Measuring the effect of patient comfort rounds on practice environment and patient satisfaction: A pilot study

Hourly rounding in the acute hospital setting has been proposed as an intervention to increase patient satisfaction and safety, and improve the nursing practice environment, but the innovation has not been adequately tested. A quasi-experimental pretest post-test non-randomized parallel group trial design was used to test the effect of hourly patient comfort rounds on patient satisfaction and nursing perceptions of the practice environment, and to evaluate research processes and instruments for a proposed larger study. A Patient Satisfaction Survey instrument was developed and used in conjunction with the Practice Environment Scale of the Nursing Work Index. Results on patient satisfaction showed no significant changes. Significant changes were found for three of the five practice environment subscales. Consistent with the aim of a pilot study, this research has provided important information related to design, instruments and process that will inform a larger sufficiently powered study.     

Isolation of Leishmania amastigote protein fractions which induced lymphocyte stimulation and remission of psoriasis

A first generation polyvalent vaccine (AS100¹) was manufactured with protein from several cultured leishmania species, which proved to be effective in the treatment of psoriasis. To determine the effective factor, a single blind trial with four monovalent second generation vaccines (AS100²) was done in 26 subjects, which also resulted in remission of psoriasis. AS100² vaccines were further purified, resulting in seven chromatography fractions (AS200) per species. In vitro testing of the fractions on blood lymphocytes resulted in subjects being categorized as low or high responders before treatment. Both responder groups had no statistical difference in clinical outcome after AS100¹ treatment. Subsequently, a single-blind trial in 55 subjects treated with AS200 fractions from Leishmania brasiliensis also induced remission of Psoriasis. Two HIV ± subjects with plaque psoriasis experienced remission after treatment with AS100¹. There are factors in leishmania species which induce remission of psoriasis by stimulating lymphocytes.     

Dementia in Down’s syndrome: an MRI comparison with Alzheimer’s disease in the general population

Background

Down’s syndrome (DS) is the most common genetic cause of intellectual disability. People with DS are at an increased risk of Alzheimer’s disease (AD) compared to the general population. Neuroimaging studies of AD have focused on medial temporal structures; however, to our knowledge, no in vivo case–control study exists comparing the anatomy of dementia in DS to people with AD in the general population. We therefore compared the in vivo brain anatomy of people with DS and dementia (DS+) to those with AD in the general population.

Method

Using MRI in 192 adults, we compared the volume of whole brain matter, lateral ventricles, temporal lobes and hippocampus in DS subjects with and without dementia (DS+, DS-), to each other and to three non-DS groups. These included one group of individuals with AD and two groups of controls (each age-matched for their respective DS and general population AD cohorts).

Results

AD and DS+ subjects showed significant reductions in the volume of the whole brain, hippocampus and temporal lobes and a significant elevation in the volume of the lateral ventricle, compared to their non-demented counterparts. People with DS+ had a smaller reduction in temporal lobe volume compared to individuals with AD.

Conclusions

DS+ and AD subjects have a significant reduction in volume of the same brain regions. We found preliminary evidence that DS individuals may be more sensitive to tissue loss than others and have less ‘cognitive reserve’.     

White matter microstructural abnormalities in the frontal lobe of adults with antisocial personality disorder

Antisocial personality disorder (ASPD) and psychopathy involve significant interpersonal and behavioural impairments. However, little is known about their underlying neurobiology and in particular, abnormalities in white matter (WM) microstructure. A preliminary diffusion tensor magnetic resonance imaging (DT-MRI) study of adult psychopaths employing tractography revealed abnormalities in the right uncinate fasciculus (UF) (Craig et al., 2009), indicating fronto-limbic disconnectivity. However, it is not clear whether WM abnormalities are restricted to this tract or are or more widespread, including other tracts which are involved in connectivity with the frontal lobe.We performed whole brain voxel-based analyses on WM fractional anisotropy (FA) and mean diffusivity (MD) maps acquired with DT-MRI to compare 15 adults with ASPD and healthy age, handedness and IQ-matched controls. Also, within ASPD subjects we related differences in FA and MD to measures of psychopathy.Significant WM FA reduction and MD increases were found respectively in ASPD subjects relative to controls. FA was bilaterally reduced in the genu of corpus callosum while in the right frontal lobe FA reduction was found in the UF, inferior fronto-occipital fasciculus (IFOF), anterior corona radiata and anterior limb and genu of the internal capsule. These differences negatively correlated with measures of psychopathy. Also in the right frontal lobe, increased MD was found in the IFOF and UF, and the corpus callosum and anterior corona radiata. There was a significant positive correlation between MD and psychopathy scores.ConclusionsThe present study confirms a previous report of reduced FA in the UF. Additionally, we report for the first time, FA deficits in tracts involved in interhemispheric as well as frontal lobe connectivity in conjunction with MD increases in the frontal lobe. Hence, we provide evidence of significant WM microstructural abnormalities in frontal brain regions in ASPD and psychopathy.     

