High sensitivity C-reactive protein in systemic lupus erythematosus: relation to disease activity, clinical presentation and implications for cardiovascular risk.

Measurement of high sensitivity C-reactive protein (hs-CRP), has been used in the assessment of disease activity in numerous rheumatic conditions including systemic lupus erythematosus (SLE). However, the utility of hs-CRP measurement in patients with lupus is uncertain. This study examined if hs-CRP can be used to assess disease activity, severity and cardiovascular risk in SLE. Serum samples from 601 visits of 213 SLE patients and 134 controls were analysed for hs-CRP by nephelometry. Detailed demographic data were obtained from all subjects and medication history and key laboratory parameters were collected. Disease activity was assessed using the SLEDAI. High sensitivity CRP was not associated with disease activity (SLEDAI), number of ACR SLE criteria or presence of any particular organ involvement. hs-CRP levels were significantly correlated with standard cardiovascular risk factors including body weight (P = 0.0002), hypertension (P = 0.001), and apolipoprotein A-I (P < 0.0001). Interestingly an inverse correlation was seen between hs-CRP levels and antimalarial use (P = 0.0018). Our results suggest that measurement of hs-CRP, though not valuable as marker of disease activity in SLE may be of some use in the assessment of cardiovascular risk. We speculate that antimalarials may help to reduce cardiovascular risk in patients with SLE.

The teaching of health care ethics to students of nursing in the UK: a pilot study.

Senior lecturers/lecturers in mental health nursing (11 in round one, nine in round two, and eight in the final round) participated in a three-round Delphi study into the teaching of health care ethics (HCE) to students of nursing. The participants were drawn from six (round one) and four (round three) UK universities. Information was gathered on the organization, methods used and content of HCE modules. Questionnaire responses were transcribed and the content analysed for patterns of interest and areas of convergence or divergence. Findings include: the majority (72.8%) of the sample believed that insufficient time was allocated to the teaching of HCE; case studies were considered a popular, although problematic, teaching method; the 'four principles' approach was less than dominant in the teaching of HCE; and virtue ethics was taught by only 36.4% of the participants. The Delphi technique proved adequate and worth while for the purposes of this study. Further empirical research could aim to replicate or contradict these findings, using a larger sample and recruiting more university departments. Reflection is required on several issues, including the depth and breadth to which ethics theory and, more controversially, meta-ethics, are taught to nursing students.

An inquiry into moral virtues, especially compassion, in psychiatric nurses: findings from a Delphi study.

A three-round Delphi study was conducted to gather data on ethical reasoning among psychiatric nurses (N = 26 in round one (R1), decreasing to N = 14 in the final round (R3)). Transcripts of questionnaires were carefully read and compared. Responses were manually sorted into categories, themes and patterns of interest. Eight debates emerged from the data. This article discusses two in detail: the nature of moral virtues and the meaning of compassion in psychiatric nursing. A sympathetic overview of virtue ethics is also provided. The nurses' responses included a lot of virtue terms, such as, 'honest', 'fair', and 'care". However, 'nurses' moral virtues' was ranked low in importance as a notion invoked in ethical decision making in the round-one ranking exercise. Only half of the sample believed that the moral character of a psychiatric nurse is important in ethical decision-making. Further, most of the round-one sample thought the virtues could not be acquired. Compassion was identified as crucial to psychiatric nursing and the nurse-client relationship, though, as expected, many diverse meanings were attributed to this notion. While the Delphi method proved adequate for our purposes, problems with regard to accurately understanding the respondents' intended meanings highlighted a major weakness of this technique, in common with other methods relying on questionnaires. Further inquiry is needed regarding the role of moral virtues and virtue ethics in both psychiatric nursing and nurse education.

Familial breast cancer: report of a family pedigree.

Following a report of several relatives suffering from breast cancer, the occurrence of neoplasms in 3 generations of a large family was carefully checked. Members of one out of 8 branches were found to have a high incidence of breast cancer with 6 women affected, 4 of them under the age of 40. As well as early onset, these women presented other features typical of "breast cancer families": bilateral breast cancer, other second primary tumours, ovarian cancer in the daughter of one affected patient, and benign breast disease in the sister of another.