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Lecanemab, an anti-amyloid antibody with effects on biomarker and clinical endpoints in early Alzheimer's Disease (AD), was granted accelerated approval by the FDA in 2023 and regulatory review in Europe is ongoing. We estimate the population potentially eligible for treatment with lecanemab in the 27 EU countries to 5.4 million individuals. Treatment costs would exceed 133 billion EUR per year if the drug is priced similarly as in the United States, amounting to over half of the total pharmaceutical expenditures in the EU. This pricing would be unsustainable; the ability to pay for high-priced therapies varies substantially across countries. Pricing similarly to what has been announced for the United States may place the drug out of reach for patients in some European countries. Disparities in access to novel amyloid-targeting agents may further deepen the inequalities across Europe in health outcomes. As representatives of the European Alzheimer's Disease Consortium Executive Committee, we call for pricing policies that allow eligible patients across Europe to access important innovations, but also continued investments in research and development. Infrastructure to follow up the usage of new therapies in routine care and new payment models may be needed to address affordability and inequalities in patient access.

Purpose This study explored the experiences of people with stress-related illness participating in a nature-based intervention programme in a northern natural setting. Methods A longitudinal case study was conducted with two women participating in a nature-based intervention programme on a farm. Data were collected by semi-structured interviews, diaries, rating scales, and self-assessment. Qualitative data were analysed by qualitative content analysis and quantitative data are presented descriptively. Results The theme of finding a source for recovery and well-being permeates all categories. The participants perceived the farm and nature to be a calming refuge; they learned to be in the present and could manage the tasks. In togetherness with each other and the facilitator on the farm they felt understood and confident, experienced joy, and found opportunities for change. They gained knowledge and positive memories and found new approaches in life. Self-assessment questionnaires indicated improvements of functioning in everyday life and reduced stress-related exhaustion at the end of the NBI programme. Conclusions Nature-based interventions lasting for a relatively short period seem to promote health and may be a complement to other treatments of stress-related illness. Further research is needed with a larger number of participants and in various natural settings.PurposeThis study explored the experiences of people with stress-related illness participating in a nature-based intervention programme in a northern natural setting. Validerad;2022;Nivå 2;2022-11-29 (sofila);Funder: European Union New Nordic Nature Based Service Models

Background Stress-related illness is increasing and is a common cause of sick leave. Spending time in nature have a positive effect on health and well-being for instance by reducing stress. Specific programmes with nature-based interventions (NBI) with the intention to involve people in activities in a supportive natural environment have been developed for people with stress-related illness.AimTo identify and summarise scientific studies of NBIs to promote health for people with stress-related illness. Method The design used in this study is integrative literature review. Scientific studies focusing on any type of NBI for people with stress-related illness were sought in Cinahl, PubMed, PsycInfo, AMED and Scopus. In total, 25 studies using both qualitative and quantitative designs were included in the review.ResultThe reviewed studies focused on garden or forest interventions. In the majority of the studies, NBIs were performed in groups, including individual activities, and the length of programmes varied. Interventions in natural environments have unique qualities for individualised, meaningful activities and interactions with others in a non-demanding atmosphere. NBIs offer restoration that reduces stress, improves health and well-being and strengthen self-efficacy and work ability. Connectedness with nature support existential reflections and people with stress-related illness can achieve balance in everyday life. Conclusion In conclusion, NBIs may have advantages to promote health for people with stress-related illness and should therefore be considered as an alternative to those affected. Further research from different perspectives, including nursing, is needed to understand the possibilities of NBIs and how they can be integrated into practice. Validerad;2022;Nivå 2;2022-11-11 (joosat)

