Waiting for a liver transplant: the experience of patients with familial amyloidotic polyneuropathy

Liver transplant is a new treatment for familial amyloidotic polyneuropathy. The purpose of this phenomenological study is to describe the experience of waiting for a liver transplant from the familial amyloidotic polyneuropathy patients' perspective. Unstructured and open-ended interviews were conducted with 14 familial amyloidotic polyneuropathy patients and the analysis of data was inspired by Colaizzi's method. Waiting was found to involve two theme categories: waiting for a decision; and waiting for the operation. Seven themes were identified: bargaining with oneself; no influence/powerlessness; relief and joy; impatience; agony; time to prepare; and need for information and support. Implications for nursing practice, such as informational and emotional support, are discussed.     

Evaluation of Point-of-Care Blood Glucose Measurements in Patients with Diabetic Ketoacidosis or Hyperglycemic Hyperosmolar Syndrome Admitted to a Critical Care Unit

Background

Point-of-care (POC) blood glucose (BG) measurement is currently not recommended in the treatment of patients presenting with diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar syndrome (HHS).

Methods

We prospectively evaluated and compared capillary and venous POC BG values with laboratory venous glucose in patients with DKA or HHS admitted to one critical care unit over 8 months.

Results

Venous laboratory glucose was strongly correlated with venous (r = 0.98) and capillary (r = 0.96) POC glucose values, though POC glucose values were higher than venous laboratory values (venous POC 21 ± 3 mg/dl, capillary POC 30 ± 4 mg/dl; both p < .001). Increased plasma osmolality had no effect on glucose meter error, while acidemia (pH < 7.3) was associated with greater glucose meter error (p = .04) independent of glucose levels. Comparing hypothetical insulin infusion rates based on laboratory venous glucose to actual infusion rates based on POC glucose values showed that 33/61 insulin infusion rates would have been unchanged, while 28 out of 61 rates were on average 7% ± 2% higher. There were no instances of hypoglycemia in any of the patients.

Conclusions

Overall, both venous and capillary POC BG values were safe for the purpose of titrating insulin infusions in patients with severe hyperglycemia. Acidemia, but not hyperosmolality, increased POC BG value errors.     

Brief cognitive screening of right hemisphere stroke: relation to functional outcome.

OBJECTIVES: Traditional mental status screens have limited sensitivity in detection of focal brain damage and are particularly insensitive to right hemisphere stroke (RHS). Addition of a simple measure of constructional ability, clock drawing, should enhance the sensitivity of the Modified Mini-Mental State Exam (3MS) in RHS. The relation between the 3MS-clock drawing screen and functional outcome in RHS was also examined. DESIGN: Logistic regression analysis (Study 1) with cross validation on an independent sample (Study 2). SETTING: Inpatient medical rehabilitation. PATIENTS: Study 1: 32 acute RHS patients (mean age 75.2yrs) and 35 age- and education-matched healthy controls. Study 2 (cross-validation): 32 acute RHS patients (mean age 72.8yrs) and 36 matched healthy controls. OUTCOME MEASURES: 3MS, clock drawing, and Functional Independence Measure scores. RESULTS: The 3MS-clock screen accurately distinguished RHS patients from controls. The clock drawing was a valuable and unique addition to the 3MS. RHS patients who were impaired on the 3MS-clock drawing screen had significantly worse FIM scores at discharge than RHS patients who were not impaired on the cognitive screen. CONCLUSION: Clinicians can enhance the sensitivity of their brief mental status examination of RHS patients, in addition to obtaining useful prognostic information, by including a clock drawing task in their screen.     

A case of loiasis in Rome

BACKGROUND: Owing to the increase of an immigrant population and of Italian citizens travelling for tourism or on business, it is nowadays possible to observe clinical pictures characteristic of tropical regions, often with indistinct symptoms. One of these is Loa loa infestation, or loiasis, a form of filariasis caused by Loa loa and transmitted by the Chrysops fly. We present the case of a male immigrant from Cameroon. Characteristic symptoms were intense xerosis, mostly of the third inferior part of the legs, intensely pruritic, with numerous lesions from scratching. No benefit was obtained by emollient topics, anti-acarus and systemic antihistamines. METHOD: Serum samples and Giemsa, haematoxylin, haematoxylin + Giemsa concentration-on-membrane stains, have evidenced the presence of Loa loa microfilariae. RESULTS: A diagnosis for L. loa (loiasis) infestation was made. CONCLUSIONS: At the beginning of the migration phenomenon, particularly from Africa, Italian physicians, especially dermatologists, were eagerly looking for 'tropical' diseases; this approach can be defined as 'Salgari's syndrome' from the name of the Italian novelist who, though never travelling out of Italy, had perfectly described environments and habits typical of far away countries. Now, conversely, we have to avoid the opposite approach of considering real tropical diseases as related to social or psychological difficult conditions.     

A telephone-delivered coping improvement group intervention for middle-aged and older adults living with HIV/AIDS

Background: By 2015, the Centers for Disease Control and Prevention predicts that 50% of all cases of HIV/AIDS in the United States will be in persons 50 years of age or older.Purpose: This pilot research tested whether a 12-session, coping improvement group intervention delivered via teleconference technology could improve life quality in 90 middle-age and older adults living with HIV/AIDS.Method: This research used a lagged-treatment control group design. Forty-four HIV-infected persons 50-plus years of age participated in a coping improvement group intervention immediately after study enrollment, whereas 46 individuals received the intervention after their time-matched immediate treatment participants completed the intervention. Participants completed self-administered surveys that assessed depressive and psychological symptoms, life-stressor burden, ways of coping, coping self-efficacy, and loneliness.Results: Outcome analyses indicated that, compared to their delayed treatment counterparts, immediate treatment participants reported fewer psychological symptoms, lower levels of life-stressor burden, increased coping self-efficacy, and less frequent use of avoidance coping. After receiving the intervention, delayed treatment participants reported greater coping self-efficacy and less psychological symptomatology, lifestressor burden, and loneliness. However, the intervention demonstrated little ability to reduce depressive symptoms in this sample of HIV-infected older adults diagnosed with depression.Conclusions: Although findings from this research suggest that telephone-delivered, coping improvement group interventions have potential to facilitate the adjustment efforts of HIV-infected older adults, more rigorous evaluations of this intervention modality for this group are needed. This research was supported by a grant from the National Institute on Aging (R21 AG20334).