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Issue 37 - 1 Nov 2012

OUT NOW - 2012 issue of Kai Tiaki Nursing Research
The third issue of NZNO’s annual research magazine, Kai Tiaki Nursing Research (KTNR) has been published, with five articles of original New Zealand nursing research.
Subjects include: An analysis of the success of an extended Plunket Well Child/Tamariki Ora service for teenage mothers; an examination of the views of internationally qualified nurses and New Zealand-educated nurses in an increasingly multicultural workforce; what nurses see as impediments to the delivery of nursing care; the career commitment of generation Y nurses; and embedding quality improvement change in nursing practice.
To subscribe:
Phone 0800 28 38 48

Books Available for Borrowing

1. Profiles and Portfolios of Evidence (includes cd-rom)
By Ruth Pearce; Published 2003

2. The Suffrage Trail: A guide to places, memorials and the arts commemorating New Zealand women
By Jill Pierce; Published 1995

3. Will they do it again?: Assessing and managing risk
Edited by Ken McMaster and Leon Bakker
Topics include:
- Psychopathy and prediction of offending
- Assessing and managing risk in family violence cases

4. The village on the hill: celebrating 125 years of Waikato Hospital.
Edited by Mary Anne Gill; Published 2011


5. Gastrointestinal stem cells in self-renewal and cancer
By Lin, S.; Barker, Nick. Journal of Gastroenterology. Sep 2011, Vol. 46 Issue 9: p1039-1055
The gastrointestinal epithelium is a unique model for the study of mammalian stem cells. Not only does it have a highly stereotypical organization, its remarkable rate of self-renewal provides a daily readout of stem cell activity. The past decade has seen a major investment in developing technologies dedicated to revealing the identity of the long-elusive gastrointestinal stem cells. An array of purported stem cell biomarkers is now available for the mouse, including surface-expressed proteins that hold great promise as antibody targets for use in isolating human stem cells. Here we critically appraise the validity of these biomarkers and discuss their likely impact on our understanding of stem cell roles in self-renewal and cancer in the gastrointestinal tract. [ABSTRACT FROM AUTHOR].

6. Ectopic expression of blood type antigens in inflamed mucosa with higher incidence of FUT2 secretor status in colonic Crohn's disease
By Miyoshi, Jun; Yajima, Tomoharu; Okamoto, Susumu; Matsuoka, Katsuyoshi; Inoue, Nagamu; Hisamatsu, Tadakazu; Shimamura, Katsuyoshi; Nakazawa, Atsushi; Kanai, Takanori; Ogata, Haruhiko; Iwao, Yasushi; Mukai, Makio; Hibi, Toshifumi. Journal of Gastroenterology. Sep 2011, Vol. 46 Issue 9: p1056-1063
  Host-intestinal microbial interaction plays an important role in the pathogenesis of inflammatory bowel diseases (IBDs). The surface molecules of the intestinal epithelium act as receptors for bacterial adhesion and regulate the intestinal bacteria. Some known receptors are the mucosal blood type antigens, which are regulated by the fucosyltransferase2 ( FUT2) gene, and individuals who express these antigens in the gastrointestinal tract are called secretors. Recent research has revealed that the FUT2 gene is associated with Crohn's disease (CD) in western populations.
Methods: To clarify the contribution of mucosal blood type antigens in IBD, we determined the incidence of five previously reported single-nucleotide polymorphisms of the FUT2 gene in Japanese patients. We also used immunohistochemistry to investigate the antigen expression in mucosal specimens from IBD patients and animal models.
Results: Genetic analysis revealed that all of the patients with colonic CD were secretors, whereas the incidence of secretors was 80, 80, 67, and 80%, respectively, for the control, ileocolonic CD, ileal CD, and ulcerative colitis groups ( P = 0.036). Abnormal expression of blood type antigens was observed only in colonic CD. Interleukin-10 mice, but not dextran sulfate sodium colitis mice, had enhanced colonic expression of blood type antigens, and the expression of these antigens preceded the development of colitis in the interleukin-10 mice.
Conclusions: FUT2 secretor status was associated with colonic-type CD. This finding, taken together with the immunohistochemistry data, suggests that the abnormal expression of blood type antigens in the colon may be a unique and essential factor for colonic CD. [ABSTRACT FROM AUTHOR].

