Kompetenzen und Aufgabenbereiche von Advanced Practice Nurses auf der Notfallstation : ein Internationaler Literaturreview

Aufgrund von demografischen Veränderungen hin zu mehr älteren multimorbideren Menschen in der Schweiz, sowie einem zunehmenden Anstieg an Notfallkonsultationen, bedarf es der Definition von Kompetenzen und Aufgabenbereichen von Advanced Practice Nurses (APNs) auf Schweizer Notfallstationen. Dies fordern Gesundheitsfachpersonen, sowie das Bundesamt für Gesundheit, um weiterhin eine hohe Versorgungsqualität im Schweizer Gesundheitssystem gewährleisten zu können. Daraus ergibt sich folgende Fragestellung: Welche weltweiten Kompetenzen und Aufgabenbereiche haben Advanced Practice Nurses in Notfallstationen? Das Ziel dieser Bachelorarbeit ist es, weltweite Kompetenzen und Aufgabenbereiche von APNs in Notfallstationen zu identifizieren und daraus einen Praxistransfer für Schweizer Notfallstationen abzuleiten. Die systematische Literaturrecherche wird in den Datenbanken CINAHL, Cochrane und PubMed durchgeführt und die Ergebnisse im Rahmen des APN-Modells von Ann Hamric illustriert. Die Ergebnisse der inkludierten Studien zeigen, dass die Hauptkompetenzen und Aufgabenbereiche von APNs im Bereich der Triage, des klinischen Assessments, im Medikamentenverordnen und im Austrittsmanagement angesiedelt sind

Livre d’hôtes

…ou Gästebuch, plutôt que Livre d’or, ce registre où « étaient inscrits les noms des nobles », rappelle Littré, et qui cultivait « l’entre-soi ». Et sûrement pas Livre d’honneur, répertoire de vainqueurs, que les dictionnaires donnent habituellement pour équivalent. Les termes français usuels ne peuvent, au fond, que gauchir ce qui réunit les pages qu’on va lire ici. Car ce sont des voix amies et diverses qui s’expriment, des écrivains, des collègues, des lectrices et des lecteurs passionnés par l’oeuvre de la romancière, qui ont répondu à notre invitation et à qui carte blanche a été donnée. Livre d’hôtes, donc, qui nous font l’amitié de partager réflexions ou expériences, saisissant, chacune et chacun à sa manière, la façon d’être au monde et d’écrire le monde de Pascale Kramer. Qu’elles et qu’ils en soient vivement remerciés. Keywords : Pascale Kramer, roman contemporain, roman francophon

Physical activity in asthma control and its immune modulatory effect in asthmatic preschoolers

Background: The impact of physical activity on immune response is a hot topic in exercise immunology, but studies involving asthmatic children are scarce. Our aims were to examine whether there were any differences in the level of physical activity and daily TV attendance, to assess its role on asthma control and immune responses to various immune stimulants. Methods: Weekly physical activity and daily television attendance were obtained from questionnaires at inclusion of the PreDicta study. PBMC cultures were stimulated with phytohemagglutinin (PHA), R848, poly I:C, and zymosan. A panel of cytokines was measured and quantified in cell culture supernatants using luminometric multiplex immunofluorescence beads-based assay. Results: Asthmatic preschoolers showed significantly more TV attendance than their healthy peers (58.6% vs. 41.5% 1-3 h daily and only 25.7% vs. 47.2% = 3 times weekly vs. 62%). Asthmatics with increased PA exhibited elevated cytokine levels in response to polyclonal stimulants, suggesting a readiness of circulating immune cells for type 1, 2, and 17 cytokine release compared to subjects with low PA and high TV attendance. This may also represent a proinflammatory state in high PA asthmatic children. Low physical activity and high TV attendance were associated with a decrease in proinflammatory cytokines. Proinflammatory cytokines were correlating with each other in in vitro immune responses of asthmatic children, but not healthy controls, this correlation was more pronounced in children with sedentary behavior. Conclusion: Asthmatic children show more sedentary behavior than healthy subjects, while poor asthma control is associated with a substantial decrease in physical activity. Our results suggest that asthmatic children may profit from regular exercise, as elevated cytokine levels in stimulated conditions indicate an immune system prepared for responding strongly in case of different types of infections. However, it has to be considered that a hyperinflammatory state in high PA may not be beneficial in asthmatic children.</p

