Perceptions infirmières quant à la réalisation de la collecte des données auprès de la clientèle à l'urgence, étape préalable à la formulation du jugement clinique infirmier

Depuis l’adoption de la Loi 90 en 2002, la Loi sur les infirmières et infirmiers (LII, article 36) confère une autonomie élargie aux infirmières en reconnaissant, notamment, leur compétence et leur responsabilité à l’égard de l’évaluation clinique qui est représentée dans cette loi comme l’assise de l’exercice infirmier (Pellerin, 2009; OIIQ, 2010). La collecte des données constitue une étape fondamentale du processus d’évaluation clinique (Dillon, 2007; Doyon, Brûlé & Cloutier, 2002; Pellerin, 2009; Weber & Kelley, 2007). L’infirmière d’urgence a une responsabilité majeure à l’égard de la collecte des données. En effet, elle œuvre auprès de clientèles de tous âges qui présentent des problèmes de santé variés, aigus et parfois urgents et doit souvent intervenir, sur la base de son évaluation clinique, avant qu’un diagnostic n’ait été établi ou que le patient n’ait été vu par le médecin (Newberry & Criddle, 2005). Or, malgré toute l’importance que revêtent dorénavant l’évaluation clinique et la collecte des données au sens de la loi, ce rôle de l’infirmière semble tarder à s’actualiser dans la pratique clinique. Le but de cette étude qualitative descriptive consiste à explorer les perceptions d’infirmières, de gestionnaires en soins infirmiers et d’infirmières ressources cliniques d’urgence relativement à la réalisation de la collecte des données. La norme clinique « collecte des données » (assessment) de l’Emergency Nurses Association (1999) constitue le cadre de référence de l’étude. Cinq entrevues individuelles semi-dirigées de 60 minutes ainsi qu’un groupe de discussion de 90 minutes ont été réalisés auprès d’infirmières d’urgence. Un deuxième groupe de discussion a également réuni deux gestionnaires en soins infirmiers et deux infirmières ressources cliniques de l’urgence. Les données recueillies ont été analysées selon l’approche proposée par Miles et Huberman (2003). Les résultats obtenus démontrent que les infirmières considèrent la collecte des données comme un aspect fondamental de leur pratique à l’urgence, qui contribue à améliorer la qualité et la sécurité des soins dispensés. Or, les résultats révèlent également que leur compréhension de la collecte des données est variable, que leur pratique est aléatoire et largement influencée par le modèle biomédical. Plusieurs facteurs influencent la pratique des infirmières relativement à la collecte des données notamment : la conception individuelle de la collecte des données et du rôle infirmier, les relations et l’interaction avec les membres de l’équipe des soins infirmiers et les autres professionnels ainsi que le soutien de l’organisation et des gestionnaires en soins infirmiers. Ce dernier facteur semble prépondérant dans le contexte de l’urgence et démontre que le soutien des gestionnaires et des infirmières ressources cliniques influence de façon importante la pratique dans les milieux cliniques. Cette étude propose des pistes de réflexion sur la formation académique, la formation continue, l’administration des soins infirmiers et la collaboration interprofessionnelle qui pourraient faciliter l’actualisation du rôle des infirmières à l’égard de la collecte des données et de l’évaluation clinique afin d’améliorer la qualité des soins dispensés à l’urgence.

The effectiveness of scoliosis screening programs: methods for systematic review and expert panel recommendations formulation

Background: Literature on scoliosis screening is vast, however because of the observational nature of available data and methodological flaws, data interpretation is often complex, leading to incomplete and sometimes, somewhat misleading conclusions. The need to propose a set of methods for critical appraisal of the literature about scoliosis screening, a comprehensive summary and rating of the available evidence appeared essential. METHODS: To address these gaps, the study aims were: i) To propose a framework for the assessment of published studies on scoliosis screening effectiveness; ii) To suggest specific questions to be answered on screening effectiveness instead of trying to reach a global position for or against the programs; iii) To contextualize the knowledge through expert panel consultation and meaningful recommendations. The general methodological approach proceeds through the following steps: Elaboration of the conceptual framework; Formulation of the review questions; Identification of the criteria for the review; Selection of the studies; Critical assessment of the studies; Results synthesis; Formulation and grading of recommendations in response to the questions. This plan follows at best GRADE Group (Grades of Recommendation, Assessment, Development and Evaluation) requirements for systematic reviews, assessing quality of evidence and grading the strength of recommendations. CONCLUSIONS: In this article, the methods developed in support of this work are presented since they may be of some interest for similar reviews in scoliosis and orthopaedic fields.

