Help, I need to develop communication skills on donation: the "VIDEO" model.

BACKGROUND: Information about brain stem death and donation can be influence the consent rate for donation and its psychosocial effects. The aim of this study was to create a "VIDEO" model that could be used to help physicians to develop communication skills. METHODS: A video recorded 32 simulations of family interviews: 16 under-age and 16 adult donors. They were analyzed during 8 courses conducted in 2008 and 2009. During the VIDEO process, the visual presentation was followed by participants (n=192) discussing interactively the donation situation. After the transcription of the video records, family interviews were explored retrospectively regarding informing relatives about brain stem death and donation, typical communication gaps and common questions from families. The data were examined qualitatively and semiquantitatively. We think that teaching can be optimized by our results. RESULTS: A comprehensible explanation about brain stem death was provided to relatives in 65.63% of cases. The consent of the family was more important for the physicians than the application of the law in 93.75%; 78.13% of physicians emphasized altruism to support donation. Remarkable mistakes of communication included using the teams coma and brain stem death interchangeably (9.38%); applying expressions connected with life in the present tense (21.88%) and mechanically kept alive (21.88%); organ-focused behavior such as "organs to be usable" (34.38%). The frequent questions and statements of "relatives" were "heart beats" (100%), "did he really die?" (65.63%), "fear of loss of integrity of the corpse" (59.38%), and "wake up from the coma" (46.88%). DISCUSSION: Interaction with the family requires great preparation. The communication skills of physicians can be developed through the VIDEO model. The results can be integrated into educational programs that consider the particular features of the given country.

Barriers to the development of palliative care in Western Europe.

UNLABELLED: The Eurobarometer Survey of the EAPC Task Force on the Development of Palliative Care in Europe is part of a programme of work to produce comprehensive information on the provision of palliative care across Europe. AIM: To identify barriers to the development of palliative care in Western Europe. METHOD: A qualitative survey was undertaken amongst boards of national associations, eliciting opinions on opportunities for, and barriers to, palliative care development. By July 2006, 44/52 (85%) European countries had responded to the survey; we report here on the results from 22/25 (88%) countries in Western Europe. ANALYSIS: Data from the Eurobarometer Survey were analysed thematically by geographical region and by the degree of development of palliative care in each country. RESULTS: From the data contained within the Eurobarometer, we identified six significant barriers to the development of palliative care in Western Europe: (i) lack of palliative care education and training programmes; (ii) lack of awareness and recognition of palliative care; (iii) limited availability of/knowledge about opioid analgesics; (iv) limited funding; (v) lack of coordination amongst services; and (vi) uneven palliative care coverage. CONCLUSION: Findings from the EAPC Eurobarometer Survey suggest that barriers to the development of palliative care in Western Europe may differ substantially from each other in both their scope and context and that some may be considered to be of greater significance than others. A number of common barriers to the development of the discipline do exist and much work still remains to be done in the identified areas. This paper provides a road map of which barriers need to be addressed.

Effect of end of life education on medical students' and health care workers' death attitude.

One of the goals of education in end of life care is to make communication more open by exploring critical issues related to fear of dying and death in order to reduce anxiety and improve an individual's attitude to dying patients. The aim of our research was to evaluate the effects of courses for health care workers and medical students in care at the end of life. One hundred and twenty-seven health care professionals and 41 undergraduate medical students completed the Multidimensional Fear of Death Scale (MFODS) on the first and last day of the course. The most significant factors of fear of death are: Fear for Significant Others, Fear of the Dying Process and Fear of the Unknown. Overall fear of death scores were reduced as an effect of the courses. Changes in the components and level of fear of death are influenced by the participants' gender, age and profession. Improvement was evident in the attitudes to dying patients in both groups, which was related to an increase in knowledge of high-quality care of dying patients.

Production of proinflammatory cytokines by syncytiotrophoblasts infected with human cytomegalovirus isolates.

