31 research outputs found
Defective Chemokine Production in T-Leukemia Cell Lines and its Possible Functional Role
Peripheral blood lymphocytes and T-cell clones produced nanogram quantities of the chemokines
RANTES, MIP-lα, MIP-lÎČ, MCP-l, IL-8 and GRO-α as well as the motogenic
cytokine HGF. In contrast, various T-leukemia cell lines at different stages of differentiation
did not produce the same chemokines/cytokines. In order to study the possible functional
importance of the poor chemokine production different T-cell lines were compared with
respect to development of motile forms and migration on extracellular matrix components in
the absence and presence of various chemokines. RANTES, MIP-1α, MIP-1ÎČ, IL-8, GRO-α
and lymphotactin did not augment the development of motile forms including the size and
appearance of the pseudopodia activity of the T-leukemia cell lines. The T-cell lines migrated
spontaneously on/to fibronectin in a Boyden chamber assay system. Chemokines augmented
the migration of the T-leukemia cell lines on fibronectin in the Boyden system in a chemotactic
fashion with peak responses at 10 to 50 ng/ml. Thus, the production of chemokines is
defective, in neoplastic T-lymphocytes. The defective chemokine production does not seem to
play any major role for the basic locomotor capacity of the cells but may modulate the
responsiveness to exogenous chemokines
Intra-hospital transport of neonatal intensive care patients: risk factors for complications
OBJECTIVE: Evaluate factors associated with hypothermia and increased need of oxygen and/or ventilatory support during intra-hospital transport of neonatal intensive care patients. METHODS: Prospective study of infants admitted to a single neonatal unit in need of at least one intra-hospital transport during weekdays, from 8:00AM to 05:00PM, from January 1997 to December 2000. Factors associated with hypothermia and increased need of oxygen and/or need of ventilatory support during and up to two hours after transport were studied by regression analyses. RESULTS: During the study period, 502 transports were analyzed. At the time of transport, the neonates had a mean weight and gestational age of, respectively, 2,000g and 35 weeks, and they were 22 days old. The main reasons for transport were: surgery and image exams. Hypothermia occurred in 17% of the transported infants and increased need of oxygen and/or ventilatory support in 7%. Factors associated with hypothermia were: duration of transportation >3h (OR=2.1; 95%CI=1.2-3.6), neurologic malformation (OR=1.7; 95%CI=1.1-2.5), transport performed in 1997 (OR=1.7; 95%CI=1.1-2.6) and weight at time of transport >3,500g (OR=0.3; 95%CI=0.16-0.68). Factors associated with increased need of oxygen and/or ventilation support were: gestational age at birth in weeks (OR=0.9; 95%CI=0.8-0.9), age in days at transportation (OR=1.0; 95%CI=1.0-1.1) and presence of gastrointestinal and genitourinary malformation (OR=3.1; 95%CI=1.6-6.2). CONCLUSIONS: Complications related to neonatal intra-hospital transports are frequent and associated with the patients characteristics and transport conditions.OBJETIVO: Estudar os fatores associados Ă hipotermia e ao aumento da necessidade de oxigĂȘnio e/ou suporte ventilatĂłrio durante o transporte intra-hospitalar de pacientes internados em Unidade de Terapia Intensiva neonatal. MĂTODOS: Estudo prospectivo de todos os pacientes internados na unidade neonatal que necessitaram de transporte intra-hospitalar de janeiro de 1997 a dezembro de 2000, entre segundas-feiras e sextas-feiras, das 8h Ă s 17h. Fatores associados Ă hipotermia e ao aumento da necessidade de oxigĂȘnio e/ou de suporte ventilatĂłrio durante e atĂ© duas horas apĂłs o transporte foram estudados por meio de regressĂŁo logĂstica. RESULTADOS: Foram realizados 502 transportes no perĂodo. Os pacientes tinham em mĂ©dia 2.000g, 35 semanas de idade gestacional ao nascer e 22 dias de vida. As principais indicaçÔes do transporte foram: cirurgia e realização de exames de imagem. A hipotermia ocorreu em 17% dos transportes e o aumento da necessidade de oxigĂȘnio e/ou de suporte ventilatĂłrio em 7%. Fatores associados Ă hipotermia foram: duração do transporte >3h (OR=2,1; IC95%=1,2-3,6), presença de malformaçÔes neurolĂłgicas (OR=1,7; IC95%=1,1-2,5), transporte realizado em 1997 (OR=1,7; IC95%=1,1-2,6) e peso no transporte >3.500g (OR=0,3; IC95%=0,16-0,68). Fatores de risco para o aumento da necessidade de oxigĂȘnio e/ou de suporte ventilatĂłrio foram: idade gestacional ao nascimento em semanas (OR=0,9; IC95%=0,8-0,9), idade em dias no transporte (OR=1,0; IC95%=1,0-1,1) e presença de malformaçÔes gastrintestinais e geniturinĂĄrias (OR=3,1; IC95%=1,6-6,2). CONCLUSĂES: As intercorrĂȘncias relativas ao transporte intra-hospitalar sĂŁo freqĂŒentes nos neonatos em UTI e estĂŁo associadas Ă s condiçÔes dos pacientes e dos transportes.Universidade Federal de SĂŁo Paulo (UNIFESP) Escola Paulista de Medicina Departamento de PediatriaUNIFESP-EPM Departamento de PediatriaUNIFESP-EPM Departamento de Medicina PreventivaUNIFESP, EPM, Depto. de PediatriaUNIFESP, EPM Depto. de PediatriaUNIFESP, EPM Depto. de Medicina PreventivaSciEL
