De Betekenis van huisdieren in de langdurige thuiszorg.

Achtergrond: Huisdieren zijn belangrijk in het leven van thuiswonende ouderen en van degenen die langdurige thuiszorg (LTZ) ontvangen. Het doel van dit project was om de betekenis van huisdieren voor thuiswonende ouderen te verkennen en te onderzoeken of deze ook van toepassing zijn op LTZ-cliënten. Daarnaast exploreerden we mogelijke huisdiergerelateerde uitdagingen en de invloed van huisdierbezit op zorgrelaties in de LTZ. Methoden: Het project startte met een systematische kwalitatieve literatuur review gevolgd door een studie met de Consensual Qualitative Research (CQR) methode en een onlinevragenlijst om de resultaten van de review in de LTZ te toetsen. LTZ-cliënten, mantelzorgers en professionele zorgverleners namen deel aan de CQR-studie en vragenlijst. De vragenlijst bevatte daarnaast open vragen over mogelijke huisdiergerelateerde uitdagingen en hun invloed op zorgrelaties in de LTZ. Resultaten: De review bevatte vijftien artikelen die achtentwintig rollen gerelateerd aan de betekenis van huisdieren beschreven, onderverdeeld in zeven categorieën. De uitkomsten van de CQR-studie en vragenlijst toonden dat huisdieren een vergelijkbare betekenis hebben voor thuiswonende ouderen en LTZ-cliënten. Deelnemers rapporteerden mogelijke uitdagingen en zowel positieve als negatieve effecten van huisdieren op zorgrelaties. Conclusies: Huisdieren hebben een vergelijkbare betekenis voor thuiswonende ouderen en LTZ-cliënten. Bovendien ervaren LTZ-cliënten mogelijke specifieke huisdiergerelateerde uitdagingen en kunnen huisdieren zorgrelaties beïnvloeden. Daarom is het noodzakelijk om rekening te houden met huisdieren in de LTZ.

[Significance of pets in long-term care at home]. / De Betekenis van huisdieren in de langdurige thuiszorg.

BACKGROUND: Pets are important in the lives of community-dwelling older adults and of those receiving long-term care at home (LTCH). The objective of this project was to explore the significance of pets for community-dwelling older adults and if this also applies for LTCH-clients. Moreover, we investigated potential pet-related challenges and the impact of pet ownership on caregiving relationships in LTCH. METHODS: The project included a systematic qualitative literature review and a Consensual Qualitative Research method (CQR) study and an online survey to confirm the results of the review in LTCH. LTCH-clients, family caregivers, and professional caregivers participated in the CQR study and survey. The survey also included open-questions on potential pet-related challenges and their influence on caregiving relationships in LTCH. RESULTS: The review included fifteen articles describing twenty-eight themes regarding the significance of pets placed in seven categories. Outcomes of the CQR study and survey indicated similar significance of pets for community-dwelling older adults and LTCH-clients. Furthermore, participants reported potential challenges and positive and negative effects of pet ownership on caregiving relationships. CONCLUSIONS: Pets have similar significance for both community-dwelling older adults and LTCH-clients. Moreover, LTCH-clients may experience specific pet-related challenges and may positively or negatively influence caregiving relationships. Thus, it is necessary to account for pets in LTCH.

The roles of pets in long-term care at home: a qualitative study.

BACKGROUND: Pets play very important roles for older adults. However, whether the same roles apply to pets of care clients receiving long-term care at home (LTCH) is unclear. This study aimed primarily to explore whether the roles of pets for LTCH-clients who own pets are comparable to the roles of pets for older adults in the general population. Furthermore, we explored potential pet-related problems that might be encountered in LTCH in practice, and the potential influences of pet ownership on caregiving relationships. These insights may help improve long-term care services in LTCH. METHODS: This project started with a study using the Consensual Qualitative Research method (CQR). We conducted semi-structured interviews based on themes from our previous review (e.g., Relational Aspects, Emotional Aspects, and Social Aspects). Secondly, an online survey was used to confirm the findings from the CQR study by calculating Content Validity Index scores (in SPSS 26) regarding contents, relevance, and clarity. The survey also included open-ended questions on potential pet-related problems and their impact on caregiving relationships for LTCH-clients, family caregivers, and professional caregivers. RESULTS: The CQR study found that the roles pets play for LTCH-clients (N = 8), family caregivers (N = 10), and professional caregivers (N = 10) were similar to the roles pets play for older adults in the general population. The online survey confirmed most of the CQR findings. In the survey, LTCH-clients (N = 4), family caregivers (N = 8), professional caregivers (N = 8), and researchers in human-animal studies and in geriatric care (N = 5) reported various potential problems that could arise from pet ownership by LTCH-clients, such as clients with deteriorating health being forced to part with their pets. Participants also reported potential positive and negative effects of pet ownership on caregiving relationships, such as pets being a nice topic of conversation, or, conversely, a source of disagreement in the LTCH context. CONCLUSIONS: The roles pets play for LTCH-clients seem comparable to the roles pets play for older adults in the general population. In addition, LTCH-clients might experience pet-related problems specific to the LTCH context. Pets may influence caregiving relationships, either positively or negatively. Therefore, instruments and guidelines are needed to account for pets in LTCH.

