Progressive multifocal leukoencephalopathy in patients with systemic lupus erythematosus: a systematic literature review.

OBJECTIVE: To determine risk factors for progressive multifocal leukoencephalopathy (PML) in systemic lupus erythematosus (SLE) patients, and understand how underlying disease or treatment for SLE may be associated with PML in this population. METHODS: Studies published in English between January 1, 1984 and October 31, 2014 that reported PML in adult SLE patients were included. Immunosuppression was defined as exposure to ≥1 immunosuppressant drug of interest at PML diagnosis: belimumab, rituximab, mycophenolate mofetil, azathioprine, cyclophosphamide, methotrexate and high-dose corticosteroids (>15 mg/day). Minimal immunosuppression was defined as low-dose corticosteroids (≤15 mg/day) and/or anti-malarials. RESULTS: Thirty-five publications met our inclusion criteria: four observational studies, two large case series, and 29 case reports that described 35 cases. Reported PML incidence rates among SLE patients based on observational studies ranged from 1.0 to 2.4 cases/100,000 person-years. Of the 35 case reports, three cases were exposed to no immunosuppressant drugs at PML diagnosis, five cases had minimal immunosuppression, 23 cases had immunosuppression, and four cases were indeterminate. CONCLUSIONS: The evidence from this literature review suggests that, while PML is a very rare disease in SLE patients, there does appear to be an increased risk of PML associated with SLE compared to the general population, potentially due to immunosuppression, other contributing factors in their underlying disease, treatments prescribed to manage disease, or some combination of these factors. Additional large observational studies, designed to assess exposure to drugs of interest and complicated treatment histories, are needed to provide further evidence about potential mechanisms contributing to the onset of PML in SLE patients.

The extended effects of the life review in nursing home residents.

To date, there is little information on the therapeutic effects of the life review beyond one year. This analysis followed fifty-two of 256 subjects who lived for at least three years in a nursing home. These participants received either a life review or friendly visit and took part in four repeated testings to determine the lasting effects of the life review at two and three years. Measures of integrity (life satisfaction, psychosocial well being, self-esteem) and despair (depression, hopelessness, and suicide intent) were used as pretest, posttest, and retest. Results showed a trend toward continued and by year three significant improvement over time in those who received the life review on measures of depression (t = -2.20, p < .03), life satisfaction (t = 2.51, p < .02), and self-esteem (t = -2.31, p < .03).

Life review: preventing despair in newly relocated nursing home residents short- and long-term effects.

Relocation to a nursing home places frail elders at risk for developing depression and suicide ideation. This study followed two hundred and fifty-six newly relocated nursing home residents for five years. Using a Solomon Four research design, participants were divided into four groups, two control and two experimental, one each with pretesting and all with posttesting. Participants in the control groups received a friendly visit and those in the experimental groups received the intervention of life review. Immediate short-term results showed the life review to be an effective preventive intervention for clinical depression (p = .05). Additionally, when looking at long-term effects at one year, there were significant decrease in depression (p = .05), hopelessness (p = .01), and psychological well-being (p = .02) with measurable increases in life satisfaction (p = .08). These findings support the hypothesis that life review prevents despair in frail elders newly admitted to a nursing home.

Suicidal intent/life satisfaction: comparing the life stories of older women.

The purpose of this paper is to examine the Maris hypothesis that some people have relevant biographies and life histories that predispose suicidal careers. Using a life history approach, this paper reports differing themes in the lives of two groups of older women recently relocated to a nursing home--those who are satisfied with their lives and those who are not. Twelve women were selected from a sample of 256 by their scores on a life satisfaction index or suicidal intent scale. Seventy-two hours of transcribed life histories were content-analyzed for dominant themes that contributed to either life satisfaction or suicidal intent. Strong overall themes emerged for both groups under the headings of childhood, families, role models, connectedness, confidantes, life involvement, death experience, and memories. However, the most important correlates to contribute to a suicidal career for ideators were dysfunctional families of origin, poor role models, a feeling of isolation, and a pessimistic outlook.

AIDS in older people. A literature review for clinical nursing research and practice.

Older Americans, 50 years of age and older, account for 10% of the 400,000 reported cases of AIDS nationwide (Centers for Disease Control and Prevention, 1994). the integrated literature review format in this article examines the published literature on HIV/AIDS in older adults. Most articles are case studies and reports, with only 17% having a research basis. The information reviewed indicates that older adults have different risk factors than younger populations for contracting HIV disease and a different pattern of disease progression. These differences create a need for knowledge of HIV infection and AIDS and its parameters in aging populations so nurses may provide both timely and appropriate care.

