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Selected AbstractsInsulin resistance and endothelial dysfunction: the road map to cardiovascular diseasesDIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue 6 2006Eugenio Cersosimo Abstract Cardiovascular disease affects approximately 60% of the adult population over the age of 65 and represents the number one cause of death in the United States. Coronary atherosclerosis is responsible for the vast majority of the cardiovascular events, and a number of cardiovascular risk factors have been identified. In recent years, it has become clear that insulin resistance and endothelial dysfunction play a central role in the pathogenesis of atherosclerosis. Much evidence supports the presence of insulin resistance as the fundamental pathophysiologic disturbance responsible for the cluster of metabolic and cardiovascular disorders, known collectively as the metabolic syndrome. Endothelial dysfunction is an important component of the metabolic or insulin resistance syndrome and this is demonstrated by inadequate vasodilation and/or paradoxical vasoconstriction in coronary and peripheral arteries in response to stimuli that release nitric oxide (NO). Deficiency of endothelial-derived NO is believed to be the primary defect that links insulin resistance and endothelial dysfunction. NO deficiency results from decreased synthesis and/or release, in combination with exaggerated consumption in tissues by high levels of reactive oxygen (ROS) and nitrogen (RNS) species, which are produced by cellular disturbances in glucose and lipid metabolism. Endothelial dysfunction contributes to impaired insulin action, by altering the transcapillary passage of insulin to target tissues. Reduced expansion of the capillary network, with attenuation of microcirculatory blood flow to metabolically active tissues, contributes to the impairment of insulin-stimulated glucose and lipid metabolism. This establishes a reverberating negative feedback cycle in which progressive endothelial dysfunction and disturbances in glucose and lipid metabolism develop secondary to the insulin resistance. Vascular damage, which results from lipid deposition and oxidative stress to the vessel wall, triggers an inflammatory reaction, and the release of chemoattractants and cytokines worsens the insulin resistance and endothelial dysfunction. From the clinical standpoint, much experimental evidence supports the concept that therapies that improve insulin resistance and endothelial dysfunction reduce cardiovascular morbidity and mortality. Moreover, interventional strategies that reduce insulin resistance ameliorate endothelial dysfunction, while interventions that improve tissue sensitivity to insulin enhance vascular endothelial function. There is general agreement that aggressive therapy aimed simultaneously at improving insulin-mediated glucose/lipid metabolism and endothelial dysfunction represents an important strategy in preventing/delaying the appearance of atherosclerosis. Interventions that 1 correct carbohydrate and lipid metabolism, 2 improve insulin resistance, 3 reduce blood pressure and restore vascular reactivity, and 4 attenuate procoagulant and inflammatory responses in adults with a high risk of developing cardiovascular disease reduce cardiovascular morbidity and mortality. Whether these benefits hold when the same prevention strategies are applied to younger, high-risk individuals remains to be determined. Copyright © 2006 John Wiley & Sons, Ltd. [source] Hepatitis C virus risk behaviors within the partnerships of young injecting drug usersADDICTION, Issue 7 2010Judith A. Hahn ABSTRACT Aims Young injection drug users (IDU) are at high risk for hepatitis C virus (HCV). We sought to determine whether perceiving one's injecting partner to be HCV positive was associated with decreased odds of engaging in receptive needle/syringe sharing (RNS) or ancillary equipment sharing (AES) with that partner. Design Cross sectional study. Setting 2003 to 2007 in San Francisco. Participants 212 young (under age 30) IDU who were HCV antibody negative reported on 492 injecting partnerships. Measurements Self-reported RNS and AES within injecting partnerships. Findings RNS and AES (in the absence of RNS) occurred in 23% and 64% of injecting partnerships in the prior month. The odds of engaging in RNS were significantly lower for relationships in which the participant reported that his/her partner was HCV positive (odds ratio [OR] 0.49; 95% confidence interval [CI] 0.25,0.95). This association was attenuated when adjusted for reusing one's own needle/syringe (adjusted OR 0.57; 95% CI 0.28,1.15). The odds of engaging in AES were lower for participants who did not know the HCV status of their partner, only among non-sexual partnerships (OR 0.47; 95% CI 0.29,0.76). Conclusions Because perceiving one's partner to be HCV positive was associated with decreased RNS, increased HCV testing and partner disclosure may be warranted. AES was common and was decreased only among non-sexual partnerships in which the HCV status of the partner was not known. This suggests that interventions to reduce AES in young IDU must be widespread. [source] Role of peroxynitrite in methamphetamine-induced dopaminergic neurotoxicity and sensitization in miceADDICTION BIOLOGY, Issue 3 2000Syed F. Ali Methamphetamine (METH)-induced dopaminergic neurotoxicity is thought to be associated with the generation of reactive oxygen species (ROS) and reactive nitrogen species (RNS). Recently, we have reported that copper/zinc(CuZn)-superoxide dismutase transgenic mice are resistant to METH-induced neurotoxicity. In the present study, we examined the role of the neuronal nitric oxide synthase (nNOS), susceptibility of nNOS knockout (KO) mice and sensitization to psychostimulants after neurotoxic doses of METH. Male SwissWebster mice were treated with or without 7-nitroindazole (7-NI) along with METH (5 mg/kg,ip,q 3h × 3) and were sacrificed 72 h after the last METH injection. Dopamine (DA) and dopamine transporter (DAT) binding sites were determined in striatum from saline and METH-treated animals. 