Traumatic brain injury (TBI) is clinically divided into a spectrum of severities, with mild TBI being the least severe form and a frequent occurrence in contact sports, such as ice hockey, American football, rugby, horse riding and boxing. Mild TBI is caused by blunt nonpenetrating head trauma that causes movement of the brain and stretching and tearing of axons, with diffuse axonal injury being a central pathogenic mechanism. Mild TBI is in principle synonymous with concussion; both have similar criteria in which the most important elements are acute alteration or loss of consciousness and/or post-traumatic amnesia following head trauma and no apparent brain changes on standard neuroimaging. Symptoms in mild TBI are highly variable and there are no validated imaging or fluid biomarkers to determine whether or not a patient with a normal computerized tomography scan of the brain has neuronal damage. Mild TBI typically resolves within a few weeks but 10-15% of concussion patients develop postconcussive syndrome. Repetitive mild TBI, which is frequent in contact sports, is a risk factor for a complicated recovery process. This overview paper discusses the relationships between repetitive head impacts in contact sports, mild TBI and chronic neurological symptoms. What are these conditions, how common are they, how are they linked and can they be objectified using imaging or fluid-based biomarkers? It gives an update on the current state of research on these questions with a specific focus on clinical characteristics, epidemiology and biomarkers.

Introduction: General practitioners (GPs) play a key role in early identification of dementia, yet diagnosis is often missed or delayed in primary care. As part of the multinational Models of Patient Engagement for Alzheimer’s Disease project, we assess GPs’ attitude toward early and pre-dementia diagnosis of AD and explore barriers to early diagnosis. Methods: Our survey covered general attitude toward early diagnosis, diagnostic procedures, resources, and opinion on present and future treatment options across five European countries. Results: In total 343 GPs completed the survey; 74% of GPs indicated that an early diagnosis is valuable. There were country-specific differences in GPs’ perceptions of reimbursement and time available for the patient. If a drug were available to slow down the progression of AD, 59% of the GPs would change their implementation of early diagnosis. Discussion: Our findings provide insight into GPs’ attitudes by exploring differences in perception and management of early diagnosis. (Less)

Alzheimer's disease (AD), the most frequent cause of dementia, is escalating as a global epidemic, and so far, there is neither cure nor treatment to alter its progression. The most important feature of the disease is neuronal death and loss of cognitive functions, caused probably from several pathological processes in the brain. The main neuropathological features of AD are widely described as amyloid beta (Aβ) plaques and neurofibrillary tangles of the aggregated protein tau, which contribute to the disease. Nevertheless, AD brains suffer from a variety of alterations in function, such as energy metabolism, inflammation and synaptic activity. The latest decades have seen an explosion of genes and molecules that can be employed as targets aiming to improve brain physiology, which can result in preventive strategies for AD. Moreover, therapeutics using these targets can help AD brains to sustain function during the development of AD pathology. Here, we review broadly recent information for potential targets that can modify AD through diverse pharmacological and nonpharmacological approaches including gene therapy. We propose that AD could be tackled not only using combination therapies including Aβ and tau, but also considering insulin and cholesterol metabolism, vascular function, synaptic plasticity, epigenetics, neurovascular junction and blood-brain barrier targets that have been studied recently. We also make a case for the role of gut microbiota in AD. Our hope is to promote the continuing research of diverse targets affecting AD and promote diverse targeting as a near-future strategy.

