Human lactoferrin and peptides derived from a surface-exposed helical region reduce experimental Escherichia coli urinary tract infection in mice.

Lactoferrin (LF) is a multifunctional immunoregulatory protein that has been associated with host defense at mucosal surfaces through its antibacterial properties. The antibacterial and anti-inflammatory properties of LF were further explored with an animal model of experimental urinary tract infection. Bovine LF (bLF), human LF (hLF), and synthetic peptide sequences based on the antibacterial region of hLF (amino acid residues 16 to 40 [HLD1] and 18 to 40 [HLD2]) were given orally to female mice 30 min after the instillation of 10(8) Escherichia coli bacteria into the urinary bladder. The control groups received phosphate-buffered saline or water. C3H/Tif mice were treated with hLF or bLF, and C3H/HeN mice were treated with bLF only. The numbers of bacteria in the kidneys and bladder of C3H/Tif and C3H/HeN mice were significantly reduced 24 h later by the LF treatments compared to the findings for the control group. The hLF-treated group showed the strongest reduction compared with the vehicle-treated-group (P values were 0.009 and 0.0001 for the kidneys and bladder, respectively). The urinary leukocyte response was diminished in the hLF-treated group. The hLF treatment also significantly reduced the urinary interleukin-6 (IL-6) levels at 2 h and the systemic IL-6 levels at 24 h after infection (P values were 0.04 and < 0.002, respectively). In the bLF-treated animals, no such strong anti-inflammatory effects were obtained. In another series of experiments, C3H/Tif mice perorally treated with HLD1 or HLD2 also showed reduced numbers of bacteria in the kidneys compared with the vehicle-treated mice, although the results were significantly different only for HLD2 (P < 0.01). Analysis of urine from hLF-fed C3H/Tif mice showed that hLF was excreted into the urinary tract at 2 h after feeding. Testing of the in vitro bactericidal activity of LF (1 mg/ml) or the peptides (0.1 mg/ml) in mouse urine against the E. coli bacteria revealed moderate killing only by HLD2. In conclusion, these results demonstrate for the first time that oral administration of hLF or peptides thereof is effective in reducing infection and inflammation at a remote site, the urinary tract, possibly through transfer of hLF or its peptides to the site of infection via renal secretion. The antibacterial mechanism is suggested to involve bactericidal capacities of LF, fragments thereof, or its peptides.

An evaluation of patients' quality of life before, 6 weeks and 6 months after total hip replacement surgery.

Annually, throughout the world, more than 800,000 primary total hip replacement surgery procedures are performed on patients suffering from hip joint arthrosis. Since 1991, approximately 11,000 of these procedures are performed annually in Sweden. This study aimed to investigate any changes in the patients' life quality 6 weeks and 6 months after their total hip replacement surgery had been performed, compared to that immediately prior to the operation. It also aimed to examine the reason for surgery, the types of prostheses used, postoperative pain, complications and the actual usage of ambulation support. The Sickness Impact Profile self-appraisal instrument, together with personal patient interviews have been used as the basis of the research. A total of 51 patients responded to the quality of life instrument prior to their operation, 47 of these participated 6 weeks after the operation, and 40 patients 6 months after the operation. Significant differences in patients' total, physical and psychosocial quality of life 6 months postoperatively compared to the situation prior to the operation were found, but not between the situation before and 6 weeks after the total hip replacement surgery. The majority of patients were of the opinion that it was more important that the pain had disappeared or decreased, than any overall increase in the quality of life. Postoperative complications occurred within 6 weeks, and even after 6 months some patients still suffered from these.

Acute confusion and unreal experiences in intensive care patients in relation to the ICU syndrome. Part II.

