An economic appraisal of the Australian Medical Sheepskin for the prevention of sacral pressure ulcers from a nursing home perspective

<p>Abstract</p> <p>Background</p> <p>Many devices are in use to prevent pressure ulcers, but from most little is known about their effects and costs. One such preventive device is the Australian Medical Sheepskin that has been proven effective in three randomized trials. In this study the costs and savings from the use of the Australian Medical Sheepskin were investigated from the perspective of a nursing home.</p> <p>Methods</p> <p>An economic model was developed in which monetary costs and monetary savings in respect of the sheepskin were balanced against each other. The model was applied to a fictional (Dutch) nursing home with 100 beds for rehabilitation patients and a time horizon of one year. Input variables for the model consisted of investment costs for using the sheepskin (purchase and laundry), and savings through the prevented cases of pressure ulcers. The input values for the investment costs and for the effectiveness were empirically based on a trial with newly admitted rehabilitation patients from eight nursing homes. The input values for the costs of pressure ulcer treatment were estimated by means of four different approaches.</p> <p>Results</p> <p>Investment costs for using the Australian Medical Sheepskin were larger than the monetary savings obtained by preventing pressure ulcers. Use of the Australian Medical Sheepskin involves an additional cost of approximately €2 per patient per day. Preventing one case of a sacral pressure ulcer by means of the Australian Medical Sheepskin involves an investment of €2,974 when the sheepskin is given to all patients. When the sheepskin is selectively used for more critical patients only, the investment to prevent one case of sacral pressure ulcers decreases to €2,479 (pressure ulcer risk patients) or €1,847 (ADL-severely impaired patients). The factors with the strongest influence on the balance are the frequency of changing the sheepskin and the costs of washing related to this. The economic model was hampered by considerable uncertainty in the estimations of the costs of pressure ulcer treatment.</p> <p>Conclusions</p> <p>From a nursing home perspective, the investment costs for use of the Australian Medical Sheepskin in newly admitted rehabilitation patients are larger than the monetary savings obtained by preventing pressure ulcers.</p

Slope Instability on the French Guiana Transform Margin from Swath-Bathymetry and 3.5 kHz Echograms

Although transform margins represent ~30% of rifted margins around the world, few studies have investigated mass-movement processes in such areas and their links with this specific structural context. The French Guiana transform margin and adjacent Demerara abyssal plain have been surveyed during the GUYAPLAC cruise, collecting multibeam bathymetric data, backscatter imagery, 3.5 kHz echograms and 6-channel seismic profiles. The study area is divided into three domains: the shallow Demerara plateau, the Guiana slope and rise, and the Demerara abyssal plain. The Demerara plateau displays multi-scale slope instabilities from huge deep-seated collapses of the whole margin to surficial creeping folds and recent slumps. Giant elongated pockmarks have been also observed for the first time in this area. Fluid escape is common everywhere on the plateau and probably enhances slope instability. On the Guiana slope and rise, large stacked lobate masses have been identified testifying to repetitive failure events. Fluid escape is also ubiquitous there, suggesting a dewatering of debris flows due to sediment loading. Two main types of sedimentary structures are observed on the Demerara Abyssal Plain: small meandering channels of the Amazon Fan at its eastern edge and sediment waves at its western edge, along the foot of Demerara continental slope

BeST - Belgian screening tools : mise à disposition d'outils d'aide à la décision en soins infirmiers

Objectif : Les infirmières n'ont souvent aucune idée de la validité et fiabilité des échelles qu'elles utilisent dans leur pratique. Néanmoins, ces échelles sont rarement accessibles. L'objectif du projet BeST - Belgian Screening Tools - était de construire une base de données avec des échelles valides et fiables utiles dans les soins infirmiers, pour lesquelles un aperçu des critères psychométriques est détaillé. Méthodes : Une revue de la littérature a été réalisée afin d'identifier les échelles valides et fiables. Dès lors, un filtre de recherche a été utilisé dans plusieurs bases de données (Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Cinahl, Invert). Les critères d'inclusion étaient : articles rédigés en anglais, français, néerlandais, allemand entre 1993 et 2009. Les thèmes investigués étaient : désorientation, risque d'escarres, état buccal, nausées-vomissements, coma, douleur, fatigue, sédation, fonction cognitive, état fonctionnel et psychosocial, nutrition, continence, soins de plaies, soins autogérés, qualité de vie et soins aux cathéters. Résultats : Parmi les 141 échelles sélectionnées, 20 sont spécifiques aux enfants, 24 aux adultes, 48 aux personnes âgées et 49 destinées à tout patient ; 42 échelles sont destinées aux infirmières, 21 aux médecins, 39 à tous les prestataires et 20 utilisables par le patient lui-même. Toutes les échelles sélectionnées sont disponibles dans la base de données BeST gratuitement accessible et régulièrement actualisée. Par thème et par échelle, une description de l'échelle, de l'objectif, du groupe-cible, des tables d'évidence et des références est mentionnée. Conclusion : Nombre d'échelles validées sont gratuitement téléchargeables sur le site www.best.ugent.be et donc, facilement accessibles et applicables en pratique clinique

