"They're kept in a bubble": Healthcare professionals' views on transitioning young adults with congenital heart disease from paediatric to adult care.

BACKGROUND: Due to medical advances, growing numbers of adolescents with congenital heart disease (CHD) survive into adulthood and transferring from paediatric to adult healthcare. This transfer is significant step in a young person's life, and this study examines the views of Irish healthcare professionals' on how best to manage this transition. METHODS: Purposeful sampling was used to invite participation by healthcare professionals (HCPs) from a variety of disciplines whose caseloads include adolescents and young adults with CHD. Fourteen professionals participated in semistructured interviews regarding their experiences of the transition process and their recommendations. Data were collected during Spring 2016 and analysed using thematic analysis. RESULTS: Results indicated that the current approach to transition and transfer could be improved. Professionals identified barriers hindering the transition process such as cultural and attitudinal differences between HCPs dealing with child and adult patients, inadequate preparation and education of patients about their condition, parental reluctance to transfer, and concern about parents' role in on-going treatment. Measures such as better support and education for both the patients and their parents were recommended, in order to facilitate a smoother transition process for all parties involved. Additionally, HCPs identified the need for better collaboration and communication, both between paediatric and adult healthcare professionals and between hospitals, to ensure greater continuity of care for patients. CONCLUSIONS: Action is required in order to improve the current transition process. Measures need to be taken to address the barriers that currently prevent a smooth transition process for young adult CHD patients. Professionals recommended the implementation of a structured transition clinic to deal with the wide variety of needs of transitioning adolescent patients and their families. Recommendations for future research are also made.

Multiple responses to administration of liposome-encapsulated hemoglobin (LEH): Effects on hematopoiesis and serum IL-6 levels.

Liposome-encapsulated hemoglobin (LEH) has been tested in animals as an oxygen-carrying red cell substitute and has been shown to be beneficial in the treatment of hemorrhagic shock. The effects of LEH on immune responses have not been studied thoroughly in any well-controlled model. Using a murine model, we evaluated nephrotoxicity and hepatotoxicity as well as immune function parameters following LEH administration. Following intravenous administration of LEH, 1) a serum spike of interleukin-6 (IL-6) occurred in mice at 4-8 hours, with no elevation of IL-1, tumor necrosis factor (TNF), or interferon-gamma (IFN-gamma); 2) the serum liver function enzymes SGOT (AST, aspartate aminotransferase) and SGPT (ALT, alanine aminotransferase) were elevated at 48 hours; 3) only a slight increase in serum antibody to bovine hemoglobin was observed; and 4) increased hematopoietic activity was observed in the spleen and bone marrow. The finding that only IL-6 but not the associated TNF, IL-1, or IFN-gamma is secreted in vivo following LEH administration is novel and may have significance in defining the mechanisms underlying specific adverse responses observed with LEH administration in animals.

Elevated CK-MB and CK-BB in serum and tumor homogenate of a patient with lung cancer.

Elevated serum levels of creatine kinase (CK) were found in a patient with small-(oat) cell carcinoma of the lung. Fractionation of the enzyme showed markedly elevated CK-MB and CK-BB isoenzymes. Clinical and subsequent pathological examination showed no evidence of infarction, inflammation, or tumor involvement of the heart; however, analysis of tumor tissue for CK showed predominance of CK-MB and CK-BB isoenzymes, thus implicating tumor as the source of the circulating levels of CK-MB and CK-BB. Our case is the first to document CK-MB from neoplastic tissue homogenates, and illustrates that markedly elevated circulating levels of CK-MB, or increased levels of CK-MB in combination with CK-BB may point away from a myocardial source, and toward the existence of a malignancy.

Measurement of Erythrocyte 2,3-diphosphoglycerate with a centrifugal analyzer.

Intra-erythrocytic concentration of 2,3-diphosphoglycerate is a major determinant of the oxygen affinity of hemoglobin. We report here the adaptation of its assay to a centrifugal analyzer, with use of a commercially available reagent. Results are calculated by using the reagent-blank-corrected absorbance change at 340 nm between 120 and 300 s for the samples and a 2.5 mmol/L standard. Under these conditions the standard curve is linear to 5 mmol/L. The compound in a 101-fold aqueous hemolysate is stable for several weeks at either -4 or -70 degrees C. Assay sensitivity and precision are excellent and results agree well with those by the corresponding manual method.

Partial characterization of a beta-lactamase from Vibrio parahaemolyticus by a new automated microiodometric technique.