Design of a randomized controlled study of a multi-professional and multidimensional intervention targeting frail elderly people
<p>Abstract</p> <p>Background</p> <p>Frail elderly people need an integrated and coordinated care. The two-armed study "Continuum of care for frail elderly people" is a multi-professional and multidimensional intervention for frail community-dwelling elderly people. It was designed to evaluate whether the intervention programme for frail elderly people can reduce the number of visits to hospital, increase satisfaction with health and social care and maintain functional abilities. The implementation process is explored and analysed along with the intervention. In this paper we present the study design, the intervention and the outcome measures as well as the baseline characteristics of the study participants.</p> <p>Methods/design</p> <p>The study is a randomised two-armed controlled trial with follow ups at 3, 6 and 12 months. The study group includes elderly people who sought care at the emergency ward and discharged to their own homes in the community. Inclusion criteria were 80 years and older <it>or </it>65 to 79 years with at least one chronic disease and dependent in at least one activity of daily living. Exclusion criteria were acute severely illness with an immediate need of the assessment and treatment by a physician, severe cognitive impairment and palliative care. The intention was that the study group should comprise a representative sample of frail elderly people at a high risk of future health care consumption. The intervention includes an early geriatric assessment, early family support, a case manager in the community with a multi-professional team and the involvement of the elderly people and their relatives in the planning process.</p> <p>Discussion</p> <p>The design of the study, the randomisation procedure and the protocol meetings were intended to ensure the quality of the study. The implementation of the intervention programme is followed and analysed throughout the whole study, which enables us to generate knowledge on the process of implementing complex interventions. The intervention contributes to early recognition of both the elderly peoples' needs of information, care and rehabilitation and of informal caregivers' need of support and information. This study is expected to show positive effects on frail elderly peoples' health care consumption, functional abilities and satisfaction with health and social care.</p> <p>Trial registration</p> <p>ClinicalTrials.gov: <a href="http://www.clinicaltrials.gov/ct2/show/NCT01260493">NCT01260493</a></p
Elderly persons in the risk zone. Design of a multidimensional, health-promoting, randomised three-armed controlled trial for "prefrail" people of 80+ years living at home
Background The very old (80+) are often described as a "frail" group that is particularly exposed to diseases and functional disability. They are at great risk of losing the ability to manage their activities of daily living independently. A health-promoting intervention programme might prevent or delay dependence in activities of daily life and the development of functional decline. Studies have shown that those who benefit most from a health-promoting and disease-preventive programme are persons with no, or discrete, activity restrictions. The three-armed study "Elderly in the risk zone" is designed to evaluate if multi-dimensional and multi-professional educational senior meetings are more effective than preventive home visits, and if it is possible to prevent or delay deterioration if an intervention is made when the persons are not so frail. In this paper the study design, the intervention and the outcome measures as well as the baseline characteristics of the study participants are presented. Methods/Design The study is a randomised three-armed single-blind controlled trial with follow-ups 3 months, 1 and 2 years. The study group should comprise a representative sample of pre-frail 80-year old persons still living at home in two municipalities of Gothenburg. To allow for drop-outs, it was estimated that a total of about 450 persons would need to be included in the study. The participants should live in their ordinary housing and not be dependent on the municipal home help service or care. Further, they should be independent of help from another person in activities of daily living and be cognitively intact, having a score of 25 or higher as assessed with the Mini Mental State Examination (MMSE). Discussion We believe that the design of the study, the randomisation procedure, outcome measurements and the study protocol meetings should ensure the quality of the study. Furthermore, the multi-dimensionality of the intervention, the involvement of both the professionals and the senior citizens in the planning of the