Dynamic group communication for large-scale parallel data mining

Exascale systems are the next frontier in high-performance computing and are expected to deliver a performance of the order of 10^18 operations per second using massive multicore processors. Very large- and extreme-scale parallel systems pose critical algorithmic challenges, especially related to concurrency, locality and the need to avoid global communication patterns. This work investigates a novel protocol for dynamic group communication that can be used to remove the global communication requirement and to reduce the communication cost in parallel formulations of iterative data mining algorithms. The protocol is used to provide a communication-efficient parallel formulation of the k-means algorithm for cluster analysis. The approach is based on a collective communication operation for dynamic groups of processes and exploits non-uniform data distributions. Non-uniform data distributions can be either found in real-world distributed applications or induced by means of multidimensional binary search trees. The analysis of the proposed dynamic group communication protocol has shown that it does not introduce significant communication overhead. The parallel clustering algorithm has also been extended to accommodate an approximation error, which allows a further reduction of the communication costs. The effectiveness of the exact and approximate methods has been tested in a parallel computing system with 64 processors and in simulations with 1024 processing elements.

Efficient group communication for large-scale parallel clustering

Global communication requirements and load imbalance of some parallel data mining algorithms are the major obstacles to exploit the computational power of large-scale systems. This work investigates how non-uniform data distributions can be exploited to remove the global communication requirement and to reduce the communication cost in iterative parallel data mining algorithms. In particular, the analysis focuses on one of the most influential and popular data mining methods, the k-means algorithm for cluster analysis. The straightforward parallel formulation of the k-means algorithm requires a global reduction operation at each iteration step, which hinders its scalability. This work studies a different parallel formulation of the algorithm where the requirement of global communication can be relaxed while still providing the exact solution of the centralised k-means algorithm. The proposed approach exploits a non-uniform data distribution which can be either found in real world distributed applications or can be induced by means of multi-dimensional binary search trees. The approach can also be extended to accommodate an approximation error which allows a further reduction of the communication costs.

Evaluation of the performance of a castor-oil based formulation in limiting pesticide residues in strawberry crops

A study was made to evaluate the effect of a castor oil-based detergent on strawberry crops treated with different classes of pesticides, namely deltamethrin, folpet, tebuconazole, abamectin and mancozeb, in a controlled environment. Experimental crops of greenhouse strawberries were cultivated in five different ways with control groups using pesticides and castor oil-based detergent. The results showed that the group 2, which was treated with castor oil-based detergent, presented the lowest amount of pesticide residues and the highest quality of fruit produced.

Cytotoxic effects and pulpal response caused by a mineral trioxide aggregate formulation and calcium hydroxide

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Gauge formulation for higher order gravity

This work is an application of the second order gauge theory for the Lorentz group, where a description of the gravitational interaction is obtained that includes derivatives of the curvature. We analyze the form of the second field strength, G=partial derivative F+fAF, in terms of geometrical variables. All possible independent Lagrangians constructed with quadratic contractions of F and quadratic contractions of G are analyzed. The equations of motion for a particular Lagrangian, which is analogous to Podolsky's term of his generalized electrodynamics, are calculated. The static isotropic solution in the linear approximation was found, exhibiting the regular Newtonian behavior at short distances as well as a meso-large distance modification.

Geometrical Lagrangian for a supersymmetric Yang-Mills theory on the group manifold

Perhaps one of the main features of Einstein's General Theory of Relativity is that spacetime is not flat itself but curved. Nowadays, however, many of the unifying theories like superstrings on even alternative gravity theories such as teleparalell geometric theories assume flat spacetime for their calculations. This article, an extended account of an earlier author's contribution, it is assumed a curved group manifold as a geometrical background from which a Lagrangian for a supersymmetric N = 2, d = 5 Yang-Mills - SYM, N = 2, d = 5 - is built up. The spacetime is a hypersurface embedded in this geometrical scenario, and the geometrical action here obtained can be readily coupled to the five-dimensional supergravity action. The essential idea that underlies this work has its roots in the Einstein-Cartan formulation of gravity and in the 'group manifold approach to gravity and supergravity theories'. The group SYM, N = 2, d = 5, turns out to be the direct product of supergravity and a general gauge group g: G = g circle times <(SU(2, 2/1))over bar>.

