Toward a caring culture in professional nursing

Nursing is a profession founded on the traditional value of caring. Faced with rapid and tumultuous change in the health care system, nurses are finding the environment of practice more stressful and less supportive. The ideal of nursing as a caring community is at risk because of economic and political forces. The authors review the impact of managed care and reaffirm the notion of the caring community in the nursing profession. Specific assessment guidelines and recommendations for the caring community are set forth for practitioners working in a variety of organizational settings. Organizational culture is emphasized as the context for caring practice.     

Sustained silver-releasing dressing in the treatment of diabetic foot ulcers

This study investigated the clinical performance and safety of a sustained silver-releasing foam dressing, Contreet Foam, in the treatment of diabetic foot ulcers. Twenty-seven patients with diabetic foot ulcers of grade I or II (Wagner's classification) were followed for six weeks: one week run-in using Biatain dressings, four weeks' treatment with Contreet dressings. Four ulcers healed during the four-week treatment with Contreet 56% in average. Contreet Foam showed good exudate management properties and was considered easy to use. Only two infections occurred showed that all six of the non-study ulcers developed an infection during the study. All ulcers (study ulcers as well as non-study ulcers) were treated according to good practice of diabetic wound care. There were no directions for the treatment of secondary wounds. No device-related adverse events were observed. This study demonstrated that Contreet Foam is safe and easy to use and effectively supports healing and good wound progress of diabetic foot ulcers.     

Selenium and human health

Selenium is incorporated into selenoproteins that have a wide range of pleiotropic effects, ranging from antioxidant and anti-inflammatory effects to the production of active thyroid hormone. In the past 10 years, the discovery of disease-associated polymorphisms in selenoprotein genes has drawn attention to the relevance of selenoproteins to health. Low selenium status has been associated with increased risk of mortality, poor immune function, and cognitive decline. Higher selenium status or selenium supplementation has antiviral effects, is essential for successful male and female reproduction, and reduces the risk of autoimmune thyroid disease. Prospective studies have generally shown some benefit of higher selenium status on the risk of prostate, lung, colorectal, and bladder cancers, but findings from trials have been mixed, which probably emphasises the fact that supplementation will confer benefit only if intake of a nutrient is inadequate. Supplementation of people who already have adequate intake with additional selenium might increase their risk of type-2 diabetes. The crucial factor that needs to be emphasised with regard to the health effects of selenium is the inextricable U-shaped link with status; whereas additional selenium intake may benefit people with low status, those with adequate-to-high status might be affected adversely and should not take selenium supplements.     

Pathophysiology of postprandial hyperglycaemia in women with type 1 diabetes during pregnancy

Aims/hypothesis

Although maternal hyperglycaemia is associated with increased risk of adverse pregnancy outcome, the mechanisms of postprandial hyperglycaemia during pregnancy are poorly understood. We aimed to describe glucose turnover in pregnant women with type 1 diabetes, according to stage of gestation (early vs late gestation).

Methods

The rates of systemic glucose appearance (R _a) and glucose disposal (R _d) were measured in ten pregnant women with type 1 diabetes during early (12?C16?weeks) and late (28?C32?weeks) gestation. Women ate standardised meals??a starch-rich 80?g carbohydrate dinner and a sugar-rich 60?g carbohydrate breakfast??and fasted between meals and overnight. Stable-label isotope tracers ([6,6-²H₂]glucose and [U-¹³?C]glucose) were used to determine R _a, R _d and glucose bioavailability. Closed-loop insulin delivery maintained stable glycaemic conditions.

Results

There were no changes in fasting R _a (10?±?2 vs 11?±?2???mol?kg^?C1?min^?C1; p?=?0.32) or fasting R _d (11?±?2 vs 11?±?1???mol?kg^?C1?min^?C1; p?=?0.77) in early vs late gestation. There was increased hepatic insulin resistance (381?±?237 vs 540?±?242???mol?kg^?C1?min^?C1?×?pmol/l; p?=?0.04) and decreased peripheral insulin sensitivity (0.09?±?0.04 vs 0.05?±?0.02???mol?kg^?C1?min^?C1 per pmol/l dinner, 0.11?±?0.05 vs 0.07?±?0.03???mol?kg^?C1?min^?C1 per pmol/l breakfast; p?=?0.002) in late gestation. It also took longer for insulin levels to reach maximal concentrations (49 [37?C55] vs 71 [52?C108] min; p?=?0.004) with significantly delayed glucose disposal (108 [87?C125] vs 135 [110?C158] min; p?=?0.005) in late gestation.

Conclusions/interpretation

Postprandial glucose control is impaired by significantly slower glucose disposal in late gestation. Early prandial insulin dosing may help to accelerate glucose disposal and potentially ameliorate postprandial hyperglycaemia in late pregnancy. Trial registration: ISRCTN 62568875 Funding: Diabetes UK Project Grant BDA 07/003551. H.R. Murphy is funded by a National Institute for Health Research (NIHR) research fellowship (PDF/08/01/036). Supported also by the Juvenile Diabetes Research Foundation (JDRF), Abbott Diabetes Care (Freestyle Navigator CGM and sensors free of charge), Medical Research Council Centre for Obesity and Related Metabolic Diseases and NIHR Cambridge Biomedical Research Centre.     

Myeloid-derived suppressor cell accumulation and function in patients with newly diagnosed glioblastoma

To assess the accumulation of myeloid-derived suppressor cells (MDSCs) in the peripheral blood of patients with glioma and to define their heterogeneity and their immunosuppressive function. Peripheral blood mononuclear cells (PBMCs) from healthy control subjects and from patients with newly diagnosed glioma were stimulated with anti-CD3/anti-CD28 and T cells assessed for intracellular expression of interferon (IFN)-γ. Antibody staining of PBMCs from glioma patients and healthy donors (CD33, HLADR, CD15, and CD14) followed by 4-color flow cytometry analysis-defined MDSC levels in the peripheral blood. To assess the role of MDSCs in suppressing T cell IFNγ production, PBMCs were depleted of MDSCs using anti-CD33 and anti-CD15 antibody-coated beads prior to T cell stimulation. Enzyme-linked immunosorbent assays were used to assess plasma arginase activity and the level of granulocyte colony-stimulating factor (G-CSF). Patients with glioblastoma have increased MDSC counts (CD33+HLADR-) in their blood that are composed of neutrophilic (CD15(+); >60%), lineage-negative (CD15(-)CD14(-); 31%), and monocytic (CD14(+); 6%) subsets. After stimulation, T cells from patients with glioblastoma had suppressed IFN-γ production when compared with healthy, age-matched donor T cells. Removal of MDSCs from the PBMCs with anti-CD33/CD15-coated beads significantly restored T cell function. Significant increases in arginase activity and G-CSF levels were observed in plasma specimens obtained from patients with glioblastoma. The accumulation of MDSCs in peripheral blood in patients with glioma likely promotes T cell immune suppression that is observed in this patient population. Increased plasma levels of arginase and G-CSF may relate to MDSC suppressor function and MDSC expansion, respectively, in patients with glioma.