[Hypertension due to fibromuscular dysplasia: look for additional disease sites]. / Hypertensie door fibromusculaire dysplasie.

Fibromuscular dysplasia (FMD) is a non-inflammatory, non-atherosclerotic vasculopathy that can lead to arterial stenosis, occlusion, aneurysms, and dissection. FMD of the renal arteries can lead to renovascular hypertension. Percutaneous angioplasty of the renal arteries (PTRA) can lead to normalization of blood pressure in 45% of patients with renal artery stenosis caused by FMD, particularly in younger patients and patients with a short history of hypertension. A considerable number of the patients with renovascular FMD also have cervical FMD, which can lead to ischaemic or haemorrhagic stroke. In this article we discuss diagnostic and therapeutic options, illustrated by two cases of patients with renovascular and carotid FMD. Most of the recommendations are based on data from retrospective studies and expert opinion; prospective studies on the optimal diagnostic strategy and treatment are therefore, urgently required.

IL-10 induces the development of immunosuppressive CD14(+)HLA-DR(low/-) monocytes in B-cell non-Hodgkin lymphoma.

The biological role of monocytes and macrophages in B-cell non-Hodgkin lymphoma (NHL) is not fully understood. We have previously reported that monocytes from patients with B-cell NHL have an immunosuppressive CD14(+)HLA-DR(low/-) phenotype that correlates with a poor prognosis. However, the underlying mechanism by which CD14(+)HLA-DR(low/-) monocytes develop in lymphoma is unknown. In the present study, we found that interleukin (IL)-10, which is increased in the serum of patients with B-cell NHL, induced the development of the CD4(+)HLA-DR(low/-) population. Using peripheral blood samples from patients with B-cell NHL, we found that absolute numbers of CD14(+) monocytic cells with an HLA-DR(low/-) phenotype were higher than healthy controls and correlated with a higher International Prognostic Index score. IL-10 serum levels were elevated in lymphoma patients compared with controls and were associated with increased peripheral monocyte counts. Treatment of monocytes with IL-10 in vitro significantly decreased HLA-DR expression and resulted in the expansion of CD14(+)HLA-DR(low/-) population. We found that lymphoma B cells produce IL-10 and supernatants from cultured lymphoma cells increased the CD14(+)HLA-DR(low/-) population. Furthermore, we found that IL-10-induced CD14(+)HLA-DR(low/-) monocytes inhibited the activation and proliferation of T cells. Taken together, these results suggest that elevated IL-10 serum levels contribute to increased numbers of immunosuppressive CD14(+)HLA-DR(low/-) monocytes in B-cell NHL.

Alzheimer's residents' cognitive and functional measures: special and traditional care unit comparison.

The aim of this field experiment was to compare the effects of a special care unit (SCU) on residents with Alzheimer's disease (AD) who lived on the SCU and on traditional (integrated) nursing home units. Twenty-two subjects, 13 on the SCU and 9 on traditional integrated units were compared. Repeated measures ANOVA was used to assess differences between the two groups and within the groups over two bimonthly pretests and two bimonthly posttests. No significant differences on cognitive or functional abilities scores were evident for the groups and no significant differences were found over time. However, consistent with the prediction of the Progressively Lower Stress Threshold Model, the SCU subjects' function was better than subjects on traditional units when measured by socially accessible behaviors.

Alzheimer's disease.

This chapter has included a review of nursing research in Alzheimer's disease. Much of what is in the literature regarding nursing of Alzheimer's disease patients and their families is anecdotal and has not been validated by systematic research and is atheoretical. The majority of nursing research on Alzheimer's disease has been focused on patient characteristics and problem behaviors or on the needs and experiences of family caregivers. Research should continue in these areas along with testing nursing interventions to maintain optimal cognitive, physical, social, and emotional function of Alzheimer's disease patients. Explanatory theories should be devised and tested to advance the development of nursing knowledge in the care of Alzheimer's disease patients and family caregivers. Finally, more evaluation research is needed to test the cost effectiveness of home-based and institutional programs, including effects on Alzheimer's disease patients, family members, and staff caregivers.

Professional practice for the extended care environment: learning from one model and its implementation.

