A roadmap for paediatric and neonatal critical care nursing science in Europe: Engage, action and impact

Guest editoria

Clinical recommendations for pain, sedation, withdrawal and delirium assessment in critically ill infants and children: an ESPNIC position statement for healthcare professionals

Background: This position statement provides clinical recommendations for the assessment of pain, level of sedation, iatrogenic withdrawal syndrome and delirium in critically ill infants and children. Admission to a neonatal or paediatric intensive care unit (NICU, PICU) exposes a child to a series of painful and stressful events. Accurate assessment of the presence of pain and non-pain related distress (adequacy of sedation, iatrogenic withdrawal syndrome, and delirium) is essential to good clinical management and to monitoring the effectiveness of interventions to relieve or prevent pain and distress in the individual patient. Methods: A multidisciplinary group of experts was recruited from the members of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC). The group formulated clinical questions regarding assessment of pain and non-pain related distress in critically ill and non-verbal children, and searched the PubMed/Medline, Cinahl, and Embase databases for studies describing the psychometric properties of assessment instruments. Further, level of evidence of selected studies was assigned and recommendations were formulated, and grade or recommendations were added based on the level of evidence. Results: An ESPNIC Position Statement was drafted which provides clinical recommendations on assessment of pain (n=5), distress and/or level of sedation (n=4), iatrogenic withdrawal syndrome (n=3), and delirium (n=3). These recommendations were based on the available evidence and consensus amongst the experts and other members of the ESPNIC society. Conclusions: This multidisciplinary ESPNIC Position Statement guides professionals in the assessment and re-assessment of the effectiveness of treatment interventions for pain, distress, inadequate sedation, withdrawal syndrome and delirium

Shopping for Food in Nonmetropolitan Nebraska: 2017 Nebraska Rural Poll Results

Conclusion Rural Nebraskans purchase their food from a variety of stores. Almost four in ten buy most of their food from a supercenter (like Wal-Mart or Costco). Just over three in ten typically shop at a supermarket and just under three in ten buy most of their food at a small grocery store. Differences in the type of store most utilized occur by community size. Persons living in or near larger communities are more likely than persons living in or near smaller communities to purchase the majority of their food from either a supermarket or supercenter. Persons living in or near mid-sized communities (populations ranging from 1,000 to 4,999) are the group most likely to purchase most of their food from a small grocery store. This size of community is most likely to be able to sustain a grocery store but not be a target for a supermarket or supercenter. Thus, local grocery stores do maintain market share in communities which are large enough for them to be viable, but too small to be major markets. Rural Nebraskans are most concerned with the quality, cost and selection of food as well as store characteristics such as cleanliness and customer service when selecting where they shop for food. These characteristics rate higher than location. Most rural Nebraskans shop for food at least once a week. Rural Nebraskans report being satisfied with most items at the store from which they purchase most of their food, although satisfaction with cost consistently ranks lower than quality or selection across major food categories. Most rural Nebraskans are within 30 minutes of the store where they do most of their food shopping. However, persons living in or near larger communities are more likely than persons living in or near smaller communities to be within 10 minutes of the store from where they purchase most of their food. Most rural Nebraskans have options for their food shopping. Most rural Nebraskans have a corner/convenience store closer than the store where they normally shop for food as well as a general merchandise store (like Dollar General or Family Dollar). Almost one-half have a small grocery store closer to them than the store where they normally do most of their food shopping. Almost two-thirds of persons who normally buy most of their food from a supercenter say they have a small grocery store closer to them. Only six percent of persons who purchase most of their food from a small grocery store say there is a supercenter closer to them and only five percent have a supermarket closer. Beyond retail shopping, rural Nebraskans do utilize other sources for foods. Most rural Nebraskans get at least some of their food from a garden and many get some of their food from a farmer’s market or CSA (community supported agriculture)

Protocolized Versus Nonprotocolized Weaning to Reduce the Duration of Invasive Mechanical Weaning in Neonates A Systematic Review of All Types of Studies

Mechanical ventilation is one of the most commonly used treatments in neonatology. Prolonged mechanical ventilation is associated with deleterious outcomes. To reduce the ventilation duration, weaning protocols have been developed to achieve extubation in adult and pediatric care in a safe and uniform manner. We performed a systematic review to obtain all available evidence on the effect of protocolized versus nonprotocolized weaning on the duration of invasive mechanical ventilation in critically ill neonates. The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, Web of Science, and the International Clinical Trial Registry Platform were searched until January 2018. Quantitative and qualitative studies involving neonates that investigated or described protocolized versus nonprotocolized weaning were included. Primary outcome was the difference in weaning duration. A total of 2099 potentially relevant articles were retrieved. Three stud

Clonal expansion of Staphylococcus epidermidis strains causing Hickman catheter-related infections in a hemato-oncologic department

