Learning model and curriculum designs for international health in nursing

Aim: Nursing's domain of inquiry for international health is unclear. A learning model to frame this specialty is unavailable. The goal of this analysis was to open debate worldwide on the nature of concepts, relationships, and analytic constructs that can serve as a foundational blueprint for international nursing curriculums. The aim was to define and operationalize international health in nursing by constructing a learning model. Methods: The exercise was exploratory using content analysis to distinguish key concepts in disciplinary and multidisciplinary documents through relevancy sampling. Sources of certainty were expert knowledge and experience and the embodied practices in international health. Procedures to ensure interrater reliability were used to strengthen confidence in formulating the bases for robust curriculum designs. Results: The five main concepts discerned were environment, demography, culture, technology, and research. Nursing goals framed as analytic constructs with amplification serve as the basis for statements of student outcome competencies. The resulting concepts, constructs, and competencies taken together provide a beginning operationalization of international health in nursing for a variety of progressive curriculum designs. Conclusions: In Japan, higher education is increasingly international and, for this, clear, agreed‐on academic goals are warranted. Nursing's higher education is obligated to prepare students for a future in environments highly globalised and technological with a culture of tolerance. The model facilitates scholarly debate for a progressive view of international health characterized by emphasis on theory and practical application.     

Antibiotic prophylaxis in radical prostatectomy: 1-day versus 4-day treatments

OBJECTIVE: The standard protocol of antibiotic prophylaxis in radical prostatectomy remains to be established. We retrospectively compared the occurrence of perioperative infections following radical prostatectomy between two different protocols of antibiotic prophylaxis. METHODS: This study included 106 cases of radical retropubic prostatectomy managed on the clinical pathways. Two different protocols of antibiotic prophylaxis were used in otherwise identical pathways. Between January and December 2004, 50 patients received a second generation cephem, cefotiam, for 4 days, beginning 30 min before surgery (4-day group), whilst between December 2004 and July 2005, only two doses of cefotiam were given on the day of operation in 56 patients (1-day group). The incidence of surgical site infection (SSI) and remote infection (RI) was retrospectively investigated. RESULTS: Superficial incisional SSI occurred in one (1.8%) patient in the 1-day group, whereas no patient in the 4-day group developed SSI. No RI was observed in either the 1-day or 4-day group. Intravenous antibiotics were administered besides the pathway in a patient in the 1-day group because unexplained fever more than 38 degrees C continued postoperative day (POD) 2 through POD 4 without signs of SSI or RI. Excluding this case, postoperative more than 38 degrees C was rare and transient after POD 2. CONCLUSION: The incidence of SSI and RI was low and not significantly different between the 1-day and 4-day groups. Therefore, the 1-day protocol of prophylactic antibiotic treatment seems adequate for preventing perioperative infections in radical prostatectomy.     

Controlled Study of Therapeutic Granulocyte Transfusions in Granulocytopenic Patients with Severe Infections

The effectiveness of therapeutic granulocyte transfusions wasstudied in a controlled trial involving 75 granulocytopenicpatients with severe infections. Patients who had granulocytecounts of less than 200/mm³ and no response to antibiotic therapywere assigned to receive antibiotic therapy alone or granulocytetransfusions plus antibiotic therapy. Granulocytes were collectedby filtration leukapheresis (FL), intermittent flow centrifugeleukapheresis (IFCL) or continuous flow centrifuge leukapheresis(CFCL). Therapeutic effects of granulocyte transfusions wereevaluated on the basis of 20-day survival after entry into thestudy. The patients were divided into three groups: 1) 22 patientsreceived antibiotic therapy alone for 29 infectious episodes(control group); 2) 27 patients received 131 transfusions ofgranulocytes collected by FL for 31 infectious episodes (FLgroup); 3) 26 patients received 139 transfusions of granulocytescollected by IFCL and CFCL for 27 infectious episodes (IFCL& CFCL group). The overall survival of the transfused patientswas not significantly different from that of the untransfusedpatients. Similarly, there was no significant difference insurvival between the transfused and untransfused patients whenthe data concerning septicemia were analyzed. When patientsshowed bone-marrow recovery, which was indicated by recoveryof granulocytes to 500/mm³ or more during the study, 20-daysurvival was observed in 13 of 14 untransfused patients andin all of 26 transfused patients. In contrast, the survivalrate for the patients without bone-marrow recovery was 13% (2/15)in the control group, 39% (7/18) in the FL group and 57% (8/14)in the IFCL & CFCL group respectively. Thus, the survivalrate was significantly higher for the transfused than for theuntransfused patients. These observations suggest that therapeutic granulocyte transfusionsmay be of limited value in improving the outcome of severe infectionsin persistently granulocytopenic patients. Since bone-marrowrecovery is a critical factor for the prognosis of severe infections,therapeutic granulocyte transfusions do not provide any beneficialeffects in granulocytopenic patients whose bone-marrow functionwill recover.     

