. Moreover, patients suffering from chronic illness are likely to benefit from pet companionship.

Conclusions.?There is a contrast between physical effects (for which the evidence is fairly clear) and the psychological benefits (for which the evidence is controversial). Further randomised researches are necessary to convey scientific dignity to the human – animal relationship.     

Is there a place for epidemiology in nursing?

BACKGROUND: Epidemiological research is seen by many to have immense value in helping to determine the health of populations and in helping to plan and determine health service policy. Despite this it seems to be poorly understood and greatly underused by the nursing profession. CONCLUSION: Epidemiological studies can potentially offer considerable benefits to the way nurses incorporate health-related practices into their professional role. Research also offers a valuable opportunity for the nursing profession to become more active in helping to determine health policy issues. This article explores the nature of the dilemmas surrounding nursing and epidemiology and argues that nursing might be better served by a more proactive role in this valuable research discipline.     

Is there a role for statins in fungal infections?

It has been hypothesized that statins, HMG-CoA reductase inhibitors, may be used to treat fungal infections. Here we review data on antifungal properties of statins, effects on the host inflammatory response as well as available clinical evidence. We conclude that: statins exhibit antifungal properties in vitro although at supraphysiological concentrations; statins appear to have anti-inflammatory effects on host cells in vitro; statins have effects on fungal physiology beyond direct growth inhibition; clinical studies are scarce (n = 5), and their design is retrospective and observational, which is associated with a high risk of bias. Given the limited evidence for a beneficial effect of statins in fungal infection, randomized and controlled trials are highly warranted in this field.     

Is there a case for paternalism in forensic nursing?

Forensic nurses often face a competing duty to patients and society. This article explores possible solutions to the ethical conflict.