Microparticle‐associated tissue factor activity,venous thromboembolism and mortality in pancreatic,gastric, colorectal and brain cancer patients

Summary. Background: Tissue factor (TF) expression by tumors contributes to tumor growth. Release of TF‐positive microparticles (MPs) may contribute to venous thromboembolism (VTE). Objectives: To conduct a prospective cohort study to determine whether elevated MP‐associated TF (MP‐TF) activity is predictive of VTE and mortality in four cancer types. Patients/Methods: We determined MP‐TF activity in pancreatic, gastric, colorectal and brain cancer patients. We used a chromogenic endpoint assay for all patients and also a chromogenic kinetic assay for patients with pancreatic and brain cancer. Results: During follow‐up, 12/60 (20%) pancreatic, 6/43 (14%) gastric, 12/126 (10%) colorectal and 19/119 (16%) brain cancer patients developed VTE; 46/60 (77%), 30/43 (70%), 47/126 (37%) and 67/119 (56%), respectively, died. MP‐TF activity levels were highest in pancreatic cancer. We did not find a statistically significant association of MP‐TF activity with the risk of VTE in any of the four cancer types by using two statistical methods. An association of MP‐TF activity with the risk of mortality was detected in pancreatic cancer with the endpoint assay (hazard ratio [HR] 1.8 and 95% confidence interval [CI] 1.4–2.3 per doubling of activity, P < 0.001) and the kinetic assay (HR 1.2, 95% CI 1.1–1.4, P < 0.001); adjustment for type of treatment was not performed. In pancreatic cancer, MP‐TF activity correlated with D‐dimer level (endpoint assay, r = 0.51; chromogenic assay, r = 0.48), and a correlation between assays (r = 0.61) was found. Conclusion: MP‐TF activity was not associated with future VTE in pancreatic, gastric, colorectal and brain cancer. However, we found a strong association of MP‐TF activity with mortality in pancreatic cancer. MP‐TF activity might be reflective of an aggressive pancreatic cancer phenotype.     

Neutrophilic dermatosis of the dorsal hands in a farmer

Neutrophilic dermatosis of the dorsal hands is a recently described disorder, which is similar to Sweet's syndrome. It is characterized by erythematous plaques, pustules and haemorrhagic bullae located solely on the dorsal surface of the hands. We describe a 57-year-old man with neutrophilic dermatosis of the dorsal hands that occurred following exposure to a chemical fertilizer. There are few cases reported in the literature regarding neutrophilic dermatosis and the aetiology remains unclear. For the present case, we propose that neutrophilic dermatosis of the dorsal hands might have been induced by the chemical fertilizer.     

喉切除术后患者的生存质量量表

目的:研制并测试喉切除术后患者生存质量量表。方法:依据1993年WHO制定的生存质量一般准则,通过指标的收集和筛选,制定喉切除术后患者生存质量量表。选择1996-06/2002-06在中山大学附属第一医院因喉癌行喉切除术后满6个月的患者81例,对36例喉部分切除和45例喉全切除的患者进行上述量表问卷调查,考核该量表的可行性、信度和效度。结果:①量表指标筛选结果:经过对收集的81个指标的多次筛选,最终得到生存质量量表的22个评价指标。②量表结构:由22个评价指标及1个有关患者对自己总体健康状况和生存质量评价的问题(满分100分)组成。覆盖了身体机能、喉功能、心理状态、独立生活能力、社会关系与环境以及气管造口等6个方面。采用等级描述评分法,每个问题有5个选项,由差到好依次分值为1～5分。③量表的接受率和完成率分别为73%和93%,完成时间为10min以内;分半信度、克朗巴赫系数和方差比分别为0.842,0.889和0.155,表明量表有较好的信度。通过测试准则关联效度及内容效度,表明量表是有效的。结论:设计的喉切除术后患者生存质量量表有喉切除术的专业特性,具有较好的可行性、信度及效度。     

Transcutaneous posterior tibial nerve stimulation: evaluation of a therapeutic option in the management of anticholinergic refractory overactive bladder

Introduction and hypothesis

This study evaluated the efficacy and tolerability of transcutaneous posterior tibial nerve stimulation (TPTNS) in the treatment of overactive bladder (OAB) after failure of a first-line anticholinergic treatment.

Materials and methods

We performed a prospective observational study and included all patients treated in a single center for OAB persisting after first-line anticholinergic treatment from November 2010 to May 2013. The protocol consisted of daily stimulation at home. The efficacy end point was defined as improvement on the Urinary Symptom Profile (USP) and the French-validated urinary symptom score Mesure du Handicap Urinaire (MHU).

Results

We assessed 43 consecutive patients. TPTNS was successful following 1 month of treatment in 23 (53 %) patients. Bladder capacity was the only predictive factor for treatment success (p?=?0.044). For patients who showed improved symptoms (n?=?23; 53 %), mean MHU and USP decreased significantly, from 11.8 ± 2.8 to 5.6 ± 3 (p?<?0.001) and from 14 ± 3.3 to 6.9 ± 3.2 (p?<?0.001), respectively. After a mean follow-up of 10.8 ± 1.6 months, 21 (49 %) patients continued the TPTNS. Mean MHU and USP scores were 4.4 ± 2.8 and 5.4 ± 3.5, respectively, and stayed lower than baseline (p?<?0.001). Patients reported no adverse events.

