bluuebunny/crossref_metadata_2025 huggingface dataset:
Can interferon-γ and interleukin-10 balance be associated with severity of human Leishmania (Viannia) braziliensis infection?
Authors: Gomes-Silva A , de Cássia Bittar R , dos Santos Nogueira R , Amato V S , da Silva Mattos M , Oliveira-Neto M P , Coutinho S G , Da-Cruz A M
Published: August 2010

Suitable levels of interferon (IFN)-γ and interleukin (IL)-10 seem to favour the outcome of cutaneous leishmaniasis (CL), while high IFN-γ and low IL-10 production are associated with severity of mucosal leishmaniasis (ML). Considering that cytokine balance is important for the maintenance of protective responses in leishmaniasis, our aim was to investigate leishmanial antigens-induced IFN-γ and IL-10 levels maintained in healed individuals who had different clinical outcomes of Leishmania infection. Thirty-three individuals who recovered from L. braziliensis infection were studied: cured CL (CCL), cured ML (CML), spontaneous healing of CL (SH) or asymptomatic individuals (ASY). Cytokines were quantified by enzyme-linked immunosorbent assay (ELISA) in culture supernatants of L. braziliensis-stimulated peripheral blood mononuclear cells (PBMC). IFN-γ levels were higher in CML (7593 ±  5994 pg/ml) in comparison to SH (3163 ± 1526 pg/ml), ASY (1313 ±  1048 pg/ml) or CCL (1897 ± 2087 pg/ml). Moreover, cured ML cases maintained significantly lower production of IL-10 (127 ± 57·8 pg/ml) in comparison to SH (1373 ± 244 pg/ml), ASY (734 ± 233 pg/ml) or CCL (542 ±  375 pg/ml). Thus, a high IFN-γ/IL-10 ratio observed in CML can indicate unfavourable cytokine balance. On the other hand, no significant difference in the IFN-γ/IL-10 ratio was observed when CCL individuals were compared to SH or ASY subjects. In conclusion, even after clinical healing, ML patients maintained a high IFN-γ/IL-10 secretion profile in response to leishmanial antigens. This finding can explain a delayed down-modulation of exacerbated inflammatory responses, which can be related in turn to the necessity of prolonged therapy in ML management. Conversely, lower IFN-γ/IL-10 balance observed in CCL, SH and ASY individuals can represent a better-modulated immune response associated with a favourable prognosis.
IgM plays an important role in induction of collagen-induced arthritis
Authors: Zheng B , Zhang X , Guo L , Han S
Published: August 2010

IgM is one major type of B cell receptor (BCR) expressed on most of the B cells from immature to mature stages. During normal B cell ontogeny, signals transduced through the IgM BCR play an important role in regulating B cell maturation and survival at multiple checkpoints. In addition, IgM BCR is also required for antigen-dependent differentiation and activation of B cells. However, whether IgM BCR-mediated signalling is important for the pathogenesis of autoimmune diseases remains elusive. Using IgM-deficient mice, we examined the effect of absence of IgM on the development of collagen-induced arthritis (CIA), an animal model of rheumatoid arthritis (RA). Compared to their wild-type littermates, IgM-deficient mice were either resistant to arthritis induction or developed significantly less severe arthritis. There was a significant decrease of autoantibody production in IgM-deficient mice, particularly IgG2a antibodies, which is believed to be pathogenic in CIA. Thus, although IgM–/– mice have relatively normal B cell development with IgD BCR replacing IgM BCR, the absence of IgM-mediated signals has a profound impact on the development of CIA, indicating that IgM plays an important role in the development and pathogenesis of autoimmune arthritis and IgM-mediated signalling is critical in the generation of pathogenic autoreactive antibodies.
Overexpression of the autoantigen IA-2 puts beta cells into a pre-apoptotic state: autoantigen-induced, but non-autoimmune-mediated, tissue destruction
Authors: Harashima S-I , Harashima C , Nishimura T , Hu Y , Notkins A L
Published: August 2010

IA-2 is a major autoantigen in type 1 diabetes and autoantibodies to it have become important diagnostic and predictive markers. IA-2 also is an intrinsic transmembrane component of dense core secretory vesicles and knock-out studies showed that IA-2 is a regulator of insulin secretion. Here we show that overexpression of IA-2 puts mouse insulinoma MIN-6 beta cells into a pre-apoptotic state and that exposure to high glucose results in G2/M arrest and apoptosis. Molecular study revealed a decrease in phosphoinositide-dependent kinase (PDK)-1 and Akt/protein kinase B (PKB) phosphorylation. Treatment of IA-2-transfected cells with IA-2 siRNA prevented both G2/M arrest and apoptosis and increased Akt/PKB phosphorylation. A search for IA-2 interacting proteins revealed that IA-2 interacts with sorting nexin (SNX)19 and that SNX19, but not IA-2, inhibits the conversion of PtdIns(4,5)P2 to PtdIns(3,4,5)P3 and thereby suppresses the phosphorylation of proteins in the Akt signalling pathway resulting in apoptosis. We conclude that IA-2 acts through SNX19 to initiate the pre-apoptotic state. Our findings point to the possibility that in autoimmune diseases, tissue destruction may be autoantigen-induced, but not necessarily immunologically mediated.
Response to region of difference 1 (RD1) epitopes in human immunodeficiency virus (HIV)-infected individuals enrolled with suspected active tuberculosis: a pilot study
Authors: Vincenti D , Carrara S , Butera O , Bizzoni F , Casetti R , Girardi E , Goletti D
Published: August 2010

