Sjuksköterskors upplevelser av att vårda patienter i livets slutskede enligt Liverpool Care Pathway (LCP)

Syfte: Att beskriva sjuksköterskors upplevelser av att vårda patienter i livets slutskede enligt en vårdplan utformad som en journal med riktlinjer för vård i livets slutskede, den så kallade Liverpool Care Pathway (LCP). Metod: Studien är utförd som en litteraturöversikt. Artiklarna söktes via databaserna CINAHL, PubMed, MedLine, SAGE Journals och Scopus. Tolv artiklar valdes ut för kvalitétsgranskning enligt en förutbestämd granskningsmall. Elva artiklar godkändes och utgjorde grunden för resultatet. Resultat: En tydlig effekt av införandet av LCP var att sjuksköterskorna upplevde ett ökat självförtroende och en ökad kunskap i vårdandet. Detta bidrog till förbättringar gällande symtomkontroll samt ifrågasättande av fortsatt rutinmässig behandling. LCP anågs vara en bra utgångspunkt för samtal och undervisning i möten med patienter och anhöriga. LCP upplevdes ge ramar och gemensamma utgångspunkter i teamarbetet runt patienten vilket bidrog till en bättre planering och tydligare mål i vårdandet. Trots alla positiva upplevelser kände en del sjuksköterskor att de kunde uppstå svårigheter i vårdandet enligt LCP. Brister i vårdmiljön ansågs av sjuksköterskorna göra att målen med vården inte kunde tillgodoses. Tidsbrist och underbemanning ledde ofta till att patienter i livets slutskede fick en lägre prioritet. Vidare ansågs kriterierna vara för hårda enligt vissa sjuksköterskor gällande införande av LCP.

Sjuksköterskors erfarenhet av att vårda patienter i livets slutskede enligt Liverpool Care Pathway (LCP) : En litteraturöversikt

Syfte: Att redogöra för sjuksköterskors erfarenhet av att vårda patienter i livets slutskede enligt Liverpool Care Pathway (LCP). Metod: Litteraturstudien baseras på tio vetenskapliga artiklar med kvalitativ ansats. De vetenskapliga artiklarna söktes i databaserna CINAHL, PubMed och World of Science. Inklusionskriterier var att artiklarna skulle vara primärkällor, vara skrivna på svenska eller engelska samt publicerade mellan år 2003-2013. Ytterligare inklusionskriterier var att sjuksköterskorna skulle ha erfarenhet av LCP, samt att de vetenskapliga artiklarna erhöll medel eller hög poäng vid granskningen och var godkänd av en etisk kommitté. Studier från hela världen inkluderades. Huvudresultat: Ett flertal studier visade att LCP bidrog till ett ökat självförtroende och tydligare riktlinjer för den palliativa vården. Sjuksköterskorna upplevde en förbättrad symtomkontroll och förbättrad vård efter införandet av LCP. Sjuksköterskorna var positiva till dokumentationen i LCP och det framgick också att LCP hade förbättrat och underlättat kommunikationen med närstående. LCP erbjöd stöd och vägledning i vården men det framgick också att det fanns oklarheter vad beträffar diagnostiserande av en patient som döende. Slutsats: Syftet med litteraturstudien var att undersöka sjuksköterskors erfarenhet av att vårda patienter i livets slutskede enligt Liverpool Care Pathway. Det framgick att det fanns bristande kunskaper om palliativ vård, men att införandet av LCP gett sjuksköterskor stöd och vägledning samt förbättrat kunskapen om palliativ vård. En vårdplan som LCP kan vara ett stöd för sjuksköterskan i omvårdnaden av patienter inom palliativ vård, men en sådan vårdplan kan aldrig ersätta sjuksköterskans kliniska kompetens. Det är därför viktigt att sjuksköterskor erbjuds fortlöpande utbildning inom palliativ vård, samt att en vårdplan som LCP används utifrån ett kritiskt förhållningssätt.  