Distribution of EGF receptor expressing and DNA replicating epidermal cells in psoriasis vulgaris and Bowen''s disease

We have examined the localization of DNA replicating cells and EGF receptor-expressing cells in the epidermis of psoriasis vulgaris, a benign hyperproliferative skin disease, and Bowen's disease, a pre-malignant hyperproliferative skin disease, and normal skin. DNA replicating cells were detected by anti-BrdU monoclonal antibody after incubating tissue sections with BrdU, and EGF receptors were detected by the anti-EGF receptor monoclonal antibody B4G7. In normal skin, DNA replicating cells were localized exclusively in the basal and suprabasal layers. EGF receptor expression was observed most strongly in the basal and parabasal layers, but diminished gradually towards the upper squamous layer. In psoriatic skin, DNA replicating cells were also localized in the basal and parabasal layers, but the number of these mitotic cells was about 10 times higher than in normal skin. In this case, more EGF receptors were detected in all viable layers of the epidermis. Apparently normal skin adjacent to psoriasis lesions showed persistent expression of EGF receptors in the upper squamous layer without an increased number of DNA replicating cells in the basal and parabasal layers. In Bowen's disease, DNA replicating cells and EGF receptor expressing cells were distributed in all layers of the epidermis. These findings indicate that the increased production of EGF receptors may be, in part, responsible for the hyperproliferative state of the epidermis and that cells in the upper squamous layer of psoriasis may have lost a mechanism by which EGF receptor expression is diminished thus allowing differentiation. This altered process of EGF receptor production may be involved in the onset of psoriasis vulgaris.     

Radiofrequency Catheter Ablation of Left Ventricular Outflow Tract Tachycardia from the Coronary Cusp: A New Approach to the Tachycardia Focus

INTRODUCTION: Idiopathic ventricular tachycardia (VT) originating from the left ventricular outflow tract (LVOT) is rare. Previously reported were two cases of LVOT tachycardia which were treated with radiofrequency (RF) catheter ablation through endocardial aortomitral continuity. We report here a case of a repetitive LVOT tachycardia in which the QRS morphology during VT exhibited an atypical left bundle branch block and inferior axis. Pace mapping revealed that the origin of this VT was very close to the left sinus of Valsalva. Transcoronary cusp RF catheter ablation abolished the VT in this patient and is a new approach for the treatment of this kind of VT. The application of this approach to the other types of VT has yet to be determined.     

Urinary incontinence among community‐dwelling people aged 40 years or older in Japan: Prevalence,risk factors,knowledge and self‐perception

