Föräldrarnas upplevelse av mötet med anestesisjuksköterskan i samband med barnets operation

Bakgrund: När ett barn opereras finns ett starkt samband mellan föräldrarnas och vårdpersonalens beteende vilket påverkar barnet sätt att hantera den nya miljön och anestesin. Att anestesisjuksköterskan möter barn i alla åldrar ställer höga krav på bemötandet och hur informationen anpassas till dem och deras föräldrar. Syfte: Syftet med studien är att belysa föräldrarnas upplevelse av mötet med anestesisjuksköterskan när deras barn skall sövas inför ett kirurgiskt ingrepp. Metod: Semistrukturerade intervjuer med 14 föräldrar. Materialet analyserades med kvalitativ innehållsanalys. Resultat: Resultatet utmynnade i tre kategorier: Information, Föräldrar på operationssalen och Anestesisjuksköterskans professionalitet. Konklusion: Föräldrarna önskar tydlig information i ett tidigt skede. Anestesisjuksköterskans bemötande upplevs viktig för att lämna över barnet i andras händer. Även en lugn miljö på operationssalen var önskvärt

Changes in SARS-CoV-2 viral load and mortality during the initial wave of the pandemic in New York City

Funding: This work was partially supported by the National Center for Advancing Translational Sciences of the National Institutes of Health (UL1 TR0023484 to Julianne Imperato-McGinley) and the National Institute of Allergy and Infectious Diseases (UM1 AI069470 to M.E.S).Public health interventions such as social distancing and mask wearing decrease the incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, but it is unclear whether they decrease the viral load of infected patients and whether changes in viral load impact mortality from coronavirus disease 2019 (COVID-19). We evaluated 6923 patients with COVID-19 at six New York City hospitals from March 15-May 14, 2020, corresponding with the implementation of public health interventions in March. We assessed changes in cycle threshold (CT) values from reverse transcription-polymerase chain reaction tests and in-hospital mortality and modeled the impact of viral load on mortality. Mean CT values increased between March and May, with the proportion of patients with high viral load decreasing from 47.7% to 7.8%. In-hospital mortality increased from 14.9% in March to 28.4% in early April, and then decreased to 8.7% by May. Patients with high viral loads had increased mortality compared to those with low viral loads (adjusted odds ratio 2.34). If viral load had not declined, an estimated 69 additional deaths would have occurred (5.8% higher mortality). SARS-CoV-2 viral load steadily declined among hospitalized patients in the setting of public health interventions, and this correlated with decreases in mortality.Peer reviewe

Multidimensional performance assessment of public sector organisations using dominance criteria

Public sector organisations pursue multiple objectives and serve a number of stakeholders. But stakeholders are rarely explicit about the valuations they attach to different objectives, nor are these valuations likely to be identical. This complicates the assessment of their performance because no single set of weights can be chosen legitimately to aggregate outputs into unidimensional composite scores. We propose the use of dominance criteria in a multidimensional performance assessment framework to identify best practice and poor performance under relatively weak assumptions about stakeholders' preferences. We use as an example providers of hip replacement surgery in the English National Health Service and estimate multivariate multilevel models to study their performance in terms of length of stay, readmission rates, post-operative patient-reported health status and waiting time. We find substantial correlation between objectives and demonstrate that ignoring the correlation can lead to incorrect assessments of performance

The management of adult patients with severe chronic small intestinal dysmotility

Adult patients with severe chronic small intestinal dysmotility are not uncommon and can be difficult to manage. This guideline gives an outline of how to make the diagnosis. It discusses factors which contribute to or cause a picture of severe chronic intestinal dysmotility (eg, obstruction, functional gastrointestinal disorders, drugs, psychosocial issues and malnutrition). It gives management guidelines for patients with an enteric myopathy or neuropathy including the use of enteral and parenteral nutritio

Molecular Pathology of Neuro-AIDS (CNS-HIV)

