Specialist nurse in Europe: education, regulation and role.

BACKGROUND: The concept of a 'specialist nurse' has existed for many years and related education programmes are proliferating. However, while literature clearly outlines the roles and practice of registered nurses and advanced practice nurses, those of specialist nurses remain unclear and nursing specializations across Europe need clarifying. AIM: This pilot study aimed to explore the competencies, education requirements and regulation of specialist nurses in Europe. DESIGN: A descriptive cross-sectional survey. METHODS: An online questionnaire named 'Specialist nurse and specialization in Europe' was sent to 550 members of the European Federation of Nurse Educators and ten members of the European Specialist Nurses Organizations. Snowball sampling was then used to build a convenience sample of nurse educators, clinical nurses and specialist nurses, national nursing association members, and chief nursing officers from all European countries. Besides quantitative aspects, responses to open-ended questions were analysed using a qualitative content analysis process. RESULTS: A total of 77 experts from 29 European countries responded to the questionnaire. Findings highlighted variations in titles, levels and length of education, certification, regulation and scope of practice for specialized nurses in Europe. Analysis of the promoted competencies revealed dominant clinical and technical aspects of the role with a high level of knowledge. CONCLUSIONS: The study emphasized the need to improve standards for education, certification and regulation for specialist nurses. Interpretation of the role and competencies is diverse with a weak presence of health policy that would enhance and develop the specialities. IMPLICATIONS FOR NURSING AND HEALTH POLICY: To address the current lack of provisions for automatic recognition of specialist nurses, common training frameworks corresponding to the relevant level of the European Qualifications Framework should promote lifelong learning and mobility, and enhance levels of health care and patient safety.

Restless legs syndrome associated with exercise intolerance: Data from a retrospective observational clinical neuromuscular center study.

INTRODUCTION: Exercise intolerance (EI) is a frequent motive for seeking neuromuscular consultation and may be a sign of metabolic disease or, rarely, muscular dystrophy. The diagnosis is not established in many patients with a typical clinical presentation. Nevertheless, some of them complain of sleep disorders and more especially of restless legs syndrome (RLS). OBJECTIVE: The objective of our study was to estimate the frequency of RLS in patients presenting with EI. METHODS: Our retrospective observational study included all patients seen in the center from 2005 to 2011, who were subsequently investigated for EI in the neuromuscular department of the Caen University hospital. Data were collected on clinical RLS and muscular investigations (creatine kinase [CK], EMG, maximal exercise tests magnetic resonance imaging [MRI] and muscle biopsy obtained along with muscle exploration). RESULTS: Of the 318 patient records analyzed, 84 showed patients accurately complaining of EI. RLS was diagnosed in 25 of these patients (29.7%). This percentage was significantly higher (P<0.001) than found in the general population. Improvement was seen in 91.3% of the patients receiving specific treatment. CONCLUSION: RLS can sometimes present with pain, potentially worsening with exercise, inappropriately leading to a hypothesis of EI. Clinicians should thus explore the possible diagnosis of RLS when a muscular disease is not found in patients presenting with such symptoms.

Trends in nursing research in France: a cross-sectional analysis.

AIM: To examine the engagement of French registered nurses with the Ministry of Health's initiative to spur scientific inquiry in the community. BACKGROUND: French nursing research has suffered from a lack of dedicated funding. Positive signs of change have recently appeared, with the launch of the first national public funding programme dedicated to nursing research. This initiative, begun in 2010, was launched by the French Ministry of Health. Through this initiative, 149 registered nurses, serving as principal investigators, and their teams submitted research proposals between 2010 and 2011. The administrative guidelines of the funding programme are clearly oriented towards producing quantitative and exogenous nursing research. METHOD: A cross-sectional analysis of 149 nursing research projects submitted during the first and second years of a French national funding programme for hospital-based nursing research was conducted. Research proposals were included in the analysis whether they received funding or not. Data collection took place in 2011. The categories used in the analysis were the following: (1) the socio-demographic data on the registered nurse principal investigators, (2) the research teams and (3) the research proposals (methodologies, bibliography, focus of the research, output, the status of the research proposals). RESULTS: This study highlights the presence of methodological homogeneity among the research proposals submitted for funding. Clear tendencies were towards interventional and quantitative studies and those with an exogenous factor research objective. Between 2010 and 2011, 25 projects were funded out of 149 submitted. They were mostly quantitative and/or focused on the exogenous factors in patient care. CONCLUSION: The socio-political context of a funding programme designed to encourage nursing research has had an implicit influence on the type of research to which French nurses have committed themselves to and the scientific positions with which these nurse researchers align themselves.

