End-of-life expectations and experiences among nursing home patients and their relatives—A synthesis of qualitative studies

Objective

Synthesize research about patients’ and relatives’ expectations and experiences on how doctors can improve end-of-life care in nursing homes.

Methods

We systematically searched qualitative studies in English in seven databases (Medline, Embase, PsycINFO, CINAHL, Ageline, Cochrane Systematic Reviews and Cochrane Trials). We included 14 publications in the analysis with meta-ethnography.

Results

Patients and families emphasized the importance of health personnel anticipating illness trajectories and recognizing the information and palliation needed. Family members who became proxy decision-makers reported uncertainty and distress when guidance from health personnel was lacking. They worried about staff shortage and emphasized doctor availability. Relatives and health personnel seldom recognized patients’ ability to consent, and patients’ preferences were not always recognized.

Conclusion

Nursing home patients and their relatives wanted doctors more involved in end-of-life care. They expected doctors to acknowledge their preferences and provide guidance and symptom relief.

Practice implications

High-quality end-of-life care in nursing homes relies on organization, funding and skilled staff, including available doctors who are able to recognize illness trajectories and perform individualized Advance Care Planning.     

Intracerebroventricular injection of the terminal complement complex causes inflammatory reaction in the rat brain

To investigate the effect of the terminal complement complex (TCC) on the central nervous system, we injected both the cytolytically active and the inactive complexes into the lateral ventricle of rats. Both complexes promoted accumulation of leukocytes into the cerebrospinal fluid at 4-6 h post-injection. The cells recovered at this time were mostly polymorphonuclear leukocytes (PMN) that were partially replaced by mononuclear cells at 12 h. A direct contribution of the complexes to the in-vivo migration of leukocytes was ruled out by their inability to be chemotactic for rat PMN. Contaminating C5a is unlikely to be responsible for the effect of TCC because it failed to mobilize leukocytes when injected into the lateral ventricle. Histological analysis of rat brains 6 hours after injection of TCC revealed marked leukocyte infiltration of the choroid plexus, increased expression of intercellular adhesion molecule-1 and egression of leukocytes out of the meningeal vessels. The cerebrospinal fluid of rats treated with TCC exhibited chemotactic activity for rat PMN and increased levels of growth related oncogene/cytokine-induced neutrophil chemoattractant-1 and monocyte chemoattractant protein-1 preceding the accumulation of leukocytes. Elevated concentration of IL-1 beta was also found in the cerebrospinal fluid and in periventricular areas of rats treated with TCC.     

现代化医疗设备管理实践

随着现代医疗科技的不断进步,大量先进的医疗器械被医院购入并使用,使医院的医疗设备科成为医院接触先进医疗设备最多并发展最快的科室之一。医院如何应用现代化技术,更好地对医疗设备进行管理成为目前摆在医院设备科面前的主要课题。我们近一年来应用计算机、《医疗设备综合识别管理系统》、条码识别等现代化手段,在医疗设备科管理上进行了相应的管理实践,取得了一定的经验。     

白萝卜提取物对大鼠胃排空、肠推进及豚鼠离体回肠平滑肌的影响

目的 研究白萝卜提取物（ Raphanus sativus extract）对在体大鼠胃排空及肠推进的影响及对豚鼠离体回肠平滑肌条收缩活动的影响。方法 通过旋转蒸发的方法，制备得到白萝卜提取物；将32只SD大鼠随机分为白萝卜提取物高剂量组（3ml／kg）、中剂量组（1ml／kg）、低剂量（0．3ml／kg）组及空白对照组（生理盐水）4个组，每组8只，通过灌胃给药的方法，以胃肠内标记物葡聚糖蓝-2000在大鼠胃内色素相对残留率及肠推进比为指标，观察各组对大鼠胃排空及肠推进的影响，进一步在离体条件下，以豚鼠回肠平滑肌肌条的收缩幅度和频率为指标，通过不同浓度的白萝卜提取物作用于豚鼠离体回肠平滑肌，观察提取物对离体回肠平滑肌收缩活动的影响。结果白萝卜提取物在0．3ml／kg，1．0ml／kg，3ml／kg剂量下都能够提高大鼠胃排空率，与空白对照组相比，差异具有显著性（P〈0．01）；通过小肠推进比的比较，发现0、3ml／kg、1ml／kg剂量的提取物可明显促进小肠推进，与空白对照组相比，差异具有显著性（P〈0．01）；而3ml／kg剂量下的提取物未表现出明显的促进小肠推进作用，与空白对照组相比，差异无显著性（P〉0．05）。在离体条件下，提取物在0．1mg／ml下对豚鼠离体回肠平滑肌的张力和收缩频率均无明显影响，但可增加其收缩幅度（与给药前相比，P〈0．05）；而在0．3mg／ml，1．0mg／ml，3．0mg／ml剂量下，均可使豚鼠离体回肠平滑肌的张力、收缩幅度增加（与给药前相比，P〈0、01），但不改变收缩频率（与给药前相比，P〉0．05）。结论 白萝卜提取物对动物胃肠动力具促进作用，并存在一定的剂量一效应关系。     

Principles of Total Care for Children with Leukemia —Psychosocial Interventions —

Today about 70% of children with leukemia are cured by intensive chemotherapy. Therefore how to deal with the children and their families before, during, and after the treatment has become a major concern for caregivers. And it is a fact that there are still a few patients who relapse and are destined to die. We are now taking care of two groups of patients. One group is truly cured and one group is dying. We have been trying to establish a good total care system that fits our society. We have formed medical teams which consist of doctors, nurses, and care workers. From our experience, we think the most important principle for the caregivers is frankness. Sometimes this is very difficult. Other important points of total care, especially from psychosocial aspects, are mentioned.     