The intensive care unit syndrome (ICU syndrome) is defined as an altered emotional state occurring in a highly stressful environment, which may manifest itself in various forms such as delirium, confusion, crazy dreams or unreal experiences. The purpose of this part of a study of patients' experiences is to describe and illuminate patients' experiences of acute confusion, disorientation, wakefulness, dreams and nightmares during and after their stay in the ICU. The data were obtained from 19 ventilated patients, who were interviewed twice and had stayed at least 36 hours in the ICU, the first interview being about one week after discharge from the ICU, and the second 4-8 weeks later. The hermeneutic approach used when interpreting and analysing the text from the interviews revealed that patients' experiences of unreal experiences were often associated with intense fear. Intense or continuous unbearable fear seems to result in frightening unreal experiences, which further increase the level of fear. Care actions or caring relationships with relatives or nurses can reduce this fear, which can help to prevent the occurrence and/or duration and intensity of the unreal experiences. Trust and confidence in nurses or significant others and feelings of self-control or trust in self-control seemed to reduce the risk of unreal experiences so that adverse stimuli might only trigger a mild confusion.

The patient's perceived caring needs: measuring the unmeasurable.

The aim of this study is to elucidate the phenomenon of the caring need in the life-world of the patient and, on the basis of this, to compare patients' perceived caring needs with the six areas of need contained in a new instrument for patient classification, the Oulu Patient Classification (OPC). A total of 75 patients were interviewed and the data were analysed by means of a phenomenological-hermeneutical method. Seventeen perceived caring needs emerged from the process of interpretation. The patients experienced themselves as an indivisible unit that contained existential/spiritual needs and desires. The patients' caring needs are constituted from their problems, needs and desires, where human desire for life, love and meaningfulness may, express itself as bodily, psychical and existential/spiritual needs. A comparison between the patients' perceived caring needs and the OPC shows that patients' existential/spiritual needs do not emerge clearly enough and that the instrument should be supplemented by a caring perspective.

Measuring the unmeasurable: a caring science perspective on patient classification.

AIMS: To give a short historical survey of patient classification and its motives, to analyse patient classification and especially the instrument, The Oulu Patient Classification more closely from a caring science perspective. BACKGROUND: A survey of topical literature and research on patient classification show that economic and administrative justifications predominate and the caring science connection is weak, almost non-existent. ORIGINS OF INFORMATION: Topical literature and research on patient classification and the instrument, The Oulu Patient Classification. DATA ANALYSIS: Topical literature and research were evaluated from a caring science perspective in accordance with Eriksson's theory of caring and the basic concept of man as an entity of body, soul and spirit. KEY ISSUES: Patient classification is used in staff planning and is also justified from the viewpoint of content, that is, as a method of guaranteeing good quality in the care of patients and as an expression of the prevalent caring ideology. The concept of man is reduced in current literature and research on patient classification. The Oulu Patient Classification is based on a humanistic view of man, but man's spiritual and existential needs do not emerge clearly from the manual of the instrument. CONCLUSIONS: It is essential for patient classification to start from a caring perspective. Correctly dimensioned staffing based on patient classification is a prerequisite for good care. This should be combined with a caring culture that considers the whole complexity of man in order to make good care possible.

Brain death in ICUs and associated nursing care challenges concerning patients and families.

In order to document the incidence and causes of brain death (BD) and the frequency of organ donation (OD) in a Swedish University Hospital, a retrospective review of deaths in a neurosurgical department and in the general intensive care units (ICUs), was carried out for the period 1988-1994. BD diagnosis was established in 197 (10.6%) of all deaths (n = 1843). The hospital records of all BD patients were examined in detail following a specific study plan. The majority of the BD patients (89%) were acute admissions to hospital, and among them 81 were transferred between hospitals often over a long distance. Among the BD patients the total number of OD was 65 (33%). The most common diagnosis leading to BD was spontaneous intracerebral bleeding and traumatic head injury. The BD diagnosis was established by neurological examination (60%) and by cerebral angiography (40%). Of the BD patients, 50% died within 48 hours in the ICU and the majority of requests for OD (67%) were made to the relatives of these patients. The findings are discussed with focus on the workload and psychological stress of ICU nurses when caring for BD patients and their families; a task which includes taking part in processes concerning BD diagnosis information and OD requests.

A comparison of the incidence of breast feeding two and four months after delivery in mothers discharged within 72 hours and after 72 hours post delivery.