Forty per cent of women with primary cytomegalovirus (CMV) infection during gestation transmit the infection to their fetuses, which may result in abnormalities for the newborn, varying in degree from mild to severe. The factors whereby CMV in the placenta develops into a fulminating infection and spreads to the fetus are not known. In this study the production of proinflammatory cytokines was investigated in syncytiotrophoblast (ST) cultures infected with CMV strains. The interrelationships between the cytokines produced in the ST cultures and the number of nuclei of ST expressing the CMV immediate-early (IE) gene were examined. To resemble a natural infection, clinical CMV isolates and a low multiplicity of infection were used. TNF-alpha and IL-1 beta were not detected in the supernatants of any ST cultures. Similar or increased amounts of IL-6 were found in the CMV-infected cultures. The IL-8-inducing capacities of the CMV strains differed in the ST cultures. The IE gene expression of the virus provided was dependent on the amount of IL-8 produced in the STs. Our observations indicate that certain CMV strains induce high amounts of IL-8, which in turn enhances CMV replication in the placenta, while others can replicate if the IL-8 is provided by a co-infecting agent.

Factors influencing hemorrhagic transformation in ischemic stroke: a clinicopathological comparison.

As hemorrhagic transformation (HTr) is a frequent complication and can worsen the outcome of acute ischemic stroke, our aim was to assess the risk factors of HTr. Using the database of our neuropathological laboratory, 245 consecutive acute ischemic stroke patients were analyzed. An exploratory logistic regression procedure was carried out to find the best multiple model identifying the factors associated with HTr. The autopsy revealed ischemic infarct in 175 (71%) and ischemic infarct with HTr in 70 (29%) patients. Mean age was 71.5 +/- 11.4 years (mean +/- SD) and 74.8 +/- 10.2 years (mean +/- SD), respectively. The multiple model confirmed age in case of embolic stroke, and diabetes mellitus and infarct size as independent risk factors of HTr. It seems that not serum glucose level but diabetes mellitus in the case history is an independent predictor of HTr.

Role of cerebral amyloid angiopathy in intracerebral hemorrhage in hypertensive patients.

OBJECTIVE: To assess the interaction of cerebral amyloid angiopathy (CAA) and arterial hypertension as cofactors for intracerebral hemorrhage (ICH). METHODS: The authors investigated 129 postmortem brains of hypertensive patients with and without ICH. Sixty-four patients had had deep (n = 40) or lobar (n = 24) ICH. Sixty-five patients without ICH served as controls. Established risk factors for ICH (age, gender, severity of hypertension, bleeding disorders, intake of anticoagulants, and chronic alcoholism) were identified from medical records. Four specimens per brain were stained with hematoxylin-eosin and Congo red. The entire ICH cohort and subgroups were compared with controls using single-factor and multiple logistic regression analyses. RESULTS: CAA was found in 15 of 64 subjects (23%) with ICH and in five of 65 controls (8%; p = 0.026). In single-factor analysis, CAA was more prevalent in lobar ICH compared with controls (p = 0.007) but not in deep ICH. Poor control of hypertension was more prevalent in the entire ICH group (p = 0.01) and in deep ICH (p = 0.016) but not in lobar ICH. ICH was predictive of the presence of CAA (odds ratio: 5.6, 95% CI: 1.8 to 19.5, p = 0.003), and CAA was more likely to be found in lobar ICH in multivariable-adjusted analysis. After adjustment for conventional risk factors, there was a weak association between CAA and deep ICH. CONCLUSION: Cerebral amyloid angiopathy plays a major role in the pathogenesis of intracerebral hemorrhage even in patients with more evident risk factors.

Accuracy of in vivo carotid B-mode ultrasound compared with pathological analysis: intima-media thickening, lumen diameter, and cross-sectional area.

