The impact of a multidisciplinary self-care management program on quality of life, self-care, adherence to anti-hypertensive therapy, glycemic control, and renal function in diabetic kidney disease: A Cross-over Study Protocol.

Diabetic kidney disease, a global health issue, remains associated with high morbidity and mortality. Previous research has shown that multidisciplinary management of chronic disease can improve patient outcomes. The effect of multidisciplinary self-care management on quality of life and renal function of patients with diabetic kidney disease has not yet been well established. The aim of this study is to evaluate the impact of a multidisciplinary self-care management program on quality of life, self-care behavior, adherence to anti-hypertensive treatment, glycemic control, and renal function of adults with diabetic kidney disease. A uniform balanced cross-over design is used, with the objective to recruit 40 adult participants with diabetic kidney disease, from public and private out-patient settings in French speaking Switzerland. Participants are randomized in equal number into four study arms. Each participant receives usual care alternating with the multidisciplinary self- care management program. Each treatment period lasts three months and is repeated twice at different time intervals over 12 months depending on the cross-over arm. The multidisciplinary self-care management program is led by an advanced practice nurse and adds nursing and dietary consultations and follow-ups, to the habitual management provided by the general practitioner, the nephrologist and the diabetologist. Data is collected every three months for 12 months. Quality of life is measured using the Audit of Diabetes-Dependent Quality of Life scale, patient self-care behavior is assessed using the Revised Summary of Diabetes Self-Care Activities, and adherence to anti-hypertensive therapy is evaluated using the Medication Events Monitoring System. Blood glucose control is measured by the glycated hemoglobin levels and renal function by serum creatinine, estimated glomerular filtration rate and urinary albumin/creatinine ratio. Data will be analyzed using STATA version 14. The cross-over design will elucidate the responses of individual participant to each treatment, and will allow us to better evaluate the use of such a design in clinical settings and behavioral studies. This study also explores the impact of a theory-based nursing practice and its implementation into a multidisciplinary context. ClinicalTrials.gov identifier: NCT01967901 , registered on the 18th of October 2013

Revie ⊕: the influence of a life review intervention including a positive, patient-centered approach towards enhancing the personal dignity of patients with advanced cancer-a study protocol for a feasibility study using a mixed method investigation.

It is generally recognized that existential concerns must be addressed to promote the dignity of patients with advanced cancer. A number of interventions have been developed in this regard, such as dignity therapy and other life review interventions (LRI). However, so far, none have focused on a positive approach or evaluated its effects on dignity and personal growth. This study aims to explore the feasibility of Revie ⊕, a life review intervention comprising a positive, patient-centered approach, and to determine potential changes of patients' sense of dignity, posttraumatic growth, and satisfaction with life. A mixed method study will be performed, which includes specialized nurses and 40 patients with advanced cancer in an ambulatory and in-patient setting of a Swiss university hospital. Quantitative methods involve a single group, pre- and post-intervention, and outcome measurements include the Patient Dignity Inventory, the Posttraumatic Growth Inventory, and the Satisfaction with Life Scale. Feasibility data relating to process, resource, and scientific elements of the trial will also be collected. A semi-directed interview will be used to collect qualitative data about the process and the participants' experiences of the intervention. In this way, enhanced quantitative-qualitative evidence can be drawn from outcome measures as well as individual, contextualized personal views, to help inform researchers about the plausibility of this complex intervention before testing its effectiveness in a subsequent full trial. Patient dignity is a goal of quality end-of-life care. To our knowledge, this is the first trial to evaluate the role of a life review intervention that is focused on personal growth and on changes relating to the experience of having cancer. This study will evaluate the feasibility of a novel intervention, Revie ⊕, which we hope will contribute to promote the dignity, personal growth, and overall life satisfaction of patients with advanced cancer. ISRCTN, ISRCTN12497093

