Development of a subset of ICNP Nursing Diagnoses for the promotion of self-care in people with diabetes mellitus: a multi-center observational study.

INTRODUCTION: Self-care is a key for people with diabetes mellitus (DM) to avoid severe complications and to maintain quality of life. Person-centered and accurate nursing care plans can help nurses to deliver effective self-care promotion interventions. Few studies focused on nursing diagnoses that are specific for diabetes self-care education, and none of them used the International Classification for Nursing Practice (ICNP). International Catalogues of ICNP nursing diagnoses are missing in this field. AIMS: To identify the ICNP nursing diagnoses that are useful to promote self-care in people with DM; to describe the prevalence of ICNP nursing diagnoses in self-care of people with DM. METHODS: A subset of 55 ICNP nursing diagnoses was developed based on the Middle Range Theory of Self-care of Chronic Illness, and most recent diabetes clinical guidelines. Then, the subset was tested through a multicenter cross-sectional design involving a consecutive sample of 170 adults with confirmed diagnosis of Type 1 or Type 2 DM. Data were collected by medical records, physical examinations and semi-structured interviews. RESULTS: 1343 nursing diagnoses were identified, with an average of 8 nursing diagnoses per patient. The 100% of the nursing diagnoses were described using the pre-developed subset. Overall, the five prevalent nursing diagnoses were: Body weight problem (56.4%), Non adherence to immunization regime (53.5%), Conflicting attitude toward dietary regime (41.7%), Impaired weight monitoring (39.4%), and Lack of knowledge about blood glucose diagnostic test result (32.3%). Nursing diagnoses by self-care maintenance, monitoring and management were also described. CONCLUSIONS: A huge amount of nursing diagnoses was identified suggesting the need of intensive education. Clinicians and administrators can use this subset to improve the accuracy of the documentation of diabetes care. In Public Health, the subset can be used to assess the cost-effectiveness of diabetes healthcare services. Future research is needed to assess the effectiveness of this subset in settings that are different from the one where it was developed. Finally, this subset could be a starting point to develop and International ICNP Catalogue for diabetes care.

Developing a subset of ICNP nursing diagnoses for medical and surgical hospital settings, informed by an Italian nursing conceptual model: a multicenter cross-sectional study.

BACKGROUND: The International Classification for Nursing Practice (ICNP) is designed to facilitate the expression of nursing diagnoses, interventions and outcomes. The development of the ICNP subsets may support nurses by providing appropriate terms for documenting nursing care. This project aimed to develop a subset of ICNP nursing diagnoses oriented by an Italian Nursing Conceptual Model (MPI) to describe nursing clinical data in medical and surgical acute hospital wards. STUDY DESIGN: A subset of ICNP nursing diagnoses was developed based on a literature review and on an expert consensus. A cross-sectional study was conducted in three Northern Italian hospitals to empirically test the subset in target settings. METHODS: In accordance with the guidelines adopted by the International Council of Nursing, the study followed the process for developing an ICNP subset. Twelve expert nurses from clinical settings and nursing education in surgical and medical care participated in a Delphi method to further validate the subset. A cross-mapping process has been implemented and the prevalence of diagnoses was described. Data were collected from healthcare documentation of admitted patients, including, retrospectively, nursing clinical data from the patients' admission date to the time of data collection. RESULTS: Documentation from 476 admitted patients was analysed: 228 were from surgical and 248 from medical wards. 24,142 nursing diagnoses were detected consulting retrospectively each documentation. A total number of 21,401 nursing diagnoses (88%) were fully mapped by the ICNP subset. CONCLUSION: Results showed a high capability of ICNP terminology to describe nursing care in acute medical and surgical areas in Italian hospitals. The identified subset of ICNP diagnoses could be a valuable way to support a computerized documentation system for hospitals using MPI and ICNP. Results could be used to start revising nursing education programs in order to introduce this nursing standardized terminology combining it with the nursing conceptual model in use.

A comparative study of the in vitro activity of iodopropynyl butylcarbamate and amphotericin B against Prototheca spp. isolates from European dairy herds.

