Family satisfaction in the intensive care unit: what makes the difference?

Purpose: To assess family satisfaction in the ICU and to identify parameters for improvement. Methods: Multicenter study in Swiss ICUs. Families were given a questionnaire covering overall satisfaction, satisfaction with care and satisfaction with information/decision-making. Demographic, medical and institutional data were gathered from patients, visitors and ICUs. Results: A total of 996 questionnaires from family members were analyzed. Individual questions were assessed, and summary measures (range 0-100) were calculated, with higher scores indicating greater satisfaction. Summary score was 78±14 (mean±SD) for overall satisfaction, 79±14 for care and 77±15 for information/decision-making. In multivariable multilevel linear regression analyses, higher severity of illness was associated with higher satisfaction, while a higher patient:nurse ratio and written admission/discharge criteria were associated with lower overall satisfaction. Using performance-importance plots, items with high impact on overall satisfaction but low satisfaction were identified. They included: emotional support, providing understandable, complete, consistent information and coordination of care. Conclusions: Overall, proxies were satisfied with care and with information/decision-making. Still, several factors, such as emotional support, coordination of care and communication, are associated with poor satisfaction, suggesting the need for improvemen

Among Persons With Multiple Sclerosis (MS), Objective Sleep, Psychological Functioning, and Higher Physical Activity Scores Remained Stable Over 2 Years-Results From a Small Study Under Naturalistic Conditions

Background:; Persons with multiple sclerosis (PwMS) are at increased risk to report poor sleep patterns and lower physical activity indices. To date, data on longitudinal objectively sleep assessment is missing. In the present study, we investigated the pattern of objective sleep and subjective physical activity indices over a period of 13.5 months, under naturalistic conditions.; Method:; 13.5 months after their first assessment, a total of 16 PwMS (mean age = 49.13 median EDSS score: 5; 11 females) were reassessed on their objective sleep via portable sleep-electroencephalogram (EEG-) devices, along with their subjective sleep patterns (symptoms of insomnia, restless legs syndrome (RLS), and sleep-disordered breathing), physical activity indices, psychological functioning (symptoms of depression, fatigue, daytime sleepiness), and MS-related information (fatigue, EDSS; disease-modifying treatments). While the baseline assessment was performed in a rehabilitation center, the follow-up assessment took place at participants' naturalistic and familiar setting.; Results:; Statistically, symptoms of depression and fatigue, subjective sleep, and physical activity levels did neither increase, nor decrease over time, although descriptively, both moderate and vigorous physical activity levels decreased, and fatigue and subjective insomnia increased. Time awake after sleep onset statistically significantly decreased, while light sleep duration increased by trend.; Conclusions:; Among a smaller sample of PwMS, objective sleep in their naturalistic setting remained fairly stable over a mean time lapse of 13.5 months after clinic discharge. Physical activity levels descriptively decreased. The present results are of clinical and practical importance for treatment counseling: PwMS can be reassured that their sleep quality does not deteriorate, once they have left a rehabilitation center. Further, they should be encouraged to keeping their physical activity levels as stable as possible

Family satisfaction in the intensive care unit: what makes the difference?

PURPOSE: To assess family satisfaction in the ICU and to identify parameters for improvement. METHODS: Multicenter study in Swiss ICUs. Families were given a questionnaire covering overall satisfaction, satisfaction with care and satisfaction with information/decision-making. Demographic, medical and institutional data were gathered from patients, visitors and ICUs. RESULTS: A total of 996 questionnaires from family members were analyzed. Individual questions were assessed, and summary measures (range 0-100) were calculated, with higher scores indicating greater satisfaction. Summary score was 78 +/- 14 (mean +/- SD) for overall satisfaction, 79 +/- 14 for care and 77 +/- 15 for information/decision-making. In multivariable multilevel linear regression analyses, higher severity of illness was associated with higher satisfaction, while a higher patient:nurse ratio and written admission/discharge criteria were associated with lower overall satisfaction. Using performance-importance plots, items with high impact on overall satisfaction but low satisfaction were identified. They included: emotional support, providing understandable, complete, consistent information and coordination of care. CONCLUSIONS: Overall, proxies were satisfied with care and with information/decision-making. Still, several factors, such as emotional support, coordination of care and communication, are associated with poor satisfaction, suggesting the need for improvement. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s00134-009-1611-4) contains supplementary material, which is available to authorized users

Befragung zu körperlicher Aktivität, Befindlichkeit und Schlaf bei Patientinnen und Patienten mit Multipler Sklerose (MS) – eine Querschnittsstudie