The cognitive deficits in patients with HIV profoundly affect the quality of life of people living with this disease and have often been linked to the neuro-inflammatory condition known as HIV encephalitis (HIVE). With the advent of more effective anti-retroviral therapies, HIVE has shifted from a sub-acute to a chronic condition. The neurodegenerative process in patients with HIVE is characterized by synaptic and dendritic damage to pyramidal neurons, loss of calbindin-immunoreactive interneurons and myelin loss. The mechanisms leading to neurodegeneration in HIVE might involve a variety of pathways, and several lines of investigation have found that interference with signaling factors mediating neuroprotection might play an important role. These signaling pathways include, among others, the GSK3β, CDK5, ERK, Pyk2, p38 and JNK cascades. Of these, GSK3β has been a primary focus of many previous studies showing that in infected patients, HIV proteins and neurotoxins secreted by immune-activated cells in the brain abnormally activate this pathway, which is otherwise regulated by growth factors such as FGF. Interestingly, modulation of the GSK3β signaling pathway by FGF1 or GSK3β inhibitors (lithium, valproic acid) is protective against HIV neurotoxicity, and several pilot clinical trials have demonstrated cognitive improvements in HIV patients treated with GSK3β inhibitors. In addition to the GSK3β pathway, the CDK5 pathway has recently been implicated as a mediator of neurotoxicity in HIV, and HIV proteins might activate this pathway and subsequently disrupt the diverse processes that CDK5 regulates, including synapse formation and plasticity and neurogenesis. Taken together, the GSK3β and CDK5 signaling pathways are important regulators of neurotoxicity in HIV, and modulation of these factors might have therapeutic potential in the treatment of patients suffering from HIVE. In this context, the subsequent sections will focus on reviewing the involvement of the GSK3β and CDK5 pathways in neurodegeneration in HIV

Lysophosphatidate Induces Chemo-Resistance by Releasing Breast Cancer Cells from Taxol-Induced Mitotic Arrest

Taxol is a microtubule stabilizing agent that arrests cells in mitosis leading to cell death. Taxol is widely used to treat breast cancer, but resistance occurs in 25-69% of patients and it is vital to understand how Taxol resistance develops to improve chemotherapy. The effects of chemotherapeutic agents are overcome by survival signals that cancer cells receive. We focused our studies on autotaxin, which is a secreted protein that increases tumor growth, aggressiveness, angiogenesis and metastasis. We discovered that autotaxin strongly antagonizes the Taxol-induced killing of breast cancer and melanoma cells by converting the abundant extra-cellular lipid, lysophosphatidylcholine, into lysophosphatidate. This lipid stimulates specific G-protein coupled receptors that activate survival signals.In this study we determined the basis of these antagonistic actions of lysophosphatidate towards Taxol-induced G2/M arrest and cell death using cultured breast cancer cells. Lysophosphatidate does not antagonize Taxol action in MCF-7 cells by increasing Taxol metabolism or its expulsion through multi-drug resistance transporters. Lysophosphatidate does not lower the percentage of cells accumulating in G2/M by decreasing exit from S-phase or selective stimulation of cell death in G2/M. Instead, LPA had an unexpected and remarkable action in enabling MCF-7 and MDA-MB-468 cells, which had been arrested in G2/M by Taxol, to normalize spindle structure and divide, thus avoiding cell death. This action involves displacement of Taxol from the tubulin polymer fraction, which based on inhibitor studies, depends on activation of LPA receptors and phosphatidylinositol 3-kinase.This work demonstrates a previously unknown consequence of lysophosphatidate action that explains why autotaxin and lysophosphatidate protect against Taxol-induced cell death and promote resistance to the action of this important therapeutic agent