The objective of this study was to assess the in vitro effect of iodopropynyl butylcarbamate (IPBC) and amphotericin B (AMB) on Prototheca zopfii genotype 2 and Prototheca blaschkeae isolates recovered from dairy herds of Belgium, France, Italy, Germany, and Poland. The combination of IPBC with AMB on Prototheca isolates and toxicity of IPBC to the bovine mammary epithelial cells were also evaluated. The in vitro activity of IPBC and AMB against 96 isolates of P. zopfii genotype 2 and 42 isolates of P. blaschkeae was performed. Minimum inhibitory concentrations (MIC) and minimum algicidal concentrations (MAC) of IPBC and AMB were determined. To determine any synergistic, additive, or antagonistic effect of the combination of IPBC and AMB, 2-dimensional checkerboard combination tests were also performed to calculate fractional inhibitory concentrations. Cytotoxicity analysis of IPBC to the bovine mammary epithelial cell line was performed using a 3-(4,5-dimethyl-2-thiazol-2yl)-2,5-diphenyl tetrazolium bromide (MTT) assay. The MIC for 50 and 90% of isolates (MIC50 and MIC90, respectively) for IPBC were 4 and 8 mg/L versus 0.5 and 1 mg/L for AMB, respectively. The MIC profiles differed between P. zopfii genotype 2 and P. blaschkeae, with the latter species being more susceptible to both compounds. The MIC50 and MIC90 of IPBC were 4 and 8 mg/L for P. zopfii genotype 2 and 1 and 2 mg/L for P. blaschkeae, respectively. The MIC50 and MIC90 of AMB were both 1 mg/L for P. zopfii genotype 2 and 0.25 and 1 mg/L for P. blaschkeae, respectively. Both IPBC and AMB exhibited the ability to kill Prototheca spp. The MAC for 90% of isolates of IPBC was twice the MIC90, whereas an 8-fold increase of the MIC90 was algicidal in the case of AMB. Overall, the combined use of IPBC and AMB exhibited an increased algicidal effect, albeit the fractional inhibitory concentration index showed synergistic activity only against 3 P. zopfii genotype 2 isolates. For all the remaining isolates (87.5%), this combination produced only an additive effect. The MTT assay results showed both IPBC and AMB, at the concentrations employed in the study, to be nontoxic to the epithelial mammary gland cells (cell viability >90%). Notably, only IPBC at the highest concentration (i.e., 8 mg/L) exerted a slight cytotoxic effect on the cell line tested (mean cell viability: 88.54 ± 3.88 and 90.66 ± 3.0, after 2 and 4 h of MTT treatment, respectively). The anti-Prototheca activity of IPBC was here demonstrated for the first time. In addition, the combined use of IPBC with AMB enhanced each other's effect, creating an additive rather than synergistic interaction. Both agents, used at concentrations corresponding to MIC values against Prototheca spp., showed no toxic effect for the mammary epithelial cells. In conclusion, IPBC, used either alone or in combination with AMB, can be considered a promising option in the treatment armamentarium for protothecal mastitis in dairy cows.

Intracellular and extracellular miRNome deregulation in cellular models of NAFLD or NASH: Clinical implications.

BACKGROUND & AIMS: Nonalcoholic fatty liver disease (NAFLD) represents the most common chronic liver disease in industrialized countries. NAFLD has the potential to progress through the inflammatory phase of nonalcoholic steatohepatitis (NASH) to fibrosis, cirrhosis, and hepatocellular carcinoma. Identifying patients at risk for this transition is a relevant clinical challenge. The complexity of these phenotypes in vivo made necessary the development of in vitro models in order to dissect the molecular signalling affected in NAFLD and NASH, but also to identify potential circulating biomarkers. METHODS AND RESULTS: We profiled the expression of 754 cellular and medium-secreted human miRNAs in HepG2 cells after lipotoxic (Palmitate, model of NASH) or not-lipotoxic stimuli (Oleate-Palmitate, model of NAFLD). Results were validated through Single TaqMan assays. We performed computational analysis of miRNA targets and pathways. Oleate-palmitate treatment induced a variation of 2.8% and 10% of total miRNAs in cells and medium, respectively; palmitate treatment caused 10% and 19% intracellular and extracellular miRNA deregulation, respectively. We validated miR-126, miR-150, miR-223, miR-483-3p, miR-1226*, and miR-1290 deregulation. Through computational analysis, we observed that targets of both intracellular and extracellular DE miRNAs were involved in processes associated with the onset and progression of NAFLD and NASH, such as fatty acid metabolism, apoptosis and inflammation. CONCLUSIONS: These data would be useful to elucidate the role of miRNAs in the pathogenesis and progression of the NAFLD spectrum, but they also allow the identification of novel potential biomarkers for differential diagnosis to be tested in vivo.