7-NI completely protected against the depletion of DA, and DAT in striatum. In follow-up experiments nNOS KO mice along with appropriate control (C57BL/6N, SV129 and B6JSV129) mice were treated with METH (5 mg/kg,ip, q 3h × 3) and were sacrificed 72 h after dosing. This schedule of METH administrations resulted in only 10,20% decrease in tissue content of DA and no apparent change in the number of DAT binding sites in nNOS KO mice. However, this regime of METH resulted in a significant decrease in the content of DA as well as DAT binding sites in the wild-type animals. Pre-exposure to single or multiple doses of METH resulted in a marked locomotion sensitization in response to METH. However, the nNOS KO mice show no sensitization in response to METH after single or multiple injections of METH. Therefore, these studies strongly suggest the role of peroxynitrite, nNOS and DA system in METH-induced neurotoxicity and behavioral sensitization. [source] Seronegative myasthenia gravis: comparison of neurophysiological picture in MuSK+ and MuSK, patientsEUROPEAN JOURNAL OF NEUROLOGY, Issue 3 2006L. Padua The aim of this study was to compare the neurophysiological and clinical pictures of a large sample of seronegative myasthenia gravis (SNMG) patients with and without anti-MuSK antibodies. Fifty-two consecutive SNMG patients were retrospectively evaluated. They had undergone an extended neurophysiological evaluation: repetitive nerve stimulation (RNS), single fiber EMG (SFEMG), and electromyography (EMG) with nerve conduction study. A muscle biopsy was performed in 11 of 52 patients, the edrophonium test in 44 of 52 patients and anti-AChR antibodies and anti-MuSK antibodies were tested in all patients. Anti-MuSK antibodies were detected in 25 SNMG patients (48.1%). The number of women in the MuSK+ group was significantly higher (P = 0.01) than in the MuSK, group. Seronegative MuSK+ patients are more severely affected and the deficit often involves the bulbar and the respiratory muscles. No statistically significant differences were observed in the edrophonium test between MuSK+ and MuSK, groups. The RNS test was abnormal in a significantly higher number of MUSK, patients than MUSK+ patients (P < 0.00001). With regard to SFEMG data, MuSK, patients were characterized to have more severe neurophysiological pattern. Our observations showed several differences between the clinical and neurophysiological pictures of MUSK+ and MUSK, patients. [source] Is ,-lipoic acid a scavenger of reactive oxygen species in vivo?IUBMB LIFE, Issue 6 2008Evidence for its initiation of stress signaling pathways that promote endogenous antioxidant capacity Abstract The chemical reduction and oxidation (redox) properties of ,-lipoic acid (LA) suggest that it may have potent antioxidant potential. A significant number of studies now show that LA and its reduced form, dihydrolipoic acid (DHLA), directly scavenge reactive oxygen species (ROS) and reactive nitrogen species (RNS) species and protect cells against a host of insults where oxidative stress is part of the underlying etiology. However, owing to its limited and transient accumulation in tissues following oral intake, the efficacy of nonprotein-bound LA to function as a physiological antioxidant has been questioned. Herein, we review the evidence that the micronutrient functions of LA may be more as an effector of important cellular stress response pathways that ultimately influence endogenous cellular antioxidant levels and reduce proinflammatory mechanisms. This would promote a sustained improvement in cellular resistance to pathologies where oxidative stress is involved, which would not be forthcoming if LA solely acted as a transient ROS scavenger. © 2008 IUBMB IUBMB Life, 60(6): 362,367, 2008 [source] Nitric Oxide, Mitochondria, and Cell DeathIUBMB LIFE, Issue 3-5 2001Guy C. Brown Abstract NO or its derivatives (reactive nitrogen species: RNS) have three types of actions on mitochondria: 1) reversible inhibition of mitochondrial respiration at cytochrome oxidase by NO, and irreversible inhibition at multiple sites by RNS; 2) stimulation of mitochondrial production of superoxide, hydrogen peroxide, and peroxynitrite by NO; and 3) induction of mitochondrial permeability transition (MPT) by RNS. Similarly there are three main roles of mitochondria in NO-induced cell death: a) NO inhibition of respiration can induce necrosis (or excitotoxicity in neurons) and inhibit apoptosis if glycolysis is insufficient to compensate, b) RNS- or oxidant-induced signal transduction or DNA damage may activate the mitochondrial pathway to apoptosis, and c) RNS-induced MPT may induce apoptosis or necrosis. [source] Persistence of Pulmonary Vein Isolation After Robotic Remote-Navigated Ablation for Atrial Fibrillation and its Relation to Clinical OutcomeJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 10 2010STEPHAN WILLEMS M.D. Robotic Remote Ablation for AF. Aims: A robotic navigation system (RNS, HansenÔ) has been developed as an alternative method of performing ablation for atrial fibrillation (AF). Despite the growing application of RNS-guided pulmonary vein isolation (PVI), its consequences and mechanisms of subsequent AF recurrences are unknown. We investigated the acute procedural success and persistence of PVI over time after robotic PVI and its relation to clinical outcome. Methods and Results: Sixty-four patients (60.7 ± 9.8 years, 53 male) with paroxysmal AF underwent robotic circumferential PVI with 3-dimensional left atrial reconstruction (NavXÔ). A voluntary repeat invasive electrophysiological study was performed 3 months after ablation irrespective of clinical course. Robotic PVI was successful in all patients without complication (fluoroscopy time: 23.5 [12,34], procedure time: 180 [150,225] minutes). Fluoroscopy time demonstrated a gradual decline but was significantly reduced after the 