Cognitive factors in student nurses' clinical problem solving

Rationale, aims and objectives The assumption that the acquisition and mastery of the nursing process alone is sufficient to explain problem‐solving performance has been challenged in recent literature. Researchers have argued that the quality of prior knowledge is a key component in explaining performance. In addition, motivational orientation and the quality of reasoning have been found to have different effects on performance in cognitive tasks. The aim of this study is to explore student nurses’ clinical problem solving based on a model consisting of their motivational orientation, prior knowledge, diagnostic reasoning and diagnostic solutions. Methods One hundred and thirty‐five second‐year nursing students completed the Study Process Questionnaire and the Causal Attribution Questionnaire prior to receiving five lectures on mental illness. A knowledge test and a clinical problem‐solving task provided measures of prior knowledge, quality of diagnostic reasoning, and the quality and comprehensiveness of nursing diagnosis. A correlational design using pairwise correlations, hierarchical regression and path analysis examined the relationships among these data. Results and conclusions The results indicated an important role for a belief in personal control, for the accessibility and structuring of prior knowledge, and the quality of diagnostic reasoning, in generating high quality and comprehensive nursing diagnoses. The findings suggest that all contributing components of clinical problem solving need to be addressed in nursing education.     

Oxidative stress - a link between endothelial injury, coagulation activation, and atherosclerosis in haemodialysis patients

BACKGROUND/AIM: Recently emerging evidence suggests that oxidative stress (SOX) may participate in atherogenesis. The aim of the present study was to establish whether enhanced SOX, involving endothelial injury, activation of coagulation, and inflammatory reaction, could be implicated in atherosclerotic diseases in haemodialysis (HD) patients. METHODS: Markers of SOX, endothelial injury, coagulation, and cytokines, were measured in the plasma of HD patients with and without cardiovascular disease (CVD), and of healthy controls by ELISA methods. Remodeling of the carotid arteries was assessed by measuring the intima-media thickness (IMT) as a surrogate of atherosclerotic disease in all groups. RESULTS: Markers of SOX, endothelial injury, and extrinsic coagulation pathway activation and IMT values were significantly elevated in HD patients, especially in those with CVD when compared with the control group. The von Willebrand factor antigen (vWF:Ag) levels were more increased in the patients with CVD than in those without. Furthermore, the plasma levels of tumour necrosis factor alpha, monocyte chemo-attractant protein 1, and macrophage inflammatory protein 1 beta were significantly higher only in the HD group with CVD when compared with the controls. The IMT was strongly and directly correlated with Cu/Zn superoxide dismutase. Both IMT and Cu/Zn superoxide dismutase were positively correlated with age, thrombomodulin, vWF:Ag, tissue factor, tissue factor pathway inhibitor, prothrombin fragment F1 + 2, monocte chemo-attractant protein 1, macrophage inflammatory protein 1 beta, and tumour necrosis factor alpha levels. Multivariate analysis identified vWF:Ag as the only independent variable significantly associated with an increased IMT. CONCLUSIONS: The present study suggests that enhanced SOX, involved pro-atherogenic cytokine and chemokines levels, endothelial injury, and coagulation activation may constitute a pathway for accelerated atherosclerosis in HD patients. The significant, independent association between IMT and vWF:Ag should be assessed in future studies to determine whether vWF:Ag elevation is causative or a by-product of the increased IMT.     

Diagnostic difficulties in primary mesothelioma

A 54-year-old woman with a history of fatigue and shortness of breath was found to have a pericardial effusion and mild mediastinal lymphadenopathy. Video-assisted pericardioscopy revealed thickened pericardium studded with multiple nodules. Histologically the tumor was diagnosed as papillary adenocarcinoma. The site of the primary tumor could not be identified. As lung cancer is one of the most frequent causes of pericardial metastases the patient was treated with cisplatin and vinblastin. Following 5 courses of chemotherapy--given over a 4 month period--the amount of pericardial effusion and pericardial thickness did not change. The material from pericardial biopsy was reexamined and positive immunostaining for calretinine was found. The final diagnosis was primary pericardial mesothelioma of epithelioid type. Palliative radiotherapy of mediastinum was planned but the patient deteriorated and died due to disease progression with venous thrombosis and superior vena cava syndrome. The case illustrates the difficulties in establishing diagnosis of primary pericardial mesothelioma which is a rare tumor with poor prognosis.     

Peritoneal metastasis from regionally advanced hypopharyngeal cancer

A very rare case of patient with locally advanced hypopharyngeal cancer with solitary, large peritoneal metastasis was presented. Diagnostic imaging excluded other organs metastases (lungs, liver, bones). At 62-old patient with advanced hypopharyngeal cancer (T4N2b) a dynamical nodal progression (within 1.5 months) without primary tumour progression was observed, and number of metastatic nodes was increased from 2 to 9. Simultaneously, a solitary peritoneal metastasis was detected and other metastases were excluded. Stage of disease was determined as T4N2cM1 and patient was qualified to palliative treatment.     