Tuberculosis is the most frequent co-infection in human immunodeficiency virus (HIV)-infected individuals, and which still presents diagnostic difficulties. Recently we set up an assay based on interferon (IFN)-γ response to region of difference 1 (RD1) peptides selected by computational analysis which is associated with active Mycobacterium tuberculosis replication. The objective of this study was to investigate the response to RD1 selected peptides in HIV-1-infected individuals in a clinical setting. The mechanisms of this immune response and comparison with other immune assays were also investigated. A total of 111 HIV-infected individuals with symptoms and signs consistent with active tuberculosis were enrolled prospectively. Interferon (IFN)-γ responses to RD1 selected peptides and recall antigens were evaluated by enzyme-linked immunospot assay. Results were correlated with CD4+ T cell counts, individuals' characteristics, tuberculin skin test, QuantiFERON-TB Gold and T-SPOT.TB. Results from 21 (19%) individuals were indeterminate due to in vitro cell anergy. Among ‘non-anergic’ individuals, sensitivity for active tuberculosis of the assay based on RD1 selected peptides was 67% (24 of 36), specificity was 94% (three of 54). The assay also resulted positive in cases of extra-pulmonary and smear-negative pulmonary active tuberculosis. The response was mediated by CD4+ effector/memory T cells and correlated with CD4+ T cell counts, but not with plasma HIV-RNA load. Moreover, the RD1 selected peptides assay had the highest diagnostic odds ratio for active tuberculosis compared to tuberculin skin test (TST), QuantiFERON-TB Gold and T-SPOT.TB. RD1 selected peptides assay is associated with M. tuberculosis replication in HIV-infected individuals, although T cell anergy remains an important obstacle to be overcome before the test can be proposed as a diagnostic tool.
Understanding diseases by mouse click: the promise and potential of computational approaches in Systems Biology
Authors: Klauschen F , Angermann B R , Meier-Schellersheim M
Published: August 2010

Computational modelling approaches can nowadays build large-scale simulations of cellular behaviour based on data describing detailed molecular level interactions, thus performing the space- and time-scale integrations that would be impossible just by intuition. Recent progress in the development of both experimental methods and computational tools has provided the means to generate the necessary quantitative data and has made computational methods accessible even to non-theorists, thereby removing a major hurdle that has in the past made many experimentalists hesitate to invest serious effort in formulating quantitative models. We describe how computational biology differs from classical bioinformatics, how it emerged from mathematical biology and elucidate the role it plays for the integration of traditionally separated areas of biomedical research within the larger framework of Systems Biology.
Dynamic changes in CD4+ CD25+ high T cell apoptosis after the diagnosis of type 1 diabetes
Authors: Glisic-Milosavljevic S , Wang T , Koppen M , Kramer J , Ehlenbach S , Waukau J , Jailwala P , Jana S , Alemzadeh R , Ghosh S
Published: August 2010

Because type 1 diabetes (T1D) is a chronic, autoimmune, T cell-mediated disease, interventions affecting T cells are expected to modulate the immune cascade and lead to disease remission. We propose that increased CD4+ CD25+high T cell apoptosis, a trait we discovered in recent-onset T1D subjects, reflects T1D partial remission within the first 6 months after diagnosis. Apoptosis of forkhead box P3 (FoxP3)+ CD4+ CD25+high T cells, in addition to total daily doses of insulin (TDD), blood glucose, HbA1c and age, were measured in 45 subjects with T1D at various times after diagnosis. Sixteen healthy control subjects were also recruited to the study. Higher CD4+ CD25+high T cell apoptosis levels were detected within the first 6 months of diagnosis (odds ratio = 1·39, P = 0·009), after adjustment for age, TDD and HbA1c. A proportional hazards model confirmed that the decline of apoptosis after diagnosis of T1D was related significantly to survival time (hazards ratio = 1·08, P = 0·014), with TDD and age also contributing to survival. During this time there was an inverse relationship between CD4+ CD25+high T cell apoptosis with TDD (r = −0·39, P = 0·008). The CD4+ CD25+high T cell apoptosis levels decline significantly after the first 6 months from diagnosis of T1D and may help in the close monitoring of autoimmunity. In parallel, there is an increase in TDD during this time. We also propose that CD4+ CD25+high T cell apoptosis assay can be used to gauge the efficacy of the several immune tolerance induction protocols, now under way.
Conditional regulation of cyclooxygenase-2 in tracheobronchial epithelial cells modulates pulmonary immunity
Authors: Park G Y , Hu N , Wang X , Sadikot R T , Yull F E , Joo M , Stokes Peebles R , Blackwell T S , Christman J W
Published: August 2010

