Marketing Nursing in a Nurse Practitioner Practice

This issue of our journal contains the inaugural column of a new feature. When the Editorial Board of the journal met in St. Louis at NANDA's 25th year anniversary celebration, we discussed strategies to further spread the word that nursing diagnosis is alive, well, and at work daily in clinical settings. The idea for this column was born, and it will appear regularly from now on.
I can think of no better beginning than the one Dr. Judy Carlson-Catalano has given us. Dr. Catalano not only uses nursing diagnosis in her private nursing practice; she uses nursing diagnosis to advertise her work. I invite you to read and enjoy the first column of Nursing Diagnosis at Work. MKMJ.     

Effect of the secretory leucocyte proteinase inhibitor (SLPI) on Candida albicans biological processes: A therapeutic alternative?

Objectives

The aim of this study was to evaluate the effect of SLPI on the growth and biological processes of Candida albicans.

Methods

Two C. albicans strains were used in this study, a clinical isolate resistant to fluconazole (PRI) and a reference strain ATCC 24433. The minimal inhibitory concentration (MIC) was determined according to the CLSI methodology. The influence of SLPI on secreted serine proteinase activities (SSP) was measured by the cleavage of specific substrate, and surface hydrophobicity was determined by the aqueous-hydrocarbon biphasic separation method. Flow cytometry was performed to investigate receptors for SLPI and variations in the cell wall mannoprotein expression. Interaction between yeast and epithelium was assessed using the MA-104 cells lineage. Ultrastructure was analyzed by transmission electron microscopy (TEM).

Results

MIC values were calculated as 18 and 18.9 μM for the PRI and ATCC 24433, respectively. SSP activity was reduced by 48.8% by 18 μM of SLPI and cell surface hydrophobicity increased by 11.1%. Flow cytometry suggest the existence of SLPI binding sites on the surface of the yeast. Results showed a reduction in the expression of mannoproteins in 20.8% by the cells treated with 80 μM of SLPI, and 18 μM reduced the adhesion of yeasts to mammalian cells in 60.1%. TEM revealed ultrastructural changes in cells treated with 80 μM of SLPI, such as the presence of membrane-like structures within the cytoplasm.

Conclusions

SLPI exerts a significant influence on C. albicans viability and biological processes. Considering its constitutive and physiologic features, SLPI may become a promising tool for the development of new methodologies for the treatment and control of candidiasis.     

22-year longitudinal study of repetitive colonoscopy in patients with a family history of colorectal cancer

Introduction

We report the outcomes of a long-term surveillance programme for individuals with a family history of colorectal cancer.

Methods

The details of patients undergoing a colonoscopy having been referred on the basis of family history of colorectal cancer were entered prospectively into a database. Further colonoscopy was arranged on the basis of the findings. The outcomes assessed included incidence of cancer and adenoma identification at initial and subsequent colonoscopy.

Results

The records of 2,293 patients (917 men; median patient age: 51 years) were entered over 22 years, giving data on 3,982 colonoscopies. Eight adverse events (0.2%) were recorded. Twenty-seven cancers were found at first colonoscopy and thirteen developed during the follow-up period. There were significantly more cancers identified in those with more than one first-degree relative with cancer than in other groups (p=0.01). The number of adenomas identified at subsequent surveillance colonoscopies remained constant with between 9.3% and 12.0% of patients having adenomas that were removed. Two-thirds (68%) of patients with cancer and three-quarters (77%) with adenomas fell outside the British Society of Gastroenterology (BSG) 2006 guidelines.

Conclusions

Repeated colonoscopy continues to yield significant pathology including new cancers. These continue to occur despite removal of adenomas at prior colonoscopies. The majority of patients with cancers and adenomas fell outside the BSG 2006 guidelines; more would have fallen outside the 2010 guidelines.     

Brazilian Sepsis Epidemiological Study (BASES study)

Introduction

Consistent data about the incidence and outcome of sepsis in Latin American intensive care units (ICUs), including Brazil, are lacking. This study was designed to verify the actual incidence density and outcome of sepsis in Brazilian ICUs. We also assessed the association between the Consensus Conference criteria and outcome

Methods

This is a multicenter observational cohort study performed in five private and public, mixed ICUs from two different regions of Brazil. We prospectively followed 1383 adult patients consecutively admitted to those ICUs from May 2001 to January 2002, until their discharge, 28th day of stay, or death. For all patients we collected the following data at ICU admission: age, gender, hospital and ICU admission diagnosis, APACHE II score, and associated underlying diseases. During the following days, we looked for systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, and septic shock criteria, as well as recording the sequential organ failure assessment score. Infection was diagnosed according to CDC criteria for nosocomial infection, and for community-acquired infection, clinical, radiological and microbiological parameters were used.

Results

For the whole cohort, median age was 65.2 years (49–76), median length of stay was 2 days (1–6), and the overall 28-day mortality rate was 21.8%. Considering 1383 patients, the incidence density rates for sepsis, severe sepsis and septic shock were 61.4, 35.6 and 30.0 per 1000 patient-days, respectively. The mortality rate of patients with SIRS, sepsis, severe sepsis and septic shock increased progressively from 24.3% to 34.7%, 47.3% and 52.2%, respectively. For patients with SIRS without infection the mortality rate was 11.3%. The main source of infection was lung/respiratory tract.

Conclusion

Our preliminary data suggest that sepsis is a major public health problem in Brazilian ICUs, with an incidence density about 57 per 1000 patient-days. Moreover, there was a close association between ACCP/SCCM categories and mortality rate.     

Anxiety, Somatic Complaints, and Depressive Symptoms in Rural Adolescents

PROBLEM: Undiagnosed and untreated anxiety in adolescents is often associated with greater rates of mood and behavior problems, somatic complaints, and risk for future psychiatric disorders. METHODS. A self-report anxiety instrument was administered as part of a community survey of 466 rural adolescents. FINDINGS: Anxiety symptoms were strongly correlated with both physical complaints and depression. Females had higher scores for total anxiety and the anxiety subtypes of generalized anxiety disorder, separation anxiety disorder, panic disorder, social phobia, and school phobia. CONCLUSIONS: Implications for nursing practice are provided.     

A Cognitive Developmental Approach to Understanding How Children Cope With Disasters

TOPIC: This paper applies cognitive developmental theory to explain how preschoolers, school-age children, and adolescents process and respond to disasters. PURPOSE: To help clinicians understand the disaster experience from a child's point of view, recognize age-specific reactions, identify symptoms that may signal coping difficulties, and plan effective interventions. SOURCES: Case examples from the author's work with flood victims illustrate typical reactions for children (preschool to adolescents) within a family context, along with developmentally appropriate interventions. CONCLUSIONS: Children affected by disasters need nursing interventions geared toward their particular developmental level and sensitive to their perception of the disaster.