Parent satisfaction with the Loire Infant Follow-up Team (LIFT) premature and at-risk infant network in the Pays-de-la-Loire area (France)

BACKGROUND: The Loire Infant Follow-up Team (LIFT) is a network for caring for premature infants whose gestational age is 34 WA or less and at-risk neonates in the Pays-de-la-Loire area in France. The network aims to screen for clinical anomalies early and to propose adapted care. Trained physicians follow the included children in a standardized manner at 3, 6, 9, 12, and 18 months and 2 years, with a specific examination by psychologists at 2 years. The aim of the study was to assess the satisfaction of the parents of the children followed.METHODS: To evaluate parent satisfaction, a questionnaire from the Consumer Satisfaction Survey (CSS) in its French version was sent to parents whose infants were 2 years old, stratifying on the presence of an anomaly. The questioner had 39 items, with 8 specific items on the network and 31 from the CSS. The questionnaire was mailed twice in September 2006. RESULTS: Out of 300 questionnaires mailed, 269 were returned (rate 89.7 %). The questionnaire was assessed using principal component analysis with 2 dimensions for the 30 items common to all children, one of which covered empathy with physicians and the other with the consulting psychologists at 2 years. The validity was good (Cronbach coefficient, 0.91). The answers to overall questions such as "We are satisfied with the care in the network" scored 16.1±0.7/20, with 90 % "totally agree" or "moderately agree" responses. The "The care is perfect" scored 14.6±0.7/20 with 78 % agreeing with the statement. The total score for 30 general questions was 14.6±3.1 (median, 14.9). The total score was lower for infants with anomalies: 13.7±3.3 versus 14.9±2.9 (P<0.01). The answers with a low score (<10) were given by 22 parents (8.2 %). There was no significant relation between the total score or the satisfaction score and neonatal events. CONCLUSION: A postal survey is helpful to know the views of parents on the follow-up of their infants. This good level of satisfaction seems to stem from the parents feeling they belong to the network, the quality of the relationships with personnel, and the doctors\u27 empathy, as well as the number of contacts between parents and the network coordinator

Factors associated with death and limitation of life-sustaining therapies in patients with traumatic brain injury

Aim of the Study: A substantial proportion of deaths of patients in the Intensive Care Unit (ICU) follow a decision to limit life-sustaining therapies. Patients with moderate to severe Traumatic Brain Injury (TBI) differ from the general ICU population: They are usually younger, previously healthy, and often with no advance directives. The objective of this study was to identify factors associated with mortality and limitation of life-sustaining therapies in patients with moderate to severe traumatic brain injury in a Swiss academic tertiary care hospital. Methods: This study was a retrospective single center analysis of 170 non-elective admissions to the surgical ICU of a Swiss academic tertiary care hospital over a three-year period. Patients were eligible for the study if diagnosed with moderate to severe blunt TBI, and if the ICU length of stay was at least 48 hrs. Factors associated with mortality were investigated. Results: Mean age was 48 ± 21 years, 72.3% were male, and pre-existing medical conditions were overall rare. Forty-five patients (26.5%) died within 6 months after TBI (Non-survivors group). Most deaths (n=43, 95.5%) occurred after limitation of life-sustaining therapies. In the multiple binary logistic regression model age, Protestant religion, hypoxemia during the rescue phase, a higher category in the Marshall classification and a higher Injury Severity Score were independently associated with death. Conclusion: At our institution, most deaths of patients with moderate to severe TBI occurred after a deliberate decision to limit life-sustaining therapies. This decision was associated with age, spiritual belief of the patient, hypoxemia in the pre-hospital setting, radiological findings, and severity scores. Written advance directives should be encouraged to help surrogate decision makers and physicians in the acute and sudden setting of TBI to respect the patient’s willed

Tolerance to cardiac allografts via local and systemic mechanisms after adenovirus-mediated CTLA4Ig expression

Blockade of the CD28/B7 T cell costimulatory pathway prolongs allograft survival and induces tolerance in some animal models. We analyzed the efficacy of a CTLA4Ig-expressing adenovirus in preventing cardiac allorejection in rats, the mechanisms underlying heart transplant acceptance, and whether the effects of CTLA4Ig were restricted to the graft microenvironment or were systemic. CTLA4Ig gene transfer into the myocardium allowed indefinite graft survival (>100 days vs 9 +/- 1 days for controls) in 90% of cases, whereas CTLA4Ig protein injected systemically only prolonged cardiac allograft survival (by up to 22 days). CTLA4Ig could be detected in the graft and in the serum for at least 1 year after gene transfer. CTLA4Ig gene transfer induced local intragraft immunomodulation at day 5 after transplantation, as shown by decreased expression of the IL-2R and MHC II Ags; decreased levels of mRNA encoding for IFN-gamma, inducible NO synthase, and TGF-beta; and inhibited proliferative responses of graft-infiltrating cells. Systemic immune responses were also down-modulated, as shown by the suppression of Ab production against donor alloantigens and cognate Ags, up to at least 120 days after gene transfer. Alloantigenic and mitogenic proliferative responses of graft-infiltrating cells and total splenocytes were inhibited and were not reversed by IL-2. In contrast, lymph node cells and T cells purified from splenocytes showed normal proliferation. Recipients of long-term grafts treated with adenovirus coding for CTLA4Ig showed organ and donor-specific tolerance. These data show that expression of CTLA4Ig was high and long lasting after adenovirus-mediated gene transfer. This expression resulted in down-modulation of responses against cognate Ags, efficient suppression of local and systemic allograft immune responses, and ultimate induction of donor-specific tolerance

Transgenic expression of CTLA4-Ig by fetal pig neurons for xenotransplantation

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