Cyclooxygenase-2 (COX-2) gene expression in the lung is induced in pathological conditions such as asthma and pneumonia; however, the exact impact of COX-2 gene expression in the airway in regulating inflammatory and immunological response in the lung is not understood. To define a physiological role of inducible COX-2 in airway epithelial cells, we developed a novel line of transgenic mice, referred to as CycloOxygenase-2 TransActivated (COTA) mice, that overexpress a COX-2 transgene in the distribution of the CC-10 promoter in response to doxycycline. In response to doxycycline treatment, COX-2 expression was increased in airway epithelium of COTA mice and whole lung tissue contained a three- to sevenfold increase in prostaglandin E2 (PGE2), prostaglandin D2 (PGD2) thromboxane B2 (TXB2) and 6-Keto prostaglandin F2α (PGF2α) compared to wild-type and untreated COTA mice. Interestingly, primary mouse tracheal epithelial cells from COTA mice produced only PGE2 by doxycycline-induced COX-2 activation, providing an indication of cellular specificity in terms of mediator production. In the ovalbumin model, in which doxycycline was given at the sensitization stage, there was an increase in interleukin (IL)-4 level in lung tissue from COTA mice compared to untreated COTA and wild-type mice. In addition, COTA mice that were treated with doxycycline had impaired clearance of Pseudomonas aeruginosa pneumonia compared to wild-type mice. COX-2 gene expression in airway epithelial cells has an important role in determining immunological response to infectious and allergic agents.
Low mannose-binding lectin (MBL) levels in neonates with pneumonia and sepsis
Authors: Frakking F N J , Brouwer N , Van Eijkelenburg N K A , Merkus M P , Kuijpers T W , Offringa M , Dolman K M
Published: August 2010

We investigated whether deficiency of mannose-binding lectin (MBL), a component of innate immunity, is associated with neonatal pneumonia and sepsis during the first 72 h, i.e. early onset, and during the first month after birth. In 88 neonatal intensive care patients (71 premature), MBL2 genotype and MBL plasma levels at birth were determined prospectively by Taqman analysis and enzyme-linked immunosorbent assay, respectively. Thirty-five neonates (40%) had low, i.e. ≤ 0·7 µg/ml, MBL plasma levels at birth. Median (interquartile range) MBL plasma levels in 32 no early-onset sepsis (EOS) cases, 44 possible EOS cases and 11 EOS cases were 1·57 (0·57–2·67) µg/ml, 1·05 (0·41–1·70) µg/ml and 0·20 (0·10–0·77) µg/ml, respectively (P < 0·01). During the first month, 28 neonates (32%) had no infection, 49 (55%) had suspected infection, five (6%) had pneumonia and six (7%) had culture-proven sepsis. Low MBL levels at birth were associated both with an increased risk of developing pneumonia (OR: 12·0; 95% CI: 1·1–126·1; P = 0·04) and culture-proven sepsis (OR: 15·0; 95% CI: 1·5–151·3; P = 0·02). These results were confirmed by genetic analysis of MBL deficiency. Low MBL levels at birth are associated with an increased risk of early-onset sepsis, culture-proven sepsis and pneumonia during the first month of life.
Indoleamine 2,3-dioxygenase activity is increased in patients with systemic lupus erythematosus and predicts disease activation in the sunny season
Authors: Pertovaara M , Hasan T , Raitala A , Oja S S , Yli-Kerttula U , Korpela M , Hurme M
Published: August 2010

Indoleamine 2,3-dioxygenase (IDO) is a tryptophan-degrading enzyme which suppresses T lymphocyte activity. IDO activity can be determined by relating kynurenine, the main metabolite of tryptophan, to tryptophan (kyn/trp). We have demonstrated recently that systemic lupus erythematosus (SLE) is activated during the sunny season as measured by the European Consensus Lupus Activity Measurement Index (ECLAM) activity score. Our aim here was to establish whether IDO-dependent mechanisms are involved in the activation process of SLE. Kyn/trp was measured by reverse-phase high-performance liquid chromatography (HPLC) in 33 (30 female, three male) SLE patients in winter, spring and summer and in 309 healthy control subjects. At the same time-points the SLE patients were examined by a rheumatologist and a dermatologist and the activity of SLE assessed by the ECLAM score. IDO activity was higher in SLE patients than in healthy subjects. There was no seasonal variation in IDO activity in SLE patients and it did not correlate with the ECLAM activity score in winter. However, there was a significant correlation between IDO activity and the ECLAM score both in spring and in summer. High IDO activity in winter predicted subsequent activation of SLE in spring and summer. Our results indicate that IDO-dependent immunosuppressive mechanisms are activated in SLE patients. Exposure to sunlight or another factor causing seasonal variation in SLE activity leads to insufficiency of this suppression in a subgroup of patients, causing activation of SLE. High IDO activity in winter predicts activation of SLE in the sunny season.
Serum levels of interferon-γ, tumour necrosis factor-α, soluble interleukin-6R and soluble cell activation markers for monitoring response to treatment of leprosy reactions
Authors: Iyer A , Hatta M , Usman R , Luiten S , Oskam L , Faber W , Geluk A , Das P
Published: August 2010

