Listening to the neurological teams for multiple sclerosis: the SMART project.

OBJECTIVE: Aim of the research was to define the quality of life of Italian neurologists and nurses' professional caring for multiple sclerosis, to understand their living the clinical practice and identify possible signals of compassion fatigue. MATERIAL AND METHODS: One hundred five neurologists and nurses from 30 Italian multiple sclerosis centres were involved in an online quali-quantitative survey on the organization of care, combined with the Satisfaction and Compassion Fatigue Test and a collection of narratives. Descriptive statistics of the quantitative data were integrated with the results obtained by the narrative medicine methods of analysis. RESULTS: Most of the practitioners were neurologists, 46 average years old, 69% women, 43% part time dedicated to multiple sclerosis. An increased number of patients in the last 3 years were referred in 29 centres. Differences were found between neurologists and nurses. Physicians showed higher risks of burnout, reporting intensive working paces, lack of medical personnel, and anxiety caused by the precarious employment conditions. Nurses appeared more satisfied, although the reference to the lack of spaces, and the cross professional roles risk of compassion fatigue. Both positive and negative relationships of care were depicted as influencing the professional quality of life. CONCLUSION: The interviewed neurological teams need to limit the risk of compassion fatigue, which appeared from the first years of the career. The prevalence of the risk among neurologists suggests more awareness among scientific societies and health care managers on the risk for this category, as first step to prevent it.

Sentinel node biopsy after primary systemic therapy in node positive breast cancer patients: Time trend, imaging staging power and nodal downstaging according to molecular subtype.

BACKGROUND: The management of axilla after Primary Systemic Therapy (PST) for breast cancer is a highly debated field. Despite the proven axillary downstaging occurring after PST, there is still some degree of reluctance in applying sentinel node biopsy (SNB) in the neoadjuvant setting. PATIENTS AND METHODS: We performed a retrospective analysis on 181 PST patients with axillary positive nodes at presentation treated between 2005 and 2017 at San Raffaele Hospital in Milan. The aim was to observe the application time trend of SNB, to determine the imaging staging power and the axillary downstaging according to molecular subtypes. RESULTS: Median follow-up after surgery was 32.5(IQR: 12-59) months. After PST, 119 (65.7%) patients had no clinically palpable nodes, 72 (39.7%) converted to N0 on final imaging and 34 (18.8%) underwent SNB with an increasing application trend. Axillary-US showed the highest accuracy (69.3%) in re-staging axilla after PST. Staging power of preoperative testing varied with tumour biology: Positive Predictive Value was higher in Luminal A (80% for clinical examination and 100% for axillary-US) and Luminal B (72% and 70.5%) tumours, whilst Negative Predictive Value was higher in HER2 positive (100% and 93.3%), and triple negative (71.4% and 93.3%) tumours. Ninety five (52.5%) patients experienced axillary downstaging after PST, by molecular subtype 15% (3/20) in Luminal A, 46.4% (45/97) in Luminal B, 90.9% (20/22) in HER2+ and 70.3% (26/37) in triple negative breast tumours. CONCLUSION: SNB application after PST for breast cancer in node positive patients at presentation is increasing. Pre-operative axillary imaging and tumour biology help identify patients who might be candidates for SNB as a single staging procedure.

Genotype comparison of sorbitol-negative Escherichia coli isolates from healthy broiler chickens from different commercial farms.

Hybridization on arrays was used to assess the presence of virulence-associated genes and to determine the relatedness of 32 non-O157 sorbitol-negative Escherichia coli isolates from healthy broiler chickens. These isolates were from commercial farms that used feed supplemented with different antimicrobial agents (virginiamycin, bacitracin, salinomycin, narasin, nicarbazin, or diclazuril). For each isolate, fluorescent probes were made from genomic DNA and were hybridized on DNA arrays composed of genes associated with general functions, virulence, iron uptake systems, and DNA repair genes (e.g., mut genes). Hybridization on arrays results showed that isolates from the same farm tended to be clustered but actually represented 18 genetically distinct groups of isolates. Results revealed that some isolates showed similarity to human uropathogenic E. coli or avian pathogenic E. coli. Four avian pathogenic E. coli-like isolates were detected. Another isolate possessed the intimin gene (eaeA) and typical genes of the type 3 secretion system associated with enteropathogenic E. coli and enterohemorrhagic E. coli strains. Genes from a second system (secondary type 3 secretion system) homologous to that found in Salmonella Typhimurium were detected in many isolates. Several of the studied isolates also possessed the aerobactin, salmochelin, and yersiniabactin genes involved in iron acquisition in pathogenic bacteria. Our results clearly suggest that commensal E. coli isolates from chickens are reservoirs of virulence-associated genes and may represent colibacillosis and zoonotic risks.

