Family Narratives About Providing End-of-Life Care at Home.

Currently, the dying process in Spain is moving to the home environment where responsibility for care falls largely on the family, thereby challenging and testing the stability of the family. Previous research has focused on the impact of illness on the primary caregiver; therefore, a knowledge gap exists. This study aimed to understand families' unitary experiences of providing home care to terminally ill family member. Using the "Model of Interpersonal Relationship Between the Nurse and the Person/Family Cared For," narrative research included family and individual interviews with nine families (9 groups/23 individuals). Thematic narrative analysis was used to interpret the interviews. The results highlight the impact of illness on family well-being as a whole. Family members often felt abandoned while caring for an ill family member and wished to be cared for themselves. However, their immediate community and the nurses caring for their ill family member neglected them. A paradigm shift is required by society and in home care at the end of life to better support the family.

van Manen's phenomenology of practice: How can it contribute to nursing?

Phenomenology of practice is a useful, rigorous way of deeply understanding human phenomena. Therefore, it allows research to be conducted into nursing's most sensitive and decisive aspects. While it is a widely used research approach and methodology in nursing, it is seldom addressed and made use of in its practical and applied value. This article aimed to approach the global outlook of van Manen's hermeneutic-phenomenological method to better understand its theoretical background and to address and support the contribution this method can make to nursing, if rigorously applied. For a professional discipline like nursing, van Manen's approach is especially interesting because, in addition to contributing to the body of knowledge of nursing, it provides a special kind of knowledge that allows nurses to act in a more reflective manner, and with tact and skill, in certain situations and relationships that arise in their daily practice. A more in-depth understanding of this research methodology may help nurse-researchers make good use of it and also harness knowledge derived from this type of research. This comes as a result of assuming that phenomenological texts, the final product of the research, have tremendous educational potential for people who read them carefully.

Conducting phenomenological research: Rationalizing the methods and rigour of the phenomenology of practice.

AIMS: To offer a complete outlook in a readable easy way of van Manen's hermeneutic-phenomenological method to nurses interested in undertaking phenomenological research. BACKGROUND: Phenomenology, as research methodology, involves a certain degree of complexity. It is difficult to identify a single article or author which sets out the didactic guidelines that specifically guide research of this kind. In this context, the theoretical-practical view of Max van Manen's Phenomenology of Practice may be seen as a rigorous guide and directive on which researchers may find support to undertake phenomenological research. DESIGN: Discussion paper. DATA SOURCES: This discussion paper is based on our own experiences and supported by literature and theory. Our central sources of data have been the books and writings of Max van Manen and his website "Phenomenologyonline". IMPLICATIONS FOR NURSING: The principal methods of the hermeneutic-phenomenological method are addressed and explained providing an enriching overview of phenomenology of practice. A proposal is made for the way the suggestions made by van Manen might be organized for use with the methods involved in Phenomenology of Practice: Social sciences, philosophical and philological methods. Thereby, nurse researchers interested in conducting phenomenological research may find a global outlook and support to understand and conduct this type of inquiry which draws on the art. CONCLUSION: The approach in this article may help nurse scholars and researchers reach an overall, encompassing perspective of the main methods and activities involved in doing phenomenological research. Nurses interested in doing phenomenology of practice are expected to commit with reflection and writing.

Nursing educational framework: A new nurse-driven, conceptually guided approach.

PURPOSE: The aim of this article is to present the Nursing Educational Framework (NEF) as an opportunity to integrate core elements of a humanistic person/family-centered view and as guidance in structuring a relationship-based curriculum. DATA SOURCES: Empirical and theoretical literature studies were reviewed to define the framework rationale and its components. DATA SYNTHESIS: A deductive/inductive collaborative expert-informed approach was undertaken to develop this evidence-based codesigned framework. Its mission, along with unique components, implementation strategies, and outcomes, were successively integrated into the framework to guide nursing knowledge, learning, and curriculum development. A hermeneutic collaborative process of circular reflection was used in the development process. CONCLUSIONS: The NEF contains central guiding principles and concepts that are intended to provide structural consistency across its included programs from a humanistic person/family-centered approach. IMPLICATIONS FOR NURSING PRACTICE: This comprehensive theory-guided framework allows educators to suggest specific directions for nursing practice within the nursing discipline and articulate nursing's unique and specialized approach to promoting excellent patient care outcomes. It can assist students to develop critical lens from a person/family-centered relationship-based practice approach.

