Academic microsystems: adapting Clinical Microsystems as an evaluation framework for community-based nursing education

When an academic nursing program and clinical agency form a partnership to both educate students and effect changes in the health care of the community, evaluation presents a challenge for measuring structure, processes, and outcomes at three levels: student educational processes and outcomes; student-sensitive outcomes for the community; and the effectiveness of the partnership itself. This article describes how we adapted the Clinical Microsystems model as an Academic Microsystems model to evaluate the complementary processes and outcomes for the community and for the nursing program in a senior Community Capstone course. The Capstone is a community-based initiative in which students assess community needs, intervene appropriately, evaluate their intervention, and pass the initiative on to the next year's class. Although outcomes for students and the community were positive, the model revealed that developing the frontline microsystem of student/faculty/community nurse mentor was the key to success.     

The European Trauma Course (ETC) and the team approach: Past,present and future

The European Trauma Course (ETC) was officially launched during the international conference of the European Resuscitation Council (ERC) in 2008. The ETC was developed on behalf of ESTES (European Society of Trauma and Emergency Surgery), EuSEM (European Society of Emergency Medicine), the ESA (European Society of Anaesthesiology) and the ERC. The objective of the ETC is to provide an internationally recognised and certified life support course, and to teach healthcare professionals the key principles of the initial care of severely injured patients. Its core elements, that differentiates it from other trauma courses, are a strong focus on team training and a novel modular design that is adaptable to the differing regional European requirements.This article describes the lessons learnt during the European Trauma Course development and provides an outline of the planned future development.     

Spectrum of hearts with one underdeveloped and one dominant ventricle

Summary Hearts with one underdeveloped and one dominant ventricle form a spectrum of anomalies extending from the heart with two clearly adequate chambers to those with a true single ventricle. An angiographic concept of grouping such hearts is presented. 129 patients with unequal ventricles underwent catheterization and cineangiography between 1974 and 1983. The age at first catheterization ranged from one day to 24 years (mean 3.9 years). Male-female ratio was 2:1. Five groups of hearts (with their relative frequencies in the spectrum) were established: (1) dominant left ventricle (53%); (2) dominant right ventricle (20%), each with normally related chambers; (3) dominant left ventricle (20%); (4) dominant right ventricle (3%), each with ventricular inversion; (5) true single ventricle (5%). The incidence of atrial anatomy, venous return, intracardiac connections and associated lesions within each group was assessed. From the standpoint of deranged physiology as well as surgical implications there are more similarities than differences among these hearts. The fact that one ventricle will not generate an adequate stroke volume after repair is overwhelmingly more important than most other considerations. For the diagnostic and surgical approach, we believe that the system offers many advantages.     

Hypoxia and hypercapnia in infants with mild laryngomalacia

We evaluated 15 infants with laryngomalacia and 12 healthy infants to determine their risk of hypoxia and hypercapnia as complications of partial upper airway obstruction. Transcutaneous carbon dioxide pressure and oxygen pressure were recorded continuously overnight with episodes of hypercapnia and/or hypoxia scored for frequency, duration, and relationship to activity. Episodes occurred in 12 infants with laryngomalacia and eight control infants. Infants with laryngomalacia had significantly more episodes. The greatest decrease in transcutaneous oxygen pressure was 29 mm Hg and increase in transcutaneous carbon dioxide pressure was 31 mm Hg, both occurring in infants with laryngomalacia. Three infants had prolonged episodes of hypoxia and hypercapnia. History or physical examination did not distinguish those infants with laryngomalacia who had hypercapnia and/or hypoxia from those without episodes. Two- to 15-month follow-ups in 13 infants with laryngomalacia revealed that symptoms were unchanged or improved. Twelve of these 13 infants had normal growth without developmental delay or other complications. These results demonstrate that episodes of hypoxia and hypercapnia occur more frequently in infants with laryngomalacia than in control infants; however, their apparent risk for complications is low.     