30th patient following the introduction of additional navigation software (34 [29,45] vs 12 [9,17] minutes; P < 0.001). A repeat study at 3 months was performed in 63% of patients and revealed electrical conduction recovery in 43% of all PVs. Restudied patients without AF recurrence (n = 28) showed a significantly lower number of recovered PVs (1 (0,2) vs 2 (2,3); P = 0.006) and a longer LA-PV conduction delay than patients with AF recurrences (n = 12). Persistent block of all PVs was associated with freedom from AF in all patients. At 3 months, 67% of patients were free of AF, while reablation of recovered PVs led to an overall freedom from AF in 81% of patients after 1 year. Conclusion: Robotic PVI for PAF is safe, effective, and requires limited fluoroscopy while yielding comparable success rates to conventional ablation approaches with PV reconduction as a common phenomenon associated with AF recurrences. (J Cardiovasc Electrophysiol, Vol. 21, pp. 1079-1084) [source] Updating the effects of fatty acids on skeletal muscleJOURNAL OF CELLULAR PHYSIOLOGY, Issue 1 2008Leonardo R. Silveira In this review we updated the fatty acid (FA) effects on skeletal muscle metabolism. Abnormal FA availability induces insulin resistance and accounts for several of its symptoms and complications. Efforts to understand the pathogenesis of insulin resistance are focused on disordered lipid metabolism and consequently its effect on insulin signaling pathway. We reviewed herein the FA effects on metabolism, signaling, regulation of gene expression and oxidative stress in insulin resistance. The elevated IMTG content has been associated with increased intracellular content of diacylglycerol (DAG), ceramides and long-chain acyl-coenzyme A (LCA-CoA). This condition has been shown to promote insulin resistance by interfering with phosphorylation of proteins of the insulin pathway including insulin receptor substrate-1/2 (IRS), phosphatidylinositol-3-kinase, (PI3-kinase) and protein kinase C. Although the molecular mechanism is not completely understood, elevated reactive oxygen (ROS) and nitrogen species (RNS) are involved in this process. Elevated ROS/RNS activates nuclear factor-kappaB (NFkB), which promotes the transcription of proinflammatory tumoral necrosis factor alpha (TNF,), decreasing the insulin response. Therefore, oxidative stress induced by elevated FA availability may constitute one of the major causes of insulin resistance in skeletal muscle. J. Cell. Physiol. 217: 1,12, 2008. © 2008 Wiley-Liss, Inc. [source] Oxidative modification of mitochondrial proteins and cell death in Parkinson's diseaseJOURNAL OF NEUROCHEMISTRY, Issue 2002W. Maruyama Oxidative stress is one of the cell death mechanisms in neurodegenerative disorders, such as Parkinson's disease (PD) and Alzheimer's disease. Most of reactive oxygen species (ROS) generate in mitochondria through oxidative phosphorylation, and a part of them are not scavenged by antioxidative system and react with bioactive molecules. Recently, alpha-synuclein containing nitrotyrosine, a marker for oxidative modification by peroxynitrite, was identified in Lewy body. In addition, inhibitors of mitochondrial respiratory chain were reported to induce formation of Lewy body-like inclusion in vivo and in vitro. In this paper it was examined whether ROS and reactive nitrogen species (RNS) generated in mitochondria oxidize mitochondrial respiratory enzymes and induce the formation of inclusion body and cell death in PD. Human neuroblastoma SH-SY5Y cells were treated with a peroxynitrite donor, SIN-1, or an inhibitor of complex I, rotenone. After the treatment, proteins modified with toxic aldehydes, 4-hydroxynonenal and acrolein, and containing nitrotyrosine were analyzed by immunoblotting. Particularly in mitochondrial fraction, the oxidized protein was characterized by two-dimensional immunoblotting. Most of the oxidized proteins were detected in subunits proteins of complex I. These results indicate that mitochondrial complex I is a main target of oxidative stress in dopamine neurons and its dysfunction may be involved in the death mechanism in neurodegenerative disorders. [source] L -NAME reverses quinolinic acid-induced toxicity in rat corticostriatal slices: Involvement of src family kinasesJOURNAL OF NEUROSCIENCE RESEARCH, Issue 12 2007Cinzia Mallozzi Abstract Quinolinic acid (QA) is an endogenous excitotoxin acting on N -methyl- d -aspartate receptors (NMDARs) that leads to the pathologic and neurochemical features similar to those observed in Huntington's disease (HD). The mechanism of QA toxicity also involves free radicals formation and oxidative stress. NMDARs are particularly vulnerable to the action of reactive oxygen species (ROS) and reactive nitrogen species (RNS) that can act as modulators of the activity of protein tyrosine kinases (PTKs) and phosphotyrosine phosphatases (PTPs). Because QA is able to activate neuronal nitric oxide synthase (nNOS) as well as to stimulate the NMDARs, we evaluated the effect of N,-Nitro- l -arginine-methyl ester (l -NAME), a selective nNOS inhibitor, on QA-induced neurotoxicity in rat corticostriatal slices. In electrophysiologic experiments we observed that slice perfusion with QA induced a strong reduction of field potential (FP) amplitude, followed by a partial recovery at the end of the QA washout. In the presence of l -NAME the recovery of FP amplitude was significantly increased with respect to QA alone. In synaptosomes, prepared from corticostriatal slices after the electrophysiologic recordings, we observed that l -NAME pre-incubation reversed the QA-mediated inhibitory effects on protein tyrosine phosphorylation pattern, c-src, lyn, and fyn kinase activities and tyrosine phosphorylation of NMDAR subunit NR2B, whereas the PTP activity was not recovered in the presence of l -NAME. These findings suggest that NO plays a key role in the molecular mechanisms of QA-mediated excitotoxicity in experimental model of HD. © 2007 Wiley-Liss, Inc. [source] Trigeminal