Attention-deficit hyperactivity disorder and intellectual disability: a study of association with brain-derived neurotrophic factor gene polymorphisms.

Symptoms of attention-deficit hyperactivity disorder (ADHD) have been found in several studies of children with intellectual disabilities (ID) but the two diseases are not always associated. Several lines of evidence implicate the involvement of brain-derived neurotrophic factor (BDNF) in ADHD, and it may also be relevant in ID due to its known involvement in the development of the central nervous system (CNS) and in learning/memory functions. We genotyped paediatric patients with ADHD and ID for the Val66Met and 270 C/T polymorphisms in BDNF. Diagnosis of ADHD and ID was confirmed by the clinicians in accordance with DSM-IV criteria. The G/A genotype of the Val66Met SNP was associated with both ADHD and ID, and the G allele was significantly associated with ADHD. The C/C genotype of the C270T SNP was significantly overrepresented in both ADHD and ID groups compared with the controls. Data suggest that both BDNF polymorphisms could play a role in the etiology of ADHD. In addition, we present the first results suggesting that these BDNF SNPs are significantly associated with ID.

Using Clinical Narratives in Program and Curriculum Evaluation.

Background: Using personal experience stories as teaching tools, clinical narratives are an effective means for sharing the art of nursing practice and provide insight into nurses' critical thinking and clinical proficiency. Using clinical narratives to assess curriculum effectiveness provides important insights into changed practice and learning beyond the classroom. Aim: This article provides an example of using clinical narratives in the evaluation of the Department of Veterans Health Affairs Office of Nursing Services (ONS) Evidence Based Practice Curriculum (EBPC). Methods: As part of a larger mixed-method evaluation of the EBPC, clinical narrative methods were employed to describe one incident where participants (n=3) applied at least two of three evidence based practice components (best available evidence; clinical expertise; patient preference). Results: Examination of clinical narratives demonstrated successful application of key components of evidence based practice and an integration into individual nursing practice beyond data obtained from other evaluation methods. Conclusions: Incorporating rich clinical narratives into a rigorous mixed-method program evaluation protocol provides insights beyond information uptake, satisfaction, efficacy, or competency assessment scores.

Evaluating an Evidence-Based Practice Curriculum for Nurses Entering Clinical Practice in the Veterans Health Administration.

Introduction: The Veterans Health Administration (VHA) registered nurse (RN) Transition to Practice (TTP) program is a 1-year comprehensive, standardized curriculum taught for entry-level nurses to assist them in transitioning to VA-trained, competent, professional RNs. The TTP program includes revised modules on Evidence-Based Practice (EBP) clinical decision making. The revised curriculum emphasizes EBP as a problem-solving approach to clinical decision making rather than a project-based approach to implement practice changes. The goal of this quality improvement project was to evaluate the content, delivery, and outcomes of a revised Evidence-Based Practice Curriculum (EBPC) for use in the VHA RN TTP program. Methods: Focus groups were conducted with TTP coordinators, who teach the program and facility EBP content experts from 32 VHA Medical Centers. All attended a three-day face-to-face training at a central location. Qualitative data were managed and analyzed with a rapid assessment process. Discussion: Leaders within and outside of organizations are commonly believed to affect the success of implementing and sustaining any program or initiative through their influence on organizational climate, leadership processes, and leadership alignment across multiple levels of leadership. Our findings were in line with other research showing that leaders should prioritize EBP and fuel it with resources to create sustainable change. Conclusions: In conclusion, the EBPC was reviewed very favorably by all who planned to use it in their facilities in teaching the content to practicing registered nurses. Future evaluation will focus on the degree to which faculty use the program, how they use the modules, and what feedback nurses provide after exposure to EBPC.

Niveles de Tirotrofina y Hormonas Tiroideas en el Paciente Renal Crónico en Hemodiálisis / Thyrotropin and thyroid hormone levels in chronic renal patients under hemodyalisis

Las enfermedades críticas presentan cambios en el eje hipotálamo-hipófiso-tiroideo que dependen de la patología y de la gravedad de la misma. La Insuficiencia Renal Crónica es una patología grave con un alto índice de morbimortalidad. El objetivo del presente trabajo fue evaluar las hormonas del eje tiroideo en pacientes renales crónicos en hemodiálisis (HD) y su utilidad como pronosticadores de morbilidad. Se estudiaron pacientes renales crónicos de un Servicio de nefrología y hemodiálisis y se comparó con un grupo control (CT) sin enfermedad renal y/o tiroidea. Se monitoreó al enfermo pre (pre-DL) y posdiálisis (pos-DL), se realizó un seguimiento durante un año y se lo agrupó según el tiempo de permanencia bajo HD. Se evaluaron concentraciones de tirotrofina (TSH), triiodotironina (T3), tiroxina (T4) y tiroxina libre (T4L) y parámetros bioquímicos sensibles al estado del paciente: urea, creatinina, albúmina y proteínas totales. Las muestras pre-DL evidenciaron un aumento significativo en los niveles de TSH (p<0.05), con un descenso también significativo de T3 y de T4 y T4L aunque de menor magnitud (p<0.05) con respecto al CT. En el procedimiento de diálisis se observó una fluctuación transitoria de los niveles de las hormonas tiroideas (p<0.05), con una concentración máxima en la muestra pos-DL y mínima en la pre-DL, sin modificación en TSH. Durante el seguimiento de los pacientes detectamos una tendencia descendente de T3. Además, se constató un aumento de TSH y una disminución de T3 (p<0.05) en pacientes con mayor tiempo de permanencia en HD. Además, comprobamos una correlación directa entre TSH y urea e inversa entre TSH y albúmina, y correlaciones inversa entre T3 y urea y directa entre T3 y albúmina. Nuestro estudio muestra las modificaciones hormonales en el eje tiroideo debido a la enfermedad y al procedimiento de diálisis y la posible utilidad de T3 como otro indicador de morbilidad en estos pacientes.

Severe illness induces various hormonal changes in the hypothalamic-pituitary-thyroid axis. Chronic renal failure is a serious condition showing a high mortality index. The aim of this work was to evaluate thyroid hormone level in chronic renal patients under hemodialysis in order to estimate its potential use as morbidity / mortality indicator. We studied chronic renal patients from Nephrology and Hemodialysis Units of our Hospital and compared them with a control group (CT) without renal or thyroid pathology. We evaluated patients before (pre-dialysis) and after dialysis (post-dialysis) during one year. We then classified patients according to the duration of their hemodialysis treatment. We assessed Thyrotropin (TSH), triiodothyronine (T3), thyroxine (T4) and free thyroxine (T4L) levels and other biochemical indicators: urea, creatinine, albumin, and total protein. Pre-dialysis samples showed higher TSH levels (p<0.05), a significant decrease in T3, and a lower decrease in T4 and T4L than CT. During the dialysis procedure, we observed a fluctuation in thyroid hormone levels (p<0.05), higher in post-dialysis samples, and no changes in TSH levels. The one- year follow- up showed a low decrease in T3 levels in pre- and post-dialysis samples. An increase in TSH levels and a decrease in T3 levels (p<0.05) was observed in patients after long hemodialysis treatment. Renal patients showed a direct correlation between TSH and urea and inverse correlation between TSH and albumin. However, an inverse correlation between T3 and urea and a direct correlation between T3 and albumin was observed. This study shows that thyroid-hormonal changes are induced by pathology and dialysis treatment. We suggest T3 measurement as a useful morbidity indicator for chronic renal patients.