Background : Urinary incontinence (UI) is a common problem in adults, especially among the elderly. We examined the prevalence and risk factors of UI and potential factors hindering individuals from seeking treatment for UI among a community‐dwelling population aged over 40 years. Methods : Data were collected by mailing a 23‐item urinary incontinence questionnaire to a random sample of community‐dwelling individuals aged 40–75 years (n = 3500) in seven towns of Shiga Prefecture, Japan. Collected data were then used to estimate the prevalence of UI and to provide information regarding subtypes of UI, knowledge and self‐perception about UI. Results : The overall response rate was 52.5%. Prevalence of UI for male and female respondents were 10.5% and 53.7%, respectively. The incidence of urge incontinence increased as age increased in the male group. In women, stress incontinence was prevalent at all ages and the incidence of urge incontinence increased over 70 years of age. Urinary incontinence was more likely as activities of daily living limitations and cystitis increased. Women with a history of hysterectomy or diabetes mellitus and men who had stroke were at increased risk for UI. Of those who reported UI, only 3% had ever consulted doctors or other health care professionals concern‐ ing it, 25% recognized their condition as a disease and 38% considered it curable by appropriate treatments. In addition, 63% regarded UI as an unavoidable consequence of aging, 63% con‐ sidered their condition was embarrassing and 54% were reluctant to seek treatment from a health professional. Conclusions : Although UI is common among community‐dwelling individuals over 40 years of age, the majority of affected individuals remained untreated due to lack of knowledge and/or a negative perception of UI. Thus, community education on UI may be needed to increase the number of UI patients who receive treatment.     

Histological study of fetal kidney with urethral obstruction and vesicoureteral reflux: A consideration on the etiology of congenital reflux nephropathy

PURPOSE: A recent subject of interest regarding reflux nephropathy is the presence of renal abnormalities in neonates and infants who have no history of urinary tract infections. Debates have centered on the etiology of this renal abnormality - congenital reflux nephropathy; regarding whether it is the result of abnormal ureteral budding or of back pressure effect from sterile reflux. We examined the renal pathology of fetuses with urethral obstruction and vesicoureteral reflux, and we suggest herein a possible etiology of congenital reflux nephropathy. METHODS: The renal pathology of seven autopsied fetuses with vesicoureteral reflux was studied. Reflux was demonstrated at autopsy by slow injection of contrast medium into the bladder. Severe urethral obstruction, either atresia or urethral valves, was evident in six of the subjects. RESULTS: In six subjects, abnormality of the urinary tracts was detected by prenatal ultrasonography. Of these six subjects, three revealed characteristics of prune belly syndrome. Reflux was graded as moderate in five subjects, and severe in two. In three subjects autopsied at 21 weeks gestation or earlier, the kidneys were well-developed with normal corticomedullary configuration, and nephrogenesis was retained. In three cases autopsied at over 25 weeks of gestation, the kidneys were grossly cystic, and the nephrogenic zone was completely absent. Contrast medium was observed not only in the dilated ducts and tubules, but also in the subcapsular cysts. Extravasation of the contrast medium was seen in the peritubular space. In the last subject with normal lower urinary tract, abnormal segments among normal cortical structures were observed. CONCLUSION: Our findings of renal pathology in fetuses with reflux are quite similar to those seen in fetal hydronephrosis. Back pressure from reflux probably damages the developing kidney leading to a degeneration of the ampullae and a reduction in the number of nephrons. Both dilatation of the collecting ducts and tubules, and extravasation of the urine may result in interstitial fibrosis. We postulate that one of the important etiologies of congenital reflux nephropathy may be the result of back pressure from sterile reflux.     

An immunocytochemical study of changes in the human erythrocyte membrane skeleton produced by stretching examined by the quick-freezing and deep-etching method

A quick-freezing and deep-etching method in combination with erythrocyte splitting was used to examine the cytoplasmic aspect of whole-mount human erythrocyte membranes. Various external forces induced alterations in membrane skeletal organisation during the splitting procedure. The initial change was elongation in the peripheral part of the membrane skeleton, examined by immunostaining with a monoclonal antispectrin antibody. Under severe stretching conditions, a linear rearrangement of filamentous components was evident; these were disposed parallel to the rim of the erythrocyte, while the central part of the concavity exhibited a more compacted structure. These changes resulted in a different distribution of membrane skeletal components between central rigid and peripheral flexible areas in biconcave erythrocytes. It is suggested that the reversible membrane skeletal changes in the flexible areas which resist the external forces are important for maintaining the normal framework of biconcave human erythrocytes.