Patient evaluation of the care and rehabilitation process in geriatric hospital care

Purpose : To gain a deeper understanding of how elderly persons experience and evaluate the care and rehabilitation process.

Method : Qualitative interview data from elderly patients were analysed using a grounded theory approach. The patients were interviewed twice, at the beginning of geriatric hospital care and some weeks after discharge.

Results : The patient-perceived outcome of the care and rehabilitation process reflected two dimensions; the effect on their health and the quality of the process, i.e. how their needs were met. The analysis revealed that the patients' needs differed during the care and rehabilitation process. It also indicated that patients perceived their needs and the care differently based on their previous experience of the care unit, their perceived trajectory of illness and their 'patient character' which represented the patient's definition of himself/herself and the situation. A hypothetical model of the patients' evaluation process has been derived.

Conclusion : The results indicate the importance of using a process perspective in the assessment and the interpretation of patient-perceived outcome of care and rehabilitation, and that patient expectations, trajectories of illness and the patient character must be taken into consideration.     

Allelic polymorphism -491A/T in apo E gene modulates the lipid-lowering response in combined hyperlipidemia treatment

BACKGROUND: Combined hyperlipidemia (CHL) is one of the dyslipidemias more frequently found in clinical practice, and lipid-lowering drugs are often necessary in its management. Some genetic loci have been associated with CHL expression, and some studies have shown modulation of drugs efficiency in the treatment of dyslipidemias by genetic polymorphisms. We have investigated whether common polymorphisms and mutations in the apolipoprotein (apo) E, lipoprotein lipase (LPL), and apo CIII genes influence atorvastatin or bezafibrate responses in patients with CHL. DESIGN: One hundred and sixteen subjects participating in the ATOMIX study (Atorvastatin in Mixed dyslipidemia) were randomized to treatment with either atorvastatin or bezafibrate. Apolipoprotein E genotype and common -491A/T and -219T/G polymorphisms in the apo E gene promoter region, Sst I polymorphism in the apo CIII gene (3238C/G), and D9N and N291S common mutations in the LPL gene were determined by polymerase chain reaction (PCR) and restriction enzyme digestion. RESULTS: Statistical analysis showed the influence of the -491A/T polymorphism in atorvastatin and bezafibrate treatments. Subjects carrying the -491T allele showed an increased LDL-cholesterol-lowering effect with atorvastatin compared with -491T allele noncarriers (-35% vs. -27%, P = 0.037). Subjects carrying the -491T allele, when on bezafibrate treatment, showed a lower triglyceride reduction compared with -491T allele noncarriers (-23% vs. -39%, P = 0.05). CONCLUSIONS: In our study, the -491A/T polymorphism in the apo E gene promoter region modulated the lipid-lowering efficiency of atorvastatin and bezafibrate in CHL patients. Such influence might explain some of the interindividual response variabilities observed for the two drugs, and could help in CHL management.     

Massive recurrent haemoptysis in a pregnant woman with preeclampsia

Massive haemoptysis are rare in pregnant woman. Besides usual causes of haemoptysis, cases of idiopathic haemoptysis have been described during pregnancy, probably with a hormonal role. A pregnant woman at 22 weeks amenorrhoea was admitted in intensive care unit for massive and recurrent haemoptysis, enhanced by bouts of hypertension in a context of preeclampsia. Arteriography showed bronchial hypervascularisation, with abnormally dilated bronchial arteries, and a lot of collateral arteries. Three sessions of bronchial artery embolization have been performed with success. The management of idiopathic haemoptysis in pregnant woman seems to be based on the usual algorithm of management, emphasizing on the control of blood pressure, and the key role of interventional radiology.     

Chios gum mastic: a review of its biological activities

The resin of Pistacia lentiscus (L.) var. chia (Duham), an evergreen shrub belonging to the family Anacardiaceae and uniquely cultivated in southern Chios, is known as mastic. It has been used for more than 2500 years in traditional Greek medicine for treating several diseases such as gastralgia and peptic ulcers, while the actions of the gum are mentioned in the works of Herodotus, Dioscorides and Galen. Several Roman, Byzantine, Arab and European authors make extensive references to mastic's healing properties. Modern scientific research has justified the beneficial action of mastic to gastric diseases, by revealing its in vivo and in vitro activity against Helicobacter pylori, which is considered as the main cause for gastric ulcers. Furthermore, studies of the antimicrobial, antifungal, antioxidant, hypolipidemic, anti-inflammatory, anti-Crohn and anticancer activities of mastic have characterized it as a wide-range therapeutic agent and a potential source of nature-originated treatments.     

In vivo bubble nucleation probability in sheep brain tissue

Gas nuclei exist naturally in living bodies. Their activation initiates cavitation activity, and is possible using short ultrasonic excitations of high amplitude. However, little is known about the nuclei population in vivo, and therefore about the rarefaction pressure required to form bubbles in tissue. A novel method dedicated to in vivo investigations was used here that combines passive and active cavitation detection with a multi-element linear ultrasound probe (4-7 MHz). Experiments were performed in vivo on the brain of trepanated sheep. Bubble nucleation was induced using a focused single-element transducer (central frequency 660 kHz, f-number = 1) driven by a high power (up to 5 kW) electric burst of two cycles. Successive passive recording and ultrafast active imaging were shown to allow detection of a single nucleation event in brain tissue in vivo. Experiments carried out on eight sheep allowed statistical studies of the bubble nucleation process. The nucleation probability was evaluated as a function of the peak negative pressure. No nucleation event could be detected with a peak negative pressure weaker than -12.7 MPa, i.e. one order of magnitude higher than the recommendations based on the mechanical index. Below this threshold, bubble nucleation in vivo in brain tissues is a random phenomenon.     

CT Features of an unusual calcified schwannoma of the superior laryngeal nerve

We report the CT findings in a patient with a lateral neck mass histologically diagnosed as a laryngeal schwannoma but presenting some uncommon CT features. CT showed unusual calcified components, very rarely observed and potentially misleading for diagnosis. However, this imaging feature can be found in ancient schwannomas. Our case is, therefore, a very rare one and reviews the main differential diagnoses.     

Senescence impairs successful reprogramming to pluripotent stem cells

Somatic cells can be reprogrammed into induced pluripotent stem (iPS) cells by overexpressing combinations of factors such as Oct4, Sox2, Klf4, and c-Myc. Reprogramming is slow and stochastic, suggesting the existence of barriers limiting its efficiency. Here we identify senescence as one such barrier. Expression of the four reprogramming factors triggers senescence by up-regulating p53, p16^INK4a, and p21^CIP1. Induction of DNA damage response and chromatin remodeling of the INK4a/ARF locus are two of the mechanisms behind senescence induction. Crucially, ablation of different senescence effectors improves the efficiency of reprogramming, suggesting novel strategies for maximizing the generation of iPS cells.