PROPÓSITO: El objetivo de este artículo es presentar el Modelo Formativo de Enfermería como una oportunidad para integrar los elementos principales de una visión humanística centrada en la persona/familia y como una guía para estructurar un currículo basado en la relación enfermera/paciente. FUENTES DE DATOS: Se revisó literatura teórica y empírica con el fin de definir las bases fundamentales del modelo y sus componentes. SÍNTESIS DE LOS DATOS: Con el fin de desarrollar el modelo, se planteó una aproximación deductiva/inductiva con enfoque colaborativo y basado en expertos. Su misión, junto con los componentes conceptuales más específicos, estrategias de implementación y resultados, fueron progresivamente integrados en él, para guiar el desarrollo del conocimiento, el aprendizaje y la conformación curricular. Se empleó un proceso hermenéutico colaborativo de reflexión circular. CONCLUSIONES: El modelo contiene los principios guía y conceptos que dan consistencia estructural a todos los programas incluidos, desde un punto de vista humanístico y centrado en la persona/familia. IMPLICACIONES PARA LA PRÁCTICA DE ENFERMERÍA: Este amplio marco teórico permite a los educadores sugerir direcciones específicas para la práctica de la enfermería dentro de la disciplina y articular su enfoque único y especializado para promover excelentes resultados en el cuidado del paciente. Puede ayudar a los estudiantes a desarrollar una lente crítica desde un enfoque de la práctica basada en la relación enfermera/paciente ycentrado en la persona y la familia.

Experiencing the possibility of near death on a daily basis: A phenomenological study of patients with chronic heart failure.

BACKGROUND: Chronic heart failure (CHF) is a syndrome that greatly impacts people's lives. Due to the poor prognosis of CHF, together with the frequent exacerbations of symptoms, death is a topic that is very present in the lives of patients with CHF. OBJECTIVE: To explore thoughts about death experienced by patients with chronic heart failure in their daily lives. METHODS: A hermeneutic phenomenological study was carried out. Conversational interviews were conducted with 20 outpatients with chronic heart failure. Analysis of the responses was based on the method proposed by van Manen. RESULTS: From the analysis, four main themes emerged: (1) Feeling afraid of the possibility of dying; (2) Acceptance of the possibility of death; (3) Desiring death for relief from suffering; and (4) Striving to continue living to enjoy family. CONCLUSIONS: This study presents, as a novel finding, that people with CHF experience the possibility of near death on a daily basis. This experience, which they must encounter on their own, makes them afraid. In addition, some of them, in view of the discomfort they are living, wish to die, with some even considering committing suicide.

[Iron deficiency in reproductive age university women at the School of Medicine, Uruguay]. / Deficiencia de hierro en mujeres universitarias en edad reproductiva en la Facultad de Medicina, Uruguay.

Introduction: Disorders of iron metabolism are very common pathological conditions. Iron deficiency, with or without anemia, is estimated to affect more than 2 billion people.The aim of this study was to determine the prevalence of iron deficiency and anemia and their predisposing factors in a group of premenopausal women, university students of the School of Medicine of the University of the Republic in Uruguay. Methods: An observational cross-sectional study was carried out, including women of reproductive age, university students of the Faculty of Medicine. They were interviewed in order to collect clinical data and monthly menstrual volume was recorded through a pictogram. A hemogram was performed and ferritin levels were determined. Results: 196 women aged from 18 to 37 years were included. The prevalence of iron deficiency was 8.7% (n = 17) and the prevalence of anemia was 2.1% (n = 4). The presence of iron deficiency was associated with a lower consumption of red meat (p = 0.024), a higher menstrual volume (p = 0.018) and a higher frequency of abnormal uterine bleeding (p = 0.019). Conclusions: This study shows the high frequency of iron deficiency in healthy women in relation to abnormal uterine bleeding and low consumption of red meat, which raises the need to implement programs that promote educational measures in order to promote early consultation and avoid anemia and iron deficiency in these women of reproductive age.

Introducción: Los trastornos del metabolismo del hierro son condiciones patológicas muy frecuentes. La deficiencia de hierro, con o sin anemia, se estima que afecta a más de 2 billones de personas. El objetivo de este estudio fue determinar la prevalencia de deficiencia de hierro y anemia y los factores predisponentes en un grupo de mujeres premenopáusicas, estudiantes universitarias de la Facultad de Medicina de la Universidad de la República en Uruguay. Métodos: Se realizó un estudio observacional de corte transversal donde se incluyeron mujeres en edad reproductiva estudiantes universitarias de la Facultad de Medicina. Se les realizó una entrevista con el objetivo de recabar los datos clínicos y se registró el volumen menstrual mensual a través de un pictograma. Se realizó un hemograma y se determinaron los niveles de ferritina. Resultados: Se incluyeron 196 mujeres de 18 a 37 años. La prevalencia de ferropenia fue 8.7% (n=17) y la prevalencia de anemia fue de 2.1% (n=4). La presencia de ferropenia se asoció a un menor consumo de carne roja (p=0.024), a un mayor volumen menstrual (p=0.018) y a una mayor frecuencia de sangrado uterino anormal (p=0,019). Conclusión: Este estudio pone de manifiesto la frecuencia elevada de deficiencia de hierro en mujeres sanas en relación con sangrado uterino anormal y bajo consumo de carne roja, lo que plantea la necesidad de implementar programas que promuevan medidas educativas a fin de promover la consulta precoz y evitar la anemia y ferropenia en estas mujeres en edad reproductiva.

