Invitation to the home of Mr. and Mrs. B.G. Humphreys

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Hepcidin and iron homeostasis during pregnancy.

Hepcidin is the master regulator of systemic iron bioavailability in humans. This review examines primary research articles that assessed hepcidin during pregnancy and postpartum and report its relationship to maternal and infant iron status and birth outcomes; areas for future research are also discussed. A systematic search of the databases Medline and Cumulative Index to Nursing and Allied Health returned 16 primary research articles including 10 human and six animal studies. Collectively, the results indicate that hepcidin is lower during pregnancy than in a non-pregnant state, presumably to ensure greater iron bioavailability to the mother and fetus. Pregnant women with undetectable serum hepcidin transferred a greater quantity of maternally ingested iron to their fetus compared to women with detectable hepcidin, indicating that maternal hepcidin in part determines the iron bioavailability to the fetus. However, inflammatory states, including preeclampsia, malaria infection, and obesity were associated with higher hepcidin during pregnancy compared to healthy controls, suggesting that maternal and fetal iron bioavailability could be compromised in such conditions. Future studies should examine the relative contribution of maternal versus fetal hepcidin to the control of placental iron transfer as well as optimizing maternal and fetal iron bioavailability in pregnancies complicated by inflammation

Effectiveness of Youth Engagement Through Intervention (YETI): An Intensive Treatment

Autism Spectrum Disorder (ASD) represents a range of developmental disorders involving difficulties with communication and nonverbal behaviors (American Psychological Association, 2013)., and impacts roughly 1 in 68 births (Centers for Disease Control and Prevention, 2016).Those diagnosed may exhibit poor eye contact, repetitive or compulsive behavior, and inability to understand others’ emotions (Barry et al., 2003). Children with ASD struggle with social interaction, often removing themselves from social situations or engaging in inappropriate behavior that can cause further isolation from their typically developing peers (Kalyva & Avramidis, 2005). The current study examines the effectiveness of Youth Engagement Through Intervention (YETI), a group-based social skills intervention that uses multiple evidence-based practices (i.e. video modeling, social narratives and visual schedules) creating individualized treatment for each child with ASD. The purpose of this study was to improve social interactions of children with ASD. We defined social interaction as 1) verbal and nonverbal greetings and goodbyes, 2) orientation of face and body towards a clinician or peer when they are being spoken to, 3) and engagement in back and forth, turn taking, communication with peers. We expected YETI would be successful in improving these skills. Three children with ASD participated in the current study: Two males (ages 7 and 11) and one female (age 7). Observational data using event recording was collected throughout the eight-week program (1.5-hour weekly sessions), on how often each child exhibits social interactions. YETI is provided in a limited timeframe, thus an AB single subjects design is appropriate to assess the treatment effects. However, AB designs cannot determine between-subjects effects, detect small effects, or be generalized. With rising rates of ASD it is important to develop and implement effective treatments to assist individuals with social skill deficits to better navigate our social world

Wellness Counseling and Education Effects on Diabetes Self-Management

The project's purpose was to assess the effects of wellness counseling and education on individuals with elevated HbA1c levels to enhance and strengthen their diabetes self-management skills. The project provided wellness counseling on lowering their blood glucose levels, including the topics of medication adherence, healthy eating and nutrition, and physical activity. Six individualized wellness counseling sessions were held with 18 participants with uncontrolled diabetes ages 31-65 years, who reside in a rural area of eastern North Carolina. Quantitative findings indicate that with counseling, HbA1c levels can be reduced. Qualitative results found several areas where the participants could make improvements, including (a) an understanding of how diabetes affects the body, (b) a better understanding of how insulin, both natural and supplemental, works in the body, (c) what each medication does to control diabetes, (d) how stress affects blood glucose, and (e) how healthy eating and nutrition along with physical exercise reduces glucose levels and creates energy. Improvements in diabetes self-management using wellness counseling as a technique can assist participants in reducing their HbA1c levels as well as preventing the longer-term complications of heart disease, renal disease, loss of limbs, stroke, and dementia.D.N.P

Transformation of cytogenetically normal chronic myelomonocytic leukaemia to an acute myeloid leukaemia and the emergence of a novel +13,+15 double trisomy resulting in an adverse outcome

A 58-year-old man was admitted with symptoms of lethargy and easy bruising for four months duration. Peripheral blood (PB) analysis revealed a white blood cell count (WBC) of 15.9 × 109/l with monocytes 5.4 × 109/l. Bone marrow (BM) was hypercellular with 15% blasts, monocytosis and trilineage dysplasia. Conventional cytogenetic analysis (G-banding) detected an apparently normal male karyotype (46,XY). A diagnosis of chronic myelomonocytic leukaemia (CMML) was made. After 3 years, PB analysis revealed a WBC count of 22 × 109/l and a predominance of blasts. BM aspirate analysis also revealed 89% myeloid blasts and G-banding detected the emergence of an abnormal clone harbouring an extra copy of chromosomes 13 and 15. A diagnosis of disease transformation to acute myeloid leukaemia (AML) was made. Post chemotherapy BM aspirate was very hypocellular and the abnormal +13,+15 clone was still present suggesting primary refractory disease. A second course of chemotherapy was only administered for 24 hours due to complications. The abnormal +13,+15 clone was still present and it was decided that no further treatment apart from palliative care could be offered. The patient died 11 weeks later, five months after AML transformation. This is the first description of a cytogenetically normal CMML patient transforming to AML with the emergence of a unique +13, +15 double trisomy resulting in an adverse outcome