Geropsychiatric nursing knowledge--a need in home care.

Few nursing schools include in their curriculum home care work; fewer still include coursework in geropsychiatric issues. Yet this is a vital area of knowledge, particularly for home care nurses. What might such courses cover, and how important are they?

Appointment, promotion, and tenure criteria to meet changing perspectives in healthcare.

With anticipated changes in healthcare delivery systems, nursing faculty members need to redefine the faculty role and scholarship as a product of that role. The authors describe the development of appointment, promotion, and tenure criteria that value scholarly outcomes generated from both practice and research within the educational model.

Answering a need: geropsychiatric nursing course development.

1. A part of the commitment to holistic nursing care is meeting the mental health needs of its clients. 2. There exists a great need to deal with both mental and physical problems in older persons. Moreover, geropsychiatry is greatly lacking in the policy and practice of nursing education. 3. Graduate-level courses must focus on both mental health promotion and disease prevention, particularly for the older persons who are consumers.

Does nursing education promote ageism?

The literature is replete with diverse studies about gerontological nursing education on the attitudes of nursing students. This study examined the effect of a 3-year curriculum on ageism over all 3 years. Students were exposed first to well elderly subjects, then hospitalized older subjects, then severely ill older subjects. They were tested with the Kogan's Old People Scale and a semantic differential scale to see how their attitudes towards older people changed according to their experiences. The Kogan scale was most sensitive and showed that older students and those with grandparent role models had better attitudes towards older adults. Also, there were great increases in positive attitudes towards ageing in year 1 that slowly decreased by the end of year 3.

Reminiscence and life review: therapeutic interventions for older people.

Gerontological literature in general, and gerontological nursing literature specifically, does not clearly differentiate two important therapeutic interventions for older people: reminiscence and life review. However, practitioners often implement both interventions in a variety of settings. Because of the confusion regarding the interventions, this paper explains the differences between reminiscence and life review, and offers protocols to improve the effectiveness of both interventions. The three protocols include one-to-one reminiscence therapy, group reminiscence, and one-to-one life review.

A staff development plan for the graying of America's hospital patients.

In this article, the authors describe a program created by a nursing inservice department to address the graying of America's hospital patients. The increased number of aging patients presents a challenge that hospitals must confront. Elderly patients who take longer to get well and consume more resources make unprecedented demands on nursing staff members. Because basic nursing education programs fail to address the problem, the task of preparing nursing personnel to care for aging patients falls to the hospital's department of staff development.

Graduate education. Creating nursing diagnoses.

Students participating in this clinical exercise learned to critically evaluate problems occurring in their practice areas. In addition, they learned ways of addressing problems through nursing diagnosis. They experienced research as they conducted surveys, calculated results, and listed characteristics. The students had the opportunity to create a product. Unfortunately, as students graduated and became busy with their new positions, they no longer pursued the academic activity of getting a diagnosis accepted by NANDA. The acceptance process seemed particularly formidable after the initial rejection. An even more serious loss exists for graduates who work in gerontological nursing--that of not having these existent problems readily identified and labeled.

Reminiscence and life review: explaining the differences.

Although the terms reminiscence and life review continue to be used interchangeably in the literature, they are separate interventions. This article describes the differences, similarities, and commonalities in these two nursing interventions by highlighting differences in goals, theory base, the nurse's role, and the client's role. The implementation process and the desired outcomes are also differentiated to move forward nurse's understanding of these two important nursing interventions.

Long-term effects of a structured life review process.

This study examined the long-term effects of a structured life review process in a group of 52 homebound elderly clients. Subjects in three groups were tested three times on four dependent variables. At 8 weeks the experimental group, after receiving the life review process, showed significant gains on two dependent variables, life satisfaction and psychological well-being, with analyses of covariance of F = 11.52, p less than .0001 and F = 9.90, p less than .003, respectively. Two other dependent variables, depression and activities of daily living, demonstrated no significant change at the 8 weeks posttest. Retesting 35 survivors at 1 year revealed little significant change for any group. There was, however, an upward trend in the experimental group on the outcome measure of life satisfaction and a downward trend in all groups on measures of activities of daily living and depression.