ABSTRACT
Inhibitory synapse dysfunction may contribute to many developmental brain disorders, including the secondary consequences of sensory deprivation. In fact, developmental hearing loss leads to a profound reduction in the strength of inhibitory postsynaptic currents (IPSCs) in the auditory cortex, and this deficit persists into adulthood. This finding is consistent with the general theory that the emergence of mature synaptic properties requires activity during development. Therefore, we tested the prediction that inhibitory strength can be restored following developmental hearing loss by boosting GABAergic transmission in vivo. Conductive or sensorineural hearing loss was induced surgically in gerbils prior to hearing onset and GABA agonists were then administered for one week. IPSCs were subsequently recorded from pyramidal neurons in a thalamocortical brain slice preparation. Administration of either a GABA(A) receptor a1 subunit specific agonist (zolpidem), or a selective GABA reuptake inhibitor (SGRI), rescued IPSC amplitude in hearing loss animals. Furthermore, this restoration persisted in adults, long after drug treatment ended. In contrast, a GABA(B) receptor agonist baclofen did not restore inhibitory strength. IPSCs could also be restored when SGRI administration began 3 weeks after sensory deprivation. Together, these results demonstrate long-lasting restoration of cortical inhibitory strength in the absence of normal experience. This suggests that in vivo GABA(A) receptor activation is sufficient to promote maturation, and this principle may extend to other developmental disorders associated with diminished inhibitory function.
Subject(s)
Gerbillinae/physiology , Hearing Loss/physiopathology , Neural Inhibition , Synapses/pathology , Animals , Baclofen/pharmacology , Baclofen/therapeutic use , Cochlea/drug effects , Cochlea/physiopathology , GABA Uptake Inhibitors/pharmacology , GABA Uptake Inhibitors/therapeutic use , GABA-A Receptor Agonists/pharmacology , GABA-A Receptor Agonists/therapeutic use , Hearing Loss/drug therapy , Hearing Loss/pathology , Inhibitory Postsynaptic Potentials/drug effects , Neural Inhibition/drug effects , Pyridines/pharmacology , Pyridines/therapeutic use , Receptors, GABA-A/metabolism , Synapses/drug effects , ZolpidemABSTRACT
BACKGROUND: There are few studies that examine the processes that interdisciplinary teams engage in and how we can design health information systems (HIS) to support those team processes. This was an exploratory study with two purposes: (1) To develop a framework for interdisciplinary team communication based on structures, processes and outcomes that were identified as having occurred during weekly team meetings. (2) To use the framework to guide 'e-teams' HIS design to support interdisciplinary team meeting communication. METHODS: An ethnographic approach was used to collect data on two interdisciplinary teams. Qualitative content analysis was used to analyze the data according to structures, processes and outcomes. RESULTS: We present details for team meta-concepts of structures, processes and outcomes and the concepts and sub concepts within each meta-concept. We also provide an exploratory framework for interdisciplinary team communication and describe how the framework can guide HIS design to support 'e-teams'. CONCLUSION: The structures, processes and outcomes that describe interdisciplinary teams are complex and often occur in a non-linear fashion. Electronic data support, process facilitation and team video conferencing are three HIS tools that can enhance team function.
Subject(s)
Interdisciplinary Communication , Patient Care Team/organization & administration , Anthropology, Cultural , British Columbia , Decision Support Systems, Clinical/organization & administration , HumansABSTRACT
PURPOSE/OBJECTIVES: To describe women's experiences with lower limb lymphedema to inform both preventive and management clinical practices. DESIGN: A retrospective survey. SETTING: The gynecology/oncology unit of a tertiary referral women's hospital in Australia. SAMPLE: 82 women who developed lower limb lymphedema after surgical and radiation treatment for gynecologic cancers. METHODS: Structured interviews. MAIN RESEARCH VARIABLES: Psychosocial and emotional impact, physical effects, knowledge, support, treatment modalities. FINDINGS: Women identified changes in appearance and sensation in the legs and the triggers that both preceded and exacerbated symptoms. Women described seeking help and receiving inappropriate advice with as many as three assessments prior to referral to lymphedema specialists. Many women implemented self-management strategies. Lower limb lymphedema had an impact on appearance, mobility, finances, and self-image. CONCLUSIONS: Increasing longevity after gynecologic oncology treatment requires all practitioners to be aware of known or potential triggers of lower limb lymphedema and the appropriate referral and management strategies available. Women at risk need to know early signs and symptoms and where to seek early care. IMPLICATIONS FOR NURSING: The role of nursing in acute and community care of women at risk for developing lower limb lymphedema includes (a) engaging women in protecting their legs from infection or trauma pre- and postoperatively, (b) providing nursing care and education during the pre- and postoperative phases, and (c) ensuring that women being discharged are aware of early signs and symptoms of lower limb lymphedema and how to access qualified, specialized therapists so that early and effective management can be initiated.
Subject(s)
Genital Neoplasms, Female/complications , Lymphedema/nursing , Lymphedema/psychology , Patient Education as Topic/statistics & numerical data , Quality of Life , Adaptation, Psychological , Bandages , Clothing , Cohort Studies , Female , Genital Neoplasms, Female/radiotherapy , Genital Neoplasms, Female/surgery , Humans , Interviews as Topic/methods , Leg , Life Style , Lymphedema/rehabilitation , Pain/etiology , Patient Education as Topic/methods , Patient Education as Topic/standards , Physical Therapy Modalities , Population Surveillance , Referral and Consultation/statistics & numerical data , Retrospective StudiesABSTRACT
OBJECTIVE: To determine the prevalence and incidence of lower limb lymphoedema (LLL) in a cohort of women who had treatment for gynaecological cancer between May 1995 and April 2000. DESIGN: A retrospective survey. SETTING: The study took place at an urban referral centre in an Australian tertiary referral women's hospital. SAMPLE: The data collection was based on 66% of 743 women on the database of the Gynaecological Cancer Centre. METHODS: Interviews and assessments were conducted to determine the status of lower limbs; medical records were reviewed for age, weight, site and type of cancer and treatment. MAIN OUTCOME MEASURES: Leg swelling, diagnosed lower limb lymphoedema, no swelling of the legs and type of surgery were determined as the main outcome measures. RESULTS AND CONCLUSIONS: The diagnosis of lower limb lymphoedema was made in 18% of the total sample: 53% of these were diagnosed within 3 months of treatment, a further 18% within 6 months, 13% within 12 months and the remaining 16% up to 5 years following treatment. Women most at risk for developing LLL were those who had treatment for vulvar cancer with removal of lymph nodes and follow up radiotherapy. For this subsample, the prevalence was 47%. The finding that LLL occurs within the first year is earlier than hitherto generally believed. It is therefore imperative for all health professionals to include care and assessment of the legs particularly during the immediate pre- and postoperative period.