Undergraduate nursing education reform in France: from vocational to academic programmes.

BACKGROUND: France is currently implementing a number of reforms to the healthcare and education systems. Within this context, a comprehensive reform of undergraduate nurse education was launched in 2009, bringing nurse education closer to the higher education environment. It is likely in future to move from being vocational towards becoming an academic educational programme. AIM: In this paper, the 2009 reform of the French pre-registration nursing curriculum will be analysed in light of the European framework. PROCESS: The pedagogical approach, methods and content of nursing education in France are undergoing an in-depth reorganization. The main innovation that the reforms introduce is a competency-based approach. France is joining the group of countries that require first degree-level entry to the nursing profession. CONCLUSION: There are still many unanswered questions regarding the competencies and qualifications required by both the academic and clinical educators many of whom have not been previously involved in research or publications. The future status of nursing science is unclear, as is the way in which the nursing profession will be able to retain control over its educational mechanisms.

[Lipofilling and weight gain. Case report and review of the literature]. / Lipomodelage et prise de poids. A propos d'un cas et revue de la littérature.

Since Coleman's studies, lipofilling has become an easy, reliable and reproducible surgical technique particularly in severe Romberg's syndrome that is characterised by a progressive facial hemi-atrophy of cutaneous and subcutaneous tissues. Considering a young patient case, the authors expose a rare complication of lipofilling: deterioration of the aesthetic results after a significative weight gain due to corticosteroids, oral contraception and a change of lifestyle. Lipofilling is an adipocyte graft realised after centrifugation of liposuction products. Thus, the increasing volume of the fat graft remains hypertrophic and hyperplasic theories. Indeed, the technique produces a concentrated fat graft that realises an asymmetry of fat distribution in both sides of the face. The authors present their preliminary results.

New data on the cytolytic effects of natural killer cells (Kurloff cells) on a leukemic cell line (guinea pig L2C).

L2C leukemia is a leukemia that occurs in strain two guinea pigs. The L2C cells are natural killer-sensitive. The Kurloff cell (KC), a guinea pig NK cell, develops a 3-fold increase in lysosomal enzyme activity and the number of KC cells increases during leukemogenesis, leading to KC cell-mediated L2C cytolysis. This paper shows that conjugates are produced by incubating KC and L2C for 4 h, with 34% of L2C showing chromatin compaction and shrinkage of the cytoplasm. There was also a reorientation of the KC cytoplasmic organelles to face the target cell and an elongation of the KC to produce arms that engulfed the L2C. The L2C had either necrotic or apoptotic characteristics. L2C DNA fragmentation was demonstrated in situ with the comet and the TUNEL assays. 22.2% of the viable L2C lost their membrane asymmetry during KC-L2C conjugation as shown by incubation with Annexin V-FITC. These results provide new evidence that the death of L2C is due, at least partly, to apoptosis. The cytolytic effect of the NKKC might be a model of the cytological changes that occur in NK cell-leukemic cell conjugates.

Arylsulfatase B in Kurloff cells: increased activity of anionic isoforms in guinea pig acute lymphoblastic leukemia.