OBJECTIVE: To compare breast feeding at two and four months after delivery in mothers discharged early (ED = before 72 hours post delivery) and late (LD = after 72 hours post delivery), and to explore the factors of greatest importance to the successful practice of breast feeding. DESIGN: Ex-post facto design. SETTING: In the country of Härryda, Sweden. PARTICIPANTS: All Swedish speaking women in the country of Härryda whose babies were born between 01.01.94 and 31.05.94 and who were registered at the Child Health Station (CHS) by the age of three months. One hundred and ninety women were invited to participate and 157 (83%) accepted. MEASUREMENTS AND FINDINGS: No significant difference was found in the breast feeding rates between the ED and LD group. However, ED mothers breast fed exclusively to a higher extent at two and at four months (exclusive breast feeding: at two months 89% and 86% respectively, and at four months 84% and 74% respectively, partial breast feeding: at two months 6% and 10% respectively, and at four months 5% and 12% respectively). If the woman considered that she had received encouragement and support while breast feeding for the first time, the probability of her breast feeding at two and at four months were about six times as great (Exp(B) 5.7594, df = 1, p = 0.0270; (Exp(B) 5.9781 df = 1, p = 0.0005 respectively). KEY CONCLUSIONS: The length of the hospital stay had no significant effect on the incidence of breast feeding at two and four months post delivery. The most predominant factors influencing breast feeding were seen to be the mother's first experience of breast feeding and the degree of support, help and encouragement she received. Less than half of the women received a visit from the CHS nurse after their return home from hospital. IMPLICATIONS FOR PRACTICE: The findings suggest that it is important that the midwife or nurse should prepare, support and encourage the mother when breast feeding for the first time. The midwife's or nurse's interventions are important for the incidence of breast feeding, at least during the first four months, and indirectly affect public health. This must also be taken into consideration when caring for mothers in the delivery ward and before discharge, i.e. that the breast feeding is working well, that the mother experiences it as working well, and also for planning follow-up after discharge.

Evaluating nurses' knowledge and patients energy intake after intervention.

The aims of this study were to describe and assess nutritionally at-risk patients' energy intake and nurses' knowledge and opinions of patients' need of energy during their hospital stay, before and after training and education. The effects of the intervention were evaluated by using a questionnaire, answered by the nurses before and after the intervention, and indirectly by measuring the patients' nutritional outcome, using a nutritional assessment form. A total of 230 matched patients and 171 nurses (86 before the intervention and 85 after) participated in the study. After the education, results indicated that a greater number of patients received increased levels of energy intake, an increased average intake of energy, and more dietary supplements. Nurses' knowledge about the content of energy in a standard portion of food had increased, and they found it easier to assess patients' need of energy. After the education, more nurses had the opinion that well-educated nurses in nutrition make it easier to motivate patients to reach a sufficient intake of energy.

A comparison between patients' experiences of how their caring needs have been met and the nurses' patient classification--an explorative study.

AIM: To examine whether patient classification carried out in accordance with the Oulu Patient Classification (OPC) method can measure the patient's caring needs in a reliable manner as seen from the patient's perspective. BACKGROUND: On the basis of earlier research it can be established that there are differences between nurses' and patients' assessments of patients' caring needs. Research on patients' assessments of perceived caring needs and the care they receive in connection with patient classification does not seem to have interested researchers in caring science. METHODS: The reliability from the patient's perspective is gauged by comparing the patient's perceived caring needs with the nurse's patient classification during a 24-h bed-day. Data was collected during a semi-structured interview with a total of 73 patients. Documentary analysis was carried out on the basis of patient classifications by 30 ward nurses. FINDINGS: On the basis of the degree of correspondence between nursing care intensity experienced by the patients and the nurses' patient classification it was decided whether the patients' caring needs had been met. The results indicate, however, that patient classification as a gauging method has a built-in reductive function regarding the patient's need for care and nursing care intensity. CONCLUSIONS: Nevertheless the OPC offers possibilities from a patient perspective of providing an overall picture of the patient's nursing care intensity and can therefore serve as a reliable basis for decisions concerning staff planning.

Patients' experience of being critically ill or severely injured and cared for in an intensive care unit in relation to the ICU syndrome. Part I.