Endectocide activity of a new long-action formulation containing 2.25% ivermectin+1.25% abamectin in cattle

The present work aimed to evaluate the endectocide activity of a new injectable long-action formulation, containing ivermectin (IVM) and abamectin (ABA). In each one of the four experiments performed, the following groups were formed: group I: 2.25% IVM (450 mu g/kg) + 1.25% ABA (250 mu g/kg), group II: 3.15% IVM (630 mu g/kg) and group III: control. Eighteen bovine naturally infected by gastrointestinal nematoda were selected for anthelmintic evaluation and necropsied on posttreatment day (PTD) 14 to estimate the total parasitic burden. For the Rhipicephalus (Boophilus) microplus field trial, 30 bovine were selected by means of counts of semi-engorged R. (B.) microplus and the therapeutic and residual efficacy evaluated by tick counts on PTDs 1, 3, 7, 14, 21, 28, 35, 42, 49, 56, 63, 70, 77, 84 and 91. In the stall test, 15 calves were artificially infested with 5000 R. (B.) microplus (Mozzo strain) larvae three times a week and daily collections of all the engorged female ticks detached from each calf were performed until the PTD 80. Forty bovine naturally infected with Dermatobia hominis larvae were selected and the number of larvae was counted by visual and tactile inspection on PTDs 3, 7, 14, 28, 35, 49, 63, 77, 91 and 105. In this trial, a formulation containing 1% doramectin (200 mu g/kg) was also used. IVM + ABA formulation and 3.15% IVM eliminated four of the eight species of nematode identified. The anthelmintic efficacy of the avermectins association against Haemonchus placei, Cooperia spatulata and C. punctata was 89.64%, 98.84% and 97.69%, while 3.15% IVM achieved 30.98%, 84.79% and 75.56%, respectively. The two formulations evaluated showed reduced acaricide action on the PTD I and 3, reaching high efficacy percentages from PTD 14 onward. The IVM + ABA showed efficacy above 95% in the period between PTDs 21 and 49. In the stall test, it observed no difference (P > 0.05) between the two formulations regarding the R. (B.) microplus counts during the entire evaluation period. IVM + ABA reduced the number of ticks from the PTD 1 to 77 (P < 0.05) and 3.15% IVM reduced (P < 0.05) the tick number from PTD 4 up to PTD 80. The three endectocides showed no difference (P > 0.05) regarding the number of D. hominis larvae and prevented this parasite reestablishment until PTD 105. These results indicate that the IVM + ABA association showed higher anthelmintic activity and similar efficacy against arthropods to the formulation containing 3.15% IVM. (C) 2008 Elsevier B.V. All rights reserved.

Proliferating cell nuclear antigen (PCNA) in non-Hodgkin's lymphomas: Correlation with working formulation and Kiel classification in formalin-fixed paraffin-embedded material

PCNA is a 36-KD proliferating cell nuclear antigen associated with the cell cycle. The immunocytochemical detection of PCNA represents a useful tool for the study of tumor proliferation activity. This study documents the detection of PCNA, using antibody PC 10 in formalin-fixed, paraffin-embedded tissue, and correlates the proliferative activity of the non-Hodgkin's lymphomas (NHL) with histological grading assessed by the International Working Formulation (WF) and Kiel classification. In 92 cases of NHLs we found a strong correlation between the PCNA index and lymphoma grading. Statistically significant differences were also found between the proliferative index (PI) in low and high grade lymphomas according to the Kiel classification (t = 9.519; p < 0.001) and between low, intermediate and high grade lymphomas according to the WF classification (F = 79.01; p < 0.001). In the Kiel classification the mean of low grade lymphomas was 39.5% and of high grade 75.7%. In the WF the average of low grade lymphomas was 29.7%, intermediate 53.1% and high 75.1%. Although the differences among the groups had been significant, we found variations inside each histological subgroup in both classifications. The intermediate lymphomas were the most heterogeneous group, with PI inside the same histologic subtypes coincident with low and high grade lymphomas. Since PCNA may be used as a marker of cell proliferation in clinical studies to estimate the biological aggressiveness of lymphomas, its determination in intermediate grade NHL could be very useful to evaluate individual cases in this group and determine prognosis and probably the appropriate therapy.