Identifying pathogen and host-related laboratory parameters are essential for the early diagnosis of leprosy reactions. The present study aimed to clarify the validity of measuring the profiles of serum cytokines [interleukin (IL)-4, IL-6, IL-10, interferon (IFN)-γ and tumour necrosis factor (TNF)-α], the soluble IL-6 receptor (sIL-6R), soluble T cell (sCD27) and macrophage (neopterin) activation markers and Mycobacterium leprae-specific anti-PGL-I IgM antibodies in relation to the leprosy spectrum and reactions. Serum samples from 131 Indonesian leprosy patients (82 non-reactional leprosy patients and 49 reactional) and 112 healthy controls (HC) from the same endemic region were investigated. Forty-four (89·8%) of the reactional patients had erythema nodosum leprosum (ENL) while only five (10·2%) had reversal reaction (RR). Follow-up serum samples after corticosteroid treatment were also obtained from 17 of the patients with ENL and one with RR. A wide variability in cytokine levels was observed in the patient groups. However, IFN-γ and sIL-6R were elevated significantly in ENL compared to non-ENL patients. Levels of IFN-γ, TNF-α and sIL-6R declined significantly upon corticosteroid treatment of ENL. Thus, although the present study suggests limited applicability of serial measurement of IFN-γ, TNF-α and sIL-6R in monitoring treatment efficacy of ENL, reactions it recommends a search for a wider panel of more disease-specific markers in future studies.
Leptin improves pulmonary bacterial clearance and survival inob/obmice during pneumococcal pneumonia
Authors: Hsu A , Aronoff D M , Phipps J , Goel D , Mancuso P
Published: August 2010

The adipocyte-derived hormone leptin is an important regulator of appetite and energy expenditure and is now appreciated for its ability to control innate and adaptive immune responses. We have reported previously that the leptin-deficient ob/ob mouse exhibited increased susceptibility to the Gram-negative bacterium Klebsiella pneumoniae. In this report we assessed the impact of chronic leptin deficiency, using ob/ob mice, on pneumococcal pneumonia and examined whether restoring circulating leptin to physiological levels in vivo could improve host defences against this pathogen. We observed that ob/ob mice, compared with wild-type (WT) animals, exhibited enhanced lethality and reduced pulmonary bacterial clearance following Streptococcus pneumoniae challenge. These impairments in host defence in ob/ob mice were associated with elevated levels of lung tumour necrosis factor (TNF)-α, macrophage inflammatory peptide (MIP)-2 [correction added after online publication 28 September 2007: definition of MIP corrected], prostaglandin E2 (PGE2), lung neutrophil polymorphonuclear leukocyte (PMN) counts, defective alveolar macrophage (AM) phagocytosis and PMN killing of S. pneumoniae in vitro. Exogenous leptin administration to ob/ob mice in vivo improved survival and greatly improved pulmonary bacterial clearance, reduced bacteraemia, reconstituted AM phagocytosis and PMN H2O2 production and killing of S. pneumoniae in vitro. Our results demonstrate, for the first time, that leptin improves pulmonary bacterial clearance and survival in ob/ob mice during pneumococcal pneumonia. Further investigations are warranted to determine whether there is a potential therapeutic role for this adipokine in immunocompromised patients.
Generation of functionally distinct B lymphocytes from common myeloid progenitors
Authors: Yang G-X , Lian Z-X , Chuang Y-H , Shu S-A , Moritoki Y , Lan R , Wakabayashi K , Ansari A A , Dorshkind K , Ikehara S , Gershwin M E
Published: August 2010

Current models of adult haematopoiesis propose that haematopoietic stem cells (HSCs) differentiate into common lymphoid (CLP) and common myeloid (CMP) progenitors and establish an early separation between myeloid and lymphoid lineages. Nevertheless, the developmental potential of CMP-associated B cells suggests the existence of alternate pathways for B lymphopoesis. The aim of this study was to compare the developmental and functional properties of CMP- and CLP-derived B cells. While both populations matured through pro-B cell and transitional B cell intermediates in the bone marrow and spleen, respectively, following transfer into irradiated mice, mature CMP- and CLP-derived B cells exhibit distinct functional responses. Specifically, CMP-derived B cells did not respond to mitogenic stimulation to the same degree as their CLP-derived counterparts and secrete lower levels of IgM and the inflammatory cytokines such as interleukin (IL)-6 and IL-10. Together, these data suggest the existence of multiple pathways for generating functionally distinct B cells from bone marrow precursors.
Translocation of bacterial DNA from Gram-positive microorganisms is associated with a species-specific inflammatory response in serum and ascitic fluid of patients with cirrhosis
Authors: Francés R , González-Navajas J M , Zapater P , Muñoz C , Caño R , Pascual S , Santana F , Márquez D , Pérez-Mateo M , Such J
Published: August 2010