nerve repetitive stimulation in myasthenia gravisMUSCLE AND NERVE, Issue 4 2004Devon I. Rubin MD Abstract The aim of this study was to evaluate the utility of repetitive nerve stimulation (RNS) of the trigeminal nerve in assessing patients with myasthenia gravis (MG). In 26 normal controls and 21 patients with myasthenia gravis (MG), 2-Hz repetitive stimulation of the trigeminal nerve was performed using a monopolar needle for percutaneous nerve stimulation and recording over the surface of the masseter. In the MG patients, repetitive stimulation of the ulnar, spinal accessory, and facial nerves was also performed. The mean percent decrement in the compound muscle action potential (CMAP) amplitude among the different nerves at rest were: ulnar, 4.3%; spinal accessory, 10.1%; facial, 14%; and trigeminal, 17.3%. The facial nerve demonstrated abnormal decrement in 57% of all patients, compared with the spinal accessory (48%), trigeminal (43%), and ulnar (20%) nerves. All patients tolerated trigeminal RNS better than or as well as facial RNS. The study demonstrates that trigeminal RNS is a safe, reliable, efficient, and well-tolerated technique that provides another cranial nerve,muscle combination that can be used to supplement repetitive stimulation of other limb or cranial nerves in the evaluation of patients with bulbar or generalized MG. Muscle Nerve 29: 591,596, 2004 [source] Decrement in area of muscle responses to repetitive nerve stimulationMUSCLE AND NERVE, Issue 4 2003Y.L. Lo MD Abstract Measurement of the decremental muscle response to repetitive nerve stimulation (RNS) has low yields for the diagnosis of neuromuscular transmission defects compared with single fiber electromyography (SFEMG). We compared area and amplitude of muscle responses to RNS in 87 patients and 30 controls, using SFEMG as the reference standard. Decrement of response area provided additional diagnostic yields of 5.3% to 30% depending on the muscle examined and disease severity, and is recommended as a diagnostic adjunct to measurement of amplitude decrement during RNS. Muscle Nerve 27: 494,496, 2003 [source] The in vitro effects of melatonin on human sperm function and its scavenging activities on NO and ROSANDROLOGIA, Issue 2 2010S. S. Du Plessis Summary Various systems of antioxidants exist endogenously in the body to help protect it against free radical damage by scavenging excessive ROS and RNS. Melatonin, a hormone secreted by the pineal gland, and responsible for controlling the circadian rhythm, is one such endogenous antioxidant. Melatonin has been reported to be present in human seminal fluid, but its antioxidant activities in semen are rather contradictory. This study aimed at establishing the effects of melatonin treatment on human spermatozoa. Spermatozoa were incubated with 2 mm melatonin (120 min, 37 °C, 5% CO2) after which motility parameters were measured by computer aided motility analysis, while cell viability (PI), intracellular NO (DAF-2/DA) and ROS (DCFH-DA) were assessed using flow cytometry. In vitro melatonin treated samples (n = 12) showed a significantly higher percentage of motile, progressive motile and rapid cells, while simultaneously reducing the number of nonviable spermatozoa when compared with the control. Endogenous NO was significantly decreased, but no effect was observed on ROS levels. From these results, it can be concluded that melatonin was able to directly or indirectly scavenge NO, as indicated by the reduction in 4,5-diaminofluorescein-2/diacetate fluorescence. Future studies will indicate whether melatonin treatment during sperm preparation techniques could protect spermatozoa from excessive NO production. [source] Striking Inflammation from Both Sides: Manganese(II) Pentaazamacrocyclic SOD Mimics Act Also as Nitric Oxide Dismutases: A Single-Cell Study,ANGEWANDTE CHEMIE, Issue 25 2010Beseitigung von Zellgiften: Ein MnII -Pentaazamakrocyclus kann NO., O2., und Produkt ONOO, abfangen, wie Echtzeit-Amperometrie an einzelnen Zellen zeigt. Der Komplex (siehe Struktur) ist die erste Verbindung, die die zytotoxische Wirkung von reaktiven Sauerstoff- (ROS) und Stickstoffspezies (RNS), wie sie in Entzündungsreaktionen auftreten, komplett unterdrücken kann. [source] Effect of plant active compounds on immune response and disease resistance in Cirrhina mrigala infected with fungal fish pathogen, Aphanomyces invadansAQUACULTURE RESEARCH, Issue 10 2009Ramasamy Harikrishnan Abstract The antibacterial activity of individual and mixed medicinal plant compounds, azadirachtin (Az), camphor (Ca) and curcumin (Cu), was tested at 100, 200, 300, 400, 500, 600 and 700 ppm (mg L,1) against fungal fish pathogen, Aphanomyces invadans, in vitro. At the lower concentrations between 100 and 300 ppm, the mixture of the tri-herbal (Az+Ca+Cu) compound yielded a higher (P>0.05) zone of inhibition (ZI) of 7 mm than the positive control; the maximum ZI values (8,15 mm) were realized between 400 and 700 ppm (P<0.05). At the lowest minimum inhibitory concentration (MIC) the tri-herbal compound (100 ppm) yielded 13 colony-forming units; hence, this dose can be effectively used at the lowest concentration of 100 mg L,1 to ward off the growth of A. invadans in vitro. In Cirrhina mrigala, intramuscular administration (100 ,L) of the selected doses of 100, 400 and 700 ppm (mg L,1) significantly enhanced (P<0.05) the serum lysozyme activity (Ly), production of reactive oxygen species and reactive nitrogen species (RNS or NO) by peripheral blood leucocytes on the 10th, 20th and 30th day. A priori administration of the compound in the fish (100 ppm on 30th day) decreased the percentage mortality when challenged with the pathogen while in the untreated group the mortality increased (P<0.05). This study indicates that intramuscular administration of the tri-herbal compound Az+Ca+Cu at a concentration of 100 ppm could augment the immune response in C. mrigala against A. invadans. [source] Monozygous twins with neuromuscular transmission defects at opposite sides