Home care from the perspective of older clients and their professional carers

The aim of this cross-sectional study was to explore and compare the views of older home care Cs and their professional carers in relation to the care given. The data were collected with a postal questionnaire distributed to 200 Cs (≥65 years) and 570 Ps (Ps), with a total response rate of 63%. The differences in responses between Cs and Ps were analyzed using cross-tabulations, the Pearson χ²-test and Fisher's exact test. The Cs’ and the staff's perceptions of Cs’ own resources were very similar. The collaboration between the Cs and the staff was experienced as being confidential. However, their views differed when separate issues of the collaborative relationship were queried. The staff saw the coordination of care in a positive light. The results showed that information transfer between staff, Cs and close relatives still needs to be developed. The evaluation of home care interventions was also quite weak.     

Effect of treatment of larynx and hypopharynx carcinomas on serum syndecan-1 concentrations

Purpose: Syndecan-1 is a multifunctional transmembrane heparan sulfate proteoglycan present on a variety of cell types that mediates basic fibroblast growth factor (bFGF) and other growth factor binding. High serum syndecan-1 (S-syndecan-1) ectodomain levels have been found to be associated with poor outcome in lung cancer and myeloma, but little is known about the effect of cancer treatment on S-syndecan-1 levels. We studied S-syndecan-1 levels longitudinally in a series of patients diagnosed with logoregional squamous cell larynx or hypopharynx carcinoma (n=44) and who we treated with surgery and/or radiation therapy. Methods: S-syndecan-1 and S-bFGF levels were measured with ELISA prior to, during, and following primary treatment of patients. Syndecan-1 expression was assessed from formalin-fixed and paraffin-embedded tumour samples using immunohistochemistry. Results: S-syndecan-1 levels tended to correlate positively with S-bFGF levels, and the pretreatment levels decreased from a median value of 75 to 58 ng/ml 3 months following treatment (P<0.0001). Patients treated with radiation therapy had a transient increase in S-syndecan-1 during the course of radiation therapy. Patients whose S-syndecan-1 decreased ≥10% from the pretreatment level had more favourable survival than those whose levels remained stable or increased (P=0.0069). Recurred cancer was associated with elevated S-syndecan-1 as compared to the levels measured 3 months following completion of primary therapy. Conclusions: These findings suggest that a part of S-syndecan-1 originates from the cancerous tissue, and that S-syndecan-1 levels generally decrease following successful cancer treatment.This work was supported by the Cancer Society of Finland, Helsinki University Central Hospital Research Funds, and the Sigrid Juselius Foundation.     

Actual practice vs guidelines in laboratory monitoring of older patients with primary hypothyroidism in primary care

BACKGROUND AND AIMS: Clinical guidelines are produced in order to achieve an acceptable standard of care, especially for patients with common diseases in primary care. The treatment of primary hypothyroidism serves as an example of the content of clinical guidelines and actual practice. The aim of this study was to compare the follow-up of primary hypothyroidism by thyroid function tests, serum TSH and serum-free T4, in older patients managed in primary care, with recommendations in treatment guidelines and textbooks. METHODS: Participation rate 82% (n=1260), mean age 74 years, (range 64-100 yrs). Patients with primary hypothyroidism were identified by means of cross-sectional survey (Lieto Study 1998-1999) and 4-year retrospective collection of laboratory database medical records (1994-1998), performed in autumn 2003. RESULTS: In most stable (=treated for more than 14 months) thyroxine users, both serum TSH (mean 1.4 measurements/year) and serum-free T4 (mean 0.8 measurements/year) values were measured over the 4-year period of thyroxine treatment. 66.4% of serum TSH and 85.3% of serum-free T4 values were within normal range. 41.7% of serum-free T4 determinations had been performed without indication (=with TSH in normal range). CONCLUSIONS: Compared with the recommended testing frequency given in various guidelines, a considerable number of extra measurements, especially serum-free T4, were performed. However, some key issues in the recommendations were difficult to interpret, and the age or other main characteristics of the patient were not taken into consideration adequately.     

