Time-course of neopterin levels in patients suffering from severe sepsis treated with and without Drotrecogin-alpha (activated).

Neopterin is secreted by activated monocytes/macrophages upon stimulation with interferon-gamma. The release of this pro-inflammatory mediator permits the activation status of cell-mediated immune system to be examined. We assayed neopterin plasma concentrations in septic patients under treatment with (n=10) and without Drotrecogin-alpha (activated) (n=10) on d 1 and 6 of severe sepsis. In septic patients treated with Drotrecogin-alpha (activated), neopterin levels decreased significantly (p=0.027) from d 1 (baseline) (mean 140.8 nmol/l, +/-standard error of mean (SEM) 106.2) to d 6 (mean 68.9 nmol/l, +/-SEM 46.4). In patients not treated with Drotrecogin-alpha (activated) there was no significant (p=0.96) decrease of neopterin levels from d 1 (mean 147.8 nmol/l, +/-SEM 58.4) to d 6 (mean 139.7 nmol/l, +/-SEM 52.6). Furthermore, neopterin levels showed significant correlations with bilirubin in all patient groups on d 1 of severe sepsis (range of correlation coefficient, r: 0.69-0.88; p<0.05). Neopterin levels correlated significantly with creatinine with regard to all patient groups (range of correlation coefficient, r: 0.73-0.92; p<0.05). In conclusion, Drotrecogin- alpha (activated) was associated with a significant decrease of neopterin plasma levels in septic patients. Neopterin concentrations appear to depend on renal function and enterohepatic circulation.

Can words hurt? Patient-provider interactions during invasive procedures.

Patients are often prepared for procedural discomforts with descriptions of pain or undesirable experiences. This practice is thought to be compassionate and helpful, but there is little data on the effect of such communicative behavior. This study assesses how such descriptions affect patients' pain and anxiety during medical procedures. The interactions of patients with their healthcare providers during interventional radiological procedures were videotaped during a previously reported 3-arm prospective randomized trial assessing the efficacy of self-hypnotic relaxation. One hundred and fifty-nine videos of the standard care and attention control arms were reviewed. All statements that described painful or undesirable experiences as warning before potentially noxious stimuli or as expression of sympathy afterwards were recorded. Patients' ratings of pain and anxiety on 0-10 numerical scales (0=No Pain, No Anxiety at All and 10=Worst Pain Possible, Terrified) after the painful event and/or sympathizing statement were the basis for this study. Warning the patient in terms of pain or undesirable experiences resulted in greater pain (P<0.05) and greater anxiety (P<0.001) than not doing so. Sympathizing with the patient in such terms after a painful event did not increase reported pain, but resulted in greater anxiety (P<0.05). Contrary to common belief, warning or sympathizing using language that refers to negative experiences may not make patients feel better. This conclusion has implications for the training in medical communication skills and suggests the need for randomized trials testing different patient-practioner interactions.