The role of pets in the support systems of community-dwelling older adults: a qualitative systematic review.

OBJECTIVE: Western countries face ageing populations and increasing numbers of older adults receiving long-term care at home (home care). Approximately 50% of households in Western countries own pets, and while pets impact the health and wellbeing of their owners, most healthcare organisations do not account for the role of pets in the lives of their clients. Due to the lack of research in older adults receiving home care that own pets, this study aimed to review previous qualitative research about the role and significance of pets for older adults in general. METHOD: PubMed and PsycINFO were systematically searched with variations on (MeSH) terms for older adults (mean age 65 years and older), pets, and qualitative study designs. Iterative-inductive thematic analyses were performed in ATLAS.ti. RESULTS: We included fifteen studies and extracted twenty-eight themes within seven categories: Relational Aspects, Reflection and Meaning, Emotional Aspects, Aspects of Caregiving, Physical Health, Social Aspects, and Bidirectional Behaviour. Older adults reported not only on positive aspects of pet ownership such as the emotional support their pets provided but also on negative aspects such as postponing personal medical treatment. CONCLUSION: Older adults perceived pets as important for their health and wellbeing. This implies that care workers may be able to improve home care by accounting for the role of pets of older adults receiving home care. Based on our findings, we suggest that community healthcare organisations develop guidelines and tools for care workers to improve care at home for clients with pets.

Monitored natural attenuation (MNA) of contaminated soils: state of the art in Europe--a critical evaluation.

The use of natural attenuation (NA) processes for contaminated site cleanup and remediation has been gaining more attention over the last few years. However, the need for an inventory of the existing information concerning monitored natural attenuation (MNA), including the existing return on experience, has been sounding increasingly louder over recent years as well. This paper will focus on the application of MNA throughout Europe. First, a literature study and a survey were performed in order to collect all available data on both qualitative and quantitative aspects of MNA. Secondly, a questionnaire was created and sent out to experts in the field of regulation and research from six countries, including Finland, Spain, and the UK. Thirdly, further contributions from a SNOWMAN workshop concerning MNA (November 7th, 2011, Paris) were included in this paper. The result is a state of the art concerning MNA for several countries, including the legal framework and existing protocols, a comparison between different countries, and an overview of some existing MNA cases throughout Europe combined with a discussion on relevant aspects related to "return on experience". The results demonstrate that MNA is now considered to be a conventional remediation technique in most countries that were included in this study. Although MNA is currently being applied for the remediation of contaminated sites, some countries still don't recognise it as an official remediation technique (e.g. Finland). This study also confirms and illustrates the differences concerning the MNA approach that exists between different countries, as well as the differences in application levels. However, it is important to note that at the same time a certain level of coherence exists concerning the MNA approach, e.g. with regard to the importance of biodegradation processes. Furthermore, the main outcome of this study emphasises the clear need to systematically collect and share information concerning existing MNA cases. Only then a clear return of experience will be possible.

Disturbed nuclear orientation and cellular migration in A-type lamin deficient cells.

The nuclear lamina and the cytoskeleton form an integrated structure that warrants proper mechanical functioning of cells. We have studied the correlation between structural alterations and migrational behaviour in fibroblasts with and without A-type lamins. We show that loss of A-type lamins causes loss of emerin and nesprin-3 from the nuclear envelope, concurring with a disturbance in the connection between the nucleus and the cytoskeleton in A-type lamin-deficient (lmna -/-) cells. In these cells functional migration assays during in vitro wound healing revealed a delayed reorientation of the nucleus and the microtubule-organizing center during migration, as well as a loss of nuclear oscillatory rotation. These observations in fibroblasts isolated from lmna knockout mice were confirmed in a 3T3 cell line with stable reduction of lmna expression due to RNAi approach. Our results indicate that A-type lamins play a key role in maintaining directional movement governed by the cytoskeleton, and that the loss of these karyoskeletal proteins has important consequences for functioning of the cell as a mechanical entity.

