Water-loss dehydration and aging

This review defines water-loss and salt-loss dehydration. For older people serum osmolality appears the most appropriate gold standard for diagnosis of water-loss dehydration, but clear signs of early dehydration have not been developed. In older adults, lower muscle mass, reduced kidney function, physical and cognitive disabilities, blunted thirst, and polypharmacy all increase dehydration risk. Cross-sectional studies suggest a water-loss dehydration prevalence of 20-30% in this population. Water-loss dehydration is associated with higher mortality, morbidity and disability in older people, but evidence is still needed that this relationship is causal. There are a variety of ways we may be able to help older people reduce their risk of dehydration by recognising that they are not drinking enough, and being helped to drink more. Strategies to increase fluid intake in residential care homes include identifying and overcoming individual and institutional barriers to drinking, such as being worried about not reaching the toilet in time, physical inability to make or to reach drinks, and reduced social drinking and drinking pleasure. Research needs are discussed, some of which will be addressed by the FP7-funded NU-AGE (New dietary strategies addressing the specific needs of elderly population for a healthy ageing in Europe) trial

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

CAS-DAS HES-SO en oncologie et soins palliatifs ::enraciné dans l’histoire romande des soins en oncologie, orienté vers l’avenir

Les formations de spécialisation en oncologie et soins palliatifs de la Haute École de Santé de Genève ont traversé les décennies. Elles ont contribué à promouvoir les soins infirmiers aux personnes souffrant de cancer et à leurs proches, à permettre aux institutions de bénéficier de professionnels spécialisés. Le CAS-DAS HES en oncologie et en soins palliatifs, en partenariat avec les Hôpitaux Universitaires de Genève, est la dernière mouture de cette formation engagée vers l’à-venir

Médecine sexuelle et cancers : une main tendue vers l’humain

Le cancer et ses traitements peuvent induire de nombreux effets secondaires. Parmi eux, les problèmes liés à la santé sexuelle sont souvent laissés de côté, tant par les cliniciens que par les patients eux-mêmes. Du côté des cliniciens, les principaux obstacles évoqués sont le sentiment d’une formation inadéquate, ou le manque de temps ou d’intimité. Du côté des patients, la gêne ou l’impression que les problèmes sexuels liés au cancer sont incurables, sont souvent retrouvées. Devant cette problématique, un groupe multidisciplinaire a été créé pour traiter de la santé sexuelle des patients oncologiques et mettre en place une formation spécialisée pour les cliniciens, avec comme objectif global d’intégrer la problématique sexuelle dans la prise en charge globale de ces patients

Prise en charge de la sexualité chez les patients oncologiques: Un projet de recherche au sein des Hôpitaux universitaires de Genève

Les cancers affectent la fonction sexuelle, la santé sexuelle, la relation de couple, ainsi que la santé mentale et la qualité de vie. Pour assurer une prise en charge et une qualité de soins optimales, en raison de l’importance de la santé sexuelle pour chaque individu, nous avons évalué la demande concernant la sexualité et la santé sexuelle chez les patients atteints d’un cancer et les besoins de connaissances professionnelles dans ce domaine du personnel soignant. Les résultats ont montré que la sexualité avait une place importante chez les patients et les soignants. De plus, les soignants souhaitent créer un meilleur réseau professionnel, dans le but de rediriger les patients vers des spécialistes, en fonction de leurs besoins spécifiques. Enfin les soignants ont exprimé une volonté de mieux se former en sexologie et en santé sexuelle

Création d’une unité spécifique de soins palliatifs dans un service d’urgences en période de pandémie ::étude descriptive qualitative

Création d’une unité spécifique de soins palliatifs dans un service d’urgences en période de pandémie : étude descriptive qualitative – Cet article décrit l’expérience des professionnels impliqués dans la création d’une unité de soins palliatifs dans un service d’urgences en contexte de la pandémie COVID-19. Une approche descriptive qualitative est utilisée. Les professionnels venant de différents secteurs avec des connaissances diversifiées, se sont retrouvés autour des valeurs partagées de soins palliatifs : l’unicité, la dignité et l’authenticité. Ces valeurs ont été déclinées autour de quatre thèmes : soignant en tant que qui je suis, l’esprit d’équipe, l’être humain, l’environnement. Des pistes en sont proposées pour faire face à de nouvelles crises sanitaires.The creation of a specialist palliative care unit in an emergency department during a pandemic : A qualitative descriptive study – This article describes the experience of professionals involved in the creation of a palliative care unit in an emergency department during the COVID-19 pandemic. A qualitative descriptive approach is used. Professionals from different sectors and with a diverse range of knowledge came together around shared values of palliative care : uniqueness, dignity, and authenticity. These values were broken down into four themes : the caregiver as who I am, team spirit, the human being, and the environment. We propose some pathways for dealing with new health crises

Regard sur les retombées d’activités artistiques pour des adultes présentant une déficience intellectuelle

