KEZKAK: a new bilingual questionnaire to measure nursing students' stressors in clinical practice

OBJECTIVE: To develop a bilingual questionnaire (Basque-Spanish) to measure nursing students' stressors in clinical practice. METHODS: Ideas were gathered from nursing students in group discussions. Initially, 287 nursing students from the School of Nursing in San Sebastián (Spain) completed the State-Trait Anxiety Inventory (STAI) and the 55-item version of our questionnaire. After analyzing the items, we selected 41 items for the final version. Some of the subjects completed this final version two (198 = 198) and six months (n = 211) later. RESULTS: The questionnaire presented high internal consistency (Cronbach's alpha: 0.95), considerable reliability (Spearman's correlation: 0.72 at two months and 0.68 at six months), and acceptable concurrent validity (Spearman's correlation with anxiety: 0.39). Factor analysis produced nine factors, with high internal consistency, which explained 64.4% of the variance. Based on these factors, the main stressors for nursing students in the workplace were produced by lack of competence (11.2%), contact with suffering (9.1%), relationships with tutors, workmates and classmates (8.9%), uncertainty and impotence (7.7%), lack of control in relationships with patients (7.6%), emotional involvement (5.8%), relationships with patients [being harmed by the relationship (5.2%) and patients seeking a close relationship (4.6%)], and overwork (4.3%). Methodological and practice aspects of the questionnaire are discussed, as well as its utility in planning the training of future nurses. CONCLUSION: The KEZKAK questionnaire is a useful instrument for measuring nursing students' stressors in clinical practice.     

Computerisation and decision making in neonatal intensive care: a cognitive engineering investigation

This paper reports results from a cognitive engineering study that lookedat the role of computerised monitoring in neonatal intensive care. A range of methodologies was used: interviews with neonatal staff, ward observations, and experimental techniques. The purpose was to investigate the sources of information used by clinicians when making decisions in the neonatal ICU. It was found that, although it was welcomed by staff, computerised monitoring played a secondary role in the clinicians' decision making (especially for junior and nursing staff) and that staff used the computer less often than indicated by self-reports. Factors that seemed to affect staff use of the computer were the lack (or shortage) of training on the system, the specific clinical conditions involved, and the availability of alternative sources of information. These findings have relevant repercussions for the design of computerised decision support in intensive care and suggest ways in which computerised monitoring can be enhanced, namely: by systematic staff training, by making available online certain types of clinical information, by adapting the user interface, and by developing intelligent algorithms. This revised version was published online in July 2006 with corrections to the Cover Date.     

Direct and indirect costs of Multiple Sclerosis in Baix Llobregat (Catalonia, Spain), according to disability

Background  

Multiple sclerosis (MS) is an incurable chronic disease that predominantly affects young adults. It has a high socio-economic impact which increases as disability progresses. An assessment of the real costs of MS may contribute to our knowledge of the disease and to treat it more efficiently. Our objective is to assess the direct and indirect costs of MS from a societal perspective, in patients monitored in our MS Unit (Baix Llobregat, Catalonia) and grouped according to their disability (EDSS).     

The link between excitotoxic oligodendroglial death and demyelinating diseases

Oligodendrocytes, the myelinating cells of CNS axons, are highly vulnerable to excitotoxic signals mediated by glutamate receptors of the AMPA and kainate classes. Receptors in these cells are commonly activated by glutamate that is released from axons and glial cells. In addition, oligodendrocytes contribute to the control of extracellular glutamate levels by means of their own transporters. However, acute and chronic alterations in glutamate homeostasis can result in overactivation of AMPA and kainate receptors and subsequent excitotoxic oligodendroglial death. Furthermore, demyelinating lesions caused by excitotoxins can be similar to those observed in multiple sclerosis. This, together with the effect of AMPA and kainate receptor antagonists in ameliorating the neurological score of animals with experimental autoimmune encephalomyelitis (an animal model of multiple sclerosis), indicates that oligodendrocyte excitotoxicity could be involved in the pathogenesis of demyelinating disorders.     

Excitotoxic damage to white matter

Glutamate kills neurons by excitotoxicity, which is caused by sustained activation of glutamate receptors. In recent years, it has been shown that glutamate can also be toxic to white matter oligodendrocytes and to myelin by this mechanism. In particular, glutamate receptor-mediated injury to these cells can be triggered by activation of alpha-amino-3-hydroxy-5-methylisoxazole-4-propionic acid, kainate and N-methyl-D-aspartate glutamate receptor types. Thus, these receptor classes, and the intermediaries of the signal cascades they activate, are potential targets for drug development to treat white matter damage in acute and chronic diseases. In addition, alterations of glutamate homeostasis in white matter can determine glutamate injury to oligodendrocytes and myelin. Astrocytes are responsible for most glutamate uptake in synaptic and non-synaptic areas and consequently are the major regulators of glutamate homeostasis. Activated microglia in turn may secrete cytokines and generate radical oxygen species, which impair glutamate uptake and reduce the expression of glutamate transporters. Finally, oligodendrocytes also contribute to glutamate homeostasis. This review aims at summarizing the current knowledge about the mechanisms leading to oligodendrocyte cell death and demyelination as a consequence of alterations in glutamate signalling, and their clinical relevance to disease. In addition, we show evidence that oligodendrocytes can also be killed by ATP acting at P2X receptors. A thorough understanding of how oligodendrocytes and myelin are damaged by excitotoxicity will generate knowledge that can lead to improved therapeutic strategies to protect white matter.     