Amyloid is the main constituent of protein deposits associated with certain human diseases, some of which pose major medical and socio-economic challenges. Alzheimer's disease and type II diabetes mellitus are perhaps the most well-known examples of amyloid-associated human diseases. Amyloid is also related to several functional protein assemblies, mainly in bacteria and yeast but also in arthropods and mammals. Moreover, amyloid structures have recently been found to play important roles in infectious diseases, although in opposite ways in different settings: amyloid-like nanonets trap bacteria in the gut, whereas HIV and other viruses can use binding to amyloid fibrils in order to enhance their infectivity. Amyloid is a unique and highly stable protein fold. Its properties have led to a strong interest in the possible use of amyloid-like structures made from naturally occurring proteins and peptides, or simplified designed versions thereof, for the development of novel biomaterials for regenerative medicine and other applications. The formation of insoluble amyloid fibrils from soluble proteins is a self-templated, nucleation-dependent reaction. In the case of the prion protein, this process can be transferred between individuals of the same species and also, with some barriers, between individuals of different species. The basis for this transmissibility of the prion protein is now beginning to be understood at a molecular level. It is alarming that amyloid composed of one specific protein can cross-seed the formation of amyloid by another protein and that amyloid is present in the food we eat [1]. However, there are also reasons for optimism; it is becoming increasingly clear that molecular chaperones act in different ways to maintain proteostasis and that amyloid formation, like protein folding in general, is regulated in several ways. The underlying mechanisms are promising targets for the treatment of amyloid diseases and are currently under intense investigation. In this issue of the Journal of Internal Medicine, four review articles cover in depth four salient aspects of amyloid: the structural biology of amyloid and how its formation is modulated by molecular chaperones is reviewed by Landreh et al. [2], Bergman et al. [3] discuss the involvement of amyloid in infectious diseases, the transmissibility of amyloid is reviewed by Tjernberg et al. [4] and current trends in the treatment of amyloid diseases are considered by Ankarcrona et al. [5]. The four reviews provide summaries of presentations at a recent Nobel minisymposium in the series Frontiers in Medicine held at Karolinska Institutet, Sweden. The aim of the symposium was to highlight the immediate medical relevance of amyloid in human health and disease and to bridge the recent progress in understanding amyloid formation from preclinical studies and clinical results from treating amyloid disorders.

IMPORTANCE: Mild cognitive impairment (MCI) is a transition state between normal cognitive aging and dementia that increases the risk for progressive cognitive decline. Preventing cognitive decline is a public health priority. OBJECTIVE: To determine whether behavioral activation prevents cognitive and functional decline over 2 years in black individuals with MCI. DESIGN, SETTING, AND PARTICIPANTS: Single-center, single-masked, attention-controlled randomized clinical trial. Participants were enrolled from June 21, 2011, to October 3, 2014, and follow-up ended December 13, 2016. Community-based recruitment and treatment of black individuals older than 65 years with amnestic MCI. Volunteer sample of 1390 persons with memory complaints were screened. Overall, 536 individuals had baseline assessment, and 315 (58.8%) were ineligible, most often owing to normal cognition (205 of 315 [65%]) or dementia (59 of 315 [18.7%]); 221 fully eligible participants were randomized. Analyses were intention to treat. INTERVENTIONS: Participants were randomized to behavioral activation, which aimed to increase cognitive, physical, and social activity (111 [50.2%]), or supportive therapy, an attention control treatment (110 [49.8%]). MAIN OUTCOMES AND MEASURES: The prespecified primary outcome was a decline of 6 or more recalled words on the total recall score of the Hopkins Verbal Learning Test–Revised assessed at 6, 12, 18, and 24 months. The secondary outcome was functional decline. RESULTS: Of 221 randomized participants (mean [SD] age, 75.8 [7.0] years, 175 women [79%]), 77 behavioral activation participants (69.4%) and 87 supportive therapy participants (79.1%) had 2-year outcome assessments. After baseline, behavioral activation participants engaged in significantly more cognitive activities than supportive therapy participants. The 2-year incidence of memory decline was 1.2% (95% CI, 0.2-6.4) for behavioral activation vs 9.3% (95% CI, 5.30-16.4) for supportive therapy (relative risk, 0.12; 95% CI, 0.02-0.74; P = .02). Behavioral activation was associated with stable everyday function, whereas supportive therapy was associated with decline (difference in slopes, 2.71; 95% CI, 0.12-5.30; P = .04). Rates of serious adverse events for behavioral activation and supportive therapy, respectively, were: falls (14 [13%] vs 28 [25%]), emergency department visits (24 [22%] vs 24 [22%]), hospitalizations (36 [32%] vs 31 [28%]), and deaths (7 [5%] vs 3 [4%]). CONCLUSIONS AND RELEVANCE: Behavioral activation prevented cognitive and functional decline, but this finding requires further investigation. Black individuals have almost twice the rate of dementia as white individuals; behavioral activation may reduce this health disparity. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01299766