Anthelmintic efficacy of an oral formulation of Aurixazol against gastrointestinal nematodes of naturally and experimentally infected sheep

As a result of the need to develop new active principles for the control of endoparasites in ruminants, the present in vivo study evaluated a formulation containing 24% Aurixazol (48 mg/kg), a parasiticide molecule based on disophenolate of levamisole. Two experiments were conducted: one evaluating the anthelmintic efficacy of 24% Aurixazol (48 mg/kg) against gastrointestinal nematodes in naturally infected sheep, compared to an association of ivermectin (0.2 mg/kg) + albendazole (5.0 mg/kg) + levamisole (7.5 mg/kg) (IAL), and a second one which evaluated the persistent efficacy of the same formulation against immature stages (L4) and adults of Haemonchus contortus in experimentally infected animals. In experiment I, against H. contortus, the formulation of Aurixazol and the IAL association reached efficacies (arithmetic means) of 99.32% and 96.11%, respectively. For Trichostrongylus colubriformis, the efficacy values were 88.92% and 98.08% for Aurixazol and the IAL association, respectively. Both formulations were totally effective against Oesophagostomum columbianum (100%). The results of the statistical analysis demonstrated that the mean parasitic burden of treated animals was significantly different (P ≤ 0.05) compared to the average number of helminths diagnosed in animals from the control group for H. contortus, T. colubriformis and O. columbianum. Comparing only the treated groups, it was possible to verify that the average number of H. contortus recovered from animals treated with Aurixazol was different (P ≤ 0.05) when compared to the mean amount recovered from sheep treated with the IAL association. When evaluating the prevention of H. contortus infection in experiment II, Aurixazol did not present preventive efficacy. Up until 21 days after treatment the groups treated with Aurixazol contained less adults and L4 of H. contortus (P ≤ 0.05) when compared to the non-medicated control group. However, future studies will be necessary to assess the effectiveness of Aurixazol against nematode strains resistant to levamisole and disophenol, but the efficacy results described in this study allow to state that Aurixazol can, associated with other measures, become an important tool in the control of sheep nematodes. © 2013.

Reproductive toxicology and clastogenic evaluation in mice of a phytotherapeutic formulation obtained from Cinchona calisaya Weddel (Rubiaceae) used in Brazilian folk medicine as female fertility stimulant

Ethnopharmacological relevance: In Brazil, a phytotherapeutic preparation produced from a standardized tincture of Cinchona calisaya Weddel such that each mL of product contains 400 mu g of quinine, known in Portuguese as Agua Inglesa (R) (English water), is indicated by the manufacturer as a tonic, appetite stimulant, and digestive. However, this preparation has long been used in folk medicine as a female fertility stimulant. Despite its widespread use in folk medicine to stimulate female fertility, no study has been undertaken to assess the potential teratogenic and genotoxic effects of this phytotherapeutic preparation. The aim of the present study was to investigate possible toxic reproductive effects in mice caused by exposure to Agua Inglesa (R), either before mating or during the pre- and post-embryo implantation periods. The genotoxic potential was evaluated using the micronucleus assay.Material, Methods, and Results: Virgin female mice, with at least one estrous cycle evidenced by vaginal cytology, were divided into five groups of 15 individuals each (Group I - control, Group II - treated with ethanol solution at 16%, Groups III, IV and V treated with phytotherapeutic preparation at 1.5 mL/kg/day, 3.0 mL/kg/day and 4.5 mL/kg/day, respectively). After the first 28 days of treatment, females were caged individually with adult fertile males. Pregnant females continued to receive treatment for seven days (preimplantation period). Body weight was recorded weekly during treatment. Signs of toxicity (weight loss, food intake, piloerection, apathy, prostration, diarrhea, seizures, behavioral changes, and locomotion) were also observed. The females were sacrificed on the 15th day of pregnancy, uterine horns were evaluated for implantation, and the placental index was recorded. In the micronucleus test, 2000 polychromatic erythrocytes (PCE) per animal, obtained from bone marrow, were scored. Results The results showed that exposure of the females during the pre- and post-implantation periods did not significantly alter the reproductive capacity (p < 0.05); however, in higher dose (three times human dose)reduction of fetal weight was observed. There was no difference between the control and phytotherapeutic preparation (p > 0.05) in terms of the average number of micronucleated polychromatic erythrocytes.Conclusions: Although folk medicine suggests that the Agua Inglesa (R) preparation is useful as a female fertility stimulant, no such effect was confirmed in mice. (C) 2014 Elsevier Ireland Ltd. All rights reserved.

