Predictors for achieving adequate protein and energy intake in nursing home rehabilitation patients.

BACKGROUND: Adequate energy and protein intake could be essential for contributing significantly to the rehabilitations process. Data on the actual nutritional intake of older nursing home rehabilitation patients have not yet been investigated. AIMS: To investigate the nutritional intake and predictors for achieving protein and energy requirements on the 14th day of admission in nursing home rehabilitation patients. METHODS: Fifty-nine patients aged 65+ years newly admitted to nursing home rehabilitation wards were included. Data on potential variables were collected on admission. On the fourteenth day nutritional intake was assessed. Intake was considered 'adequate' if patients had achieved ≥ 1.2 g of protein/kg bodyweight and ≥ 85% of their energy needs according to Harris and Benedict + 30%. Multiple logistic regression analyses were performed to select predictors for adequate intake. RESULTS: Protein and energy intake was assessed in 79 patients [67% female, mean age 82 ± (SD) 8 years, BMI 25 ± 6 kg/m2]. Mean energy intake was 1677 kcal (± 433) and mean protein intake was 68 g (± 20). Fourteen patients (18%) achieved an adequate protein and energy intake. Predictors for adequate intake were use of sip/tube feeding (OR = 7.7; 95% CI = 1.35-44.21), BMI (0.68; 0.53-0.87) and nausea (8.59; 1.42-52.01). CONCLUSION: Only 18% of older nursing home rehabilitation patients had an adequate protein and energy intake at 14 days after admission. Patients with higher BMI were less likely, while those using sip/tube feeding or feeling nauseous were more likely to achieve an adequate protein and energy intake.

Undernutrition in nursing home rehabilitation patients.

OBJECTIVE: To examine the prevalence of undernutrition, received dietetic treatment and self-perception of nutritional status in older patients admitted to Dutch nursing home rehabilitation wards. METHODS: Between December 2012-February 2014, we included 190 patients (≥65 y) admitted to seven nursing home rehabilitation wards. Nutritional status in the first week of admission was characterized as: severely undernourished (>10% unintentional weight loss in the past six months and/or >5% unintentional weight loss in the past month and/or BMI < 20 kg/m2), moderately undernourished (5-10% unintentional weight loss in the past 6 months and/or BMI 20-22 kg/m2), well-nourished (<5% unintentional weight loss in the past 6 months and BMI 22-28 kg/m2) and overweight (BMI>28 kg/m2). Primary diagnosis was categorized as: trauma, elective orthopaedics, stroke and other. Perceived nutritional status was determined with the question: 'Do you currently consider yourself undernourished?' (yes/no). Information regarding dietetic treatment was obtained from medical records. RESULTS: A complete dataset was obtained from 179 patients (70% female, age 81 ± 8 y). 26% of the patients was found to be severely undernourished and 14% moderately undernourished. Prevalence of undernutrition did not differ by sex or age. Of all undernourished patients, 56% had been treated by a dietitian. Only one out of five of undernourished patients considered themselves undernourished. Elective orthopaedics patients had the lowest prevalence of undernutrition (19%) while patients categorised as 'other' had the highest prevalence (51%). CONCLUSION: More than one in three older patients in Dutch nursing home rehabilitation wards are moderately to severely undernourished. Out of these patients the majority does not consider themselves undernourished and almost half has not received dietetic treatment. More attention to undernutrition in nursing home rehabilitation patients seems necessary.

Interaction between tramadol and selective serotonin reuptake inhibitors: are doctors aware of potential risks in their prescription practice?