of the motor endplateACTA NEUROLOGICA SCANDINAVICA, Issue 3 2009A. R. Punga Disorders affecting the postsynaptic side of the neuromuscular junction include autoimmune myasthenia gravis (MG) as well as some of the congenital myasthenic syndromes (CMS). Lambert-Eaton myasthenic syndrome (LEMS) is an acquired autoimmune neuromuscular disorder in which autoantibodies are directed against the presynaptic calcium channels. Here we describe two monozygous twin brothers: case 1 was diagnosed with an indeterminate form of acquired postsynaptic neuromuscular junction defect at age 32 and case 2 with LEMS at age 47. Case 1 presented clinically with mild generalized myasthenic weakness, neurophysiological examination revealed disturbed neuromuscular transmission along with probable myositis and serum analysis regarding antibodies against the acetylcholine receptor and muscle-specific tyrosine kinase was negative. Case 2 presented with proximal muscle fatigue accompanied by areflexia at rest and antibodies against the P/Q-type voltage-gated calcium channels were present. Neurophysiologically, case 2 had reduced baseline compound motor action potential amplitudes on neurography, decrement on low-frequency repetitive nerve stimulation (RNS) and pathological increment on high frequency RNS. To our knowledge this is the first case report of its kind and adds an intriguing contrast to the more common diagnosis of CMS in monozygous twins. [source] 2223: Carbon monoxide as a mediator in the retinaACTA OPHTHALMOLOGICA, Issue 2010C BUCOLO Purpose Carbonic monoxide (CO) is organic gas ubiquitously synthesized in mammalian tissues by enzyme that has constitutive and inducible forms. This gas is produced as metabolic end-product in specific cell life phases, and may acts as atypical neuronal messenger. Evidence has recently accumulated suggesting that CO may be cytoprotective because its bioactions, including inhibition of apoptosis, platelet aggregation, complement activation, and inflammatory cytokine production. CO appears to be important to counteract the cytotoxicity caused by excessive production of reactive oxygen (ROS) and nitrogen (RNS) species. Methods In vitro and in vivo models. Results Induction of heme oxygenase (HO)-1 by hemin has been found to prevent retinal cell death after ischemia provoked by ocular hypertension in rats. The LPS-induced expression of pro-inflammatory cytokines, in rat eye, is also inhibited by CO. Interestingly, drugs active as inhibitors of iNOS block CO-induced increases in cGMP in the retina.Drugs inhibiting NO formation by acting on iNOS activity have been found to potently reduce intraocular pressure. Studies from our lab showed that an increase of CO availability by hemin or carbon monoxide-releasing molecules lower the intraocular pressure, suggesting a suppress action of iNOS-derived NO production. Conclusion A better understanding of CO regulation may lead to new therapeutic options that are safer and more efficacious than currently available treatments for various sight-threatening eye diseases, such as retinal degenerations. [source] Home clinic programme: An alternative model for private mental health facilities and sufferers of major depressionINTERNATIONAL JOURNAL OF MENTAL HEALTH NURSING, Issue 1 2006Eddie Blacklock ABSTRACT:, Depression demands high emotional and social costs to people suffering it while private hospitals and health funds are economically affected in respect to elongated episodes of care and readmission rates. There is a dearth of nurse-led initiatives aimed to reduce length of stay. An innovative model of care is proposed, offering the opportunity for depressed clients to return home earlier from hospital where they will receive the professional guidance and support of mental health registered nurses (RNs) providing contemporary counselling. Clinical links between the home and the hospital would be maintained by the RNs for a specified time frame. The framework of home clinic programme is to discharge clients from hospital into community within specified time frame (maximum 14 days hospitalization) and the clients will be visited by RNs in their homes five times in the first week, twice in the second week and once in the third week to ascertain their emotional and clinical needs and provide biopsychosocial support. The use of this model has potential benefits for mental health consumers, clinicians, services, and funders. [source] Determining Critical Incident Nursing Interventions for the Critical Care Setting: A Pilot StudyINTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 3 2009Elizabeth Wong CRNA PURPOSE., The purpose of this research survey was to determine which Adult Critical Care Core Nursing Interventions (ACCCNIs) in the Nursing Interventions Classification constitutes a critical incident nursing intervention (CINI). A CINI is defined as any indirect or direct care registered nurse (RN)-initiated treatment performed in response to a life-threatening nursing diagnosis. METHODS., A list of ACCCNIs were sent to 50 critical care RNs in two survey rounds. Responses >80% for each ACCCNI was determined to be a CINI. FINDINGS., Forty-one ACCCNIs were determined to be CINIs. CONCLUSIONS., It is recommended that CINIs be included as a separate Nursing Intervention Classification category to reflect current nursing practice. IMPLICATIONS FOR NURSING PRACTICE., CINIs can enhance RN competency, education, and vigilance, thereby preventing or decreasing the number of deaths that occur from critical incidents. [source] Quality of Nursing Diagnoses: Evaluation of an Educational InterventionINTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 2 2005Jan Florin RN PURPOSE.,To investigate the effects on the quality of nursing diagnostic statements in patient records after education in the nursing process and implementation of new forms for recording. METHODS.,Quasi-experimental design. Randomly selected patient records reviewed before and after intervention from one experimental unit (n = 