Bicarbonate Enhances Sodium Absorption from Glucose and Glycine Rehydration Solutions

ABSTRACT. Sodium, potassium and water absorption was studied over the whole length of rat jejunum and ileum by an in vivo marker perfusion technique. The composition of solutions were similar to the oral rehydration solution currently in use for the treatment of acute diarrhoeal diseases. The study shows that bicarbonate and chloride containing glucose or glycine electrolyte solutions induce a significantly greater absorption of sodium, potassium and water compared to those containing chloride only. The study also confirms that an amino acid such as glycine is as efficient as glucose in promoting the absorption of sodium, potassium and water from rat small intestine.     

Smooth muscle relaxant activities of compounds isolated from malaysian medicinal plants on rat aorta and guinea-pig ileum

Muscle relaxant activities of six compounds isolated from Malaysian medicinal plants were investigated on the smooth muscles of the rat aorta and longitudinal muscle of the guinea-pig ileum. Except for goniothalamin, the other five compounds exhibited varying degrees of muscle relaxant activities on the two smooth muscles. Dicentrine, isocorydine, altholactone and usnic acid reduced the contractions to KCI and phenylephrine in the rat aorta, whilst atranorin slightly reduced the contractions to phenylephrine but not KCI. In addition, dicentrine and isocorydine markedly reduced the contractile response to phenylephrine in Ca²⁺-free Krebs solution. In the longitudinal muscle of the guinea-pig ileum, altholactone, atranorin, dicentrine and isocorydine inhibited to a greater extent the phasic than the tonic responses to KCI. All four compounds similarly inhibited the contractions induced by ACh. The results suggest that the relaxant activities of the compounds are attributed mainly to inhibition of Ca²⁺ influx via the calcium channels in the membrane of the smooth muscles. Furthermore, the greater sensitivity of dicentrine, isocorydine and altholactone against phenylephrine-induced contractions or KCI-induced phasic contractions are due to their abilities to inhibit intracellular Ca²⁺ release in these muscles.     

INTESTINAL AGANGLIONOSIS IN THE SMITH-LEMLI-OPITZ SYNDROME

ABSTRACT. Two unrelated cases with clinical and autopsy findings of the Smith-Lemli-Opitz syndrome are described. Narrowing of the terminal ileum and congenital intestinal aganglionosis was found in both. This is a rare association and the importance of microscopic examination of the intestine in cases of the Smith-Lemli-Opitz syndrome is emphasized.     

Urodynamic study of enhanced continent mechanism using tapered ileum as continent urinary reservoir

Objective To investigate the effect of extramural support from the pouch and abdominal wall to enhance the continent mechanism of tapered ileum. Methods A total of 24 patients underwent a procedure in which an ileal segment was tapered into an efferent tube, of which a part was placed between the back surface of the rectus muscle and the ileal pouch wall. The internal orifice of the tapered ileum was anastomosed to the ileal pouch and its external orifice was anastomosed to the umbilicus. A urodynamic study of the efferent tubes and pouch was done 1.5 to 3 months and 6 to 24 months postoperatively. Results One patient died of heart disease 55 days postoperatively, while 22 of the remaining 23 were completely continent day and night. At 1.5 to 3 months, the urodynamic study of the efferent tubes demonstrated that the maximum closure pressure with a full pouch was 46-124 cmH20 （91.26±15.71 cmH20）and with an empty pouch was 34-84 cmH20 （67±10.60 cmH20）. The difference in mean maximum closure pressure in the full and empty pouches was statistically significant (t=-11.78 and P=0.00001). At 6 to 24 months, a second urodynamic study was performed on 18 cases, demonstrating a reservoir capacity of 420 to 750 ml (481.67±78.83 ml). Reservoir pressure was 6 to 9 cmH(2)O (7.17±1.17 cmH20) when the pouch was filled to 50 ml, and 16 to 35 cmH(2)O (24.12±5.61 cmH20) when it was filled to maximum capacity. There was no contractive wave during the filling in any patient. Maximum closure pressure in the efferent tube was 80 to 194 cm H(2)O (98.89±26.34 cmH20) when the pouch was filled with saline, and 64 to 128 cmH(2)O (74.78±14.54 cmH20) when the pouch was empty. The difference in mean maximum closure pressure in the full and empty pouches was statistically significant (t=-7.58 and P=0.00003). Conclusions This study indicates that the continent mechanism of tapered ileum may be greatly enhanced by extramural support from the abdominal and pouch walls.     

晚期癌症患者生存期间家庭其他成员的心理状况研究

目的了解晚期癌症患者家庭其他成员的心理状况。方法随机选择我院的晚期癌症患者家属186例做自评焦虑量表(SAS)、自评抑郁量表(SDS)测评。按患者家属角色分为妻子组、女儿组、丈夫组、儿子组。将各组评分结果与常模做统计学分析。分别计算各组的焦虑、抑郁发生率,并进行统计学分析。结果妻子组、女儿组、丈夫组、儿子组SAS、SDS评分结果与常模间差异有显著性意义(P<0.05)。焦虑发生率4组家属间差异无显著性意义(P>0.05);抑郁发生率女儿组、丈夫组、儿子组3者之间差异无显著性意义(P>0.05),妻子组与其他3组间差异具有显著性意义(P<0.05)。结论晚期癌症患者生存期间家庭其他成员焦虑、抑郁水平较常人高。家庭不同成员焦虑、抑郁水平也有所不同,患者的妻子焦虑、抑郁水平最高。因此关注晚期癌症患者家庭其他成员心理状况,给予他们心理上的疏导和支持是宁养医疗服务工作的任务之一。