BACKGROUND AND PURPOSE: This study aimed to determine the correlation of in vivo ultrasound measurements of intima-media thickening (IMT), lumen diameter, and cross-sectional area of the common carotid artery (CCA) with corresponding measurements obtained by gross pathology and histology. METHODS: Sixty-six moribund neurological patients (mean age 71 years) underwent B-mode ultrasound of the CCA a few days before death. During autopsy, carotid specimens were removed in toto. Carotid arteries were ligated and cannulated for injection of a hydrophilic embedding material under standardized conditions. The carotid bifurcation was frozen and cut manually in 3-mm cross slices. Digital image analysis was carried out to determine the diameter and the cross-sectional area of the frozen slices of the CCA. IMT was assessed by light microscope. Ultrasonic and planimetric data were compared. RESULTS: Mean measurements of lumen diameter and cross-sectional area were 7.13+/-1.27 mm and 0.496+/-0.167 cm(2), respectively, by ultrasound, and 7.81+/-1.45 mm and 0.516+/-0.194 cm(2), respectively, by planimetric analysis of the unfixed redistended carotid arteries (R(2)=0.389 and 0.497). The mean IMT was 1.005+/-0.267 mm by ultrasound and 0.67+/-0.141 mm histologically, resulting in a mean difference of -31%. CONCLUSIONS: Transcutaneous B-mode ultrasound provides a reliable approach for in vivo measurements of the cross-sectional area and, less exactly, of the lumen diameter of the CCA. Compared with histological results, in vivo ultrasound measurements of the IMT are systematically larger.

Oncology patients' and oncology nurses' perceptions of nurse caring behaviours.

Previous research on patients' and nurses' perceptions of nurse caring behaviours has documented significant differences in the ranking of important behaviours. However, these samples have included a variety of medical-surgical patients and nurses and different types of institutional settings, all of which may have affected the results. The present study sought to determine if patients and nurses from one subspecialty area and one institution would have more concordant perceptions of caring. Forty-four oncology patients and 49 oncology nurses completed the Respondents Perceptions of Caring Behaviour Scale (RPCBS). Results showed that overall mean patient rankings were highly correlated with mean nurse rankings (Spearman's correlations coefficient 0.94, P<0.0001). The Wilcoxon two-sample rank sum test was used to test the difference in rank of the 20 items between the patients and nurses. There was a significant difference in rank in only six of the 20 items. These data suggest that oncology patients and nurses have more concordant perceptions of caring than previously investigated groups. Implications for practice and further research are discussed.

Providers' and consumers' perspective of nurses' caring behaviours.

The primary purpose of this article is to discuss the development and testing of a scale designed to examine nurses' caring behaviours. A pilot study was conducted with a convenience sample (n = 81) of 42 nurses (providers) and 39 patients (consumers). The setting was two community hospitals in the New England Region. The respondents were able to assign a rank of the items (nurses' caring behaviours) with a spread of mean values from 3.5 to 16.7. There was agreement on the most caring behaviour, 'The nurses treat me as an individual', on the behaviour in the middle range of caring, 'The nurses comfort me by their silent presence', and on the least caring behaviour, 'The nurses did not talk about how my illness might affect my life'. The Wilcoxon two-sample rank-sum test was used to test the difference in rank of the 20 items between the providers and the consumers. There was a significant difference between the providers and the consumers in the ranking of nine of the 20 items. The consumers valued behaviours that recognized their individual perspective as well as that of their family and behaviours that helped them anticipate and prepare for change. The providers placed a greater emphasis on the behaviours that were more geared towards the comforting aspects of care by encouraging patients to express and vent their feelings. These findings allow clinicians to be sensitized to their caring behaviours by increasing their realization of how behaviours are perceived by patients. The instrument needs minor revision and then further testing is indicated.

[Percutaneous drainage in the treatment of accidentally discovered hydatid cyst in patients with polycystic liver]. / Polycystás májbetegekben véletlenszerüen felismert máj Echinococcus-cysták percutan drainage kezelése.

This article report on a not very well-known therapeutical procedure used among only fairly diagnosed cases based on international and Hungarian experiences. In Hungary echinococcus cyst of the liver is mostly treated surgically (the average mortality rate of liver resection is 0-6.3%). In many places the percutan puncture and drainage are contraindicated in case of echinococcus cysts. The authors assert that the percutaneous treatment of echinococcus cysts in proper technical and methodic circumstances in safe regarding the previous studies and their own data obtained of a few cases, and describe the technique and raise some question in them. Drainage treatment is very well tolerated by the patients it reduces the duration (of time) and the cost of the hospitalization.

Incongruence between nurses' and parents' perceptions of nurses' caring behaviors in a neonatal intensive care unit.