We examined the in vivo role of Kurloff cells (KC), guinea pig natural killer cells, during the development of L2C leukemia, by analysing changes in the arylsulfatases (Asases) in the lysosomal Kurloff body. The Kurloff body is rich in acid phosphatase, esterase and proteoglycans, as are large granular lymphocyte granules. Moreover, the Kurloff body contains lysosomal Asase B, with unusual anionic isoforms. Injection of L2C cells elicited a three-fold increase in KC Asase activity on day 6. The increase in KC Asase activity was correlated with the number of circulating L2C cells. The basic Asase form (pl 8) was lost, and a concomitant increase in anionic isoforms (pl 5-6) was observed on day 6. The role of the latter in cytolysis was investigated by examining their capacity to lyse L2C target cells. We conclude that Asase participates in cytolysis when lysis is mediated by the complete assembly of cytolytic proteins. Changing and increasing KC Asase activity during leukemia development may be a marker for activated KC in vivo. These findings suggest that the cytolytic activation of KC occurs during the preleukemic period.

Increase of a guinea pig natural killer cell (Kurloff cell) during leukemogenesis.

The guinea pig Kurloff cell (KC) is an estradiol-dependent circulating mononuclear cell that had natural killer cytotoxic activity in vitro. We studied the variation of KC number during the development of transplanted leukemia in inbred strain 2 (S2) leukemia-sensitive guinea pigs. Grafts of leukemic cells (L2C) produced a significant increase in the number of KC. Leukemia occurred in 35.5% of non-estrogenized animals and in 18.3% of estrogenized guinea pigs. The increased number of KC seems to have antileukemia activity in vivo. This could be part of the general phenomenon of cancer resistance in guinea pigs.

In vitro cytotoxic effect of guinea-pig natural killer cells (Kurloff cells) on homologous leukemic cells (L2C).

The Kurloff cell (KC) of the guinea-pig develops natural killer cytotoxic activity in heterologous systems. We report in this paper the effective in vitro cytotoxic activity of the KC in a homologous guinea-pig system, i.e. against the guinea-pig target leukemic L2C cells. A dual-color flow analysis of homologous effector-target conjugates, using calcein-labeled KC and hydroethidine-labeled L2C shows a 40% frequency KC-L2C conjugation. The specific cytotoxicity of KC against L2C (78%) was estimated as the target-loss of green fluorescence due to hydrolysed carboxy-fluorescein diacetate after 4 hours at 37 degrees C. We propose that the Kurloff cell could be involved in surveillance against spontaneously arising leukemic cells, and this could be an explanation for the high degree of resistance to spontaneous or experimentally-induced cancers, in the guinea-pig.

17 beta estradiol affects the expression of guinea pig blood leukocyte MHC antigens.

Sex hormones have an effect on various immune responses but the mechanisms of action are unknown. One of these mechanisms might be a modification of expression of major histocompatibility complex (MHC) antigens in blood leucocytes. Estradiol-induced variations of the expression of guinea pig blood leukocytes MHC antigens (GPL-A) was studied. Class I and class II MHC antigens were detected by a sensitive rosetting method using specific alloimmune sera (AIS) and staphylococcal protein A-coated sheep red blood cells (SPA-SRBC) and evaluated by counting the number of bound SPA-SRBC per 100 cells. MHC antigens decreased after estrogen treatment. Estradiol modifies the expression of GPL-A antigens on the mononuclear cells including the Kurloff cells, which are involved in immunity or in a natural killer effect, but did not affect the expression of polymorphonuclear cells, ones which are not involved in immunity.

The Kurloff cell in estrogenized guinea pigs as a CT7+ 8BE6- CT6- MR-1- CT10- IgM- lymphocyte with natural killer activity.

