ABSTRACT
OBJECTIVE: design and evaluate a document to enable older inpatients in an NHS hospital to discuss and record end-of-life healthcare preferences. DESIGN: user and professional collaboration to design the Expression of Healthcare Preferences (EHP). Prospective questionnaire survey and outcome evaluation. SETTING AND PARTICIPANTS: inpatients on wards for older adults in a London NHS Hospital Trust. RESULTS: the EHP consists of a form and explanatory booklet. 95 patients (mean age 81, median MMSE 28) received the EHP. 61 (64% (54-74%)) read the EHP and 29 (48% (35-61%)) of these recorded their healthcare preferences in the EHP form. The form prompted end-of-life care discussions between 43% (30-57%) of these patients and medical staff and between 52 (38-65) of these patients and "those close to them". The EHP was highly rated: on a score of 1 to 10 it was thought to be helpful (median score 8), interesting (8), informative (8) and reassuring (7) but not upsetting (1). CONCLUSION: the EHP is an end-of-life advance healthcare planning tool that we have shown can be used to prompt older inpatients to discuss and record their end-of-life healthcare preferences.
Subject(s)
Advance Directives , Health Services for the Aged/organization & administration , Patient Care Planning/organization & administration , Patient Satisfaction , State Medicine , Surveys and Questionnaires , Advance Directives/psychology , Aged , Aged, 80 and over , Confidence Intervals , Data Collection , Delivery of Health Care/methods , Female , Hospitals, Special , Humans , Male , Middle Aged , Terminal Care , United KingdomABSTRACT
Intermittent failures of healthcare delivery culminating in patient safety incidents are an international problem. Collecting information on incidents and where necessary analysing causes allows problems to be identified which, when resolved, can prevent future errors and incidents. To support incident reporting, it is vital to have an effective data collecting system and, in addition, an open and fair culture where those who report are supported and not punished. Where this has been introduced, large numbers of incidents are identified and solutions that improve patient safety can be implemented.
Subject(s)
Organizational Culture , Safety Management/organization & administration , Employee Performance Appraisal , Health Facility Environment/organization & administration , Humans , Public Relations , United KingdomABSTRACT
Some common childhood infections appear to prevent the development of atopy and asthma. In some Mycobacterium bovis BCG-vaccinated populations, strong delayed-type hypersensitivity responses to mycobacterial antigens are associated with a reduced risk of atopy. Although BCG exposure decreases allergen-induced lung eosinophilia in animal models, little attention has been given to the effect of immunity to BCG on responses against live pathogens. We used the murine Cryptococcus neoformans infection model to investigate whether prior BCG infection can alter such responses. The present study shows that persistent pulmonary BCG infection of C57BL/6 mice induced an increase in gamma interferon, a reduction in interleukin-5, and a decrease in lung eosinophilia during subsequent Cryptococcus infection. This effect was long lasting, depended on the presence of live bacteria, and required persistence of mycobacterial infection in the lung. Reduction of eosinophilia was less prominent after infection with a mutant BCG strain (DeltahspR), which was rapidly cleared from the lungs. These observations have important implications for the development of vaccines designed to prevent Th2-mediated disease and indicate that prior lung BCG vaccination can alter the pattern of subsequent host inflammation.
Subject(s)
BCG Vaccine/immunology , Cryptococcosis/pathology , Interferon-gamma/physiology , Pulmonary Eosinophilia/prevention & control , Adoptive Transfer , Animals , CD4-Positive T-Lymphocytes/immunology , CD8-Positive T-Lymphocytes/immunology , Female , Flow Cytometry , Interleukin-4/biosynthesis , Interleukin-5/biosynthesis , Lung/pathology , Mice , Mice, Inbred C57BL , Th2 Cells/immunology , VaccinationABSTRACT
Acredita-se que a produçäo abundante de fator de necrose tumoral alfa (TNFÓ) por macrófagos alveolares e outras células pode contribuir para o desenvolvimento de dano pulmonar permanente em muitas doenças inflamatórias. Há a necessidade de um agente, sem os efeitos colaterais dos corticosteróides, que possa reduzir a produçäo de TNFÓ pelos macrófagos ativados pela doença. Este estudo avaliou o efeito da talidomida na produçäo de TNFÓ induzida por lipopolissacarídeo (LPS) pelos macrófagos alveolares obtidos de pacientes com tuberculose e outras doenças associadas com a ativaçäo de macrófagos. Macrófagos alveolares obtidos de lavado broncoalveolar de 31 pacientes (tuberculose: 12, sarcoidose: 3, câncer do pulmäo: 5, bronquite crônica: 5, pneumonia: 6) forma estimulados com LPS isoladamente ou com LPS combinado ou com talidomida ou com dexemetasona. TNFÓ associado à célula, analisado por imunocitoquímica ou TNFÓ liberado por macrófagos, avaliado pelo método de ELISA, estavam muito aumentados nas células incubadas com LPS (p<0,05) e ambos estavam diminuidos após a adiçäo de talidomida (p<0,05) ou de dexametasona(p<0,05) atingindo níveis semelhantes aos observados quando os macrófagos eram incubados apenas com meio de cultura. Domesmo modo, a medida do mRNA do TNFÓ, medido pela hibridizaçäo in situ (ISH), aumentava após a incubaçäo com LPS (p<0,05) mas este aumento näo ocorria quando se adicionava talidomida (p<0,05) ou dexametasona (p<0,05). A capacidade da talidomida em reduzir a produçäo de TNFÓ induzida pelo LPS pelos macrófagos alveolares era a mesma tanto nas células de pacientes com tuberculose como dos pacientes com outras doenças. A capacidade da talidomida em reduzir a produçäo de TNFÓ por macrófagos alveolares destes pacientes com pneumopatias em atividade neste experimento sugere que ela, ou seus análogos, possam ter potencial medicamentoso em reduzir a produçäo de TNFÓ na doença clínica