The epilepsy specialist nurse: A mixed-methods case study on the role and activities.

PURPOSE: To describe the role and activities of epilepsy specialist nurses (ESNs) operating as a team in the setting of a hospital specialising in the diagnosis and management of seizure disorders. METHODS: We conducted a descriptive mixed-methods embedded single case study. We recruited 9 ESNs, 14 of their professional colleagues and 9 'key informants' to analyse their perceptions of the role and activities of ESNs. We collected data through interviews, questionnaires, observations, and documentation. The study was conducted at the Filadelfia Epilepsy Hospital, Denmark. RESULTS: The team of ESNs offers holistic care to patients and their caregivers regarding the clinical, social, and emotional aspects of epilepsy. The ESNs are integrated in a multidisciplinary team and promote collaboration among the team members. ESNs also contribute to organisational aspects and perform research activities. CONCLUSION: A structured group of ESNs can operate effectively and extensively in a specialised hospital setting. Our findings contribute to clarifying the description of the ESN's role, and provide an example of how ESNs can be incorporated into a hospital's organisational structure.

Expression of muscle-gene-specific isozymes of phosphorylase and creatine kinase in innervated cultured human muscle.

Isozymes of creatine kinase and glycogen phosphorylase are excellent markers of skeletal muscle maturation. In adult innervated muscle only the muscle-gene-specific isozymes are present, whereas aneurally cultured human muscle has predominantly the fetal pattern of isozymes. We have studied the isozyme pattern of human muscle cultured in monolayer and innervated by rat embryo spinal cord explants for 20-42 d. In this culture system, large groups of innervated muscle fibers close to the ventral part of the spinal cord explant continuously contracted. The contractions were reversibly blocked by 1 mM d-tubocurarine. In those innervated fibers, the total activity and the muscle-gene-specific isozymes of both enzymes increased significantly. The amount of muscle-gene-specific isozymes directly correlated with the duration of innervation. Control noninnervated muscle fibers from the same dishes as the innervated fibers remained biochemically immature. This study demonstrated that de novo innervation of human muscle cultured in monolayer exerts a time-related maturational influence that is not mediated by a diffusable neural factor.

Neuromuscular forms of glycogen branching enzyme deficiency.

Deficiency of glycogen branching enzyme is causative of Glycogen Storage Disease type IV (GSD-IV), a rare autosomal recessive disorder of the glycogen synthesis, characterized by the accumulation of amylopectin-like polysaccharide, also known as polyglucosan, in almost all tissues. Its clinical presentation is variable and involves the liver or the neuromuscular system and different mutations in the GBE1 gene, located on chromosome 3, have been identified in both phenotypes. This review will addresses the neuromuscular clinical variants, focusing on the molecular genetics aspects of this disorder.

Mutations in the SURF1 gene associated with Leigh syndrome and cytochrome C oxidase deficiency.

Cytochrome c oxidase (COX) deficiency is one of the major causes of Leigh Syndrome (LS), a fatal encephalopathy of infancy or childhood, characterized by symmetrical lesions in the basal ganglia and brainstem. Mutations in the nuclear genes encoding COX subunits have not been found in patients with LS and COX deficiency, but mutations have been identified in SURF1. SURF1 encodes a factor involved in COX biogenesis. To date, 30 different mutations have been reported in 40 unrelated patients. We aim to provide an overview of all known mutations in SURF1, and to propose a common nomenclature. Twelve of the mutations were insertion/deletion mutations in exons 1, 4, 6, 8, and 9; 10 were missense/nonsense mutations in exons 2, 4, 5, 7, and 8; and eight were detected at splicing sites in introns 3 to 7. The most frequent mutation was 312_321del 311_312insAT which was found in 12 patients out of 40. Twenty mutations have been described only once. We also list all polymorphisms discovered to date.

