Reflective learning with drama in nursing education--a Swedish attempt to overcome the theory praxis gap

It is obvious that the gap between theory and praxis in nursing education affects the students' ability to develop understanding and professional knowledge that stems both from theory and practice. Appropriate didactic methods are thus needed in nursing education. In a project we developed and practised a didactic model with the intention of encouraging a reflective attitude within the student, considering caring science in theory as well as in praxis. The didactic model, based on educational drama, was implemented during three terms of the nursing education programme. In this paper we present the educational model and its theoretical foundation. We also present the preliminary outcomes of the project.     

Ill health is powerlessness: a phenomenological study about worthlessness, limitations and suffering

The aim of the study was to create an understanding of the different dimensions of subjective ill health through discovering the essence of ill health, based on the individual experience. A philosophical, phenomenological method has been employed, and in-depth interviews were conducted with 25 individuals. The findings showed that the essence of ill health is powerlessness, which is made by a self-image of worthlessness, a sense of being imprisoned in one's life situation, and emotional suffering. The individual views her/himself as worthless, based on societal norms, attitudes and human models. Incapability and a sense of worthlessness cause the individual to distrust her/himself and others. She/he is imprisoned in her/his own life situation due to limited choices and ability. Such a situation gives rise to apathy. Destructive feelings of alienation, anguish, shame and guilt take over, and the individual's autonomy and existence are threatened. Stigmatization results from suffering and a sense of worthlessness. The informants compensated for their vulnerability by means of human support, intimacy with others, a society adapted to disability, living in the present and awareness.     

The juvenile three-spined stickleback (Gasterosteus aculeatus L.) as a model organism for endocrine disruption II--kidney hypertrophy, vitellogenin and spiggin induction

This study investigated the suitability of juvenile three-spined sticklebacks, Gasterosteus aculeatus L., for detecting both androgen- and oestrogen-induced endocrine disruption. The investigated endpoints were kidney hypertrophy and the induction of the protein markers spiggin and vitellogenin. Juveniles were exposed to steroid hormones 17β-oestradiol (E2: nominal 0.01, 1.0 and 10 μg/L), 17-ethinylestradiol (EE2: nominal 0.05 μg/L) and 17-methyltestosterone (MT: nominal 1.0 μg/L) from the day of hatching until the termination of the experiments between 39 and 58 days after hatching. E2 (10 μg/L) and MT were applied during different time windows: (a) 14 days after hatching only and (b) continuously with start 14 days after hatching.

Kidney hypertrophy is an androgen-dependent secondary sexual character in adult male sticklebacks and corresponds to the production of the glue protein spiggin during the breeding season. The kidneys were hypertrophied and spiggin levels were elevated in juvenile sticklebacks after treatment with MT. Paradoxically, slightly elevated spiggin levels and kidney hypertrophy were observed also in fish treated with high dose E2. Levels of vitellogenin, the oestrogen-inducible yolk precursor protein, were elevated in juvenile sticklebacks after E2 medium and high dose and EE2 treatment.

The tested endpoints are suitable for the study of endocrine disruption in juvenile sticklebacks, a fish species that is easy to handle in laboratory and relevant for temperate geographical regions.     

Assessment of the longitudinal changes in bone mineral density in patients receiving home parenteral nutrition

BACKGROUND: Low bone mineral density (BMD) is commonly reported in patients receiving home parenteral nutrition (HPN), but it remains unclear whether or not an accelerated bone loss occurs during HPN therapy. We evaluated the spinal, hip, and forearm bone mass density longitudinally in a cohort of 75 patients receiving HPN. METHODS: A total of 943 regional dual-energy x-ray absorptiometry scans, 335 spinal, 318 hip, and 290 forearm, obtained between 1995 and 2003 in 75 patients receiving HPN, were used for the analysis of the annual changes in BMD. The average (SD) number of scans per patients was 4.4 (2.9), and follow-up time was 4.1 (1.9) years. Diagnoses were Crohn's disease (n = 35) and other conditions (non-Crohn's diseases; n = 40). Data were analyzed using a linear random coefficient model. RESULTS: There was a statistically significant overall decline over time in spinal, hip, and forearm BMD, corresponding roughly to a 1% annual loss (p < .005); however, the loss was not significantly larger than that of age and sex-matched healthy subjects. In Crohn's disease patients, model estimates of spinal and hip BMD on the initiation of HPN therapy were significantly reduced compared with normal, whereas values were not significantly reduced in non-Crohn's disease patients. CONCLUSIONS: With the current protocols for HPN treatment, the annual decline in BMD is moderate and not significantly larger than in age- and sex-matched healthy subjects. A considerable part of the metabolic bone disease in these patients is related to the underlying disease for which the HPN was indicated.     

