The immediate life support course: implementation into an undergraduate nursing programme

Aim: The aim of this paper is to outline how the immediate life support (ILS) course was incorporated into an undergraduate nursing curriculum in a university in Northern Ireland. It also reports on how the students perceived the impact of this course on their clinical practice.
Rationale and Background: The rationale of the course was to develop the student's ability to recognize the acutely ill patient and to determine the relevance of this to clinical practice. Prior to this, the ILS course was only available to qualified nurses, and this paper reports on the first time undergraduate nursing students were provided with an ILS course.
Methods: The ILS course was delivered to 89 third-year nursing students from the adult branch pathway of the BSc (Hons) programme in Nursing Sciences. Each course was taught to 10–12 students and was completed over eight 7·5 h sessions within a 2-week period. Recognized advanced life support (ALS) instructors, in keeping with the UK Resuscitation Council guidelines, taught the students.
Results and Conclusion: Student feedback reported that the ILS course helped them understand what constituted the acutely ill patient and the role of the nurse in managing a deteriorating situation. Students also reported that they valued the experience as highlighting gaps in their knowledge.     

The origin of the genetic code and of the earliest oligopeptides

Reconstruction of the earliest proteins in the ancient binary alphabet [glycine family G, alanine family A] leads to repeats of G alternating with repeats of A. In addition, omnipresent motifs can be assembled in two of the earliest genes involved in energy supply, crucial for Life, i.e. ATP/GTP binding and ATPase activity. They are an almost perfect match to the alternating G and A and are complementary to each other.     

强直性脊柱炎患者血清IL-18水平及临床意义

[目的]了解IL-18在活动期强直性脊柱炎(AS)发病中的作用。[方法]53例AS患者,40例正常对照组。活动期AS患者均以非甾体类抗炎药和改善病情药治疗,分别在治疗前、治疗后l2周、24周测外周血IL-18和TNF-d水平,并动态观察临床病情活动指标(BASDAl指数、BASFl指数、BASMl指数)及ESR、CRP变化。[结果](1)治疗前AS患者与正常对照组比较血清IL-l8水平明显升高(P﹤0.05),治疗12周与治疗前比较、治疗24周与治疗12周比较血清IL-18水平均有明显下降(P﹤0.05);(2)所有AS患者治疗后临床病情活动指标(BASDAl指数、BAS-Fl指数、BASMl指数)明显改善(P﹤0.05),Pearson直线相关法分析显示血清IL-18水平与BASDAl、BASFl、BASMl呈正相关(r=0.632,0.583,0.480,P﹤0.05);(3)活动期AS患者治疗前后比较ESR、CRP、TNF-a水平明显下降(P﹤0.05),直线相关分析显示血清IL-18水平与ESR、CRP、TNF-a呈正相关(r=0.520,0-672,0.522,P﹤0.05)。[结论]活动期AS患者血清IL-18、TNF-a水平明显升高,治疗后明显下降,血清IL-18水平与AS病情活动指标呈正相关,提示IL-18可能参与AS的发病,并可作为临床病情活动的指标之一。     

上海市松江区手足口病控制图法预警界值优选研究

目的 采用控制图法预警技术确定上海市松江区手足口病最佳预警界值,提高手足口病疫情监测的预警能力.方法 利用2005~2008年松江区手足口病报告数据建立预警数据库,采用控制图法建立预警模型,通过计算比较灵敏度、特异度、阳性预测值和阴性预测值及绘制ROC曲线,优选出最佳预警界值.结果 综合平衡预警的灵敏度、特异度、阳性预测值、阴性预测值等指标后,将P90作为松江区手足口的预警界值.结论 根据传染病发病特点结合当地疫情信息优选出适合于当地的传染病预警界值,提高传染病疫情监测的预警能力.     