7. Mucin phenotype and narrow-band imaging with magnifying endoscopy for differentiated-type mucosal gastric cancer
By Kobayashi, Masaaki; Takeuchi, Manabu; Ajioka, Yoichi; Hashimoto, Satoru; Sato, Akito; Narisawa, Rintaro; Aoyagi, Yutaka. Journal of Gastroenterology. Sep 2011, Vol. 46 Issue 9: p1064-1070
  Several studies have described the surface glandular structure in differentiated early gastric cancer observed by narrow-band imaging with magnifying endoscopy (NBI-ME) in two main patterns, i.e., a papillary or granular structure in an intralobular loop pattern (ILL) and a pit structure in a fine network pattern (FNP). However, it is uncertain why the NBI-ME findings of differentiated-type carcinomas are divided into two main patterns. We investigated the significance of the mucin phenotype in the morphogenetic difference between ILL and FNP. Methods: We evaluated 120 intramucosal, well- or predominantly well-differentiated tubular adenocarcinomas. In each lesion, one area that showed the predominant pattern of microsurface structures and microvessels was selected and marked by electrocoagulation for a strict comparative study by NBI-ME and pathological investigation. NBI-ME findings were classified into three patterns: ILL, FNP, and intermediate. Mucin phenotypes were judged as gastric, intestinal, or gastrointestinal type by immunohistochemistry. Results: The mucin phenotype was gastric or gastrointestinal type in 24 (92.3%) of 26 ILL lesions. Intestinal phenotype was observed in 22 (84.6%) of 26 FNP lesions. The gastrointestinal phenotype was observed in 50 (73.5%) of 68 intermediate pattern lesions. The mucin phenotype and NBI-ME results were significantly correlated ( P < 0.001). Conclusions: The mucin phenotype of differentiated early gastric cancer might be involved in morphogenetic differences between the papillary and pit structures visualized by NBI-ME. [ABSTRACT FROM AUTHOR].

8. Effect of repetitive transcranial magnetic stimulation on rectal function and emotion in humans. 
By Aizawa, Yuuichi; Morishita, Joe; Kano, Michiko; Mori, Takayuki; Izumi, Shin-Ichi; Tsutsui, Kenichiro; Iijima, Toshio; Kanazawa, Motoyori; Fukudo, Shin. Journal of Gastroenterology. Sep 2011, Vol. 46 Issue 9: p1071-1080
  A previous brain imaging study demonstrated activation of the right dorsolateral prefrontal cortex (DLPFC) during visceral nociception, and this activation was associated with anxiety. We hypothesized that functional modulation of the right DLPFC by repetitive transcranial magnetic stimulation (rTMS) can reveal the actual role of right DLPFC in brain-gut interactions in humans. Methods: Subjects were 11 healthy males aged 23.5 ± 1.4 (mean ± SE) years. Viscerosensory evoked potential (VEP) with sham (0 mA) or actual (30 mA) electrical stimulation (ES) of the rectum was taken after sham, low frequency rTMS at 0.1 Hz, and high frequency rTMS at 10 Hz to the right DLPFC. Rectal tone was measured with a rectal barostat. Visceral perception and emotion were analyzed using an ordinate scale, rectal barostat, and VEP. Key results: Low frequency rTMS significantly reduced anxiety evoked by ES at 30 mA ( p < 0.05). High frequency rTMS-30 mA ES significantly produced more phasic volume events than sham rTMS-30 mA ES ( p < 0.05).
Conclusions and inferences: We successfully modulated the gastrointestinal function of healthy individuals through rTMS to the right DLPFC. Thus, rTMS to the DLPFC appears to modulate the affective, but not direct, component of visceral perception and motility of the rectum. [ABSTRACT FROM AUTHOR].