Alzheimer's disease (AD) is the leading cause of dementia, and because the primary risk factor for AD is old age, the prevalence of the disease is increasing dramatically with ageing populations worldwide. Even in high-income countries, the cost of medical care and associated societal burdens of dementia threaten to become overwhelming as more people live into old age. In view of the lack of progress in developing a cure for AD and the rapidly increasing costs of dementia, policy makers and governments have a powerful incentive to provide more resources to develop AD therapeutics. The Lancet Neurology Commission was formed with the overarching aim to provide information and expert recommendations to policy makers and political leaders about the growing problem of AD and related dementias of ageing.

Aim: The overall aim of this thesis was to gain a deeper understanding of F-LNMs’ leadership. Another aim was to examine possible differences in self-rated health between F-LNMs and registered nurses (RNs) on various psychosocial factors. Method: Study I and III are single case studies. Study I concerns a first-line nurse manager working in a unit for care of older people. Data collection comprised of two interviews, observations, and documents. A hermeneutic approach was used for the analysis. Study II was carried out in three units at three Swedish hospitals. Three F-LNMs and 14 RNs participated. Interviews were used to collect data. The interviews were analysed using qualitative content analysis. Study III was conducted at a palliative care unit. Data were collected using three separate instruments: a questionnaire, group interviews with nurses and leaders, and documents. Qualitative content analysis was used to analyse the material. Study IV was conducted at a university hospital. Seventy-eight F-LNMs and their 1,806 subordinated RNs participated in the study. Data were collected using a web-based questionnaire (Web-QPS) to assess the participant’s psychosocial work environment and their self-rated health. Result: The main finding in study I was that the F-LNM goal-profile consisted of three goals - the nurse goal, the administrator goal and the leadership goal. The administrator and leadership goal were in accordance to her job description, while the nurse goal was interpreted as a personally chosen and prioritised goal. In study II the result was illustrated in one main theme referred to as between being and doing. The RNs and F-LNMs described what it was to be a good professional (being), how they were engaged in creating a good work climate (doing) and personal outcomes of this project (gaining). In study III the result showed that the most important component at the palliative care unit was to accomplish the vision of good palliative care. Congruence in leadership, mature group functioning, adequate organisational structures and resources, and comprehensive and shared meaningfulness were all identified as essential components for fulfilling the vision. In study IV both F-LNMs and RNs found their work in general important, interesting and meaningful and reported self-rated health as good. However, about 10-15% shoved signs of being at risk for stress related ill health. The results showed statistically significant differences in the distribution between the F-LNMs and the RNs on three indices: job control, job demand and managerial support in a direction which would be favorable to the F-LNMs. Conclusion: Nurses and F-LNMs seem to have high ideals and expectations of giving good care. The value- system of nursing, i.e. providing the best care for each patient, seems to be a point of departure for the F-LNMs leadership. Key factors for obtaining this are sufficient resources and adequate structures as well as good climate in the teams. One can therefore assume that the F-LNMs should be based on creating a healthy and sustainable work environment that promotes the quality of care and employee well-being. This is obtained by promoting development of ethical competence of the F-LNMs themselves as well as the employees. F-LNMs’ work conditions have a significant impact on how they can support and promote such a development.

As a result of a number of government reports, there have been numerous systemic changes in Indigenous education in Australia revolving around the importance of partnerships with the community. A forum with our local Dubbo community established the importance of working together and developed a model which placed the child in an ecological perspective that particularly noted the role of Elders and the place of the child in the family. However, there was also the issue of curriculum and mathematics education to be addressed. It was recognised that a colonised curriculum reduces the vision of what might be the potential for Indigenous mathematics education. This paper reports on the sharing that developed between our local community and some researchers and teachers from Sweden, Papua New Guinea and New Zealand. It has implications for recognising the impact of testing regimes, the teaching space, understanding the ways children learn, the curriculum, and teacher education. As a result of these discussions, a critical pedagogy that considers culture and place is presented as an ecocultural perspective on mathematics education. This perspective was seen as critical for the curriculum and learning experiences of Indigenous children.