intervention should have the potential to effectively target the heterogeneous needs of the
elderly. Trial registration ClinicalTrials.gov, NCT0087705
Proceedings of the 3rd Biennial Conference of the Society for Implementation Research Collaboration (SIRC) 2015: advancing efficient methodologies through community partnerships and team science
It is well documented that the majority of adults, children and families in need of evidence-based behavioral health interventionsi do not receive them [1, 2] and that few robust empirically supported methods for implementing evidence-based practices (EBPs) exist. The Society for Implementation Research Collaboration (SIRC) represents a burgeoning effort to advance the innovation and rigor of implementation research and is uniquely focused on bringing together researchers and stakeholders committed to evaluating the implementation of complex evidence-based behavioral health interventions. Through its diverse activities and membership, SIRC aims to foster the promise of implementation research to better serve the behavioral health needs of the population by identifying rigorous, relevant, and efficient strategies that successfully transfer scientific evidence to clinical knowledge for use in real world settings [3]. SIRC began as a National Institute of Mental Health (NIMH)-funded conference series in 2010 (previously titled the âSeattle Implementation Research Conferenceâ; $150,000 USD for 3 conferences in 2011, 2013, and 2015) with the recognition that there were multiple researchers and stakeholdersi working in parallel on innovative implementation science projects in behavioral health, but that formal channels for communicating and collaborating with one another were relatively unavailable. There was a significant need for a forum within which implementation researchers and stakeholders could learn from one another, refine approaches to science and practice, and develop an implementation research agenda using common measures, methods, and research principles to improve both the frequency and quality with which behavioral health treatment implementation is evaluated. SIRCâs membership growth is a testament to this identified need with more than 1000 members from 2011 to the present.ii SIRCâs primary objectives are to: (1) foster communication and collaboration across diverse groups, including implementation researchers, intermediariesi, as well as community stakeholders (SIRC uses the term âEBP championsâ for these groups) â and to do so across multiple career levels (e.g., students, early career faculty, established investigators); and (2) enhance and disseminate rigorous measures and methodologies for implementing EBPs and evaluating EBP implementation efforts. These objectives are well aligned with Glasgow and colleaguesâ [4] five core tenets deemed critical for advancing implementation science: collaboration, efficiency and speed, rigor and relevance, improved capacity, and cumulative knowledge. SIRC advances these objectives and tenets through in-person conferences, which bring together multidisciplinary implementation researchers and those implementing evidence-based behavioral health interventions in the community to share their work and create professional connections and collaborations
Healthcare staffs perceptions of person-centered care
Bakgrund: Personcentrering Àr en etik som grundar sig i en humanistisk vÀrdegrund, dÀr
utgÄngspunkten Àr att möta individen utifrÄn ett helhetsperspektiv. Begreppet personcentrerad
vÄrd (PCV) har i sin tur vuxit fram som en beskrivning av god och humanistisk omvÄrdnad.
FörhÄllningssÀttet utgÄr frÄn tre nyckelbegrepp: partnerskap, patientberÀttelsen och
dokumentation. Personcentrerat arbetssÀtt (PCA) Àr en förenklad version av PCV, dÀr olika
verktyg anvÀnds i syfte att stÀrka patientens stÀllning och delaktighet samt frÀmja arbetsmiljön
för vÄrdpersonal. PCA infördes pÄ en geriatrisk slutenvÄrdsavdelning 2017. Befintlig forskning
beskriver effekter av att arbeta personcentrerat, men vÄrdpersonals upplevelser saknas, vilket
skulle bidra till en fortsatt utveckling av vÄrdens kvalitet. Syfte: Syftet med studien var att
beskriva vÄrdpersonals erfarenheter av ett personcentrerat arbetssÀtt inom geriatrisk slutenvÄrd.
