A multicentre study on epidemiology and prevention of needle stick injuries among students of nursing schools.

INTRODUCTION: Among the health professions with a long period of training, the students of the Nursing Bachelor's Degree are the most exposed to biological risk resulting from accidents, in particular with needles and cutting edges. The aim of the study was to estimate the frequency and the circumstances for the occurrence of needle stick injuries, as a knowledge base for targeted prevention interventions. METHODS: The study was carried out between May and July 2017 in 11 Universities in Italy and 1 in Albania (associated with the "Tor Vergata" University of Rome). An anonymous semi-structured questionnaire was proposed to 1st (second semester), 2nd and 3rd year students of Nursing Bachelor's Degree. RESULTS: A total of 2742 questionnaires were collected. The average age of participants was 22.9 years (median 22, range 19-60 years), 73% of whom were females. A total of 381 injuries were reported. Three hundred and sixteen students (11.8%) underwent at least 1 injury (12.7% among females, 9.7% among males); 41 students declared two or more injuries; four students did not report the number of injuries occurred. The first injury occurred, as an average, 17 days after the start of the internship (median 15 days) and, in 25% of the cases, during the first 9 days. The highest percentage of accidents occurred during the first internship (25.3% of the total) and decreased with the progress of the training path. The injuries occurred in 38% of cases during drug preparation, 24% when disposing of sharp devices, 15% while re-capping needles, 13% during blood sampling and 10% in other circumstances. In 51.2% of cases, the needle was not sterile. Among the nursing students who suffered a needle stick injury, 58.1% declared that they had performed the post-exposure prophylaxis. 96% of students stated to be vaccinated against Hepatitis B virus. Amongst the students who had their serological status checked (74%), 18% stated the antibody titre was not protective. 49.8% of students answered to have been trained in advance on the correct procedures to avoid needle stick and cutting edges injuries in each clinical ward attended, 41.2% referred that this occurred only in some wards and 10% in no ward at all. CONCLUSION: The results of this study show a high percentage of needle stick injuries in students of the Nursing Bachelor's Degree. Therefore, there is a need for careful reflection on the most effective methods of targeted training acquisition of knowledge, skills and behavioural models useful for the exercise of the profession.

Is it time to consider population screening for fracture risk in postmenopausal women? A position paper from the International Osteoporosis Foundation Epidemiology/Quality of Life Working Group.

The IOF Epidemiology and Quality of Life Working Group has reviewed the potential role of population screening for high hip fracture risk against well-established criteria. The report concludes that such an approach should strongly be considered in many health care systems to reduce the burden of hip fractures. INTRODUCTION: The burden of long-term osteoporosis management falls on primary care in most healthcare systems. However, a wide and stable treatment gap exists in many such settings; most of which appears to be secondary to a lack of awareness of fracture risk. Screening is a public health measure for the purpose of identifying individuals who are likely to benefit from further investigations and/or treatment to reduce the risk of a disease or its complications. The purpose of this report was to review the evidence for a potential screening programme to identify postmenopausal women at increased risk of hip fracture. METHODS: The approach took well-established criteria for the development of a screening program, adapted by the UK National Screening Committee, and sought the opinion of 20 members of the International Osteoporosis Foundation's Working Group on Epidemiology and Quality of Life as to whether each criterion was met (yes, partial or no). For each criterion, the evidence base was then reviewed and summarized. RESULTS AND CONCLUSION: The report concludes that evidence supports the proposal that screening for high fracture risk in primary care should strongly be considered for incorporation into many health care systems to reduce the burden of fractures, particularly hip fractures. The key remaining hurdles to overcome are engagement with primary care healthcare professionals, and the implementation of systems that facilitate and maintain the screening program.

Prevalence of osteoporosis and fractures among women prescribed osteoporosis medication in five European countries: the POSSIBLE EU study.

