Endogenous Na/K ATPase inhibitor ouabain in critically ill children with lung injury

Objectives: To measure ouabain, an endogenous adrenocortical Na/K ATPase inhibitor, in critically ill children with acute lung injury and relate it to parameters reflecting epithelial sodium transport. Design: Prospective observational study. Setting: Paediatric Intensive Care Unit of Royal Liverpool Children's Hospital. Subjects: Consecutive children ventilated on a Paediatric Intensive Care Unit. Measurements and main results: 27 patients were recruited including 11 children with septicemia, 5 patients with localized infections, and 11 patients ventilated for non-infective causes like elective surgery and head injury. Median age of included patients was 5 years (range 1.1-15.5 years). 17 patients had lung injury with radiological evidence of pulmonary edema and/or a paO₂/FiO₂ ratio of <300 on admission. Ouabain levels were measured in peripheral blood by radioimmunoassay on admission and correlated with sweat sodium levels and renal sodium excretion, paO₂/FiO₂ ratio and analysis of a chest X-ray on admission. Ouabain levels in all patients had a mean of 23.6 pmol/l (SD 13.3, range 10.2-58.2). Ouabain levels were higher in male patients versus female. Children with radiological evidence of septicemia related pulmonary edema, ventilation requirements indicating lung injury or inotrope requirements did not have significantly different ouabain levels compared to patients without lung injury or not on inotropes. There was no significant correlation between sweat sodium or renal sodium excretion and ouabain levels (p = 0.91 and p = 0.19 respectively). Conclusions: Ouabain levels in children ventilated on a Paediatric Intensive Care Unit were not different in patients with lung injury or inotrope requirements. Quabain levels did not relate to parameters reflecting epithelial sodium transport in sweat gland or kidney.     

A theoretical model of ageing hospital nurses' well-being at work

utriainen k., kyngäs h. & nikkilä. j. (2011) Journal of Nursing Management 19, 1037–1046
A theoretical model of ageing hospital nurses’ well-being at work Aim To describe the development process of a theoretical model of ageing hospital nurses’ well-being at work and the subsequent testing of the model itself. Background Factors evoking well-being at work need to be identified to promote nurses’ well-being. Method Qualitative data (n = 21) from ageing hospital nurses, consisting of interviews, diaries and open data collection forms were collected and analysed using grounded theory method. Based on the finding, a survey was developed. Quantitative data (n = 328) were collected from hospital nurses born between the years 1948–1962. Explorative factor analysis was used to create the theoretical model. Results The main concepts of the model were nurse–nurse interaction, nurse–patient interaction and patient-care centeredness. Conclusion According to the theoretical model, well-being at work can be described as nurses’ experience of collaboration, cooperation and togetherness with other nurses in a supporting and caring work environment. The aim and possibility of high-quality patient care, in a spirit where nurses and nursing are appreciated, were also revealed. Implications for nursing management The importance of nurse–nurse interaction and nurse–patient interaction as well as ageing nurses’ patient-care centeredness needs to be taken into account in nursing management and leadership.     

Transplantation of human embryonic stem cell-derived neural precursor cells and enriched environment after cortical stroke in rats: cell survival and functional recovery

Cortical stem cell transplantation may help replace lost brain cells after stroke and improve the functional outcome. In this study, we transplanted human embryonic stem cell (hESC)-derived neural precursor cells (hNPCs) or vehicle into the cortex of rats after permanent distal middle cerebral artery occlusion (dMCAO) or sham-operation, and followed functional recovery in the cylinder and staircase tests. The hNPCs were examined prior to transplantation, and they expressed neuroectodermal markers but not markers for undifferentiated hESCs or non-neural cells. The rats were housed in either enriched environment or standard cages to examine the effects of additive rehabilitative therapy. In the behavioral tests dMCAO groups showed significant impairments compared with sham group before transplantation. Vehicle groups remained significantly impaired in the cylinder test 1 and 2 months after vehicle injection, whereas hNPC transplanted groups did not differ from the sham group. Rehabilitation or hNPC transplantation had no effect on reaching ability measured in the staircase test, and no differences were found in the cortical infarct volumes. After 2 months we measured cell survival and differentiation in vivo using stereology and confocal microscopy. Housing had no effect on cell survival or differentiation. The majority of the transplanted hNPCs were positive for the neural precursor marker nestin. A portion of transplanted cells expressed neuronal markers 2 months after transplantation, whereas only a few cells co-localized with astroglial or oligodendrocyte markers. In conclusion, hESC-derived neural precursor transplants provided some improvement in sensorimotor function after dMCAO, but did not restore more complicated sensorimotor functions.     