The detailed analysis of 411 strains of coagulase-negative staphylococci (CoNS) obtained from 40 neutropenic hemato-oncologic patients (61 Hickman catheter episodes) on intensive chemotherapy is described. By random amplification of polymorphic DNA (RAPD) analysis, a total of 88 different genotypes were detected: 51 in air samples and 30 in skin cultures prior to insertion, 12 in blood cultures after insertion, and only 5 involved in catheter-related infections (CRI). Two RAPD genotypes of Staphylococcus epidermidis predominated, and their prevalence increased during patient hospitalization. At insertion, these clones constituted 11 of 86 (13%) CoNS isolated from air samples and 33 of 75 (44%) CoNS isolated from skin cultures. After inser

A CD146 FACS Protocol Enriches for Luminal Keratin 14/19 Double Positive Human Breast Progenitors

Publisher's version (útgefin grein).Human breast cancer is believed to arise in luminal progenitors within the normal breast. A subset of these are double positive (DP) for basal and luminal keratins and localizes to a putative stem cell zone within ducts. We here present a new protocol based on a combination of CD146 with CD117 and CD326 which provides an up to thirty fold enrichment of the DP cells. We show by expression profiling, colony formation, and morphogenesis that CD146high/CD117high/CD326high DP cells belong to a luminal progenitor compartment. While these DP cells are located quite uniformly in ducts, with age a variant type of DP (vDP) cells, which is mainly CD146-negative, accumulates in lobules. Intriguingly, in specimens with BRCA1 mutations known to predispose for cancer, higher frequencies of lobular vDP cells are observed. We propose that vDP cells are strong candidates for tracing the cellular origin of breast cancer.We thank Lena Kristensen, Tove Marianne Lund and Anita Sharma Friismose for expert technical assistance. Benedikte Thuesen and Trine Foged Henriksen, Capio CFR Hospitaler are acknowledged for providing breast biopsy material. The Core Facility for Integrated Microscopy (University of Copenhagen) is acknowledged for confocal microscope accessibility. This work was supported by Novo Nordisk Fonden and Danish Research Council grant 10-092798 (to DanStem), Toyota-Fonden Denmark and Anita og Tage Therkelsens Fond (to R.V.), Familien Erichsens Mindefond and Vera og Carl Johan Michaelsens Legat (to J.K.), Harboefonden, Else og Mogens Wedell-wedellborgs Fond and Danish Cancer Society Grant R146-A9257 (to L.R.-J.).Peer Reviewe

Molecular epidemiology of apparent outbreak of invasive aspergillosis in ahematology ward

During a 2-month period, five patients suffering from invasive infections caused by Aspergillus flavus or Aspergillus fumigatus were identif

Well-being through learning: a systematic review of learning interventions in the workplace and their impact on well-being

The view that learning is central to well-being is widely held and the workplace is an important setting in which learning takes place. Evaluations of the effectiveness of well-being interventions in work settings are commonplace, but to date, there has been no systematic review of the effectiveness of learning interventions with regard to their impact on well-being. The review synthesizes evidence from 41 intervention studies, and although no studies report a negative impact on well-being, 14 show no effect on well-being, with 27 studies having a positive impact. We classify the studies according to the primary purpose of the learning intervention: to develop personal resources for well-being through learning; to develop professional capabilities through learning; to develop leadership skills through learning; and to improve organizational effectiveness through organizational-level learning. Although there is an abundance of workplace learning interventions, few are evaluated from a well-being perspective despite the commonly held assumption that learning yields positive emotional and psychological outcomes. The evidence indicates an important gap in our evaluation of and design of workplace learning interventions and their impact on well-being, beyond those focusing on personal resources. This raises important theoretical and practical challenges concerning the relationship between learning and well-being in the context of professional capability enhancement, leadership capability and organizational learning

Stromal Hedgehog signalling is downregulated in colon cancer and its restoration restrains tumour growth

A role for Hedgehog (Hh) signalling in the development of colorectal cancer (CRC) has been proposed. In CRC and other solid tumours, Hh ligands are upregulated; however, a specific Hh antagonist provided no benefit in a clinical trial. Here we use Hh reporter mice to show that downstream Hh activity is unexpectedly diminished in a mouse model of colitis-associated colon cancer, and that downstream Hh signalling is restricted to the stroma. Functionally, stroma-specific Hh activation in mice markedly reduces the tumour load and blocks progression of advanced neoplasms, partly via the modulation of BMP signalling and restriction of the colonic stem cell signature. By contrast, attenuated Hh signalling accelerates colonic tumourigenesis. In human CRC, downstream Hh activity is similarly reduced and canonical Hh signalling remains predominantly paracrine. Our results suggest that diminished downstream Hh signalling enhances CRC development, and that stromal Hh activation can act as a colonic tumour suppressor