Familial systemic carnitine deficiency.

Two sisters with systemic carnitine deficiency showed the heterogenicity of this condition and a lack of correlation between measurable carnitine levels and clinical manifestations. One child experienced recurrent metabolic encephalopathy, which was diagnosed as Reye's syndrome. The older child, despite lower carnitine concentrations, was asymptomatic. Lipid inclusion myopathy was shown in both children. Serum, muscle, and liver carnitine levels were reduced. The parents had normal serum carnitine concentrations. Both children had significantly abnormal renal handling of carnitine, and their mother, a mild alteration. This family provided evidence for genetic transmission and presumed autosomal recessive inheritance in this disease. Both children were treated with carnitine without clear benefit; no side effects were noted. Previously reported cases of systemic carnitine deficiency were reviewed.

Muscle carnitine deficiency and fatal cardiomyopathy.

A 23-month-old boy with progressive muscle weakness and severe cardiomyopathy was found to have oil red O positive vacuoles predominantly in type 1 muscle fibers. Serum carnitine was normal, but muscle carnitine content was decreased. Both parents were clinically normal, but the muscle carnitine level was low in the father. Despite oral treatment with carnitine, the condition progressed and was fatal. At autopsy, cardiac muscle showed borderline low carnitine content and numerous mitochondria, but no lipid accumulation.

Dominantly inherited mitochondrial myopathy with multiple deletions of mitochondrial DNA: clinical, morphologic, and biochemical studies.

We studied a large family with a dominantly inherited mitochondrial myopathy characterized by progressive external ophthalmoplegia, dysphagia, cataract, lactic acidosis, exercise intolerance, and early death. Morphologic studies of muscle biopsies suggested mitochondrial heteroplasmy and revealed ragged-red fibers and decreased histochemical reactions for cytochrome c oxidase and succinate dehydrogenase. Biochemistry showed a partial defect of cytochrome c oxidase and a mild generalized reduction of other mitochondrial enzymes requiring mitochondrial DNA-encoded subunits. Southern blot analysis and PCR amplification showed mitochondrial DNA deletions in muscle of all affected members, but not in lymphocytes or fibroblasts, suggesting a tissue-specific distribution. Deletions were multiple and seemed to increase with time and to correlate with the severity of the disease.

MELAS syndrome: characteristic migrainous and epileptic features and maternal transmission.

Severe prolonged migrainous symptoms and prolonged partial status epilepticus are characteristic features of the MELAS syndrome (mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes). Maternal transmission previously found in myoclonus epilepsy and ragged-red fibers (MERRF), another mitochondrial disease, is suggested in this disorder as well.

Coenzyme Q10 reverses pathological phenotype and reduces apoptosis in familial CoQ10 deficiency.

Two brothers with myopathic coenzyme Q10 (CoQ10) deficiency responded dramatically to CoQ10 supplementation. Muscle biopsies before therapy showed ragged-red fibers, lipid storage, and complex I + III and II + III deficiency. Approximately 30% of myofibers had multiple features of apoptosis. After 8 months of treatment, excessive lipid storage resolved, CoQ10 level normalized, mitochondrial enzymes increased, and proportion of fibers with TUNEL-positive nuclei decreased to 10%. The authors conclude that muscle CoQ10 deficiency can be corrected by supplementation of CoQ10, which appears to stimulate mitochondrial proliferation and to prevent apoptosis.

Antibodies against ox-LDL serum levels in patients with hepatocellular carcinoma.