UNLABELLED: European observational 1-year study assessed osteoporosis and fracture patterns in 3,402 postmenopausal women prescribed osteoporosis medication. Almost 40% of patients had a previous fracture, while 25% had neither fracture nor dual energy X-ray absorptiometry (DXA) diagnosis and were prescribed medication, probably due to other risk factors. INTRODUCTION: This analysis assessed osteoporosis and fracture prevalence in postmenopausal women prescribed osteoporosis treatment in the Prospective Observational Study Investigating Bone Loss Experience in Europe(POSSIBLE EU). METHODS: Women in this observational, multicenter 1-year study were categorized by fracture history and location at baseline. Baseline characteristics were analyzed according to no DXA and DXA diagnosis (osteoporosis or osteopenia). Fractures occurring during the 1-year follow-up period were recorded. RESULTS: Of the 3,402 women enrolled, 39% had a previous fracture, of whom 30% had ≥ 2 fractures. One thousand seven hundred and eighty-four (52%) patients had a DXA diagnosis (osteoporosis 68%, osteopenia 31%, and unknown 1%). Among the osteoporosis patients, 37% had a previous fracture (hip 2.9%, vertebral 8.8%, and non-hip, non-vertebral 25%) and 35% had fractures associated with major trauma. Of the 3,402 women, 1,476 (43%) had no DXA diagnosis; of these, 57% had no fracture (25% of all women). Risk factors varied across patients with and without DXA diagnosis. During the 1-year follow-up period, the fracture incidence in patients with or without a previous fracture at baseline was 4.7% and 1.6%, respectively. CONCLUSION: Almost 40% of patients prescribed osteoporosis medication had a previous fracture, highlighting a population with advanced disease. In contrast, 25% of patients had neither a previous fracture nor DXA diagnosis and were prescribed treatment, probably due to other risk factors. There is a need for continued improvement of disease management in European women.

Relationship between 3-month changes in biochemical markers of bone remodelling and changes in bone mineral density and fracture incidence in patients treated with strontium ranelate for 3 years.

SUMMARY: From two randomised controlled trials, it is shown that 3-month changes in biochemical markers of bone formation (bone-specific alkaline phosphatase and C-terminal propeptide of type I procollagen) were associated with 3-year bone mineral density (BMD) changes, but not fracture incidence in patients treated with strontium ranelate. INTRODUCTION: The purpose of this study was to assess if short-term change in biochemical markers of bone remodelling is associated with long-term BMD change and fracture incidence observed during treatment with strontium ranelate. METHODS: From the SOTI and TROPOS trials, bone-specific alkaline phosphatase (BALP), C-terminal propeptide of type I procollagen (PICP), serum C-terminal telopeptides (S-CTX) and urine N-terminal telopeptides of type I collagen (U-NTX) were assessed at baseline and after 3 months. RESULTS: Two thousand three hundred seventy-three women were included in this study. Multiple regression analysis showed that 3-month changes in PICP and BALP but not s-CTX I nor s-NTX I were significantly (p < 0.001) associated with 3-year BMD changes at the lumbar spine and the femoral neck. Changes in s-CTX I, PICP and BALP were significantly associated with change in total proximal femur BMD. Changes in biochemical markers explain less than 8% of the BMD changes. The 3-month changes in BALP, PICP s-CTX I and s-NTX I were not significantly associated with fracture incidence. CONCLUSIONS: Short-term changes in biochemical markers of bone formation are associated with future BMD changes in patients treated with strontium ranelate, suggesting a bone-forming activity of this treatment, but are not appropriate to monitor the efficacy of strontium ranelate at the individual level.

Decreased periprosthetic bone loss in patients treated with clodronate: a 1-year randomized controlled study.

The efficacy of clodronate to reduce bone loss around uncemented stems after total hip arthroplasty(THA) was evaluated. Ninety-one patients operated with uncemented THA were randomized to receive either intramuscular clodronate at a dose of 100 mg weekly for 12 months or no treatment. Periprosthetic and contralateral bone mineral density (BMD) scans were performed and biochemical markers of bone turnover measured at baseline and at 3, 6, and 12 months. At month 12, with the exception of Gruen zones 4 and 5, patients treated with clodronate showed less bone loss at all zones, reaching statistical significance (P\0.05) in Gruen zones 2 and 6 (difference of 6.6 and 5.9%, respectively). Analysis of data according to gender revealed sex-related differences in bone loss and efficacy of treatment. After 12 months, the difference in bone loss between treated and untreated women in five out of seven Gruen zones ranged from 6.2 to 13.3% (SS at zones 2 and 6), whereas comparison between treated and untreated men showed no BMD differences in all zones(P[0.05). Median percent changes in serum levels of markers of bone metabolism by gender were consistent with BMD changes. A 1-year treatment with intramuscular clodronate determined a significant reduction of bone loss after THA. This was mainly attributed to its greater efficacy in the female population, which is at higher risk for bone loss. This observation suggests the need for the characterization of high-risk subjects as potential candidates for prevention strategies.