PurposeThe purpose of this study is to describe the perceptions of registered nurses (RNs), enrolled nurses (ENs), and leaders (i.e. the first‐line nurse manager, F‐LNM and the substitute F‐LNM) as to what characterises an excellent work environment in a palliative care unit and the involvement of leadership in that environment.Design/methodology/approachData were collected using two separate instruments: a questionnaire, group interviews with nurses and leaders, and documents at a palliative care unit. Qualitative content analysis was used to analyse the material.FindingsAccording to the participants, the most important component at the palliative care unit was to accomplish the vision of good palliative care. Congruence in leadership, mature group functioning, adequate organisational structures and resources, and comprehensive and shared meaningfulness were all identified as essential components for fulfilling the vision.Originality/valueThis study indicates that fulfilling the vision of good palliative care may function as a buffer against stress in such a workplace

Aims and objectives. The aim of this study was to describe first-line nurse managers’ (F-LNMs) and subordinate registered nurses’ (RNs) conceptions and experiences of their routine work and how lea ...

This study focuses on parental involvement in Smi schools when developing a culturally sensitive school curriculum. The research recognizes a number of competing and complementary interests that pl ...

Background: Little or no knowledge is available about which service is offered to patients with heart failure in primary care. Aims: To describe nurse-led follow-up of patients with heart failure in primary care in Sweden. Methods and results: A questionnaire was sent to all primary health care centres in Sweden and 6 10 of 939 centres returned the questionnaire. Special nurses had designated time for follow-up of heart failure patients at 18% (n = 111) of the centres, compared to 93% and 78% for diabetes and obstructive lung disease. Centres with nurse-led follow-up of heart failure patients more frequently provided heart failure information (p

To study symptom panorama in students, to identify undiagnosed iron deficiency, and to evaluate any changes in symptoms and laboratory test results after treatment with iron supplementation.Descriptive and prospective, interventional study.Healthcare in upper secondary school.Treatment with iron supplementation for a period of 3 months.Students in the first grade of one upper secondary school.Frequency of iron deficiency related to symptoms measured by a questionnaire (30 questions) on symptoms related to quality of life and 9 questions about diet and exercise.Iron deficiency was diagnosed in 12% of the students (two or more abnormal laboratory tests) and in 61% of the students one or more laboratory tests were abnormal. Symptoms of vertigo/ dizziness were significantly more common in students with iron deficiency. After iron supplementation there was a significant increase in s-ferritin levels and a decrease in s-transferrin levels, with an accompanying significant reduction of the symptom scores of vertigo/dizziness, irritability, depressive symptoms, and indisposition.Symptoms of vertigo/dizziness were significantly more common in students with iron deficiency. Iron supplementation reduced the symptoms of vertigo/dizziness, irritability, depressive symptoms, and indisposition.

Background: An emergency cesarean section is often a traumatic experience for women, and can be associated with postnatal depression and posttraumatic stress. Various types of interventions have been tested to prevent such consequences. The purpose of this study was to test a model of group counseling for mothers after emergency cesarean section, and to examine its possible effects. Method: After undergoing an emergency cesarean section, 162 Swedish-speaking women were randomized to group counseling or the control group. The participation rate was 75 percent. The counseling consisted of 2 sessions, conducted at about 2 months postpartum; 72 percent of the women randomized to the counseling group actually attended the sessions. At 6 months postpartum, all study participants completed a postal questionnaire (response rates were 92% in the counseling group and 89% in the control group). Results: No difference between the groups was found in terms of the level of fear after childbirth, symptoms of posttraumatic stress, or postnatal depression at 6 months after the emergency cesarean. The group counseling was much appreciated by the participating women, some of whose experiences are reported in this paper. Conclusion: Group counseling for mothers after emergency cesarean section did not influence their views on the recent delivery or prevent symptoms of posttraumatic stress or postnatal depression. It was, however, appreciated and did no harm. In future studies, other outcomes should be measured.

