The need for nursing instruction in patients receiving steroid pulse therapy for the treatment of autoimmune diseases and the effect of instruction on patient knowledge

<p>Abstract</p> <p>Background</p> <p>Many patients who receive steroid pulse therapy go home the same day or the day after steroid administration. Nursing instructions are important for improving patient knowledge related to their diseases and treatments, but the short hospital stay often prevents complete education and guidance regarding the given therapy. The purpose of this study was to investigate the need for nursing instruction in patients receiving steroid pulse therapy for the treatment of autoimmune diseases and the effect of instruction on patient knowledge of their disease and treatment.</p> <p>Methods</p> <p>Patients with systemic lupus erythematosus (SLE) and systemic sclerosis receiving steroid pulse therapy (N = 63) were recruited from a medical center in Taipei. A structured questionnaire was used for data collection before and after nursing instruction, and 1 week as well as 2 weeks after therapy. The need for nursing instruction and knowledge levels were validated using Cronbach's α reliability test.</p> <p>Results</p> <p>There was a significant difference (<it>P </it>< 0.001) in the need for nursing instruction among the 4 time points. There was a positive correlation between the need for nursing instruction and body weight change, frequency of treatment, and distress, but there was a negative correlation with knowledge level (β = -0.012, <it>P </it>= 0.003) regarding symptoms. The knowledge level of subjects after nursing instruction was significantly higher than before nursing instruction (80 ± 14.31 vs. 70.06 ± 17.23, <it>P </it>< 0.001).</p> <p>Conclusions</p> <p>This study indicates that nursing instruction is needed by patients receiving steroid pulse therapy, and that by designing and administering nursing instructions according to the priority of patient symptoms, nurses can improve patient knowledge related to their diseases and treatments. In addition, the need for nursing instruction can be affected by patient characteristics.</p

An ex-vivo Human Intestinal Model to Study Entamoeba histolytica Pathogenesis

Amoebiasis (a human intestinal infection affecting 50 million people every year) is caused by the protozoan parasite Entamoeba histolytica. To study the molecular mechanisms underlying human colon invasion by E. histolytica, we have set up an ex vivo human colon model to study the early steps in amoebiasis. Using scanning electron microscopy and histological analyses, we have established that E. histolytica caused the removal of the protective mucus coat during the first two hours of incubation, detached the enterocytes, and then penetrated into the lamina propria by following the crypts of Lieberkühn. Significant cell lysis (determined by the release of lactodehydrogenase) and inflammation (marked by the secretion of pro-inflammatory molecules such as interleukin 1 beta, interferon gamma, interleukin 6, interleukin 8 and tumour necrosis factor) were detected after four hours of incubation. Entamoeba dispar (a closely related non-pathogenic amoeba that also colonizes the human colon) was unable to invade colonic mucosa, lyse cells or induce an inflammatory response. We also examined the behaviour of trophozoites in which genes coding for known virulent factors (such as amoebapores, the Gal/GalNAc lectin and the cysteine protease 5 (CP-A5), which have major roles in cell death, adhesion (to target cells or mucus) and mucus degradation, respectively) were silenced, together with the corresponding tissue responses. Our data revealed that the signalling via the heavy chain Hgl2 or via the light chain Lgl1 of the Gal/GalNAc lectin is not essential to penetrate the human colonic mucosa. In addition, our study demonstrates that E. histolytica silenced for CP-A5 does not penetrate the colonic lamina propria and does not induce the host's pro-inflammatory cytokine secretion

Functional outcomes in symptomatic versus asymptomatic patients undergoing incisional hernia repair: Replacing one problem with another? A prospective cohort study in 1312 patients