70) and three control units (n = 70). A scale with 14 characteristics pertaining to nursing diagnoses was developed and used together with the instrument (CAT-CH-ING) for record review. FINDINGS.,Quality of nursing diagnostic statements improved in the experimental unit, whereas no improvement was found in the control units. Serious flaws in the use of the etiology component were found. CONCLUSION.,Nurses must be more concerned with the accuracy and quality of the nursing diagnoses and the etiology component needs to be given special attention. PRACTICE IMPLICATIONS.,Education of RNs in nursing diagnostic statements and peer review using standardized evaluation instruments can be means to further enhance RNs' documentation practice. [source] Acculturation and socialization: voices of internationally educated nurses in OntarioINTERNATIONAL NURSING REVIEW, Issue 2 2007A. Sochan rn Background:, This paper describes a study that explores the experiences of internationally educated nurses (IENs) in their efforts to gain entry to practice as Registered Nurses (RNs) in the province of Ontario, Canada. Aim:, The aim was to uncover, in part, the issues related to professional nursing credentialling. Methods:, This study was guided by a biographical narrative (qualitative) research methodology. A convenience sample of 12 IEN students volunteered for this study representing the Philippines, Mainland China, Korea, Ukraine and India. Findings:, The findings were that the IENs progress through a three-phase journey in their quest for licensure in Ontario. These phases include: (1) hope , wanting the Canadian dream of becoming an RN in Ontario; (2) disillusionment , discovering that their home-country nursing qualifications do not meet Ontario RN entry to practice; and (3) navigating disillusionment , living the redefined Canadian dream by returning to nursing school to upgrade their nursing qualifications. Conclusions:, Professional regulatory nursing bodies and nursing educators, as well as practising nurses, must be aware of the potentially confusing and unpleasant processes IENs go through as they qualify for the privilege of practising nursing in Ontario. [source] Two approaches to nursing: a study of Iranian nursesINTERNATIONAL NURSING REVIEW, Issue 2 2007A. Emami rn Background:, Studying nurses' experience from a sociocultural perspective can contribute to improving knowledge and understanding in this field. Purpose:, To describe and compare three different groups of Iranian nurses' experiences of their profession. Methods:, The study was conducted in Iran and Sweden. The data were collected from semi-structured telephone interviews and analysed with latent content analysis. The participants were three groups of registered nurses (RNs) (21 persons). All RNs were born and grew up in Iran. The first group (A) were educated and had worked in Iran but were now working and living in Sweden. The second group (B) were educated and worked in Sweden. The third group (C) were educated and worked in Iran. Findings:, The nurses in Sweden worked with a patient-orientated approach while nurses in Iran worked with a task-orientated approach. Nurses in all three groups explained that they suffered from stress, had a heavy workload, were underpaid and understaffed. The findings showed that RNs working with a patient-orientated approach, experienced work satisfaction to a greater extent than RNs working with a task-orientated approach, although other aspects also influenced the nurses' situation considerably. [source] Reflection, the way to professional development?JOURNAL OF CLINICAL NURSING, Issue 3 2004Christine Gustafsson MA Background., Many studies have focused on reflection and the advantages that can be gained from the practice of reflection among Registered Nurses (RNs) but, what are the implications of the nurses' reflections, what do they reflect about, and how do they deal with their reflections? Aims and objectives., The aim of this study was to describe the RNs' experiences of reflection in relation to nursing care situations, and to understand how RNs use reflection in their daily work. What are the implications of the nursing care situations that the RNs' reflect upon? What consequences did the practice of reflection have in nursing care situations in relation to the RNs professional development? Design and method., The study was carried out with interviews and the phenomenographic method. Interviews were carried out with four RNs. The choice of informants was made with purposive sampling with the aim of finding informants who could bring the kind of knowledge that was necessary for the study. Results., The qualitative differences regarding the RNs' experiences of reflection were categorized as follows: to reflect (to think back , consider, mirroring, to reflect before and reflect after, to use experiences), nursing care situations (ethical considerations, to have courage, to use one's imagination, empathy) and consequences (to meet the unique, empathy, development). Finally, the findings were implicated in the model of professional development. Conclusion., By using reflection as a tool, many advantages can be gained in the development of nursing care. Encouraging RNs to reflect upon nursing situations, in order to promote the nurse's professional development, will imply better nursing care for the patients. The model for professional development implies a simplified representation of the thoughts pertaining to professional nursing development. Relevance to clinical practice., The relevance for clinical practice will be to understand the contents of the RNs reflections, to recognize the advantages of reflective practice and how and when to use such measures. Furthermore, to show how the model for professional development can be used in order to create a framework for evaluating these observations and consequently, for expressing tacit knowledge. [source] Clinical group supervision in an intensive care unit: a space for relief, and for sharing