Dietary modifications for infantile colic

Infantile colic can be defined as periods of inconsolable, unexplained, and incessant crying in a seemingly healthy infant that, quite understandably, leads to exhausted, frustrated, and concerned parents seeking to comfort their child (Landgren 2010). The prevalence of excessive crying varies according to the definition used although, most often, it peaks during the second month of life,with a prevalence of 1.5%to 11.9%(Reijneveld 2001).Traditionally, the definition of the condition was based on the rule of three (Wessel 1954): that is, unexplained episodes of paroxysmal crying for more than three hours per day, for three days per week, for at least three weeks. More recently a new definition has been proposed. It refers to a clinical condition of fussing and crying for at least one week in an otherwise healthy infant (Hyman 2006). Colic can be graded as mild, moderate, or severe, though there is no consensus for this classification. Colic can affect up to 10% to 30% of infants worldwide (Clifford 2002; Rosen 2007)

Symptom-Level Description of Nursing Perceptions About Unwarranted Clinical Variation, Inequality in Access to Cancer Services, Specific-Symptom Knowledge: An Italian Web-Based Survey

Objectives: This study aimed to describe the cancer nurses’ views regarding the relevance of cancer symptom-specific knowledge, unwarranted clinical variation, and inequities in access to cancer services. Describing how nurses perceive these aspects could help identify research priorities and a practical framework to prioritize clinical practice guidelines. Data Sources: A web-based survey was performed using a convenience sample of 810 nurses employed in cancer settings and cross-sectional data collection. The survey adopted a previously validated questionnaire investigating 14 symptoms. Conclusion: This study revealed which cancer symptoms require priority attention to define evidence-grounded guidance for decreasing unwarranted clinical variation and inequities in access to cancer services. Future multiprofessional and multinational studies are recommended to provide an in-depth description of the investigated phenomena. Implications for Nursing Practice: Participants reported higher mean scores in pain-specific knowledge than other symptoms. Social functioning alterations and psychological disorders seem to be highly susceptible to unwarranted clinical variation and inequities in access to cancer services. This information could drive tailored interventions to improve nursing practice

Crafting strategic thinking: Creative pedagogy for management studies

This paper presents a format from the creative arts, refocused for application in management studies, as a method to enhance and support the development of strategic thinking. It involves the application of multi-page paper constructions (zines) within facilitated sessions to enhance imaginative strategic thinking by both management learners and practitioners. It draws on a longitudinal case study of the six-phase evolution of affordances of a zine as a method for reflective, creative and connected thinking. The focus moves from purely personal private reflections to the possibility of deploying zines for collective reflection and action. Specific examples are provided of zine workshops and events. Strategic thinking relates to volatility, uncertainty, complexity and ambiguity (VUCA). The affordances of zines relating to tangibility, efficiency and mental processes appear well-suited to a VUCA context. The paper concludes with reflections on the nature of multi-disciplinary and trans-disciplinary collaborations such as this one

The Role of Professional Competency in Influencing Job Satisfaction and Organizational Citizenship Behaviour among Palliative Care Nurses

It is crucial that palliative care nurses feel competent to practice their profession in accordance with ethical principles, to personalise care, to remain sensitive, to ensure respect, and to communicate effectively. The aim of this study was to verify that higher levels of perceived professional competency predict better individual and organizational outcomes, such as job satisfaction (JS) and organizational citizenship behaviour (OCB). METHOD: An online cross-sectional survey was conducted with 107 Italian palliative care nurses. Structural equation modelling technique was employed for data analysis. RESULTS: The model fitted the data well: χ2 = 33.50 p = 0.12, CFI = 0.98, TLI = 0.97, RMSEA = 0.06, SRMR = 0.04. Professional competency was positively associated with both JS (β = 0.39) and OCB (β = 0.53). SIGNIFICANCE OF RESULTS: The more confidence palliative care nurses have in their professional competency, the more they are satisfied with their job and engage in OCB. Fostering professional competency in palliative nursing can help not only patients and their families, but also the nurses themselves, the organisation, and their co-workers