Biochemical and genotoxic effects of a commercial formulation of the herbicide tebuthiuron in Oreochromis niloticus of different sizes

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Effect of a spray formulation on the reproductive parameters of a susceptible population of Rhipicephalus (Boophilus) microplus

The number of studies emphasizing the possible damage that acaricidal spray formulations can cause on engorged female ticks'reproductive parameters is small. The present study evaluated the deleterious effects of a spray formulation (dichlorvos 60% + chlorpyrifos 20%) on the reproductive parameters of a susceptible population of Rhipicephalus (B.) microplus females, using the Stall Test. The ticks were allocated randomly to treatments according to the mean numbers of females detached from each cow on days -3, -2 and -1 and the cattle pen location. The numbers of engorged female ticks that naturally detached from the cattle were counted daily from day 1 to day 30. For each group, 20 detached engorged female ticks or the available number collected daily were evaluated regarding reproductive parameters. Associations of organophosphates demonstrated elevated acaricidal efficacy, as well as deleterious effects on the reproductive parameters of R. (B.) microplus females. The engorged female weight (days 1 to 7), weight of egg masses (days 5 to 10) and larval hatching percentage (days 5 to 19) were decreased (P <= 0.05). It is possible that a formulation can lead to deleterious effects on R. (B.) microplus females when the tick population analyzed shows elevated sensitivity towards a particular formulation. However, further studies need to be conducted.

Endectocide activity of a pour-on formulation containing 1.5 per cent ivermectin +0.5 per cent abamectin in cattle

The present work aimed to evaluate, through ten different studies, the therapeutic efficacy of a new pour-on formulation, containing 1.5 per cent ivermectin +0.5 per cent abamectin, against parasites of cattle. Results obtained on trials against Rhipicephalus (Boophilus) microplus showed that the pour-on combination of 1.5 per cent ivermectin +0.5 per cent abamectin obtained superior efficacy indexes against this ectoparasite, when compared with formulations containing 0.5 per cent ivermectin, 1 per cent ivermectin and the combination of 1 per cent abamectin +20 per cent levamisole. The results of efficacy of the ivermectin+abamectin and the 0.5 per cent ivermectin against Haematobia irritans were similar. Against Cochliomyia hominivorax larvae, all pour-on formulations tested (1.5 per cent ivermectin +0.5 per cent abamectin, 0.5 per cent ivermectin and 0.5 per cent abamectin), as well as 1 per cent doramectin administered subcutaneously, were considered ineffective. Cattle medicated with 1.5 per cent ivermectin +0.5 per cent abamectin, pour-on, remained free from parasitism by Dermatobia hominis larvae during 42 days (96 per cent efficacy), while values superior to 90 per cent were obtained by 0.5 per cent ivermectin (92 per cent) and 0.5 per cent abamectin (93 per cent) until the 42nd and 35th days post treatment, respectively. Against Haemonchus placei and Oesophagostomum radiatum, the pour-on of ivermectin+abamectin showed better efficacy than the 0.5 per cent ivermectin and 0.5 per cent abamectin. As to Cooperia punctata, there was no difference regarding efficacy results obtained by the avermectins combination and abamectin. The pour-on combination of 1.5 per cent ivermectin +0.5 per cent abamectin obtained high efficacy against R. (B.) microplus, D. hominis and some species of cattle gastrointestinal helminths when compared with formulations of 0.5 per cent ivermectin and 0.5 per cent abamectin administered through the same route.