This article describes a model of professional nursing governance in an 800-bed long-term care facility and discusses the model's implications for nursing education. Seventy registered nurses, 330 ancillary staff, and 50 other health professionals provide care for about 100 residential, 350 intermediate, and 350 skilled nursing care patients in the facility. The governance model includes a registered nurse organization that determines all standards for nursing practice, policies governing practice, and nursing clinical programming. Each registered nurse has 24-hour, seven-days-a-week authority and accountability for a patient caseload. Average annual turnover of registered nurses is 5 per cent, and the average length of employment among the nurses is 7.5 years. Since the model was implemented, measures of patient welfare have increased. Experience with the governance model indicates that nursing education curricula need to increase students' (1) understanding of professional autonomy and accountability, (2) understanding of the role of nursing diagnoses and interventions to structure nursing knowledge, (3) skills of diagnostic and intervention reasoning, (4) consensus decision-making abilities, (5) knowledge of organizational structures and mechanisms for governance, and (6) mastery of technical intervention skills.

Family visitation on special care units.

1 With placement of a family member with Alzheimer's disease on a SCU, the family does not relinquish the caregiving role, rather they take on different roles in relation to the residents. 2 Family visitation of the residents on the SCU is an integral part of family involvement in care of individuals with Alzheimer's disease, as well as SCU functioning. 3 Within the context of changing relationships with the residents, family members visited the residents as a sense of duty to "be faithful," to monitor care by "being their eyes and ears," and to foster a sense of family through ongoing relationships and family rituals. 4 Nurses have critical roles in promoting physical, emotional, and interactive environments which foster family visitation on SCUs.

Special care units for people with Alzheimer's disease. Only for the privileged few?

The number of Special Care Units (SCUs) for people with Alzheimer's disease (AD) in nursing homes have increased dramatically in the past 10 years. Despite the rapid increase in number of SCUs and the concern that most SCUs report higher costs than traditional nursing home units where residents with AD are integrated with cognitively intact residents, the evaluation of costs has been largely unsystematic and noncomparative. Studies are urgently needed to assess comparative costs so that administrators and policy makers can make informed decisions. This article reviews studies that examine the costs of care in SCUs and presents cost-related data comparing the outcomes of care for residents with AD on a SCU and on traditional units in one long-term care setting.

Organizational characteristics that facilitate the use of nursing diagnoses.

The effective use of nursing diagnosis is facilitated by an organizational structure that accommodates nursing professional autonomy and accountability. Nurse executives who plan for the implementation of nursing diagnosis should expect nurses to develop as an autonomous and accountable collective. There should be shared leadership to achieve mutual goals, make decisions about nursing practice, socialize its members, build and maintain effective communication processes, and use the process of change to effect and maintain the model of practice. When these structures and processes compose the organizational milieu, nursing diagnoses will be used and will promote the further development of nurses as autonomous and accountable professionals who develop and use knowledge to deliver quality client care.

Alzheimer's special care units.

An overview of Alzheimer's special care units is provided, including the several models that have been used to guide their development. Philosophy and programming, physical and social environments, staff selection and training, admission and discharge criteria, family programming, and quality and cost features are described. Evaluation and research of special units and interventions for residents with Alzheimer's, their family members and staff caregivers are discussed.

Critical issues for the development of clinical nursing knowledge.

This article reviews the other articles in this issue that provide evidence of recent progress in clinical nursing research. The authors, guest editors of this issue, issue a call for further research to develop improvements in clinical nursing practice.

Staff stress on an Alzheimer's unit.

Nurses working with the elderly encounter many complex and potentially stressful care situations. Nowhere is this more true than for nursing home staff who work in highly demanding, labor- and client-intensive jobs. A number of factors contribute to the high levels of stress found among nurses who work with the elderly, including continual exposure to physical and emotional pathology and death, and conflict with families, co-workers, supervisors, and representatives from other departments or professions (Goldin, 1985; Klus, 1980). When the stress level in a long-term care facility becomes overwhelming, role conflict, ambiguity, poor self-esteem, and burnout may ensue (Goldin, 1985; Heine, 1986; Klus, 1980; Morrow-Winn, 1985). The process of burnout is characterized by a progressive loss of idealism, energy, and purpose that eventually leads to emotional overextension and exhaustion (Price, 1984).

A model of organizational power: analysis and significance to nursing.

