Uncovering tacit caring knowledge

Abstract The aim of this article is to present re‐enactment interviewing and to propose that it can be used to reveal tacit caring knowledge. This approach generates knowledge not readily attainable by other research methods, which we demonstrate by analysing the epistemological and methodological underpinnings of re‐enactment interviewing. We also give examples from a study where re‐enactment was used. As tacit knowledge is often characteristic of care, re‐enactment interviewing has the potential to engage the informant in a holistic mode and thereby reveal wisdom of the body. When the care provider recalls an event, the details are articulated, which contributes to in‐depth data, which subsequently serves as a basis for trustworthy analysis.     

Taking care of their baby at home but with nursing staff as support: The use of videoconferencing in providing neonatal support to parents of preterm infants

The aim was to describe the experiences of parents of preterm infants on the use of real-time videoconferencing between their home and the Neonatal Intensive Care Unit (NICU). Ten couples participated in the study. After taking their infant home, parents had access, via video and sound in real-time, to the staff at the NICU. Data were collected by notes and interviews with the parent; thereafter a thematic content analysis was used to analyze the texts. The analysis revealed four categories: security provided by access to the staff; face-to-face supportive meetings; need for control over the use of videoconferencing; other possible uses of videoconferencing. The identified theme was ‘feeling strengthened by having a link between the home and the NICU’. Parents experienced videoconferencing as positive, which empowered them and gave them confidence in their new situation of being at home with their infant.     

Stereotactic implantation of deep brain stimulation electrodes: a review of technical systems,methods and emerging tools

Deep brain stimulation (DBS) has become increasingly important for the treatment and relief of neurological disorders such as Parkinson’s disease, tremor, dystonia and psychiatric illness. As DBS implantations and any other stereotactic and functional surgical procedure require accurate, precise and safe targeting of the brain structure, the technical aids for preoperative planning, intervention and postoperative follow-up have become increasingly important. The aim of this paper was to give an overview, from a biomedical engineering perspective, of a typical implantation procedure and current supporting techniques. Furthermore, emerging technical aids not yet clinically established are presented. This includes the state-of-the-art of neuroimaging and navigation, patient-specific simulation of DBS electric field, optical methods for intracerebral guidance, movement pattern analysis, intraoperative data visualisation and trends related to new stimulation devices. As DBS surgery already today is an information technology intensive domain, an “intuitive visualisation” interface for improving management of these data in relation to surgery is suggested.     

Oral lichen planus and the p53 family: what do we know?

J Oral Pathol Med (2011) 40 : 281–285 Oral lichen planus (OLP) is a relatively common chronic disease of the oral mucosa for which the aetiopathogenesis is not fully understood. It mainly affects middle aged and elderly. The finding of autoantibodies against p63, a member of the p53 family, is a strong indication of autoimmunity as a causative or contributing factor. The WHO classified OLP as a potentially malignant disorder, but still there is an ongoing debate in the literature on this subject. The TP53 gene encodes a tumour suppressor protein that is involved in induction of cell‐cycle arrest or apoptosis of DNA‐damaged cells. The p63 gene encodes six different proteins that are crucial for formation of the oral mucosa and skin. The coordinated stabilization of p53 and decreased expression of p63 seen in OLP cause induction of apoptosis enabling removal of DNA‐damaged cells. In view of the complexity of cancerogenesis, no firm statement can at present be made about the relevance of the observed relationship between p53 and p63 and the possible malignant transformation of OLP.     

Induction of corticospinal regeneration by lentiviral trkB-induced Erk activation

Several experimental manipulations of the CNS environment successfully elicit regeneration of sensory and bulbospinal motor axons but fail to elicit regeneration of corticospinal axons, suggesting that cell-intrinsic mechanisms limit the regeneration of this critical class of motor neurons. We hypothesized that enhancement of intrinsic neuronal growth mechanisms would enable adult corticospinal motor axon regeneration. Lentiviral vectors were used to overexpress the BDNF receptor trkB in layer V corticospinal motor neurons. After subcortical axotomy, trkB transduction induced corticospinal axon regeneration into subcortical lesion sites expressing BDNF. In the absence of trkB overexpression, no regeneration occurred. Selective deletion of canonical, trkB-mediated neurite outgrowth signaling by mutation of the Shc/FRS-2 activation domain prohibited Erk activation and eliminated regeneration. These findings support the hypothesis that the refractory regenerative state of adult corticospinal axons can be attributed at least in part to neuron-intrinsic mechanisms, and that activation of ERK signaling can elicit corticospinal tract regeneration.     