The intensive care unit (ICU) syndrome is regarded principally as a complex interaction of several contributory factors, all of which can be seen as partly responsible for the development of the syndrome. The purpose of this study was to describe and give a deeper insight into patients' experiences and memory recall, both during and after their stay in the ICU. Nineteen patients who had been respirator treated (ventilated), and had stayed at least 36 hours in the ICU, were interviewed about one week after discharge, and again 4-8 weeks after their discharge from the ICU. Patients' experiences are interpreted and related to previous views held concerning the syndrome, together with an awareness of other important and significant phenomena, i.e. a hermeneutic approach. This study partly confirms the findings of earlier studies concerning the ICU syndrome, but also reveals some new aspects, which have not previously been considered. The patients described themselves as experiencing some sort of state of chaos following the onset of their sickness, injury or accident, which resulted in feelings of extreme instability, vulnerability and fear, often experienced as prolonged inner tension. It was reported that even the most trivial events in circumstances or routines could trigger changes-either an increase or decrease-in patients' feelings of fear or inner tension. The caring relationship was perceived as providing an important degree of security and comfort. Nursing care actions can therefore be seen as vital factors in patients overcoming the accompanying horrific experiences to which they can be subjected. This state of chaotic feeling, and how it is combated and treated, appear to be one critical factor in the development and progression of the ICU syndrome.

How to translate nursing care into costs and staffing requirements: part two in the Zebra system.

The purpose of this paper is to describe part two of the Zebra system-the activity study: how such a study can be conducted, which requirements must be met and how the data are processed and can be used. The activity studies described were conducted in two of the wards of the oncology department in the University Hospital of Lund, Sweden. The results of the studies make it possible to calculate the distribution of different activities for nurses and practical nurses during 24 hours and the total nursing care minutes per patient and category of care. Together with the patient classification, part one in the Zebra system, it is possible to calculate nursing costs per patient stay and the patients'staffing requirements. It will be possible to relate nursing costs and staffing requirements to actual nursing care given instead of fixed standard costs and staffing figures.

Proportion of Swedish school nurses' time devoted to different health care activities.

School nurses play an important role in the preventive health care of children and adolescents. This study aimed to describe and investigate the school nurses' different activities and time spent on these activities. By completion of a time study record form all 26 school nurses, in a medium-sized town in Sweden, documented their activities during 10 working-days. Altogether 635 record forms were received. It was found that almost half of the school nurses' time was used for individual pupil activities, 17% for groups of pupils and 34% for administrative activities. School nurses spent 17% of all their working time at the school clinic, which in some way may reflect the pupils need of the nurse in the school. These results highlighted the importance of school nurses and resulted in internal structural changes of school nurses' working time.

Lactoferrin or a fragment thereof inhibits the endotoxin-induced interleukin-6 response in human monocytic cells.

Human milk is in several ways anti-inflammatory. This study investigates whether or not human milk lactoferrin (LF) in comparison with bovine LF can affect the IL-6 release from human cells. Human, as well as bovine, LF and a bactericidal pepsin-derived fragment of bovine LF (lactoferricin B) were found to suppress the IL-6 response in a monocytic cell line (THP-1) when stimulated by lipopolysaccharide (LPS). The suppression of bovine LF was similar to or higher than that of human LF. Lactoferricin B was the strongest inhibitor of the LPS-induced IL-6 response. A time-dependence regarding the inhibitory capacity of LF was found. For human LF, the strongest inhibition was observed when added 15-30 min after the addition of LPS. Addition of LF before the LPS induced an approximately 45% reduction of the IL-6 response. The results suggest an anti-inflammatory activity of both human and bovine LF, and of the LF fragment lactoferricin B through their suppressive effects on the cytokine release.

Intensive care syndrome: a literature review.

The aim in this literature review is to describe the definitions, denominations, clinical signs and symptoms, explanations, causative factors and interrelationships of the intensive care syndrome discussed since 1950. It was found that there is no agreement about which symptoms should be included in the syndrome, when the syndrome may appear and how many patients may be affected. Furthermore, it is unclear what causes the development of the syndrome; most authors conclude that there are many reasons for it. The syndrome has generally been examined by using a medical or psychological approach, but during the last few years it has also been described and analysed from a nursing care perspective. From this nursing perspective the syndrome may be seen as an individual pattern developed by patients during their stay in an intensive care unit (ICU) and sometimes this pattern of clinical signs and symptoms lasts for a shorter or longer period even after discharge from the unit. From a wider viewpoint the development of the syndrome can be seen as an increase by degrees or as a vicious circle. finally, most authors agree that the ICU syndrome consists of, and is caused by, a complex interaction between many factors.

