Effect of immunosuppression on the development of experimental hematogenous Candida endophthalmitis.

The induction of neutropenia and immunosuppression by the administration of nitrogen mustard (HN2) decreased the frequency and altered the morphology of clinically detectable hematogenous Candida endophthalmitis in the rabbit model of disseminated candidiasis. Whereas 95% of eyes in rabbits infected with Candida albicans without pretreatment with HN2 developed typical lesions of hematogenous Candida endophthalmitis, only 6.2% of eyes in rabbits that had been given 3.0 mg of HN2 per kg developed clinically detectable endophthalmitis. Lesions that developed in the severely immunocompromised and neutropenic rabbits were small and atypical in appearance. From these data, we conclude that ophthalmoscopic examination may not be a sensitive diagnostic modality for disseminated candidiasis in severely immunocompromised, neutropenic patients.     

The Dietary Inflammatory Index and Human Health: An Umbrella Review of Meta-Analyses of Observational Studies

Numerous observational studies have investigated the role of the Dietary Inflammatory Index (DII®) in chronic disease risk. The aims of this umbrella review and integrated meta-analyses were to systematically synthesize the observational evidence reporting on the associations between the DII and health outcomes based on meta-analyses, and to assess the quality and strength of the evidence for each associated outcome. This umbrella review with integrated meta-analyses investigated the association between the DII and a range of health outcomes based on meta-analyses of observational data. A credibility assessment was conducted for each outcome using the following criteria: statistical heterogeneity, 95% prediction intervals, evidence for small-study effect and/or excess significance bias, as well as effect sizes and P values using calculated random effects meta-analyses. In total, 15 meta-analyses reporting on 38 chronic disease-related outcomes were included, incorporating a total population of 4,360,111 subjects. Outcomes (n = 38) were examined through various study designs including case-control (n = 8), cross-sectional (n = 5), prospective (n = 5), and combination (n = 20) study designs. Adherence to a pro-inflammatory dietary pattern had a significant positive association with 27 (71%) of the included health outcomes (P value < 0.05). Using the credibility assessment, Class I (Convincing) evidence was identified for myocardial infarction only, Class II (Highly suggestive) evidence was identified for increased risk of all-cause mortality, overall risk of incident cancer, and risk of incident site-specific cancers (colorectal, pancreatic, respiratory, and oral cancers) with increasing (more pro-inflammatory) DII score. Most outcomes (n = 31) presented Class III (Suggestive) or lower evidence (Weak or No association). Pro-inflammatory dietary patterns were nominally associated with an increased risk of many chronic disease outcomes. However, the strength of evidence for most outcomes was limited. Further prospective studies are required to improve the precision of the effect size.     

The future nurse: selection and training; autonomy; should her health-care role be modified for future patient demands?*

This paper was presented in the context of an international interdisciplinary conference on Priorities in Health Care. The focus of the paper is the relationship between the nurse's role and the demands of patients, now and in the future. The incongruence between patients' needs and their demands is discussed and the question is raised as to whether the nurse's skills and knowledge currently acquired will be appropriate to meet patients' needs and demands in the future. Future patient needs and demands are not the only external pressures on changes in the nurse's role; advances in medical treatment and technology and changing roles of other health professionals are others. The paper highlights the dilemma between the profession having to give way to such external pressures or the risk of preparing nurses for irrelevant roles. A case is made for greater interchangeability of first level health care workers through a common portal of entry. It is suggested that diversion into the various professional fields should occur after the foundation course to health care and suitable counselling. Among the top level professionally qualified nurses should be both generalists and specialists. A speciality of nursing generalism, as a parallel with general medical practice, is advocated. A plea is made for a liberating rather than a restricting interpretation of professionalism so that necessary changes in the nurse's role can be initiated and directed by the profession rather than being forced upon it by external pressures.