Impact of cancer patients’ quality of life on that of spouse caregivers

Goals of work This study aimed to examine the correlation between quality of life (QOL) in cancer patients and that of their spouse caregivers and to identify factors that influence this correlation.Patients and methods This cross-sectional study collected data from 121 cancer patient/spouse caregiver dyads. The Functional Assessment of Cancer Therapy Scale-General (FACT-G) was used to measure patients QOL, and the Caregiver Quality of Life Index (CQLI) was used to measure spouse caregivers QOL. Correlation coefficients between patients and caregivers QOL were computed for four dimensions of QOL, as well as a total score for QOL. Correlations between patients and caregivers total QOL scores were furthered analyzed by three groups of factors: disease-/treatment-related, caregiving-related, and relationship-related variables.Main results Only the social/family and functional dimensions of patient QOL and total score for patient QOL were associated with each dimension of their caregivers QOL and with the total score (r=0.27–0.44). Physical and emotional dimensions of patients QOL did not significantly influence spouse caregivers QOL for any dimension nor for the total score. Factors influencing the association between patients and caregivers overall QOL included cancer diagnosis, length of hospitalization, caregiving intensity and duration, marital satisfaction, and caregiving self-esteem.Conclusions Social and functional aspects of patients QOL play a significant role in determining the QOL of their spouse caregivers. The strength of association between patients and spouse caregivers overall QOL can be moderated by some factors.     

Cardiac troponin I release and cytokine response during experimental human endotoxaemia

Objective To study the relationship between cytokine levels and cardiac troponin I (cTnI).Design Prospective experimental study.Setting Intensive care unit of a university hospital.Participants Six healthy male volunteers.Interventions Endotoxin, 4 ng/kg, was given as a 1-min intravenous infusion.Measurements and results Circulating cardiac troponin I levels and proinflammatory cytokines tumour necrosis factor- (TNF-), interleukin-6 (IL-6) and interleukin-8 (IL-8) were analysed at various time points during a 24-h period. TNF- appeared in the circulation 30 min after injection (T=0.5 h), reaching peak levels (5,665±1,910 pg/ml) 2 h after infusion. At T=24 h TNF- was still elevated in the circulation compared to T=0. None of the six volunteers had a cTnI value higher than 0.1 g/l at T=0, 6 h or 24 h.Conclusion The presence of significant amounts of TNF-, IL-6 and IL-8 in the systemic circulation does not lead to increased levels of cTnI in experimental human endotoxaemia.     

The Driver's Angry Thoughts Questionnaire: A Measure of Angry Cognitions When Driving

Five forms of driving-related angry cognitions were identified—Judgmental/Disbelieving Thinking ( = .94), Pejorative Labeling/Verbally Aggressive Thinking ( = .92), Revenge/Retaliatory Thinking ( = .93), Physically Aggressive Thinking ( = .93), and Coping Self-instruction ( = .83). Pejorative labeling/verbally aggressive, physically aggressive, and revengeful/retaliatory thinking correlated positively with each other and with driving anger, aggressive driving anger expression, aggression, and risky driving behavior. Coping self-instruction tended to correlate negatively with these variables. Judgmental/disbelieving thinking correlated positively with other forms of angry thinking, but was only somewhat correlated with other variables. Driving-related angry thoughts, except coping self-instruction, correlated positively with general hostile automatic thoughts. Differences in strengths of correlations with specific variables, and contributions to regression analyses supported the discriminant and incremental validity of driving-related angry thoughts. Implications for cognitive processes in anger and interventions were discussed.     

The patients’ perceptions of migraine and chronic daily headache: a qualitative study

This study aimed to gain insight into the management of migraine and chronic daily headache (CDH) from the patients perspective. This article outlines the patients perceptions of migraine and chronic daily headache. Thirteen semi–structured interviews were carried out with patients suffering from IHS migraine. Five patients, due to their headache frequency of more than 15 headache days per month, were classed as CDH patients. The data were transcribed verbatim and analysed in accordance with the grounded theory methodology. The main themes were: headaches, impact and headaches related to health issues. The theme headaches was sub-divided into their pain and symptoms, differentiating between their headaches and perceptions of headaches as barriers and facilitators to management. The patients perceptions of migraine and CDH were sometimes conflicting and influenced the patients management behaviours. The qualitative methodology may help to inform doctors, other healthcare professionals and headache researchers about the patients perspective and possibly develop future headache research, care and education.     

