Implementation and evaluation of a nurse-allied health clinic for patients after haematopoietic stem cell transplantation.

PURPOSE: Patients who undergo haematopoietic stem cell transplantation (HSCT) often have multiple health issues following hospital discharge. In many centres, outpatient follow-up is solely conducted by specialist physicians. We aimed to implement and describe the outcomes of a nurse-allied health multidisciplinary clinic. METHODS: The clinic consisted of six disciplines-nursing, pharmacy, dietetics, physiotherapy, occupational therapy and social work. All allogeneic and high risk autologous HSCT patients were reviewed at 2 weeks after discharge and on day 100 post HSCT, with additional reviews as needed. Occasions of service, interventions, readmission data and physician satisfaction survey were collected prior to and after implementation. Additionally, patient feedback and quality of life survey (FACT-BMT) were collected during the first 6 months. RESULTS: From July to December 2019, 57 patients were reviewed in the clinic (475 reviews, average 8.3 reviews per patient). Common interventions included the following: exercise programs by physiotherapist (n = 111), diet prescription (n = 103), counselling by social worker (n = 53), medication lists provision (n = 51), fatigue management (n = 43) and nurse education (n = 22). The clinic did not reduce patients' readmission rate; however, positive feedback from patients and physicians were reported. FACT-BMT results demonstrated that there are unmet needs, particularly fatigue management, sexual education and support, body images, back to work support and quality of life improvement. From discharge to day 100, there was no significant improvement in quality of life. CONCLUSIONS: This clinic provides an innovative approach to patient-centred care in HSCT. It has been well received by patients who were supported by multidisciplinary interventions.

The effects of surgical lengthening of hamstring muscles in children with cerebral palsy--the consequences of pre-operative muscle length measurement.

Children with cerebral palsy often undergo multiple orthopaedic surgical procedures in a single episode. Evidence of the effectiveness of individual components within the overall package is sparse. The introduction of musculoskeletal modelling in Oswestry has led to a more conservative management approach being taken with hamstring muscles for children walking in a degree of crouch. Muscles which were shown to be of at least normal length at initial contact were not surgically lengthened, as would have been the case previously. A retrospective review of 30 such patients was therefore possible, comparing 15 patients treated before the policy change who had their hamstrings lengthened with 15 treated after who did not. All patients had pre and post operative gait assessments and significant changes were observed for each group separately and for the two groups when compared. The comparison revealed that preserving the hamstrings does tend to reduce, and therefore normalize, the dynamic muscle length. Examination of the two patient groups separately, however, reveals a more complex picture with more global gait improvements seen when the hamstrings were lengthened. No absolute recommendation can be made to inform the clinical management of all children with normal to long hamstring muscles during gait. The final decision of whether to include a hamstring lengthening will need to take into account the characteristics of the individual child.

Nicotine modifies in vivo and in vitro rat hippocampal amyloid precursor protein processing in young but not old rats.

Previous studies have shown that administration of nicotine modifies the expression and secretion of amyloid precursor protein (APP) in various cell lines. The present study investigated the extent to which chronic subcutaneous nicotine administration influences APP levels and processing in cerebral cortex, striatum and hippocampus of young and old rat brains. The results showed that constant nicotine infusion (0.25 or 4.00mg/kg/day) increased the levels of particulate APP (APPp) but not secreted APP (APPs) in the hippocampus of young rats in vivo. This response to nicotine was not observed in the striatum or cerebral cortex of young rats or in any of the brain regions examined in old animals. Subsequent in vitro analysis demonstrated that nicotine enhanced the release of APPs from hippocampal slice preparations and that this increase was attenuated by mecamylamine, a non-selective nicotinic acetylcholine receptor (nAChR) antagonist. The in vitro effect of nicotine on APPs was age-related, being only detected from hippocampal slices derived from the young but not the older animals. These results suggest that nicotine modulates APP expression and secretion in the hippocampus and that the responses observed to the drug are age-dependent being only detected in younger rats.

The effects of chronic nicotine on spatial learning and bromodeoxyuridine incorporation into the dentate gyrus of the rat.

RATIONALE: Nicotine is reported to improve learning and memory in experimental animals. Improved learning and memory has also been related to increased neurogenesis in the dentate gyrus (DG) of the hippocampal formation. Surprisingly, recent studies suggest that self-administered nicotine depresses cell proliferation in the DG. OBJECTIVE: To test the hypothesis that the effects of nicotine on cell proliferation in the DG and learning and memory depend upon the nicotine dose administered. METHODS: Rats were chronically infused from subcutaneous osmotic mini pumps with nicotine (0.25 or 4 mg kg(-1) day(-1)) or the saline vehicle for 10 days. Half the rats in each treatment group were trained to locate a hidden platform in a water maze task on days 4-7; a probe trial was performed on day 8. The remaining rats remained in their home cages. The effects of nicotine and of training in the water maze task on cell genesis in the DG were determined by measuring 5-bromo-2'-deoxyuridine (BrDU) uptake using fluorescence immunohistochemistry. RESULTS: Training in the water maze task increased cell proliferation in the DG. Infusions of nicotine at 4 mg kg(-1) day(-1), but not 0.25 mg kg(-1) day(-1), decreased cell proliferation in both untrained animals and animals trained in the maze and impaired spatial learning. CONCLUSIONS: The data suggest that learning in the water maze task is impaired by higher doses of nicotine tested, and that this response may be related to reduced cell genesis in the DG.