Metod: En kvalitativ forskningsmetod anvÀndes. Tretton semistrukturerade intervjuer
genomfördes med vÄrdpersonal som arbetade pÄ en geriatrisk slutenvÄrdsavdelning. Insamlad
data analyserades med en manifest innehÄllsanalys. Resultat: Resultatet presenteras i tre
teman; âPositiva upplevelser av PCA som arbetssĂ€ttâ, âFaktorer som försvĂ„rar att arbeta kring
PCAâ och âFaktorer som gĂ„r att förbĂ€ttra inom PCAâ. Vidare delades temana in i Ă„tta
kategorier; âTeamarbete - att utnyttja all tillgĂ€nglig kunskapâ, âĂkad patientdelaktighet och
förbĂ€ttrad relation till patientenâ, âVĂ„rdplan och tavelrondâ, âTid och stressâ, âMotivation
hos patientâ, âStrukturella faktorerâ, âDokumentationâ samt âPersonalens engagemang spelar
rollâ. Slutsatser: Upplevelserna berör samtliga yrkeskategorier pĂ„ den geriatriska
slutenvÄrdsavdelningen, dÀrför bör PCA som begrepp inkluderas i alla vÄrdutbildningar för att
vÄrdpersonal ska kunna ge och upprÀtthÄlla en personcentrerad vÄrd. Vidare Àr kontinuerlig
utbildning sÄvÀl som stöd och uppmuntran mellan kollegor viktigt för att bidra till en fortsatt
utveckling av PCA
Experiences of Physical Activity Among People 80 Years of Age and Older; Physical Activity as a Means of Counteracting Disability, Balanced in Relation to Frailty.
The aim of this study was to describe experiences of physical activity, perceived meaning and importance of, and motives and barriers for participation in physical activity, among people 80 years of age and older. A qualitative design with focus-group methodology was used. The sample consisted of 20 community-living people aged 80-91 years. Data analyses revealed four themes: physical activity as a part of everything else in life, joie de vivre, fear of disease and dependence and perceptions of frailty. Our results suggest that physical activity was not seen as a separate activity but rather as a part of activities often rated as more important than the physical activity itself. Thus, when designing physical activity interventions for elderly people, health care providers should consider including time for social interaction and possibilities of being outdoors. Moreover, assessment of physical activity levels among elderly people should include the physical activity in everyday activities
Swedish Health Care Professionals' View of Frailty in Older Persons
There is a paucity of research literature concerning frailty in older persons from the health care professionals' perspective. Consequently, the purpose of this study was to elucidate health care professionals' view of frailty in older persons. An explorative, qualitative design was selected and four focus groups comprising 21 health care professionals were conducted, audiotaped, transcribed verbatim, and analyzed. Frailty was found to consist of seven dimensions: "being bodily weak and ill," "being negatively influenced by personal qualities," "lacking balance in everyday activities," "being dependent in everyday life," "not being considered important," "being hindered by the physical milieu and defective community service," and "having an inadequate social network." The results showed that health care professionals' view of frailty in older persons differed from the current state of knowledge on frailty. This implies that the seven dimensions found to constitute frailty could contribute to a more comprehensive understanding of the concept
Barriers for Inter-Organisational Collaboration: What Matters for an Integrated Care Programme?
Introduction: Inter-organisational collaboration is challenging but essential in managing the complex and comprehensive needs of frail older people. Therefore, there is a need to investigate the influence of different barriers to inter-organisational collaboration when implementing an integrated care programme. The aim of this study was to investigate both inpatient and outpatient staff views on the factors they deemed to be influential to inter-organisational collaboration for an integrated care programme. Methods: The study was a cross-sectional study and included staff from hospitals, primary care and municipal health and social care. Results: There were no significant differences between staff from inpatient and outpatient care in measuring factors that may cause difficulties for inter-organisational collaboration. Staff views diverged significantly on all factors, such as educational level at long physical distances, laws and regulations, knowledge of each others work settings, experience from inter-organisational collaboration, different professions, variations in professional status and power, psychosocial factors such as positive work environment and interpersonal chemistry. Discussion: A multidisciplinary team culture and avenues for inter-organisational collaboration need to be developed for improved care continuity. Conclusion: The staffsâ educational level influenced what was perceived as barriers to inter-organisational collaboration, and may guide future development of integrated care programmes