[Perception of night-time sleep by the surgical patients in an intensive care unit]. / Percepción de los pacientes quirúrgicos del sueño nocturno en una Unidad de Cuidados Intensivos.

Night-time rest of the patients hospitalized in Intensive Care is a very important feature within the health/disease process since it has a direct repercussion on their adequate recovery. The objectives of this investigation are: 1) describe how the surgical patients perceive their night-time sleep in the Polyvalent Intensive Care Unit: 2) compare the subjective perception of the patients with the nursing record in the care plan and analyze the degree of agreement between both assessments. Night-time sleep has been studied in 104 patients; surgery patients from emergencies, patients who are intubated, with previous psychiatric treatment, sleep apnea, drinking habit or impossibility of adequate communication were not included. To measure the patient's perception, the five item sleep questionnaire of Richards-Campbell and the assessment of sleep by the nurse, as well as the remaining variables included in a computerized care plan, were used. The total mean score of the sleep on the first post-operative night was 51.42 mm. When the scores obtained in each one of the questionnaire items are analyzed, it is seen that the sleep profile of these patients has been characterized by being light sleep, with frequent wakenings and generally with little difficulty to go back to sleep when woke op or were awakened. The assessment of the night-time sleep performed by the nurse coincides with the perception of the patients on many occasions, and when there is discrepancy, the nurse has overestimated the patient's sleep.

Percepción de los pacientes quirúrgicos del sueño nocturno en una Unidad de Cuidados Intensivos / Perception of night-time sleep by the surgical patients in an Intensive Care Unit

El descanso nocturno de los pacientesingresados en Cuidados Intensivos es un aspecto de gran importancia dentro del proceso de salud/enfermedad, ya que tiene una repercusión directa en su adecuada recuperación. Los objetivos de esta investigación son: 1) describir cómo perciben los pacientes quirúrgicos su sueño nocturno en una Unidad de Cuidados Intensivos Polivalente; 2) comparar la percepción subjetiva de los pacientes con el registro de la enfermera en el plan de cuidados y analizar el grado de acuerdo entre ambas valoraciones. Se ha estudiado el sueño nocturno de 104 pacientes, no se han incluido los pacientes de cirugía de urgencia, intubados, tratamiento psiquiátrico previo, con apnea del sueño, hábito enólico e imposibilidad de una adecuada comunicación. Para medir la percepción del paciente se utilizó el cuestionario del sueño de Richards-Campbell de cinco ítems y la valoración del sueño, por parte de la enfermera, así como el resto de variables, se recogió del plan de cuidados informatizado. La puntuación total media del sueño de la primera noche postoperatoria fue de 51,42 mm. Al analizar las puntuaciones obtenidas en cada uno de los ítems del cuestionario se observa que el perfil de sueño de estos pacientes se ha caracterizado por ser un sueño ligero, con despertares frecuentes y que generalmente cuando se despertaban o les despertaban les costaba relativamente poco volver a dormirse. La valoración del sueño nocturno realizada por la enfermera coincide con la percepción de los pacientes en bastantes ocasiones, y cuando existe discrepancia la enfermera sobreestima el sueño del paciente

Night-time rest of the patients hospitalized in Intensive Care is a very important feature within the health/disease process since it has a direct repercussion on their adequate recovery. The objectives of this investigation are: 1) describe how the surgical patients perceive their night-time sleep in the Polyvalent Intensive Care Unit: 2) compare the subjective perception of the patients with the nursing record in the care plan and analyze the degree of agreement between both assessments. Night-time sleep has been studied in 104 patients; surgery patients from emergencies, patients who are intubated, with previous psychiatric treatment, sleep apnea, drinking habit or impossibility of adequate communication were not included. To measure the patient's perception, the five item sleep questionnaire of Richards-Campbell and the assessment of sleep by the nurse, as well as the remaining variables included in a computerized care plan, were used. The total mean score of the sleep on the first post-operative night was 51.42 mm. When the scores obtained in each one of the questionnaire items are analyzed, it is seen that the sleep profile of these patients has been characterized by being light sleep, with frequent wakenings and generally with little difficulty to go back to sleep when woke op or were awakened. The assessment of the night-time sleep performed by the nurse coincides with the perception of the patients on many occasions, and when there is discrepancy, the nurse has overestimated the patient's sleep

Antimetastatic effect of immunization with liposome-encapsulated tumor cell-membrane proteins obtained from experimental tumors.

