Bewonersparticipatie in het openbaar groenbeheer : 'State of the art' na vijf jaar zelfbeheer in de wijk EVA-Lanxmeer (Culemborg)

De wijk EVA-Lanxmeer (1997) is een duurzame woon- en werkwijk in Culemborg, op een grondwaterwingebied van Vitens. Het is een voorbeeldproject op het gebied van duurzame stedenbouw en participatief beleid. Het wordt door gemeenten en groepen burgers in binnen- en buitenland gebruikt om inspiratie, kennis en ervaring op te doen en uit te wisselen op het gebied van innovatief denken binnen de eigen gemeentelijke organisatie. Bewoners onderhouden zelf een belangrijk deel van het wijkgroen op een ecologische wijze. Zij doen dat in samenwerking en overleg met de gemeente Culemborg en Waterwinbedrijf Vitens. De meeste bewoners hebben sterk het gevoel dat het zelfbeheer de kwaliteit en diversiteit van het groen in de wijk verhoogt. De gezamenlijke werkzaamheden maken ongedwongen ontmoetingen met andere bewoners in de wijk mogelijk

EVALUACIÓN DE RESULTADOS QUIRÚRGICOS DESDE LA PERSPECTIVA DEL PACIENTE

RESUMENMedir la calidad de vida relacionada a salud y los síntomas de los pacientes es un problema difícil. Las medición de los problemas de salud mediante escalas o cuestionarios se ha desarrollado para crear los Instrumentos de Evaluación desde la Perspectiva del Paciente o PRO's por su nombre en inglés: Patient-reported outcomes. Los PROs evalúan la calidad de vida en forma genérica o específica en un continuo, entregando instrumentos que pueden evaluar la gravedad de una enfermedad o el impacto de una intervención desde la perspectiva del paciente en frecuentes escenarios clínicos. El objetivo de la presente revisión es entregar a clínicos e investigadores una introducción hacia los PROs y resumir sus principales propiedades.SUMMARYQuantifying health-related quality of life and specific patient symptoms it is a difficult problem. Health measurement scales has developed to include rigorous techniques to develop patient-reported outcome measures (PROs). PROs assess objectively the QoL in a continuum, providing instruments to measure the severity of a given disease or the impact of a therapeutic intervention from patient perspective in different clinical problems. The following review aims to introduce the PROs to clinicians and researchers and summarize its main properties

Influenza and associated co-infections in critically ill immunosuppressed patients

Background: It is unclear whether influenza infection and associated co-infection are associated with patient-important outcomes in critically ill immunocompromised patients with acute respiratory failure. Methods: Preplanned secondary analysis of EFRAIM, a prospective cohort study of 68 hospitals in 16 countries. We included 1611 patients aged 18 years or older with non-AIDS-related immunocompromise, who were admitted to the ICU with acute hypoxemic respiratory failure. The main exposure of interest was influenza infection status. The primary outcome of interest was all-cause hospital mortality, and secondary outcomes ICU length of stay (LOS) and 90-day mortality. Results: Influenza infection status was categorized into four groups: patients with influenza alone (n = 95, 5.8%), patients with influenza plus pulmonary co-infection (n = 58, 3.6%), patients with non-influenza pulmonary infection (n = 820, 50.9%), and patients without pulmonary infection (n = 638, 39.6%). Influenza infection status was associated with a requirement for intubation and with LOS in ICU (P < 0.001). Patients with influenza plus co-infection had the highest rates of intubation and longest ICU LOS. On crude analysis, influenza infection status was associated with ICU mortality (P < 0.001) but not hospital mortality (P = 0.09). Patients with influenza plus co-infection and patients with non-influenza infection alone had similar ICU mortality (41% and 37% respectively) that was higher than patients with influenza alone or those without infection (33% and 26% respectively). A propensity score-matched analysis did not show a difference in hospital mortality attributable to influenza infection (OR = 1.01, 95%CI 0.90-1.13, P = 0.85). Age, severity scores, ARDS, and performance status were all associated with ICU, hospital, and 90-day mortality. Conclusions: Category of infectious etiology of respiratory failure (influenza, non-influenza, influenza plus co-infection, and non-infectious) was associated with ICU but not hospital mortality. In a propensity score-matched analysis, influenza infection was not associated with the primary outcome of hospital mortality. Overall, influenza infection alone may not be an independent risk factor for hospital mortality in immunosuppressed patients

From arginine methylation to ADMA: A novel mechanism with therapeutic potential in chronic lung diseases

Protein arginine methylation is a novel posttranslational modification regulating a diversity of cellular processes, including protein-protein interaction, signal transduction, or histone function. It has recently been shown to be dysregulated in chronic renal, vascular, and pulmonary diseases, and metabolic products originating from protein arginine methylation have been suggested to serve as biomarkers in cardiovascular and pulmonary diseases

N-acetylcysteine reduces oxidative stress in sickle cell patients

Oxidative stress is of importance in the pathophysiology of sickle cell disease (SCD). In this open label randomized pilot study the effects of oral N-acetylcysteine (NAC) on phosphatidylserine (PS) expression as marker of cellular oxidative damage (primary end point), and markers of hemolysis, coagulation and endothelial activation and NAC tolerability (secondary end points) were studied. Eleven consecutive patients (ten homozygous [HbSS] sickle cell patients, one HbSβ0-thalassemia patient) were randomly assigned to treatment with either 1,200 or 2,400 mg NAC daily during 6 weeks. The data indicate an increment in whole blood glutathione levels and a decrease in erythrocyte outer membrane phosphatidylserine exposure, plasma levels of advanced glycation end-products (AGEs) and cell-free hemoglobin after 6 weeks of NAC treatment in both dose groups. One patient did not tolerate the 2,400 mg dose and continued with the 1,200 mg dose. During the study period, none of the patients experienced painful crises or other significant SCD or NAC related complications. These data indicate that N-acetylcysteine treatment of sickle cell patients may reduce SCD related oxidative stress

New-onset type 1 diabetic ketoacidosis complicated by acute respiratory distress syndrome

A young female patient was admitted to the intensive care unit with severe acute respiratory distress syndrome following diabetic ketoacidosis. Intubation and mechanical ventilation were necessary to ensure adequate gas exchange. However, severe hypercapnia with respiratory acidosis persisted despite high ventilatory pressures potentially aggravating ventilator-associated lung injury. A veno-venous extracorporeal membrane ventilator was used to effectively eliminate carbon dioxide. Within a week, the patient could be weaned from the extracorporeal membrane circuit and mechanical ventilator. This case report highlights the importance of considering ARDS as a consequence of diabetic ketoacidosis

New-onset type 1 diabetic ketoacidosis complicated by acute respiratory distress syndrome

A young female patient was admitted to the intensive care unit with severe acute respiratory distress syndrome following diabetic ketoacidosis. Intubation and mechanical ventilation were necessary to ensure adequate gas exchange. However, severe hypercapnia with respiratory acidosis persisted despite high ventilatory pressures potentially aggravating ventilator-associated lung injury. A veno-venous extracorporeal membrane ventilator was used to effectively eliminate carbon dioxide. Within a week, the patient could be weaned from the extracorporeal membrane circuit and mechanical ventilator. This case report highlights the importance of considering ARDS as a consequence of diabetic ketoacidosis