Translocation of bacterial-DNA in patients with cirrhosis and ascites triggers an innate immune response. Identification of characteristics to which this response is sensitive is relevant from a clinical standpoint. The aim of this study has been to determine if the proinflammatory immune response established in vivo in cirrhotic patients with ascites as a consequence of bacterial-DNA translocation is related to the identified bacterial species and their frequency of cytosine-guanosine content in serum and ascitic fluid. Patients with advanced cirrhosis and ascites were included in the study and distributed into groups I and II according to the absence or presence of bacterial-DNA translocation, respectively. Serum and ascitic fluid levels of proinflammatory cytokines after normalization of bacterial-DNA concentration and the activated form of nuclear factor-kappa B in ascitic fluid pellets were measured by enzyme-linked immunosorbent assay techniques. Translocation of bacterial-DNA with higher cytosine-guanosine content induced the highest cytokine response, which was higher than that in patients without bacterial-DNA translocation. The activated form of nuclear factor-kappa B in ascitic fluid pellets of patients with bacterial-DNA translocation was greater in patients with higher bacterial-DNA cytosine-guanosine content, whereas the amount of total nuclear factor-kappa B remained unaltered. Bacterial-DNA translocation induces a marked immune reaction in vivo in patients with advanced cirrhosis and ascites which is related, among other factors, to the bacterial-DNA cytosine-guanosine content. Therefore, the host's immune response to bacterial-DNA translocation constitutes a species-specific phenomenon.
Relation of nursing activities to increases in intracranial pressure
Authors: Snyder Mariah
Published: August 2010

Increased intracranial pressure (ICP), a frequent finding in head trauma and other cerebral pathology, poses a serious threat to patients' prognosis and recovery. While considerable attention has been given to medical therapies used in reducing ICP, only recently has nursing looked at the effect care specific activities may have. In this descriptive and observational study of nine patients with cranial pathology and a Richmond bolt for measuring ICP, findings confirmed that nursing activities and environmental factors are associated with pressure increases. Respiratory care activities (mean 12–7 mmHg) and repositioning (mean 12–6 mmHg) resulted in the highest increases while lesser increases were associated with doing neuroassessments (mean 7 2 mmHg) and spontaneous movements (mean 7–9 mmHg) of the patient. When the conversation was directed to the patient, the pressure increased in 33 of the 86 observations (mean 8–6 mmHg), in 21 of the 35 conversations about the patient, the mean pressure increase was 9–03 mmHg. Because many activities occurred simultaneously, it was difficult to derive the extent of elevation associated with a specific activity. Findings from this study and studies by other nurse researchers suggest actions nurses can use to minimize pressure increases. Many areas for further study exist.
Moral reasoning and the student nurse
Authors: Clay Mary , Povey Robert , Clift Stephen
Published: August 2010

The traditional curriculum in nurse education has tended to emphasize the acquisition of knowledge and practical skills and to ignore, for the most part, close examination of the social and moral dimensions of the nuree's role. The authors suggest that we ought to include a much more substantial consideration of moral issues in the nurse education and, in particular, they argue that Kohlberg's model of moral development could provide a theoretical framework. This model is based on a cognitive‐developmental approach in which an individual's level of reasoning is assessed by the use of a variety of hypothetical dilemmas. Kohlberg claims to identify six qualitatively distinct stages and argues that the transition from one stage to the next results from the individual's active attempts to resolve conflicts arising from moral dilemmas. Some suggestions are made about the ways in which discussion of moral dilemmas might be incorporated within a moral reasoning module in the nurse education curriculum and proposals are made for methods of teaching such a module.
Recent progress in cardiac nursing and rehabilitation programmes
Authors: Mayberry J. , Kent S. V.
Published: August 2010

The value of coronary care units in reducing mortality has been questioned in recent years. However, nurses working in such units have acquired considerable specialist knowledge about coronary artery disease and the psychological problems of patients requiring intensive care. During the 1970s several formal studies of patient management and secondary prevention were developed and reported by nurses. In this review these findings and their effects on patients, relatives and nursing staff are discussed.
Social support: how does it really work?
Authors: Spitzer Ada , Bar‐Tal Yoram , Colander Hava
Published: August 2010

This study examines social support effect on stress and adaptation through the mediating effect of control Participants in the study were 12 male and 65 female rheumatoid arthritis patients who were being treated in the outpatient clinics of three large hospitals in Israel Findings suggest that social support did have a significant effect on stress and adaptation, though this effect was through the mediating effect of control and not as a buffer as was suggested previously Implications of the results for nursing science are discussed
Nurses’ knowledge and beliefs about AIDS: comparing nurses in hospital, community and hospice settings
Authors: Steele A , Melby V
Published: August 2010

The literature reports an ongoing debate amongst nurses regarding the risk of contracting human immunodeficiency virus (HIV) through routine nursing care An emotionally charged dilemma appears to exist for many nurses regarding what they perceive as conflict between professional obligation and personal risk This study investigates nurses’ beliefs, knowledge and perceptions of risk of contracting HIV while implementing their nursing care The study focuses on qualified nurses in the hospice, hospital and community settings No other similar comparative study that also focuses on hospice nurses has been identified This quantitative study was implemented within Northern Ireland, by way of a respondent‐administered questionnaire The study's sample consisted of 45 qualified nurses and a response rate of 93% (42 respondents) was achieved Analysis of the data involved the use of descriptive and correlational statistics Overall findings indicated that many nurses, but particularly those who work in the hospital and community settings, hold negative and biased beliefs, and have inadequate knowledge and misguided perceptions regarding their risk of contracting HIV through the implementation of routine nursing care of clients Many of those nurses readily admit their lack of knowledge On the whole, hospice nurses appear more knowledgeable and exhibit a more positive approach to AIDS clients, and appear less fearful than do nurses in the other two settings Implications for hospital management, for nurse education, for nurses themselves and for clients are discussed This study should be seen as a springboard for future research within Northern Ireland
The nature of ophthalmic services, and the education and qualifications of nurses: a national survey*
Authors: Waterman H , Hope K W , Beed P , Clayton E , McQueen L , Owen C , Stott M , Studley M
Published: August 2010