A number of characteristics were determined with a new automated method for a partially purified beta-lactamase from Vibrio parahaemolyticus. The enzyme had a molecular weight of 28,000 by gel filtration, a pH optimum between 6.5 and 7.0, and a temperature optimum at 36 degrees C. With penicillin G as the substrate, the K(m) value for the beta-lactamase was 54.4 muM. The beta-lactamase was inhibited by cloxacillin but not by p-chloromercuribenzoate. The enzyme was similar but not identical to beta-lactamases from gram-negative, "nonhalophilic" organisms described by other workers. The microiodometric assay to measure beta-lactamase activity was automated with the use of a centrifugal analyzer that permitted 14 simultaneous determinations. Within-run precision was tested by putting the same reaction mixture in each well, and the coefficient of variation was only about 3%. Four extracts from different strains of halophilic vibrios were used to demonstrate that reaction rates were linear with enzyme concentration. The correlation coefficient of activity by the automated method with activity by the spectrophotometric method was 0.9721, demonstrating that the methods compared favorably with each other. The automated method greatly facilitated the characterization of the beta-lactamase.

Lithium chloride: protective and antisecretory properties in rats.

Lithium chloride was evaluated as a potential protective agent against ethanol-induced hemorrhagic gastritis in rats. Rats received lithium chloride intragastrically (30, 60, or 90 mg/kg i.g.) or subcutaneously (3, 5, 10, 15, 20, 30, 60, or 90 mg/kg s.c.), or a placebo (H2O i.g. or 0.9% NaCl s.c.). Ninety minutes later 1 cm3 of 95% ethanol was administered intragastrically. After 30 min, the rats were killed and their stomachs were removed and visually scored for gross hemorrhagic gastritis. Lithium chloride at all doses less than 3 mg/kg significantly improved hemorrhagic gastritis when compared with the placebo. Moreover, rats treated with lithium chloride intragastrically had significantly less hemorrhagic gastritis than those treated subcutaneously even though serum lithium levels were similar. To determine if lithium's protective properties related to acid inhibition, pylorus-ligated and gastric fistula rats were studied. The median effective dose for lithium chloride was 20-30 mg/kg and the nonantisecretory dose was 3 mg/kg. No difference in hemorrhagic gastritis was noted between controls and animals receiving the nonantisecretory dose. However, at higher doses (LiCl 30, 60, and 90 mg/kg), lithium's protective properties persisted in spite of adding 150 mM HCl to the intragastrically administered ethanol (p less than 0.001). To determine further if lithium chloride stimulated endogenous prostaglandins, indomethacin, a prostaglandin inhibitor, was administered. Indomethacin did not alter lithium chloride's protective properties. In fact, when compared with exogenously administered 16,16-dimethyl prostaglandin E2 (5 and 500 micrograms/kg), high-dose LiCl (30, 60, or 90 mg/kg) resulted in significantly more protection against ethanol-induced injury (p less than 0.001). In contrast, when both nonantisecretory doses were compared, 16,16-dimethyl prostaglandin E2 (5 micrograms/kg) gave significantly better protection than LiCl (3 mg/kg). These data indicate that LiCl is a potent gastric antisecretory and protective agent. The protective properties of LiCl appear to be related to acid inhibition and be independent of endogenous prostaglandins, although other protective mechanisms may be present at higher LiCl doses. Additionally, this study indicates that LiCl may have clinical application in protecting the gastric mucosa against hemorrhagic gastritis.

Hemorrhagic shock treatment with hot intravenous fluid in dogs.

In hot climates, only high temperature fluids (are greater than 100 F) may be available for treatment of blood loss shock in combat casualties. Can the hot fluid be used safely and effectively? We compared hot Ringer's lactate (51.7% C/125 F) resuscitation (n=10) to body-temperature (100 F) fluid resuscitation (n=10) in a hemorrhagic shock dog model. One liter of 125 F fluid, as part of the resuscitation, did not cause hyperthermia, red blood cell hemolysis, or any significantly different response in the cardiovascular system when compared to body-temperature fluid. All animals in both groups survived. These findings suggest that battlefield use of hot fluids in controlled amounts can be safe and effective for treatment of blood loss shock in human combat casualties.

Incidence of human immunodeficiency virus seroconversion in US Navy and Marine Corps personnel, 1986 through 1988.

From 1986 through 1988, the US Navy and US Marine Corps administered 1,956,631 enzyme-linked immunosorbent assay screening tests for antibodies to the human immunodeficiency virus to 1,070,511 active-duty enlisted and officer personnel. This study identified all persons who had an initial test with negative results. This population was then followed up and those who later tested positive for human immunodeficiency virus were identified as seroconverters. There were 582 seroconversions identified from a total of 987,479 person-years at risk. The age adjusted seroconversion rate and 95% Poisson confidence intervals for navy personnel was 0.69 per 1000 person-years (95% confidence interval, 0.63 to 0.76). Age-adjusted rates in men were 5.0 times those of women. Age-adjusted rates in blacks were 3.7 times those of whites. The age-adjusted seroconversion rate in Marine Corps personnel was 0.28 per 1000 person-years (95% confidence interval, 0.22 to 0.36). Similar demographic patterns were present in the Marine Corps and the US Navy. This study is one of the first reports of incidence of human immunodeficiency virus seroconversion by demographic characteristics in a large, young, and apparently healthy population.