Activation of coagulation by administration of recombinant factor VIIa elicits interleukin 6 (IL-6) and IL-8 release in healthy human subjects

The activation of coagulation has been shown to contribute to proinflammatory responses in animal and in vitro experiments. Here we report that the activation of coagulation in healthy human subjects by the administration of recombinant factor VIIa also elicits a small but significant increase in the concentrations of interleukin 6 (IL-6) and IL-8 in plasma. This increase was absent when the subjects were pretreated with recombinant nematode anticoagulant protein c2, the inhibitor of tissue factor-factor VIIa.     

Classification,identification and subtyping of bacteria based on pyrosequencing and signature matching of 16S rDNA fragments

The rapid identification of the etiological agent of microbial infections can bring about both clinical and financial benefits. Thus, fast and generally applicable classification methods are needed that will enable us to rapidly distinguish pathogenic bacteria from commensals or saprophytic bacteria found in the same habitat. We here show that provisional classification of bacterial isolates can be performed on a large scale based on 16S rRNA sequence comparisons using Pyrosequencing, a recently described real-time DNA sequence analysis technique, and the concept of signature matching. The probes we have developed, together with the new technology, will enable early diagnosis of specific pathogens, which is critical for the rational use of antimicrobial therapy in clinical medicine.     

Comparison of the cardiac effects of the antimalarials co-artemether and halofantrine in healthy participants

Co-artemether (Coartem, Riamet) is a tablet containing 20 mg artemether and 120 mg lumefantrine for treatment of falciparum malaria. Lumefantrine has some chemical similarities to halofantrine (Halfan), an antimalarial known for QTc prolongation. Effects on the QTc interval of fed single oral doses of 500 mg halofantrine and 80/480 mg co-artemether were compared in 13 healthy males in a randomized double-blind crossover study. Electrocardiograms (ECGs) were recorded from 48 hours before dosing until 48 hours thereafter. The maximum QTc interval (QTc = QT/square root(RR)) was compared before and after treatment and between treatments, fitting a general linear model. Drug plasma concentrations were determined concomitantly. After halofantrine, all participants showed an increase in the QTc interval; the mean maximum increase was 28 ms. The length of the QTc interval was positively correlated to halofantrine exposure. The QTc interval remained unchanged after co-artemether. The difference between treatments was statistically significant. In conclusion, halofantrine caused a significant, exposure-dependent increase in the QTc interval. No such effect was seen with co-artemether.     

Home enteral nutrition in adults: a European multicentre survey

AIMS: This study was undertaken to report indications and practice of home enteral nutrition (HEN) in Europe. METHODS: A questionnaire on HEN practice was sent to 23 centres from Belgium (B), Denmark (D), France (F), Germany (G), Italy (I), Poland (P), Spain (S) and the United Kingdom (UK). This involved adult patients newly registered in HEN programme from 1 January 1998 to 31 December 1998. RESULTS: A total of 1397 patients (532 women, 865 men) were registered. The median incidence of HEN was 163 patients/million inhabitants/year (range: 62-457). Age distribution was 7.5%, 16-40 years; 37.1%, 41-65 years; 34.5%, 66-80 years and 20.9% >80 years. The chief underlying diseases were a neurological disorder (49.1%), or head and neck cancer (26.5%); the main reason for HEN was dysphagia (84.6%). A percutaneous endoscopic gastrostomy (58.2%) or a naso-gastric tube (29.3%) were used to infuse commercial standard or high energy diets (65.3%), or fibre diets (24.5%); infusion was cyclical (61.5%) or bolus (34.1%). Indications and feeds were quite similar throughout the different centres but some differences exist concerning the underlying disease. There was greater variation in the choice of tubes and mode of infusion. In F, G, I, S, and UK, costs of HEN are fully funded. In B, D, and P patients have to pay part or all of the charges. CONCLUSIONS: In Europe, HEN was utilised mainly in dysphagic patients with neurological disorders or cancer, using a standard feed via a PEG. However, there were important differences among the countries in the underlying diseases treated, the routes used, the mode of administration and the funding.     