Pharmacognostical studies of the plant drug Mimosae tenuiflorae cortex.

The bark of the Mimosa tenuiflora (Willd.) Poiret (Leguminoseae) tree, known as tepescohuite in Mexico, is commonly used in this country and in Central America to elaborate different products for the treatment of skin burns and lesions. The cicatrizing properties of extracts obtained from this bark have been scientifically studied, attributing the main biological activity to its tannin and saponin content. Studies include clinical trials of phytodrugs based on Mimosae tenuiflora bark extracts for treatment of venous leg ulcerations. Recent commercialization of the plant drug Mimosae tenuiflorae cortex requires pharmacognostical information to develop quality-control methods for raw materials and extracts produced with this plant drug. The present paper reports a group of ethnobotanical, morphological, chemical, and molecular studies performed with Mimosae tenuiflora materials obtained by collection in the southeastern Mexican state of Chiapas. Macro- and micro-morphological parameters were established to authenticate the genuine drug that allowed detection of adulterants usually found in commercial samples of this plant material. These morphological characteristics can be used for rapid identification of the drug and are particularly useful in the case of powdered materials. The chemical studies performed demonstrated that tannins represent the major component group in the bark. Its content in genuine tepescohuite is 16% and is mainly composed of proanthocyanidins, a condition permitting a tannin-based chemical-control method for fingerprinting the plant drug. Contrariwise, the saponin concentration in Mimosae tenuiflora bark is extremely low, and its isolation and content evaluation represent a complex procedure that is unsuitable for routine control purposes. Finally, random amplified DNA (RAPD) analysis results a useful tool for obtaining DNA specific markers of Mimosae tenuiflora species which should be useful in future studies involving raw material authentication by molecular methods.

Morphoanatomical studies of Uncaria tomentosa and Uncaria guianensis bark and leaves.

The genus Uncaria Schreber (Rubiaceae) includes species that are widely distributed in tropical areas. The inner bark of the stems and leaves of two native species of South America, Uncaria tomentosa (Willd. ex Roemer & Schultes) DC., and Uncaria guianensis (Aublet) J. F. Gmelin, "cat's claw" are used in either folk medicine or in procuring phytotherapeutic drugs. These species contain about sixty active substances which are being tested widely for possible medicinal value. The following applications are considered: peptic ulcer, rheumatism, tumours, antiinflammatory effect, inflammation, diabetes and as general tonic. Currently, Uncaria tomentosa is in demand as tea, tablets or capsules in more than 30 countries outside Perú, as well as inside the country. Pharmacognosy studies are required to determine the comparative morphoanatomical and micrographic features for identification and quality control purposes. Several microscopic parameters, including phloem fibers, calcium oxalate crystals, starch granules, trichomes, and foliar architecture should be considered. The aim of our work is to analyse comparative morphoanatomical and micrographic features which might provide assistance in the identification, analysis and standardization of Uncaria tomentosa (Willd. ex Roemer & Schultes) DC. and Uncaria guianensis (Aublet) J. F. Gmelin stem bark and leaves in order to obtain phytotherapeutic drugs, and of the crude drug as well.

Inhibitory activity of xanthine-oxidase and superoxide scavenger properties of Inga verna subsp. affinis. Its morphological and micrographic characteristics.

Hexane, dichloromethane and ethanolic extracts of Inga verna subsp. affinis were evaluated as inhibitors of xanthine-oxidase and as scavengers of the superoxide produced by the action of the enzyme. Ethanolic but not hexane and dichloromethane extracts showed inhibitory properties of xanthine-oxidase (IC50=27.3 microg/ml) with an additional superoxide scavenging capacity (IC50=12.7 microg/ml). The antioxidant potential was confirmed with the free radical 1,1-diphenyl-2-picryl hydrazyl (DPPH) assay, which showed that the ethanolic extract scavenges 50% DPPH free radicals at 11.6 microg/ml. HPLC study of the phenol content of the active extract, revealed the presence of ellagic and gallic acids as its main constituents. The main morphological and micrographic characteristics of Inga verna subsp. affinis are described in this paper too, in order to aid in its inequivocal identification since Inga spp. are noted for their morphological variation, which makes taxonomic classification very difficult.

Perceptions about advance directives by nurses in a community hospital.

Despite the legal mandate for hospitals to comply with the Patient Self-Determination Act and recommendations by the American Nurses' Association for nurses to advocate for the participation of patients in end-of-life decisions, nurses' compliance has been less than enthusiastic. This study used an exploratory descriptive design and a 10-item self-reported questionnaire, which included both multiple-choice and open-ended questions. This study examined nurses' knowledge and comfort with the implementation of the Patient Self-Determination Act. An analysis of this research shows that two major themes emerged: a need for more education involving advance directives and a desire to have other healthcare workers involved in informing patients about advance directives.