Effects of long-term strontium ranelate treatment on vertebral fracture risk in postmenopausal women with osteoporosis.

SUMMARY: Vertebral fractures are a major adverse consequence of osteoporosis. In a large placebo-controlled trial in postmenopausal women with osteoporosis, strontium ranelate reduced vertebral fracture risk by 33% over 4 years, confirming the role of strontium ranelate as an effective long-term treatment in osteoporosis. INTRODUCTION: Osteoporotic vertebral fractures are associated with increased mortality, morbidity, and loss of quality-of-life (QoL). Strontium ranelate (2 g/day) was shown to prevent bone loss, increase bone strength, and reduce vertebral and peripheral fractures. The preplanned aim of this study was to evaluate long-term efficacy and safety of strontium ranelate. METHODS: A total of 1,649 postmenopausal osteoporotic women were randomized to strontium ranelate or placebo for 4 years, followed by a 1-year treatment-switch period for half of the patients. Primary efficacy criterion was incidence of patients with new vertebral fractures over 4 years. Lumbar bone mineral density (BMD) and QoL were also evaluated. RESULTS: Over 4 years, risk of vertebral fracture was reduced by 33% with strontium ranelate (risk reduction = 0.67, p < 0.001). Among patients with two or more prevalent vertebral fractures, risk reduction was 36% (p < 0.001). QoL, assessed by the QUALIOST(R), was significantly better (p = 0.025), and patients without back pain were greater (p = 0.005) with strontium ranelate than placebo over 4 years. Lumbar BMD increased over 5 years in patients who continued with strontium ranelate, while it decreased in patients who switched to placebo. Emergent adverse events were similar between groups. CONCLUSION: In this 4- and 5-year study, strontium ranelate is an effective and safe treatment for long-term treatment of osteoporosis in postmenopausal women.

Bone mass measurement by DXA: influence of analysis procedures and interunit variation.

Interunit variability among bone densitometers is due to different factors, including different calibration procedures and algorithms and variability in photon source energies and/or intensities. Other factors, such as the choice of scan parameters or the analysis procedures, can also introduce variability. The new generation of dual-energy x-ray absorptiometry (DXA) has partially improved this situation. The aim of this study was to investigate the operator-dependent analysis procedures that can affect scan results and to evaluate the phantom and in vivo interunit variation of some DXA instruments. Four DXA instruments (QDR 1000 and 1000/W, Hologic, Inc.) were used. Potential sources of variability in the analysis procedures of anteroposterior lumbar spine and hip scans were considered: in most cases these procedures significantly influenced scan results. On lumbar spine, an enlargement of the scan window of less than 3 cm was responsible for an average increase in bone mineral density (BMD) of about 3%. On the hip, lowering the scan window by about 1 cm accounted for an increase in the whole-segment BMD of about 4%. After standardization of analysis procedures, interunit and intraunit coefficients of variation and percentage differences among instruments were less than 1% for all the parameters considered (area and bone mineral content and density) with both an anatomic and a geometric phantom, and in nine subjects scanned by two different devices the percentage difference in BMD was greater than 2%. This study shows that present interunit variability allows comparisons among laboratories, but only if highly standardized analysis procedures are used.

Bone mass status in different degrees of chronic renal failure.

Bone mineral density (BMD) was evaluated in 69 patients with chronic renal failure (CRF) and in healthy controls matched for age, sex, and, for women, menopausal status. Both appendicular (predominantly cortical) and axial (predominantly trabecular) bone mass were measured. Appendicular BMD was measured by single photon absorptiometry on the distal forearm and axial BMD was measured by dual photon absorptiometry on the lumbar spine. Patients were divided into three groups on the basis of creatinine clearance: group 1, 58 to 36 ml/min; group 2, 30 to 18 ml/min; group 3, 15 to 9 ml/min. Both appendicular and axial BMD decreased with the worsening of renal failure. Parathyroid hormone levels were inversely correlated with the values of appendicular BMD. BMD values were significantly lower in postmenopausal than in premenopausal women. Months of menopause were inversely correlated with axial BMD values. Appendicular BMD was lower in CRF patients than in controls, and both appendicular and axial BMD were significantly lower in postmenopausal uremic women than in postmenopausal healthy women.

