CT of Uhl’s Anomaly in an Adult

Uhl’s anomaly is an extremely rare condition of unknown cause characterized by complete or partial absence of the right ventricular myocardial layer, which is replaced by nonfunctional fibroelastic tissue. The disease causes progressive right-sided heart failure, increased right-sided cardiac pressure, massive peripheral edema, and ascites. Patients usually present in infancy and rarely survive to adulthood. The disease appears to be congenital in origin. Diagnosis was previously made at autopsy, but advances in imaging now permit diagnosis by echocardiography or cross-sectional imaging (computed tomography or magnetic resonance). We present a case of a 51-year-old patient with Uhl’s anomaly who underwent placement of a ventricular assist device as a bridge to cardiac transplantation, and discuss CT findings.     

Families’ perspectives of participation in patient care in an adult intensive care unit: A qualitative study

BackgroundWhen a relative is admitted to the intensive care unit (ICU), stress, anxiety, and failure to cope may place families, and the patient, at risk for adverse psychological outcomes. Family participation in patient care may improve patient and family outcomes. However, to date, little is known about how families perceive and participate in patient care in ICU, and there is limited research to guide clinicians about supporting family participation in this context.ObjectiveTo describe family perspectives of participation in patient care in adult ICU.MethodsUsing a qualitative design, observation and interview data were collected from a convenience sample of 30 family members in the ICU at two metropolitan hospitals in Melbourne, Australia. An independent third party was used to recruit potential participants. Naturalistic observations and semi-structured interviews explored families’ actions and perceptions of participation. Data were integrated and subject to thematic analyses.FindingsThe major theme Families as part of the healthcare team reflected family perspectives of their own significant contribution to supporting their relative’s recovery while they were in ICU. Families' perception of their participation in patient care was characterised by three sub-themes: 1) Motivators for family participation; 2) Family roles during recovery; and 3) Influences on family participation. Families' perceived reassurance and companionship as important contributions to patient care.ConclusionFamilies perceived their contribution to the patient's psychosocial and emotional well-being to be one of the most important aspects of participation. Nevertheless, their role in the healthcare team was influenced by several motivational factors. Results of this study can inform further research to test the effectiveness of clinical practice and educational interventions aligned with family preferences to promote participation and enhance patient and family-centered care in ICU.     

Patients’ and therapists’ perception of change following physiotherapy in an orthopedic hospital’s outpatient clinic

Abstract

Objective: The aims of this observational, prospective cohort study were to: assess the patients’ and therapists’ perception of change after physiotherapy in an orthopedic hospital’s outpatient clinic; relate these retrospective assessments to a serial assessment of pain; and study the influence of patient characteristics on the perceived change. Methods: 161 patients of the outpatient clinic participated. The main outcome measures were the patient global impression of change (PGIC) and the clinical global impression of change (CGIC) after physiotherapy. The visual analogue scale was used as serial assessment. Results: The PGIC indicated improvement in 128 patients (80%) and the CGIC in 117 patients (73%). The correlation between PGIC and CGIC was good (r_S?=?0.71, p?<?0.001). The perceived change correlated little to baseline pain (PGIC: r_S?=?0.24, p?=?0.004; CGIC: r_S?=?0.18, p?=?0.024) and change in pain due to physiotherapy (PGIC: r_S?=??0.22, p?=?0.004; CGIC: r_S?=??0.31, p?<?0.001). The logistic regression model revealed a significant influence of the patients’ education level and the number of problems on the PGIC and the CGIC. Conclusions: The addition of at least one GPC scale might be valuable in evaluating the outcome in physical therapy, which requires little time and thus may be ideal for a clinical setting. Patients’ and therapists’ perception of change is significantly influenced by the patients’ education level and the number of problems, which might be of relevance when choosing adequate treatment strategies.     

The veterinary nurse’s role in nursing an equine surgical colic patient

Abstract

The nurse’s role is critical in the pre-operative, peri-operative and post-operative period in surgical colic patients, due to colic being a major cause of morbidity and mortality in horses. The nurse’s role can vary hugely when nursing a surgical colic patient as their role could include laboratory work, placing catheters and administering medication, theatre nursing, intravenous fluid therapy and general TLC.     

Depression in women’s magazines

BackgroundMass communication research suggests that the media influence both what a population thinks about and how it thinks about an event or situation by controlling what is covered and how topics are framed. One medium, popular women’s magazines, has published depression-related articles for decades. However, little is known about the content and frame of these articles.ObjectiveThe research sought to determine what women’s magazines published about depression between 1980 and 2000.DesignArticles published on depression in the top eight circulating women’s magazines, between 1980 to 1985 and 1995 to 2000 were retrieved and analyzed using qualitative media analysis methodology.ResultsBetween the two periods, the magazines increased the number of published articles on depression and increasingly framed it as a treatable but stigmatized illness.ConclusionWomen’s magazines, which regularly publish information on depression, have high circulation rates, resulting in millions of exposures to their messages. Psychiatric nurse-authors have an opportunity to influence these messages.     

