Expectations and experiences of practising veterinarians throughout an 8-week mindfulness-based stress reduction programme.

AIMS: To explore practising veterinarians' expectations of an 8-week mindfulness training programme, their perceived barriers to participating in the programme, their experiences of the programme and the extent to which they continued to engage in mindfulness practices following training. METHODS: Participants were 10 companion animal veterinarians practising in Auckland, New Zealand. All took part in an 8-week mindfulness-based training programme. A longitudinal qualitative design was used: data were collected by structured interviews prior to the programme, upon completion of the programme and 3 months after completion. Data were analysed using thematic analysis to identify recurring themes, or patterns, within the data. RESULTS: Before commencing the programme, participants generally thought mindfulness training would provide some benefits for wellbeing but were otherwise not clear on what to expect. The main concerns about taking part were time constraints and apprehensions about potentially having to share personal information, and consequently how they might be perceived by other participants. On completion of the training programme, the opportunity to share experiences within the group with the support of a trained facilitator was reported as the most valuable aspect of the programme, rather than the mindfulness practices themselves. At the 3-month follow-up, participants reported they had learnt some useful techniques for managing stressful thoughts and situations, but despite the perceived benefits, few were still practicing mindfulness techniques. CONCLUSIONS AND CLINICAL RELEVANCE: Training in mindfulness practices may have some value for helping practicing veterinarians manage their wellbeing, but it is not a complete solution in itself. Participants reported that the greatest benefits came from facilitated peer support.

Double trouble: myocardial infarction with non-obstructive coronary arteries as a presentation of Hughes syndrome in monozygotic twins.

Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a recently described, clinically significant entity, with prevalence rates ranging from 1% to 14% and a mean of 6% of all patients with myocardial infarction. Antiphospholipid syndrome (APS; Hughes syndrome) is characterized by the presence of antiphospholipid antibodies associated with thrombosis (arterial and/or venous) and/or pregnancy morbidity and could be the cause of MINOCA. Data on genetic predisposition to APS are scarce. The present study describes a unique case of monozygotic twin brothers who, at a young age, developed the same clinical presentation of APS. The diagnosis of APS was later confirmed, along with a diagnosis of systemic lupus erythematosus in one brother.

The cutaneous manifestations are significantly related to cerebrovascular in a Serbian cohort of patients with Hughes syndrome.

Objectives To investigate a possible relationship between cerebrovascular, such as stroke and transient ischaemic attack, and various cutaneous manifestations (livedo reticularis, skin ulcerations, pseudovasculitis lesions, superficial cutaneous necrosis and digital gangrene) in antiphospholipid syndrome (APS). This report is based on a Serbian cohort of APS patients. Methods A total of 508 antiphospholipid syndrome APS patients were assessed: 360 with primary (PAPS) and 148 with APS associated with SLE (SAPS). Antiphospholipid antibodies analysis included detection of anti-cardiolipin (IgG/IgM), anti-ß2glycoprotein I (IgG/IgM) and positive lupus anticoagulant test. Results The prevalence of cutaneous manifestations in our cohort was significantly higher in the SAPS group (76.4% vs. 27.2%, p = 0.0001). In both groups, the most common manifestation was livedo reticularis. The majority of cutaneous manifestations were significantly associated with cerebrovascular events in SAPS and PAPS. Cutaneous manifestations were independent predictors of transient ischaemic attack and stroke in PAPS patients (odds ratio 2.850, 95% confidence interval 1.562-5.202, p = 0.001, odds ratio 1.832, 95% confidence interval 1.024-3.277, p = 0.041, respectively). Conclusion In this cross-section analysis of a large cohort of Serbian APS patients, there was a strong relationship between cutaneous and cerebrovascular manifestations, suggesting a more cautious approach regarding neurological symptoms, especially in PAPS patients with cutaneous manifestations present.

Lipid peroxidation as risk factor for endothelial dysfunction in antiphospholipid syndrome patients.

