Development of consensus-based international antimicrobial stewardship competencies for undergraduate nurse education.

BACKGROUND: There is growing recognition by national and international policymakers of the contribution nurses make towards antimicrobial stewardship. Although undergraduate education provides an ideal opportunity to prepare nurses for antimicrobial stewardship roles and activities, only two-thirds of undergraduate nursing programmes incorporate any antimicrobial stewardship teaching and only 12% cover all the recommended antimicrobial stewardship principles. Nurses also report that they do not have a good knowledge of antibiotics, and many have not heard of the term antimicrobial stewardship. AIM: To provide international consensus on the antimicrobial stewardship competency descriptors appropriate for undergraduate nurse education. METHODS: A modified Delphi approach comprising two online surveys delivered to an international panel of 15 individuals reflecting expertise in prescribing and medicines management in the education and practice of nurses; and antimicrobial stewardship. Data collection took place between February and March 2019. FINDINGS: A total of 15 participants agreed to become members of the expert panel, of whom 13 (86%) completed round 1 questionnaire, and 13 (100%) completed round 2. Consensus was achieved, with consistently high levels of agreement across panel members, on six overarching competency domains and 63 descriptors, essential for antimicrobial stewardship practice. CONCLUSION: The competency descriptors should be used to direct undergraduate nurse education and the antimicrobial stewardship practices of qualified nurses (including those working in new roles such as Nursing Associates) due to the high levels of agreement reached on competency descriptors.

Mixed inflammatory/regulatory cytokine profile marked by simultaneous raise of interferon-gamma and interleukin-10 and low frequency of tumour necrosis factor-alpha(+) monocytes are hallmarks of active human visceral Leishmaniasis due to Leishmania chagasi infection.

Considering the complexity of the immunological events triggered during active visceral Leishmaniasis (VL), the relevance of the segregation of the immune response during human VL into type 1 and type 2 still remains unclear. For this purpose, in individuals living in risk areas for VL, we have evaluated especially asymptomatic individuals and patients with active VL, the plasmatic levels of cytokines and reactive nitrogen species under ex vivo conditions. In addition, we have also performed an analysis of intracellular cytokine patterns of circulating leucocytes after short-term culture, particularly in the absence of antigenic-specific stimulation, in order to reflect dynamic events of immune response in vivo during Leishmania chagasi infection. Although asymptomatic individuals and non-infected subjects presented a similar immunological profile, an outstanding inflammatory/regulatory profile, based on higher plasmatic levels of cytokines such as interleukin (IL)-8, interferon (IFN)-gamma, tumour necrosis factor (TNF)-alpha, IL-6 and IL-10, was associated with clinical status observed in active VL. In this context, we hypothesize that IL-10, through its ability to inhibit anti-leishmanial macrophage activation, associated with the lower frequency of TNF-alpha(+) monocytes and ordinary levels of nitrite and nitrate are the major mechanisms associated with disease onset.

Immune response in human visceral leishmaniasis: analysis of the correlation between innate immunity cytokine profile and disease outcome.

We investigated the cytokine profile of cells of the innate immune response and its association with active (ACT), asymptomatic (AS) and cured (CUR) human visceral leishmaniasis (VL), as well as noninfected (NI) subjects. The frequency of cytokine-producing cells was determined after short-term in vitro incubation of whole peripheral blood samples with soluble Leishmania antigen (SLA). Our data demonstrated a predominant type 2 cytokine profile in NI and ACT. In NI, we observed an increase of IL-4+ neutrophils, IL-10+ eosinophils besides a decrease of tumour necrosis factor (TNF)-alpha+ eosinophils/monocytes. Yet in ACT, we observed an increase of IL-4+ neutrophils and natural killer (NK) cells and IL-10+ monocytes, a reduced frequency of IL-12+ and IFN-gamma+ eosinophils and lower levels of TNF-alpha+ and IL-12+ monocytes. AS presented a mixed profile, characterized by an increase of IFN-gamma+ neutrophils/eosinophils and NK cells, of IL-12+ eosinophils/monocytes, as well as increase of IL-4+ neutrophils and NK cells and IL-10+ eosinophils/monocytes. In contrast, CUR was characterized by a type 1 response with an increase of IFN-gamma+ neutrophils/eosinophils and NK cells, associated with an increase in IL-12+ monocytes. In conclusion, we show a correlation between innate immune cytokine patterns and clinical status of VL, suggesting that these cells, in addition to other factors, may contribute to the cytokine microenvironment in which Leishmania-specific T cells are primed and to disease outcome.