Alzheimer’s Disease (AD) is the most common form of dementia, affecting approximately 36 million people worldwide. To date there is no preventive or curative treatment available for AD, and in absence of major progress in therapeutic development, AD manifests a concrete socioeconomic threat. The awareness of the growing problem of AD is increasing, exemplified by the recent G8 Dementia Summit, a meeting held in order to set the stage and steer the compass for the future. Simultaneously, and paradoxically, we have seen key players in the pharmaceutical industry that have recently closed or significantly decreased their R&D spending on AD and other CNS disorders. Given the pressing need for new treatments in this area, other actors need to step-in and enter this drug discovery arena complementing the industrial efforts, in order to turn biological and technological progress into novel therapeutics. In this article, we present an example of a novel drug discovery initiative that in a non-profit setting, aims to integrate with both preclinical and clinical academic groups and pharmaceutical industry to explore the therapeutic potential of new concepts in patients, using novel biology, state of the art technologies and rapid concept testing.

The Fifth International Pharmaco-Economic Conference on Alzheimer's Disease was held in New York, on March 27-29 in 2008. The attendees included researchers and key opinion leaders within the academia, pharmaceutical industry, patient organizations and regulatory bodies, collecting the worldwide leading expertise in Alzheimer research today. A summary of the presentations and conclusions from the discussions are presented in this publication. Pharmaco-economics need to play a leading role in developing and communicating evidence of the value of anti-dementia drugs, now and in the future. For the development of evidence, the challenges include transparency and standardization of costs of care assessment, improved diagnostics for identifying target patient groups, improved endpoints for assessing outcomes and improved models for assessing the long term consequences of competing treatment strategies. For the communication of evidence, the challenge lies in convincing decision makers to recognize the integrated burden of the disease, including its interaction with co-morbidities and burden on caregivers, and to consider the consequences of competing treatment strategies from a societal perspective.

In this study a sensor array and pattern recognition routines (an electronic nose) were used to monitor a sausage fermentation in order to follow the changes in emitted volatile compounds during the fermentation process and to compare the electronic nose results with a sensory analysis. From the sensor array responses the fermentation time could be predicted using different methods, where principal component regression and an artificial neural network based on all sensors in the electronic nose performed best. A sensory panel evaluated the final product and these results were compared with the electronic nose measurements in the early stage of the process and on the final sausages. A principal component analysis showed that one of the sausage batches clearly deviated from the other using both the sensory panel data and the electronic nose responses. The deviating batch was different already after 4 h and the difference was consistent during the process.

Studies show that first-line nurse managers (F-LNMs) experience high psychological job demands and inadequate managerial guidance. The purpose of this study was to investigate whether F-LNMs have higher stress levels and show more signs of stress-related ill health than registered nurses (RNs).The aim of this study was to examine possible differences in self-rated health between F-LNMs and RNs on various psychosocial factors (e.g. job demand, job control and managerial support).Data were collected at a university hospital in Sweden. Sixty-four F-LNMs and 908 RNs filled in a web-based questionnaire.Both F-LNMs and RNs reported having good health. Approximately 10-15% of the F-LNMs and RNs showed signs of being at risk for stress-related ill health. Statistically significant differences (Mann-Whitney U-test) were found in the distribution between the F-LNMs and the RNs on three indices of job control, job demand and managerial support.Our findings suggest that F-LNMs were able to cope with high-demand job situations because of relatively high control over work.The implication for nursing management shows the needs for a work environment for both F-LNMs and RNs that includes high job control and good managerial support.