Pain-relieving agents for infantile colic

Background: Infantile colic is a common disorder in the first months of life, affecting somewhere between 4% and 28% of infants worldwide, depending on geography and definitions used. Although it is self limiting and resolves by four months of age, colic is perceived by parents as a problem that requires action. Pain-relieving agents, such as drugs, sugars and herbal remedies, have been suggested as interventions to reduce crying episodes and severity of symptoms. Objectives: To assess the effectiveness and safety of pain-relieving agents for reducing colic in infants younger than four months of age. Search methods: We searched the following databases in March 2015 and again in May 2016: CENTRAL, Ovid MEDLINE, Embase and PsycINFO, along with 11 other databases. We also searched two trial registers, four thesis repositories and the reference lists of relevant studies to identify unpublished and ongoing studies. Selection criteria: We included randomised controlled trials (RCTs) and quasi-RCTs evaluating the effects of pain-relieving agents given to infants with colic. Data collection and analysis: We used the standard methodological procedures of The Cochrane Collaboration. Main results: We included 18 RCTs involving 1014 infants. All studies were small and at high risk of bias, often presenting major shortcomings across multiple design factors (e.g. selection, performance, attrition, lack of washout period). Three studies compared simethicone with placebo, and one with Mentha piperita; four studies compared herbal agents with placebo; two compared sucrose or glucose with placebo; five compared dicyclomine with placebo; and two compared cimetropium - one against placebo and the other at two different dosages. One multiple-arm study compared sucrose and herbal tea versus no treatment. Simethicone. Comparison with placebo revealed no difference in daily hours of crying reported for simethicone at the end of treatment in one small, low-quality study involving 27 infants. A meta-analysis of data from two cross-over studies comparing simethicone with placebo showed no difference in the number of of infants who responded positively to treatment (risk ratio (RR) 0.95, 95% confidence interval (CI) 0.73 to 1.23; 110 infants, low-quality evidence). One small study (30 participants) compared simethicone with Mentha piperita and found no difference in crying duration, number of crying episodes or number of responders. Herbal agents. We found low-quality evidence suggesting that herbal agents reduce the duration of crying compared with placebo (mean difference (MD) 1.33, 95% CI 0.71 to 1.96; three studies, 279 infants), with different magnitude of benefit noted across studies (I2 = 96%). We found moderate-quality evidence indicating that herbal agents increase response over placebo (RR 2.05, 95% CI 1.56 to 2.70; three studies, 277 infants). Sucrose. One very low-quality study involving 35 infants reported that sucrose reduced hours spent crying compared with placebo (MD 1.72, 95% CI 1.38 to 2.06). Dicyclomine. We could consider only one of the five studies of dicyclomine (48 infants) for the primary comparison. In this study, more of the infants given dicyclomine responded than than those given placebo (RR 2.50, 95% CI 1.17 to 5.34). Cimetropium bromide. Data from one very low-quality study comparing cimetropium bromide with placebo showed reduced crying duration among infants treated with cimetropium bromide (MD -30.20 minutes per crisis, 95% CI -39.51 to -20.89; 86 infants). The same study reported that cimetropium increased the number of responders (RR 2.29, 95% CI 1.44 to 3.64). No serious adverse events were reported for all of the agents considered, with the exception of dicyclomine, for which two of five studies reported relevant adverse effects (longer sleep 4%, wide-eyed state 4%, drowsiness 13%). Authors' conclusions: At the present time, evidence of the effectiveness of pain-relieving agents for the treatment of infantile colic is sparse and prone to bias. The few available studies included small sample sizes, and most had serious limitations. Benefits, when reported, were inconsistent. We found no evidence to support the use of simethicone as a pain-relieving agent for infantile colic. Available evidence shows that herbal agents, sugar, dicyclomine and cimetropium bromide cannot be recommended for infants with colic. Investigators must conduct RCTs using standardised measures that allow comparisons among pain-relieving agents and pooling of results across studies. Parents, who most often provide the intervention and assess the outcome, should always be blinded

