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Re-thinking stroke rehabilitation: the Corbin and Strauss chronic illness trajectory framework.
Re-thinking stroke rehabilitation: the Corbin and Strauss chronic illness trajectory framework The dramatic effects of a stroke can have far-reaching implications for patients and carers. Effective recovery involves a considerable array of coping strategies that facilitate and promote engagement in the social world. Their development is a long-term process that requires considerable effort, motivation and enterprise on the part of patients and their families. Traditional approaches to the provision of stroke rehabilitation services, however, appear to be underpinned by frameworks that are short-term in outlook. As a consequence, nursing interventions often focus on the progression of the patient through the care system, rather than on facilitating future recovery. Much of the work of stroke recovery is consequently done by patients and their families at home, with little provision of ongoing professional help and advice. This paper explores the application of the Corbin and Strauss Chronic Illness Trajectory Framework for stroke. In particular, the major concepts of the framework are applied to a vignette derived from a longitudinal study of patients' experiences of recovery. The trajectory framework is shown to be a useful structure that has the potential to enhance the appropriateness of nursing interventions for stroke patients. However, the validity of the framework can only be established through its application and evaluation in clinical practice. The purpose of this paper is to contribute to a debate that encourages consideration of the framework's utility for nurses to enhance the stroke rehabilitation experience.
Re-reading Lévi-Strauss: "The raw and the cooked" thirty years on.
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Proliferation of human peripheral lymphocytes. Characteristics of cells once stimulated or re-stimulated by concanavalin A.
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The animism controversy re-examination of Huang-Lee data.
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Vesicoileosigmoidostomy in the treatment of exstrophy: re-evaluation.
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Official re-registration of a female transsexual following medical treatment.
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Telemedicine in ultrasound: new solutions.
The transport of dynamic ultrasound (US) pictures as video files or streams no longer presents a problem. Despite teleconferencing, this method of transfer provides no active influence on the data sent for the receiving expert. We are evaluating a software-based 3-D US system that provides the new opportunity of an active US re-evaluation of a virtual patient. The 3-D volumes can be reanalyzed, time- and examiner-independent, wherever the device is installed. To test the clinical feasibility of this virtual US investigation, we installed the device in a peripheral hospital and in our US unit. The transfer of the volume (about 10 to 15 MB) could be done with two parallel Integrated Services Digital Network (ISDN) lines with a conduction capacity of 128 KB/s. In this basic assessment, the transmission of US volumes of patients proved to be easy in the acquisition, quick in off-line transmission and reliable in off-line re-evaluation of the data.
Adult quality of life and associated factors in adolescent onset schizophrenia and affective psychotic disorders.
BACKGROUND: Subjects in treatment for affective disorders are usually less satisfied with life compared to subjects with schizophrenia. AIMS: The aims of this study were to compare subjective quality of life (QoL) at adult age of adolescent onset psychotic disorders and analyse associated factors. METHOD: Fifty-three patients with adolescent onset psychotic disorders were followed up at age 25, diagnostically re-evaluated according to the DSM-IV and assessed with the Positive and Negative Symptoms Scale, the Strauss-Carpenter Scale and the Lancashire Quality of Life Profile. RESULTS: Subjects diagnosed with schizophrenia or schizoaffective disorder (n = 27) experienced significantly lower overall QoL than subjects with psychotic mood disorders (n = 26). Overall QoL was strongly associated to depressed mood (R2 = 0.49) in the schizophrenia group and to degree of employment (R2 = 0.39) in the mood disordered group. CONCLUSION: Depression is a major concern in the evaluation and treatment of patients with schizophrenia, while vocational support seems particularly important after an episode of psychotic mood disorder.
A non-surgical uterine lavage technique in large cats intended for treatment of uterine infection-induced infertility.