Families’ control preference for participation in patient care in adult intensive care

ObjectiveUnderstand families’ preferences and observed participation in patient care in an adult ICU.Research methodologyThe mixed-methods design used survey and naturalistic observation to collect data from a convenience sample of 30 family members of critically ill patients.SettingTwo public hospital intensive care units in Australia.Main outcome measures1) Families’ preferences for participation in decision-making and physical patient care activities in the adult intensive care unit, measured using a modified Control Preference Scale; 2) the type and frequency of family participation in patient care activities in the intensive care unit.ResultsAlmost half (47%) reported a preference to share in decision-making about care for their relative with healthcare professionals; 17% reported a preference for active participation in decision-making. Alternatively, most families preferred a passive (60%) role in the physical care of their relative ; 33% preferred shared participation with staff and very few (3%) preferred active participation with little involvement of staff. Of the 193 activities observed, family participation in physical care was the least frequent (24%).ConclusionDifferences emerged in family preferences for participation in physical care compared to their involvement in decision-making about care for their relative. The findings indicate a need for tailored interventions to support family participation aligned with their preferences.     

The repeatability of Stewart’s parameters and anion gap in a cohort of critically ill adult patients

Purpose

To examine the repeatability of Stewart’s parameters and anion gap in a cohort of critically ill patients and to determine the smallest detectable changes in individual patients.

Methods

A total of 161 patients were included prospectively. They underwent two subsequent blood samplings within 10?min of each other and samples were analyzed using the same central laboratory analyzer. Measured and calculated parameters from the two samples were compared. The repeatability was expressed as the smallest detectable difference (SDD), coefficient of variation (CV) and intraclass correlation coefficient (ICC).

Results

The mean differences?±?SD (mEq/L) for the repeated measurements were 0.1?±?0.76, 0.12?±?0.68, ?0.02?±?1.02, and ?0.08?±?1.05 for the apparent strong ion difference (SID_app), effective strong ion difference (SID_eff), strong ion gap (SIG), and albumin-corrected anion gap (AG_corr), respectively. The SDDs (mEq/L) for SID_app, SID_eff, SIG, and AG_corr, were ±1.49, ±1.33, ±2, and ±2.06, respectively. The CVs (%) for these variables were 1.4, 1.45, 13.3, and 4.15, respectively. The ICCs for all these variables were high, largely above 0.75.

Conclusions

The repeatability of all these calculated variables was good. In repeated measurements, a change in value of these parameters exceeding 1.96√2 CV (%), the least significant change (LSC) or the SDD should be regarded as significant. Use of SDD is preferable to CV and LSC (%) because of its independence from the levels of variables and its expression in absolute units. Expressed as SDD, a SIG change value, e.g., of at least ±2?mEq/L should be significant.     

CXCR3 promotes plaque formation and behavioral deficits in an Alzheimer’s disease model

Chemokines are important modulators of neuroinflammation and neurodegeneration. In the brains of Alzheimer’s disease (AD) patients and in AD animal models, the chemokine CXCL10 is found in high concentrations, suggesting a pathogenic role for this chemokine and its receptor, CXCR3. Recent studies aimed at addressing the role of CXCR3 in neurological diseases indicate potent, but diverse, functions for CXCR3. Here, we examined the impact of CXCR3 in the amyloid precursor protein (APP)/presenilin 1 (PS1) transgenic mouse model of AD. We found that, compared with control APP/PSI animals, plaque burden and Aβ levels were strongly reduced in CXCR3-deficient APP/PS1 mice. Analysis of microglial phagocytosis in vitro and in vivo demonstrated that CXCR3 deficiency increased the microglial uptake of Aβ. Application of a CXCR3 antagonist increased microglial Aβ phagocytosis, which was associated with reduced TNF-α secretion. Moreover, in CXCR3-deficient APP/PS1 mice, microglia exhibited morphological activation and reduced plaque association, and brain tissue from APP/PS1 animals lacking CXCR3 had reduced concentrations of proinflammatory cytokines compared with controls. Further, loss of CXCR3 attenuated the behavioral deficits observed in APP/PS1 mice. Together, our data indicate that CXCR3 signaling mediates development of AD-like pathology in APP/PS1 mice and suggest that CXCR3 has potential as a therapeutic target for AD.