Sarcoidosis: correlation of extent of disease at CT with clinical, functional, and radiographic findings

Computed tomography (CT) was compared with chest radiography in the assessment of disease severity in 27 patients with sarcoidosis. The CT scans and radiographs were each read twice by two independent observers. Disease extent was assessed on CT scans by visual scoring (0%-100% involvement of the lung parenchyma) and on radiographs by using an adaptation of the International Labour Office classification. The severity of parenchymal changes on the CT scan and on the radiograph was significantly correlated with the severity of dyspnea (r = .61 and .58, respectively; P less than .001), diffusing capacity (r = -.62 and -.52, P less than .01), and vital capacity (r = -.49 and -.51, P less than .01). Patients with predominantly irregular opacities had more severe dyspnea and lower lung volumes than patients with predominantly nodular opacities (P less than .05). The authors conclude that in patients with sarcoidosis, the radiographic and CT assessments of disease severity show similar correlation with clinical and functional impairment.     

The implementation of Project 2000 in the community: a new perspective on the community nurse's role

This paper considers some of the initiatives taken by community nurses in England in implementing Project 2000 placements The data were obtained during an English National Board funded study in two phases The first phase involved a series of exploratory interviews, a postal questionnaire survey, and semi-structured interviews with 15 managers In phase two, one Project 2000 demonstration district was studied in depth by means of interviews complemented by small-scale questionnaire studies Community nurses had confronted a number of difficulties in implementing Project 2000 Among the most serious of these were shortage of time, poor communication with the colleges of nursing and lack of preparation As a consequence, community nurses took what they saw as independent approaches to students' placements Many set their own aims and objectives for placements and produced written guidelines and teaching plans for students Many also asserted the importance of their role in the assessment of students' practical work     

Cytokine regulation of proliferation and cell adhesion are correlated events in human CD34+ hemopoietic progenitors

Adhesive interactions with the extracellular matrix of the bone marrow (BM) stroma are of critical importance in the regulation of hematopoiesis. In part, these interactions are presumed to play an important role in retaining CD34+ hematopoietic progenitor cells (HPCs) within the BM environment, in close proximity with BM stromal cells and the cytokines they produce. Evidence of a more direct role for cell adhesion in the regulation of hematopoiesis is provided by recent data showing that adhesive interactions can also provide important costimulatory signals. We have previously shown that normal CD34+ HPCs express high levels of fibronectin (Fn) receptors very late antigen-4 (VLA-4) and VLA-5 in a low-affinity state, which do not allow HPCs to strongly adhere on immobilized Fn, and that cytokines such as interleukin-3, granulocyte-monocyte colony-stimulating factor, and stem cell factor transiently activate these receptors, providing HPCs with an adhesive phenotype on Fn. Thus, knowledge of the functional states of adhesion receptors is critical to our understanding of the physiological mechanisms responsible for the regulation of normal hematopoiesis. Herein, we show that combinations of cytokines that synergize to stimulate the proliferation of CD34+ HPCs result in additive stimulation of the adhesion of these cells to Fn. Thus, the activation level of Fn receptors expressed by normal CD34+ HPCs is highly correlated with their proliferative state, suggesting a functional link between these two events. Therefore, we propose a 2- step model with an initial activation of VLA-4 and VLA-5 generated by cytokine receptors that is followed by a secondary signal resulting from Fn binding to VLA-4 and VLA-5, which may cooperate with those generated by cytokine receptors.     

Living and dying: responsibility for end‐of‐life care in care homes without on‐site nursing provision ‐ a prospective study

The aim of the study was to describe the expectations and experiences of end‐of‐life care of older people resident in care homes, and how care home staff and the healthcare practitioners who visited the care home interpreted their role. A mixed‐method design was used. The everyday experience of 121 residents from six care homes in the East of England were tracked; 63 residents, 30 care home staff with assorted roles and 19 National Health Service staff from different disciplines were interviewed. The review of care home notes demonstrated that residents had a wide range of healthcare problems. Length of time in the care homes, functional ability or episodes of ill‐health were not necessarily meaningful indicators to staff that a resident was about to die. General Practitioner and district nursing services provided a frequent but episodic service to individual residents. There were two recurring themes that affected how staff engaged with the process of advance care planning with residents; ‘talking about dying’ and ‘integrating living and dying’. All participants stated that they were committed to providing end‐of‐life care and supporting residents to die in the care home, if wanted. However, the process was complicated by an ongoing lack of clarity about roles and responsibilities in providing end‐of‐life care, doubts from care home and primary healthcare staff about their capacity to work together when residents’ trajectories to death were unclear. The findings suggest that to support this population, there is a need for a pattern of working between health and care staff that can encourage review and discussion between multiple participants over sustained periods of time.     

Getting ready for user involvement in a systematic review

Objective  This paper aims to support the critical development of user involvement in systematic reviews by explaining some of the theoretical, ethical and practical issues entailed in 'getting ready' for user involvement.
Background  Relatively few health or social care systematic reviews have actively involved service users. Evidence from other research contexts shows that user involvement can have benefits in terms of improved quality and outcomes, hence there is a need to test out different approaches in order to realize the benefits of user involvement and gain a greater understanding of any negative outcomes.
Design  Setting up a service-user reference group for a review of user involvement in nursing, midwifery and health visiting research involved conceptualizing user involvement, developing a representation framework, identifying and targeting service users and creating a sense of mutuality and reciprocity.
Setting and participants  Recruitment was undertaken across England by two researchers. Members from 24 national consumer organizations were selected to participate in the review.
Main variables studied  Learning was gained about finding ways of navigating consumer networks and organizations, how best to communicate our goals and intentions and how to manage selection and 'rejection' in circumstances where we had stimulated enthusiasm.
Results and conclusions  Involving service users helped us to access information, locate the findings in issues that are important to service users and to disseminate findings. User involvement is about relationships in social contexts: decisions made at the early conceptual level of research design affect service users and researchers in complex and personal ways.     

血清肝细胞生长因子与高血压患者高三酰甘油血症的相关性

目的:观察高三酰甘油血症对高血压患者血清肝细胞生长因子水平的影响。方法:选择2004-09/2005-10安徽医科大学附属医院心内科门诊和保健中心体检患者中资料完整的高血压患者70例,其中单纯高血压患者49例,高血压合并高三酰甘油血症(血三酰甘油浓度>1.70 mmol/L)患者21例,20例血压正常的健康体检者作为正常对照组。所有病例排除继发性高血压、心脏瓣膜病、心肌病、肺源性心脏病、糖尿病、脑血管疾病、心肺肝肾功能不全以及感染、出血、栓塞等全身性疾病,2周内未使用肝素、降压药物以及调脂药物。用双抗体夹心法测定血清肝细胞生长因子水平,同时测定血脂、血尿酸、血糖等指标并询问吸烟史和早发性心血管病家族史。结果:90例受试者全部试进入结果分析。①高血压合并高三酰甘油血症组患者血清肝细胞生长因子水平高于单纯高血压组和正常对照组[(1527.00±327.19),(1337.35±310.29),(789.20±114.59)ng/L,F=38.607,P<0.01];单纯高血压组高于正常对照组(P<0.01)。②除血压和三酰甘油浓度外,3组血脂、血尿酸、血糖、吸烟史和早发性心血管病家族史比较,差异均不显著(P>0.05)。结论:高血压患者血肝细胞生长因子增高,高三酰甘油血症可能会增加高血压患者血肝细胞生长因子水平。