The omnipresence of cancer

The incidence of colorectal cancer has increased over the past few decades. Reasons for the increase have been associated with malnutrition (Almendingen et al., 2002; Bain et al., 2002). A need was identified to explore the experience of having received a diagnosis of colorectal cancer and what this means to the person concerned. An empirical phenomenological study was undertaken grounded in Heidegger’s Ontology of Dasein as presented in his seminal work 'Being and Time’ (1993a; 1996) to investigate The Da-sein of Colorectal Cancer. Seven patients diagnosed with colorectal cancer were interviewed over a time-span of thirteen months. The patients were recruited from three hospitals in the German speaking part of Switzerland. At the end of data collection patients specifically pointed out the benefit of having had the opportunity to participate in the interviews. They said the interviews provided them with an opportunity to talk about their illness openly and engage in catharsis. Data analysis employing Colaizzi’s eight step process as cited by Haase (1987: 66-67) elicited one core category - The Omnipresence of Cancer - and two sub-categories, Toward Authentic Dasein and Mapping Out The Future. Each of the sub-categories comprised three constructs that were identified as Uncertainty, Transitoriness and Locus of Control. Toward Authentic Dasein represents the Fear and Anxiety (Heidegger, 1993a: 140ff; 1993a: 184ff; 1996: 179ff; 1996: 228ff) patients experienced. Mapping Out The Future represents the Existential Understanding (Heidegger, 1993a: 143ff; 1996: 183ff) of Dasein. By associating these findings from the study with Heidegger’s Ontology of Dasein (1993a; 1996) The Omnipresence of Cancer, a new theory, emerged. The Omnipresence of Cancer is a descriptive-explanatory, middle-range theory due to its close association with Heidegger’s Ontology of Dasein (1993a; 1996). It provides a perspective on the experience of having received a diagnosis of cancer and what this means for the person concerned. Receiving a diagnosis of cancer is threatening and provokes deep Fear and Anxiety. Patients experience Uncertainty from the onset of symptoms throughout treatment that extends beyond the conclusion of the treatments. By being given a diagnosis of cancer, patients are confronted with their mortality. They consider their potential demise. In doing so, some choose to move Toward a more Authentic Dasein. Coping with the gravity of the illness involves patients’ Locus of Control. Initially, patients delegate control to healthcare professionals as a coping strategy. Gradually patients rebel against the delegation of control and work toward regaining it. Moving from an external Locus of Control toward an internal Locus of Control is key in Mapping Out The Future. Initial Uncertainty is partly resolved, but new worries arise. In order to successfully manage the return to a familiar routine, patients develop a variety coping strategies in their awareness of the Transitory nature of life. Patients want to return to normality. Therefore, gaining an internal Locus of Control becomes crucial. They realise that cancer is a lifelong disease that stays with them as long as they live. Whenever individuals who have once been diagnosed with cancer are confronted with another health problem, the thought of cancer - whether justified or not - is at the forefront of their minds. Patients consider themselves belonging to an illness group. Cancer is Omnipresent

Trends and characteristics of attendance at the emergency department of a Swiss university hospital: 2002-2012.

BACKGROUND: The numbers of people attending emergency departments (EDs) at hospitals are increasing. We aimed to analyse trends in ED attendance at a Swiss university hospital between 2002 and 2012, focussing on age-related differences and hospital admission criteria. METHODS: We used hospital administrative data for all patients aged ≥16 years who attended the ED (n = 298,306) at this university hospital between 1 January 2002, and 31 December 2012. We descriptively analysed the numbers of ED visits according to the admission year and stratified by age (≥65 vs <65 years). RESULTS: People attending the ED were on average 46.6 years old (standard deviation 20 years, maximum range 16‒99 years). The annual number of ED attendances grew by n = 6,639 (27.6%) from 24,080 in 2002 to 30,719 in 2012. In the subgroup of patients aged ≥65 the relative increase was 42.3%, which is significantly higher (Pearson's χ2 = 350.046, df = 10; p = 0.000) than the relative increase of 23.4% among patients <65 years. The subgroup of patients ≥65 years attended the ED more often because of diseases (n = 56,307; 85%) than accidents (n = 9,844; 14.9%). This subgroup (patients ≥65 years) was also more often admitted to hospital (Pearson's χ2 = 23,377.190; df = 1; p = 0.000) than patients <65 years. CONCLUSIONS: ED attendance of patients ≥65 years increased in absolute and relative terms. The study findings suggest that staff of this ED may want to assess the needs of patients ≥65 years and, if necessary, adjust the services (e.g., adapted triage scales, adapted geriatric screenings, and adapted hospital admission criteria)