Methylene blue-photoinactivated plasma versus quarantine fresh frozen plasma in thrombotic thrombocytopenic purpura: a multicentric, prospective cohort study.

Plasma exchange (PE) with plasma infusion is the treatment of choice for thrombotic thrombocytopenic purpura (TTP) but doubts remain as to whether all kinds of plasma are equally effective. A multicentric cohort study was conducted to compare methylene blue-photoinactivated plasma (MBPIP) with quarantine fresh frozen plasma (qFFP) in the treatment of TTP. One hundred and two episodes of idiopathic TTP were included; MBPIP was used in 63 and qFFP in 39. The treatment schedule consisted of daily PE and costicosteroids, and the main end-point was remission status on day 8. Patients treated with MBPIP required more PEs (median: 11 vs. 5, P = 0.002) and a larger volume of plasma (median: 485 ml/kg vs. 216 ml/kg, P = 0.007) to achieve a remission, and presented more recrudescences while on PE therapy (29 of 63 vs. 8 of 39, P = 0.02) than those receiving qFFP. After adjustment for possible confounding factors, the use of MBPIP was associated with a lower likelihood of remission on day 8 [Odds ratio (OR): 0.17; 95% confidence interval (CI): 0.06-0.47] and a higher risk of recrudescence while on treatment (OR: 4.2; 95% CI: 1.6-10.8). In conclusion, MBPIP is less effective than qFFP in the treatment of TTP.

Long-term bone marrow culture data are the most powerful predictor of peripheral blood progenitor cell mobilization in healthy donors.

BACKGROUND AND OBJECTIVES: There is wide interindividual variation in progenitor cell mobilization. The present study was aimed to analyze steady state hematopoiesis in healthy donors and its influence on hematopoietic progenitor cell (HPC) mobilization. DESIGN AND METHODS: Bone marrow (BM) was aspirated from 72 healthy donors prior to administration of recombinant human granulocyte colony-stimulating factor (G-CSF). Analyses of CD34+ cells and semisolid cultures as well as long-term cultures were performed from BM or leukapheresis products. RESULTS: Male donors showed a higher number of BFU-E (p=0.007) and committed progenitors (p=0.05), a better stromal layer (p=0.02), and higher long-term bone marrow culture (LT-BMC) counts (p<0.05) when compared to those in female donors. When correlating the culture pattern of the BM with the data from the leukapheresis products, we observed that the number of the immature progenitors in BM correlated significantly with both the number of CD34 + cells and CFU-GM in the first leukapheresis. Univariate analysis revealed that the following variables had a beneficial impact on the number of CD34+ cells: male sex, body weight >73 Kg, G-CSF schedule and results of LT-BMC, although in the multivariate analysis only the number of CFU-GM obtained after LT-BMC showed a significant influence (p<0.001). INTERPRETATION AND CONCLUSIONS: These results confirm the interindividual variation in HPC mobilization among healthy subjects, with LT-BMC counts being the most reliable predictor, expressing the behavior of the immature progenitors and their relationship with the microenvironment.

[Incidence and distribution of the genus Armillaria in vineyards of the five protected designation of origin wines in Galicia (Northwestern Spain)]. / Incidencia y distribución del género Armillaria en viñedos de las cinco denominaciones de origen de vino de Galicia (noroeste de España).

BLACKGROUND: The genus Armillaria, specifically Armillaria mellea, is an important phytopathological problem in the wine sector in Galicia (NW Spain), having caused yield reductions in vineyards for the last 15 years. The fungus attacks the root system, resulting in a decrease in vigour, and eventually in the death of the plant. Up to now, there is no chemical or biological method really effective against the pathogen once it has infected the plant. AIMS: The main objective of this work was to study the incidence and distribution of the genus Armillaria across the five Galician protected designation of origin (DO) wines (namely Rías Baixas, Ribeiro, Ribeira Sacra, Valdeorras and Monterrei) through the application of molecular techniques. METHODS: A total of 624 samples (483 soils and 141 symptomatic vines) were analyzed by nested-PCR/RFLP, PCR-RFLP and phylogeny. RESULTS: Armillaria mellea is widely distributed in vineyards of the five DO wines, with the highest incidence in the Ribeiro DO. CONCLUSIONS: Preventive control measures against Armillaria mellea must be established in the five DO wines of Galicia, in order to reduce the advance of white root rot.