Nurses gain more time with patients.

Clinical pathways that incorporate charting by exception eliminate repetitive documentation and give nurses more time to educate and care for patients. In this case, nurses report a gain of 15 minutes per patient each day.

Continuing education outcomes related to pain management practice.

BACKGROUND: Nursing practice outcomes of continuing education need to be measured and reported as one indicator of the value of nursing continuing education. This article makes the case that knowledge gain, the traditional measure of continuing education effectiveness, is not necessarily sufficient to assess changes in nursing practice. METHOD: A pretest/posttest design was used to measure nursing practice outcomes of a continuing education program about pain management. A total of 50 attendees returned both the pretests and posttests and 68 attendees returned the follow-up evaluation. RESULTS: Ninety-four percent of the respondents had improved scores on the posttest. Ninety-one percent of the follow-up evaluation respondents stated they had an opportunity to use the new information and 98% stated the use of this information has improved patient care. CONCLUSION: This study found that a continuing education program triggered practice changes. The results of this study correlate with previous research that supports the need for practice outcome measurements.

Effects of the infection of toxigenic fungi and an antagonistic Streptomyces strain on wheat spikes.

The objective of the present study was to determine the effect on infection of wheat spikes by toxigenic fungi (Aspergillus parasiticus NRRL 2999, Fusarium tricinctum NRRL 3299, Fusarium graminearum CEREMIC 136/92) and a strain of Streptomyces sp. that is antagonistic to the above-mentioned fungi. Wheat grains (variety GRANERO INTA) were sown in 8 pots containing natural soil and kept in a greenhouse chamber. In the period of the early anthesis the wheat spikes were inoculated with conidial suspensions of each of the fungi in the presence or absence of Streptomyces. Each pot was assigned a different treatment. After an incubation of 100 days and when the wheat plants had attained maturity, the spikes were separated and the following items were determined: (a) number of grains obtained with each treatment, (b) weight of the grains, (c) average weight of the grains/treatment, (d) average number and weight of the grains/spike, and (e) invasion of the caryopses by the microorganisms determined by the analysis of the caryopses in seriate histological sections. There was a significant decrease (p < 0.01) in the average weight of the caryopses and in the weight and number of grains/spike in the presence F. graminearum. The wheat grains were invaded by of F. graminearum and A. parasiticus, an effect which was partially attenuated by the presence of antagonist Streptomyces sp. Nevertheless, the effect was not strong enough to prevent the degenerative consequences on the size and weight of the grains produced by F. graminearum.

[Mental stress and ambulatory monitoring of arterial pressure]. / Stress mentale e monitoraggio ambulatoriale della pressione arteriosa.

The aim of this study was to validate the use of arithmetical mental stress testing as an indicator of an abnormal subject's response to stress in general. For this purpose 82 males (mean age 31 +/- 7 years, mean body surface area--BSA--1.76 m2), free from cardiovascular disease, underwent mental stress testing. In the sample examined we found 13 so-called reactive subjects, (mean age 32 +/- 7 years, mean BSA 1.8 +/- 0.1 m2), who during the test showed increases in mean blood pressure (greater than 20%) greater than mean values of the whole sample (17.8%). In any case blood pressure was higher than 150/100 mmHg. These data were compared with those of 15 subjects (mean age 32 +/- 4 years, mean BSA 1.77 +/- 0.1 m2) randomly selected among those, whose mean pressure increases were not higher than 17.8% (mean increase within sample). The 2 groups underwent blood pressure ambulatory monitoring and submaximal bicycle test. In reactive subjects, values of systolic (PAS) and diastolic pressure (PAD) were significantly higher than in controls (p less than 0.001) during blood pressure ambulatory monitoring, with a greater variability of such values as can be seen from the higher standard deviation (PAS 121 +/- 19 mmHg vs PAS 113 +/- 13 mmHg; PAD 82 +/- 11 mmHg vs PAD 75 +/- 10 mmHg). During ergometric testing, blood pressure trend was similar in the 2 groups.(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of testing on the reported incidence of medication errors in a medical center.

This study explores the impact of eliminating a yearly medication test on the medication error rate reported on both incident reports and questionnaires and describes nurse-identified strategies that may prevent medication errors. Results indicate that eliminating the annual medication test does not significantly change the overall medication error rate. However, the number of errors involving the administration of a medication to the wrong patient has increased significantly. More medication errors have been reported on the questionnaires than on the incident reports. Four factors have been identified by the nurses as being helpful in preventing medication errors. Several limitations of this study dictate that the results be applied with caution. However, in this setting, the use of an annual medication test as a strategy for reducing medication errors has not been supported.