The aim of this study was to evaluate oxidative stress markers and it relations to endothelial damage as risk factor for thrombosis in patients with primary (PAPS) and secondary (SAPS) antiphospholipid syndrome (APS) in correlation to traditional risk factors. Flow-mediated (FMD) and nitroglycerine (NMD)-induced dilation of the brachial artery were studied in 140 APS patients (90 PAPS, 50 SAPS) and 40 controls matched by age, sex, and conventional risk factors for atherosclerosis. Markers of oxidative stress, lipid hydroperoxydes (LOOH), advanced oxidation protein products (AOPP), total sulfhydryl groups (tSHG), and paraoxonase 1 activity (PON1) were determined by spectrophotometric method. Oxidative stress dominates in APS patients. LOOH and AOPP correlate to lipid fractions (p < 0.05), unlike PON1, tSHG that correlated to antiphospholipid antibody positivity (p < 0.05). FMD was lower in APS patients comparing to controls (p < 0.001). Cholesterol is independent variable for FMD impairment in control group (p = 0.011); LOOH in PAPS (p = 0.004); LOOH, aCL, and triglycerides in SAPS patients (p = 0.009, p = 0.049, and p = 0.012, respectively). Combined predictive of aCL and LOOH is better for FMD impairment than LOOH alone in both PAPS and SAPS patients (AUC 0.727, p = 0.001, 95 % CI 0.616-0.837 and AUC 0.824, p˂0.001, 95 % CI 0.690-0.957, respectively). Lipid peroxidation is independent predictor for endothelial dysfunction in APS patients. We demonstrated synergistic effect of aCL and LOOH as risk for endothelial impairment in both PAPS and SAPS patients.

Tomography and blood vessels in Hughes syndrome.

Antiphospholipid antibody syndrome (APS) or Hughes syndrome is a multisystem autoimmune disorder that is characterized by venous and arterial thrombosis and/or pregnancy complications (miscarriage and fetal death, preeclampsia, placental insufficiency, and fetal growth restriction), and positive serologic tests for anticardiolipin antibodies (aCL), lupus anticoagulant (LA), or antibodies against beta2-glycoprotein I (anti-ß2GPI) either of IgG or IgM isotype. APS is characterized by accelerated atherosclerosis that, together with an increased tendency toward thrombosis, leads to the occurrence of various vascular events. Timely diagnosis of vascular changes, preferably in the subclinical phase, is required both because of their severity and the high mortality rate. Detection of arterial and venous changes is performed by various invasive and noninvasive diagnostic methods. Computed tomographic angiography (CTA) seems to be the most precise method with low exposure time, giving clinicians an opportunity for early diagnosis and timely treatment of APS patients.

Healthcare workers satisfaction and patient satisfaction - where is the linkage?

BACKGROUND: This study aims to assess at what level healthcare worker satisfaction affects patient satisfaction, as well as which elements of healthcare worker satisfaction affect health service quality and patient satisfaction. METHODS: Data was collected via questionnaire-based surveys, from 18,642 healthcare workers and 9,283 patients across 50 secondary healthcare institutions in Serbia. Data analysis was based on descriptive statistics, correlations and the I2-distance method. RESULTS: Despite the general belief that healthcare worker satisfaction has a significant impact on patient satisfaction, the research results show that the correlation factor between these two is relatively low. Despite this, the obtained value of correlation cannot be neglected, therefore it can only corroborate the fact that healthcare worker satisfaction does impact patient satisfaction. The results of the study show that the satisfaction of healthcare workers with the time they have to accomplish their assigned tasks has the greatest effect upon patient satisfaction. CONCLUSION: By understanding the importance of certain elements of healthcare worker satisfaction and its effects on patient satisfaction, it is possible to make decisions about factors that need to be improved in order to raise patient satisfaction to the highest possible level. These research results are significant for the management of health care institutions and responsible state institutions which create policy and strategy for improving the quality of health care services.

Pulmonary events in antiphospholipid syndrome: influence of antiphospholipid antibody type and levels.

OBJECTIVE: This prospective clinical study examined the association between subclasses of antiphospholipid antibodies (aPL) and pulmonary manifestations in antiphospholipid syndrome (APS). METHODS: The cohort involved 329 patients: 214 patients with primary APS (PAPS) and 115 patients with secondary APS (SAPS). aPL analysis included detection of serum anticardiolipin antibodies [aCL (IgG/IgM)], ß2 glycoprotein I [ß2GPI (IgG/IgM)], and lupus anticoagulant (LA). RESULTS: In SAPS, high aCL IgG levels (> 100 PLU/mL) were more common in major pulmonary arterial thrombosis (p = 0.006) and medium aCL IgG levels (41-99 PLU/mL) in adult respiratory distress syndrome (ARDS; p = 0.047) and fibrosing alveolitis (p = 0.002). aCL IgG antibodies were more common in SAPS (p = 0.037). In PAPS, fibrosing alveolitis was more common in patients with medium ß2GPI IgM levels (p = 0.0001). LA correlated with pulmonary embolism (p = 0.03) and microthrombosis (p = 0.03) in SAPS, and with pulmonary microthrombosis (p = 0.03) in PAPS. Males were more likely to develop secondary pulmonary hypertension when diagnosed with PAPS (p = 0.019). CONCLUSION: Certain classes of aPL are associated with distinct pulmonary manifestation, indicating their predictive role and importance in diagnosis and treatment of APS.