Immunization of C57BL/6 mice with tumor-derived membrane-proteins encapsulated in sized liposomes (0.2 microgram/mouse) and composed by phosphatidylcholine or sphingomyelin, significantly reduced the mean values of spontaneous lung metastasis from both B16 (0.7 +/- 0.5 and 1.2 +/- 0.6, respectively) and 3LL (4.8 +/- 2.5 and 7.2 +/- 4.1, respectively) tumors, with respect to control (HEPES) groups (4.8 +/- 1.1 and 19.0 +/- 4.4, respectively). However, no significant antimetastatic effect was observed using free tumor-derived proteins (2 micrograms/mouse) or liposome vehicle alone. Specific humoral immune response after the vaccination was studied by flow cytometry of tumor cells incubated with a pooled sample from each group of immunized mice and FITC-conjugate antimouse immunoglobulins. The results showed that the highest number of positive tumor cells was identified using sera from immunized mice with sized liposomes encapsulating tumor-derived proteins whereas the immunization with the protein fraction in free form failed to induce this effect. In addition, an increased cytotoxicity towards 3LL and B16 tumor cells can also be observed when tumor cells were incubated with spleen effector cells plus specific immunosera. In conclusion, our results show that antitumor active vaccination, using sized liposomes as adjuvants, induces an antitumor host response and a significant inhibition of tumor progression.

Efficacy of liposome-encapsulated indomethacin in response against metastatic 3LL and B16F1 tumor cells.

The ability of large liposomes to be taken up by tissue phagocytic cells, e.g., macrophages, has made it possible to increase the efficacy of several drugs as immunomodulating agents. In the present work, we have evaluated the effect of indomethacin, a prostaglandin synthesis inhibitor, both free and encapsulated in liposomes, on the spontaneous metastatic potential of 3LL and B16F1 tumor cells. Liposomes containing either carboxyfluorescein, indomethacin, or carboxyfluorescein plus indomethacin, were made in order to evaluate their in vitro plasma stability and in vivo clearance from the blood. The liposomes showed a high stability after 6 hours of plasma incubation and they were rapidly cleared in vivo. Liposomes encapsulating propidium iodide, a fluorescent DNA binding dye, were mainly taken up in vivo by hepatic and spleen macrophages 1 hour after intravenous injection, but not by lung macrophages. When C57BL/6 mice were intravenously inoculated with 10(5) 3LL or B16F1 tumor cells previously incubated with indomethacin (10(-7) M) for 48 hours, the number of experimental lung metastatic foci was increased with respect to their respective control groups. Also, in 3LL or B16F1 tumor-bearing mice, treatment with indomethacin (0.5 mg/kg weight/day) for 10 days enhanced the number of lung metastases, but not significantly. However, when mice received indomethacin encapsulated in liposomes, the number of metastases was significantly reduced. In addition, encapsulated indomethacin (0.5 mg/kg weight/day) inhibits prostaglandin E2 production by peritoneal and spleen macrophages, whereas no significant inhibitory effect was observed with control-liposomes or equivalent doses of free indomethacin. We conclude that intravenous administration of liposome-encapsulated indomethacin has an antimetastatic effect on tumor-bearing mice. Use of indomethacin in liposomes may avoid the stimulation of metastases observed when the drug is administered alone.

Antimetastatic effects of liposome entrapped indomethacin.

The "in vivo"administration of sized liposomes encapsulating indomethacin to mice bearing 3LL tumor, significantly reduced the incidence and/or number of superficial lung metastases. Also liposomes encapsulating indomethacin had significant inhibitory effects on the experimentally induced lung metastases. We conclude: i) indomethacin encapsulated in liposomes is more efficient than the free drug in mediating the antimetastatic effects and ii) liposomes are an valuable vehicle in evading the side metastatic effects of this drug during indomethacin treatment of tumor bearing mice.