Characterization of the growth hormone receptor in human dermal fibroblasts and liver during development.

Human tissues express growth hormone receptors (hGHR) by the 3rd mo of gestation. We assessed developmental changes in hGHR function in fibroblasts and liver, testing binding and hormonal response. Fetal cells showed low but reproducible hGH binding. No age-related changes occurred in fibroblasts (9 wk-34 yr). In contrast, there was a fourfold increase in hGH binding in postnatal liver, with a sixfold increase in hGHR mRNA. Both full-length and truncated hGHR mRNAs were detected in all livers. Cross-linking revealed a larger hGH/receptor complex in fetal liver. Fetal hepatocytes produced 10 times more insulin-like growth factor (IGF)-II than IGF-I, and responded to hGH (150 ng/ml) with a significant increase in IGF-II. Fetal hepatocytes secreted three IGF-binding proteins (IGFBPs), including IGFBP1, but not IGFBP3. hGH did not alter fetal hepatocyte IGFBPs but stimulated glucose uptake. Exposure of fibroblasts to hGH decreased hGH binding only in >1-yr postnatal fibroblasts, whereas treatment with dexamethasone (100-400 nM) increased binding only in postnatal cells. Thus, although fetal hepatocytes and fibroblasts possess functional hGHR, these receptors (and/or their signaling pathways) are immature or have adapted to the in utero environment.

[AIDS patients' compliance with antiretroviral treatment: notified difficulties and measures for improvement at a teaching hospital]. / Adesão de pacientes com AIDS ao tratamento com antiretrovirais: dificuldades relatadas e proposiçao de medidas atenuantes em um hospital escola.

This study aimed at identifying the incidence of drug intake errors and the main therapy-related difficulties among AIDS patients as well as at proposing measures to increase patients' adherence to treatment. Sixty-one patients with AIDS assisted by the University Hospital of São Paulo State University at Campinas were interviewed. The most frequent errors concerned the combinations of drugs and the length of fasting. The difficulties reported were adverse effects and the variety of drugs. Based on these data, the authors proposed the use of an illustrated guide for drug-related information. It is hoped that individualized guidance can contribute to minimize errors concerning adherence to therapy.

Needs for assistance and emotional aspects of caregiving reported by AIDS patient caregivers in a day-care unit in Brazil.

The advent of AIDS in families, following the chronic evolution of the illness, has produced crisis situations unknown until now. With the objective of knowing this new reality better, 20 caregivers of AIDS patients were interviewed in southeastern Brazil. The collected data were analyzed using a qualitative method. The results showed difficulties regarding caregiving, such as a lack of orientation, materials, transport, and people to share the role of caregiver, as well as emotional difficulties, such as fears from infection, revulsion, pity, and impotence in the face of death. The role of families is essential in patient assistance, due to the inability of the health system to attend to all AIDS patients. Nevertheless, these families have to receive support mainly from nurses, in order to be helped in executing an aid plan to the ill person at home. Nurses and health care.

Effects of protein-energy malnutrition on muscarinic receptor density and acetylcholinesterase activity in rat brain.

The effect of protein-energy malnutrition on the muscarinic receptor density as indicated by 3H-N-methylscopolamine binding, and acetylcholinesterase activity was studied in several brain areas (hippocampus, motor area, somatosensory area, and basal ganglia) of adult female rats. Malnutrition tended to cause a decrease in muscarinic receptors in the motor cortex (undernourished 350.0 +/- 33.5 vs. control 410.0 +/- 26.9 fmol/mg protein) and somatosensory cortex (undernourished 357.1 +/- 35.9 vs. control 416.7 +/- 29.4 fmol/mg protein). However, significant decreases in muscarinic receptor occurred in the hippocampus (undernourished 319.2 +/- 31.7 vs. control 403.1 +/- 43.6 fmol/mg protein) and basal ganglia (undernourished 297.0 +/- 11.8 vs. control 401.3 +/- 17.7 fmol/mg protein). No significant differences in acetylcholinesterase activity or protein content were observed between control and undernourished animals in any of the brain areas studied.

