Effectiveness of interventions for informal caregivers of people with end-stage chronic illness: a systematic review.

BACKGROUND: People living with advanced, non-malignant chronic conditions often have extensive and complex care needs. Informal or family caregivers often provide the care and support needed by those with advanced chronic conditions at home. These informal caregivers experience many challenges associated with their caring role, which can impact their own wellbeing. Whilst there is growing evidence around the impact on carers, guidance on support for informal caregivers of patients with advanced, non-malignant, chronic conditions is lacking, with little evidence available on effective psychosocial carer interventions. This systematic review explored existing interventions for caregivers of those with advanced, non-malignant, chronic illness, in order to assess the effectiveness of these interventions in improving psychosocial outcomes. METHODS: Electronic databases, Medline, CINAHL, EMBASE, and PsycINFO, were searched up to the end of March 2023. Studies meeting the inclusion criteria, focusing on interventions to improve psychosocial outcomes, such as depression, anxiety, quality of life, and caregiver burden, in this cohort of caregivers were included. Data were extracted regarding study setting, design, methods, intervention components, and outcomes. Risk of bias and quality assessment were conducted. RESULTS: A total of 5281 articles were screened, ultimately identifying 12 studies for inclusion, reported in 13 publications. A narrative synthesis revealed mixed results. Psychosocial interventions resulted in more significant improvements in psychosocial outcomes than psychoeducational or support interventions, with interventions for carer-patient dyads also reflecting more positive outcomes for caregivers. Evidence-based interventions, guided by an appropriate theoretical model, were reportedly more effective in improving caregiver outcomes. Differences in outcomes were related to intervention development, design, delivery, and outcome assessment. CONCLUSIONS: This review, to our knowledge, is the first to explore the effectiveness of interventions in improving psychosocial outcomes for caregivers of those with advanced, non-malignant, chronic conditions. The review highlights the need for more robust, sufficiently powered, high-quality trials of evidence-based interventions for caregivers of people with advanced chronic illness. Optimal intervention duration and frequency of sessions are unclear and need further exploration.

Foundation studies in education for therapy practice: curriculum updating.

OBJECTIVE: To describe the foundation studies element of the education for practice as a speech and language therapist in one Irish University, and how this element features in curriculum development and updating. BACKGROUND: This paper addresses the question of how best to introduce students to the ever-increasing depth and range of knowledge regarding communication disorders. This foundation is the basis upon which to build the knowledge, skills and attitudes that lead ultimately to generating prerequisites for clinician scientists to provide services for people with communication and swallowing disabilities. METHODS/RESULTS: Since its institution as a university course, the course curriculum in our department at Trinity College Dublin, Ireland, has been subjected to regular revision and updating to be in line with educational, professional and service requirements. In this paper, we select elements of our most recent revision of the curriculum, incorporating the redefinition of the desirable characteristics of our graduates. This paper presents an overview of curriculum development, and focuses on the initial part of the education that sets the foundation for acquiring the knowledge that we consider to be a relevant, solid basis for entering clinical work. CONCLUSIONS: The current foundation stage of the curriculum encompasses elements that reflect increasing knowledge, trends in education practices, and the seeds of life-long learning.

Histamine potentiates N-methyl-D-aspartate responses in acutely isolated hippocampal neurons.

N-methyl-D-aspartate (NMDA)-evoked currents were recorded from acutely isolated rat hippocampal neurons, using the whole-cell patch-clamp technique and a rapid perfusion system. Histamine, at concentrations from 0.5 to 100 microM, reversibly enhanced NMDA currents by up to 50%. The effect cannot be ascribed to activation of the known histamine receptors (H1, H2, H3) but is occluded by spermine. These results suggest an interaction of histamine with the polyamine-binding site on the NMDA receptor complex. This modulatory action could allow the histaminergic system to determine time and loci of NMDA receptor-mediated events, such as memory formation according to behavioral state.

Somatic mutagenesis studies of NF-kappa B signaling in human T cells: evidence for an essential role of IKK gamma in NF-kappa B activation by T-cell costimulatory signals and HTLV-I Tax protein.