Effects of oral alendronate and intranasal salmon calcitonin on bone mass and biochemical markers of bone turnover in postmenopausal women with osteoporosis.

The main objective of this study was to determine the effect of daily oral alendronate treatment on bone mass in postmenopausal women affected by osteoporosis. The efficacy of intranasal salmon calcitonin was also examined. Nine centers in Italy enrolled 286 postmenopausal women between the ages of 48 and 76 with spinal bone mineral density > or = 2 SD below adult mean peak in the two-year, double-blind, randomized, placebo-controlled trial. Patients were randomized to one of four treatment arms: double-blind placebo, alendronate 10 mg/day, alendronate 20 mg/day, or open-label intranasal salmon calcitonin 100 IU/day; all patients received 500 mg Ca++ supplements. Bone mass was measured by dual-energy x-ray absorptiometry every six months for two years. Patients who received alendronate 10 or 20 mg experienced significant increases in bone mass at all sites measured. At the end of the second year, the mean percent changes, for alendronate 10 and 20 mg relative to placebo, were 5.2% and 7.3% at the lumbar spine, 3.8% and 4.6% at the femoral neck, and 7.1% and 7.5% at the trochanter, respectively. In contrast, intranasal salmon calcitonin failed to increase bone mineral mass significantly at any site. Both alendronate doses significantly decreased serum alkaline phosphatase, serum osteocalcin, and urinary pyridinolines, markers of bone turnover, whereas placebo and intranasal calcitonin did not. Alendronate was generally well tolerated and no serious adverse events were attributed to its use.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of ipriflavone--a synthetic derivative of natural isoflavones--on bone mass loss in the early years after menopause.

OBJECTIVE: We studied whether oral administration of ipriflavone, a synthetic derivative of naturally occurring isoflavones, could prevent bone loss occurring shortly after menopause. DESIGN: Fifty-six women with low vertebral bone density and with postmenopausal age less than five years were randomly allocated to receive either ipriflavone, 200 mg three times daily, or placebo. All subjects also received 1,000 mg elemental calcium daily. RESULTS: Vertebral bone density declined after two years in women taking only calcium (4.9 +/- 1.1%, SEM, p = 0.001), but it did not change in those receiving ipriflavone (-0.4 +/- 1.1%, n.s.). A significant (p = 0.010) between-treatment difference was evidenced at both year 1 and year 2. At the end of the study, urine hydroxyproline/creatinine excretion was higher in the control group than in the ipriflavone group, as compared to no difference at baseline. Five patients taking ipriflavone and five taking placebo experienced gastrointestinal discomfort or other adverse reactions, but only one and four subjects, respectively, had to discontinue the study. CONCLUSIONS: Ipriflavone prevents the rapid bone loss following early menopause. This effect is associated with a reduction of bone turnover rate.

Quasi-single-helicity reversed-field-pinch plasmas

The reversed field pinch (RFP) is a configuration for plasma magnetic confinement. It has been traditionally viewed as dominated by a bath of MHD instabilities producing magnetic chaos and high energy transport. We report experimental results which go beyond this view. They show a decrease of magnetic chaos and the formation of a coherent helical structure in the plasma, whose imaging and temperature profile are provided for the first time. These quasi-single-helicity states are observed both transiently and in stationary conditions. The last case is consistent with a theoretically predicted bifurcation. Our results set a new frame for improving confinement in high current nonchaotic RFP's.

Short-term intravenous therapy with Neridronate in Paget's disease.

AIMS: To describe the effects of two consecutive intravenous infusions of aminohexane bisphosphonate (Neridronate) in patients with active Paget's disease of bone. METHODS: The study population included 83 patients, aged 41 to 85 years, randomized to 4 cumulative doses of Neridronate (25, 50, 100, 200 mg) given over 2 days, with a follow up of 180 days. The baseline serum alkaline phosphatase activity was at least 10% above the upper limit of the laboratory range. The response to treatment was assessed by changes in the serum total alkaline phosphatase (primary end point of the study), bone alkaline phosphatase and N-telopeptide urinary excretion. RESULTS: All Neridronate doses significantly suppressed the biochemical indices of disease activity. The nadir of total alkaline phosphatase levels ranged from -16 % to -57.5% of pretreatment values in the four groups, with a dose-response relationship that was apparent even between the two highest doses. The proportion of patients still maintaining a partial response (decreases in serum total alkaline phosphatase >25%) at the 6 month follow-up was also related to the dose: 98%, 67%, 57%, 21% in the patients given 200, 100, 50, 25 mg respectively. The proportion of responders in terms of bone alkaline phosphatase and N-telopeptide excretion changes was similar. Bone pain attributed to Paget's disease was significantly reduced. A typical acute phase reaction (fever and/or arthromyalgia) occurred in 16 out of 83 patients. CONCLUSIONS: We conclude that all of the Neridronate doses tested here were well tolerated and effective in decreasing, in a dose-related manner the bone turnover parameters of Paget's disease. The highest dose (200 mg) resulted in the normalization of the markers of disease activity in more than 60% of the patients.

