What determines echogenicity in a general population? The Troms? Study.

BACKGROUND: It is widely recognized that in some people it is difficult or impossible to acquire adequate measurements of cardiac performance and anatomy by any echocardiographic technique. We used our population-based screening to determine the characteristics of such unmeasurable subjects. METHOD: In a sample of 3287 subjects aged 25 to 85 years, we used standard 2-dimensional guided M-mode echocardiography and pulsed and color Doppler to assess left ventricular (LV) structure and function. RESULTS: Of 3287 subjects only 0.4% could not be measured by any technique. In 2794 subjects M-mode registrations of good quality were obtained, which allowed calculation of LV mass and LV ejection fraction. Those in whom measurements could not be obtained had a significantly higher age, body mass index, blood pressure, waist/hip ratio, and were more likely to smoke, be a man, be taking antihypertensive medication, have a history of ischemic heart disease, and have a low level of physical activity. CONCLUSION: Because subjects with high cardiovascular risk factor levels are less likely to be measurable with echocardiography, a need exists for other noninvasive diagnostic methods in these persons.     

What determines the management of anxiety disorders and its improvement?

Introduction Although anxiety disorders are highly prevalent, lack of correct diagnosis and related concerns about treatment are serious clinical problems. Several factors affect, positively or negatively, management of anxiety and its improvement. A literature review and thematic analysis was executed to obtain an overview of the types of determinants of anxiety care and its improvement. Methods Literature was identified from electronic database searching (January 1995–March 2006), contact with authors of studies, and searching of websites of organizations concerned with mental health. By using a template analysis approach, a set of strong themes relating to determinants of anxiety care and its improvement was identified. Results The 15 eligible studies identified 43 factors that impeded or facilitated optimal anxiety care and its improvement. Individual characteristics of both patients (n = 13) and professionals (n = 6) were most frequently reported as determinants of anxiety care and its improvement. A considerable number of factors were related to the organizational context (n = 12), such as practice type and location. Some factors related to the social context (n = 4), the economic context (n = 2), or to the innovation itself (n = 6) were identified. Conclusion The findings show that there is a multitude of barriers and facilitators to optimal anxiety care and its improvement. Some determinants are modifiable, and thus responsive to interventions. Examples are collaboration within and between organizations, financial resources and assignment of both an opinion leader and responsible staff. The quality of anxiety care can be improved by systematically designing innovation strategies which are tailored to a selection of the determinants identified in this study.     

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.     

What determines supportive behaviors following bereavement? A systematic review and call to action

Very few factors that impact the grieving process can be modified after the fact to the extent that social support can. However, social support has received limited research attention, resulting in little conceptual understanding of the mechanisms behind perceptions of, and intentions to support, grieving persons. This systematic review aimed to explore bereaved, decedent, and respondent-related determinants of the provision of social support. The review yielded 42 studies impacted by various methodological and sampling limitations. This review poses a call to the field for more rigorous study of social support determinants to better assist the bereaved and their natural supporters.     

Crisis? What crisis?

The fact that 50% of the 4600 hours that constitute a pre-registration nursing programme takes place in the practice setting, means that there is considerable reliance on mentors and other clinicians to support and teach students. Clinical experience is vital if student nurses are to implement the theory they have learnt in the classroom and become competent and safe practitioners (Panther, 2008). There is, therefore, a need for high-quality clinical learning environments which both provide students with the support they need and measure their clinical competence. Mentors play a vital role in both these aspects and are the fulcrum on which practice learning depends (Pellatt, 2006).     

Does fluid loading influence measurements of intestinal permeability?

Introduction  

Urinary recovery of enterally administered probes is used as a clinical test of intestinal mucosal permeability. Recently, evidence has been provided that the recovery of some but not all sugar probes is dependent on the amount of diuresis and renal function. The aim of this study was to assess the effect of fluid loading on the urinary recovery of sugar probes in healthy volunteers.