Exploring the relationship between geriatric patients and their carers through portraiture: giving, receiving, observing & witnessing care (GROWing Care)

The process of creating a portrait relies on a series of intimate interactions. Portraits, even those that depict a single individual, are a visual testament to a relationship. Portrait sitters are required to engage with artists in the creation of their personal visual narrative. As viewers of a portrait, we are invited to actively participate in other’s stories, to observe, to question, even stare. This process is integral to the portraits evolving meaning. Giving, receiving, observing & witnessing care (GROWing Care), the case study presented in this manuscript, draws on these multiple exchanges to explore the experience of dementia and portraiture among older adults and their partners in care as they work with artist/researcher Mark Gilbert, and geriatrician, Kenneth Rockwood

Cutaneous polyarteritis nodosa

Classic polyarteritis nodosa (PAN) is a segmentary leucocytoclastic vasculitis that affects small- and medium-sized arteries. In 1931, Lindberg (Acta Med Scand 1931; 76: 183-225) described the existence of a cutaneous variant of PAN, without visceral involvement and with a more favourable prognosis. We present four patients diagnosed with cutaneous PAN in our hospital between 1987 and 1998. The study group was composed of three women and one child, whose ages ranged from 11 to 70 years old. The follow-up period was between 2 and 13 years. Each patient was submitted for an initial clinical, histological and laboratory evaluation and subsequent follow-up. The presence of nodules was the most frequent cutaneous lesion, preferentially located in the lower limbs. The erythrocyte sedimentation rate was the only parameter that was altered in all patients. Cutaneous biopsies from all patients showed a segmentary leucocytoclastic vasculitis in the arteries of the deep dermis and/or hypodermis. Direct immunofluorescence was positive in just one patient. No visceral involvement was found in any patient. There is confusion about the correct definition of cutaneous PAN. Some clinical findings, such as nodules or livedo reticularis, typical of cutaneous PAN suggest a good prognosis; however, we consider that it is necessary to evaluate these patients for systemic involvement for the possibility of arteritis in other organs as the term polyarteritis suggests

What Lawrence’s Story Tells Health Researchers About Arts-Based Interactions

In arts-based-research, knowledge and meaning emerge from people’s experiences of being in dynamic, ambiguous, intentional, and ethical relationships with each other and the arts. This case study draws on Launer’s “7 C’s” (context, conversations, curiosity, complexity, challenge, caution, and care) to understand the aesthetics (shape and form) and ethics of relationships between an artist-researcher and patient-sitter in portraiture-based medical research. This case supports the 7 C’s being embodied in the art-making process, as the approach can usefully frame ethical challenges and rewards of portraiture-based health research for artist-researcher and patient-participant

Health Care Professionals’ Journeys of Caring Through Portraiture

Metropolitan Community College, a comprehensive multicampus academic institution in Omaha, Nebraska, installed portraits by the third author (MG) in the Health Careers Building and integrated them into an associate degree nursing curriculum. One goal was to expose nursing students to patients’ stories in ways that encourage them to look beyond pain rating scales and protocols to the many dimensions of patients as human beings. Using portraiture in this way could be applied to any health professions curriculum, as the intersections of humanities and health care prompted students and clinicians to look beyond science and into the emotional journeys of caring

Anthony and the Role of Silence in Portraiture in Clinical Settings

This article describes one collaborative arts-based research project. Portrait artist Mark Gilbert and coinvestigators consider lessons for art and healing from one patient, Anthony, whose experience of head and neck cancer diagnosis, surgery, and recovery suggests how silence is ethically, artistically, and clinically significant

Disseminated epidermolytic acanthoma probably related to trauma

Epidermolytic acanthoma is a rare benign tumour, which may occur in both isolated and disseminated forms. Only seven cases of disseminated epidermolytic acanthoma (DEA) have been described. This entity should be distinguished from other hereditary or acquired conditions which involve epidermolytic hyperkeratosis and other benign acanthomas. On the basis of the clinical history and the histological findings, we diagnosed a case of DEA which was probably secondary to repeated trauma

Iliopsoas and Gluteal Muscles Are Asymmetric in Tennis Players but Not in Soccer Players

To determine the volume and degree of asymmetry of iliopsoas (IL) and gluteal muscles (GL) in tennis and soccer players.IL and GL volumes were determined using magnetic resonance imaging (MRI) in male professional tennis (TP) and soccer players (SP), and in non-active control subjects (CG) (n = 8, 15 and 6, respectively).The dominant and non-dominant IL were hypertrophied in TP (24 and 36%, respectively, P<0.05) and SP (32 and 35%, respectively, P<0.05). In TP the asymmetric hypertrophy of IL (13% greater volume in the non-dominant than in the dominant IL, P<0.01) reversed the side-to-side relationship observed in CG (4% greater volume in the dominant than in the contralateral IL, P<0.01), whilst soccer players had similar volumes in both sides (P = 0.87). The degree of side-to-side asymmetry decreased linearly from the first lumbar disc to the pubic symphysis in TP (r = -0.97, P<0.001), SP (r = -0.85, P<0.01) and CG (r = -0.76, P<0.05). The slope of the relationship was lower in SP due to a greater hypertrophy of the proximal segments of the dominant IL. Soccer and CG had similar GL volumes in both sides (P = 0.11 and P = 0.19, for the dominant and contralateral GL, respectively). GL was asymmetrically hypertrophied in TP. The non-dominant GL volume was 20% greater in TP than in CG (P<0.05), whilst TP and CG had similar dominant GL volumes (P = 0.14).Tennis elicits an asymmetric hypertrophy of IL and reverses the normal dominant-to-non-dominant balance observed in non-active controls, while soccer is associated to a symmetric hypertrophy of IL. Gluteal muscles are asymmetrically hypertrophied in TP, while SP display a similar size to that observed in controls. It remains to be determined whether the different patterns of IL and GL hypertrophy may influence the risk of injury

Impact of a new palliative care consultation team on opioid prescription in a University Hospital

There are no validated measuring tools to gauge the effectiveness of a Hospital Palliative Care Consultation Team (PCCT). One way would be to consider its effect on the consumption of opioids expressed in total amounts and different formulations administered. We perform this study to evaluate the impact of a hospital PCCT on the trends of opioid prescription in a University Hospital. Methods: A seven year retrospective study on opioid prescription was carried out in the Clínica Universidad de Navarra. The period includes three years before and three years after the PCCT was implemented. Prescription was analysed calculating yearly the Defined Daily Dose (DDD) adjusted to 1000 hospital stays (DDD/1000HS). Indicators considered were the proportion of patients treated using opioids compared to the total estimated in need of treatment (rate of effectiveness) and the proportion of patients potentially requiring opioids but not treated who were incorporated into the treatment group (rate of improvement). Results: From 2001 to 2007, total opioid prescription was low in non-oncology Departments (range: 69–110 DDD/1000HS) while parenteral morphine and fentanyl did not register any changes. In the same period of time, total opioid prescription increased in the Oncology Department from 240 to 558 DDD/1000HS. The rate of effectiveness in the three years prior to the implantation of the consultation team was 64% and in the three following years rose to 87%. The rate of improvement prior to the palliative care consultation team was 43% and in the three following years was 64%. A change in opioid prescription was registered after the implementation of the PCCT resulting in an increase in the prescription of parenteral morphine and methadone and a decrease in transdermal fentanyl. Conclusion: Implementation of a PCCT in a University Hospital is associated with a higher and more adequate use of opioids