Immunophenotypic analysis of peripheral blood stem cell harvests from patients with multiple myeloma.

BACKGROUND AND OBJECTIVES: Four-color multiparameter immunophenotyping has recently proven to be an attractive technique for evaluating the plasma cell (PC) compartment since it allows discrimination between myelomatous and normal PC. This study was designed to investigate: i) whether peripheral blood is less contaminated than bone marrow as a source for an autologous transplant; ii) the effect of growth factors on mobilizing myelomatous PC into peripheral blood; iii) the degree of contamination by myelomatous PC in apheresis samples; and iv) whether the number of PC increases during the last days of apheresis. DESIGN AND METHODS: Using 4-color antigen staining we investigated the composition of the PC compartment in 90 apheresis products from 40 patients with MM; in 17 cases bone marrow and peripheral blood samples were also simultaneously evaluated. RESULTS: (i) All pre-mobilization bone marrow samples analyzed were always contaminated with myelomatous PC whereas only 41% of the post-mobilization peripheral blood samples were contaminated. Moreover, the use of peripheral blood would lead to a reduction of >5x10(5) infused myelomatous PC; (ii) mobilization with cytokines increased the number of circulating PC, generally because of an expansion of the normal PC population; (iii) forty-eight percent of all peripheral blood stem cell harvests were contaminated with myelomatous PC, although normal PC usually represented the predominant population; (iv) no significant changes were observed in the amount of contaminating myelomatous PC during the first three days of apheresis. INTERPRETATION AND CONCLUSIONS: Multiparameter immunophenotyping is a useful approach for investigating the PC compartment in apheresis products.

Prospective evaluation of a transfusion policy of D+ red blood cells into D- patients.

BACKGROUND: Although D- patients should receive red blood cells (RBCs) from D- donors, the scarcity of D- blood components in certain situations makes the transfusion of D+ RBCs unavoidable. Therefore it is recommended that guidelines be developed in order to standardize transfusion policy in these scenarios. STUDY DESIGN AND METHODS: We have prospectively evaluated a policy for the use of D+ RBCs in 905 D- patients. The amount of D- RBCs saved as well as the incidence of hemolytic reactions and anti-D alloimmunization were assessed. RESULTS: 554 patients received D- RBCs while 351 received a total of 1032 D+ RBCs, all of them within our criteria for the acceptable use of D+ RBCs. This strategy allowed us to save 25.6 percent of D- RBCs (1032 out of 4024 RBCs requested). No hemolytic reactions were reported. The incidence of alloimmunization was 21.4 percent. Most patients who developed anti-D did so within the first 2 or 4 RBCs transfused (64% after the first 2 RBCs transfused and 88% after the first 4). In multivariate analysis the age of less than 77 years was the only predictor for alloimmuization (HR = 2.48 [95% CI = 1.21-3.81]; p = 0.014). CONCLUSION: The use of D+ RBCs in selected D- patients does not induce adverse reactions and allows the saving of a significant number of D- RBCs.

The composition of leukapheresis products impacts on the hematopoietic recovery after autologous transplantation independently of the mobilization regimen.

BACKGROUND: Effects of mobilization regimen on the composition of leukapheresis products (LPs) and on hematopoietic reconstitution after autologous peripheral blood progenitor cell transplantation (PBPCT) are not well known. STUDY DESIGN AND METHODS: The effects of three different mobilization regimens--stem cell factor (SCF) plus granulocyte colony stimulating factor (G-CSF) plus cyclophosphamide (CCP), G-CSF alone, and G-CSF plus CCP--on the composition of LPs from patients with nonhematologic PBPC malignancies compared to LPs from G-CSF-mobilized healthy donors and normal marrow (BM) samples were analyzed. The impact of LP composition on both short- and long-term engraftment after autologous PBPCT was also evaluated. RESULTS: The most effective regimen for mobilization of CD34+ hematopoietic progenitor cells (HPCs) into peripheral blood was SCF, G-CSF, and CCP, providing the highest numbers of all CD34+ HPCs subsets analyzed. Patients mobilized with SCF plus G-CSF plus CCP showed the highest numbers of neutrophils and monocytes, whereas the highest numbers of lymphocytes and NK cells were observed in LPs from G-CSF-mobilized patients. The overall number of CD34+ HPCs was the strongest factor for predicting recovery of platelets, whereas the number of myelomonocytic-committed CD34+ precursors was the most powerful independent prognostic factor for WBC and neutrophil recovery. The overall number of CD4+ T cells returned showed an independent prognostic value for predicting the occurrence of infections, during the first year after transplant. CONCLUSIONS: The use of different mobilization regimens modifies the overall number of CD34+ HPCs obtained during leukapheresis procedures, and also affects both the absolute and the relative composition of the LPs in different CD34+ and CD34- cell subsets.