emotions and experiences of careJOURNAL OF CLINICAL NURSING, Issue 6 2002Berit Lindahl MSc Summary , ,Much has been written about models, aims and the concept of clinical group supervisional, although few studies are empirical or focus on intensive care. , ,The aim of the study was to illuminate the process and describe, using qualitative content analysis, the content of conversations carried out during the course of clinical group supervision sessions among Registered Nurses (RN) and enrolled nurses (EN) working in an intensive care unit (ICU). , ,During the supervision sessions, ENs talked about their life-world from a caring perspective, while RNs focused on their professional development. Both ENs and RNs regarded the supervision sessions as a space for relief and for sharing emotions and caring experiences, which helped to manage complex nursing care. , ,The findings are viewed in the light of Roach's theoretical framework describing the attributes of professional care as five Cs. Clinical group supervision is interpreted as supportive in developing interpersonal skills and a sensitive nursing practice. [source] Home alone: Assessing mobility independence before discharge,,§¶JOURNAL OF HOSPITAL MEDICINE, Issue 4 2009Dennis M. Manning MD, FACC Abstract Hospitalists are often confronted with discharge planning responsibility and decisions for elderly patients who live alone. The absence of an in-home helper (spouse, partner, or care-giver) reduces the margin of safety and resilience to any new debility. Research has documented that during hospital stays elderly patients tend to become deconditioned, even if there is no new specific neurologic or motor deficit. In the patient whose pre-hospital mobility independence is not robust, and perhaps marginally compensated, inpatient stays for any diagnosis may result in critical decrements in mobility independence. The present study is an effort to design a bedside tool for the hospitalist by which to discern, or screen, for such debility. The tool is a hierarchical performance test we named I-MOVE (Independent Mobility Validation Examination). It is a quick series of bedside mobility requests to demonstrate capability of fundamental movements critical to independent living. We describe manner in which I-MOVE can be performed. Moreover, we describe the face validity and the high interrater reliability (> 0.90 intra-class correlation coefficient) of two RNs who independently administered and scored I-MOVE for 41 patients on a General Medical Care Unit. Although not yet studied in correlation with outcomes, nor with validated mobility assessment tools, we believe I-MOVE can serve as a useful extension of the nurse's assessment, or the Hospitalist's physical examination. Discerning the continued capability of mobility independence is a desirable, on-going insight for discharge planning of the elderly patient who resides alone. Journal of Hospital Medicine 2009;4:252,254. © 2009 Society of Hospital Medicine. [source] Disordered eating and job stress among nursesJOURNAL OF NURSING MANAGEMENT, Issue 7 2009CHES, KEITH A. KING PhD Aim, The purpose of this study was to examine disordered eating behaviours among nurses in the state of Ohio. Background, Individuals involved in disordered eating tend to report more frequent and higher levels of perceived stress than their counterparts. As nurses regularly perform stressful roles and responsibilities within a high-stress environment, this group may be at elevated risk of disordered eating. Method, A 65-item survey was mailed to a random sample of 1000 nurses in the state of Ohio. Results, A total of 435 nurses (47%) returned completed surveys. Most (93%) were registered nurses (RNs) and 87% were over 31 years old. Results indicated that disordered eating differed significantly based on perceived job stress and perceived body satisfaction. Nurses with high levels of perceived job stress and low levels of body satisfaction had higher disordered eating involvement. Conclusions, Nurses reporting high levels of job stress are at increased risk of disordered eating behaviours. Recommendations for future research are offered. Implications for nursing management, Employee wellness programmes should be developed that educate and support nurses to make healthy lifestyle choices. [source] A survey-based exploration of the impact of dyslexia on career progression of UK registered nursesJOURNAL OF NURSING MANAGEMENT, Issue 1 2007DAVID MORRIS MSc RGN RCNT RNT DipN CertEd Aim, To explore the effects of dyslexia on the practice and career progression of UK registered nurses (RN). Background, Literature suggests dyslexia can have a negative impact in the workplace and may pose particular difficulties for nurses, where accuracy in information processing activities is essential for practice. Methods, A questionnaire was used to survey RNs with dyslexia (n = 116) and results analysed using content analysis. Findings, Dyslexia provided a challenge to the everyday work of RNs, which was often met successfully using a range of individualized strategies. Career progression was achievable but compared with peers, was perceived to take longer. Disclosure of dyslexia to work-colleagues was selective and dependent on the perceived benefits. Informal support mechanisms were commonly utilized with formal management support less well defined. Conclusion, Dyslexia appears to have a negative impact on working practices and career progression, but remains a poorly understood and often hidden disability. [source] HEALTH POLICY AND SYSTEMS: Critical Thinking of Nurse Managers Related to Staff RNs' Perceptions of the Practice EnvironmentJOURNAL OF NURSING SCHOLARSHIP, Issue 3 2010NEA-BC, Susan Zori RN Abstract Background Information and Significance: Critical thinking (CT) skills and the inclination to engage in critical thinking are essential for nurse managers to function as transformational leaders capable of influencing staff to align with organizational goals. In an extensive literature