Malgré le potentiel que présentent les activités artistiques, elles sont encore peu documentées auprès des personnes présentant une déficience intellectuelle (DI). Cette étude visait à documenter les retombées d’activités basées sur la musique, la danse et le théâtre pour les adultes présentant une DI. Des entrevues ont été menées auprès de personnes présentant une DI, de leurs parents, d’intervenants et des responsables des ateliers. La participation aux activités artistiques a eu des retombées positives sur la dimension physique, cognitive, affective et spirituelle des usagers. Elles ont favorisé le développement de leur estime de soi et de leur sentiment d’appartenance au groupe. L’offre d’activités artistiques représente une stratégie fort pertinente pour les engager à long terme dans un projet adapté à leurs capacités.The potential of the arts to improve the quality of life of individuals engaging in it is well documented. However, when it comes to research documenting the effectiveness of such activities with individuals with intellectual disability (ID), there is a paucity of research. The following study aimed to detail the benefits of engaging in performance art activities such as music, dance and theater for adults with ID. Interviews were conducted with various actors, including adults with ID. Results showed that participation in performance art activities had a positive impact on physical, cognitive, emotional, and spiritual dimensions for adults with ID. These activities supported the development of their self-esteem and increased their sense of belongingness to the group. The findings of this study clearly indicate that using performance art mediums can improve engagement and participation in a long-term project specifically adapted to the participant’s capacities

Normal human epithelial cells regulate the size and morphology of tissue-engineered capillaries

The survival of thick tissues/organs produced by tissue engineering requires rapid revascularization after grafting. Although capillary-like structures have been reconstituted in some engineered tissues, little is known about the interaction between normal epithelial cells and endothelial cells involved in the in vitro angiogenic process. In the present study, we used the self-assembly approach of tissue engineering to examine this relationship. An endothelialized tissue-engineered dermal substitute was produced by adding endothelial cells to the tissue-engineered dermal substitute produced by the self-assembly approach. The latter consists in culturing fibroblasts in the medium supplemented with serum and ascorbic acid. A network of tissue-engineered capillaries (TECs) formed within the human extracellular matrix produced by dermal fibroblasts. To determine whether epithelial cells modify TECs, the size and form of TECs were studied in the endothelialized tissue-engineered dermal substitute cultured in the presence or absence of epithelial cells. In the presence of normal keratinocytes from skin, cornea or uterine cervix, endothelial cells formed small TECs (cross-sectional area estimated at less than 50 μm2) reminiscent of capillaries found in the skin's microcirculation. In contrast, TECs grown in the absence of epithelial cells presented variable sizes (larger than 50 μm2), but the addition of keratinocyte-conditioned media or exogenous vascular endothelial growth factor induced their normalization toward a smaller size. Vascular endothelial growth factor neutralization inhibited the effect of keratinocyte-conditioned media. These results provide new direct evidence that normal human epithelial cells play a role in the regulation of the underlying TEC network, and advance our knowledge in tissue engineering for the production of TEC networks in vitro

Les infirmiers de pratique avancée français, de la vision à la mise en œuvre au sein d’un établissement de santé mentale

International audienc

Effect of medroxyprogesterone acetate on the efficiency of an oral protein-rich nutritional support in HIV-infected patients

We have examined the effect of a medroxyprogesterone therapy in HIV-infected patients under appropriate nutrition for anabolism. The experiments were performed on 12 men (mean age 40 y), HIV seropositive but free of any clinically active opportunistic infection for at least one month. The patients underwent a 2-week baseline diet period (1.2 g protein$\cdot$kg$^{-1}$ body weight (BW)$\cdot$d$^{-1}$) and then a 5-week experimental period with again the baseline diet in conjunction with supplements including Tonexis HP (0.7 g protein$\cdot$kg$^{-1}$ BW)$\cdot$d$^{-1}$), L-threonine (0.018 g$\cdot$kg$^{-1}$ BW$\cdot$d$^{-1}$) and L-methionine (0.013 g$\cdot$kg$^{-1}$ BW$\cdot$d$^{-1}$). Indeed HIV-infected patients showed deficiencies in these amino acids. They were randomly divided into groups I and II under double- blinded condition. Group II was given medroxyprogesterone acetate (0.4 g$\cdot$d$^{-1}$) during the last 3 weeks whereas group I received a placebo. All the patients significantly increased their body weight ($P <$ 0.05) during the experimental periods. Those under medroxyprogesterone tended to show a higher but not significant weight gain (+3.1 $\pm$ 1.0 kg in group II and +1.9 $\pm$ 0.3 kg in group I). Blood free amino acids were used as rough indicators of amino acid utilization and were analyzed prior and during acute 150 min intravenous infusion of a complete glucose-amino acid mixture. This test was done before and at the end of the experimental periods. Basal essential blood free amino acids were similar in the two groups and did not change during the experimental period. Most essential amino acids increased following glucose-amino acid infusions. The incremental increase was of less magnitude after the experimental period than before when medroxyprogesterone was present ($P <$ 0.05 for valine, leucine, lysine, threonine and methionine). This was not the case in the absence of the hormone. We concluded that medroxyprogesterone might improve the efficacy of an oral protein-rich nutritional support in HIV-infected patients