Emergency medicine: do societal pressure, stress and technicality leave any place for humane treatment and compassionate approach care?

Introduction: To look after a person in an emergency situation leaves little time for philosophical reflections. A life must be saved. The sensitivity of care receivers and their relatives is however at its highest when faced with the caregiver's humane negligence, which they perceive as abusive

Materials and methods:Creating a working group of the different professional caregivers and of care-receivers. Writing down a list of shared values of care, and of what is considered to be unacceptable behavior. Definition of care, both that which is respectful of the individual person and that which is not, and what to do in the case of excesses of abusive situations. Conclusions of the French Ministerial Group "Humane treatment in health care institutions [2010-2011]"

Results: The ordinary, involuntary non-respectful care treatment [the "bad care"] is found in all our activities, mostly through the trivialization of the human being and the caregivers' indifference, preoccupied more with urgency, action, the medico-economic and administrative contingencies, and technicality. Awareness must be increased, which will allow the questioning of all those who take part in the care chain. Discussions should be led with a selection of caregivers, which would allow them to express their human values and their feelings about the quality of their work environment. A virtuous circle unites humane treatment of care receivers with that of caregivers

Discussion: All caregivers' efforts must tend to an improvement in quality of life of care receivers, to a care system which respects the human being. Nevertheless, recent concepts which tend to make the patient a "health system user", if not a "client", carry within them the seeds of a consumerist tendency which, far from building a joint relationship of trust, where one requires the other, impose its views while asking the other to assume all the responsibilities. And, unlike the past paternalistic approach in medicine, it is not the caregiver that put themselves in such position. Good care can only come from shared trust and respect

Effect of recipient mouse splenocytes taken orally by donor mouse on GVHD after splenocyte transplantation / 中国实验血液学杂志

This study was aimed to explore whether the GVHD in mice can be ameliorated and the GVL effect in mice can be reserved by transfusion of lymphocytes of donors fed with recipient splenocytes effect. Male (DBA-2) mice (H-2(d)) as donors were fed with BALB/c splenocytes, DBA-2 splenocytes, bovine serum albumin, or regular chow, every other day. Induction of tolerance was assessed by a mixed lymphocyte reaction (MLR). Female (BALB/c) mice (H-2(d)) as recipients received total body irradiation (TBI) of 6.0 Gy ((60)Cogamma-ray) followed by inoculation of 3 x 10(3) P388 mouse leukemia cells on the same day. Subsequently, tail vein injection of 2 x 10(7) splenocytes supplied by DBA-2 was undertaken. Control groups were fed identically without leukemia cell inoculation. The results showed that GVHD was significantly ameliorated and CD4(+)/CD8(+) ratio increased in recipient-mice transplanted with splenocytes of tolerated donors, compared with control animals. There was no significant difference in survival rate between different groups of recipients inoculated with leukemia cell. It is concluded that the peroral recipient-mouse splenocytes can ameliorate GVHD without hampering effect on GVL.

Selective elimination of alloreactive donor lymphocytes by using TBI and cyclophosphamide / 中国实验血液学杂志

This study was aimed to investigate a new method of avoiding graft-vs-host disease (GVHD) through selective elimination of alloreactive donor lymphocytes by using total body irradiation (TBI) and cyclophosphamide (Cy). Female (BALB/c x C57BL/6) F1 mice (H-2(d/b)) as recipients received (60)Co gamma-ray sublethal TBI of 4 Gy on day 0 followed by being inoculated with P388D1 leukemia cell line on day 1, injection of allogeneic splenocytes from C57BL/6 male mice (H-2(b)) was carried out for induction of graft-vs-leukemia (GVL) effect prior to stem cell transplantation (SCT), intraperitoneally injection of cyclophosphamide (Cy) (200 mg/kg) and TBI (9 Gy) was given on day 6. One day later, treated mice were rescued with bone marrow hematopoietic stem cells from (BALB/c x C57BL/6) F1 male mice (H-2(d/b)). The results showed that recipients had no occurrence of leukemia and GVHD through selective elimination of alloreactive donor lymphocytes by Cy and TBI, survived more than 210 days, the complete-donor chimerism occurred on day 21 after transplantation. The ratio of chimerism descended subsequently, but still displayed mixed-chimerism at 90 days. Control mice died of GVHD, leukemia or other death-related-transplantation within 20 to 36 days (P<0.01). It is concluded that to induce GVL effects by MHC mismatched splenocytes given before syngeneic bone marrow transplantation followed by selective elimination of alloreactive donor lymphocytes through TBI and Cy, graft-vs-host disease was thus avoided.