AIM: Hepatocellular carcinoma (HCC) is a malignancy with high incidence worldwide. The related cachexia is induced by proinflammatory cytokines, responsible for a wide number of metabolic disorders, essentially including lipidic and oxidative metabolism. Oxidized LDL (ox-LDL), produced by LDL-cholesterol oxidation, are one of the risk factors for atheromatosis. Also, ox-LDL act on the deliverance of some cytokines involved in the development and progression of a lot of human tumours. The removal of ox-LDL from the blood is performed by the liver. The intracellular amount of ox-LDL, through various cytokines, might induce HCC by reduction of the apoptotic mechanism of protection. Our aim was to evaluate the behaviour of serum antibodies against ox-LDL levels in order to study their possible changes and influences on a study series composed of HCC patients. METHODS: We enrolled 41 patients (29 males, mean age 67.45+/-8.28 years and 12 females, mean age 64.62+/-7.2 years) with primitive HCC and 30 healthy control subjects (15 males and 15 females, mean age 61.86+/-2.51 years). Diagnosis of HCC was performed on the basis of clinical, laboratory and instrumental findings (Ultrasonography, Computed Tomography and Magnetic Nuclear Resonance, liver biopsy). Of the 41 HCC patients, 30 were affected by hepatitis C virus (HCV), 5 were HBsAg and HBcAg positive and 6 virus B and C negative but consumers of more than 150 g/day of alcohol. Liver biopsy confirmed the presence of HCC derived from cirrhosis in 10 of HCV positive patients, as well as in the patients with high alcohol consumption. Serum IgG antibodies versus the ox-LDL levels have been evaluated by ELISA method and oLAB reactive by Biomedica-Austria. Data have been analysed by 2 tailed Student's "t" test and a value of p<0.05 was considered significant. RESULTS: Lipid pattern values were within the normal ranges except for the Lp(a), that presented low serum levels in both groups. Twenty-five patients presented HCC as well as severe chronic active hepatitis. Serum mean levels of ox-LDL antibodies (ox-LDL Ab), still being within the normal ranges, were significantly lower than in control subjects (p<0.001) in both sexes. CONCLUSION: We hypothesize that the lower ox-LDL Ab serum levels in our HCC patients may be related to the smaller feeding of HCC patients or to the greater uptake of these modified lipoproteins by the hepatic reticular endothelial system. This phenomenon might result especially in the release of cytokines and growth factors for hepatocytes that may induce HCC development and progression.

A diary model for monitoring blood pressure in the elderly.

Activity can significantly change blood pressure. Twenty four hour ambulatory blood pressure monitoring (Holter method) was introduced to optimize diagnosis and the changes in blood pressure. It was flanked by the purpose to use diaries to correlate symptoms and pressure changes, pressure changes and psychophysical activity, life style and drugs. The diary model adopted by us for 380 elderly subjects between 65 and 85 years old is divided into four main sections: 1. general activities (8 items); 2. situational variations (7 items); 3. correlation between symptoms and pressure changes; 4. drug treatment and pressure changes. The aim of our study was to assess the compliance of the elderly to keeping a diary. Our results showed that compliance was satisfactory in 352/380 subjects (93%).

On the importance of multidimensional evaluation of elderly oncologic patients.

The role of comorbidity and the psycho-affective attitudes have been studied in 108 elderly oncological patients, in comparison with 25 elderly subjects without tumor pathologies. The results have revealed positive correlations between the activity of daily living (ADL), as well as the instrumental activity of daily living (IADL) scales and the comorbidity both in the oncological subjects and the controls. The performance status defined by the eastern cooperative oncology group (ECOG-PS) positively correlated with the parameters of ADL and IADL scales, demonstrating an increased vulnerability and fragility of the oncological patients in their everyday activities. An increased psychological fragility of the oncological patients has also been revealed by the scores of the geriatric depression scale (GDS), which might be cause and consequence at the same time of the disease itself. In addition, the polypathologies are not associated with an increased gravity of the tumor stage, although there have been 2.5 accompanying pathologies, mainly diseases of osteoarticular and cardial character. The correction of functional damages of various organs due to aging or concomitant or previous diseases is a period of fundamental importance for an adequate oncological therapy. The principal goal of any intervention in the elderly oncological patient should certainly be an improvement of the quality of life, including an alleviation of the impact of the diagnostic and therapeutic procedures on it.

Comparison of ambulatory and clinical blood pressures, and their correlation with organic heart damage, in the elderly.