NF-kappa B plays a pivotal role in normal T-cell activation and may also mediate human T-cell leukemia virus (HTLV)-induced T-cell transformation. Activation of NF-kappa B by both T-cell costimulatory signals and the HTLV Tax protein involves stimulation of I kappa B kinase (IKK). As a genetic approach to dissect the intermediate steps involved in NF-kappa B activation in human T cells, we performed somatic cell mutagenesis to isolate signaling-defective mutant Jurkat T-cell lines. One of the mutant cell lines was shown to have a specific blockade in the IKK signaling pathway but remained competent in the c-Jun N-terminal kinase and MAP kinase pathways. Interestingly, this mutant cell line lacks expression of IKK gamma, a non-catalytic component of the IKK complex. Expression of exogenous IKK gamma in the mutant cells restored NF-kappa B activation by both the T-cell costimulation agents and Tax. These findings provide genetic evidence for the requirement of IKK gamma in NF-kappa B signaling triggered by both T-cell costimulatory signals and HTLV-I Tax protein.

Ionic currents in cultured rat suprachiasmatic neurons.

Whole-cell voltage-clamp recordings were made from cultured neurons obtained by dissociation of the suprachiasmatic area of rat fetuses. Neurons were held for seven to 14 days in culture. These neurons possessed several voltage-dependent ionic currents. A transient inward Na+ current was present, which could be completely blocked by tetrodotoxin. No inward Ca2+ currents were detected. Three types of outward K+ currents were recorded, which could be separated to a reasonable extent by their differences in voltage sensitivity and pharmacology. These K+ currents corresponded to the transient current IA, the delayed rectifier current IKo and a calcium-dependent current IK(Ca) as described in other neurons. The A current activated at -50 mV, reached half-maximal conductance at about -30 mV and maximum conductance between 0 and 30 mV. During depolarizing steps it inactivated completely within 100 ms and steady-state inactivation was half-maximal at -66 mV. The outward rectifier activated at -30 mV, reached half-maximal conductance close to 0 mV and maximum conductance at about 70 mV. Slow inactivation of IKo occurred with 50% reduction in amplitude at the end of 2 s depolarizations above 0 mV. The K+ channel blocker 4-amino-pyridine (4 mM) reduced the amplitude of IA by 21% and of IKo by 32%, whereas tetraethylammonium (10 mM) decreased IA by 27% and IKo by 83%. The calcium-dependent K+ component was also voltage dependent and was present at voltages more positive than 0 mV. No inward rectifying K+ current was present. Considering its voltage dependence, IA must play a role in determining the excitability of these neurons, through its probable influence on the action potential threshold and interspike interval. Both IA and IKo should take part in membrane repolarization following an action potential. The Ca(2+)-dependent current should also contribute to repolarization following any event which gives rise to an increase in intracellular Ca2+. Apart from IA, which may make a slight contribution, none of these currents appear to be involved in determining the resting membrane potential. All three outward current components will act together in suprachiasmatic neurons to control their spontaneous firing frequency, which is the major feature of the output of these neurons in vivo. Variations in properties of these conductances could contribute to the circadian rhythm in firing frequency described in suprachiasmatic hypothalamic neurons.

Contractile properties of human renal cell carcinoma recruited arteries and their response to nicotinamide.

