New Insights into Esca of Grapevine: The Development of Foliar Symptoms and Their Association with Xylem Discoloration.

A new study on the development of foliar symptoms of esca was carried out from 2004 to 2006 in five mature vineyards in Aquitaine, France. Symptoms were monitored for severity and changes over time. Initial foliar symptoms were characterized by the presence of drying zones or discolorations (reddening or yellowing), which are symptoms that have also been attributed to Black Dead Arm (BDA). Then, the less-severely affected leaves persisted throughout the summer and developed into typical "tiger-stripe" symptoms of esca. The most severely symptomatic leaves fell soon after symptoms appeared. Severely diseased vines showed typical apoplectic or acute forms of esca that did not differ from the severe BDA forms. The appearance of leafsymptomatic vines increased uniformly over time, reaching a maximum incidence by the end of July. A second survey in 41 European and Lebanese vineyards showed that longitudinal discolorations were visible under the bark of 95% of the vines showing foliar esca symptoms. These wood symptoms, also previously attributed to BDA, appeared as xylem orange-brown stripes. Thus, foliar symptoms of esca showed transitory phases which overlapped with some BDA descriptions. Most of these symptoms, in the west-palearctic regions that were investigated, were commonly associated with the presence of one or several xylem discolorations.

[Care to the end-stage patient: help and obstacles perceived by Intensive Care nurses]. / Cuidados del paciente al final de la vida: ayudas y obstáculos que perciben las enfermeras de Cuidados Intensivos.

BACKGROUND: The Intensive Care Unit (UCI) environment is not the most appropriate for the development of the end-of-life process, due to the fact that ICU is a hi-tech setting and its focus is on curing and giving life support, rather than delivering palliative care to patients. AIMS: To investigate supportive behaviours and obstacles, and the nurses' demographic characteristics. METHOD: A descriptive correlational design was used in five tertiary Spanish hospitals. A convenience sample included 151 critical care nurses. A self-administered anonymous questionnaire (Beckstrand and Kirchhoff, 2005) was used to investigate supportive behaviours and obstacles perceived by nurses providing end-of-life care, in a scale from 0 to 5 (O = not help/obstacle; 5 = main help/obstacle). Some demographic data of the sample were also collected. FINDINGS: Nurses mean age was 35 (min. 22-max. 57; SD = 7,6) and had an average of 9,2 (min. 1-max. 30; SD = 6,9) years of experience working in ICU. Physicians agreeing on direction of patient care was perceived as the most supportive item (x = 4.46); whereas ethics committee constantly involved in the unit as the least supportive one (x = 2.93). The main obstacle for nurses was patient having pain that is difficult to control or alleviate (x = 4.38), and nurses knowing poor prognosis before family was seen as the less important obstacle (x = 1.37) Statistically significant correlations were found between nurses age and years of experience in ICU and their perception of some helps/obstacles. Statistically significant differences were found between nurses with postgraduate education in intensive care and those without it and their perception of some helps/obstacles. CONCLUSIONS: Intensive care nurses perceive adequate patients' pain management, agreement between health professionals on decision-making, and facilitating a comfortable environment for patients and families, during the whole end-of-life process as a priority.

Cuidados del paciente al final de la vida: ayudas y obstáculos que perciben las enfermeras de Cuidados Intensivos / Care to the end-stage patient: help and obstacles perceived by Intensive Care nurses