Glucagon‐like peptide‐1 inhibits voltage‐gated potassium currents in mouse nodose ganglion neurons

Background Glucagon‐like peptide‐1 (GLP‐1) is a major hormone known to regulate glucose homeostasis and gut function, and is an important satiety mediator. These actions are at least in part mediated via an action on vagal afferent neurons. However, the mechanism by which GLP‐1 activates vagal afferents remains unknown. We hypothesized that GLP‐1 acts on nodose ganglion neuron voltage‐gated potassium (KV) channels, increasing membrane excitability. Methods Employing perforated patch clamp recordings we examined the effects of GLP‐1 on membrane properties as well as voltage‐gated potassium currents. Extracellular recordings of jejunal afferents were performed to demonstrate the functional relevance of these effects at the nerve terminal. Key Results Glucagon‐like peptide‐1 depolarized a subpopulation of nodose neurons. This membrane depolarization was used to identify neurons containing functional GLP‐1 receptors. In these neurons, GLP‐1 decreased rheobase and broadened the action potential, and increased the number of action potentials elicited at twice rheobase. We identified a GLP‐1 sensitive current whose reversal potential shifted in a depolarizing direction when extracellular potassium was increased. We identified two macroscopic K currents, IA, an inactivating current and IK a sustained current. GLP‐1 caused inhibition of these currents, IK by 45%, P < 0.05 and IA currents by 52%P < 0.01, associated with a hyperpolarizing shift of steady‐state inactivation curves for both currents. In extracellular recordings of jejunal afferents, GLP‐1 increased firing rate, the effect blocked by the K⁺ channel antagonist 4‐AP. Conclusions & Inferences These experiments indicate that GLP‐1 receptor activation results in vagal afferent excitation, due at least in part to inhibition of sustained and inactivating potassium currents. This mechanism may be important in satiety and glucose homeostatic signals arising from the gastrointestinal tract.     

Haemopoietic cell transplantation. An overview

Major technological advances in the last ten years have facilitated the efficient harvesting and manipulation of specialised haemopoietic progenitor cells that have the capacity to reconstitute the body's entire haemopoietic and immune system following myeloablative cancer therapy.     

Effect of infectious diseases on outcome after heart transplant

OBJECTIVE: To determine how often cardiac allograft recipients develop infectious diseases and how the infections affect these patients. PATIENTS AND METHODS: We retrospectively studied 313 patients who underwent heart transplant at Mayo Clinic's site in Rochester, MN, from January 1, 1988, through June 30, 2006. RESULTS: In the early postoperative period (ie, period between heart transplant and discharge from the hospital), infectious diseases occurred in 70 (22%) of 313 patients but were not associated with 1-year mortality; the most commonly infected sites were the lungs (7%), bloodstream (6%), upper respiratory tract (5%), and urinary tract (4%). In the 18 years after transplant, the cumulative incidence of infectious diseases was 93%; the most common infectious complications were skin and soft tissue (63%), urinary tract (46%), cytomegalovirus (40%), lung (36%), upper respiratory tract (23%), and varicella zoster virus (15%) infections. After adjustment for baseline predictors, lung (hazard ratio [HR], 3.87; 95% confidence interval [CI], 2.49-6.02; P less than .001) and central nervous system (HR, 4.48; 95% CI, 1.75-11.46; P equals .002) infections were predictive of mortality. Serum creatinine levels (HR, 1.74; 95% CI, 1.07-2.81; P equals .02) and sirolimus use (HR, 2.72; 95% CI, 1.00-7.36; P equals .05) were predictive of lung infection. Death occurred during the study period in 95 (30%) of 313 patients, with a cumulative incidence of 71% at 18 years. The cause of death was infection in 17 (18%) of 95 patients. CONCLUSION: Early postoperative infectious complications are frequent in cardiac allograft recipients but are not associated with 1-year mortality. Lung and central nervous system infections are predictors of mortality.