Helical CT cholangiography in the evaluation of the biliary tract: application to the diagnosis of choledocholithiasis

BACKGROUND: We evaluated the role of helical computed tomographic (HCT) cholangiography in the study of the biliary tract, especially in the detection of choledocholithiasis, and compared it with direct cholangiography. METHODS: One hundred one patients with biliary lithiasic pathology undergoing direct cholangiography to rule out choledocholithiasis were included in this study. HCT was performed before and after slow infusion of cholangiographic contrast. Three-dimensional reconstructions and axial images were reviewed by two independent observers. Ultrasonography also was performed on all patients. RESULTS: The success rate of HCT cholangiography was 99%, with only a slight reaction to the contrast. The density values were significantly higher in the distal region of the tract and showed a significant correlation with serum bilirubin levels. Anatomic evaluation of the biliary tract with CT was similar to that with direct cholangiography. Anatomic variants were found on 23 studies. Twenty-two patients had choledocholithiasis, and 21 cases were detected with HCT cholangiography. The sensitivity of this technique (95.5%) was greater than that with unenhanced CT (60%) and ultrasonography (27.3%). Maximum intensity projection reconstructions were the most valuable for detecting choledocholithiasis. CONCLUSION: HCT cholangiography is a reliable technique that is similar to direct cholangiography in visualizing biliary anatomy, anatomic variants, and choledocholithiasis.     

Effects of paraquat (Osaquat® Formulation) on survival and total cholinesterase activity in male and female adults of Cnesterodon decemmaculatus (Pisces,Poeciliidae)

Ecotoxicity assessment of the herbicide paraquat was carried out with adults of a native freshwater fish Cnesterodon decemmaculatus. The acute toxicity of paraquat was evaluated and the enzymatic activity of the total cholinesterases was measured using sublethal concentrations of the herbicide. Experiments were designed to separate the responses between sexes. In the study, paraquat was added as a commercial formulation Osaquat® containing 27.6% of active ingredient. The 96-h LC₅₀ values for males and females were 67.40- and 52.48-mg of paraquat per liter, respectively. This significant, but close difference between sexes changes when we compare acute toxicity data between adults and fry of Cnesterodon decemmaculatus. The 96-h LC₅₀ for the latter is 9.41-mg of paraquat per liter and the adult/fry ratio approaches 1 order of magnitude. Sublethal concentrations of paraquat (the higher of these was 20 mg/L) did not produce inhibition of the total cholinesterase activity for males and females compared to the controls at 96 h of exposure. On the other hand, we found a significant difference between sexes (p≤0.05): about 50% for the enzymatic activity measured. Thus, our results indicate that total cholinesterase activity of Cnesterodon decemmaculatus is sex dependent. © 1998 John Wiley & Sons, Inc. Environ Toxicol Water Qual 13 : 55–59, 1998     

International Development of the Patient-Reported Outcome Indices for Multiple Sclerosis (PRIMUS)

BackgroundThe Patient-Reported Indices for Multiple Sclerosis (PRIMUS) comprises a suite of three scales for assessing symptoms, activity limitations, and quality of life in multiple sclerosis (MS). It was developed in the UK and has been shown to have excellent psychometric properties. This study describes the adaptation of eight language versions for Canadian English, Canadian French, French, German, Italian, Spanish, Swedish, and US English.MethodsThe PRIMUS was translated using the dual-panel process. Cognitive debriefing interviews conducted with MS patients assessed face and content validity. Psychometric and scaling properties were assessed via a two-administration postal survey conducted in each country involving the PRIMUS, the Nottingham Health Profile (NHP), the Unidimensional Fatigue Impact Scale (U-FIS), and demographic questions.ResultsCognitive debriefing interviews demonstrated the acceptability of the new language versions. Analysis of survey data showed that the new language versions of the three PRIMUS scales were unidimensional (as indicated by fit to the Rasch model) and that they had good internal consistency and reproducibility. PRIMUS scale scores correlated as expected with those on the NHP and the U-FIS. The scales in all countries were able to discriminate between groups of patients on the basis of their self-reported MS severity, general health, and employment status.ConclusionsThe PRIMUS was successfully adapted into eight new languages. Most of the tests showed the PRIMUS to have good unidimensionality and to have good internal consistency, reproducibility, and construct validity. The measure is now available for use in clinical studies and trials involving these countries and the UK. Further work is required to assess the measure's responsiveness.     

Differential oxidative stress in oligodendrocytes and neurons after excitotoxic insults and protection by natural polyphenols

Oligodendrocytes are vulnerable to overactivation of both their AMPA receptors and their high- and low-affinity kainate receptors. Depending on the intensity of the insult and the type of receptor activated, excitotoxic oligodendrocyte death mediated by these receptors has different characteristics. One important consequence at a cellular level is the ensuing oxidative stress, related to Ca2+-dependent alterations in mitochondrial functioning. We observed that oxidative stress associated with selective AMPA receptor activation is much higher than that associated with the selective activation of high- and low-affinity kainate receptors. Moreover, excitotoxic insults generate more intense oxidative stress in oligodendrocytes than in cortical neurons, though similar alterations in [Ca2+]i and mitochondrial potential were observed in both cell types. Nanomolar concentrations of mangiferin and morin, two natural polyphenols with antioxidant properties, partially protect oligodendrocytes as well as cortical neurons from mild, but not intense, insults mediated by AMPA receptors. In addition to presenting oxygen radical scavenging activity, mangiferin and morin attenuate the intracellular Ca2+ overload subsequent to the activation of AMPA receptors, a mechanism that may contribute to their protective properties. The inclusion of these antioxidant agents in therapeutic strategies for the treatment of diseases in which oligodendrocyte as well as neuron loss occurs may prove to be beneficial.