[Profile of future nurses' aides in Campinas, SP, in 1995: reasons, expectations and problems related to their education]. / Perfil dos futuros auxiliares de enfermagem da cidade de Campinas, SP, EM 1995: motivos, expectativas e dificuldades relacionadas ao curso.

The present study aims to characterize the profile of people studying in auxiliary nurse courses at the city of Campinas. The predominantly characteristics were: ages between 18 and 30 years old, majority female, single and catholic. The major part of the studied population does not work in nursing area, being the mainly motivation to begin the course the possibility of helping other people. Their difficulties were returning to school, conciliating the study schedule with other activities and paying the course.

[Need of university students for a mental health orientation and education service]. / Necessidades de estudantes universitários para implantação de um serviço de orientação e educação em saúde mental.

The curative feature of health of university students has gained more attention. This study evaluated the needs of university students for an orientational and educational service on mental health. For mental health orientation and education, an individual consultation service, was implanted as well as lectures about the theme. This project gathered data and information important to the effective institutionalization of the service.

[Proposal for a procedure for the detection of ophthalmic disorders in school children]. / Proposição de procedimento de detecção sistemática de perturbações oftalmológicas em escolares.

The proposal for a visual acuity test (A.V.) arose from a survey conducted among School Children of the "Ciclo Básico (C.B.)" i.é., the first two years of Elementary School in S. Carlos, S. Paulo State, Brazil. Nine schools participated in this study. The teachers were properly trained to apply the A. V. and squinting tests according to a standardized procedure. Of 2,025 children tested, 88.1% showed levels of A. V. higher than 0.8, and a squinting prevalence of 2.17%. When the application of the test was over, each school presented its proposals for the systematical application of such tests. These proposals had a common point: the test should be applied by the teachers themselves under the supervision of the coordinators of the C. B. The school nurse would be responsible for giving overall assistance to all the activities of the program at all levels.

Effects of undernutrition on the ontogeny of muscarinic receptors and acetylcholinesterase activity in the rat motor cortex.

The effect of undernutrition on the ontogeny of muscarinic receptor density and acetylcholinesterase (AChE) activity was studied in the motor cerebral cortex homogenates of female Wistar rats aged 12-19 days, 2-3 months and 5-8 months. Experimental animals were fed a protein-calorie deficient diet. The binding assays, using (3H)-N-methylscopolamine as a ligand, indicated a significant increase in muscarinic receptor density in the motor cortex of 5-8-month old control rats (36%) compared to neonatal controls. No increase was observed for undernourished rats at any of the ages studied. No significant difference was observed in AChE activity at any age of either group studied.

Effects of undernutrition on the ontogeny of muscarinic receptors and acetylcholinesterase activity in the rat motor cortex

The effect of undernutrition on the ontogeny of muscarinic receptor density and acetylcholineasterase (AChE) activity was studied in the motor cerebral cortex homogenates of female Wistar rats aged 12-19 days, 2-3 months and 5-8 months. Experimental animals were fed a protein-calorie deficient diet. The dinding assays, using (3H)-N-methylscopolamine as a ligand, indicated a significant increase in muscarinic receptor density in the motor cortex of 5-8- monthes old control rats (36%) compared to neonatal controls. No increase was observed for undernourished rats at any of the ages studied. No significant difference was observbed in AChE activity at any age of either group studied

Endometriose de colon sigmoide. / Endometriosis of the sigmoid colon

O presente trabalho consiste na apresentacao de um caso de endometriose do colon sigmoide em que a lesao macroscopica se assemelhava a uma neoplasia maligna e que a inexistencia de outras lesoes pelvicas levou a que se optasse pela ampla resseccao intestinal. Os autores descrevem a incidencia desta patologia, sua clinica e os aspectos incomuns neste caso