The primary purpose of this study was to test an instrument designed to assess nurses' caring behaviors in a neonatal intensive care unit, the setting for the study. The convenience sample (n = 88) was 42 nurses who worked in a neonatal intensive care unit and 46 parents whose infants were hospitalized there. The Wilcoxon two-sample rank-sum test was used to test the difference in ranking of the 15 items (nurses' caring behaviors) between the nurses and parents. There was agreement on the most caring behavior, "The nurses understood my need to touch my baby and encouraged me to do so" and the least caring behavior, "The nurses did not know the sex of my child." However, a significant difference was found between the nurses and parents on 4 of the 15 behaviors. The findings serve to sensitize the clinicians to their caring behaviors by heightening their awareness of how caring behaviors are perceived by parents.

Effect of i.v. dipyridamole on cerebral blood flow, blood pressure, plasma adenosine and cAMP levels in rabbits.

In response to intravenous administration of dipyridamole, the quantitative and temporal changes in plasma adenosine and cyclic AMP (cAMP) levels in relation to the changes in cerebral blood flow (CBF) and mean arterial blood pressure (MABP) have not been studied. Therefore, we investigated simultaneously the changes in CBF (hydrogen and thermal clearance methods), MABP, plasma adenosine (HPLC) and cAMP (radioimmunoassay) levels for 1 h after intravenous injection of 0.7 and 1.4 mg/kg dipyridamole in rabbits. In separate experiments, only plasma adenosine concentrations were measured to determine how and for how long intravenous administration of 0.7 mg/kg dipyridamole is able to inhibit the removal of plasma adenosine. Dipyridamole decreased MABP, increased plasma adenosine and cAMP levels in a dose-dependent manner. The dose-dependency of increases in CBF could not be demonstrated owing to the marked hypotension. The increase in plasma adenosine concentrations was biphasic. The first peak could be detected at the end of the dipyridamole injection. The second peak occurred 20 min after drug administration, simultaneously with the maximal increases in plasma cAMP level and CBF, whereas the maximal fall in MABP developed earlier. Intravenous administration of 0.7 mg/kg dipyridamole inhibited adenosine uptake only by 25%, which lasted less than 10 min. We concluded that intravenously given dipyridamole is responsible only for the initial short-lasting elevation of plasma adenosine concentration, and is able to induce vasodilation without either dipyridamole itself or adenosine necessarily gaining access to the muscular layer.

Beneficial vascular and metabolic effects of cobalt-ATP in spontaneously hypertensive rabbits with diffuse chronic cerebral ischaemia.

The in vivo effects of adenosine triphosphate (ATP) have not been investigated in cerebrovascular diseases. The use of the long-acting cobalt-ATP complex (Co-ATP) permits us to observe the effects of ATP without the influence of its metabolites. This study was designed to compare the effects of intravenous Co-ATP on the cerebral blood flow (CBF), polarographically detected oxygen currents (O2a), mean arterial blood pressure (MABP), heart rate, respiration rate, cerebral electrical activity, arterial blood gases, pH, and glucose in 13 normotensive (NT) rabbits to those in 14 stroke-prone spontaneously hypertensive (HT) animals. CBF was measured by the hydrogen and heat clearance methods. In response to Co-ATP, MABP decreased and CBF increased significantly in both groups. The decrease in MABP was more marked in HT rabbits, while CBF response was 25% smaller than in NT animals. The ratio of O2a to CBF diminished moderately and simultaneously with the CBF increase in NT rabbits. In HT rabbits, the decrease in O2a/CBF was larger and began when CBF response reached its maximum. We suggest that despite the restricted CBF response, long-acting ATP should still be taken into consideration as a supplementary treatment of hypertensive encephalopathy because of its beneficial effects on cerebral metabolism and hypertension.

Caring in a neonatal intensive care unit: perspectives of providers and consumers.

Neonatal intensive care units have continually grown in number and complexity in their short history. The care given to infants and families in these units is done, in large part, by nursing. This article discusses the development of a scale that will explore the perceptions of this care by both consumers and providers. The perceptions of each group will be compared to determine if care that is thought and intended to be caring for providers is indeed perceived as such by consumers. This is of significant importance to the developing body of knowledge related to caring in nursing, and it will also promote care that is family centered.

Advanced practice: a model for neonatal/perinatal and women/child nursing.