9. Haplotype in the IBD5 region is associated with refractory Crohn's disease in Slovenian patients and modulates expression of the SLC22A5 gene. 
By Repnik, Katja; Potocnik, Uroš. Journal of Gastroenterology. Sep 2011, Vol. 46 Issue 9: p1081-1091
: The IBD5 locus (OMIM ID 606348) on chromosome 5 was suggested to be one of the most important genetic factors involved in the pathogenesis of inflammatory bowel diseases (IBDs). However the main contributor from this region is still unknown.
Methods: We investigated the possible association of the IBD5 locus with IBD in Slovenian patients and correlation between disease-associated single nucleotide polymorphisms (SNPs) and quantitative gene expression (eQTL) of candidate genes from the IBD5 locus in peripheral blood lymphocytes and colon tissue biopsies from IBD patients. We genotyped SNPs from the IBD5 locus in 312 healthy controls and 632 IBD patients.
Results: We found statistically significant association of polymorphisms rs1050152 in gene SLC22A4 ( p = 0.005, OR = 2.177, 95% CI = 1.270-3.526) and rs2631372 in gene SLC22A5 ( p = 0.001, OR = 0.473, 95% CI = 0.307-0.731) and TC haplotype of both polymorphisms ( p = 0.006, OR = 1,541, 95% CI = 1.130-2.100) with refractory Crohn's disease (CD) in Slovenian patients who do not respond to standard therapy, including patients who develop fistulas. We found decreased expression of SLC22A4 and SLC22A5 genes in peripheral blood lymphocytes from IBD patients compared to control group and decreased expression of SLC22A5 gene in inflamed tissue biopsies compared to noninflamed colon ( p = 0.009). We found lower expression of SLC22A5 gene in IBD patients with disease-susceptible genotypes for both disease-associated SNPs.
Conclusions: Our data suggest that SNPs and haplotype in the IBD5 SLC22A4/SLC22A5 region contribute to the development of particularly refractory Crohn's disease in the Slovenian population, and expression studies in blood lymphocytes and colon tissue biopsies and eQTL analysis suggest that SLC22A5 is the main gene in the IBD5 region contributing to the IBD pathogenesis. [ABSTRACT FROM AUTHOR].

10. Systematic review of the epidemiology of gastroesophageal reflux disease in Japan. 
By Kinoshita, Yoshikazu; Adachi, Kyoichi; Hongo, Michio; Haruma, Ken. Journal of Gastroenterology. Sep 2011, Vol. 46 Issue 9: p1092-1103
 Epidemiological studies of gastroesophageal reflux disease (GERD) in Japan vary in design. This systematic review examines the prevalence of GERD in Japan, distinguishing between study methodologies, and reports on changes over time and factors potentially associated with GERD. Methods: PubMed and Embase searches identified studies reporting the prevalence of GERD in the general population, primary care patients, and individuals undergoing routine health checks.
Results: Of the twenty eligible studies, half excluded individuals taking acid-suppressive medication, so these studies would have been likely to have underestimated the prevalence by 2-3%. Nine studies reported the prevalence of at least weekly reflux symptoms (the definition closest to the Montreal definition): in seven studies this was 6.5-9.5%, but in two studies that included individuals who underwent upper gastrointestinal endoscopy the prevalence was 19.0 and 21.8%. Eight studies used symptom scores: prevalence estimates ranged from 10.2 to 29.0% in five studies using the Carlsson-Dent self-administered questionnaire (QUEST), and from 27.0 to 37.6% in three studies using the frequency scale for the symptoms of GERD. Prevalence estimates were 15.1-24.3% in three studies that reported the presence of reflux symptoms of undefined frequency. Six studies reported the prevalence of reflux esophagitis as 4.9-8.2%. Changes in prevalence over time and factors associated with reflux symptoms were inconsistent. Conclusions: Few studies have reported the prevalence of GERD in Japan using standardized criteria. Thus, prevalence estimates vary substantially, reflecting differences in study populations and GERD definitions. However, seven studies reported that the prevalence of at least weekly symptoms was 6.5-9.5%, a finding which approaches that reported in Western populations (10-20%). [ABSTRACT FROM AUTHOR].