Future of stereotactic intervention in lung cancer

With the recent advances in technology, highly sophisticated hardware (linear accelerators specially designed for Stereotactic Radio-Surgery or Stereotactic Body Radiation Therapy (SBRT) using novel image guidance prior to and during the procedure) and equally sophisticated planning treatment software (static and dynamic Intensity Modulated Radiation Therapy) became available, allowing for ablative doses to be delivered with an accuracy of less than 1 mm to targets which are non-static due to respiratory motion.     

Combining factors on protein and gene level to predict radioresponse in head and neck cancer cell lines

J Oral Pathol Med (2011) 40 : 739–746 Background: Radiotherapy is the main therapy for head and neck squamous cell carcinoma (HNSCC); however, treatment resistance and local recurrence are significant problems, highlighting the need for predictive markers. In this study, we evaluated selected proteins, mutations, and single nucleotide polymorphisms (SNPs) involved in apoptosis, cell proliferation, and DNA repair alone or combined as predictive markers for radioresponse in 42 HNSCC cell lines. Methods: The expression of epidermal growth factor receptor, survivin, Bax, Bcl‐2, Bcl‐X_L, cyclooxygenase‐2 (COX‐2), and heat shock protein 70 was analyzed by ELISA. Furthermore, mutations and SNPs in the p53 gene as well as SNPs in the MDM2, XRCC1, and XRCC3 genes were analyzed for their relation to radioresponse. To enable the evaluation of the predictive value of several factors combined, each cell line was allocated points based on the number of negative points (NNP) system, and the NNP sum was correlated with radioresponse. Results: Survivin was the only factor that alone was significantly correlated with the intrinsic radiosensitivity (IR; r = 0.36, P = 0.02). The combination of survivin, Bax, Bcl‐2, Bcl‐X_L, COX‐2, and the p53 Arg72Pro polymorphism was found to most strongly correlate with radioresponse (r = 0.553, P < 0.001). Conclusion: These data indicate that the IR of 42 HNSCC cell lines can be predicted by a panel of factors on both the protein and gene levels. Moreover, among the investigated factors, survivin was the most promising biomarker of radioresponse.     

Comparison between serial skin-prick tests and specific serum immunoglobulin E to mite allergens

Sensitization to dust mite allergens can be determined by means of a skin-prick test (SPT) or by measurement of specific IgE antibodies in serum (sIgE). In our study, concordance of the results of both methods was analyzed on the basis of reproducible SPT results. Three consecutive SPTs were performed on 138 school children (age 6–8 years) at one-year intervals. SIgE was determined at the end of a two-year observation period. Seven common inhalant allergens (Dpt, Df, birch pollens, hazel pollens, grass pollens and cat and dog dander) were analyzed. The majority of subjects with positive SPT reactions to the respective allergen also showed sIgE (Dpt: 82/86; Df: 53/53; cat dander: 31/32; dog dander: 6/9; birch pollens: 29/31; hazel pollens: 22/22; grass pollens: 37/37). A significant correlation between the SPT [weal diameter (P₁) or allergen/histamine ratio (P₂)] and sIgE was found for Dpt (P₁ = 0.004/P₂ = 0.016), birch pollens (P₁ = 0.002/P₂ = 0.0001) and grass pollens (P₁ = 0.0005/P₂ = 0.0001). There was also a significant correlation between sIgE to Dpt and to either Der p 1 (p = 0.0001) or Der p 2 (p = 0.0001), as well as between sIgE of both major allergens (p = 0.0001). In the analysis of co-sensitization of Dpt and Df, most subjects sensitized to Dpt were also sensitized to Df (57/91). Children with sIgE to Dpt (n = 87) usually showed sIgE to Df (n = 83). In this study, SPT and sIgE results are concordant and appear equivalent when using reproducible SPTs. Therefore, in the case of a positive Dpt result, additional testing for sensitization to Df can be regarded as redundant when Dpt and Df are the major contributors to the allergen content of house dust.