α,ω-Bis(trichlorostannyl)alkanes: unravelling the hydrolysis pathway to organotin-oxo oligomers

New α,ω-bis(trichlorostannyl)alkanes, Cl₃Sn(CH₂)_nSnCl₃ [n = 3-5, 8], have been synthesized via tin-phenyl bond cleavage reactions on α,ω-bis(triphenylstannyl)alkanes, Ph₃Sn(CH₂)_nSnPh₃ [n = 3-5, 8], using either SnCl₄ or concentrated hydrochloric acid. Some key missing links, (H₂O)Cl₃Sn(CH₂)₃SnCl₃(H₂O) (1a) and (H₂O)₂Cl₃Sn(CH₂)₃SnCl₃(H₂O)₂ (6), in the hydrolysis pathway of organotin trichlorides were identified. Crystal structures of the nonassociated di-tin compounds (H₂O)Cl₃Sn(CH₂)₃SnCl₃(H₂O) (1a) and (H₂O)₂Cl₃Sn(CH₂)₃SnCl₃(H₂O)₂ (6, isolated as the 18-crown-6 cocrystal acetonitrile solvate) as well as the polymeric hydrolysis product [H₂O(OH)Cl₂Sn(CH₂)₃SnCl₂(OH)H₂O·₂H2O]_n (7·2H₂O) are reported.

Nicotine treatment decreases food intake and body weight via a leptin-independent pathway in Psammomys obesus

It has been reported previously that leptin may be involved in nicotine's ability to reduce body weight. Our aim was to investigate whether the anorexic action of nicotine is related to the actions of leptin by utilizing lean leptin-sensitive and obese leptin-resistant Psammomys obesus. Lean and obese P. obesus were assigned to receive nicotine sulphate at 6, 9 or 12 mg/day or saline (control) for 9 days (n = 6-10 in each group), administered using mini-osmotic pumps. Food intake, body weight, plasma leptin concentrations, plasma insulin and blood glucose were measured at baseline and throughout the study period. Nicotine treatment reduced food intake by up to 40% in lean and obese P. obesus. Plasma leptin levels fell significantly only in lean nicotine-treated animals, whereas no changes were observed in obese nicotine-treated animals. However, both lean and obese nicotine-treated animals had similar reductions in body weight. Our results show that nicotine has dramatic effects on food intake and body weight, however, these changes appear to be independent of the leptin signalling pathway.

Copper-dependent iron assimilation pathway in the model photosynthetic eukaryote chlamydomonas reinhardtii

The unicellular green alga Chlamydomonas reinhardtii is a valuable model for studying metal metabolism in a photosynthetic background. A search of the Chlamydomonas expressed sequence tag database led to the identification of several components that form a copper-dependent iron assimilation pathway related to the high-affinity iron uptake pathway defined originally for Saccharomyces cerevisiae. They include a multicopper ferroxidase (encoded by Fox1), an iron permease (encoded by Ftr1), a copper chaperone (encoded by Atx1), and a copper-transporting ATPase. A cDNA, Fer1, encoding ferritin for iron storage also was identified. Expression analysis demonstrated that Fox1 and Ftr1 were coordinately induced by iron deficiency, as were Atx1 and Fer1, although to lesser extents. In addition, Fox1 abundance was regulated at the posttranscriptional level by copper availability. Each component exhibited sequence relationship with its yeast, mammalian, or plant counterparts to various degrees; Atx1 of C. reinhardtii is also functionally related with respect to copper chaperone and antioxidant activities. Fox1 is most highly related to the mammalian homologues hephaestin and ceruloplasmin; its occurrence and pattern of expression in Chlamydomonas indicate, for the first time, a role for copper in iron assimilation in a photosynthetic species. Nevertheless, growth of C. reinhardtii under copper- and iron-limiting conditions showed that, unlike the situation in yeast and mammals, where copper deficiency results in a secondary iron deficiency, copper-deficient Chlamydomonas cells do not exhibit symptoms of iron deficiency. We propose the existence of a copper-independent iron assimilation pathway in this organism.