Stroke output variations calculated by esophageal Doppler is a reliable predictor of fluid response

Objective Esophageal Doppler allows continuous monitoring of stroke volume index (SVI) and corrected flow time (FTc). We hypothesized that variations in stroke output index SOI (SVI/FTc) during volume expansion can predict the hemodynamic response to subsequent fluid loading better than the static values.Design and setting Prospective study in the intensive care unit of a university hospital.Patients Fifty-one patients with circulatory failure were monitored by esophageal Doppler.Interventions Patients who responded to a first fluid challenge received a second one. Patients who responded to both were classified as responders-responders, and those who did not respond to the second as responders-nonresponders. In these two groups we compared SVI, FTc, and SOI during each fluid challenge and also static values at the end of each fluid challenge.Measurements and results After the first fluid challenge SOI and SVI were significantly higher in patients who responded to subsequent volume expansion than in patients who no longer responded. ROC curves showed that SOI was a better predictor of fluid responsiveness than SVI. During volume expansion a SOI value of 11% discriminated between responders and nonresponders to subsequent volume expansion with a sensitivity of 91% and a specificity of 97%. There was no significant difference between the two groups for FTc value at the end of first fluid challenge.Conclusions Analysis of SOI during fluid challenge predicts response to subsequent fluid challenge and FTc is not a reliable indicator of cardiac preload.     

Volume/pressure curve of total respiratory system in paralysed patients: artefacts and correction factors

The volume/pressure (V/P) curve of the total respiratory system in paralysed patients is drawn assuming that volume changes of the respiratory system (V resp) equals volume displacement of the measuring apparatus (V syr), usually a supersyringe. However, in 93 VP curves we found that O₂ removed from the lung-syringe system during the procedure (proportional to the time) largely exceedes the CO₂ added to the lung-syringe system (V gas). This results in a net loss of volume from the system (V resp相似文献   

Self-efficacy expectancies versus outcome expectancies as determinants of performance deficits and depressive affect

To compare the depression etiologies specified by self-efficacy theory versus the revised learned helplessness theory, 108 male and female undergraduates were assigned randomly to either high, low, or no self response expectancy manipulations and high, low, or no response outcome expectancy manipulations. Expectancies were modified by combinations of easy or difficult anagrams and graphs showing that most or few students solved the anagrams. Males exhibited performance deficits and depressed affect following manipulations only if self response expectancy had been set low and other response expectancy had been set high. Contrary to revised learned helplessness theory, no performance deficit or depressive affect occurred when both self response and response outcome expectancies were low. Females' performance and affect were not changed by combined low self response and high response outcome manipulations. Repeated subject ratings of self response and response outcome expectancies during manipulations suggest that females set their self response expectancies low before manipulations to avoid depression. Expectancy ratings also showed that self response expectancies correlated more strongly with performance than did response outcome expectancies.We thank Katherine Acosta, Michael Davis, Larry McFarland, and Janine Tronolone for their assistance as experimenters.     

Plantes et vieillissement, données actuelles*

Résumé: Le vieillissement résulte dune suite de mécanismes biologiques sacconpagnant de modifications physiologiques, anatomiques et psychologiques.Après avoir rappelé ses manifestations physiologiques (cérébrales, hormonales, cutanées, cardio-vasculaires, troubles de lappareil locomoteur), lauteur sélectionne, daprès des critères scientifiques, différentes plantes capables de contribuer à ralentir le processus de sénescence de lorganisme ou de combattre les effets du vieillissement. Ces végétaux ont fait lobjet de publications dans des revues scientifiques internationales principalement au cours de ces cinq dernières années. Dossier: Phytothérapie et vieillissement* Communication présentée lors du 5^e colloque de la revue Phytothérapie: les Avancées en Phytothérapie, janvier 2004.     

