Can the Experience of Caring at Home Affect Carers' Retrospective Evaluation of Community Care Services?

This paper investigates whether informal carers' experience of caring for their dying cancer patients at home affects their retrospective evaluation of the services received by these patients from community nurses, GPs, and the health and social services in general. Analysis was conducted on a sub-sample of the Regional Study of Care for the Dying (RSCD), a retrospective survey of family members and others who knew most about the last year of life of a random sample of people who died in 20 health districts in the UK in 1990. The sub-sample consisted of 1 858 carers of people who died from cancer (ICD, 140–208). The results showed statistically significant associations between carers' satisfaction with community nurses, GPs, and the health and social services in general and their perceptions that caring at home was a rewarding activity, and that their social activities were severely or fairly restricted. Carers' satisfaction with all providers was also more likely to have been reported by those who reported having had no need for more home help. All this suggests the importance of supporting carers to enable them to fulfil their caretaking role and to cope with caring at home. This in turn could lead to an increase in their level of acceptability of the services provided.     

CARDIOVASCULAR ACTIVITY OF 14-DEOXY-11, 12-DIDEHYDROANDROGRAPHOLIDE IN THE ANAESTHETISED RAT AND ISOLATED RIGHT ATRIA

The cardiovascular activity of 14-deoxy-11,12-didehydroandrographolide (DDA) fromAndrographis paniculata(Burm.f.) Nees (Acanthaceae) was elucidated in anaesthetised Sprague–Dawley (SD) rats and isolated rat right atria. In anaesthetised rats, DDA produced significant falls in mean arterial blood pressure (MAP) and heart rate in a dose-dependent manner with the maximum decrease of 37.6±2.6% and 18.1±4.8%, respectively. The ED₅₀value for MAP was 3.43 mmol kg⁻¹. Pharmacological antagonist studies were done using this dose. The hypotensive action of DDA was not mediated through effects on the α-adrenoceptor, muscarinic cholinergic and histaminergic receptors, for it was not affected by phentolamine, atropine as well as pyrilamine and cimetidine. However, it seems to work via adrenoceptors, autonomic ganglia receptor and angiotensin-converting enzyme, since the hypotensive effect of DDA was negated or attenuated in the presence of propranolol, hexamethonium and captopril. In the isolated right atria, DDA caused negative chronotropic action and antagonised isoproterenol-induced positive chronotropic actions in a non-competitive and dose-dependent manner. These results further supported the bradycardia-inducing and β-adrenoceptor antagonistic properties of DDAin vivo.     

Intramyocardial electrograms for non-invasive rejection monitoring: initial experience with an infection-specific parameter

Abstract Non-invasive rejection monitoring based on the analysis of paced intramyocardial electrograms enables repeated or even daily graft surveillance. The rejection-sensitive parameter is calculated from the maximum slope of the descending part of the t wave. Biopsy-proven rejection grade 2 or higher (ISHLT classification) can safely be detected. Nevertheless, infection influences the rejection-sensitive parameter in the same manner as does rejection (99% negative predictive value for rejection grade 2 or higher, 17 % positive predictive value). We defined the infection-specific parameter as the time on the O line between the pacemaker stimulus and the crossover with the maximum slope of the descending part of the t wave. Patients were classified prospectively according to infection status: patients without infection and those with clinically apparent infection. Patients with clinically apparent infections had a significantly longer infection-specific parameter. A simultaneous decrease of the rejection-sensitive parameter and an increase in the infection-specific parameter was observed during clinical infection; a decrease in the rejection-sensitive parameter and no changes in the infection-specific parameter were observed during rejection. This preliminary analysis revealed that discrimination of rejection and infection might be possible by the analysis of intramyocardial electrograms.     

Cerebral sparganosis: CT characteristics

Cerebral sparganosis is an extremely rare parasitic zoonosis caused by a migrating plerocercoid tapeworm larva, genus Spirometra. Nineteen computed tomography (CT) scans of 12 patients with cerebral sparganosis were retrospectively analyzed and correlated with clinical and pathologic data. On CT scans, the following characteristics were noted: (a) unilateral involvement; (b) extensive or multifocal areas of low density along white matter bundles, with ipsilateral ventricular dilatation and localized cortical atrophy; (c) nodular or irregular enhancement with spotty calcification; and (d) change in location of enhancing nodules on sequential scans. These pathognomonic features reflect a chronic inflammatory process with both active granulomatous lesions and widespread degeneration of brain tissue, especially in the white matter. Degeneration is probably caused by migration of the long-surviving larva along the fiber tracts of white matter.