Measuring the Contribution and Complexity of Nurse and Physiotherapy Consultants: A Feasibility Study

Advanced practice roles in nursing and other health professions have become integral to a range of healthcare services world-wide providing experienced practitioners with the opportunity to extend their roles and influence decision making whilst maintaining patient contact. However, there has been limited research to evaluate the impact on health services of these advanced practice roles

Bem-estar e qualidade de vida: importância da assistência de enfermagem humanizada no parto / Well-being and quality of life: the importance of humanized nursing care in childbirth

Introdução: A gravidez e o parto são eventos que representam alguns dos momentos mais importantes na vida da mulher. Atualmente, o modelo de assistência obstétrica no Brasil é caracterizado pelo excesso de procedimentos invasivos e intervencionistas causando medo, tensão e desconforto as gestantes.  Diante desta realidade, a Organização Mundial da Saúde (OMS) e o Ministério da Saúde fazem inúmeras recomendações para a humanização nos partos que envolvem um conjunto de cuidados, medidas e atividades que promovam o parto e o nascimento saudáveis considerando a individualidade das mulheres. Objetivo: O presente trabalho teve como objetivo apresentar uma revisão bibliográfica sobre a assistência de Enfermagem no parto, bem como analisar e compreender a importância da humanização para o bem-estar e qualidade de vida da mãe e do recém-nascido. Métodos: Trata-se de um estudo de revisão integrativa da literatura na base de dados da SciELO sobre pesquisas relacionadas as ações de Enfermagem no parto e nascimento. Para elaboração deste estudo, foi necessário consultar trabalhos publicados e artigos científicos visando à busca de referencial teórico. Resultados: Através dos critérios previamente estabelecidos, foram encontradas 26 publicações nas quais foram selecionados 08 artigos, que possibilitaram evidenciar que a adequada assistência ao parto abrange assegurar o respeito aos desejos e direitos da mulher parturiente, assim como seu conforto e segurança de forma humanizada. As principais funções realizadas pelo profissional de Enfermagem na assistência ao parto incluem garantir o apoio à mulher e sua família, monitorar o bem-estar da mãe e do recém-nascido e realizar intervenções quando necessárias. Conclusão: Dessa forma, uma assistência de Enfermagem pautada na humanização é fundamental, favorecendo a redução dos riscos e complicações, redução das taxas de mortalidade materna e infantil além de aumentar a qualidade de vida às parturientes. Além dos aspectos técnicos, os profissionais de saúde devem estar atentos em fornecer o acolhimento da gestante, respeitando suas vontades e atendendo suas necessidades de modo que ela possa exercer a maternidade com segurança e bem-estar.

Evidence-based planning and costing palliative care services for children : novel multi-method epidemiological and economic exemplar

Background: Children’s palliative care is a relatively new clinical specialty. Its nature is multi-dimensional and its delivery necessarily multi-professional. Numerous diverse public and not-for-profit organisations typically provide services and support. Because services are not centrally coordinated, they are provided in a manner that is inconsistent and incoherent. Since the first children’s hospice opened in 1982, the epidemiology of life-limiting conditions has changed with more children living longer, and many requiring transfer to adult services. Very little is known about the number of children living within any given geographical locality, costs of care, or experiences of children with ongoing palliative care needs and their families. We integrated evidence, and undertook and used novel methodological epidemiological work to develop the first evidence-based and costed commissioning exemplar. Methods: Multi-method epidemiological and economic exemplar from a health and not-for-profit organisation perspective, to estimate numbers of children under 19 years with life-limiting conditions, cost current services, determine child/parent care preferences, and cost choice of end-of-life care at home. Results: The exemplar locality (North Wales) had important gaps in service provision and the clinical network. The estimated annual total cost of current children’s palliative care was about £5.5 million; average annual care cost per child was £22,771 using 2007 prevalence estimates and £2,437- £11,045 using new 2012/13 population-based prevalence estimates. Using population-based prevalence, we estimate 2271 children with a life-limiting condition in the general exemplar population and around 501 children per year with ongoing palliative care needs in contact with hospital services. Around 24 children with a wide range of life-limiting conditions require end-of-life care per year. Choice of end-of-life care at home was requested, which is not currently universally available. We estimated a minimum (based on 1 week of end-of-life care) additional cost of £336,000 per year to provide end-of-life support at home. Were end-of-life care to span 4 weeks, the total annual additional costs increases to £536,500 (2010/11 prices). Conclusions: Findings make a significant contribution to population-based needs assessment and commissioning methodology in children’s palliative care. Further work is needed to determine with greater precision which children in the total population require access to services and when. Half of children who died 2002-7 did not have conditions that met the globally used children's palliative care condition categories, which need revision in light of findings

Strengthening knowledge and awareness in family services of domestic abuse (SKAFADA)

This rapid scoping study, conducted by researchers from the University of Central Lancashire and King’s College London, provides evidence on the knowledge, understanding, and skills of the Early Help and Family Support workforces in England with regard to domestic abuse. Early Help (EH) is designed to intervene before challenges in families reach the threshold where statutory safeguarding services are required, whereas Family Support (FS) provides services and interventions for vulnerable families and where children are defined as ‘in need’. These local authority (LA) workforces often collaborate with other partners to work with adults to develop parenting skills as well as in direct work with children. Early Help/Family Support practitioners have high levels of contact with families experiencing domestic abuse, and so it is important that the training and development they receive equips them with the tools they need to identify and deal with situations of domestic abuse