Straddling the pathway from paediatrician to mainstream health care : transition issues experienced in disability care

Objective: To identify the strengths and limitations of health care and related services provided to young adults with a disability during the period of transition from the care of a paediatrician to the mainstream health system.
Design: A descriptive design was used to address the study objectives.
Setting: Barwon and south-western region of Victoria.
Subjects: Twelve focus group discussions, with young adults with a disability, carers of young adults with a disability and health care service providers. Each focus group involved eight to 10 participants.
Results: The findings revealed a number of problems with the transition period. All participants acknowledged the supportive, coordinating role of the paediatrician. In the absence of this type of role, carers felt they lacked the knowledge and support to manage the adolescent with a disability. Communication problems between all service providers were identified as being problematical. The general lack of continuity of care between providers made it difficult for individuals to negotiate the transition period and increased the burden of care on carers.
Conclusion: There is a need for policy makers to address these transition problems and develop appropriate services that improve the situation for young adults with a disability and their carers.
What is already known: It is well documented that the transition period from paediatrician to adult health care services is problematic for the young adult with a disability and their carer. The difficulties experienced are attributed to poor communication between service providers and a lack of continuity of care.
What does this study add: This study provides insights from a number of different consumer and health care professionals' perspectives. The findings identify service delivery gaps and a need to develop health care services that could assist the young adult with the disability negotiate this transition from the paediatric services to mainstream health care services in rural and regional settings in Victoria.

'Green' treatment of acid mine drainage - a step towards sustainability

Sustainability is becoming increasingly important in the mining and mineral processing industries and must incorporate the associated waste products. Acid mine drainage (AMD) is one such by-product and is one of the most serious environmental problems facing the minerals industry today. The oxidation of sulphidic mine wastes often continues for a substantial period of time after mine closure, resulting in difficult and costly remediation and rehabilitation works. Mining companies are often reluctant to spend increasing amounts of money on waste treatment when the mine life is limited or even finished. Hence a simple, low maintenance and low-cost method of treating AMD is required. Whilst this paper does not address the issue of AMD, it does propose methods for removal of individual species from AMD with potential benefits, including raising AMD pH.

A novel concept of using biosolids as a biological adsorbent, or ‘biosorbent’, of metals from AMD is being investigated at a laboratory/pilot scale level. Biosolids are a by-product resulting from the biological treatment of wastewater, and have been previously shown to adsorb metals from aqueous solutions. This could lead to an environmentally sustainable or ‘green’ method for treating both AMD discharges and disposing/reusing the biosolids.

The result of a laboratory-scale study of the biosorption of Zn(II) is presented in this paper. Physical parameters including reaction kinetics, mixing speed and solution pH were investigated. Solution pH also rose an average of 2 pH units over the 24 hour equilibrium time – a valuable side effect when treating acid mine drainage. The outcome of the study highlights the usefulness of biosolids as a biosorbent for the removal/recovery of metal ions from acid mine drainage. A simple, low-cost treatment technology requiring low maintenance would be beneficial to the mining industry to address some issues relating to AMD and would help integrate environmental and economic considerations into sustainable environmental management.

Cytokine receptor signaling through the Jak-Stat-Socs pathway in disease

The complexity of multicellular organisms is dependent on systems enabling cells to respond to specific stimuli. Cytokines and their receptors are one such system, whose perturbation can lead to a variety of disease states. This review represents an overview of our current understanding of the cytokine receptors, Janus kinases (Jaks), Signal transducers and activators of transcription (Stats) and Suppressors of cytokine signaling (Socs), focussing on their contribution to diseases of an immune or hematologic nature.

The normative distribution of chest tube drainage volume after coronary artery bypass grafting

Background
Little evidence exists to describe expected volumes of chest tube (CT) drainage after coronary artery bypass grafting (CABG).

Objectives
The study objective was to map the trajectory of CT drainage volumes from insertion to removal after CABG.

Design

This was a retrospective, descriptive study.
Patients
The study included 239 patients who underwent CABG at a single metropolitan hospital in Melbourne, Australia.