A new NDE1/PDGFRB fusion transcript underlying chronic myelomonocytic leukaemia in Noonan Syndrome

status: publishe

A new NDE1/PDGFRB fusion transcript underlyng chronic myelomonocytic leukaemia in Noonan Syndrome

Our study shows for the first time a case of CMML with an NDE1/PDGFRB fusion in addition to a missense mutation in exon 3' of PTPN11 underlying NS. The PTPN11 gain-of-function mutation in association with the constitutively phosphorylated tyrosine kinase NDE1/PDGFRB may have triggered CMML in this patient with NS

A new NDE1/PDGFRB fusion transcript underlying chronic myelomonocytic leukaemia in Noonan Syndrome

A 35-year-old female patient with Noonan Syndrome (NS) presented with leukocytosis and splenomegaly. Recent medical history included malaise, lack of appetite and moderately painful, tender red nodules with central ulceration on face, neck and arms. Skin biopsy showed marked oedema and superficial and deep derma granulocyte infiltration, with some eosinophils. Blood counts were: white blood cells, 386_109/l (neutrophils 55%, lymphocytes 7%, monocytes 34%, eosinophils 4%); haemoglobin: 13.5 g/dl; platelets, 336_109/l. Chronic myelomonocytic leukaemia (CMML) was diagnosed on bone marrow aspirate. Bone marrow karyotype was: 46,XXt(5;16)(q33;p13). In all cells bearing t(5;16)(q33;p13), fluorescent in situ hybridization (FISH) indicated PDGFRB was rearranged. In our patient, candidates as PDGFRB gene partners were selected on the basis of FISH findings. As NDE1 was in the correct orientation and contained an N-terminal oligomerization domain, we sought an NDE1-PDGFRB fusion. Amplifying the NDE1-PDGFRB transcript by RT-PCR yielded a specific product which, upon sequencing, showed in-frame fusion of NDE1 exon 5 (GenBank no. NM_017668) with PDGFRB exon 11 (GenBank no. NM_002609) (Figure 1e). NDE1-PDGFRb is predicted to contain the 174 amino acids (including the oligomerization domain) of the NDE1 N-terminal fused to the C-terminal transmembrane and split tyrosine kinase domains of PDGFRb. Amplification and sequencing of the der(5) genomic breakpoint confirmed NDE1 intron 5 and PDGFRB intron 10 were fused (Genbank accession no. DQ317513). Denaturing high-performance liquid chromatography analysis identified a G1784T (NM_002834) nucleotide germline substitution in exon 3 of PTPN11, which given our patient’s phenotype, is most probably the congenital cause of NS. Our study shows for the first time a case of CMML with an NDE1-PDGFRB fusion in addition to a missense mutation in exon 30 of PTPN11 underlying NS. The PTPN11 gain-of-function mutation in association with the constitutively phosphorylated tyrosine kinase NDE1-PDGFRB may have triggered CMML in this patient with NS

Activation of FIP1L1-PDGFRα requires disruption of the juxtamembrane domain of PDGFRα and is FIP1L1-independent

Genetic abnormalities that result in expression of chimeric tyrosine kinase proteins such as BCR-ABL1 and ETV6-PDGFRβ are common causes of hematopoietic malignancies. The paradigm for constitutive activation of these fusion tyrosine kinases is enforced homodimerization by self-association domains present in the fusion partner proteins. The unique interstitial deletion on chromosome 4q12 that leads to expression of the FIP1L1-PDGFRα fusion tyrosine kinase was recently identified as a cause of chronic eosinophilic leukemia. In this report, we demonstrate that FIP1L1 is completely dispensable for PDGFRα activation in vitro and in vivo. Instead, truncation of PDGFRα between two conserved tryptophan residues in the juxtamembrane (JM) domain is required for kinase activation and transforming potential of FIP1L1-PDGFRα. The presence of a complete JM domain in FIP1L1-PDGFRα is inhibitory, but this autoinhibition can be overcome by enforced homodimerization. Similar effects of the JM domain in the context of PDGFRβ were observed. These results suggest that disruption of the autoinhibitory JM domain is an alternative, dimerization-independent mechanism by which chimeric tyrosine kinases are constitutively activated and induce leukemogenesis