Tissue Inhibitor of Metalloproteinase-4 Is Elevated in Early-Stage Breast Cancers with Accelerated Progression and Poor Clinical Course

An increasing number of breast cancer patients are diagnosed with small, localized, early-stage tumors. These patients are typically thought to have a good prognosis for long-term disease-free survival, but epidemiological studies indicate that up to 30% may have a recurrence within 3 to 5 years of diagnosis. Identifying patients with a high risk of recurrence and/or progression is important because they could be more aggressively treated at diagnosis to improve their chances for disease-free survival. Recent evidence suggests that elevated levels of the matrix metalloproteinase inhibitor, tissue inhibitor of metalloproteinase (TIMP)-4, are associated with malignant progression of ductal carcinoma in situ, a precancerous lesion. To examine the association of TIMP-4 with survival outcomes, we conducted a retrospective immunohistochemical analysis of 314 cases from patients with early-stage disease, defined as tumors smaller than 2 cm and no spread to lymph nodes (tumor-node-metastasis staging: T1N0MX). We found that tumors with elevated levels of TIMP-4 were correlated with a reduced probability of long-term disease-free survival, especially in patients with estrogen receptor-negative tumors. Our findings prompt further evaluation of TIMP-4 as a simple prognostic marker that may help identify patients with early-stage breast cancer who could benefit from more aggressive treatment at diagnosis.Tissue inhibitor of metalloproteinase (TIMP)-4 is one of four members of the family of TIMPs, which modify the breakdown of extracellular matrix by the matrix metalloproteinases. Studies of the TIMPs in mammalian organisms have revealed distinctions in structure, biochemical properties, and tissue-specific expression patterns, suggesting unique roles in normal physiology.^1,2,3 Because of their key roles in cell motility and tissue organization, the interactions between TIMPs and matrix metalloproteinases have been widely studied in cancer research. Until recently, TIMPs were recognized primarily only as matrix metalloproteinase inhibitors. However, recent work has made it increasingly clear that TIMPs have non-matrix metalloproteinase-associated functions in cancer,⁴ including roles in growth promotion,^5,6,7 apoptosis,^8,9,10 and angiogenesis.^10,11 In the mammary gland, the importance of TIMPs has been demonstrated during normal physiological processes such as glandular development and involution during pregnancy.¹² Although TIMPs have been studied in breast cancer, TIMP-4 has received limited attention and there is conflicting information about its significance. In one study, human breast cancer cells engineered to ectopically express TIMP-4 displayed a reduction in growth and metastasis after implantation in mice.¹³ In contrast, another study showed that a gene therapy strategy to express TIMP-4 promoted mammary tumor formation.¹⁴ Notably, in human breast cancer, TIMP-4 has been associated with the transition of ductal carcinoma in situ into invasive, infiltrating ductal carcinoma (IDC).¹⁵ With an increasing number of patients being diagnosed with small early-stage tumors (<20 mm in diameter) and no signs of spread to lymph nodes, the majority of patients are predicted to have a favorable prognosis for long-term disease-free survival according to traditional tumor-node-metastases (TNM) staging. Nevertheless, epidemiological studies indicate that 20 to 30% of these patients will have a recurrence of their breast cancer within 3 to 5 years of diagnosis.^16,17 Markers that could identify this subgroup of patients who are at higher risk of relapse and/or malignant progression would be useful to stratify them for more aggressive treatment that might improve their chances for long-term disease-free survival. In this study, we tested the hypothesis that TIMP-4 expression correlates inversely with disease-free survival for patients with early-stage disease.