Oxygenation remains unaffected by increased inspiration-to-expiration ratio but impairs hemodynamics in surfactant-depleted piglets

Objectives Prolongation of inspiratory time is used to reduce lung injury in mechanical ventilation. The aim of this study was to isolate the effects of inspiratory time on airway pressure, gas exchange, and hemodynamics, while ventilatory frequency, tidal volume, and mean airway pressure were kept constant.Design Randomized experimental trial.Setting Experimental laboratory of a University Department of Anesthesiology and Intensive Care.Animals Twelve anesthetised piglets.Interventions After lavage the reference setting was pressure-controlled ventilation with a decelerating flow; IE was 11, and PEEP was set to 75% of the inflection point pressure level. The IE ratios of 1.51, 2.31, and 41 were applied randomly. Under open lung conditions, mean airway pressure was kept constant by reduction of external PEEP.Measurement and results Gas exchange, airway pressures, hemodynamics, functional residual capacity (SF₆ tracer), and intrathoracic fluid volumes (double indicator dilution) were measured. Compared to the IE of 11, PaCO₂ was 8% lower, with IE 2.31 and 41 (p0.01) while PaO₂ remained unchanged. The decrease in inspiratory airway pressure with increased inspiratory time was due to the response of the pressure-regulated volume-controlled mode to an increased IE ratio. Stroke index and right ventricular ejection fraction were depressed at higher IE ratios (SI by 18% at 2.31, 20% at 41; RVEF by 10% at 2.31, 13% at 41;p0.05).Conclusion Under open lung conditions with an increased IE ratio, oxygenation remained unaffected while hemodynamics were impaired.This study was supported by the Swedish Medical Research Council (project 4252), the Swedish Heart-Lung Foundation, Stockholm, Sweden, and the Laerdal Foundation for Acute Medicine, Stavanger, Norway     

Prostacyclin counteracts the increase in capillary permeability induced by tumour necrosis factor-α

Objective To analyse how prostacyclin interferes with the short-term local circulatory effects of tumour necrosis factor- (TNF) in a skeletal muscle.Design An autoperfused sympathectomised cat gastrocnemius muscle enclosed in a plethysmograph.Interventions Arterial blood flow, total and segmental vascular resistances (large-bore arterial vessels, arterioles and veins), hydrostatic capillary pressure, tissue volume and capillary filtration coefficient were followed during local intraarterial infusion of TNF at various rates (2.5, 5.0 and 7.5 g/kg per min) and during intra-arterial infusion of prostacyclin simultaneously with the highest dose of TNF. The capillary filtration coefficient reflects the capillary surface for fluid exchange.Results Arterial infusion of TNF had no influence on vascular resistance up to 5.0 g/kg per min but induced vasodilation at 7.5 g/kg per min. No effects on the recorded hydrostatic capillary pressure were observed. The capillary filtration coefficient and the capillary filtration increased with the infusion rate of TNF the former by 55%. Simultaneous arterial infusion of prostacyclin (350 ng/kg per min) caused further vasodilation and an increase in hydrostatic capillary pressure and completely restored the capillary filtration coefficient to control. The TNF-induced filtration was partly restored.Conclusions The local circulatory effect of TNF is small apart from a graded increase in the capillary filtration coefficient, most likely reflecting an increase in capillary permeability. The prostacyclininduced decrease in capillary filtration coefficient most likely reflects a restoration of capillary permeability. The TNF-induced transcapillary filtration is not fully reduced by prostacyclin due to a simultaneous increase in hydrostatic capillary pressure.     

Plantes médicinales d’Amérique du Nord: apport à la phytothérapie française du traitement des affections des voies respiratoires

Résumé: Lanalyse des données littéraires, comme la constatation sur le terrain, permettent dapprocher une phytothérapie traditionnelle des États-Unis et du Canada avec des plantes des contrées nord-américaines. Lexamen des données ethnobotaniques, pharmacologiques et cliniques dun certain nombre de drogues utilisées dans les affections de la sphère respiratoire permet de proposer aux phytothérapeutes européens un complément dans leur pratique thérapeutique. Seront passées en revue des plantes classiques comme le polygala de Virginie, la grindélie, le lédon du Groenland, la médecine oshá, lyerba santa, qui sadressent à différents états pathologiques de larbre respiratoire.     