Systemic vascular diseases in the antiphospholipid syndrome. What is the best diagnostic choice?

Antiphospholipid syndrome (APS) is an autoimmune disease which is characterized by arterial and venous thromboses, fetal loss, and the presence of antiphospholipid antibodies in the serum (aPL). It is characterized by accelerated atherosclerosis and that together with an increased tendency towards thrombosis leading to the occurrence of various vascular events. Timely diagnosis of vascular changes, preferably in subclinical phase, is required due both to their severity and to the high mortality rate. Detection of arterial and venous changes nowadays is performed through diversity of invasive and non invasive diagnostic methods. 64-multi slice computed tomographic angiography (64-MSCT) seems to be the most precise method with low exposure time, giving the opportunity for clinicians to early diagnose and timely treat APS patients.

Analysis of halothane effects on myocardial force-interval relationships at anesthetic concentrations depressing twitches but not tetanic contractions.

BACKGROUND: Tetanic contractions in rat myocardium depend solely on cellular Ca2+ uptake, whereas twitches depend on Ca2+ release from the sarcoplasmic reticulum. Because halothane may cause loss of sequestered Ca2+, the anesthetic was tested for its differential effects on twitch and tetanic forces. The in vitro effects of halothane on the twitch force-interval relationship were then evaluated, using a mathematical model that relates twitch contractile force to the Ca2+ content of intracellular compartments. METHODS: Isometric contractile force was measured in paced (0.4 Hz) rat atrial preparations. The sarcoplasmic reticulum was functionally eliminated using ryanodine (10(-6) M), abolishing twitches. Rapid pacing (20 Hz, 10 s) caused tetanic contractions. The effects of identical halothane exposures on twitches and tetanic contractions were compared. Ca2+ compartment model parameters were extracted from twitch force-interval data, according to a previously employed quantitative procedure. RESULTS: Halothane (0.5-1%) depressed normal twitches, but not tetanic contractions. The anesthetic decreased the amplitude of the steady-state twitch force-frequency relationship, and accelerated the course of mechanical recovery. Halothane (0.5-1%) also accelerated the decay constant for the decline in amplitude of a series of rest-potentiated contractions. The modeling showed that a 20-30% decrease in the recirculating fraction of activator Ca2+ accounts for 0.5% halothane-induced negative inotropy and acceleration of the decay constant. CONCLUSIONS: The differential effect of halothane on twitches and tetanic contractions implies that a functioning sarcoplasmic reticulum is required for halothane-induced negative inotropy. The effects of halothane on the force-interval relationship suggest that halothane reduces the sequestered pool of activator Ca2+.

Importance of sympathetic innervation in the positive inotropic effects of bradykinin and ramiprilat.

Isolated rat left atria or right ventricular strips were electrically stimulated at a constant frequency. The amplitude of twitch contractions, thus elicited, rose as a function of stimulation intensity because of increases in the evoked release of sympathetic catecholamines. Bradykinin had no effect on contractile force in preparations paced at a minimal intensity (threshold). By contrast, bradykinin (1 nmol/L to 1 mumol/L) markedly increased twitch contractile force when the preparations were paced at a high intensity (two to three times threshold). The EC50 for the positive inotropic action of bradykinin averaged 42 nmol/L. Ramiprilat (1 mumol/L), an angiotensin I-converting enzyme/kinase II inhibitor, shifted the EC50 for bradykinin to approximately 2 nmol/L. Ramiprilat (1 mumol/L) per se also produced a modest positive inotropic effect. The effects of bradykinin and/or ramiprilate were inhibited by HOE 140 (300 nmol/L), a bradykinin B2-receptor antagonist. Propranolol (1 mumol/L), a beta-adrenoceptor blocker, abolished the effects of bradykinin. After the destruction of sympathetic nerve endings by use of 6-hydroxydopamine, bradykinin no longer exerted a positive inotropic action. Cocaine (10 micrograms/mL), an inhibitor of catecholamine reuptake, potentiated the effect of bradykinin. Bradykinin did not affect the positive inotropic response to tyramine (10 mumol/L), whereas cocaine blocked it. Furthermore, bradykinin did not modify the dose-response curves for added norepinephrine. omega-Conotoxin (100 nmol/L) inhibited the positive inotropic effect of intensified stimulation and bradykinin potentiation. Bradykinin is suggested to facilitate the evoked release of sympathetic catecholamines and thereby cause a positive inotropic effect.