[The concept of professionalism in nursing: Between tradition and progress]. / Das Professionalisierungsverständnis von Pflegenden: Zwischen Tradition und Fortschritt.

What does professionalism mean for nurses and where is the connection with the meaning of professionalism discussed in nursing science and social sciences? To answer these questions, a partly standardised questionnaire was given to 195 nurses in different health care settings. The questionnaire was specifically developed for this study and pre-tested. In total, 80 questionnaires were filled in and could considered for data analysis. More than half of the 80 participants assume that nursing is a profession with possibilities for the future, as well as it is on its way into autonomy. Additionally, nursing is characterised as a mixture between tradition and progress. Furthermore, they regard teamwork and multi disciplinary collaboration as essential tasks. About 90 percent are sure that they work on a professional level, depicted in their altruism and patience with their patients. 90 percent of the participants define quality assurance as a marker for professionalism. They regard documentation and standardisation of nursing and work processes as means which protect against liability claims. On the one hand, the concept of professionalism expressed by the nurses corresponds partially with definitions used in scientific debates on this topic. On the other hand, it shows some inconsistencies, not only in comparison with scientific perspectives, but also in itself. Based on these results following studies are necessary to develop strategies which support healthcare professionals in their practical assignments.

HLA-G is a potential tumor marker in malignant ascites.

PURPOSE: Molecular approaches as supplements to cytological examination of malignant ascites may play an important role in the clinical management of cancer patients. HLA-G is a potential tumor-associated marker and that one of its isoforms, HLA-G5, produces a secretory protein. This study is to assess the clinical utility of secreted HLA-G levels in differential diagnosis of malignant ascites. EXPERIMENTAL DESIGN: We used ELISA to assess whether secretory HLA-G (sHLA-G) could serve as a marker of malignant ascites in ovarian and breast carcinomas, which represent the most common malignant tumors causing ascites in women. RESULTS: On the basis of immunohistochemistry, 45 (61%) of 74 ovarian serous carcinomas and 22 (25%) invasive ductal carcinomas of the breast demonstrated HLA-G immunoreactivity ranging from 2 to 100% of the tumor cells. HLA-G staining was not detected in a wide variety of normal tissues, including ovarian surface epithelium and normal breast tissue. Revese transcription-PCR demonstrated the presence of HLA-G5 isoform in all of the tumor samples expressing HLA-G. ELISA was performed to measure the sHLA-G in 42 malignant and 18 benign ascites supernatants. sHLA-G levels were significantly higher in malignant ascites than in benign controls (P < 0.001). We found that the area under the receiver-operating characteristic curve for sHLA-G was 0.95 for malignant versus benign ascites specimens. At 100% specificity, the highest sensitivity to detect malignant ascites was 78% (95% confidence interval, 68-88%) at a cutoff of 13 ng/ml. CONCLUSIONS: Our findings suggest that measurement of sHLA-G is a useful molecular adjunct to cytology in the differential diagnosis of malignant versus benign ascites.

Positive serum crossmatch as predictor for graft failure in HLA-mismatched allogeneic blood stem cell transplantation.

BACKGROUND: Evaluation of patient sera for complement-fixing anti-donor antibodies (serum crossmatch [XM]) before allogeneic blood stem cell transplantation (BSCT) is routine in most centers. However, in contrast to kidney transplantation, the predictive value of a positive XM for outcome of BSCT is still unclear, and a positive XM is presently not regarded as an absolute contraindication to proceed to transplant. METHODS: To clarify the role of a positive XM as predictor for overall survival (OS) and graft failure (GF) after BSCT, a retrospective, single-center, matched-pair analysis was performed. Enrolled were all XM-positive BSCT performed at our institution from 1985 to 2000 (n=30). Controls (n=30) were matched for disease, disease stage, patient age, period of transplant, conditioning regimen, protocol for prevention of graft-versus-host disease, and type of donor (related vs. unrelated, HLA-identical vs. HLA-mismatched). RESULTS: Multivariate statistical analysis of all enrolled 60 transplants revealed GF as the all-dominating, independent risk factors for low OS (relative risk [RR]: 59.5, P<0.0001). Univariate (Kaplan-Meier) analysis could attribute inferior OS and high incidence of GF to the subgroup of HLA-mismatched, XM-positive transplants (P=0.01). CONCLUSIONS: A XM should always be performed in patients awaiting a BSCT from HLA-mismatched donors, because a positive XM is a predictor for inferior OS due to GF in BSCT.

Adhesion molecules, activin and inhibin--candidates for the biochemical prediction of hypertensive diseases in pregnancy?

BACKGROUND: The aim of the prospective study was to compare standard parameters as Doppler ultrasound and 24-h blood pressure measurement with possible maternal serological markers regarding their prognostic value in predicting hypertensive diseases in pregnancy. MATERIALS: Twenty-four-hour blood pressure measurement was performed before and after 32+0 gestational week in 57 pregnant women with either chronic hypertension ( n=13), preeclampsia ( n=21), pregnancy-induced hypertension (PIH; n=12) or normotension ( n=11). Blood samples were taken and the concentrations of soluble intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), activin A and inhibin A were determined as well as serum uric acid, creatinine, total serum protein and serum albumin. Doppler ultrasound of the uterine arteries was examined before 32+0 gestational week in the same patients. For the statistical evaluation Kruskal-Wallis-Test and Mann-Whitney-U-Test were performed. Differences in the predictive value were evaluated by receiver-operating characteristics. RESULTS: VCAM-1 was significantly elevated in women developing hypertensive diseases as compared to normotensive women (preeclampsia: p<0.001; PIH: p<0.05; chronic hypertension: p<0.001). In early pregnancy activin A and inhibin A were significantly higher in preeclamptic patients than in the other groups (activin A: normotension: p<0.005; PIH: p<0.001; chronic hypertension: p<0.005) (inhibin A: normotension: p<0.005; PIH: p<0.001; chronic hypertension: p<0.01), thus suggesting them to be specific markers for the development of preeclampsia. Mean arterial pressure was significantly elevated in preeclampsia ( p<0.001) and chronic hypertension ( p<0.005) as compared to normotensives. CONCLUSION: Twenty-four-hour blood pressure monitoring with determination of mean arterial pressure and measurement of VCAM-1, activin A and inhibin A as serum parameters can be suggested as useful tests in the specific prediction of different types of hypertensive diseases in pregnancy.