Prevalence of skin and genital mucous membrane irritations in patients confined to bed.

A comparative and prospective study of the skin and genital mucous membrane conditions of 50 intensive care patients, who were entirely confined to bed, was conducted. Skin and/or genital mucous membrane irritations were developed by 31 patients during their stay in the ICU. These patients had a significantly longer stay in bed in the ICU than those who did not develop such changes. Patients with lesions were significantly washed more often using the pH 8.5 soap than those without lesions. Erythematous was the most commonly observed symptom and the area between the buttocks and saccrum was the most affected.

Patients' experiences of herpes zoster and postherpetic neuralgia.

The purpose of the study was to investigate retrospectively whether patients (n = 73) who had suffered another disease and/or experienced psychosocial stress at the time of the onset of herpes zoster had experienced a more severe clinical course of herpes zoster, and were more subject to the development of postherpetic neuralgia than other patients (n = 45) with herpes zoster. The interview questionnaire included questions about changes in the patients' daily lives due to neuralgia, and their current living circumstances. Significantly more of the patients who had had another disease and/or psychosocial stress at the time of the onset of herpes zoster reported severe pain during the acute phase of herpes zoster. They also reported pain to a greater extent at the time of the interview and mentioned that their lives had changed owing to postherpetic neuralgia. More of these patients reported that their habits and activities had been negatively affected and they also experienced their current situation as unsatisfactory. These results must, however, be interpreted with caution as the patients' recollection of other diseases and/or psychosocial stress and the patients' current mood due to postherpetic neuralgia at the time of the interview may have influenced the memory and the answers.

An interview study of nurses' assessment and priority of post surgical pain experience.

Caring for patients in postoperative pain is an important part of clinical practice for nurses. Patients often fail to receive adequate pain relief which causes unnecessary pain experience. The aim of this study was to describe how nurses experience their clinical practice management with postoperative patients who experience pain. Eight nurses, practising in the postoperative care unit and surgical wards were interviewed. Data were gathered in unstructured interviews and analysed by means of a qualitative method. Six categories emerged: organising condition, perspective, attitude, knowledge, experience and assessment/priority. All the conditions are interrelated and influenced the nurses' handling of pain management in nursing practice. It appeared that these conditions reflected the nurses' possibilities of relieving patients' postoperative pain. An important element was the reflection of hospital management policy which makes the nurses, in spite of their desire to relieve the patients' pain, choose to have the attitude that the patient should be prepared to accept a little pain.

Nursing discharge assessment of the patient post-inguinal herniorrhaphy in the ambulatory surgery setting.

Nursing discharge assessment and patient discomfort and complications after ambulatory inguinal herniorrhaphy were studied. Of 70 patients, 40 were contacted by telephone the first postoperative day at home. On postoperative day 1, 14 patients experienced discomfort and negative feelings of well-being such as pain and nausea. However, most patients (N = 38) reported that they had "felt well" or "quite well." The results show that the nursing assessment of patient postoperative condition is satisfactory in the immediate postoperative period. The telephone follow-up was appreciated by the patients, and it also brought new possibilities of evaluating the quality of nursing care.

The Zebra system--a new patient classification system.

When the economical systems in the health care field are becoming more like those in 'the market for goods and services' it is important that the patients' need of nursing care as well as the costs for the nursing care can be documented in a systematic and reliable way. One way of doing that is to use a patient classification system. In this article the most used patient classification system in Sweden--the Zebra system--will be presented. The Zebra system makes it possible both to describe the individual patients' dependency level and to calculate the patients' requirements of nursing care both in staffing terms and costs, per month, per year, per patient stay, per diagnosis or DRG. It gives possibilities for managers to analyze the patient distribution in different categories of care during different periods of time, or if the patients' need of nursing care can explain the staffing requirements during a certain period, or if the distribution of days in different categories of care are related to age groups or diagnosis or DRG.