11. Multicenter study evaluating factors for stent patency in patients with malignant biliary strictures: development of a simple score model. 
By Boeckel, Petra; Steyerberg, Ewout; Vleggaar, Frank; Groenen, Marcel; Witteman, Ben; Weusten, Bas; Geldof, Han; Tan, Adriaan; Grubben, Marina; Nicolai, Jan; Siersema, Peter. Journal of Gastroenterology. Sep 2011, Vol. 46
Issue 9: p1104-1110
  Self-expanding metal stents (SEMS) are known to have a significantly higher patency rate than plastic stents. We aimed to identify prognostic factors, besides stent type, for stent patency and to develop a score model that could further aid in guiding stent choice for the palliation of a malignant biliary stricture. Methods: A retrospective multicenter study was conducted. Data on consecutive patients who had a stent placed between January 2002 and July 2009 were collected. Cumulative stent occlusion rates were analyzed by Kaplan-Meier curves and log rank testing, and prognostic factors were assessed by Cox regression analysis.
Results: A total of 690 stents (512 plastic stents, 174 SEMS) were endoscopically placed in 390 patients. At 8 weeks, stent occlusion had occurred in 32% of the plastic stents and 11% of the SEMS. Multivariate analysis indicated that plastic stents (hazard ratio [HR] 2.5, 95% confidence interval [CI] 1.9-3.5), a tight stricture requiring preceding dilation (HR 1.8, 95% CI 1.3-2.5), and a high initial bilirubin level (>50 µmol/L (HR 1.3, 95% CI 1.0-1.7) were independently associated with an increased risk of stent occlusion. A score model based on these 3 factors was able to distinguish between stent procedures with a relatively high and low risk of stent occlusion (median 14 vs. 26 weeks, respectively).
Conclusion: Besides plastic stents, stricture severity requiring preceding dilation, and initial higher bilirubin level were associated with a shorter period of stent patency. A simple score model based on these factors was able to predict stent occlusion and may aid in choosing the most appropriate stent type in individual patients. [ABSTRACT FROM AUTHOR].

12. Pretreatment prediction of anemia progression by pegylated interferon alpha-2b plus ribavirin combination therapy in chronic hepatitis C infection: decision-tree analysis. 
By Hiramatsu, Naoki; Kurosaki, Masayuki; Sakamoto, Naoya; Iwasaki, Manabu; Sakamoto, Minoru; Suzuki, Yoshiyuki; Sugauchi, Fuminaka; Tamori, Akihiro; Kakinnuma, Sei; Matsuura, Kentaro; Izumi, Namiki. Journal of Gastroenterology. Sep 2011, Vol. 46 Issue 9: p1111-1119
 This study aimed to develop a model to predict the development of severe anemia during pegylated interferon alpha-2b plus ribavirin combination therapy.
Methods: Data were collected from 1081 genotype 1b chronic hepatitis C patients who were treated at 6 hospitals in Japan. These patients were randomly assigned to a model-building group ( n = 691) or an internal validation group ( n = 390). Factors predictive of severe anemia (hemoglobin, Hb < 8.5 g/dl) were explored using data-mining analysis.
Results: Hb values at baseline, creatinine clearance (Ccr), and an Hb concentration decline by 2 g/dl at week 2 were used to build a decision-tree model, in which the patients were divided into 5 subgroups based on variable rates of severe anemia ranging from 0.4 to 11.8%. The reproducibility of the model was confirmed by the internal validation group ( r = 0.96). The probability of severe anemia was high in patients whose Hb value was <14 g/dl before treatment (6.5%), especially (a) in those whose Ccr was <80 ml/min (11.8%) and (b) those whose Ccr was =80 ml/min but whose Hb concentration decline at week 2 was =2 g/dl (11.5%). The probability of severe anemia was low in the other patients (0.4-2.5%).
Conclusions: The decision-tree model that included Hb values at baseline, Ccr, and an Hb concentration decline by 2 g/dl at week 2 was useful for predicting the probability of severe anemia, and has the potential to support clinical decisions regarding early dose reduction of ribavirin. [ABSTRACT FROM AUTHOR].