Hintergrund: Multiple Sklerose (MS) ist mit mehr als 2.5 Millionen bekannten Fällen, die am häufigsten verbreitete chronisch-entzündliche und demyelinisierende Erkrankung des zentralen Nervensystems (Gehirn und Rückenmark). Bis heute ist noch keine Heilung der Krankheit möglich. Eine Vielzahl von Studien bestätigen, dass die Symptome der Erkrankung mittels körperlicher Aktivität signifikant reduziert werden können. Ebenfalls ist die mentale Stärke im Zusammenhang mit der aktuellen MS-Forschung in den Vordergrund gerückt. Dennoch mangelt es in essentiellen Bereichen noch an Forschungsergebnissen. Daher verfolgte diese Studie das Ziel, Antworten auf bisher ungeklärte Forschungsfragen zu finden. Methode: Die Rekrutierung der Patienten mit MS fand über die Klinik Valens statt. Alle Patienten waren als Voraussetzung für eine Teilnahme schon bei einer vorgängigen Studie in der Klinik selbst dabei gewesen. 16 Patienten mit MS (Durchschnittsalter: 57 Jahre; 13/16 weiblich) haben sich bereit erklärt, bei dieser Nachfolgestudie dabei zu sein. Die Patientinnen und Patienten haben EDSS-Werte zwischen 4.0 und 7.5 mit einem Mittelwert von 5.7. Die Datenerhebung erfolgte mittels folgenden standardisierten und validen Messinstrumenten und Fragebögen: Mentale Stärke (MTQ18), körperliches Aktivitätsniveau (IPAQ), Actigraphie, depressive Störungen (BDI-FS), Fatigue (FSS), Schlafstörungen (ISI), Schlafeffizienz (EEG), Expanded Disability Status Scale (EDSS), Restless-Legs- Syndrome (RLS). Ergebnisse: Es kann leichte Zusammenhänge zwischen mentaler Stärke und körperlicher Aktivität, Fatigue, Schlafstörungen und dem Syndrom für ruhelose Beine (RLS) geben. Am deutlichsten ist der Zusammenhang zwischen mentaler Stärke und Fatigue. Zwischen depressiven Störungen und mentaler Stärke existiert kein Zusammenhang. Es gibt aber eine Korrelation mit der Fatigue. Dies ist interessant, da die mentale Stärke am deutlichsten einen Zusammenhang mit der Fatigue aufweist. Der Zusammenhang zwischen mentaler Stärke und den EDSSWerten konnte nicht erforscht werden. Welcher Zusammenhang zwischen mentaler Stärke und Schlafeffizienz steht, bleibt offen. Diskussion: Aufgrund der Ergebnisse bleibt unklar, ob es einen Zusammenhang zwischen mentaler Stärke, den EDSS-Werten und der Schlafeffizienz gibt. Es sind weitere Studien mit anderen Methoden und grösseren Fallzahlen nötig, um das herauszufinden

Diesel exhaust particles modulate the tight junction protein occludin in lung cells <it>in vitro</it>

Abstract Background Using an in vitro triple cell co-culture model consisting of human epithelial cells (16HBE14o-), monocyte-derived macrophages and dendritic cells, it was recently demonstrated that macrophages and dendritic cells create a transepithelial network between the epithelial cells to capture antigens without disrupting the epithelial tightness. The expression of the different tight junction proteins in macrophages and dendritic cells, and the formation of tight junction-like structures with epithelial cells has been demonstrated. Immunofluorescent methods combined with laser scanning microscopy and quantitative real-time polymerase chain reaction were used to investigate if exposure to diesel exhaust particles (DEP) (0.5, 5, 50, 125 μg/ml), for 24 h, can modulate the expression of the tight junction mRNA/protein of occludin, in all three cell types. Results Only the highest dose of DEP (125 μg/ml) seemed to reduce the occludin mRNA in the cells of the defence system however not in epithelial cells, although the occludin arrangement in the latter cell type was disrupted. The transepithelial electrical resistance was reduced in epithelial cell mono-cultures but not in the triple cell co-cultures, following exposure to high DEP concentration. Cytotoxicity was not found, in either epithelial mono-cultures nor in triple cell co-cultures, after exposure to the different DEP concentrations. Conclusion We concluded that high concentrations of DEP (125 μg/ml) can modulate the tight junction occludin mRNA in the cells of the defence system and that those cells play an important role maintaining the epithelial integrity following exposure to particulate antigens in lung cells.</p

Diesel exhaust particles modulate the tight junction protein occludin in lung cells in vitro

BACKGROUND: Using an in vitro triple cell co-culture model consisting of human epithelial cells (16HBE14o-), monocyte-derived macrophages and dendritic cells, it was recently demonstrated that macrophages and dendritic cells create a transepithelial network between the epithelial cells to capture antigens without disrupting the epithelial tightness. The expression of the different tight junction proteins in macrophages and dendritic cells, and the formation of tight junction-like structures with epithelial cells has been demonstrated. Immunofluorescent methods combined with laser scanning microscopy and quantitative real-time polymerase chain reaction were used to investigate if exposure to diesel exhaust particles (DEP) (0.5, 5, 50, 125 μg/ml), for 24 h, can modulate the expression of the tight junction mRNA/protein of occludin, in all three cell types. RESULTS: Only the highest dose of DEP (125 μg/ml) seemed to reduce the occludin mRNA in the cells of the defence system however not in epithelial cells, although the occludin arrangement in the latter cell type was disrupted. The transepithelial electrical resistance was reduced in epithelial cell mono-cultures but not in the triple cell co-cultures, following exposure to high DEP concentration. Cytotoxicity was not found, in either epithelial mono-cultures nor in triple cell co-cultures, after exposure to the different DEP concentrations. CONCLUSION: We concluded that high concentrations of DEP (125 μg/ml) can modulate the tight junction occludin mRNA in the cells of the defence system and that those cells play an important role maintaining the epithelial integrity following exposure to particulate antigens in lung cells