The relationship of the Kurloff cell (KC), guinea pig blood mononuclear cell with natural killer (NK) activity, to a known cell lineage was established. Using indirect immunoperoxidase staining and flow cytometric analysis, numerous monoclonal antibodies directed against guinea pig macrophage antigen, Ia antigen or different T lymphocyte markers and a polyclonal anti-IgM serum were tested in unimmunized estrogenized animals. We excluded any relationship between KC and the monocytic macrophage lineage (MR-1-) and between KC and the B lymphocyte lineage (CT10- and IgM-). The KC immunophenotype was pan T CT7 positive but 8BE6 (mature thymocyte) and CT6 (cytotoxic suppressor T lymphocyte) negative. Since KC displays an NK activity, this cell may be classified among the NK effector cells exhibiting some T lymphocyte markers.

A spontaneous lymphoblastic lymphoma in a guinea-pig.

The exceptional carcinoresistance of guinea-pigs is well known and only a few cases of spontaneous leukaemia and several very rare cases of lymphoma have been reported in the literature. A spontaneous malignant tumor in an old male hybrid guinea-pig is described. The monomorphous aspect of the tumour, the cellular cohesiveness, the "starry-sky" pattern and the immunocytological characterization of tumour cells as B lymphocytes bearing IgM, lead to describe this tumour as a probable spontaneous Burkitt-type malignant lymphoblastic lymphoma.

Natural killer activity of Kurloff cells: a direct demonstration on purified Kurloff cell suspensions.

In order to study their natural killer effect, guinea pig splenic Kurloff cells were fractionated by Percoll discontinuous density gradient centrifugation. Kurloff cells were collected and tested for cytotoxicity in a 24-hr chromium-release test. Comparison of different splenic cellular samples (of males or estrogenized females) with increasing percentage of Kurloff cells, revealed a highly significant positive correlation (r = 0.93, alpha less than 0.01) with the cellular cytotoxicity developed against the K 562 target cells.

Isolation of Kurloff cells by Percoll density gradient centrifugation. Protein labeling with 35S-methionine of these cells.

Large populations of splenic Kurloff (150 - 200 X 10(6) Kurloff cells) were obtained from estrogenized guinea pigs by isopycnic centrifugation in a Percoll solution of 1.085 g/ml starting density. The Kurloff cells settled at a buoyant density of about 1.100 g/ml. The purity of these cell suspensions reached 95%, as assessed by phase contrast microscopy and by specific staining. The viability assessed by Trypan blue exclusion test was also about 95%. Moreover, the good transmission electron microscopic appearance of these Kurloff cells and their ability to take up 35S-methionine in culture confirmed their physiological integrity. By autohistoradiography, this protein labeling was localized between the nucleus and the Kurloff body, and also on the Kurloff body itself. This data reinforces the hypothesis of de novo synthesis of the Kurloff body.

[Increase in the number of Kurloff cells following estrogen stimulation in guinea pigs: demonstrated latency period]. / Augmentation du nombre des cellules de Kurloff après stimulation oestrogénique chez le cobaye: mise en évidence d'un temps de latence.

The comparative study between plasma estradiol levels and KURLOFF cell numbers in the blood and some organs of adult, non pregnant female guinea-pigs, leads us to describe a biphasic response of the KURLOFF cells to estrogen stimulation. The first step, a five day lag-phase, is followed by a secondary increase of KURLOFF cell numbers with a peculiarly noticeable storage in the thymus parenchyma.

Scanning electron microscopy of pure Kurloff cell suspensions. Observation of an extrusion process.

Scanning electron microscopy has been used to examine suspensions of Kurloff cells, which are present only in guinea pig. The cells are round with a surface characterized by uniformly distributed short stubby microvilli and some ridges. Some cells show one or more pores surrounded by a smooth margin, others a smooth globular expansion about 10 microns in diameter which may correspond to a Kurloff body undergoing exocytosis. The Kurloff body is released into the medium where it can exist freely. The surface of the free body and of the expansion display the same smooth appearance. Although the nature of the Kurloff cell remains unknown, this study provides further information concerning its morphology and describes an extrusion process not observed previously.