Conclusion

TPTNS is well tolerated and is effective in one half of the patients studied after they failed anticholinergic treatment. TPTNS could become a second therapeutic option before surgical treatment in the management strategy of OAB.     

Patient resources in the therapeutic education of haemophiliacs in France: their skills and roles as defined by consensus of a working group

Summary. The activities of ‘expert patients’ or ‘patient tutors’, who help educate their peers, are gaining recognition in the health care system. This study investigates the role played by such patients in therapeutic education programmes organized by caregivers to validate the role of patients in implementing the therapeutic education of haemophilic patients and to define the skills required for such activities. This study employs the consensus methodology recommended by France’s National Authority for Health. The working group includes seven caregivers from Hemophiliac Treatment Centers (HTCs) and three patients from the French Association of Hemophiliacs (FAH). The role of patients in haemophilia education is recognized. Patients participating in the education of their peers are referred to as ‘patient resources’. A patient resource should be an adult, a volunteer and live in the same region as his peers. Candidates are chosen by the FAH and the HTCs to serve based on their motivation to facilitate the education of other patients as well as on their psychological and pedagogical aptitudes. A patient resource participates in the conception and administration of therapeutic education programmes. He also mediates between the caregivers and the patients. He ensures that the patients understand the material and are able to apply their knowledge in daily life. His activities are governed by professional ethics. Seven categories of skills were defined, permitting the group to determine precisely which skills are required to function as a patient resource. Supervision of the patients is planned to reinforce reflexive practices in the patients. Evolution of the health care system has led patients to become involved in therapeutic education. This phenomenon calls for a framework to be developed and an evaluation of its eventual effects.     

The influence of registered nurses and nurse practitioners on patient experience with primary care: results from the Canadian QUALICO-PC study

Nurses, whether registered nurses (RNs) or nurse practitioners (NPs), are becoming key providers of primary care services. While evidence for the influence of NPs on patient experience in primary care is mounting, this is less so for RNs. We use the Canadian component of the international Quality and Costs of Primary Care 2013/14 survey to investigate the mechanisms by which nurses can affect patients’ experience in primary care, focusing on accessibility and appropriateness of care. The data allow us to distinguish between family practice RNs, specialised RNs and NPs, and covers all types of patients visiting a primary care clinic in a variety of contexts in all Canadian provinces. In addition to the types of nurses and full-time equivalent (FTE) numbers, we explore the role of nurse autonomy and collaboration. Our regression results show that one of the most important predictors of patient experience is the collaboration between health professionals, whereas nurse staffing in terms of FTE numbers has little influence by itself. Different types of nurses influence different dimensions of accessibility, and the association between patient experience and nurse staffing depends on the number of physicians in the clinic. Our results can inform decision-makers on how to strengthen primary care provision, and particularly in Canadian context, the adaptation of the recently implemented interprofessional primary care teams.     

Triaging dysphagia: nurse screening for dysphagia in an acute hospital

Aims and objectives. To (1) develop a dysphagia screening tool to triage all patients at risk of aspiration/dysphagia on admission to acute hospital wards, (2) evaluate tool reliability, (3) evaluate nursing compliance and (4) develop a robust dysphagia training programme. Background. Failure to diagnose dysphagia has significant medical and economic costs. Dysphagia screening reduces pneumonia threefold. Most nurse‐screening tools have focused on stroke. However, many other conditions are associated with dysphagia. A multidisciplinary team developed a nurse‐administered, evidence‐based swallow screening tool for generic acute hospital use. Design. Prospective, quasi‐experimental. Methods. Nurses were assessed for knowledge pre‐ and post‐training. All patients were nurse‐screened for dysphagia on admission. All patients were reviewed by speech pathologists to determine screening accuracy. Results were not blinded. The one page tool encompassed (1) diagnostic categories, (2) patient/carer interview, (3) dysphagia indicators and (4) if applicable, water swallow test. Results. Thirty‐eight nurses participated in a seven‐week study; 442 patients were screened on two general medical wards. Three speech pathologists counter‐assessed each patient by clinical examination or chart review. Sensitivity was 95%; specificity was 97%. Positive predictive value was 92%; negative predictive value was 98%. 3·4% of clinical screening decisions were incorrect. Compliance rate was 85%. Conclusions. Caution is advised in interpretation of the results due to lack of blinding. Initial results suggest that the dysphagia screening tool is a quick and robust tool for triaging individuals with dysphagia. Training is critical to successful screening. Relevance to clinical practice. Twenty‐five to 30% of acute hospitalised individuals have dysphagia. All adult acute patients are screened for dysphagia using the Royal Brisbane and Women’s Hospital dysphagia screening tool. Patients are triaged into categories of ‘those requiring additional specialist intervention’ and ‘those who can proceed directly to regular diets and liquids’. Improved quality of care and cost savings is likely.