3 years of liraglutide versus placebo for type 2 diabetes risk reduction and weight management in individuals with prediabetes: a randomised, double-blind trial

Background: Liraglutide 3·0 mg was shown to reduce bodyweight and improve glucose metabolism after the 56-week period of this trial, one of four trials in the SCALE programme. In the 3-year assessment of the SCALE Obesity and Prediabetes trial we aimed to evaluate the proportion of individuals with prediabetes who were diagnosed with type 2 diabetes. Methods: In this randomised, double-blind, placebo-controlled trial, adults with prediabetes and a body-mass index of at least 30 kg/m2, or at least 27 kg/m2 with comorbidities, were randomised 2:1, using a telephone or web-based system, to once-daily subcutaneous liraglutide 3·0 mg or matched placebo, as an adjunct to a reduced-calorie diet and increased physical activity. Time to diabetes onset by 160 weeks was the primary outcome, evaluated in all randomised treated individuals with at least one post-baseline assessment. The trial was conducted at 191 clinical research sites in 27 countries and is registered with ClinicalTrials.gov, number NCT01272219. Findings: The study ran between June 1, 2011, and March 2, 2015. We randomly assigned 2254 patients to receive liraglutide (n=1505) or placebo (n=749). 1128 (50%) participants completed the study up to week 160, after withdrawal of 714 (47%) participants in the liraglutide group and 412 (55%) participants in the placebo group. By week 160, 26 (2%) of 1472 individuals in the liraglutide group versus 46 (6%) of 738 in the placebo group were diagnosed with diabetes while on treatment. The mean time from randomisation to diagnosis was 99 (SD 47) weeks for the 26 individuals in the liraglutide group versus 87 (47) weeks for the 46 individuals in the placebo group. Taking the different diagnosis frequencies between the treatment groups into account, the time to onset of diabetes over 160 weeks among all randomised individuals was 2·7 times longer with liraglutide than with placebo (95% CI 1·9 to 3·9, p&lt;0·0001), corresponding with a hazard ratio of 0·21 (95% CI 0·13–0·34). Liraglutide induced greater weight loss than placebo at week 160 (–6·1 [SD 7·3] vs −1·9% [6·3]; estimated treatment difference −4·3%, 95% CI −4·9 to −3·7, p&lt;0·0001). Serious adverse events were reported by 227 (15%) of 1501 randomised treated individuals in the liraglutide group versus 96 (13%) of 747 individuals in the placebo group. Interpretation: In this trial, we provide results for 3 years of treatment, with the limitation that withdrawn individuals were not followed up after discontinuation. Liraglutide 3·0 mg might provide health benefits in terms of reduced risk of diabetes in individuals with obesity and prediabetes. Funding: Novo Nordisk, Denmark

Racial differences in systemic sclerosis disease presentation: a European Scleroderma Trials and Research group study

Objectives. Racial factors play a significant role in SSc. We evaluated differences in SSc presentations between white patients (WP), Asian patients (AP) and black patients (BP) and analysed the effects of geographical locations.Methods. SSc characteristics of patients from the EUSTAR cohort were cross-sectionally compared across racial groups using survival and multiple logistic regression analyses.Results. The study included 9162 WP, 341 AP and 181 BP. AP developed the first non-RP feature faster than WP but slower than BP. AP were less frequently anti-centromere (ACA; odds ratio (OR) = 0.4, P &lt; 0.001) and more frequently anti-topoisomerase-I autoantibodies (ATA) positive (OR = 1.2, P = 0.068), while BP were less likely to be ACA and ATA positive than were WP [OR(ACA) = 0.3, P &lt; 0.001; OR(ATA) = 0.5, P = 0.020]. AP had less often (OR = 0.7, P = 0.06) and BP more often (OR = 2.7, P &lt; 0.001) diffuse skin involvement than had WP.AP and BP were more likely to have pulmonary hypertension [OR(AP) = 2.6, P &lt; 0.001; OR(BP) = 2.7, P = 0.03 vs WP] and a reduced forced vital capacity [OR(AP) = 2.5, P &lt; 0.001; OR(BP) = 2.4, P &lt; 0.004] than were WP. AP more often had an impaired diffusing capacity of the lung than had BP and WP [OR(AP vs BP) = 1.9, P = 0.038; OR(AP vs WP) = 2.4, P &lt; 0.001]. After RP onset, AP and BP had a higher hazard to die than had WP [hazard ratio (HR) (AP) = 1.6, P = 0.011; HR(BP) = 2.1, P &lt; 0.001].Conclusion. Compared with WP, and mostly independent of geographical location, AP have a faster and earlier disease onset with high prevalences of ATA, pulmonary hypertension and forced vital capacity impairment and higher mortality. BP had the fastest disease onset, a high prevalence of diffuse skin involvement and nominally the highest mortality