Articles - Emergency Nurse, Oct 2012

13. Staff levels to be based on patients' need for nursing
Emergency Nurse. Oct 2012, Vol. 20 Issue 6: p5
The article reports that the Royal College of Nursing (RCN) Emergency Care Association (ECA) is set to launch a latest version of a tool for assessing staffing needs and skill mix in emergency care settings. The Baseline Emergency Staffing Tool (BEST) can help staff determine staffing requirements in different settings according to patients’ need for nursing. The ECA is planning to launch an interactive BEST website at next month's annual conference in Manchester, England..

14. Providing comfort and support to older people
By Triggle, Nick. Emergency Nurse. Oct 2012, Vol. 20 Issue 6: p10-13
This article reports on a scheme run by Age UK at Hillingdon Hospital, Middlesex, to help support emergency department (ED) staff with the care of older people. The A&E support-worker team assists patients with non-clinical activities, such as going to the toilet, eating meals and finding out care-related information. The support-worker scheme has been running for nine years and its success has prompted Age UK to consider expanding it nationally. It comes at a time when there is a growing focus on the care older patients receive in hospitals. [ABSTRACT FROM AUTHOR].

15. Caring for people who have intellectual disabilities
By Blair, Jim. Emergency Nurse. Oct 2012, Vol. 20 Issue 6: p15-19
This article explores some of the challenges people with intellectual disabilities must overcome when they attend emergency departments. It also discusses some of the issues that arise for staff involved in assessment and care of people with Intellectual disabilities, including their legal responsibilities to provide care for such people that is similar in standard to that provided for the rest of the population. INSETS: Case study 1: capacity;Case study 2: reasonable adjustments. [ABSTRACT FROM AUTHOR].

16. Intermediate care for homeless people: results of a pilot project
By Schneller, Kendra. Emergency Nurse. Oct 2012, Vol. 20 Issue 6: p20-24
A year-long, nurse-led intermediate care pilot project was undertaken at a 120-bed homeless hostel in south London to improve healthcare outcomes among the clients involved, and to reduce emergency department (ED) attendance, ambulance call outs and use of acute care services. By the end of the year, the number of ED and hospital admissions had dropped significantly. The project was recognised by the Department of Health in 2010 as an example of innovative practice in work with 'at-risk' groups, and was awarded the 2011 Nursing Standard Community Nursing Award. This article considers reasons for the success of the project and the lessons that can be learned from it. INSETS: Case study 1;Case study 2. [ABSTRACT FROM AUTHOR].

17. Acute supraventricular tachycardia in children
By Paul, Siba Prosad; Blaikley, Sarah; Peevers, Camilla; Fitz-John, Lin. Emergency Nurse. Oct 2012, Vol. 20 Issue 6: p26-29
This article describes the management in emergency departments of supraventricular tachycardia (SVT) in children. Of all forms of symptomatic arrhythmia in infants, children and adolescents, SVT is the most common. Its clinical presentation varies with the child's age, and it can be difficult to diagnose in infants and young children. It is important that the nurses in the emergency department consider a diagnosis of SVT in young children with histories of poor feeding, lethargy, irritability, excessive sweating or pallor (Zeigler 1994) and in older children with histories of palpitations, dizziness, chest pain, syncope or shortness of breath (Uzun 2010). If SVT is suspected, a 12-lead electrocardiogram should be recorded. Vagal manoeuvre may be successful but in some cases intravenous adenosine is necessary. Children with Wolff-Parkinson-White syndrome are at risk of sudden cardiac death associated with SVT, and should not be treated with calcium channel blockers or digoxin. INSET: Case study. [ABSTRACT FROM AUTHOR].

18. Supraventricular tachycardia in children
Emergency Nurse. Oct 2012, Vol. 20 Issue 6: p31
The quiz concerning supraventricular tachycardia (SVT) in children, including the most common asymptomatic arrhythmia in children,show SVT presents in children, and methods for treating SVT is presented..