This paper reports on a national survey undertaken by the Royal College of Nursing (RCN) Ophthalmic Nursing Forum to assess, first, the nature of ophthalmic services and, second, skill‐mix and educational opportunities of nurses working with ophthalmic patients A questionnaire was formulated and tested by members of the committee, with research and statistical support from the School of Nursing Studies, University of Manchester The questionnaire was sent to the total population of ophthalmic units/hospitals in the UK (n= 168) Following descriptive statistical data analysis it was concluded that in smaller
Diabetes: an adolescent's perspective
Authors: Kyngas Helvi , Barlow Julie
Published: August 2010

The personal meaning and perceived impact of insulin dependent diabetes melhtus (IDDM) were investigated in an exploratory study of 51 Finnish adolescents aged between 13 and 17 Interview data were examined using continuous comparative analysis The personal meaning of IDDM was described using the following categories a habit, a little devil, a nightmare, stress, prison, death, and hell A core concept to emerge was that of control Young people felt IDDM controlled, or limited, their freedom and independence Two main themes emerged in terms of the impact of IDDM in the lives of adolescents a threat to life's equilibrium and a healthy lifestyle Diabetes was viewed as a threat to physical, psychological and social well‐being which disrupted the balance of life In contrast, the other main category, a healthy lifestyle, revolved around the notion that having IDDM offered a unique opportunity to live a healthy life The results provided a useful insight into the personal meaning of IDDM and serve to raise awareness of the problems and difficulties experienced by adolescents with this condition
Dyspnoea: a study of measurement instruments for the assessment of dyspnoea and their application for patients with advanced cancer
Authors: van der Molen Beverley
Published: August 2010

Dyspnoea or breathlessness is a problem commonly encountered in the palliative care of many patients with advanced cancer, although its impact on the patient is frequently under‐estimated In advanced cancer, the aim of effective management is to minimize the patient's perception of breathlessness which, in turn, depends on reliable assessment Most of the knowledge and experience of dyspnoea has been acquired through working with patients with chronic pulmonary disease and there is a dearth of literature relating specifically to the assessment of dyspnoea in advanced cancer A critical analysis of available literature was undertaken and measurement instruments available for assessing breathlessness and their application to dyspnoeic patients with advanced cancer were reviewed Dyspnoea is a complex, multidimensional sensation and its subjectivity makes it difficult to quantify For patients with advanced cancer, dyspnoea may be one of many symptoms and measurement instruments need to take this into account No single measurement instrument takes into account the different components of dyspnoea and as the final choice will depend on the purpose of assessment, it is likely that more than one instrument will be required
A hermeneutic study of the experiences of relatives of critically ill patients
Authors: Walters Allan John
Published: August 2010

This paper describes a hermeneutic study of experiences of relatives of critically ill patients in the context of a large tertiary referral hospital in Sydney, Australia The participants were 15 female family members of critically ill patients Taped conversations between the researcher and participants were conducted and interpreted using Reinharz's hermeneutic method Two themes emerged from the participants’ experiences and are described as ‘being‐with’ and ‘seeing’‘Being‐with’ focused on the desire of the participants to ‘be‐with’ their relatives, in a physical and emotional sense The theme 'seeing’highlighted the importance of actually seeing the patient Ontological concepts relating to the themes are described with reference to Taylor's concept of being human
Reflection and critical incident analysis: ethical and moral implications of their use within nursing and midwifery education
Authors: Rich Ann , Parker David L
Published: August 2010

Despite the dearth of rigorous empirical investigation, reflection and reflective practice have become buzz words in nursing and midwifery education Reflection and critical incident analysis may be tools which can facilitate the integration of theory and practice It is proposed that in the absence of explicit and thorough preparation of lecturers and students, together with very careful curriculum planning, these activities may be counter‐productive or even harmful In the absence of structure, reflection and associated critical incident analysis may lead to student disaffection or, worse, the potential for actual psychological disturbance Empirical studies on the use of identified models of reflection and critical incident analysis are urgently needed to assist nursing and midwifery lecturers and students to achieve predictable learning outcomes for this potentially valuable activity
The transformational experience of liver transplantation
Authors: Wainwright Steven P
Published: August 2010

Liver transplantation is now the treatment of choice for patients with end‐stage chronic liver disease However, few studies have examined the recovery of liver transplant patients and no qualitative research studies have examined the experiences of these patients Therefore the purpose of this study was to explore and describe the experiences of liver transplantation from the patient's perspective In‐depth focused interviews with 10 liver transplant patients were carried out Grounded theory data collection and data analysis methods were used A theoretical framework of the transformational experience of liver transplantation is presented The process of transformation involves moving through a five‐stage trajectory of receiving the transplant, improving in hospital, improving at home, feeling well again, and reciprocating
Living with haemophilia and HTV/AIDS: support and coping
Authors: Stewart Miriam J , Hart Geraldine , Mann Karen V
Published: August 2010