BACKGROUND AND PURPOSE: The manipulation of tumour blood supply and thus oxygenation is a potentially important strategy for improving the treatment of solid tumours by radiation. Increased knowledge about the characteristics that distinguish the tumour vasculature from its normal counterparts may enable tumour blood flow to be more selectively modified. Nicotinamide (NA) causes relaxation of preconstricted normal and tumour-supply arteries in rats. It has also been shown to affect microregional blood flow in human tumours. Direct effects of NA on human tumour supply arteries have not previously been reported. This paper describes our evaluation of the effects of NA on two parameters: 'spontaneous', oscillatory contractile activity and agonist (phenylephrine)-induced constriction in the arteries supplying human renal cell carcinomas. MATERIALS AND METHODS: Isolated renal cell carcinoma feeder vessels were perfused in an organ bath with the alpha(1)-adrenoceptor agonist phenylephrine (PE). When the arteries had reached a plateau of constriction, nicotinamide (8.2 mM) was added to the perfusate and changes in perfusion pressure were measured. RESULTS: PE (10 microM) induced a sustained constriction in the majority of the renal cell carcinoma feeder vessels examined, demonstrating that they retain contractile characteristics, at least in response to this alpha(1)-adrenoceptor agonist. In combination with NA (8.2 mM) the constriction was significantly attenuated in half of the preparations. In addition, seven arteries exhibited spontaneous contractile activity which was significantly attenuated by NA in six of them. CONCLUSIONS: NA can significantly attenuate both 'spontaneous' and agonist-induced constrictions in tumour-recruited human arteries, though not all arteries are sensitive.

Spontaneous and stimulated firing in cultured rat suprachiasmatic neurons.

Neurons from the suprachiasmatic nucleus (SCN) of the hypothalamus, the site of a circadian pacemaker in mammals, were isolated from embryonic rat. After mechanical dissociation neurons were brought into culture for 1-2 weeks, using a chemically defined medium. Recordings were made from 74 bipolar neurons using two different configurations of the patch-clamp technique. During cell attached patch recordings, 45% of neurons fired spontaneously. The mean firing rate was 0.7 +/- 0.6 Hz and the firing pattern was irregular. In whole cell recordings 73% of the investigated neurons showed spontaneous activity with an irregular firing pattern. The mean spontaneous firing rate with an intracellular Cl- concentration of 145 mM was 1.0 +/- 0.6 Hz. The resting membrane potential of the bipolar neurons was estimated to be -62 +/- 24 mV. An intracellular Cl- concentration of 145 mM depolarised the membrane potential. It also increased the probability of spontaneous firing. A depolarising current stimulus produced an action potential with a threshold voltage of -46 +/- 9 mV. Suprathreshold stimuli resulted in repetitive firing with a mean frequency of 12 +/- 4 Hz. The minimum interspike interval was 52 +/- 14 ms. All action potentials either occurring spontaneously or elicited by current stimuli were abolished by the Na(+)-channel blocker TTX. These results indicate that our cultured neurons have some electrophysiological properties in common with SCN neurons in brain slices and in vivo.

Cutaneous sarcoidosis associated with sarcoidosis of the upper airway.

The diagnosis of laryngeal sarcoidosis is frequently delayed because it is rare and often develops insidiously. A 24-year-old woman with the annular scarring form of cutaneous sarcoidosis later contracted laryngeal sarcoidosis. Despite a two-year history of upper respiratory tract symptoms, the patient's progressive respiratory distress was attributed to sarcoidal pulmonary involvement. Dermatologists should be aware of the risk of airway obstruction from laryngeal granulomas in patients with cutaneous sarcoidosis. Although most commonly associated with the lupus pernio form of sarcoidosis, upper airway granulomas also develop in patients with other cutaneous manifestations of sarcoidosis.

Two potential clinical applications of the alkaline single-cell gel electrophoresis assay: (1). Human bladder washings and transitional cell carcinoma of the bladder; and (2). Human sperm and male infertility.