Aim The purpose of this pilot study was to explore the use of massage therapy in children with cerebral palsy undergoing post-operative rehabilitation. Material and method Three participants were randomized to massage therapy and another three participants to rest. All children had undergone surgery in one or two lower limbs. Pain, wellbeing, sleep quality, heart rate and qualitative data were collected for each child. Results The scores of pain intensity and discomfort were low in all participants. Heart rate decreased in participants who were randomized to rest, but no change was found in the massage therapy group. Conclusions The lack of decrease in heart rate in the study group of massage therapy may imply an increased sensitivity to touch in the post-operative setting. Further research with larger study populations are needed to evaluate how and when massage therapy is useful for children with cerebral palsy.

9th Key symposium Introduction : Updating Alzheimer's disease diagnosis implications for prevention and treatment

The aim of this study was to describe first-line nurse managers' (F-LNMs) and subordinate registered nurses' (RNs) conceptions and experiences of their routine work and how leadership was exercised.Extensive changes in health care organisations have had a powerful impact on leadership in nursing management. Nursing leadership, in turn, has an affect on both the quality of care and the subordinates' work environment. Therefore, it is important to enhance our understanding of current leadership in nursing management.This is a descriptive qualitative study carried out in three units at three Swedish hospitals.Three F-LNMs and 14 RNs participated. Interviews were used to collect data. The interviews were analysed using qualitative content analysis.The result of this study was illustrated in one main theme referred to in this study as between being and doing. The RNs and F-LNMs described what it was to be a good professional (being), how they were engaged in creating a good work climate (doing) and personal outcomes of this project (gaining).The reciprocal relation between being and doing, which can be described as the development of virtues, was a central point in the professional work of the F-LNMs and RNs. The development of virtues is also a strategy to attain the goals of nursing and establish a work climate that motivates staff and improves performance. RELEVANCE TO CLINICAL PRACTICES: The implication for nursing management is to create ample space to develop strategies and knowledge about how leadership in nursing management can stimulate the development of a common perspective of good care and professional virtues appropriate for health care praxis.

Treatment of chronic heart failure (CHF) guided by natriuretic peptides has been studied in clinical trials with conflicting results. The aim of this study was to investigate if N-terminal pro-B-type natriuretic peptide (NT-proBNP)-guided therapy in symptomatic heart failure patients in primary care would improve clinical outcomes over and above treatment according to guidelines. SIGNAL-HF was a 9 month, randomized, single-blind, parallel group study in patients with CHF in NYHA class II-IV, ejection fraction (EF) less than 50% and elevated NT-proBNP levels (males greater than 800, females greater than 1000 ng/L). All investigators underwent a pre-study educational programme about current CHF guidelines. A control group managed by non-trained investigators was considered not possible for ethical and practical reasons. Patients were randomized to structured treatment of CHF according to guidelines with or without NT-proBNP monitoring. The choice and dose of therapy for CHF was at the investigators discretion. The primary outcome variable was the composite endpoint of days alive, days out of hospital, and symptom score from the Kansas City Cardiomyopathy Questionnaire. In all, 252 patients were randomized. The allocation groups were well balanced with regards to age, NT-proBNP, and EF. Treatment doses of beta-blockers and blockers of the renin-angiotensin-aldosterone system were markedly increased towards target doses and to a similar degree in both groups. There were no differences between the groups concerning either the primary endpoint (P = 0.28) or its components [cardiovascular (CV) death, P = 0.93; CV hospitalization, P = 0.88; or symptom score, P = 0.28]. NT-proBNP-guided CHF treatment did not result in important improvements in clinical outcomes in patients with CHF in primary care above and beyond what could be achieved by education and structured CHF treatment according to guidelines.