Cardiac compression by a thymic cyst.

A patient with a giant thymic cyst, causing cardiac compression, is presented. Thymic cysts are uncommon and often asymptomatic.

[Bisphosphonates and maxillo-mandibular osteo(chemo)necrosis]. / Bisphosphonates et ostéo(chimio)nécrose maxillo-mandibulaire.

INTRODUCTION: Maxillo-mandibular osteonecrosis is exceptional outside a context of cervico-facial radiotherapy. Bisphosphonates are non-metabolized pyrophosphate analogues which inhibit osteoclastic activity. Bisphosphonates are prescribed for the treatment of malignant hypercalcemia, osteolysis associated with metastatic bone disease, Paget's disease and osteoporosis. Maxillomandibular osteonecrosis with bisphosphonates can be observed in 1/10000 patients, but is probably underestimated due to lack of dental examination. MATERIAL AND METHODS: We describe six cases of mandibular necrosis associated with bisphosphonates: five of them as part of their treatment regimen for a neoplastic condition and one for osteoporosis. RESULTS: Two patients developed spontaneous bone necrosis. In two others, tooth extraction preceded the onset of osteonecrosis. In the last two patients, we noted a preexisting dental infection. All the histopathological examinations showed necrotic bone colonized by Actinomyces. DISCUSSION: Bisphosphonate-induced osteonecrosis is only found in the maxillomandibular area because the jaws are the only bone in the skeleton exposed to the external environment. The mandible is rendered particularly prone to necrosis even after minor trauma because of its terminal vascularization. Careful oral examination is recommended before prescribing bisphosphonate therapy.

[Chorea-athetosis in the anti-Hu syndrome]. / Mouvements choréo-athétosiques et syndrome anti-Hu.

INTRODUCTION: Paraneoplastic choreo-athetoses are rare. We report a case of anti-Hu syndrome with choreo-athetosis. CASE REPORT: A 48-year-old woman developed a small-cell lung carcinoma revealed by an anti-Hu syndrome. The neurological features included choreo-athetosis predominating in the upper limbs, chronic sensorimotor axonal polyneuropathy, and opsoclonus. The cerebrospinal fluid was acellular and contained several oligoclonal IgG bands, not found in the corresponding serum. Magnetic resonance imaging revealed bilateral high-intensity lesions on T2/FLAIR sequence in the corona radiata. Moderate transitory improvement of the paraneoplastic neurological syndrome was observed after several carboplatin-etoposid cycles. CONCLUSION: A paraneoplastic origin must be considered in all cases of unexplained choreo-athetosis. Paraneoplastic choreo-athetosis is most often associated with other neurological symptoms. The most frequent associated tumor is a small-cell lung carcinoma with anti-CRMP5 and/or anti-Hu antibodies. Our patient developed paraneoplastic choreo-athetosis related to an anti-Hu syndrome in the absence of anti-CRMP5/CV2 antibodies. Paraneoplastic choreo-athetosis might result from a central lesion, and/or from proprioceptive deafferentation subsequent to peripheral neuropathy.

[Fulminant thrombotic thrombocytopenic purpura in the course of ciprofloxacin therapy]. / Purpura thrombotique thrombocytopenique fulminant au decours d'un traitement par ciprofloxacine.

We report on a 43-year-old woman who developed a fulminant thrombotic thrombocytopenic purpura (TTP) in the early course of an oral ciprofloxacin therapy. An acute bacterial meningo-encephalitis with disseminated intravascular coagulation was first suspected. She also presented with haemolytic anaemia and a severe thrombocytopenia. The lumbar puncture was delayed and only performed after platelets transfusions. CSF examination ruled out meningo-encephalitis. A diagnosis of TTP was made and she was given plasma exchanges. However, her neurological status worsened and the cranial CT revealed a subarachnoidal hemorrhage in left sylvian valley with diffuse oedema predominating in the left cerebral hemisphere and multiple ischemic lacunes. She died four days after admission.

[Central reparative giant cell granuloma of the maxilla. Apropos of a case]. / Granulome réparateur central à cellules géantes des maxillaires. A propos d'un cas.

Central giant cell granulomas are uncommon, locally aggressive and benign tumors of the maxillofacial skeleton. The authors report a case of tumor arising from the maxilla and present a review of essential characteristics of the lesion.