Part 1: The alkaline single-cell gel electrophoresis (comet) assay was used to analyse the integrity and DNA content of exfoliated cells extracted from bladder washing specimens from 9 transitional cell carcinoma patients and 15 control patients. DNA damage, as expressed by % tail DNA and tail moment values, was observed to occur in cells from both control and bladder cancer samples. The extent of the damage was, however, found to be significantly greater in the cancer group than in the control group. Comet optical density values were also recorded for each cell analysed in the comet assay and although differences observed between tumour grades were not found to be statistically significant, the mean comet optical density value was observed to be greater in the cancer group than in the control population studied. These preliminary results suggest that the comet assay may have potential as a diagnostic tool and as a prognostic indicator in transitional cell carcinoma. Part 2: Baseline DNA damage in sperm cells from 13 normozoospermic fertile males, 17 normozoospermic infertile males and 11 asthenozoospermic infertile males were compared using a modified alkaline comet assay technique. No significant difference in the level of baseline DNA damage was observed between the 3 categories of sperm studied; however the untreated sperm cells were observed to display approximately 20% tail DNA. This is notably higher than the background DNA damage observed in somatic cells where the % tail DNA is normally less than 5%. Sperm from the 3 groups of men studied were also compared for sensitivity to DNA breakage, using the modified alkaline comet assay, following X-ray irradiations (5, 10 and 30 Gy) and hydrogen peroxide treatments (40, 100 and 200 microM). Significant levels of X-ray-induced damage were found relative to untreated control sperm in the two infertile groups following 30 Gy irradiation. Significant damage in hydrogen peroxide-treated sperm was observed in sperm from fertile samples, at 200 microM and in infertile samples at 100- and 200-microM doses relative to controls. These results therefore indicate that fertile sperm samples are more resistant to X-ray- and hydrogen peroxide-induced DNA breakage than infertile samples. Further studies involving greater numbers of individuals are currently in progress to confirm these findings.

Efficacy and safety peri-prostatic local anaesthetic injection in trans-rectal biopsy of the prostrate: a prospective randomised study.

OBJECTIVE: To assess the efficacy and safety of periprostatic lignocaine injection in trans-rectal ultrasound (TRUS) -guided biopsy of the prostate gland. METHODS: Ninety-six men (mean age 65 years, range 47-74) undergoing TRUS biopsy were randomised into the local anaesthetic (LA) or placebo group. Six to twelve biopsy cores were taken, the majority being 10 cores. Patients were asked to fill in the expected pain score on a visual analogue scale (VAS) prior to the procedure. They also completed the actual pain experienced on VAS after the biopsy. The incidence of complications was documented. RESULTS: The age, mean prostate specific antigen (PSA) were comparable in both groups. The expected pain score was also comparable (5.2 +/- 1.6 in LA, 5.0 +/- 1.4 in Placebo). In the LA group, the mean actual pain score was 3.0 +/- 1.8 and in the placebo group it was 6.5 +/- 2.2 (P = 0.0001). When patients were asked whether they would undergo the procedure again in the same way, 100% of the LA group and only 64% of the placebo group responded 'yes' (P = 0.002 using Fisher's test). The complication rates were not significantly different between the two groups. CONCLUSION: Peri-prostatic injection of local anaesthetic is safe and reduces discomfort significantly, and should be routinely offered to patients.

The suprachiasmatic nucleus of the rat hypothalamus in culture: an anatomical and electrophysiological study.

This study shows that foetal neurons from the suprachiasmatic area, after dissociation and culture, contain in vitro the same characteristics as are found in the in vivo situation. The main peptidergic neurotransmitters present in the suprachiasmatic nucleus in vivo, vasoactive intestinal polypeptide (VIP) and vasopressin, are expressed in vitro while the cytoskeleton of these cells possesses phosphorylated neurofilaments. The exclusive uptake of Lucifer Yellow liposomes by neurons is also refound in suprachiasmatic cultures. The electrophysiological results are in agreement with those characteristics found in vitro and in vivo.

Efficacy of an aerosol surface spray against container-breeding Aedes.

The effectiveness of a residual insect surface spray against container-breeding mosquitoes was tested in Cairns, Australia. A formulation containing imiprothrin and cypermethrin (Mortein Plus Cockroach Lure 'n' Kill High Performance Surface Spray) was selected based on the label claim to "kill continuously for up to 6 months." A 1-sec spray was applied to the water and interior surface of partially flooded tires and terra-cotta pots. Treatments were paired with a control and replicated at 2 sites within 3 residential properties for a total of 6 replicates. All mosquito larvae were removed and counted weekly, and a representative sample was identified in the laboratory. Complete control of Aedes species was achieved for 4 and 5 months in all tires and pots, respectively.