The aim of this case study was to acquire understanding concerning the first-line nurse manager's goal-profile, i.e. prioritization of goals in her work as a first-line nurse manager, through use of an action-theoretic and confirmatory theory.The first-line nurse manager's pivotal role regarding quality of care and development in relation to on-going changes in the health care sector is stressed by many researchers and the transition from nurse to manager is described as a demanding challenge for the first-line nurse manager.The case study described in this paper concerns a first-line nurse manager in an actual working environment in care of older people. Data collection comprised interviews, observations, a job description and policy documents. A hermeneutic interpretation was used for data analysis.The results showed that the first-line nurse manager had three goals in her goal-profile, in the following order of priority: (i) a nurse goal that she had strongly accepted and in which she had excellent control, (ii) an administrator goal that she had accepted and in which she had control, (iii) a leadership goal that she had not accepted and in which she did not have control. Both the administrator and leadership goals were based on her job description, but the nurse goal was a personally chosen goal based on her own self-relation/goal-fulfillment.The first-line nurse manager's prioritized self-identity, based on successful realization of goals in her goal-profile, was decisive in the manifestation of her work.This study contributes to a new understanding of the first-line nurse manager's self-identity related to work in terms of goal acceptance and goal control of prioritized goals. This action-theoretic approach could be a valuable 'key' for understanding leadership (or lack of leadership) in clinical practice.

Bone tissue engineering by combining bone marrow stromal cells (BMSCs) with a porous scaffold is a promising technology. Current major challenges are to upscale the technique for clinical application and to improve the handling characteristics. With respect to minimal invasive surgery, moldable and/or injectable formulations are highly preferable. Ceramic microparticles of different HA/TCP formulations (100/0, 70/30, 60/40, 40/60, and 0/100) with varying surface roughness were sieved to select 200 microg aliquots of the 212-300 microm fraction. Goat BMSCs were seeded on different aliquots one week prior to in vivo implantation. These constructs and remaining cells were cultured for one week. By then, the remaining cells were harvested and resuspended in a specific binder: hyaluronic acid, alginate, or blood plasma, combined with aliquots of 60/40 microparticles peroperatively. All constructs were implanted in nude rats (n = 10) and analyzed for their bone yield histomorphometrically after 6 weeks. All precultured constructs showed consistent bone formation of comparable quantity. No significant differences were observed between the different material compositions. Peroperatively prepared constructs hardly showed any bone formation. The present study demonstrated the osteogenic potential of a tissue- engineered bone substitute made of microparticles of various HA/TCP compositions. There was an obvious advantage when the constructs were pre-cultured.

Bacterial growth, formation of acids, lipolysis, proteolysis, fat oxidation, formation of volatile compounds and flavour characteristics were followed during ripening and storage of a fermented sausage. The starter culture used was composed of Pediococcus pentosaceus and Staphylococcus xylosus. The number of Pediococcus sp. increased by 1.5 log cfu/g during the first day of processing and remained constant at this level for 3 weeks. The corresponding initial increase in the numbers of Staphylococcus sp., 0.4 log cfu/g, was followed by a rapid decrease in the viable numbers. Lactic acid, mainly d-lactic acid, and acetic acid were formed during ripening. The triglycerides were hydrolysed to 1,2-diglycerides and free fatty acids at the beginning of ripening, followed by the formation of 1,3-diglycerides and monoglycerides, indicating lipolytic activity. Moreover, the nonprotein nitrogen increased during ripening as a result of the proteolytic activity. Most of the changes with respect to pH, formation of d-lactic acid, acetic acid, peroxides and flavour development occurred during the initial 3 days of ripening, when growth of Pediococcus sp. and Staphylococcus sp. occurred. Lipolysis as well as proteolysis continued after this initial period. The volatile compounds identified belonged to several chemical families, viz. aliphatic and aromatic hydrocarbons, aldehydes, ketones, alcohols, phenols, carboxylic acids, esters, nitrogen compounds, sulphur compounds, chloride compounds, terpenes and furans. Many of the volatile compounds probably originated from smoke and seasoning (onion/garlic and pepper), while others were a result of the activities of muscle enzymes and bacteria.