Collaboration between service and academia has often been disparate. A new model of cooperation was designed in the Fall of 1992 by faculty at the University of Connecticut School of Nursing and nurse administrators at John Dempsey Hospital of the University of Connecticut Health Center. A combined effort was undertaken to expeditiously prepare, at the graduate level, acute care nurse practitioners in Critical Care and Neonatal/Perinatal Nursing. The impetus for the collaborative effort was due in part to: reduced medical residency hours for patient coverage; limited access by patients to care in teaching hospitals because of demands in practice and academic roles; the need to bridge the gap between nursing and medicine; and fragmentation of care. The premise underlying all teaching, learning, and evaluation in the program is androgogy, or the art and science of helping adults learn. The program meets the current National Certification Corporation requirements for certification eligibility. A new evaluation instrument, the Learning Assessment Resource Scale (LARS) was designed by operationalizing Benner's seven domains of nursing practice. The Learning Assessment Resource Scale is based on the premise that expert nursing care is holistic rather than procedural. As an outcome of the collaboration between service and academe, there is enhanced mutual respect, the care-cure dichotomy has been bridged, and advanced practice nurses are educationally prepared to give expert care.

Effects of dipyridamole in spontaneously hypertensive rabbits with diffuse chronic cerebral ischemia.

The effect of intravenous dipyridamole (0.7 mg/kg) on cerebral blood flow (CBF), mean arterial blood pressure (MABP), heart rate, respiration rate, cerebral electrical activity, arterial blood gases, pH, and glucose was investigated in 14 normotensive and 14 stroke-prone spontaneously hypertensive anesthetized rabbits. CBF was measured by hydrogen and heat clearance. In both groups, MABP decreased (normotensive: -24 mm Hg, hypertensive: -47 mm Hg; ANOVA: P < 0.0001) and CBF increased (normotensive: +59 ml/100 g/min, hypertensive: +72 ml/100 g/min; ANOVA: P < 0.0002). CBF returned to the initial level 21 min later in hypertensive than in normotensive rabbits. Changes in other parameters were insignificant. In additional experiments, 30 mg/kg theophylline entirely prevented the cerebral vasodilator and systemic hypotensive effects of dipyridamole in both normotensive and hypertensive rabbits. We conclude that, in stroke-prone spontaneously hypertensive rabbits, the longer-lasting and larger CBF increase in response to dipyridamole may be attributed to reversible functional changes in the cerebral vasculature resulting from hypertension.

Effects of carbon dioxide inhalation on cerebral blood flow and oxygen tissue level in spontaneously hypertensive rabbits.

BACKGROUND AND PURPOSE: Because previous studies have yielded conflicting results, this study was designed to investigate the efficiency of cerebrovascular reactivity to carbon dioxide in hypertension associated with moderate diffuse cerebral ischemic lesions. METHODS: The effects of carbon dioxide inhalation on mean arterial blood pressure, heart and respiration rates, cerebral cortical blood flow, polarographically detected oxygen currents (oxygen availability), and cerebral electrical activity were compared in 14 spontaneously hypertensive and 16 normotensive rabbits anesthetized with urethane and alpha-chloralose. Blood flow was measured with the hydrogen clearance and thermal clearance methods. RESULTS: In the resting state the frequency of electrical activity shifted to slower components, the levels of oxygen availability and cerebral blood flow were lower (p less than 0.01), and the ratio of the two latter parameters was greater (p less than 0.01) in hypertensive rabbits than in normotensive animals. Carbon dioxide inhalation induced more marked increases in cerebral blood flow, respiration rate, and oxygen availability in hypertensive (p less than 0.01) than in normotensive (p less than 0.05) rabbits. The ratio of oxygen availability to cerebral blood flow decreased (p less than 0.01) in the former and did not change significantly in the latter group. The carbon dioxide-induced rise in blood flow was also slower and more protracted in hypertensive rabbits (p less than 0.01). Histological investigation revealed groups of neurons with ischemic changes in the cortex of the hypertensive rabbits. CONCLUSIONS: We suggest that in hypertensive rabbits the mild multiple ischemic lesions are the basis of functional disturbances, including reduced resting cerebral blood flow, greater oxygen tissue level, slower response to carbon dioxide, and greater vasodilatory capacity.