Modulation of matrix metalloproteinase and TIMP-1 expression by cytokines in human RPE cells

PURPOSE: The balance between matrix metalloproteinases (MMPs) and tissue inhibitors of MMPs (TIMPs) is crucial for homeostasis of ocular extracellular matrices. To assess altered MMP activity as a determinant in the migration of human retinal pigment epithelial (RPE) cells, expression characteristics of several MMPs and TIMP-1 in RPE cell cultures were investigated. METHODS: Expression studies were performed with RT-PCR, ELISA, and immunofluorescence analysis. Secretion of MMP-2 was demonstrated by zymography. Migration of cytokine-stimulated RPE cells was evaluated with microporous membranes of permeable chambers. RESULTS: MMP-1, -2, -3, and -9; MT2-MMP; and TIMP-1 were expressed in cultured RPE cells. MMP-2 was detected on the cell surface and in secreted inactive and active forms. TGF-beta(2), IL-1beta, and TNF-alpha enhanced secretion of MMP-1, -2, and -3. TGF-beta(2) also stimulated MT2-MMP cell surface expression and release of TIMP-1. The mRNA levels of MMP-1, -2, and -3 and TIMP-1 were markedly increased by TNF-alpha and TGF-beta(2). MMP-2 mRNA levels were also upregulated by PDGF-BB. Migration of RPE cells stimulated by TGF-beta(2) or PDGF-BB was inhibited in presence of a synthetic MMP inhibitor. CONCLUSIONS: Proinflammatory cytokines and TGF-beta(2) play an important role in the upregulation of expression of MMP-1, -2, and -3 in RPE cells and account for a directional shift in the balance between MMPs and TIMPs. Facilitation of RPE cell migration stimulated by cytokines (i.e., TGF-beta(2) or PDGF-BB) in ocular diseases may be due to increased release of MMPs, in the presence of comparatively lower levels of their inhibitors.     

Hematoporphyrin-derived soluble porphyrin-platinum conjugates with combined cytotoxic and phototoxic antitumor activity

To combine the cytotoxic activity of cisplatin and the phototoxicicity of hematoporphyrin derivatives in the same molecule, hematoporphyrin was derivatized at the two secondary alcohol positions by etherification with oligo- and poly(ethylene glycol) units. The two carboxylic acid groups of the propionate side chains were used to bind platinum fragments. The antiproliferative activity of 35 platinum complexes (0.5, 1, and 5 microM) differing in solubility and type of the platinum fragment and the corresponding porphyrin ligands were studied in tests with TCC-SUP and J82 transitional bladder cancer cells in the dark and after irradiation (lambda = 600-730 nm, 24 J/cm(2)). The most active compounds were found among the porphyrin-platinum conjugates bearing the diammine and (RR/SS)-trans-1,2-diaminocyclohexane ligand. These porphyrin-platinum conjugates, especially the water-soluble species, such as diammine(7,12-bis[1-(poly(ethylene glycol)-750-monomethyl ether-1-yl)ethyl]-3,8,13,17-tetramethylporphyrin-2,18-dipropionato)platinum(II), are promising candidates for the development of a novel type of photosensitizers with intrinsic cytotoxicity, which due to the porphyrin constituent may selectively enrich in tumor tissues.     

Superprecipitation and ATPase activity in normal, newborn and denervated muscle

Actomyosin superprecipitation and ATPase activities were studied in several muscles. Fast-contracting muscles superprecipitate more rapidly than slow ones and they have a shorter superprecipitation time. Actomyosins from newborn muscle and from denervated adult fast muscle have a slower rate of superprecipitation than adult fast muscle actomyosin. These observations, plus the relationship shown between actomyosin superprecipitation and ATPase activity, support the usefulness of superprecipitation as an in vitro model of contraction in experimental situations.     

4a. Prophylaxe der postoperativen Lungenembolie

Ohne Zusammenfassung