[Work ability of subjects with chronic musculoskeletal disorders]. / Capacidade para o trabalho em indivíduos com lesões músculo-esqueléticas crônicas.

OBJECTIVE: To evaluate the impact of personal, clinical, and occupational aspects on work ability of workers with and without work-related musculoskeletal disorders using the Work Ability Index. METHODS: There were participating 127 workers of industrial production lines of a medium-size multinational company. An approved version of the Work Ability Index, a questionnaire developed by Finland's Institute of Occupational Health, was used. Pain scale was also applied. A descriptive analysis was carried out using the Chi-square test and it was also performed a logistic regression analysis. RESULTS: A significant association was identified between the Work Ability Index and all personal, clinical and occupational aspects. Regression analysis showed that pain and sick leave together accounted for 59% of poor work ability. CONCLUSIONS: Different levels of pain severity were associated with distinct as well as equivalent levels of work ability loss. The results suggest that either pain reports were consistent or being both pain and work ability self-reported they therefore reflect the same perception mechanisms. Future studies might contribute to further understanding the trends found.

The artificial urinary sphincter. A new solution for incontinent patients.

Treatment of urinary incontinence with the artificial urinary sphincter has been available in centres such as London and Liverpool for a number of years. This service is now available in the department of urology of the Belfast City Hospital. Twelve patients have had successful implantation of an artificial urinary sphincter for urinary incontinence, and ten are now fully continent. One patient with Wegener's granulomatosis developed active disease in his urethra which has precluded activation of the device. One patient has had the device removed because of erosion into the urethra.

Prevalence of Dysphagia in acute and community mental health settings.

The incidence of dysphagia in the population with mental health disorders may be higher as a result of a number of factors including the nature of the psychiatric disorder, effects of psychiatric medications, co-occurring neurologic conditions, and institutionalization and behavioral changes associated with the mental illness. This study aimed to determine the prevalence of dysphagia among adults with mental health disorders (MHDs) who attend acute and community mental health settings. Sixty attenders at a local area psychiatric service were assessed using a simple swallowing screening test. Subjects presented with a variety of mental health disorders and were attending an acute inpatient unit, day hospital, or long-term care setting. Thirty-two percent of those assessed demonstrated overt signs of oropharyngeal dysphagia. There was an increased prevalence in the inpatient unit (35%); the lowest prevalence of dysphagia was in those attending the day hospitals (27%). Thirty-one percent of those attending long-term care settings also had dysphagic symptoms. Twenty-three percent of individuals with schizophrenia in the total group had oropharyngeal dysphagia; this figure rose to 31% in the inpatient unit. Twenty-seven percent of individuals with bipolar affective disorder (BPAD) demonstrated overt signs of oropharyngeal dysphagia. Each of these individuals with BPAD was in an inpatient setting. The results of this study provide evidence to suggest that there is an increased incidence of dysphagia in those with mental health disorders. Of particular interest is the marked proportion (approximately one third) of those attending acute and long-term care settings with dysphagia. Possible contributing factors are discussed.

Education for practice in the UK and Ireland: implementing problem-based learning.

OBJECTIVE: This paper outlines the education of speech and language therapists in the UK and Ireland, and presents a preliminary study of student therapists' perceptions of problem-based learning (PBL) as a learning strategy in preparation for clinical work. PBL has been used extensively in medical and dental education in Europe, in Canada, and in the Middle East, and has been applied to speech and language therapist education in Sweden and in Australia. Its implementation in the UK and Ireland is relatively new. METHODS: A survey questionnaire was circulated to students in two centres via e-mail. Questions posed included student impressions of the most and least useful elements of PBL in their preparation for clinical practice, as well as how they considered improvements could be made; student reflections regarding PBL were also sought. RESULTS AND CONCLUSIONS: Findings support the implementation of PBL in the education of speech and language therapists, with more experienced students showing more positive support for PBL. Issues raised by the study include emphasis on clinical relevance of problems, particularly in the early years of the course. The majority of students regarded PBL as directly relevant for clinical preparation.