OBJECTIVES: The combination of a selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitor (SNRI) with tramadol can result in serotonin syndrome, characterised by neuromuscular and autonomic nervous system excitation and altered mental state. The incidence of serotonin syndrome with this combination of drugs is low, and the serotonin syndrome is generally mild or moderate in form, but can be life threatening and is more easily prevented than treated. We aimed to investigate whether prescribers in a general hospital were aware of this risk and if it influenced their prescriptions. METHODS: A questionnaire was sent to 194 physicians in a general teaching hospital with over 650 beds in The Netherlands. The questionnaire presented four cases, two of whom used an SSRI or SNRI among other medications, and asked the respondents to prescribe an opioid in each case. The respondents were not aware of the focus of our research. Actual prescription rates of tramadol in admitted patients who did or did not use an SSRI or SNRI were assessed using the hospital pharmacy database. RESULTS: Based on the questionnaire, respondents prescribed tramadol equally in patients with or without concomitant use of SSRIs/SNRIs. About one-third of respondents who prescribed tramadol indicated they were aware of the potential interaction with SSRIs/SNRIs. About one-fifth deliberately avoided tramadol because a potential interaction with SSRIs/SNRIs was identified. However, there was no difference in actual tramadol prescriptions, as recorded in the hospital pharmacy database: 23.8% of SSRI/SNRI users received tramadol versus 24.6% of non-SSRI/SNRI-users (calculated OR 0.96; 95% CI 0.78 to 1.17). CONCLUSIONS: In total, 20-30% of prescribers in a general hospital were aware of the potential interaction between tramadol and SSRIs or SNRIs, yet this did not translate to a difference in tramadol prescriptions between SSRI/SNRI users and non-users, as documented in the hospital pharmacy database. A physician's decision to prescribe tramadol to SSRI/SNRI users may be guided by a comprehensive individual benefit-risk assessment; expected benefits of tramadol may outweigh the small risk of serotonin syndrome. In order to increase awareness of the potential risk of a serotonin syndrome, hospital pharmacies may play an important role in signalling the potential interaction and providing information on the benefits and risks of tramadol and alternative analgesics in the presence of SSRIs or SNRIs.

Results from a horizon scan on risks associated with transplantation of human organs, tissues and cells: from donor to patient.

The successful transplantation of human materials such as organs, tissues and cells into patients does not only depend on the benefits, but also on the mitigation of risks. To gain insight into recent publications on risks associated with the process of transferring human materials from donor to recipient we performed a horizon scan by reviewing scientific literature and news websites of 2011 on this subject. We found there is ample information on how extended donor criteria, such as donor age, affect the survival rates of organs or patients. Interestingly, gender mismatch does not appear to be a major risk factor in organ rejection. Data on risks of donor tumor transmission was very scarce; however, risk categories for various tumor types have been suggested. In order to avoid rejection, a lot of research is directed towards engineering tissues from a patient's own tissues and cells. Some but not all of these developments have reached the clinic. Developments in the field of stem cell therapy are rapid. However, many hurdles are yet to be overcome before these cells can be applied on a large scale in the clinic. The processes leading to genetic abnormalities in cells differentiated from stem cells need to be identified in order to avoid transplantation of aberrant cells. New insights have been obtained on storage and preservation of human materials, a critical step for success of their clinical use. Likewise, quality management systems have been shown to improve the quality and safety of human materials used for transplantation.

Development of a needs assessment system in rehabilitation.

The aim of this project was to develop a standardized, valid and reliable instrument for determining needs of patients and quality of care as perceived by patients. A questionnaire was constructed based upon the Service Quality Model. This model, patient expectations and experiences all play an important role in the questionnaire. The questionnaire contains a general part which includes ten determinants of care, the information the patient got and the perceived quality of care in general. The questionnaire also contains a specific part which includes questions about the actual care for diagnosis related problems. Twenty-four spinal cord injured patients, staying at a Dutch rehabilitation centre, participated in this study. It is concluded that with the developed questionnaire the perceived quality of care according to the Service Quality Model can be assessed. Major contributions of the questionnaire to rehabilitation care will be its ability to highlight patient needs related to identified symptoms, and to provide a tool to signal aspects in the organization that can be improved. Thus it becomes a tool for quality management. Recommendations have been made for further research to make future use of the questionnaire in other settings and populations possible.

Development of an AFLP based linkage map of Ler, Col and Cvi Arabidopsis thaliana ecotypes and construction of a Ler/Cvi recombinant inbred line population.