Assessment of left ventricular diastolic function with Doppler tissue imaging: effects of preload and place of measurements

Mitral inflow velocities are widely used for the evaluation of left ventricular (LV) diastolic function. However, they are closely affected by other factors such as preload. The purpose of this study was to evaluate the usefulness of tissue Doppler velocities obtained from the mitral annulus for the evaluation of ventricular relaxation in patients under different loading conditions. We also evaluated the effect of preload at different sides on the mitral annulus. The study population consisted of 62 consecutive patients (38 male, 24 female with a mean age of 42 ± 13 years) who have undergone hemodialysis. Both mitral inflow velocities (E wave, A wave, E wave deceleration time and isovolumetric relaxation time) and mitral annulus tissue Doppler velocities (E, A) from the septal, lateral, anterior, posterolateral and inferior sides of the mitral annulus were measured immediately before and after hemodialysis. Mitral inflow E and A wave velocities and E/A ratio decreased significantly (p < 0.001, p = 0.007, p < 0.001, respectively) after hemodialysis. Mitral annulus E wave velocities and E/A ratios obtained from five different sides of the annulus also changed significantly (p < 0.001 for all); however, there was no change in the A wave velocity (p > 0.05 for all) after hemodialysis. The decrease in E wave and E/A ratio in mitral inflow measurements and E velocities and E/A ratios in tissue Doppler measurements were correlated with the amount of fluid extracted (for mitral inflow E wave, r = 0.392, p = 0.002 and E/A ratio, r = 0.280 and p = 0.027; for lateral side E, r = 0.329, p = 0.009 and E/A ratio, r = 0.286, p = 0.04; for septal side E, r = 0.376, p = 0.003 and E/A ratio, r = 0.297, p = 0.019; for anterior side E, r = 0.342, p = 0.007 and E/A ratio, r = 0.268, p = 0.035; for posterolateral side E, r = 0.423, p = 0.001 and E/A ratio, r = 0.343, p = 0.007; and for inferior side E, r = 0.326, p = 0.01 and E/A ratio, r = 0.278, p = 0.029). We conclude that mitral annular velocities obtained by tissue Doppler are preload dependent parameters for the evaluation of LV diastolic function.     

Action bactéricide de l’acide glycyrrhétinique sur <Emphasis Type="Italic">Helicobacter pylori</Emphasis>

Résumé: Lauteur, après avoir rappelé lutilisation de la réglisse dans les problèmes gastriques, rappelle et montre que lacide glycyrrhétinique a un effet antibactérien sur Helicobacter pylori, un des facteurs de lulcère gastrique. Il montre que cet effet peut avoir lieu sur des lignées bactériennes résistantes aux antibiotiques comme la clarythromycine, lamoxicilline et le métronidazole.     

The concept of “baby lung”

Background The baby lung concept originated as an offspring of computed tomography examinations which showed in most patients with acute lung injury/acute respiratory distress syndrome that the normally aerated tissue has the dimensions of the lung of a 5- to 6-year-old child (300–500 g aerated tissue).Discussion The respiratory system compliance is linearly related to the baby lung dimensions, suggesting that the acute respiratory distress syndrome lung is not stiff but instead small, with nearly normal intrinsic elasticity. Initially we taught that the baby lung is a distinct anatomical structure, in the nondependent lung regions. However, the density redistribution in prone position shows that the baby lung is a functional and not an anatomical concept. This provides a rational for gentle lung treatment and a background to explain concepts such as baro- and volutrauma.Conclusions From a physiological perspective the baby lung helps to understand ventilator-induced lung injury. In this context, what appears dangerous is not the V_T/kg ratio but instead the V_T/baby lung ratio. The practical message is straightforward: the smaller the baby lung, the greater is the potential for unsafe mechanical ventilation.     

Phyto News

PHYTO NEWS est la revue commentée de communications dans le domaine de la plante médicinale (recherche pharmacologique et clinique) qui nous semblent présenter un intérêt médical ou pharmaceutique tel, quil puisse permettre de faire progresser dautres études qui aboutiront à une application thérapeutique. Il est cependant important davertir les lecteurs que, dune découverte ou dune démonstration pharmacologique, ne découle pas immédiatement la justification de lutilisation médicale.

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Phyto-News is a commented review of papers about medicinal plant researches all around the world. The papers must contain information leading to medicinal progress in phytotherapie practice or development in the pharmaceutical area. The reader is advised that not all discoveries will have immediate use in medicine, but each may give ideas for further investigations.

