Patient Involvement: A New Source of Stress in Health Care Work?

Patients have become increasingly well informed with higher expectations to be involved in decision-making processes regarding their care and treatment. However, few studies have examined the impact of patient involvement on health care providers’ partnership-building communication. The aim of this study was to measure and explore the self-reported effects of patient involvement on the work of physicians and nurses. A questionnaire survey was distributed among cardiology staff in 12 Swedish hospitals (N = 488, response rate 67%). The sample was comprised of registered nurses (RNs, n = 303), licensed practical nurses (LPNs, n = 132), and physicians (MDs, n = 53). Confirmatory factor analysis was used to examine seven questionnaire statements concerning implications of patient involvement for one’s clinical work. Regression analyses were used to examine factors associated with staff’s partnership-building communication. Analysis confirmed two distinct factors accounting for 57% of the total variance, representing both negative—“Hassles”—and positive—“Uplifts”—aspects of patient involvement. Regression analyses revealed that only positive aspects (i.e., uplifts) of patient involvement predicted staff behavior aimed at involving patients. Working with actively involved patients may be a source of stress, both negative and positive, for health care professionals. By developing work routines for involving patients in their care, health care workplaces may help health care professionals to buffer the negative effects, and enhance the positive effects, of that stress.     

Effect of lamotrigin on the development of neurogenic pain syndrome in rats

Analgesic activity of a new anticonvulsive agent lamotrigin was studied on the model of neurogenic pain syndrome produced in rats by penicillin applied to the dorsal surface of the spinal cord and by dissection of the sciatic nerve. Lamotrigin was shown to have a profound analgesic activity. It can be used as an efficient prophylactic agent for prevention of chronic pain syndromes by suppression of the generators of pathologically enhanced excitation in the nociceptive structures which are the pathophysiological basis of the chronic pain syndromes. Translated fromByulleten' Eksperimental'noi Biologii i Meditsiny, Vol. 125, No. 5, pp. 517–521, January, 1998.     

Deficiency of P-selectin in a patient with grey platelet syndrome

Abstract: Patient B.G. is a 29-yr-old female with a lifelong bleeding disorder characterized clinically by a highly increased bleeding time, menorrhagias, long-lasting bleeding after cuts and tooth extractions and large post-traumatic haematomas. Her coagulation tests were within normal range, platelet count was 140,000–160,000 per μl, but platelet function was impaired as demonstrated by the absence of collagen-induced aggregation, although no abnormalities were detected in aggregation response to ADP and ristocetin. Morphologically her platelets were characterized by gigantic size – average profile area was about 2.5 times higher than that of control donors, and severe deficiency of α-granules – only 16% of their number in control donors. These features taken together indicated the diagnosis of grey platelet syndrome. As has been shown by quantitative immunoblotting, patient's platelets contained small amounts of α-granule membrane protein P-selectin – about 15% of that in control donors. The content of plasma membrane glycoproteins IIb–IIIa and Ib was not reduced, suggesting the specific deficiency of α-granule membrane protein. Thus, B.G. is the second patient described in the literature (see also Lages et al, J Clin Invest 1991: 87: 919–929) with combined deficiency of α-granules and P-selectin.     

Morphological study of some hypothalamic centers in rats after deafferentation of the mediobasal hypothalamus

The volume of the nuclei and nucleoli of certain hypothalamic centers (SON, PVN, SCN, AN, VMN) was determined in control rats and in rats after deafferentation of the mediobasal hypothalamus. Sex differences were found in the parvocellular formations of the control animals: The volumes of nuclei and nucleoli of neurons of AN and VMN, and also of the nucleolus of SCN neurons were larger in females than in males. After deafferentation of the mediobasal hypothalamus the volume of the cell nuclei was increased, especially in hypothalamic formations located outside the isolated zone. This increase was more clearly defined in rats constantly in a state of estrus after the operation. Statistically significant differences between volumes of both nuclei and nucleoli of the cells in subgroups of rats with permanent estrus and with permanent diestrus were found only in the case of SCN. No such differences were found for AN, despite the considerable difference in the constant of luteinizing hormone in the pituitary of the same rats. It is suggested that gonadotropin releasing factors are not produced by the cells of AN and that control over the succession of phases of the sex cycle may be exerted by SCN.Laboratory of Neuroendocrinology, I. M. Sechenov Institute of Evolutionary Physiology and Biochemistry, Leningrad. (Presented by Academician of the Academy of Medical Sciences of the USSR V. N. Chernigovskii.) Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 89, No. 3, pp. 352–354, March, 1980.     

Study on streptococcus group A antigens common with heart tissue elements

Four different cross-reactive antigens were revealed in cultures of group A streptococci by immunoelectrophoresis using antistreptococcal sera unabsorbed, or absorbed with homogenates of rabbit heart tissue. Preliminary study of these sera by immunofluorescence showed that they react with different elements of the myocardium.

The hypothesis is suggested that the biological (immunizing) action of microbial cross-reactive antigens depends on the presence or absence of immunological tolerance to these antigens in the individual immunized. The mechanism of autoantibody formation by immunization with such common antigens is discussed.