CSF/serum matrix metallopeptidase-9 ratio discriminates neuro Behcet from multiple sclerosis

In neuro Behcet disease with multiple sclerosis-like features, diagnosis could be challenging. Here, we studied the cerebrospinal fluid and serum inflammatory profile of 11 neuro Behcet and 21 relapsing-remitting multiple sclerosis patients. Between the soluble factors analyzed (MMP9, TNF, IL6, CXCL13, CXCL10, CXCL8, IFN, IL10, IL17, IL23, and others) we found MMP9 increased in neuro Behcet serum compared to multiple sclerosis and decreased in cerebrospinal fluid. Furthermore, neuro Behcet analysis of circulating natural killer CD56(DIM) subset suggests their potential involvement in increased MMP9 production. We believe that these findings may have a translational utility in clinical practice

Inhibition of Immune Synapse by Altered Dendritic Cell Actin Distribution: A New Pathway of Mesenchymal Stem Cell Immune Regulation

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A bottom-up approach to prioritize the scientific activities of Italian Association of Cancer Nurses (AIIAO): Questionnaire validation and pilot study

Introduction. There are no national data aimed to describe nurses' perception of variability in delivering nursing activities in relation to best practice and inequality in receiving nursing care. Moreover, there are no validated tools to be used in research. Therefore, the aims of this study are: a) to develop and validate a questionnaire to describe nurses' perceptions of variability and inequality in the oncology setting; b) to test content and face validity; c) to provide preliminary data (pilot study) to plan strategies for future national studies. Material and methods. This is a multi-phase and multi-method study. Phase 1 is focused on questionnaire's development (i.e., literature review and consensus discussion); phase 2 is aimed to determine content and face validity of the questionnaire; and phase 3 was a pilot data collection through an on-line survey. Results. The questionnaire that was developed yielded an adequate content and face validity (S-CVI=0.89 and CVR >0.60 for all items). The pilot study (75 nurses) found that nurse participants perceived as the most relevant categories pain and gastrointestinal and oral cavity dysfunctions. Fatigue, impairments of social function and psychological disorders were the areas in which greater variability and inequalities in receiving nursing care emerged. Overall, more than 50% of nurses reported variability and inequalities in oncology symptom management (in the investigated categories). Conclusions. The study results support the content validity of the questionnaire that can thereby be used for pan-national investigations

GLP-1 Mediates Regulation of Colonic ACE2 Expression by the Bile Acid Receptor GPBAR1 in Inflammation

Background & Aims: ACE2, a carboxypeptidase that generates Ang-(1-7) from Ang II, is highly expressed in the lung, small intestine and colon. GPBAR1, is a G protein bile acid receptor that promotes the release of the insulinotropic factor glucagon-like peptide (GLP)-1 and attenuates intestinal inflammation. Methods: We investigated the expression of ACE2, GLP-1 and GPBAR1 in two cohorts of Crohn’s disease (CD) patients and three mouse models of colitis and Gpbar1−/− mice. Activation of GPBAR1 in these models and in vitro was achieved by BAR501, a selective GPBAR1 agonist. Results: In IBD patients, ACE2 mRNA expression was regulated in a site-specific manner in response to inflammation. While expression of ileal ACE2 mRNA was reduced, the colon expression was induced. Colon expression of ACE2 mRNA in IBD correlated with expression of TNF-α and GPBAR1. A positive correlation occurred between GCG and GPBAR1 in human samples and animal models of colitis. In these models, ACE2 mRNA expression was further upregulated by GPABR1 agonism and reversed by exendin-3, a GLP-1 receptor antagonist. In in vitro studies, liraglutide, a GLP-1 analogue, increased the expression of ACE2 in colon epithelial cells/macrophages co-cultures. Conclusions: ACE2 mRNA expression in the colon of IBD patients and rodent models of colitis is regulated in a TNF-α-and GLP-1-dependent manner. We have identified a GPBAR1/GLP-1 mechanism as a positive modulator of ACE2