Macrophages and dendritic cells express tight junction proteins and exchange particles in an in vitro model of the human airway wall

The human airway epithelium serves as structural and functional barrier against inhaled particulate antigen. Previously, we demonstrated in an in vitro epithelial barrier model that monocyte derived dendritic cells (MDDC) and monocyte derived macrophages (MDM) take up particulate antigen by building a trans-epithelial interacting network. Although the epithelial tight junction (TJ) belt was penetrated by processes of MDDC and MDM, the integrity of the epithelium was not affected. These results brought up two main questions: (1) Do MDM and MDDC exchange particles? (2) Are those cells expressing TJ proteins, which are believed to interact with the TJ belt of the epithelium to preserve the epithelial integrity? The expression of TJ and adherens junction (AJ) mRNA and proteins in MDM and MDDC monocultures was determined by RT-PCR, and immunofluorescence, respectively. Particle uptake and exchange was quantified by flow cytometry and laser scanning microscopy in co-cultures of MDM and MDDC exposed to polystyrene particles (1 μm in diameter). MDM and MDDC constantly expressed TJ and AJ mRNA and proteins. Flow cytometry analysis of MDM and MDDC co-cultures showed increased particle uptake in MDDC while MDM lost particles over time. Quantitative analysis revealed significantly higher particle uptake by MDDC in co-cultures of epithelial cells with MDM and MDDC present, compared to co-cultures containing only epithelial cells and MDDC. We conclude from these findings that MDM and MDDC express TJ and AJ proteins which could help to preserve the epithelial integrity during particle uptake and exchange across the lung epithelium

Better Objective Sleep Was Associated with Better Subjective Sleep and Physical Activity; Results from an Exploratory Study under Naturalistic Conditions among Persons with Multiple Sclerosis

Persons with multiple sclerosis (PwMS) often complain about sleep problems. There is less known about objective sleep-electroencephalography (EEG) dimensions within naturalistic conditions (i.e., home and/or familiar setting). The present cross-sectional study examined the associations between objective and subjective sleep, depression, physical activity scores, and MS-related information among PwMS in their familiar setting. The sample consisted of 16 PwMS (mean age: 50.3 years; median Expanded Disability Status Scale (EDSS): 5.5) who completed questionnaires covering subjective sleep (symptoms of insomnia, restless legs syndrome (RLS) and sleep-disordered breathing), as well as daytime sleepiness, subjective physical activity, depression, and MS-related information (fatigue, EDSS; disease-modifying treatments). Objective sleep was assessed with a mobile sleep-EEG device under naturalist conditions within the home. Descriptively, better objective sleep patterns were associated with lower sleep complaints (r; s; = -0.51) and daytime sleepiness (r; s; = -0.43), and with lower symptoms of RLS (r; s; = -0.35), but not with sleep-disordered breathing (r; s; = -0.17). More deep sleep was associated with higher moderate physical activity levels (r; s; = 0.56). Objective sleep parameters were not associated with vigorous physical activity levels (r; s; < 0.25). Descriptively, moderate and vigorous physical activity scores were associated with lower symptoms of RLS (r; s; = -0.43 to -0.47). Results from this small study carried out under naturalistic conditions suggest that among PwMS, better objective sleep correlated with better subjective sleep and higher moderate physical activity levels

Release of graphene-related materials from epoxy-based composites: characterization, quantification and hazard assessment in vitro

Due to their mechanical strength, thermal stability and electrical conductivity, graphene-related materials (GRMs) have been extensively explored for various applications. Moreover, GRMs have been studied and applied as fillers in polymer composite manufacturing to enhance the polymer performance. With the foreseen growth in GRM production, occupational and consumer exposure is inevitable, thus raising concerns for potential health risks. Therefore, this study aims (1) to characterize aerosol particles released after mechanical abrasion on GRM-reinforced epoxy composites, (2) to quantify the amounts of protruding and free-standing GRMs in the abraded particles and (3) to assess the potential effects of the pristine GRMs as well as the abraded particles on human macrophages differentiated from the THP-1 cell line in vitro. GRMs used in this study included graphene nanoplatelets (GNPs), graphene oxide (GO), and reduced graphene oxide (rGO). All types of pristine GRMs tested induced a dose-dependent increase in reactive oxygen species formation, but a decrease in cell viability was only detected for large GNPs at high concentrations (20 and 40 μg mL−1). The particle modes measured using a scanning mobility particle sizer (SMPS) were 300–400 nm and using an aerodynamic particle sizer (APS) were between 2–3 μm, indicating the release of respirable particles. A significant fraction (51% to 92%) of the GRMs embedded in the epoxy composites was released in the form of free-standing or protruding GRMs in the abraded particles. The abraded particles did not induce any acute cytotoxic effects.ISSN:2040-3364ISSN:2040-337