Immunoreactive calcitonin: a tumor marker for myelogenous leukemias.

In a series of 59 patients with chronic or acute myelogenous leukemia (CML, AML) we investigated whether circulating immunoreactive human calcitonin (i-hCT) levels correlate with diagnosis, response to therapy and clinical course. I-hCT was detectable in plasma samples of 88% of patients with CML in the chronic phase and in 100% of patients with CML in blastic transformation. In the AML patients, a significant relation was observed between the cytological subtype and i-hCT levels at diagnosis. In sequentially studied patients the i-hCT plasma concentration was related to the overall mass of leukemic cells, being lower when complete remission was achieved than at diagnosis and increasing at time of recurrence. These data suggest that circulating i-hCT levels can serve as a "tumor marker" in human myelogenous leukemias.

Basal plasma levels of calcitonin and bone mineral mass in normal and uremic women. Effect of menopause.

Basal plasma levels of immunoreactive calcitonin (iCT), forearm bone mineral content (BMC) as measured by 125I photon absorptiometry and 24-hour urinary hydroxyproline/creatinine ratio (OHPr/Cr) were determined in 32 healthy women (13 pre-menopausal, aged 40 to 54 years, and 19 post-menopausal, aged 41 to 54 years). The basal plasma levels of iCT were significantly higher in the pre-menopausal group (mean value 96 vs 54 pg/ml, P less than 0.025). The BMC value of the radius was also significantly greater in the same group (mean +/- SEM 656 +/- 13 vs. 620 +/- 9 mg/cm2, P less than 0.05), while the urinary OHPr/Cr ratio was higher in the post-menopausal group (29.9 +/- 1.5 vs. 38.7 +/- 2.7 mg/g, P less than 0.02). These results suggest that basal plasma levels of iCT decrease after the menopause and support the hypothesis that a deficiency of CT could be involved in the pathogenesis of post-menopausal bone loss. Similar results were obtained in 25 uremic women on maintenance hemodialysis (9 pre-menopausal and 16 post-menopausal) aged 30 to 65 yrs.: both basal iCT levels and BMC values were significantly higher in the pre-menopausal group.

Vitamin D metabolites in spasmophilia.

The comparison of 20 untreated spasmophilic patients (2 men, 18 women) with 25 healthy subjects revealed no significant differences in vitamin D metabolite plasma levels or in other laboratory indexes of calcium metabolism except for ionized and cytosolic free calcium levels which were lower in the former group (P less than 0.01; P less than 0.001). After 3 months treatment with calcitonin and 25-hydroxyvitamin D there was a clear improvement in patient symptoms, no significant modification of 1,25-dihydroxyvitamin D levels and significant increases in 25-hydroxyvitamin D, cytosolic free calcium and urinary calcium (P less than 0.001, P less than 0.001 and P less than 0.01, respectively). We conclude that high plasma levels of 25-hydroxyvitamin D play an important role in restoring normal cytosolic free calcium levels and reducing clinical manifestations in spasmophilia.

Effects of porcine calcitonin on human platelet fuction.

The effects of different doses of porcine calcitonin (pCT) were tested in vitro and in vivo. In vitro, pCT at a concentration ranging from 0.1 to 5 M. R. C. Units/ml induced a dose-dependent inhibition of ADP (1.2 microM) and collagen- (2 micrograms/ml) induced platelet aggregation, showing a prevalent action on the second wave of ADP-induced aggregation and causing prolongation of the lag time and reduction of both maximum aggregation and slope in collagen-induced aggregation. 45Ca uptake by platelets in the presence of the ionophore A23187 and 14C-serotonin release were also inhibited in a dose-related fashion, using concentrations ranging from 1 to 10 M. R. C. Units of pCT. The in vivo tests, performed before and after a 7-day treatment with 2 different doses of pCT (1 and 160 M. R. C. Units/daily, i. m.) confirmed the inhibitory effect of pCT on ADP- and collagen-induced platelet aggregation. It should be stressed that the effect of 1 unit was stronger than that of 160 units. It is therefore postulated that in vitro and in vivo effects of pCT on platelet functions probably depend on different mechanisms of action.