This paper presents the successful use of a non-surgical, transcervical uterine lavage technique for the treatment of uterine infection-induced infertility in three female large cats. We developed a non-surgical uterine lavage technique, which allowed repeated flushing of the uterine lumen and installation of therapeutic antibiotics. The entire procedure was performed under general anaesthesia (duration of anesthesia ranged from 40 to 70 min). It was successfully applied in a Sumatran tiger (Panthera tigris sumatrae), a Corbett tiger (Panthera tigris corbetti) and an Amur leopard (Panthera pardus orientalis). The tigers were treated only once, whereas the leopard received four uterine treatments, due to re-infection after mating. Decisions to conduct uterine treatments were based on detection of uterine fluid during previous transrectal ultrasound examinations. The catheter was guided into the vagina, with the aid of an endoscope, passing the urethra, and then into the uterus, with the aid of transrectal ultrasonography. Both uterine horns were separately flushed with approximately 300 mL of cell medium M199, followed by an antibiotic infusion. Upon ultrasonographic re-examination, the topical uterine treatments resulted in an apparent decline in the inflammatory and/or degenerative processes. The Corbett tiger had the most severe uterine alterations, in addition to an aseptic pyometra. As a result, she was treated 1 month prior to ovariohysterectomy (in order to reduce the surgical risk). The Sumatran tiger was artificially inseminated twice after hormone-induced estrus, and the Amur leopard expressed a spontaneous estrus and re-initiated mating behaviour.
Plasmid rescue - a tool for reproducible recovery of genes from transfected mammalian cells?
The efficient rescue of plasmids containing the thymidine kinase gene (tk) of Herpes simplex virus type I from genetically transformed mouse cells by transformation of bacteria is described. Rescued plasmids contain insertions of calf DNA used as a carrier in the transfection but usually lack portions of plasmid DNA. Deletions generally concern the region spanning from around the PvuII site of pBR322 to within the tetracycline resistance coding sequence, whereas the extent of tk sequence deletion varies, depending on the site of its integration (BamHI or PvuII) into the plasmid. Modelling the rescue process by transformation of bacteria with a mixture of original plasmids and sheared mouse cell DNA clearly demonstrates that deletions are caused by the presence of the mammalian DNA and they probably occur during re-transformation of bacteria before the onset of tetracycline gene expression. Plasmids lacking the Tcr region are reproducibly rescuable without deletion. Methods for reproducible re-isolation of transferred genes from mammalian cells are discussed.
A randomized comparison of plateletpheresis with the same donors using four blood separators at a single blood center.
At one blood center, each of 20 donors underwent plateletpheresis on four blood cell separators in random order. We compared the CS3000+, Amicus V 2.41, MCS Plus, and Spectra LRS V 7 Turbo regarding platelet (PLT) yield, pre- and post-procedure PLT counts, percent fall in donor PLT count, process time, efficiency, PLT product and donor PLT volume (MPV). Using >or= 150 x 10(9) PLTs/L pre-donation counts, a goal was set of 4.5 x 10(11) PLTs unit in up to 100 minutes processing time. Results were (mean values) PLT yields of Amicus, Spectra, CS3000+, and MCS Plus: 4.3, 4.6, 4.3, 4.0 x 10(11) PLTS, respectively; percent donor PLT fall: 24, 32, 30, 29%, respectively; processing times: 50, 74, 87, 101 minutes, respectively; relative efficiency (RE): 2.2, 1.6, 1.2,1.0, respectively (based on the MCS Plus performance with RE of 1 = 4 x 10(9) PLTS/min); PLT product MPV: 6.7, 7.4, 6.8,7.1 fL, respectively; pre-procedure donor MPV: 7.7, 7.3, 7.6 and 7.6 fL, respectively; and percent donor MPV change: -5.2, 0, -6.6, and -10%, respectively. Significant changes in the donor MPV were noted (P < 0.05) but could not be related to product MPV. Spectra seemed to collect larger PLTs (higher MPV); the significance remains unknown for both donors and recipients. Importantly, all four separators gave acceptable and comparable PLT yields (P < 0.05) with Spectra trending higher. The short process time and high RE together indicate highly efficient collections particularly by Amicus and Spectra.
