Patients’ experiences of dialysis services: are national health strategy targets being met?

Background The National Health Strategy envisages a health system incorporating patient views; and providing accessible, consultant-led dialysis services with patient choice of dialysis modality, in all regions. Aims To describe patients’ experiences of renal services against National Health Strategy objectives. Methods Telephone interviews with 192 dialysis patients from three hospitals in the Eastern region. Results One-quarter of participants (16% of haemodialysis [HD] and 46% of peritoneal dialysis patients) lived outside the Eastern region, and travelled there because dialysis was not available locally. Two-thirds (65%) had a choice of dialysis modality. High satisfaction with interpersonal care was observed (83–98% satisfaction). Dissatisfaction with physical environment included parking (39–56%), waiting areas (62–69%), HD unit space (74%). Regarding support services, dietary services were satisfactory (92–95%), with lower satisfaction ratings for social and financial support services (62%). Conclusions Structural and management issues must be addressed to advance a quality agenda for renal care in Ireland.     

Health and health care utilisation among asylum seekers and refugees in the Netherlands: design of a study

Background  

This article discusses the design of a study on the prevalence of health problems (both physical and mental) and the utilisation of health care services among asylum seekers and refugees in the Netherlands, including factors that may be related to their health and their utilisation of these services.     

Osteopontin levels and increased disease activity in relapsing-remitting multiple sclerosis patients

Osteopontin (OPN) has been identified as the most prominent cytokine-encoding gene expressed within multiple sclerosis (MS) lesions. Recently, we demonstrated that OPN plasma levels were elevated in active relapsing-remitting (RR) MS patients. In this longitudinal study, a trend was observed for OPN serum levels in relation to clinical exacerbations. Moreover, OPN protein levels were significantly elevated 1 month prior to increase of gadolinium (Gd)-enhancing lesion number, whereas no relation was observed between OPN levels and increase in Gd-enhancing lesion volume. Although no robust relation between OPN and disease activity was observed, these data suggest that OPN levels are elevated prior to increased disease activity in RR MS patients.     

Hepatic resection in the United States: indications,outcomes, and hospital procedural volumes from a nationally representative database

BACKGROUND: Hepatic resection has become common in the United States for both primary and secondary hepatic tumors. HYPOTHESIS: Variation in outcomes after hepatic resection is related to patient characteristics, the indication for operation, and hospital procedural volume. DESIGN: Observational study using a nationally representative database. PATIENTS: All patients in the Nationwide Inpatient Sample for 1996 and 1997 with a primary procedure code for hepatic resection (N = 2097). MAIN OUTCOME MEASURES: Outcomes included in-hospital mortality and length of stay. Risk-adjusted analyses were performed using hierarchical multivariate models. RESULTS: Overall mortality for the 2097 patients was 5.8%. The most common indications for hepatic resection were secondary metastases (52%), primary hepatic malignancy (16%), biliary tract malignancy (10%), and benign hepatic tumor (5%). High-volume hospitals had a mortality rate of 3.9% vs 7.6% at low-volume hospitals (P<.001). In the multivariate analysis adjusting for patient case-mix, high-volume hospitals had a 40% lower risk of in-hospital mortality compared with low-volume hospitals (odds ratio, 0.60; 95% confidence interval, 0.39-0.92; P =.02). Other predictors of mortality in the multivariate analysis included age older than 65 years, hepatic lobectomy (vs wedge resection), primary hepatic malignancy (vs metastases), and the severity of underlying liver disease. CONCLUSIONS: Hospital procedural volume is an important predictor of mortality after hepatic resection. Patients who require resection of primary and secondary liver tumors should be offered referral to a high-volume center.     

Schneckenbecken dysplasia, radiology, and histology

To our knowledge this is the first report of Schneckenbecken dysplasia with the development of hydrops early in the second trimester. The radiological findings showed the typical hypoplastic iliac bones with medial extension and very flattened, on lateral view, oval-shaped vertebral bodies and short long bones. The histology showed hypercellular and hypervascular cartilage with chondrocytes with centrally located nucleus. The absence of the lacunar space as described before was also observed in some chondrocytes in our case. This male fetus was the product of consanguineous parents of Mediterranean origin compatible with autosomal recessive inheritance. Received: 7 June 2000 Accepted: 3 August 2000     

Mass, charge, and subcellular localization of a unique secretory product identified by the basophil-specific antibody BB1

BACKGROUND: BB1 is a basophil-specific mAb (Lab Invest 1999;79:27-38). The identity of the corresponding antigen has not been determined, but it gives a granular appearance on staining and is secreted on activation of basophils. OBJECTIVE: We sought to further characterize the basophilspecific antigen identified by BB1. METHODS: Intracellular localization was determined by flow cytometry and by immunogold labeling and electron microscopy. Physical chemical properties were investigated by gel filtration chromatography and preparative isoelectric focusing. RESULTS: In flow cytometry, permeabilization of cells increased immunofluorescence 100-fold, confirming the predominantly intracellular localization of the antigen. It was further localized to the secretory granules by immunoelectron microscopy. Double labeling with a CD63-specific antibody demonstrated selective binding of BB1 to the granule matrix. Gel filtration chromatography indicated that the antigen is secreted as a complex of approximately 5 x 10(6) d, which was well resolved from the 210-kd supramolecular complex containing tryptase. The antigen was degraded by pronase. Isoelectric focusing indicated a highly basic protein with an isoelectric point of 9.6. CONCLUSION: With its granule localization, release on cell activation, and unique properties, the antigen identified by BB1 could be a novel mediator of allergic disease. We propose the name basogranulin for this novel basophil-specific protein.     

Disablement process and the utilization of home care among non-institutionalized elderly people: contrasting results between cross-sectional and panel data

PURPOSE: In this article we studied the role of disablement process variables in home care utilization in a cross-sectional and in a panel approach among low-functioning community dwelling elderly people. METHODS: We analysed data from a prospective follow-up study in The Netherlands (n = 555) and used three outcome variables: professional home care (yes or no) measured in the same year as the process variables (cross-sectional approach), professional home care (yes or no) also after 2 years (panel-approach: no change) and the new users of professional home care 2 years later (panel-approach: change). Process variables were categorized as pathology, functional limitations, disability, risk factors and psychosocial attributes. RESULTS: Trajectories of home care utilization can be divided into an unchanging part and a changing part. Both parts are not predicted by the same process variables. For instance disability did not predict the new users of professional home care 2 years later, but correlated strongly with the stable users. The changing part was predicted by the beginning of the process of disablement (i.c. pathology). In addition, far most predictors could be considered as additive in stead of interactive. CONCLUSIONS: It is important to take into consideration the design of the investigation in studying the disablement process: cross-sectional data and panel data provide different results.     

Teledermatology as a tool for communication between general practitioners and dermatologists

A feasibility study of teledermatology was undertaken in Groningen. Six general practitioners (GPs) sent digital images by email, along with relevant patient information, to dermatologists at the Martini Ziekenhuis Groningen, a general non-academic hospital. The dermatologists returned their responses by email. A total of 89 cases were dealt with in this way. On average, the GPs took three photographs per patient. The time taken by the GP to produce and transmit the images, and to implement the telemedicine advice received from the dermatologist, was 9 min and 3 min, respectively. The time spent on diagnosis, provision of advice and response by email amounted to 10 min for the dermatologist. It was concluded that teleconsultations by email are feasible in the daily practice of GPs and dermatologists in a general non-academic hospital. Generally, GPs, dermatologists and patients were satisfied with teleconsultations. Furthermore, GPs reported that 63% of the teleconsultations were of educational value.