Regional migratory osteoporosis: a pathogenetic hypothesis based on three cases and a review of the literature.

Regional migratory osteoporosis (RMO) is a migrating arthralgia of the weight-bearing joints of the lower limb which mainly affects middle-aged males. Its aetiology is unknown. The association of RMO with generalised osteoporosis has recently been reported. A concurrent systemic osteoporosis was also reported in some cases of transient osteoporosis of the hip (TOH), a disorder closely related to RMO. In its turn, TOH is considered a reversible stage of avascular necrosis of the hip (AVN), and the aetiopathogenesis of both of them remains strongly debated. We report three cases of RMO associated with generalised severe idiopathic osteoporosis. Three men, in the fourth and fifth decades of life, complained of at least four episodes of arthralgia in the lower limbs, with a migratory pattern, radiographic focal osteoporosis and final clinical resolution. The most striking common feature of these patients was the presence of a severe systemic osteoporosis with a prevailing trabecular involvement. We suggest that a prolonged or exaggerated activation of regional acceleratory phenomena (RAP) is the cause of transient osteoporosis. Bone tissue microdamage due to osteoporosis may be the most frequent noxious stimulus that turns RAP on, and, bone tissue microfracture is the most prevalent consequence. When this pathogenetic pathway is activated, the progression from focal osteoporosis and bone marrow oedema to avascular necrosis is associated with the amount of structural damage.

Mineral metabolism during a hemofiltration session in children.

We studied the effects of one session of hemofiltration on the mineral metabolism in a group of uremic children. We observed an increase of calcemia, accompanied by positive calcium balance, and a decrease of plasma phosphate and PTH-MM. No substantial loss of plasma 25-OH D was found. It is concluded that hemofiltration has a positive effect on calcemia and is very effective in removing phosphate, but it acts only temporarily on PTH removal. An adequate calcium concentration must be provided in the substitution fluid.

[The fracture risk in the elderly subject: the determining factors]. / Il rischio di frattura nell'anziano: fattori determinanti.

Recent advancements in the field of bone mass measurements allow us a precise determination of bone mineral density values in various skeletal sites. At present, their determination gives the most valuable information on individual fracture risk. However, we sometimes to witness fragility fractures in presence of regular values of bone mineral density which suggest a satisfactory status of skeletal mineralization. These cases underline that the mechanical incompetence of the skeleton is not simply the result of a decrease in bone mineral density and that other factors are responsible for the increase of fracture incidence in the elderly. In this paper, several factors potentially involved in the occurrence of fragility fractures in elderly people have been considered on the basis of the most recent data of the current literature in this field. These factors, subdivided in bone tissue extrinsic and bone tissue intrinsic factors, include: muscle synergisms, reflex reactions and sensory status, soft tissue features, bone tissue features, structural properties and loading modalities in relation to structural orientation. Awareness and analysis on these factors are important for better management of preventive as well as therapeutic measures for fragility fractures in elderly.

[Research and evaluation of Internet resources for the practice and teaching of nursing]. / Ricerca e valutazione delle risorse Internet per la pratica e l'insegnamento della professione infermieristica.

Recent changes in the Italian health care system are causing a complex redefinition of the traditional principles of nursing. Among the new principles that are being proposed, the implementation of a clinical practice based on the evidence generated by the medical research community appears to be prominent. However, objective time constraints in finding and evaluating the available information have often hampered the achievement of this highly desirable goal. In this perspective, exploitation of the intrinsic quickness of the internet-based information retrieval systems has the potential to effectively circumvent the problem. To provide nurses with a proper training in a timely search and evaluation of on-line data, we have designed and developed a guide to those websites providing clinical information. This guide consists of (1) reviews of existing websites, and (2) proposal of a standardized model for selection, evaluation, and description of existing and newly appearing websites. We believe that this guide might increase the capability of nurses to effectively exploit the medical and scientific information resources available on the net.