Cyber Security Body of Knowledge and Curricula Development

The cyber world is an ever-changing world and cyber security is most important and touches the lives of everyone on the cyber world including researchers, students, businesses, academia, and novice user. The chapter suggests a body of knowledge that incorporates the view of academia as well as practitioners. This research attempts to put basic step and a framework for cyber security body of knowledge and to allow practitioners and academicians to face the problem of lack of standardization. Furthermore, the chapter attempts to bridge the gap between the different audiences. The gap is so broad that the term of cyber security is not agreed upon even in spelling. The suggested body of knowledge may not be perfect, yet it is a step forward

Tunable self-organization of nanocomposite multilayers

In this letter we report the controlled growth and microstructural evolution of self-assembled nanocomposite multilayers that are induced by surface ion-impingement. The nanoscale structures together with chemical composition, especially at the growing front, have been investigated with high-resolution transmission electron microscopy. Concurrent ion impingement of growing films produces an amorphous capping layer 3 nm in thickness where spatially modulated phase separation is initiated. It is shown that the modulation of multilayers as controlled by the self-organization of nanocrystallites below the capping layer, can be tuned through the entire film.

Microstructural control of TiC/a-C nanocomposite coatings with pulsed magnetron sputtering

In this paper, we report some striking results on the microstructural control of TiC/a-C nanocomposite coatings with pulsed direct current (DC) magnetron sputtering. The interface morphology and microstructure evolution as a function of pulse frequency and duty cycle were scrutinized using atomic force microscopy, scanning electron microscopy and high-resolution transmission electron microscopy techniques. It is shown that, with increasing pulse frequency, the nanocomposite coatings exhibit evolutions in morphology of the growing interface from rough to smooth and in the microstructure from strongly columnar to fully columnar-free. In addition, the smoothly growing interface favors the formation of a tailor-made multilayered nanocomposite structure. The fundamental mechanisms are analyzed with the assistance of plasma diagnostic experiments. Ion mass/energy spectrometry measurements reveal that, depending on the frequency and duty cycle of DC pulses, pulsing of the magnetrons can control the flux and energy distribution of Ar+ ions over a very broad range for concurrent impingement on the growing interface of deposited coatings, in comparison with DC sputtering. The significantly enhanced energy flux density is thought to be responsible for the "adatom transfer" in interface smoothening and thus the restraint of columnar growth. (C) 2007 Acta Materialia, Inc. Published by Elsevier Ltd. All rights reserved.</p

Le point sur la pratique infirmière avancée [Update on advanced practice nursing].

We report outcomes of a clinical audit examining criteria used in clinical practice to rationalize endotracheal tube (ETT) suction, and the extent these matched criteria in the Endotracheal Suction Assessment Tool(ESAT)©. A retrospective audit of patient notes (N = 292) and analyses of criteria documented by pediatric intensive care nurses to rationalize ETT suction were undertaken. The median number of documented respiratory and ventilation status criteria per ETT suction event that matched the ESAT© criteria was 2 [Interquartile Range (IQR) 1-6]. All criteria listed within the ESAT© were documented within the reviewed notes. A direct link was established between criteria used for current clinical practice of ETT suction and the ESAT©. The ESAT©, therefore, reflects documented clinical decision making and could be used as both a clinical and educational guide for inexperienced pediatric critical care nurses. Modification to the ESAT© requires "preparation for extubation" to be added

Surface roughness evolution of nanocomposite thin films

An analysis of dynamic roughening and smoothening mechanisms of thin films grown with pulsed-dc magnetron sputtering is presented. The roughness evolution has been described by a linear stochastic equation, which contains the second- and fourth-order gradient terms. Dynamic smoothening of the growing interface is explained by ballistic effects resulting from impingements of ions to the growing thin film. These ballistic effects are sensitive to the flux and energy of impinging ions. The predictions of the model are compared with experimental data, and it is concluded that the thin film roughness can be further controlled by adjusting waveform, frequency, and width of dc pulses