Toll-like receptor 2 mediates CNS injury in focal cerebral ischemia

Toll-like receptors (TLR) recognize molecular structures associated with pathogens as well as host-derived components and initiate an inflammatory innate immune response. Microglia represent the resident immune host defense and are the major inflammatory cell type in the central nervous system (CNS). We show here that TLR2-deficient mice develop a decreased CNS injury compared to wild type mice in a model of focal cerebral ischemia. TLR2 mRNA is up-regulated in wild type mice during cerebral ischemia. In ischemic brains, TLR2 protein is expressed in lesion-associated microglia. Absence of TLR2 does not affect the recruitment of granulocytes to the infarct region. We conclude that TLR2 in microglia propagates stroke-induced CNS injury.     

Consistent chromosome abnormalities in squamous cell carcinoma of the vulva.

Six squamous cell carcinomas of the vulva (SCV) were karyotyped in short-term culture and in early passages as established cell lines. Each tumor was cytogenetically distinct, contained multiple chromosome rearrangements, and was karyotypically stable in culture. Heterogeneity within individual tumors was manifested by the presence of more than one clonal population, but the clones within each tumor were closely related to one another. Seven consistent chromosome abnormalities found in five of the six tumors were: losses of 3p14-cen, 8pter-p11, 22q13.1-q13.2, and the short arm of the inactive X; chromosome gains involving 3q25-qter and 11q21; and rearrangement breakpoints at 5cen-q12. Ten additional chromosome changes were observed in four of the six SCVs, and together, 22 changes occurred in at least three of the tumors. Two specific losses, 10q23-q25 and 18q22-q23, were present in all four tumors that exhibited biologically aggressive behavior in vivo, but these losses were not found in the tumors of the two long-term survivors. These findings indicate that: 1) SCVs are genetically complex, but homogeneous; 2) loss of 18q22-q23 and loss of 10q23-q25 may be associated with a poor prognosis; and 3) development and progression of SCV appear to result from cumulative effects of altered gene dosage at multiple, consistent loci.     

Specification of the Utility Function in Discrete Choice Experiments

BackgroundThe specification of the utility function has received limited attention within the discrete choice experiment (DCE) literature. This lack of investigation is surprising given that evidence from the contingent valuation literature suggests that welfare estimates are sensitive to different specifications of the utility function.ObjectiveThis study investigates the effect of different specifications of the utility function on results within a DCE.MethodsThe DCE elicited the public’s preferences for waiting time for hip and knee replacement and estimated willingness to wait (WTW).ResultsThe results showed that the WTW for the different patient profiles varied considerably across the three different specifications of the utility function. Assuming a linear utility function led to much higher estimates of marginal rates of substitution (WTWs) than with nonlinear specifications. The goodness-of-fit measures indicated that nonlinear specifications were superior.     

Colectomy in Intensive Care Patients: Operative Findings and Outcomes

Background

With a critical illness, intestinal complications are associated with high morbidity and mortality.

Methods

Operative findings and outcomes of 77 intensive care unit (ICU) patients treated with colectomy are described.

Results

Three conditions led to colectomy: sepsis (S group; n = 31), fulminant Clostridium difficile colitis (Cl group; n = 25), and cardiovascular surgery (CV group; n = 21). The median Acute Physiology and Chronic Health score was >25 in all groups. Thickening and distension of the colon was more frequent in the Cl group (p = 0.001), and ischemia was more frequent in the S and CV groups (p < 0.001). Widespread necrosis was more frequent in the CV patients (p = 0.001). The kappa value for ischemic operative findings and histologic necrosis was 0.64 (95 % confidence interval 0.49–0.79). Hospital mortality was 35 % without multiple organ failure (MOF) (n = 31) and 74 % with MOF (n = 46) (p < 0.001). Overall, 38 % were alive at the 1-year follow-up.

Conclusions

Although colectomy in ICU patients is associated with high hospital mortality, patients who survive beyond their hospital stay have a good 1-year outcome