An amplified fragment polymorphism (AFLP) based linkage map has been generated for a new Landsberg erecta/ Cape Verde Islands (Ler/Cvi) recombinant inbred line (RIL) population. A total of 321 molecular PCR based markers and the erecta mutation were mapped. AFLP markers were also analysed in the Landsberg erecta/Columbia (Ler/Col) RIL population (Lister and Dean, 1993) and 395 AFLP markers have been integrated into the previous Arabidopsis molecular map of 122 RFLPs, CAPSs and SSLPs. This enabled the evaluation of the efficiency and robustness of AFLP technology for linkage analyses in Arabidopsis. AFLP markers were found throughout the linkage map. The two RIL maps could be integrated through 49 common markers which all mapped at similar positions. Comparison of both maps led to the conclusion that segregating bands from a common parent can be compared between different populations, and that AFLP bands of similar molecular size, amplified with the same primer combination in two different ecotypes, are likely to correspond to the same locus. AFLPs were found clustering around the centromeric regions, and the authors have established the map position of the centromere of chromosome 3 by a quantitative analysis of AFLP bands using trisomic plants. AFLP markers were also used to estimate the polymorphism rate among the three ecotypes. The larger polymorphism rate found between Ler and Cvi compared to Ler and Col will mean that the new RIL population will provide a useful material to map DNA polymorphisms and quantitative trait loci.

AFLP: a new technique for DNA fingerprinting.

A novel DNA fingerprinting technique called AFLP is described. The AFLP technique is based on the selective PCR amplification of restriction fragments from a total digest of genomic DNA. The technique involves three steps: (i) restriction of the DNA and ligation of oligonucleotide adapters, (ii) selective amplification of sets of restriction fragments, and (iii) gel analysis of the amplified fragments. PCR amplification of restriction fragments is achieved by using the adapter and restriction site sequence as target sites for primer annealing. The selective amplification is achieved by the use of primers that extend into the restriction fragments, amplifying only those fragments in which the primer extensions match the nucleotides flanking the restriction sites. Using this method, sets of restriction fragments may be visualized by PCR without knowledge of nucleotide sequence. The method allows the specific co-amplification of high numbers of restriction fragments. The number of fragments that can be analyzed simultaneously, however, is dependent on the resolution of the detection system. Typically 50-100 restriction fragments are amplified and detected on denaturing polyacrylamide gels. The AFLP technique provides a novel and very powerful DNA fingerprinting technique for DNAs of any origin or complexity.

Delayed rupture of the extensor pollicis longus tendon: a retrospective study.

Eight patients with delayed rupture of the extensor pollicis longus tendon are presented. Six had suffered from a fracture of the wrist without dislocation. This is in our opinion a predisposing factor in the etiology of delayed tendon rupture. Our treatment of choice is transfer of the extensor indicis proprius tendon. In all patients satisfactory thumb function was restored.

Coat protein of melon necrotic spot carmovirus is more similar to those of tombusviruses than those of carmoviruses.

Complementary DNA copies of the genomic RNA of melon necrotic spot virus (MNSV) have been cloned and the region deduced to encode the coat protein has been sequenced. The putative coat protein coding region, located near the 3' end of the genome, consists of 1170 nucleotides and has the potential to encode a 390 amino acid protein of Mr 41,840. Our data show that although MNSV is a carmovirus, its coat protein more closely resembles those of the tombusviruses than those of the carmoviruses sequenced to date, in both the extent of sequence similarity and in the length of the random/arm and protruding domains of the coat protein. Furthermore, dot matrix comparisons revealed sequence similarity between the coat protein protruding domains of MNSV and the cucumber necrosis tombusvirus. This similarity may be involved in one or more of the biological properties these two viruses share, such as the ability to infect cucumbers naturally and to be transmitted by the soil-inhabiting fungus Olpidium radicale.

Acute traumatic bowing fracture of the forearm.

A patient with an acute traumatic bowing fracture of the forearm is reported. Roentgenologic aspects are discussed; relevant biomechanical and surgical features are summarized.

The value of parasternal mediastinotomy.

Parasternal mediastinotomy was performed in 28 patients. Positive findings were obtained in 12 patients (43%). The indications and findings are described. It has been found to be a simple and safe diagnostic, therapeutic and lung cancer staging procedure with a low morbidity.