Prevention of bone loss and muscle atrophy during manned space flight.
This paper reviews the biomedical literature concerning human adaptation to nonterrestrial environments, and focuses on the definition of practical countermeasures necessary for long-term survival on the Moon, Mars and during long-term space missions and exploration. Of particular importance is the development of clinically relevant countermeasures for prevention of pathophysiological changes in the musculoskeletal and cardiopulmonary systems under these conditions. The countermeasures which are proposed are based upon a combination of biomechanical and theoretical analyses. The biomechanical analyses are based upon clinical measurements of human skeletal density changes associated with weight lifting as well as clinical studies of human strength and fitness currently being conducted using an isoinertial trunk dynamometer. The theoretical analysis stems from a mathematical model for bone loss in altered gravity environments that we have begun to develop. These analyses provide guidelines for the development of practical therapeutic treatments (exercise, artificial gravity) designed to minimize musculoskeletal deconditioning associated with less than Earth gravity environments. Our findings suggest that very intensive exercise, which impose high loads on the musculoskeletal system for brief periods, may be more efficient in preserving bone and skeletal muscle conditioning within "safe" limits for longer periods than low intensity activities such as treadmill running and bicycling. A 1/6 to 1/7-g gravitational environment is predicted to be sufficient to preserve bone strength above the fracture risk level. Basic biomedical support of manned space missions, Moon and Mars bases should include routine assessment of skeletal density, muscle strength, cardiac output and total energy expenditure. This information can be used to periodically re-evaluate exercise programs and or artificial gravity requirements for crew members.
[Results of surgery of the rheumatoid forefoot. Apropos of 64 cases].
The authors analyze the outcome of 64 operations of different types of rheumatoid conditions in the foot. Of all the techniques used, plantar re-alignment, according to the technique of Lelièvre was the most often used, regularly providing satisfactory results.
Limbal allergic granulomatosis.
Four limbal diseases characterised by granuloma formation as part of an allergic response are discussed. A series of histological specimens from patients with Wegener's granulomatosis were re-examined. Genuine granulomatous disease at the limbus is rare, only occurring in two patients, whilst secondary, more non-specific limbal active chronic inflammation was more common. Comparisons between this disease, Churg Strauss allergic angiitis, some varieties of Mooren's ulcer and allergic granulomatous nodules were made. The role of the mast cell in promoting this eosinophilic leucocytic mediated group of disease is discussed briefly.
Probing protein-chromophore interactions in Cph1 phytochrome by mutagenesis.
We have investigated mutants of phytochrome Cph1 from the cyanobacterium Synechocystis PCC6803 in order to study chromophore-protein interactions. Cph1Delta2, the 514-residue N-terminal sensor module produced as a recombinant His6-tagged apoprotein in Escherichia coli, autoassembles in vitro to form a holoprotein photochemically indistinguishable from the full-length product. We generated 12 site-directed mutants of Cph1Delta2, focusing on conserved residues which might be involved in chromophore-protein autoassembly and photoconversion. Folding, phycocyanobilin-binding and Pr-->Pfr photoconversion were analysed using CD and UV-visible spectroscopy. MALDI-TOF-MS confirmed C259 as the chromophore attachment site. C259L is unable to attach the chromophore covalently but still autoassembles to form a red-shifted photochromic holoprotein. H260Q shows UV-visible properties similar to the wild-type at pH 7.0 but both Pr and Pfr (reversibly) bleach at pH 9.0, indicating that the imidazole side chain buffers chromophore protonation. Mutations at E189 disturbed folding but the residue is not essential for chromophore-protein autoassembly. In D207A, whereas red irradiation of the ground state leads to bleaching of the red Pr band as in the wild-type, a Pfr-like peak does not arise, implicating D207 as a proton donor for a deprotonated intermediate prior to Pfr. UV-Vis spectra of both H260Q under alkaline conditions and D207A point to a particular significance of protonation in the Pfr state, possibly implying proton migration (release and re-uptake) during Pr-->Pfr photoconversion. The findings are discussed in relation to the recently published 3D structure of a bacteriophytochrome fragment.