Casual blood pressure (BP) measurements may sometimes indicate the presence of cardiovascular morbidity and mortality, but the correlations between BP values and the subsequent occurrence of such complications are low. This may depend on the known inability of casual BP measurements to reflect accurately the 24-hour mean and overall profile of the BP. In this study, electrocardiography (ECG) of left ventricular muscle mass was related to various measures of BP during circadian ambulatory BP monitoring in 156 hypertensive and non-hypertensive elderly patients. Multiple regression analysis performed to establish the presence of left ventricular hypertrophy (LVH) revealed that the product of ambulatory systolic BP x diastolic BP (p = 0.027) and ambulatory diastolic BP were significant variables. Clinical pressure variables were not significant. Multiple linear regression analysis to establish the degree of LVH in function of the pressure variables generated a model where the variables included are the product of ambulatory systolic BP x diastolic BP (p = 2.7 x 10(-8)), ambulatory systolic BP (p = 7.8 x 10(-6)) and ambulatory diastolic BP (p = 2.4 x 10(-6)). Results obtained agree with the literature and revealed that LVH evaluated using ECG-Romhilt-Estes score was correlated in terms of presence/absence of organ damage and in terms of score to ambulatory monitoring values.

The effects of caloric restriction and controlled physical exercise on hypertension in the elderly.

The overweight and sedentary life style are associated with elevated blood pressure values in the elderly patients. The first step in the therapy of arterial hypertension should be hygienic-behavioral measures in order to modify the life style of the patients. The present study evaluates the independent effects of caloric restriction and physical exercise on the blood pressure and on the anti-hypertensive treatment in elderly subjects with mild-moderate hypertension. The number of enrolled patients was 74 in the age range of 61-72 years, showing up in our Geriatric Day Hospital. The results obtained confirm that the non-pharmacological measures represent a valid alternative to the pharmacological treatment of hypertension in the elderly patients, or may be applied in combination with the latter, in order to reduce the doses of pharmaca.

Urinary albumin excretion in elderly patients with white coat hypertension.

The so-called white coat effect occurs in about 42% of elderly patients. This phenomenon leads to several problems in treatment and may also cause renal disease. One of the most frequently controlled parameters is microalbuminuria, an index of renal damage. The present case-control study intended to evaluate the urinary excretion of albumin in elderly patients suffering from white coat hypertension, and comparing their data to those of normotensive subjects. In addition, the study searched for correlations between albuminuria and various clinical and ambulatory blood pressure values. A total of 258 patients were enrolled, but after screening, only 129 were considered; 13 of the latter were further excluded because of problems encountered during ambulatory monitoring of arterial blood pressure. Therefore, 116 hypertensive subjects were included in the study. This pool of hypertensive patients was compared to a normotensive group of 33 subjects. The results have shown the occurrence of white coat effect in 25% of cases, and the microalbuminuria of these patients was statistically not significantly different from that of the normotensive group of patients. The microalbuminuria correlated only with ambulatory systolic blood pressure measured during the day.

Echocardiographic studies on elderly patients with white coat hypertension to evaluate cardiac organ damages.

This case-control study was aimed at evaluating the distribution of some echocardiographic signs of cardiac organ damages in elderly patients with white coat hypertension (WCH), as compared with a normotensive group of elderly. Correlations between the signs of cardiac organ damages and the clinical and ambulatory blood pressure parameters (obtained by means of a 24-h monitoring) have also been evaluated. The first screening covered 258 elderly subjects of both sexes, aged from 65 to 82 years, with clinical diagnosis of hypertension (systolic and diastolic blood pressures being higher than 160 and 95 mmHg, respectively). Of this group, 116 subjects remained in the final pool, and their echocardiographic parameters were compared with 33 normotensive (N) subjects. Out of the 116 clinically hypertensive patients, 29 (25%) displayed WCH, according to the established criteria. Variance analyses on the ranks followed by Dunn's test revealed no statistically significant differences between the N and WCH groups, while the hypertensive group (H) proved to be significantly different from both the N and the WCH groups. In addition to the descriptive statistics, an analysis of correlations between the pressure variables and the echocardiographic parameters has also been performed by means of a forward-stepwise multiple linear regression method. The models generated by this regression analysis covered only the ambulatory diurnal systolic pressure, and the clinical diastolic pressure in most of the cases of the echocardiographic parameters, taken as independent variables. In all these cases, the standardizecl correlation coefficient of the diurnal systolic pressure was always higher than that of the clinical diastolic pressure, indicating that the echocardiographic parameters depend more strongly on the first than on the second pressure value.