Introducción. La muerte es una realidad que con frecuencia ocurre en las Unidades de Cuidados Intensivos (UCI). El ambiente de la UCI por su alta tecnología, el enfoque de los cuidados, centrado en la curación y en medidas para salvar la vida, hacen que no sea el entorno más natural para que se dé el proceso del final de la vida. Actualmente, un objetivo de los profesionales que trabajan en estas Unidades es el de crear un clima que favorezca una «buena muerte». Objetivos. Los objetivos de esta investigación son: a) conocer las ayudas y obstáculos que perciben las enfermeras de Cuidados Intensivos en la atención del paciente al final de la vida y b) analizar si existe relación entre las ayudas y obstáculos percibidos por las enfermeras y las variables sociodemográficas. Método. Estudio descriptivo correlacional realizado en 5 hospitales terciarios de dos Comunidades Autónomas de España. La muestra de conveniencia estuvo formada por 151 enfermeras de Cuidados Intensivos. El cuestionario de Beckstrand y Kirchhoff de 2005, con 6 grados de respuesta (0 = no ayuda, no obstáculo; 5 = máxima ayuda, máximo obstáculo) se utilizó para conocer las ayudas y los obstáculos que perciben las enfermeras en la atención del paciente al final de la vida. Resultados. La edad media de las enfermeras fue de 35 años (mínimo 22 - máximo 57; DE = 7,6) con una experiencia en UCI de 9,2 años (mínimo 1-máximo 30; DE = 6,9). El ítem percibido como máxima ayuda para proporcionar un buen cuidado al paciente al final de la vida fue «que todos los médicos estén de acuerdo con el enfoque de los cuidados» (x­ = 4,46). La mínima ayuda corresponde al ítem «tener un miembro del comité de ética en los pases de visita diarios» (x­ = 2,93). El máximo obstáculo correspondió al ítem «que el paciente tenga dolor difícil de controlar» (x­ =4,38) y el mínimo, a «que la enfermera/o conozca el mal pronóstico del paciente antes de que lo sepa la familia» (x­ = 1,37). Al relacionar la edad y los años de experiencia en UCI con las variables de interés, ayudas y obstáculos, se han encontrado algunas correlaciones estadísticamente significativas. De igual modo, existen diferencias estadísticamente significativas entre las enfermeras que tienen formación postgrado y las que no la tienen con la percepción de ciertas ayudas y obstáculos. Con respecto al número de pacientes atendidos al final de la vida se han encontrado también diferencias estadísticamente significativas con algunas ayudas y obstáculos. Conclusiones. Las enfermeras perciben como prioritario el adecuado control del dolor, que entre el equipo médico haya unanimidad de criterios en la toma de decisiones y que se favorezca, tanto al paciente como a la familia, un entorno digno durante todo el proceso

Background. The Intensive Care Unit (UCI) environment is not the most appropriate for the development of the end-of-life process, due to the fact that ICU is a hi-tech setting and its focus is on curing and giving life support, rather than delivering palliative care to patients. Aims. To investigate supportive behaviours and obstacles, and the nurses' demographic characteristics. Method. A descriptive correlational design was used in five tertiary Spanish hospitals. A convenience sample included 151 critical care nurses. A self-administered anonymous questionnaire (Beckstrand & Kirchhoff, 2005) was used to investigate supportive behaviours and obstacles perceived by nurses providing end-of-life care, in a scale from 0 to 5 (O = not help/obstacle; 5 = main help/obstacle). Some demographic data of the sample were also collected. Findings. Nurses mean age was 35 (min. 22-max. 57; SD = 7,6) and had an average of 9,2 (min. 1-max. 30; SD = 6,9) years of experience working in ICU. Physicians agreeing on direction of patient care was perceived as the most supportive item (x­ = 4.46); whereas ethics committee constanly involved in the unit as the least supportive one (x­ = 2.93). The main obstacle for nurses was patient having pain that is difficult to control or alleviate (x­ = 4.38), and nurses knowing poor prognosis before family was seen as the less important obstacle (x­ = 1.37) Statistically significant correlations were found between nurses age and years of experience in ICU and their perception of some helps/obstacles. Statistically significant diferences were found between nurses with postgraduate education in intensive care and those without it and their perception of some helps/obstacles. Conclusions. Intensive care nurses perceive adequate patients' pain management, agreement between health professionals on decision-making, and facilitating a comfortable environment for patients and families, during the whole end-of-life process as a priority