This paper describes sources and types of support, appraisal of support, and use of social support as a strategy for coping with Acquired Immune Deficiency Syndrome (AIDS)‐related stresses Thirty people with haemophilia, 23 family caregivers and 17 bereaved relatives participated The study was conducted in two stages individual interviews and mailed questionnaires The key coping strategies used were‘normalizing personal relationships’and ‘seeking informational support’Informational support was provided by health professionals and practical aid by relatives Respondents reported insensitivity, prejudice and avoidance from others Participants needed peers for emotional and affirmational support, and professionals for informational support The preferred intervention was support groups, co‐led by professionals and peers
Professional caring: the moral dimension
Authors: Fealy Gerard M
Published: August 2010

The concept of caring, its intentions, actions and its achievements, as it relates to nursing is a concept on which many nurses’minds have been focused The concern and at times a major preoccupation with the need to explore and explain caring among the nursing body is a concern which is rooted in sociopolitical and cultural phenomena related to the evolution of nursing The need to explore and explain caring through philosophical discourse is a necessary and an ongoing part of this evolutionary process This paper represents an attempt to partake in such discourse More precisely, the paper undertakes an analysis of the concept of caring as it happens in both nonprofessional and in professional caring contexts and represents an attempt to characterize professional caring In an effort to do this the author considers the moral‐ethical dimension of caring in the light of important theoretical positions on social morality When considered against these theories of social morality and against the professionally derived imperatives which guide caring actions, professional caring may be construed as a distinct mode of caring
Nursing informatics: state of the science*
Authors: Henry Suzanne Bakken
Published: August 2010

The phenomena of interest in nursing informatics are nursing data, nursing information and nursing knowledge The current state of knowledge related to these phenomena suggests four implications for the development of systems to support nursing First, research has provided evidence that knowledge and experience is related to the quality of nursing assessment, diagnosis or clinical inference, and planning of nursing care, and also that knowledge is task‐specific Information technology can provide access to a variety of information resources, such as knowledge bases and decision support systems, to increase the level of knowledge of the nurse decision‐maker Second, structured patient assessment forms with linkages to knowledge bases of diagnoses have the potential to improve the quality of the patient assessment and the accuracy of the diagnosis or clinical inference Third, studies on planning care have demonstrated the complexity of the task when a number of options are potentially appropriate Model‐based decision support applications such as decision analysis and multi‐attribute utility theory can assist the clinicians and patients to analyse and compare the treatment alternatives in a systematic manner Fourth, there is modest support for demonstrating the relationship between the process and outcomes of clinical decision making Large databases built upon nursing data are needed to further examine this relationship
Nursing practice in Canada: the influence of current and proposed legislation
Authors: Hadley Margaret
Published: August 2010

Nursing practice in Canada is regulated by separate acts in each of the 10 provinces and two territories These acts grant self‐governance to the nursing profession, define a scope of practice, and establish mechanisms for registration and quality assurance The Canada Health Act 1984, the Agreement on Internal Trade (1994) between provinces, and the North American Free Trade Agreement have potentially great effects on Canadian nursing by altering the regulation of professionals within the various jurisdictions
A quasi‐experimental research to investigate the retention of basic cardiopulmonary resuscitation skills and knowledge by qualified nurses following a course in professional development
Authors: Broomfield Rebecca
Published: August 2010

The research was undertaken with the intention of testing six null hypotheses regarding the retention of basic cardiopulmonary resuscitation (CPR) skills and knowledge of registered nurses The hypotheses were formulated from the broad aims of the research, which were to investigate conclusions reached by other researchers highlighting the speed with which retention of CPR skills and knowledge deteriorates, and to investigate the need for regular updating in CPR The research was quasi‐experimental in nature The 19 nurses participating in the research were qualified staff undertaking the English National Board (ENB) 923 course in Professional Development, which included a refresher on basic CPR skills and included some discussion regarding advanced techniques The latest guidelines issued by the Resuscitation Council (1993) were used, which also aided in the design and use of the two research tools, namely an eight‐point skills‐testing observation tool and a 26‐point knowledge‐testing questionnaire While a 3‐hour update in CPR skills revealed an initial improvement, the decrease in retention of skills 10 weeks later was significant (P=0 0000) The update in CPR knowledge also revealed an initial improvement but the decrease in retention of knowledge 10 weeks later was significant (P=0 0000) The findings of the research reflect similar results to previous research undertaken and discussed in the literature review, suggesting that retention of skills and knowledge quickly deteriorates if not used or updated regularly Therefore this research supports the importance of CPR refresher courses on a regular basis
The practitioner‐teacher: a study in the introduction of mentors in the preregistration nurse education programme in Wales: part 1
Authors: Phillips R M , Davies W B , Neary M
Published: August 2010