Development of a cost-effective system for digital off-line analysis of transrectal ultrasound.
BACKGROUND: Transrectal ultrasound (TRUS) is the most sensitive and accurate technique for preoperative staging and follow-up of rectal cancer. One of the most relevant problems of this technique is that the assessment of TRUS is possible only during real-time examination. Furthermore, interpretation of the ultrasound findings is difficult and requires long experience. We show the development of a new, cost-effective software solution for off-line examination and documentation of transrectal ultrasound. METHODS: The ultrasound device is connected to a frame-grabber card in a standard PC. Video capturing is done using a freeware software solution and various video codecs. The whole examination course is recorded. The examiner only has to concentrate on producing an artifact-free realization of the examination. RESULTS: The software solution offers a flexible review of each individual "frame" of the investigation on the personal computer, very similar to CT and MRI scans. Infiltration depth and lymph node status can be assessed at any time, independently of the investigation and the investigator. The picture quality is excellent even if a lossy codec is used. It is not necessary to do definitive assessment of the TRUS during the examination. CONCLUSIONS: This new technique gives a cost-effective possibility for high-quality off-line staging, re-examination, re-evaluation, and documentation of rectal cancer. TRUS becomes an examiner-independent objective examination technique for staging and follow-up of rectal cancer.
Lymphocyte subpopulations, oxidative burst and apoptosis in peripheral blood cells of patients with multiple sclerosis-effect of interferon-beta.
At present, the most efficient therapeutical treatment of multiple sclerosis (MS) is achieved by IFN-beta. However, its in vivo effects remain incompletely understood. If applied parenterally, the hydrophobic IFN-beta acts primarily on blood cells with probable selectivity for functionally different lymphocyte subpopulations, monocytes and granulocytes. We have investigated the expression of the activation marker interleukin-2 receptor-alpha (CD25) on CD3+ T cells, CD19+ B cells, foetal-type gamma(delta)+CD3+ T cells and foetal-type CD5+CD19+ B cells of the peripheral blood. In addition, the oxidative burst activity and apoptosis have been determined in mononuclear and polymorphonuclear blood cells, respectively. The study accompanied a phase III trial with IFN-beta1b (BETAFERON, Schering). Two groups of MS patients with relapsing-remitting course of the disease have been investigated at 8 time points (days 0, 5, 15, 31, 60, 90, 180 and 270 after starting therapy): (1) verum group (n = 8) with application of 8 Mill. units IFN-beta1 b every other day, and (2) placebo group (n = 4) with application of placebo for 3 months and therapy as in (1) from day 90 onward. The main results were: (1) Activated T cells decreased until day 180 in the verum group and return thereafter to pre-treatment values, whereas in the placebo group the values remained relatively stable over the whole observation period. (2) Activated B cells increased between days 90 and 270 in both groups, i.e. after verum application in both groups. (3) Foetal-type B cells were more activated than total B and T cells with increase over time in both groups. (4) Foetal-type T cells exerted relatively stable intra-individual levels with generally low CD25 expression, but punctual CD25 peaks in both groups. (5) The spontaneous oxidative burst was higher in lymphocytes, more variable in monocytes and faster increasing in granulocytes in the verum group than in the placebo group. (6) Apoptosis of mononuclear cells and granulocytes showed similar variations in the verum and placebo groups with the exception of a selective increase over time of the proportion of granulocytes undergoing induced apoptosis in the verum group. It is concluded that IFN-beta has the following main effects on the immune system of MS patients: (1) the T cell immunity is systemically and reversibly suppressed, (2) the foetal-type lymphocytes, which are responsible for the first line of defence of infections, are stimulated in the long range, (3) the oxidative burst activity is increased in lymphocytes and granulocytes and instable in monocytes, and (4) the inducibility of apoptosis in granulocytes is increased. Re-examination of the altered blood cell parameters after long-term IFN-beta therapy is warranted.