Cold‐related respiratory symptoms in the general population

Introduction: Cold‐related respiratory symptoms are common among northern populations, especially among people suffering from respiratory diseases. However, the prevalence of such symptoms in the general population and the threshold temperatures at which the symptoms start to emerge are poorly known. Objectives: The present study determined the prevalence and threshold temperatures of self‐reported respiratory symptoms related to cold, separately for healthy people and those with respiratory disease. Materials and Methods: Six thousand five hundred ninety‐one men and women aged 25 years–74 years from the national FINRISK study were queried about cold‐related respiratory symptoms. The results were expressed as age‐adjusted prevalence figures and coefficients from multivariate regressions. Results: Cold‐related respiratory symptoms were more often reported by people with asthma (men 69%/women 78%) and by subjects with chronic bronchitis (65%/76%) than the healthy subjects (18%/21%). A binomial regression showed an increase of symptom prevalence by age and excesses of 4%, 50% and 21% units because of female sex, asthma and chronic bronchitis, respectively. The reported threshold temperature for cold‐related symptoms was ?14°C for males and ?15°C for females, and it showed some increase by age (0°C–5°C), asthma (2°C) and chronic bronchitis (3°C). The threshold temperature for mucus production was exceptional as it decreased by age (2°C–5°C) and asthma (2°C). The effects of smoking and education were marginal. Conclusion: Cold‐related respiratory symptoms are common in patients with chronic respiratory diseases, but they start to emerge at relatively low temperatures. In a cold climate, the cold‐related symptoms may have an impact on the health‐related quality of life. Please cite this paper as: Harju T, Mäkinen T, Näyhä S, Laatikainen T, Jousilahti P and Hassi J. Cold‐related respiratory symptoms in the general population. The Clinical Respiratory Journal 2010; 4: 176–185.     

Increased work-satisfaction amongst geriatricians in Finland – an encouragement for further development of the specialty? Survey among geriatricians in Finland in 2008

BackgroundAlthough geriatrics is recognised as an effective strategy in the secondary care of older people, adoption of the specialty has been variable in the developed world. Information is needed on factors that affect recruitment and retention of geriatricians.MethodBased on postal questionnaire survey undertaken in 2001, a largely identical survey was undertaken among all Finnish geriatricians (167 in active practice in 2008) in 2008. Items included work position, work satisfaction, and general views about delivery of care for older people.ResultsA total of 112 physicians returned the 2008 questionnaire (60% of active specialists). The varied working profile and views about geriatricians’ status were largely similar to those in 2001. Half of all responders were employed by municipalities in primary care, 19% were employed by secondary or tertiary hospitals. The most important clinical settings for geriatricians were considered to be in memory clinics, rehabilitation and acute care. Most geriatricians (n = 84, [75%]) considered either general practitioners (GP), or GPs with specific training in geriatrics to be the best option for the management of common problems of older patients in the community. In general, geriatricians were optimistic about their work and possibilities to influence, even more so than in 2001. The biggest challenge was perceived to increase and distribute geriatric medicine knowledge and skills in health care for older people.DiscussionFinnish geriatricians believe that geriatrics is a rewarding speciality. However, the incorporation of the principles and practice of geriatrics across other is viewed as a major challenge.