This study focused on the introduction of mentors in the Common Foundation Programme of Project 2000 schemes of preregistration nurse education The research, which was commissioned by the Department of Health Research and Development Division on behalf of the Welsh Office Nursing Division, began in February 1992 and was undertaken on an all‐Wales basis The completed report aims to provide policy makers with information relating to important issues which are central to the teaching and learning of nursing in clinical locations This first paper discusses some background issues and gives a brief conceptual framework for considering policy reform, summarizes the research questions which emerged and describes the methods used to address them The second paper (to appear in the next issue of the journal) will describe the key findings from the study and discuss some ensuing potential implications and considerations for all those involved in the preparation of future practitioners of nursing
An impossible dream? Images of nursing held by pre‐registration students and their effect on sustaining motivation to become nurses
Authors: Spouse Jenny
Published: August 2010

An impossible dream? Images of nursing held by pre‐registration students and their effect on sustaining motivation to become nurses

Each year approximately 13 000 people enter higher education programmes leading to nurse registration in England. Evidence suggests that students enter nursing with strong images about how they will practice. This paper explores the nature of such images and how they are used to inform students’ approaches to nursing practice. Findings come from a longitudinal study designed to investigate how students develop their professional knowledge whilst working in clinical settings. Eight pre‐registration degree‐course nursing students participated in the study. A multi‐method approach to data collection was used over their 4‐year programme. One involved in‐depth interviews taking place during each of students’ clinical placements. Data were analysed manually and subjected to a constant comparative method of analysis. From this material individual case studies of the five completing students were constructed, with participants checking their own case study to ensure that it reflected their intended meaning. A second phase followed where cross‐case comparison addressed each of the original research questions. The question relevant to this paper was: What were students’ conceptions of nursing on entry, and how do these influence their development? Findings indicate that participating students’ preconceptions of nursing had a profound influence on their decision whether to continue with their course, sometimes despite social and academic set‐backs, or to leave nursing. An important contribution to realizing their aims was their supernumerary status and effective support from knowledgeable and experienced practitioners. These findings indicate that with better understanding of the relationship between this form of personal knowing and practice, educators would have more information with which to select students and to design professional curricula.
Language, research and nursing practice
Authors: Björnsdottir Kristin
Published: August 2010

Language, research and nursing practice

Aim of the paper. This paper highlights the centrality of language in constructing knowledge. It aims at making us sensitive to the political nature of knowledge production and the complex power relationships that may emerge as a result of our efforts to create new knowledge.

Background: Science, as understood here, is a linguistic construction, rather than a mirror reflection of reality. A number of examples are presented, demonstrating the complex ways in which language is central in shaping all our attempts to know, science included, and nursing practice.

Conclusion: Based on the analysis presented in this paper an argument is made for a substantial re‐thinking of nursing research and its relationship to nursing practice. Research needs to be an integral part of everyday nursing practice, a way of posing questions and reflecting on answers. Further, nurses need to be aware of the potentially coercive nature of knowledge as well as its liberating effect.
Are people with learning disabilities able to contribute to focus groups on health promotion?
Authors: Fraser Mary , Fraser Anne
Published: August 2010

Are people with learning disabilities able to contribute to focus groups on health promotion?

Aim. This paper shows the differences between the success of three focus groups in promoting group discussion on health promotion and also the detailed effects of individual members with speech and language difficulties in participating.

Background. Conducting focus groups with people with learning disabilities can promote their social inclusion.

Conclusions. We conclude that focus groups are an effective method of conducting exploratory research with adults with learning disabilities in the community, however, ability to participate with other members may be a limiting factor. Furthermore, special arrangements may need to be made for groups to be successful, including the use of an interpreter. The preparation of the moderator is also an important factor in group success.
Ambulatory orthopaedic surgery patients’ knowledge expectations and perceptions of received knowledge
Authors: Heikkinen Katja , Leino‐Kilpi Helena , Hiltunen Ari , Johansson Kirsi , Kaljonen Anne , Rankinen Sirkku , Virtanen Heli , Salanterä Sanna
Published: August 2010

Title.  Ambulatory orthopaedic surgery patients’ knowledge expectations and perceptions of received knowledge

Aim.  This paper is a report of a study to compare orthopaedic ambulatory surgery patients’ knowledge expectations before admission and their perceptions of received knowledge 2 weeks after discharge.

Background.  Advances in technology and population ageing are driving up the number of ambulatory orthopaedic surgical procedures. Shorter hospital stays present a major challenge for patient education.

Methods.  A descriptive comparative cross‐sectional study (pre‐ and post‐test) design was adopted. The data were collected from 120 consecutive patients in 2004, using the Hospital Patient’s Knowledge Expectations Scale and Hospital Patient’s Received Knowledge Scale. All patients participated in a preoperative education session given by a nurse.

Results.  Patients expected more knowledge than they actually perceived that they received on all dimensions except the bio‐physiological. They perceived that they received least knowledge about experiential, ethical, social and financial dimensions of knowledge. Knowledge expectations correlated with age and professional education. Perceptions of received knowledge correlated with earlier ambulatory surgery, and both expected knowledge and perceptions of received knowledge were related to the level of basic education.

Conclusion.  Patients’ knowledge expectations are greater than the knowledge they perceived that they receive, and they cannot become empowered if they lack important knowledge. Further research is needed to learn about meeting patients’ knowledge expectations.