Stammzellderivate bei Hautschäden nach Strahlenexposition

Radiation injury to skin results in a variety of deterministic effects including inflammatory reactions and cell depletion leading to distinct clinical symptoms following a defined time pattern. Therapeutic approaches are still limited, a complete restitution of affected areas is so far impossible. In the last few years increasing experimental knowledge about acquisition and administration of autologous stem cells also in the field of radiation injuries has been obtained. Evidence reviewed in this article shows that the beneficial effects of stem cell transplantation are not necessarily due to the replacement of damaged cells by transplanted cells but most probably due in the most part to a paracrine effect. Transplanted cells secrete bioactive factors that initiate the stimulation of the host stem cells to regenerate the damaged tissues. Transplanted stem cells produce trophic factors which aid the systemic healing of the victims. Furthermore, administration of stem cell secretomes in the form of conditioned media containing microvesicles or exosomes can be as effective as administering the stem cells. This hypothesis is supported by findings that cell-free derivatives from hMSCs were useful for wound healing purposes and could circumvent the need for intact cells. Furthermore, the beneficial effect of MSC injection on reperfusion and tissue damage in a mouse model of hind limb ischemia could be attributed to paracrine mechanisms with local release of arteriogenic cytokines. Further evaluation of the paracrine potential of autologous stem cells may open new means for treatment of acute as well as chronic sequelae of cutaneous radiation injuries.     

The effects of platinum chemotherapy on essential trace elements

The effects of cisplatin chemotherapy on the metabolism of essential trace elements were investigated in 12 patients before and after treatment with cisplatin. In serum, the mean post-treatment concentrations of Cu (13.19 μmoll⁻¹), Zn (9.57 μmoll⁻¹) and Mg (0.54 mmoll⁻¹) were significantly reduced compared with the pre-treatment levels (19.35, 11.86 and 0.67) while Se, caeruloplasmin and C-reactive protein concentrations were unaltered. Urinary excretion of Cu, Mg and Zn were enhanced. The urinary N-acetyl-β-D-glucosaminidase activity (a marker of proximal renal tubular dysfunction) was also increased and suggests the mechanism for decrease of certain t race elements in serum during treatment could be increased urinary excretion caused by impaired cellular metabolism. It is not clear whether the loss of trace elements via the urine has any implication for the clinical status of cancer patients treated with cisplatin.     

FLUVOXAMINE IN THE TREATMENT OF DEPRESSIVE ILLNESS. A SERIES OF DOUBLE-BUND HOSPITAL BASED COMPARATIVE STUDIES CARRIED OUT IN THE UK

A series of double-blind hospital based studies comparing fluvoxamine with other antidepressants in depressed patients is reviewed. Overall there were no significant differences in terms of efficacy between fluvoxamine and the comparators (amitriptyline, dothiepin, lofepramine and mianserin). Fluvoxamine was shown to be associated with a low incidence of anticholinergic, cardiovascular or sedative effects. This profile of activity, together with low toxicity in overdosage, has established the place of fluvoxamine in the treatment of depressive illness.     

The internal consistency and intra-rater reliability of an assessment practice grid for community nurses

The development of instruments to measure clinical competence in nursing shows little evidence of a systematic approach and studies of reliability and validity are absent. The present study was carried out using data on practice assessment collected in the course of a post-registration nursing programme. The data were analysed for internal consistency and intra-rater reliability. The instrument used to assess practice in the present study is highly internally consistent and there is evidence to support intra-rater reliability. However, further development and testing of the instrument is required.     

Nurses' attitudes and concerns pertaining to HIV and AIDS

A pilot study was conducted to identify nurses' attitudes and concerns pertaining to the care of people with human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) Data were collected using an anonymous, voluntary questionnaire, which was made available to all nurses at a Wellington Area Health Board (New Zealand) hospital Of 562 nursing staff, 286 (51%) responded, of which 74 (25 9%) had previously attended an HIV/AIDS workshop for Area Health Board staff Of those staff handling blood, 132 (49 4%) always wore gloves, and only half of the respondents (n = 148, 51%) treated all body fluids as potentially HIV positive The possible attrition rate from nursing positions in the canvassed hospital was 2 8%, with a further 43 (15 0%) undecided about resigning from their post Only 56 nurses (12 5%) believed the employer did not provide adequate safety measures The provision of education regarding HIV/AIDS, by the employer, was considered inadequate by 61 (213%) respondents This study demonstrates that further safety and education needs should be attended to or reinforced     

Measuring feeding difficulty in patients with dementia: replication and validation of the EdFED Scale #1

A study was conducted in order to replicate a scale which was previously reported for assessing the feeding difficulty of elderly patients with dementia. The clinical significance of the scale was also investigated. It was demonstrated that the scale was replicable in two separate nursing units. Also, it was demonstrated that, according to criteria such as its correlation with levels of nursing intervention, for example physical help, and with an indicator of feeding difficulty, namely leaving food on the plate at the end of a meal, the scale was clinically significant. The consequences and limitations of the present investigation are discussed and recommendations for future lines of enquiry are suggested. Specifically, the possibility of analysing data from such studies by the use of multivariate statistical techniques is raised.     

EVALUATION OF DIPSTICK TESTS AND REFLECTANCE METER FOR SCREENING FOR BACTERIURIA IN ELDERLY PATIENTS

SUMMARY When screening for bacteriuria in 615 elderly people was compared to standard methods of bacterial culture, the Ames Multistix 10 dipstick was more effective than the BM Test 7. Tests for nitrite and leucocyte esterase on the Multistix 10 had a higher sensitivity and specificity than tests for blood and protein only. Using a reflectance meter increased the sensitivity of the Multistix 10 to 80.6%. Of five common urinary symptoms only incontinence was significantly more frequent in patients with bacteriuria.     

Measuring feeding difficulty in patients with dementia: perspectives and problems

The feeding problems of demented elderly people are well documented and the need for research into the assessment of feeding difficulty and intervention by nurses has been raised The present paper reviews the literature in this area of care and outlines the problems which exist in attempting to investigate the feeding difficulty of demented patients Demented elderly people display a range of behaviours related to feeding including excessive eating in the early stages of dementia and then difficulty with feeding, refusal to eat and, finally, inability to self-feed at all The problems with research in this area revolve around the issue of measurement of feeding difficulty There are problems in deciding what to measure and in how measurements should be made which are clinically meaningful A possible strategy for investigating the feeding difficulty of demented elderly patients is suggested which includes the design of a tool for measurement and the application of single-case studies Any tool which is used for measurement should enable researchers, in the first instance, and then clinicians to categorize the feeding difficulty of individual patients Moreover, such a tool should also be sufficiently sensitive to respond to change in feeding ability The single-case methodology is considered to be the most ethically and statistically appropriate for research with this particular group of patients