Promoting autonomy and independence for older people within nursing practice: a literature review

The principles of promoting autonomy and independence underpin many approaches to improving the quality of nursing care for older people in whatever setting, and are in line with wider developments in health care such as the Patient's Charter. However, these concepts require careful definition if nursing practices which might promote autonomy and independence are to be identified. Although the generalizability of the research-based literature in this field is limited by a focus upon older people in continuing-care settings, a review of the literature found a number of indicators associated with attempts to promote patient autonomy and independence. These were grouped into the following categories: systems of care delivery which promote comprehensive individualized assessment and multidisciplinary care planning; attempts to encourage patients/clients to participate in decisions about their care; patterns of communication which avoid exerting power and control over patients/clients and attempts to modify the environment to promote independence and minimize risk. It is suggested that the review identifies a number of principles for nursing practice which can be applied in a range of care settings in order to promote the autonomy and independence of older people.     

The unusual association of three autoimmune diseases in a patient with Noonan syndrome.

We report on a 26-year-old female affected by Noonan syndrome (NS), a congenital disorder characterized by various phenotypic features and congenital anomalies) associated with a variety of autoimmune diseases, including systemic lupus erythematosus, celiac disease, and Hashimoto thyroiditis. Autoimmunity is seldom described in NS and the association between this congenital disease and three autoimmune disorders has not been previously reported. Should the occurrence of autoimmune disorders in NS be confirmed, a relevant clinical and laboratory evaluation of NS patients should be performed in order to clarify whether the immune system involvement represents only an occasional event or is a feature of the disease.     

Separation of rare cell subpopulations with the aid of biotin-labelled ligands

A universal method for selection of surface marker-positive cells is described. The cells, admixed with an excess of surface marker-negative cells, are In-st labelled with a specific biotinylated ligand and then isolated with the aid of monoclonal, anti-biotin coated beads. The method enables selection and isolation of cells with a frequency as low as 10^-4. The ligand can be an antigen (for selection of infrequent antibody-producing cells), an antibody (for selection of surface antigen-positive cells) or other molecules (for selection of specific receptor-positive cells).     

Total extrusion of the talus: A case report

Total extrusion of the talus without recovery of the bone is a very unusual injury. The authors present a case of a 25-year-old man who sustained an open total enucleation of the talus in a motorcycle accident. The talus was not recovered at the scene of the accident. An immediate tibiocalcaneal stabilization was performed by using an external fixator. In the postoperative period, a polymicrobic infection was observed and treated with parenteral antibiotics. Nine months after injury, the patient developed an infection of both the empty space and the distal third of the tibia. A wound debridement with tibial sequestrectomy and insertion of gentamicin-impregnated polymethylmethacrylate beads was performed. Three months later, after multiple negative bacteriologic examinations, a tibiocalcaneal arthrodesis with staples and autogenous bone graft was performed. Because of a pseudoarthrosis, the patient underwent a revision of the arthrodesis by retrograde tibiocalcaneal nailing, achieving clinical and radiographic success. The definitive treatment of total enucleation of the talus is still controversial because of its rarity and the high rate of complications, such as avascular necrosis, osteomyelitis, and ankle stiffness. In this case, without recovery of the talus, retrograde nailing afforded good stability by bypassing the bone defects.     

Cysticercosis of the brain. The value of computed tomography

Incidence and radiologic findings of neurocysticercosis were investigated in a series of 23,800 consecutive head examinations using computed tomography (CT). The condition was diagnosed in 168 cases (0.7%). The parenchymatous form was the most common presentation (96.3%), while the meningeal form corresponded to only 11.9 per cent of cases. These two forms coexisted in some cases. These findings reversed the knowledge on the condition based on conventional radiography. The different CT appearances in the brain are described and a new radiologic protocol for the CT evaluation of the condition is advocated, which includes a follow-up after a trial cure with Praziquantel in the presence of cysts not associated with suggestive brain calcifications. CT was more sensitive than conventional radiography in the differentiation between dead and living larvae, thus having an impact on the therapeutic management of the patients.     

Circulating levels of insulin-like growth factors 1 and 2 and somatomedin B in alcoholic patients

The levels of insulin-like growth factors 1 and 2 (IGF-1 and IGF-2) and somatomedin B in serum and cerebrospinal fluid (CSF) were investigated in alcoholic patients for 4 weeks after alcohol intake stopped. Throughout the observation period, CSF levels of IGF-2 were significantly decreased compared to those of healthy controls, whereas CSF levels of somatomedin B increased significantly 8 days after alcohol withdrawal and remained elevated throughout the observation period. CSF levels of IGF-2 were significantly correlated to measurements of ventricular enlargement on computed tomography. Somatomedin B levels were significantly correlated to clinical variables such as pulse, temperature, and agitation. No increase in the serum levels of somatomedin B were observed, but an increase in serum IGF levels was found in the patient group.