Cutaneous involvement in anti-HMGCR positive necrotizing myopathy.

OBJECTIVE Anti-3-Hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) positive immune-mediated necrotizing myopathy (IMNM) is a rare disease. It is induced by exogenous substances, most often by statins. Little is known about cutaneous manifestations of HMGCR positive IMNM and about HMGCR antibody positivity in other diseases. METHODS The characteristics of patients with anti-HMGCR autoantibodies measured at our laboratory between January 2012 and September 2020 were studied. Characteristics of patients with IMNM were compared to those patients with positive antibodies but without muscle involvement. Associations of IMNM with other organ involvements were searched for. RESULTS Of the 32 patients studied, 23 showed characteristics of IMNM, 9 did not fulfill current classification criteria but most showed signs of connective tissue diseases. Patients with IMNM were older (66 and 35 years, respectively; 0.92 (0.73-0.98); p < 0.001), had more frequent statin exposure (87% and 33%, respectively; 0.84 (0.61-0.94); p = 0.005) and higher mean peak CK (8717U/l and 329U/l, respectively; 1.0 (0.85-1.0); p < 0.001). 13/23 (56%) of IMNM patients showed cutaneous lesions; none of the patients suffered from cancer; only three IMNM patients showed drug-free complete remission. Incidence of IMNM in the catchment area of our center is at least 2.7/Mio/year. CONCLUSION Cutaneous lesions were found to be more frequent in anti-HMRCR positive IMNM than previously reported. Titer of anti-HMGCR antibodies and CK levels were significantly higher in IMNM than in other autoimmune connective tissue diseases. The data support the hypothesis of an antigen-driven response in IMNM, and suggests an activation of autoreactive B-lymphocytes in non-IMNM patients

Multi-disciplinary characterizations of the BedrettoLab – a new underground geoscience research facility

The increased interest in subsurface development (e.g., unconventional hydrocarbon, engineered geothermal systems (EGSs), waste disposal) and the associated (triggered or induced) seismicity calls for a better understanding of the hydro-seismo-mechanical coupling in fractured rock masses. Being able to bridge the knowledge gap between laboratory and reservoir scales, controllable mesoscale in situ experiments are deemed indispensable. In an effort to access and instrument rock masses of hectometer size, the Bedretto Underground Laboratory for Geosciences and Geoenergies ("BedrettoLab") was established in 2018 in the existing Bedretto Tunnel (Ticino, Switzerland), with an average overburden of 1000 m. In this paper, we introduce the BedrettoLab, its general setting and current status. Combined geological, geomechanical and geophysical methods were employed in a hectometer-scale rock mass explored by several boreholes to characterize the in situ conditions and internal structures of the rock volume. The rock volume features three distinct units, with the middle fault zone sandwiched by two relatively intact units. The middle fault zone unit appears to be a representative feature of the site, as similar structures repeat every several hundreds of meters along the tunnel. The lithological variations across the characterization boreholes manifest the complexity and heterogeneity of the rock volume and are accompanied by compartmentalized hydrostructures and significant stress rotations. With this complexity, the characterized rock volume is considered characteristic of the heterogeneity that is typically encountered in subsurface exploration and development. The BedrettoLab can adequately serve as a test-bed that allows for in-depth study of the hydro-seismo-mechanical response of fractured crystalline rock masses.ISSN:1869-9510ISSN:1869-952