review, numerous studies were found examining the concept of CT in students and no studies were found exploring CT in nurse managers. Identifying the attributes, such as CT, that lead to success in the nurse manager role is useful when preparing nurse managers to lead effectively in the current healthcare climate. Research Question: Is there a difference between nurse managers' CT dispositions and their respective staff nurses' perceptions of the practice environment? Design: A convenience sample of 12 nurse managers and a random sample of 132 of their respective staff registered nurses (RNs) participated in this descriptive study. CT in nurse managers was measured by the California Critical Thinking Disposition Inventory (CCTDI). Staff RNs' perceptions of the practice environment were measured by the Practice Environment Scale (PES). The research question was answered using a t test. Findings: Significant (p < .001) differences were found between specific nurse managers' CCTDI scores for open-mindedness, analyticity, and critical thinking confidence, and significant differences (p < .01) were found for systematicity when compared with their respective staff RNs' mean subscale and overall PES scores. Conclusions: Results of the study support the positive relationship between strength in critical thinking dispositions of nurse managers and their respective staff RNs' perceptions of the practice environment. Nurse managers with stronger CT dispositions may be better able to create positive practice environments that are conducive to job satisfaction and thus the retention of staff RNs. Inclusion of strategies to support the development and use of CT in nurse managers is recommended. CT and other leadership attributes and skills including emotional and social intelligence and management of change through an appreciative inquiry process may provide opportunities to improve leadership effectiveness in nurse managers. Clinical Relevance: Enhancing critical thinking skills and dispositions of nurse managers may help to create positive work environments for staff RNs. Staff RNs who work in an environment perceived to be positive may be in a better position to deliver high quality, safe patient care. [source] Case Management Workforce in the United StatesJOURNAL OF NURSING SCHOLARSHIP, Issue 2 2009Eun-Jun Park RN Abstract Purpose: The purpose of this study was to investigate and compare characteristics of the case management (CM) workforce in the US by age, years of experience, and original profession. Design: This study was an exploratory, descriptive secondary analysis of demographic and job characteristics of 24,085 certified case managers (CCMs). Methods: Descriptive statistics, Chi-square tests, and correlation coefficients were calculated. Findings: The majority of the case-management workforce is made up of RNs (93.3%). The CCMs were older, with a mean age of 55.0 years, than were those in their original profession and started to work as CCMs late in their careers. The educational level of RN-CCMs was lower than that of CCMs from other professions. Also, job titles and work settings of CCMs were diverse, with different focus areas depending on clients' needs. The distribution of CCMs was associated with the number of managed-care enrollees. Conclusions: Profiles of CCMs in this study are valuable for clinical practice and can assist with deployment of the CM workforce. Clinical Relevance: To develop and deploy CCMs better matched to societal healthcare needs, characteristics of CCMs should be precisely understood. Managing the CM workforce is expected to be critical because of a shortage of RN workers and aging-of-the-workforce issues in the US. [source] International Experts' Perspectives on the State of the Nurse Staffing and Patient Outcomes LiteratureJOURNAL OF NURSING SCHOLARSHIP, Issue 4 2007Koen Van den Heede Purpose: To assess the key variables used in research on nurse staffing and patient outcomes from the perspective of an international panel. Design: A Delphi survey (November 2005-February 2006) of a purposively-selected expert panel from 10 countries consisting of 24 researchers specializing in nurse staffing and quality of health care and 8 nurse administrators. Methods: Each participant was sent by e-mail an up-to-date review of all evidence related to 39 patient-outcome, 14 nurse-staffing and 31 background variables and asked to rate the importance/usefulness of each variable for research on nurse staffing and patient outcomes. In two subsequent rounds the group median, mode, frequencies, and earlier responses were sent to each respondent. Findings: Twenty-nine participants responded to the first round (90.6%), of whom 28 (87.5%) responded to the second round. The Delphi panel generated 7 patient-outcome, 2 nurse-staffing and 12 background variables in the first round, not well-investigated in previous research, to be added to the list. At the end of the second round the predefined level of consensus (85%) was reached for 32 patient outcomes, 10 nurse staffing measures and 29 background variables. The highest consensus levels regarding measure sensitivity to nurse staffing were found for nurse perceived quality of care, patient satisfaction and pain, and the lowest for renal failure, cardiac failure, and central nervous system complications. Nursing Hours per Patient Day received the highest consensus score as a valid measure of the number of nursing staff. As a skill mix variable the proportion of RNs to total nursing staff achieved the highest consensus level. Both age and comorbidities were rated as important background variables by all the respondents. Conclusions: These results provide a snapshot of the state of the science on nurse-staffing and patient-outcomes research as of 2005. The results portray an area of nursing science in evolution and an understanding of the connections between human resource issues and healthcare quality based on both empirical findings and opinion. [source] | |||||||||||||||||||||||||||||||