Background: Incisional hernias can be associated with pain or discomfort. Surgical repair especially mesh reinforcement, may likewise induce pain. The primary objective was to assess the incidence of pain after hernia repair in patients with and without pre-operative pain or discomfort. The secondary objectives were to determine the preferred mesh type, mesh location and surgical technique in minimizing postoperative pain or discomfort. Materials and methods: A registry-based prospective cohort study was performed, including patients undergoing incisional hernia repair between September 2011 and May 2019. Patients with a minimum follow-up of 3–6 months were included. The incidence of hernia related pain and discomfort was recorded perioperatively. Results: A total of 1312 patients were included. Pre-operatively, 1091 (83%) patients reported pain or discomfort. After hernia repair, 961 (73%) patients did not report pain or discomfort (mean follow-up = 11.1 months). Of the pre-operative asymptomatic patients (n = 221), 44 (20%, moderate or severe pain: n = 14, 32%) reported pain or discomfort after mean follow-up of 10.5 months. Of those patients initially reporting pain or discomfort (n = 1091), 307 (28%, moderate or severe pain: n = 80, 26%) still reported pain or discomfort after a mean follow-up of 11.3 months postoperatively. Conclusion: In symptomatic incisional hernia patients, hernia related complaints may be resolved in the majority of cases undergoing surgical repair. In asymptomatic incisional hernia patients, pain or discomfort may be induced in a considerable number of patients due to surgical repair and one should be aware if this postoperative complication

Importance du parasitisme par des strongles gastro-intestinaux chez les chèvres laitières dans le Sud-Est de la France

National audienceParasitological and pathophysiological measurements were performed monthly in a nock of 120 grazing goats surveyed for 2 years in the south-east of The study provided additional information on epidemiology of trichostrongylosis of the digestive in dairy goats. It was also aimed at assessing the of various factors on the level of nematode infected their consequences on milk production. The infection was not influenced by the mode of grazing (rotational vs continuous). In contrast, host factors were identified which modulate the of parasitism. In the first grazing season, and particularly those in first lactation, excreted more eggs and hence contributed largely to pasture contamination. In addition, the goats within the flock with the highest level of milk produced were more severely infected. They were also more to the impact of parasitism on milk yield. The relevancy of the identification of these animals a nock as a major epidemiological risk for infection is discussed in relation with a possible targeted application of anthelmintic treatments.L’étude avait pour objectif de compléter les données sur l’épidémiologie des strongyloses gastrointestinales dans l’espèce caprine et de préciser l’influence relative de divers facteurs sur ce parasitisme et ses conséquences sur la production laitière. Plusieurs paramètres parasitologiques et physiopathologiques ont été mesurés dans un troupeau de 120 chèvres laitières au pâturage pendant deux ans. Les pics de parasitisme ont été observés en début d’automne et les genres dominants identifiés étaient Teladorsagia et Trichostrongylus. La conduite du troupeau selon un système de pâturage tournant ou continu n’a eu que peu d’influence sur les infestations par les nématodes. En revanche plusieurs facteurs de réceptivité de l’hôte ont été identifiés. Au cours des deux années, une excrétion d’œufs de parasites plus forte, entraînant une contamination accrue du pâturage, a été relevée dans deux groupes d’animaux au sein du troupeau : d’une part, chez les chèvres en première saison de pâturage et notamment les primipares ; d’autre part, chez les chèvres présentant le meilleur niveau de production de lait. Chez ces dernières, des répercussions physiopathologiques plus marquées du parasitisme ont aussi été notées, en particulier lors des pics d’excrétion d’œufs de strongles. Les implications de cette identification d’individus à risque parasitaire élevé dans le troupeau sur la possibilité d’application ciblée des traitements anthelminthiques sont discutées

Including a client sexual health pathway in a national youth mental health early intervention service--project rationale and implementation strategy

Young people have higher rates of sexually transmissible infections (STIs) than the general population. Research has shown that there is a clear link between emotional distress, depression, substance abuse and sexual risk taking behaviours in young people. ‘headspace’ is a youth mental health early intervention service operating in more than 55 locations around Australia. This setting is ideal for accessing troubled young people who are at risk of STIs and are unlikely to attend mainstream general practice services. In 2013, a partnership was formed between headspace National Office and Hunter New England Local Health District to develop a clear clinical pathway to ensure at-risk headspace clients received sexual health assessments, advice, appropriate treatment and referral as indicated. This article describes the implementation of the pathway at the national level and a control trial to measure its efficacy. Future work will involve providing sustainable sexual health training for headspace general practitioner and allied health professionals to supplement the roll-out of the pathway in headspace centres across Australia. Support will also be provided in adapting headspace environments to encourage service utilization by Aboriginal and Torres Strait Islander and gay, lesbian, bisexual, transsexual and intersex young people

Immunological surrogate parameters in a prognostic model for multi-organ failure and death

To assess the ability of clinical or biochemical parameters to predict outcome (survival or non-survival; severe or moderate/no complication) using multiple regression analyses