     

Knowledge-based decision support for patient monitoring in cardioanesthesia

An approach to generating intelligent alarms is presented that aggregates many information items, i.e. measured vital signs, recent medications, etc., into state variables that more directly reflect the patient's physiological state. Based on these state variables the described decision support system AES-2 also provides therapy recommendations. The assessment of the state variables and the generation of therapeutic advice follow a knowledge-based approach. Aspects of uncertainty, e.g. a gradual transition between normal and below normal, are considered applying a fuzzy set approach. Special emphasis is laid on the ergonomic design of the user interface, which is based on color graphics and finger touch input on the screen. Certain simulation techniques considerably support the design process of AES-2 as is demonstrated with a typical example from cardioanesthesia.     

Urinary excretion of cyclic AMP in bacterial infections

Summary Urinary cyclic AMP excretion was found to be increased in patients with severe bacterial infections and normal renal function. The observed changes appeared due to a combination of an increased filtered load plus augmented nephrogenous production in some patients; while in others, only an increase in the apparent nephrogenous production of cAMP could be found to account for the elevation in the total urinary excretion. Since total serum calcium was found to be low in most of these patients, increased PTH secretion to reduce urinary excretion of calcium may have been responsible for an increase in renal parenchymal production, and subsequent excretion of cyclic AMP. Although speculative, this theory is tenable in that ionized hypocalcemia exists in septic patients.Abbreviations cAMP cyclic 3, 5-adenosine monophosphate - PTH parathormone - ADH andidiuretic hormone - GFR glomerular filtration rate     

A Prospective Study of the Impact of Polygraphy on High-Risk Behaviors in Adult Sex Offenders

This study examined whether polygraph testing would result in sex offenders engaging in fewer high-risk behaviors. Fifty adult male sex offenders taking part in community treatment programs were allocated into 2 groups: Polygraph Aware subjects were told they would receive a polygraph examination in 3 months regarding their high-risk behaviors, while Polygraph Unaware subjects were told their behavior would be reviewed in 3 months. Relevant behaviors for each subject were established at baseline interviews, following which both groups were polygraphed at 3 months. All subjects were polygraphed again at 6 months. The hypothesis was that subjects in the Polygraph Aware group would have engaged in fewer high-risk behaviors, based on their self-report during the examination. Thirty-two subjects (64%) attended the first polygraph examination, with 31 (97%) disclosing an average of 2.45 high-risk behaviors each previously unknown to supervising probation officers. There was no significant difference between the two groups. Because of the high failure rate, all subjects were told to expect a second polygraph. Twenty-one subjects (42%) completed the second polygraph test, with 71% disclosing an average of 1.57 behaviors, a significant decrease compared with the first test. Disclosures to treatment providers and probation officers also increased. It was concluded that polygraph testing resulted in offenders engaging in less high-risk behavior, although the possibility that offenders fabricated reports of high-risk behaviours to satisfy examiners is also considered; similarly, offenders seemed to be more honest with their supervisors, but this only occurred after experience of the test itself. Feedback from offenders who completed the study, taken together with the high drop out rate, suggested that those motivated not to reoffend found polygraphy useful, while those less motivated sought to avoid it.     

Phytothérapie et Internet

À lheure dune mise en question des politiques de santé publique et dun regain de faveur pour des thérapeutiques jugées plus naturelles, la phytothérapie suscite un intérêt croissant qui se mesure au nombre des sites Internet consacrés à la médecine par les plantes. Mais aujourdhui la masse dinformations disponibles et labsence totale de contrôle de la qualité de ces informations rendent de plus en plus difficiles les recherches documentaires sur les «autoroutes de linformation». Dans cette nouvelle rubrique Phytothérapie & Internet seront signalés les sites qui semblent présenter le plus dintérêt pour nos lecteurs.

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At a time when the politics of public health are being challenged and natural treatments are witnessing a popularity revival, phytotherapy is arousing a growing interest that can be measured by the number of Internet sites devoted to plants based medicine.However, the large amount of available information and the total absence of quality controls concerning the information these sites give, make documentary research increasingly difficult on these information motorways. In this new section, Phytotherapy & Internet, the sites that present the most interest for our readers are mentioned.