Inequalities in Croatian pupils' risk behaviors associated to socioeconomic environment at school and area level: A multilevel approach

The socioeconomic inequality in pupils' risk behaviors has been the topic of many studies with quite contradictory findings. Furthermore, the role of socioeconomic environment has been analyzed much less often than the role of individual socioeconomic status (SES). This study examined the association between school/area-level socioeconomic environment and Croatian pupils' risk behaviors (tobacco use, drunkenness, cannabis use, early sexual initiation and fighting). Data from the WHO-Collaborative ‘Health Behavior in School-aged Children' study conducted in Croatia in 2006 (1601 secondary schools' pupils, aged 15) and census data were used. Multilevel logistic regression analyses, adjusted by gender, were performed. The individual level of SES explained the majority of differences in all risk behaviors among adolescents. Differences in tobacco use, early sexual initiation and fighting were more closely attributed to school level than area level, which was more closely associated with differences in adolescent drunkenness and cannabis use. At the individual level, high individual SES was associated with higher probability for tobacco use and drunkenness compared to low individual SES. Furthermore, school heterogeneity (compared to school homogeneity) and medium school-level SES (compared to low school-level SES) were associated with higher probability for cannabis use. Compared to the most advanced schools (gymnasiums), attending the least advanced schools (industrial and crafts schools) was associated with higher probability for fighting. Compared to low area-level SES, medium area-level SES was associated with higher probability for cannabis use and fighting. Conclusively, it was found that low SES at individual, school and area levels, school homogeneity and advanced school attendance play a protective role against risk behaviors. To reduce inequalities in pupils' risk behaviors, there is a need for community and school-based programs that take into consideration not only individual SES but also school- and area-level socioeconomic circumstances.     

Espondiloartritis en la infancia

Juvenile-onset spondyloarthritis is a special group within the entities included in the concept of spondyloarthritis, and is characterized by a predominantly peripheral involvement (arthritis and enthesitis), and more frequent presentation as undifferentiated forms. However, like its adult-onset equivalent, it has the potential to develop structural damage and progress to juvenile ankylosing spondylitis, with consequent irreversible functional impairment. Many important advances have been made in the understanding of the genetics and pathophysiology of juvenile-onset spondyloarthritis, as well as in the diagnosis and treatment of this entity. These advances are summarized in this article.     

Facilitating Early Integration of Palliative Care into Breast Cancer Therapy. Promoting Disease-Specific Guidelines

To comply with patients' needs as well as ASCO and WHO recommendations, our institution aims to integrate palliative care (PC) early in the course of breast cancer (BC) therapy. The evaluation of relevant pilot project data revealed that these recommendations were too vague to trigger PC integration. Therefore, a standard operating procedure (SOP) was developed by our interdisciplinary working group to provide disease-specific information to overcome the ambiguity of the WHO recommendations and guide PC integration. Literally, the SOP states that 'Specialized PC is recommended regularly for all BC patients without curative treatment options, specifically for patients with i) metastasized and inoperable, or ii) locally advanced and inoperable, or iii) relapsing BC, who are receiving intravenous chemotherapy'. This SOP for the first time presents disease-specific guidelines for PC integration into comprehensive BC therapy by defining 'green flags' for early integration of PC and delineating PC from senology assignments. Although disease-specific SOPs have also been developed by this working group for other malignancies, the decision when to first integrate PC into BC therapy differs substantially because of the different clinical characteristics of the disease.     

Differences between the early and advanced stages of rheumatoid arthritis in the expression of EDA-containing fibronectin

In the present study the expression of alternatively spliced synovial EDA-containing FN (EDA-FN) was analyzed in plasma and synovial fluid samples of rheumatoid arthritis (RA) patients with from 2 months to 20 years disease duration. The patient samples were divided into groups: those with early, established, and late progressive radiographic changes as well as those with different disease activity established by a CRP concentration. The expression of EDA-FN was determined by sandwich-type ELISA using a specific anti-EDA monoclonal antibody. The relative amount of EDA-FN in synovial fluid, but not in plasma samples, was significantly lower in the early RA group than in established and late RA. In contrast, its level did not correlate with the CRP concentration. Synovial EDA-FN might be used as a supplemented marker of early RA.