In this article a causal model of the process of interorganizational power is presented with results of one test using survey data from 39 non-nursing organizations. The model argues that interaction strategies of organizations are outcomes of the relative basis and use of resources in interorganizational transactions. Multiple regression and multiple-partial correlation analyses were used to analyze the data. The findings partially support the model and indicate that it holds promise for development and refinement. Conclusions are that the model should be tested with nursing organizations and used to conceptualize additional aspects of the power process that nursing can foster.

Advancing nursing's accountability for outcomes.

Nursing outcomes accountability is in its infancy. Progress awaits the use of standardized nursing diagnoses, interventions, and nursing-sensitive patient outcomes in nursing clinical decision making and documentation. Changes in nursing delivery systems also are required so that nurses are empowered as individuals and as a professional collective to demonstrate their accountability for the outcomes of patients. Finally, the attitudes and behaviors of nurse clinicians, administrators, and educators, individually and collectively, are important in advancing nursing's accountability as a single discipline and as a member of the interdisciplinary team. In subsequent columns, each of these issues and needed actions will be explored more fully.

Nursing diagnoses in a professional model of nursing: keystone for effective nursing administration.

While the benefits of nursing diagnoses in clinical practice have been well documented, reports of the advantages from a nursing administration viewpoint are scant. In this article, the author highlights how nursing diagnoses can be used as a leadership strategy to achieve a professional model of practice and to increase organizational effectiveness.

Nursing's role in interdisciplinary accountability for patient outcomes.

Few disagree that health care is improved by effective interdisciplinary teamwork. Most nurses are anxious to collaborate with members of other disciplines in the delivery of cost-effective care. Unfortunately, some overly zealous and mistaken proponents of the interdisciplinary approach argue that a disciplinary focus is incongruous with interdisciplinary teamwork. Nurses must resist this notion, work to strengthen the discipline, and gain the tools needed to be visible and accountable. Nursing has an important role in interdisciplinary care, and interdisciplinary teams depend on nurses' contributions to be effective and accountable.

Research review committees in long-term care settings.

As the number of elderly people grows, the interest in research for this population increases. Federal funding is available for research regarding elders' needs, and researchers are recognizing the problems this population incurs. Residents and staff members in long-term care facilities are prime candidates for study subjects, and institutional research review committees, supported by the facilities' administration, are necessary to protect them. This article discusses ways to establish a research review committee and its working processes.

Classifying nursing-sensitive patient outcomes.

This report describes research at the University of Iowa College of Nursing to develop a comprehensive classification of nursing-sensitive patient outcomes. The Nursing-Sensitive Outcomes Classification (NOC) completes the nursing process elements of the Nursing Minimum Data Set (NMDS). We describe resolution of conceptual and methodological problems that define the inductive approach taken to develop the NOC. Strategies used to develop NOC included review of the literature, clinical databases and instruments; concept analysis; and surveys of nurse experts. Examples of outcomes, definitions, and indicators are presented. The NOC provides standardized patient outcomes for determining the effectiveness of nursing interventions and enables inclusion of these data in data sets for healthcare effectiveness research.

Nursing outcomes classification. An essential element in data sets for nursing and health care effectiveness.

The Nursing Outcomes Classification (NOC) is a comprehensive classification of patient outcomes responsive to nursing interventions. The NOC is complementary to taxonomies of the North American Nursing Diagnosis Association and the Nursing Interventions Classification. The NOC provides the language for the evaluation step of the nursing process and the content for the outcomes element in the Nursing Minimum Data Set (NMDS). The patient information system Patient Care Data Set (PCDS) is a new, computerized health care information system introduced by the Blue Chip Company and the faculty at Wright State University Miami Valley College of Nursing and Health. An important innovation for evaluation of health care delivery and effectiveness, the PCDS is a record of the patient's health/medical history. Documentation and evaluation of health care must include nursing data along with data from all health care disciplines in minimum data sets. Standardized nursing languages are necessary for inclusion of nursing data. The NOC is a comprehensive classification of patient outcomes that are responsive to nursing interventions. It provides a standardized language for the outcomes element of the NMDS, and contains outcomes that can be shared by all health care disciplines. The PCDS is an innovative minimum data set and patient health record system that is consistent with the NMDS. The NOC is a perfect fit for the PCDS.