Journal - Table of Contents

19. From Journal of Nursing Administration (JONA); Supplement to October 2012, Volume 42, Number 10
The Art of Communicating Outcomes [Successful nursing leaders learn through formal mechanisms such as mentorship and role modeling or through trial and error. Communicating the value of nursing and the business case for resources and change is an art]
19B. State of the Science Related to Nurse Work Environments, Safe Practices, and Organizational Outcomes [The Magnet Recognition Program® was developed by the American Nurses Credentialing Center (ANCC) more than 20 years ago to recognize healthcare organizations for quality patient care, nursing excellence, and innovations in professional nursing practice.1 The program has evolved over the years, from the 41 reputable hospitals cited by the American Academy of Nursing in 1993,2 to 395 organizations in mid-2012]
19C. Transformational Leadership Practices of Chief Nursing Officers in Magnet(R) Organizations
19D. Effects of Nurse Staffing and Nurse Education on Patient Deaths in Hospitals With Different Nurse Work Environments
19E. Work environment factors other than staffing associated with nurses' ratings of patient care quality
19F. Quality and strength of patient safety climate on medical-surgical units
19G. Adoption of National Quality Forum Safe Practices by Magnet(R) Hospitals
19H. Nurse Outcomes in Magnet(R) and Non-Magnet Hospitals
19I. Employer-Provided Support Services and Job Dissatisfaction in Canadian Registered Nurses

Conferences, Workshops and Training Opportunities

17. 8th Biennial Joanna Briggs International Colloquium
Channelling the Rivers of Knowledge to Improve Global Policy and Practice
: November 12th - 14th, 2012
Venue: The Empress Hotel, Chiang Mai, Thailand

18. Workshop on Determinants of Health
 Equity, Rights and the Determinants of Health
Date: Wednesday 21st November, 2012
Location: Wellington 
Venue: To be Confirmed
For further information: Emma Frost (09) 531 5504 or

News - National

19. Euthanasia will open floodgates of nastiness
The Press - Rosemary McLeod

OPINION: Whenever you see the word "rational" it's a safe bet that something isn't.I read, then, a report involving Britain's Society for Old Age Rational Suicide and Friends at the End because I couldn't resist. As euthanasia catches on as a cause, there's no shortage of spokesmen excited by the possibilities. This week it was Silvan Luley, on behalf of Dignitas, the Swiss assisted-suicide organisation

20. Cross-party support for Natural Health Products Bill
Tony Ryall; 31 October, 2012

The Natural Health Products Bill has been reported back to Parliament with the support of all parties on the Health Select Committee. Health Minister Tony Ryall is pleased with progress on the bill, which will provide regulation of commercial natural health products, such as vitamin supplements, Echinacea and fish oil. “New Zealanders can continue to support and manage their own health as they do now, but the bill will ensure the natural health products they buy are safe, the labels are accurate and the claims the products make, such as ‘will improve your immunity’, are true,” Mr Ryall said

News - International

21. Smoke-free laws are saving lives By Laura Blue,
CNN - October 30, 2012

You can't smoke in most restaurants and malls, and those laws may be responsible for saving thousands of lives.
According to two separate studies, recent laws that limit smoking in public places are contributing to fewer tobacco-related hospital visits and deaths. In 2009, the Institute of Medicine concluded that smoking bans contributed to fewer heart problems in areas where the policies were implemented, but the panel was unable to determine how much benefit the laws provided.

22. More jobs in health, fewer in retail
Sydney morning Herald - October 30, 2012

MORE Australians are now working in healthcare than any other profession, while less of us are blue-collar workers, census results released by the Bureau of Statistics today show. With Australia's population ageing, health and social care workers now account for 11.6 per cent of Australia's employment - a jump of 1.1 per cent since the last census in 2006. But the jump in health employment has come as more and more jobs go from retail and manufacturing. "Healthcare and social assistance is now Australia's number one industry of employment," census executive director Andrew Henderson said. Healthcare professions include doctors, nurses, dentists, physiotherapists, childcare workers and aged care providers.

23. Sugary drinks linked to higher stroke risk for women
Calgary Herald - 31 Oct 2012

NEW YORK — Women who imbibe sugary soft drinks almost every day are 83 per cent more likely to have a certain type of stroke than women who rarely drink sodas and other sweetened beverages, according to a Japanese study. The results, which appeared in The American Journal of Clinical Nutrition, agree with a host of other studies tying sugary drinks to numerous untoward health effects, including heart attacks, obesity and diabetes, and prompting government moves, such as New York’s ban on super-sized sodas.


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