Results of myringoplasty and type I tympanoplasty with the use of fascia, cartilage and perichondrium grafts

Since the publication of Miodoński, Zollner and Wullstein different methods and grafting materials have been promoted in tympanoplasty. The purpose of this study was to demonstrate the anatomical and functional results of tympanoplasty in comparison with the material used. The studies included a selected group of 142 patients who were operated on because of perforation of tympanic membrane. The analysed group consisted of 112 patients when perichondrium and cartilage were used to reconstruct the tympanic membrane. The comparison group consisted of 30 patients when fascia of the musculus temporalis was used to close a defect of the eardrum. In all cases before and after operation there was made tonal audiometry with indication for air and bone conduction within range from 500 to 4000 Hz, verbal audiometry after operation with indication of speech detection and speech reception threshold using mono-syllable NLA-93 test, tympanometry after operation and evaluation of anatomical results after surgery. The comparison of operation results showed that there was no significant difference between the two groups.     

Adenolymphoma of parotid gland--analysis of 75 cases

The authors present a clinical analysis of the group of 75 patients, who was treated in Department of Otolaryngology in the years 1986-2000 and who was diagnosed as adenolymphoma. The frequency of incidence of Warthin's tumour is 17,6% of all 426 cases of parotid gland's tumours. In 72 cases (96%) the tumour was localized in the superficial part, only in 3 cases (4%)--in the deep part of the gland. In one patient we observed recurrence of adenolymphoma. In one case adenolymphoma coexisted with carcinoma planoepitheliale of parotid gland.     

An evaluation of postural stability and the effects of middle-ear drainage on vestibulo-spinal reflexes of children with chronic otitis media with effusion

OBJECTIVE: Many authors agree that chronic otitis media with effusion (OME) are the main causes of vertigo and balance disturbances in children. The aim of this work was the stabilometric evaluation of postural stability and the influence of middle ear drainage on vestibulo-spinal reflexes in children with OME. METHODS: Fifteen children with OME (5-14 years old, 13 males and two females) were selected for bilateral drainage of the middle ear after conservative treatment proved ineffective. The control group consisted of 15 healthy children of an analogous age range. Static and quasi-dynamic posturography was performed to evaluate balance. The tests were performed three times: 1 day before drainage, 1 day after drainage and 4 weeks after drainage. Parameters including the field of the developed area and the average velocity of body deflection were analysed. RESULTS: There was statistically significant elevation of stabilogram parameters in almost all the tests in children with OME as compared to the control group. The changes in the stabilogram parameters were analysed with reference to the timing of the evaluation. Significant improvement was noted after the fluid was removed from the ear, although recovery was not complete after 4 weeks. CONCLUSIONS: The presence of fluid in the middle ear impairs the functioning of the balance system in children. Postural stability and the quantity of vestibulo-spinal reflexes seem to depend on the functional condition of the middle ear. Prolonged cases of OME could potentially handicap a child's motor development.     

How income and education contribute to risk factors for cardiovascular disease in the elderly in a former Communist country

OBJECTIVES: Careful examination of the risk factors for cardiovascular disease (CVD) may enable clinicians to develop a reasonably preventive programme among the elderly. The main purpose of this paper was to examine the effects of income and education on CVD risk factors in an elderly population who had lived most of their lives in Communist times. METHODS: The CINDI (Countrywide Integrated Non-communicable Diseases Intervention) Programme questionnaire was used to collect data from an elderly (65+ years) population in Lodz, a large industrial city in Poland. The study population (n = 1,461) was selected at random, and the overall response rate was 57.1%. The following risk factors were evaluated: hypertension, obesity, elevated cholesterol, elevated blood sugar and smoking. RESULTS: Hypertension was the most frequently observed CVD risk factor (83.4% of participants) followed by hypercholesterolaemia (70.2%), obesity (30.5%), diabetes (18.4%) and smoking (8.5%). Hypertension and hypercholesterolaemia were related to age (OR=0.91, 95%CI: 0.88-0.95 and OR=0.95, 95%CI: 0.92-0.98, respectively). The younger people in the study population exhibited the highest prevalence of hypertension and hypercholesterolaemia; hypercholesterolaemia was observed more frequently among widowed respondents. Obesity and diabetes were associated with education level (OR=0.52, 95%CI: 0.34-0.79 and OR=0.60, 95%CI: 0.37-0.97, respectively). Younger single males with a lower level of education and income exhibited the highest prevalence of smoking. Multivariate analysis showed that age, education and gender were the best predictors for the cumulative risk factors of CVD. CONCLUSIONS: Education is more strongly associated with CVD risk factors than material status in the elderly. The best predictors of risk factors were age, sex and education. As we gain knowledge about CVD risk factors, we may be able to target preventive services in the elderly population more accurately and effectively, and help older adults make health decisions to reduce risk factors and increase their quality of life.     

Synthesis and cytotoxic effect of carbocyclic potential minor groove binders

New carbocyclic potential minor groove binders were synthesised, using 3-nitrobenzoyl chloride and aliphatic alpha,omega-diamines with three, four and five methylene fragments. The half structures, compounds IV-VI can be compared to bis-amidines, compounds X-XII to bis-netropsin. All of the compounds were investigated antiproliferative and cytotoxic effects in the standard cell line of mammalian tumour MCF-7.