Results
The sample (N = 234), aged 68.7 years (standard deviation [SD] 9.9), was predominantly male (N = 185, 79.1%). The mean duration of CT insertion was 45.2 hours (SD 26.7), and total drainage volume was 1300.6 mL (SD 763.8). Drainage volumes plateau to 31 mL per hour, 8 hours after surgery. From 24 to 48 hours, the mean drainage was 21 mL per hour. Drainage volumes varied between genders.

Conclusions
Evidence of similar drainage patterns in other populations is difficult to locate. If the pattern of drainage shown in this study is consistent, experimental intervention studies comparing standard removal time and earlier removal are recommended. If not, prospective collection of relevant preoperative, intraoperative, and postoperative factors across multiple sites is necessary to determine which patient or practice variations influence CT drainage patterns after CABG.

Sudden drawdown and drainage of a horizontal aquifer

Drainage of a saturated horizontal aquifer following a sudden drawdown is reanalyzed using the Boussinesq equation. The effect of the finite length of the aquifer is considered in detail. An analytical approximation based on a superposition principle yields a very good estimate of the outflow when compared to accurate numerical solutions. An illustration of the new analytical approach to analyze basin-scale field data is used to demonstrate possible field applications of the new solution.

Hydrolysis of bis((trimethylsilyl)methyl)tin dihalides. Crystallographic and spectroscopic study of the hydrolysis pathway

The synthesis and characterization by multinuclear NMR spectroscopy of the diorganotin dihalides (Me₃SiCH₂)₂SnX₂ (1, X = Cl; 2, X = Br), the diorganotin dichloride water adduct (Me₃SiCH₂)₂SnCl₂·H₂O (1a), the dimeric tetraorganodistannoxanes [(Me₃SiCH₂)₂(X)SnOSn(Y)(CH₂SiMe₃)₂]₂ (3, X = Y = Cl; 4, X = Br, Y = OH; 5, X = Br, Y = F; 6, X = Y = OH; 8, X = Cl, Y = OH), and the molecular diorganotin oxide cyclo-[(Me₃SiCH₂)₂SnO]₃ (7) are reported. The structures in the solid state of compounds 1a, 3, 6, and 7 were determined by single-crystal X-ray analysis. In toluene solution, the hydroxy-substituted tetraorganodistannoxane 6 is in equilibrium with the diorganotin oxide 7 and water. The eight-membered diorganotin oxide cyclo-[(Me₃SiCH₂)₂SnO]₄ (7a) is proposed to be involved in this equilibrium. On the basis of the results of this and previous works, a general hydrolysis pathway is developed for diorganotin dichlorides containing reasonably bulky substituents.

The Jak-Stat pathway in Hematopoiesis and Disease

This book for the first time comprehensively surveys the research investigating the Jak-Stat pathway and its role in normal blood development as well as its perturbation in disease. It draws on the expertise of world-renowned medical researchers to take the reader from basic biology through to recent therapeutic advances.

Pathway planning and 'becoming somebody' : Exploring the tensions between wellbeing and credentialism with students at (educational) risk

This paper maps the policy shifts around the education and training of youth that frame how schools respond to issues of youth' at risk'. These shifts have occurred with the move from the self managing schools marked by market discourses of competition, autonomy and image management that supplanted earlier discourses of welfare and community, through to recent policies in Victoria arising from the Kirby Review of Post compulsory Education and Public Education, the Next Generation undertaken by the Labor government. These reports, and the policies emerging out of them, are producing new discourses about youth and schooling focusing on wellbeing, learning networks and more systemic support for schools at the same time as there is increased accountability and expectations of schools. Drawing on the school exclusion literature from the U.K, and using Bourdieu's notion of habitus, we examine the findings from a recent study undertaken on the Geelong Pathways Planning project, funded through a Victorian government strategy, to discuss how schools respond to such initiatives. The project explored the ways in which students in the Geelong region understood and worked with the job planning pathways program, and how service providers (schools, community education facilities, job networks etc) coordinated to meet the needs of individual youth. There was a disjuncture in the participating schools between the discourses of care and welfare for students at risk, and the actual practices and policies that ignored or excluded such students. This paper concludes with a discussion of what might be required systemically, in schools and in their relations to other education providers, to build the capacity to respond more effectively to all students.