How can attending physicians be more attentive? On being attentive versus producing attentiveness

This article is about caregivers being attentive to patients in healthcare. From earlier work on the understanding of the other, we know that it is impossible to completely understand the experiences of others. By the sharing of subjectivity—intersubjectivity—we may try to ‘grasp’ the other’s point of view. However, we can never assume that the same experience produces the same experience. Now, if it is principally impossible to understand the experience of one another, and if paying attention always implies an understanding of what to pay attention to, then how is it possible to be attentive to the experiences of those who are entirely at the mercy of our care? How can caregivers perceive the impossibility of understanding the experiences of patients as an appeal to be attentive to their experiences? This is discussed in this article. It departs from the authors being confronted with inexplicabilities in the empirical study of attentiveness in healthcare. It presents two examples and discusses the meaning of these emergent properties. This leads to a discussion of the existent literature on the indefiniteness and openness of attentiveness. It becomes clear why, although we can understand and predict much of it, attentiveness will always be characterized by a certain uncontrollability as well.     

Attentiveness in care: towards a theoretical framework

The purpose of this article is to shape a theoretical framework of attentiveness in care, which may function as a background to study attentiveness in a health care setting empirically. More insight into the functions, forms, and aspects of attentiveness in a particular health care setting is important, as there is a lack of indicators and criteria that enable a sharp picture of the caring side of health provision. The concept of attentiveness and its relation to care have seldom been examined thoroughly and broadly. This article argues that attentiveness is constitutive for good care, as it can create a space in which a relationship may arise.     

Early involvement of hepatic parenchymal cells in erythrohepatic protoporphyria? An ultrastructural study of patients with and without overt liver disease and the effect of chenodeoxycholic acid treatment

Liver biopsy specimens obtained from two groups of erythrohepatic protoporphyria patients were studied histopathologically and ultrastructurally. Group 1 comprised seven erythrohepatic protoporphyria patients with a normal liver histology; from two patients liver biopsy specimens were available before and after 1 yr of chenodeoxycholic acid treatment. Group 2 consisted of four patients with a history of liver disease and liver histopathology; three patients were observed before and after 1 yr of chenodeoxycholic acid treatment. Liver specimens of nine kidney transplant donors served as controls. Unlike the morphology at the light microscopic level, the ultrastructure of hepatic parenchymal cells was affected in both groups of erythrohepatic protoporphyria patients. In both groups the nuclei, endoplasmic reticulum, lateral plasma membranes and bile canaliculi were altered. Collagen fibers were frequently present. In addition, in group 2 bile thrombi and intracytoplasmic protoporphyrin crystals were observed. After chenodeoxycholic acid administration, the latter feature had diminished. It is concluded that (a) in erythrohepatic protoporphyria ultrastructural changes are present in the hepatic parenchymal cells even in early stages of the disease. Changes in bile canalicular ultrastructure suggest a defective hepatic excretory function, probably caused by the toxic effect of protoporphyrin. (b) Chenodeoxycholic acid administration causes no distinct improvement of the ultrastructure of organelles in the hepatic parenchymal cell or the bile canalicular system but may decrease crystalline protoporphyrin deposition in the liver.     

A universal method for sequential immunofluorescent analysis of chromatin and chromatin-associated proteins on chromosome spreads

Immunofluorescence has been widely used to study histone modification dynamics and chromosome-associated proteins that regulate the segregation of chromosomes during cell divisions. Since many of these regulatory proteins interact (in)directly to exert their proper function, it is of interest to detect these proteins simultaneously, to establish their spatiotemporal relation. However, the detection of multiple epitopes on the same material is limited by the availability of antibodies derived from different host species. For Western blot membranes, buffers were developed to remove antibodies after the first round of detection and enable a second round of detection. In this study, we establish that this “stripping” principle can also be applied for sequential immunofluorescence on chromosome preparations. We first adapted a drying down fixation technique for the use on cultured cells from different primary cells and cell lines. These chromosome spreads were subsequently used to optimize the stripping procedure for this application. We investigated feasibility and reliability of detection of histones and their posttranslational modifications as well as chromatin interacting proteins in two subsequent rounds of immunofluorescence. We conclude that this method is a reliable option when spatial resolution and co-expression need to be investigated and the material or the choice of antibodies is limited.     

Do you see what you are hearing? Cross-modal effects of speech sounds on lipreading

It is well known that visual information derived from mouth movements (i.e., lipreading) can have profound effects on auditory speech identification (e.g. the McGurk-effect [16]). Here we examined the reverse phenomenon, namely whether auditory speech affects lipreading. We report that speech sounds dubbed onto lipread speech affect immediate identification of lipread tokens. This effect likely reflects genuine cross-modal integration of sensory signals and not just a simple response bias because we also observed adaptive shifts in visual identification of the ambiguous lipread tokens after exposure to incongruent audiovisual adapter stimuli. Presumably, listeners had learned to label the lipread stimulus in accordance with the sound, thus demonstrating that the interaction between hearing and lipreading is genuinely bi-directional.     

Development and validation of a prediction model for low hemoglobin deferral in a large cohort of whole blood donors

BACKGROUND: Each year, approximately 5% of the invited blood donors is eventually deferred from donation because of low hemoglobin (Hb) levels. Estimating the risk of Hb deferral in blood donors can be helpful in the management of the donation program. We developed and validated a prediction model for Hb deferral in whole blood donors, separately for men and women. STUDY DESIGN AND METHODS: Data from a Dutch prospective cohort of 220,946 whole blood donors were used to identify predictors for Hb deferral using multivariable logistic regression analyses. Validity of the prediction models was assessed with a cross‐validation. RESULTS: A total of 12,865 donors (5.8%) were deferred because of a low Hb level. The strongest predictors of Hb deferral were Hb level measured at the previous visit, age, seasonality, difference in Hb levels between the previous two visits, time since the previous visit, deferral at the previous visit, and the total number of whole blood donations in the past 2 years for both men and women. The prediction models had an area under the receiver operating characteristic curve of 0.89 for men and 0.84 for women. Cross‐validation showed similar results and good calibration. CONCLUSION: Using a limited number of easy‐to‐measure characteristics enables a good prediction of Hb deferral risk in whole blood donors. The prediction models may guide the decision which donors to invite for a next donation and for which donors the invitation should be postponed. Potentially, this could decrease the number of Hb deferrals in blood donors.     

Management of nonstaphylococcal toxic epidermal necrolysis: follow-up study of 16 case histories

In this study the clinical and laboratory data of 14 patients who experienced 16 attacks of nonstaphylococcal toxic epidermal necrolysis (TEN) are presented. All patients were treated in the Department of Dermatology of the University Hospital of Utrecht. Only 1 patient died. Attention is focused on a successful management consisting of reversed barrier nursing, painstakingly executed skin care, timely use of antibiotics and a therapy consisting of high dosages of corticosteroids. Thorough management in centers experienced in the treatment of TEN is essential for good treatment results. Further investigations concerning the use of corticosteroids in treating TEN are needed.