Effect of integrated caregiver support on caregiver burden for people taking care of people with cancer at the end of life: A cohort and quasi-experimental clinical trial

BackgroundPrevious studies have shown small-to-medium effects of support on reducing the caregiver burden for advanced cancer patients. A dearth of studies utilized longitudinal design to examine and evaluate the effect of support for the caregiving burden till the patient's death.ObjectivesTo test the ability of an integrative intervention program for caregivers of advanced cancer patients to lower caregiving burden as death approaches.DesignA two-group comparative design with repeated measures.SettingTwo cancer wards of a single university hospital.ParticipantsAdvanced cancer patients (N = 81) and their caregivers were allocated into two groups: an experimental group (N = 40) receiving coping strategies, assistance, recourses, and education intervention and a control group (N = 41) receiving standard care.MethodsCaregivers received training in the caregiver support intervention at least 3 times every 2 weeks to help them reduce their caregiving burden. Subjective (Caregiver Reaction Assessment) and objective (Heart Rate Variability) measures of caregiver burden were evaluated for caregivers of patients approaching death. Only data within 3 months before the patients’ death were analyzed.ResultsCaregiver self-efficacy significantly increased and the subjective caregiving burden significantly decreased in the experimental group as patients’ death approached. Heart Rate Variability also indicated a calming effect of the intervention, helping caregivers face patients’ death.ConclusionsThe caregiver support intervention can increase caregiver self-efficacy and reduce the subjective caregiving burden. Heart Rate Variability parameters have the potential to be useful for monitoring caregiver burden in facing patients’ death.     

婴幼儿牛奶蛋白过敏对罗马Ⅳ标准功能性胃肠病诊断的影响

目的 探讨婴幼儿牛奶蛋白过敏（CMPA）对罗马Ⅳ标准功能性胃肠病（FGID）诊断的影响。方法 选取84例1月龄至3岁的CMPA患儿作为病例组，84例健康体检确诊无CMPA的婴幼儿作为对照组。由儿科消化专科医生使用罗马Ⅳ标准FGID诊断问卷询问两组婴幼儿的父母，评估临床症状，进行FGID诊断。结果 病例组家族过敏史发生率明显高于对照组（P < 0.05）。84例病例组中，38例（45%）符合罗马Ⅳ版诊断FGID的标准；而84例对照组中，13例（15%）符合罗马Ⅳ版诊断FGID的标准（P < 0.05）。根据FGID罗马Ⅳ标准，婴儿反流、功能性腹泻、婴儿排便困难、功能性便秘等胃肠病，病例组的诊断率均高于对照组（P < 0.05）。对对照组中诊断为FGID的患儿进行FGID常规治疗，病例组中诊断为FGID的患儿除常规治疗外，进行了牛奶蛋白回避治疗。治疗3个月后，病例组的症状缓解率显著高于对照组（P < 0.05）。结论 在婴幼儿中，CMPA对罗马Ⅳ标准FGID的诊断有重要影响，诊断FGID时应该考虑CMPA的可能。     

腰麻术后患者去枕平卧和垫枕自由卧位效果比较

目的 探讨蛛网膜下腔麻醉(腰麻)患者术后垫枕自由卧位的可行性。 方法 将200例腰麻术后患者随机分为观察组和对照组,每组100例,观察组术后采取垫枕自由卧位,对照组术后采取常规去枕平卧位6h。结果 2组均未发生头痛;观察组不舒适率、皮肤受压及腰背酸痛发生率均低于对照组(χ²=67.307,P<0.001; χ²=7.446,P=0.006; χ²=42.017,P<0.001)。2组生命体征比较,差异无统计学意义。 结论 腰麻术后患者若无特殊医嘱或麻醉师交班时有明确要求,可予垫枕自由卧位,有利于提高患者舒适度,防止术后并发症的发生。     

Oxyntic gland polyp/adenoma

Gastric oxyntic gland polyp/adenomas, OGA are uncommon polypoid lesions that arise from oxyntic mucosa located in the body and fundus of the stomach. A case of oxyntic gland polyp/adenoma with typical histological and immunohistochemical features is presented and controversy over nomenclature and biological behavior is discussed.     

RAGE: a new frontier in chronic airways disease

Asthma and chronic obstructive pulmonary disease (COPD) are heterogeneous inflammatory disorders of the respiratory tract characterized by airflow obstruction. It is now clear that the environmental factors that drive airway pathology in asthma and COPD, including allergens, viruses, ozone and cigarette smoke, activate innate immune receptors known as pattern-recognition receptors, either directly or indirectly by causing the release of endogenous ligands. Thus, there is now intense research activity focused around understanding the mechanisms by which pattern-recognition receptors sustain the airway inflammatory response, and how these mechanisms might be targeted therapeutically. One pattern-recognition receptor that has recently come to attention in chronic airways disease is the receptor for advanced glycation end products (RAGE). RAGE is a member of the immunoglobulin superfamily of cell surface receptors that recognizes pathogen- and host-derived endogenous ligands to initiate the immune response to tissue injury, infection and inflammation. Although the role of RAGE in lung physiology and pathophysiology is not well understood, recent genome-wide association studies have linked RAGE gene polymorphisms with airflow obstruction. In addition, accumulating data from animal and clinical investigations reveal increased expression of RAGE and its ligands, together with reduced expression of soluble RAGE, an endogenous inhibitor of RAGE signalling, in chronic airways disease. In this review, we discuss recent studies of the ligand–RAGE axis in asthma and COPD, highlight important areas for future research and discuss how this axis might potentially be harnessed for therapeutic benefit in these conditions.     

Allergic airway diseases in childhood – marching from epidemiology to novel concepts of prevention

In the past years, a wide range of epidemiological, clinical, and experimental studies have produced remarkable advances in the field of respiratory allergies in childhood. By the recent investigations on epidemiological trends, risk factors, and prevention of asthma and allergic rhinitis, various exiting concepts have been challenged, and novel innovative approaches have been developed. Pediatric Allergy and Immunology (PAI), with a number of highly relevant contributions between 2010 and 2012, has become an important forum in this area. The prevalence of asthma in some developed countries may have reached a plateau, while in developing countries, where the prevalence was previously low, allergic diseases are still on the increase. A wide array of risk and protective factors, including hygiene, infections, outdoor and indoor air pollution, allergen exposure, breast‐feeding practices, nutrition, and obesity, play a multifaceted role in shaping the observed worldwide trends of respiratory allergies. Under the guidance of recent research, prediction and prevention strategies in the clinical practice are progressively changing, the focus moving away from avoidance of allergen exposure and toward tolerance induction.