Systemic effects of treatment with mTOR inhibitors in tuberous sclerosis complex: a comprehensive review.

Tuberous sclerosis complex (TSC) is a genetic multisystem disorder associated with constitutive overactivation of the mammalian target of rapamycin (mTOR) pathway and characterized by development of benign tumours in various organs. mTOR inhibitors have proven to be effective in the targeted therapy of certain TSC-associated pathologies such as subependymal giant cell astrocytomas (SEGAs) and renal angiomyolipomas (AMLs). Accumulating experimental and clinical data suggest that mTOR inhibitors might have a systemic, disease-modifying influence on affected individuals. This systematic review provides an analysis of available clinical data concerning systemic effect of mTOR inhibitors and the influence of mTOR inhibition on different manifestations of TSC in individual patients.

[Situation of acute inpatient geriatric patients. A retrospective analysis of health care processes of geriatric and non-geriatric patients with acute myocardial infarction]. / Akutstationäre Versorgungssituation geriatrischer Patienten. Retrospektive Analyse der Versorgungsverläufe geriatrischer und nichtgeriatrischer Patienten mit akutem Myokardinfarkt.

BACKGROUND: Although cardiovascular diseases belong to the most frequent causes of inpatient treatment of older people the specific characteristics of geriatric patients in the acute care unit still receive marginal attention. The aim of this study was the descriptive representation of clinical health care processes of geriatric and non-geriatric patients with acute myocardial infarction. PATIENTS AND METHODS: Using a retrospective document analysis 83 medical patient records were examined with regard to nursing, therapeutic as well as medical measures and social counseling. The classification in geriatric and non-geriatric patients was based on a predefined list of criteria. RESULTS: In the study a total of 48 geriatric and 35 non-geriatric patients could be identified. There was a comprehensive need for support of nursing and therapeutic care, a high frequency of complications and a long length of stay as well as specifics concerning the place of discharge in geriatric patients. CONCLUSIONS: Complex problems and special care needs of geriatric patients with acute myocardial infarction were shown. This vulnerable group of patients should be given more attention in acute care. Further investigations with a prospective character are necessary in order to detect the specific needs of geriatric patients in acute care.

Use of a physician consultant in a primary care nursing practice.

This article describes a study of the nature of consultation requests made to a physician consultant by nurse practitioners in an urban university-affiliated ambulatory nursing practice. During a 50-week period, 1,504 client encounters resulted in 225 consultations, an average consultation rate of 15 percent. The types of consultation requests, the medical specialty to which the content of the request related and the outcomes of the consultations were recorded in a consultation log. Knowledge of the pattern and nature of consultation needs has multiple benefits. Careful study of practice needs may assist in determining the qualifications of a prospective consultant and the amount of time required for on-site consultation. Such a study may provide insight into the types of problems seen in the practice and identify areas of need for continuing education and protocol development. The consultation process enhances continuity of care, while knowledge of practice needs for consultation may lead to more efficient, cost-effective health care.