Psychometric evaluation of a modified caring assessment tool

Caring is the essence of nursing the measurement of caring and its effectiveness on patient outcomes is central to nursing, efficient, theoretically sound evaluation of caring, remains problematic. This descriptive study aimed to modify the caring assessment tool, to test the validity and internal consistency reliability of the tool. A convenience sample of 200 hospitalized adult patients in medical-surgical units at Ain Shams University hospitals were included in the study. The modified caring assessment tool consisted of 33 items divided into seven factors. [Basic human needs, human respect, attentive reassurance, healing environment, affiliation needs, dependence-independence continuum and therapeutic intervention]. The results showed that the items loaded significantly on the factors and alpha reliability recorded statistical significance between 0.85 to 0.95. Homogeneity coefficients for internal consistency reliability of the modified caring assessment tool through factor loading showed support for the classification of the tool and ascertain pertinent items for the factors, as well as the content validity investigated by varied sources achieved acceptable confirmation

study of T-helper 2 / T-Helper 1 imbalance in respiratory syncytial virus bronchiolitis in relation to severity and outcome

The present study was carried out on 80 infants with acute bronchiolitis. Their ages ranged from 2-22 mo. They were 60 males and 20 females. 30 apparently healthy infants of matchable age and sex were enrolled in the study as controls. Besides taking history, thorough clinical examination and routine laboratorial investigations, arterial oxygen saturation, RSV tissue culture of nasopharyngecil lavage, direct immunoflourescence for serum RSV Ig-M, serum IL-4 and INF-gamma were done. Results showed that viral bronchiolitis is predominant in males around 6 mo of age and in winter months. RSV infection was found, in 72.5% of cases. Serum IL-4 was not different between RSV negative patients and controls but it was significantly higher in RSV positive patients than either RSV-ve cases or controls [P< 0.001 for each]. Furthermore in RSV + ve patients it was significantly higher in severe and fatal cases than in milder and surviving ones [P<0.001 for each]. Serum INF-gamma showed no significant difference between RSV + ve and RSV -ve patients hut it was significantly higher in both groups than controls [P< 0.001 for each]. In RSV+ve cases it was significantly lower in more severe and fatal cases than milder and living ones [P<0.05 respect]. The ratio I-L-4/ INF-gamma was significantly higher in RSV + ve group than RSV-ve and than controls [P<0.001 and P< 0. 05 respectively]. ARC and SaO[2]% showed significantly lower values in RSV + ve patients than RSV-ve ones [P<0.001], but the latter showed significantly higher AEC than controls [P < 0.05]. In RSV + ve group, both parameters were significantly lower in severer and fatal cases than milder and living ones [P < 0.001 for each]. In RSV positive group, significant positive correlations were found between disease severity and either serum IL-4 or IL-4 /INF-gamma ratio [r=0.789 and r=0.823, P < 0.001 respectively] but disease severity was inversely correlated with either AEC or SaO2% [r = - 0.962 and r = - 0.828, P < 0.001 respectively]. RSV is the major etiologic virus of bronchiolitis in young infants. Viral tissue cultures and direct immunoflourescene are of equally diagnostic value but both may be needed. Most of the severe and fatal cases are in RSV + ve group. Th2 / Th-l imbalance reflected on IL-4 /INF gamma ratio is more deranged in RSV bronchiolitis with Th-2 predominance especially in more severe and fatal cases. These conclusions may be a rationale for addition of antiviral in severe cases of bronchiolitis but further studies of antiviral drugs and their effect on cytokines may be needed to address this recommendation

A study of some viral pathogens in infants and children with lowe respiratory tract infection and attending the intensive care unit

Acute lower respiratory tract infections are the most common illness in pediatrics. A great variety of viruses especially RSV can cause bronchopneumonia and bronchiolitis in infants and children. This work aimed to evaluate some viral pathogens in pneumonia and bronchiolitis in infants and children admitted to the ICU. This study included 142 patients, 70 suffered bronchopneumonia and 72 suffered bronchiolitis admitted to the ICU in Assiut Pediatric University Hospital, Egypt. The study was done from November 2002 to February 2003 and from the period of November 2003 to February 2004. Clinical evaluation, chest x-ray, complete blood count and arterial blood gases as well as endotracheal suction for collection of the samples for viral study and bacterial cultures were done. Regarding viral tissue culture 66 patients were positive to the studied viruses [26 with bronchopneumonia and 40 with bronchiolitis] with male predominance [43 males with 65.1%]. Out of the 66, 48 were below age of 12 months, 12 were below age of 24 months and 6 were below 36 months. Respiratory Synsytial virus [RSV] was found in 32 cases [484%], influenza A was in 12 [18.1%], Parainfluenza 3 in 18[27.2%], Parainfluenza I in 4 [6%] and adenovirus in 4 [6%]. It was noticed that there were positive bacterial cultures in 27 cases and also mixed viral types. Malnutrition especially the severe type was concomitant with viral infection specially RSV, As regards the blood gases and respiratory rate it was found that cases with bronchiolitis showed significant differences than those of bronchopneumonia where bronchiolitis was more severe than bronchopneumonia. There were 76 cases negative to the studied viruses 44 were bronchopneumonia and 32 were bronchiolitis. Bacterial cultures were positive in 25 patients. Analysis of the blood count showed leucocytosis in the cases as a whole with significant higher levels in the cases with positive bacterial cultures than those with viral infection only. Lymphocytes were significantly higher in the cases with positive viral cultures than those negative to these cultures and eosinophils were significantly higher in the cases negative to the studied viruses and also showed negative bacterial cultures that the cause could be due to allergic conditions. As regards the outcome of the cases that were positive to the studied viruses 29 died [43.9%], 20 of them were due to RSV infection. It is concluded that RSV is the commonest cause of viral lower respiratory tract infection in infants and children. Mixed viral and bacterial infection is not uncommon which is strongly concomitant with the immunocompromised patients' especially malnourished cases. So the use of immunostimulants in addition to antimicrobial and antiviral drugs may be beneficial in such cases

Histochemical study of epithelial mucin in endometrial hyperplasia and adenocarcinomas

The pattern and type of mucin were studied on 37 curettage specimens. These cases were formed of 25 endometria showing normal proliferative and secretory phase and 12 endometria showing hyperplastic changes. Fifteen hysterectomy specimens from cases of endometrial adenocarcinoma were also examined in this work. All cases were stained by Hematoxylin and Eosin, periodic acid-schiff [P.A.S.] and alcian blue. The cases of endometrial hyperplasia showed the same distribution of both types of mucin secreted by the normal endometrial glands, although increased in quantity. Most of endometrial adenocarcinomas contained different quantities of cellular mucin, which was found to be more abundant and widely distributed in the well differentiated than in the moderately or poorly differentiated ones. It was observed that the histochemical properties, site and pattern of mucin secretion in these cases strongly resembled that seen in the normal endometrium. This may play a role in differentiating adenocarcinoma of endometrial origin from other carcinomas in the female genital tract like that of endocervical origin