Cyclin-Dependent Kinase Activity Controls the Onset of the HCMV Lytic Cycle

The onset of human cytomegalovirus (HCMV) lytic infection is strictly synchronized with the host cell cycle. Infected G0/G1 cells support viral immediate early (IE) gene expression and proceed to the G1/S boundary where they finally arrest. In contrast, S/G2 cells can be infected but effectively block IE gene expression and this inhibition is not relieved until host cells have divided and reentered G1. During latent infection IE gene expression is also inhibited, and for reactivation to occur this block to IE gene expression must be overcome. It is only poorly understood which viral and/or cellular activities maintain the block to cell cycle or latency-associated viral IE gene repression and whether the two mechanisms may be linked. Here, we show that the block to IE gene expression during S and G2 phase can be overcome by both genotoxic stress and chemical inhibitors of cellular DNA replication, pointing to the involvement of checkpoint-dependent signaling pathways in controlling IE gene repression. Checkpoint-dependent rescue of IE expression strictly requires p53 and in the absence of checkpoint activation is mimicked by proteasomal inhibition in a p53 dependent manner. Requirement for the cyclin dependent kinase (CDK) inhibitor p21 downstream of p53 suggests a pivotal role for CDKs in controlling IE gene repression in S/G2 and treatment of S/G2 cells with the CDK inhibitor roscovitine alleviates IE repression independently of p53. Importantly, CDK inhibiton also overcomes the block to IE expression during quiescent infection of NTera2 (NT2) cells. Thus, a timely block to CDK activity not only secures phase specificity of the cell cycle dependent HCMV IE gene expression program, but in addition plays a hitherto unrecognized role in preventing the establishment of a latent-like state

Virology under the microscope—a call for rational discourse

Viruses have brought humanity many challenges: respiratory infection, cancer, neurological impairment and immunosuppression to name a few. Virology research over the last 60+ years has responded to reduce this disease burden with vaccines and antivirals. Despite this long history, the COVID-19 pandemic has brought unprecedented attention to the field of virology. Some of this attention is focused on concern about the safe conduct of research with human pathogens. A small but vocal group of individuals has seized upon these concerns – conflating legitimate questions about safely conducting virus-related research with uncertainties over the origins of SARS-CoV-2. The result has fueled public confusion and, in many instances, ill-informed condemnation of virology. With this article, we seek to promote a return to rational discourse. We explain the use of gain-of-function approaches in science, discuss the possible origins of SARS-CoV-2 and outline current regulatory structures that provide oversight for virological research in the United States. By offering our expertise, we – a broad group of working virologists – seek to aid policy makers in navigating these controversial issues. Balanced, evidence-based discourse is essential to addressing public concern while maintaining and expanding much-needed research in virology

Upplevelse av livsstilsförändringar vid Diabetes Mellitus typ 2

Bakgrund: Enligt Socialstyrelsen lever omkring 320 000 människor i dagens Sverige med sjukdomen Diabetes Mellitus typ 2. Enligt Socialstyrelsens nationella riktlinjer för diabetesvård finns det ett starkt vetenskapligt underlag för att livsstilsförändringar som bra kost och fysisk aktivitet kan förebygga och förhindra senkomplikationer i samband med Diabetes Mellitus typ 2 vilket är viktigt för denna patientgrupp att eftersträva. Att kunna bistå med stöd skulle kunna underlätta för patienten att genomföra och bibehålla livsstilsförändringar i samband med sjukdomen Diabetes Mellitus typ 2. Syfte: Att beskriva patientens upplevelse av livsstilsförändringar vid sjukdomen Diabetes Mellitus typ 2 Metod: En litteraturstudie med kvalitativ ansats som baserats på elva vetenskapliga artiklar. Artiklarna har granskats med hjälp av ett modifierat granskningsprotokoll från Willman, Stoltz och Bahtsevani. Resultat: I resultatet framkom att patienterna hade skilda upplevelser av livsstilsförändringarna. Kategorier som uppkom var; upplevelse av praktiska livsstilsförändringar, upplevelse av sociala aspekter samt känslomässiga upplevelser i samband med livsstilsförändringar. Dessa kategorier kunde sedan delas upp i elva underkategorier. Slutsats: I resultatet framkom att patienter med Diabetes Mellitus typ 2 har blandade upplevelser av livsstilsförändringar. För att varje patient ska få motivation att genomföra och bibehålla livsstilsförändringar bör därför informationen till patienten individanpassas. Då resultatet påvisar att familjens stöd eller brist på stöd påverkar patientens upplevelse av livsstilsförändringar bör ytterligare studier med denna inriktning genomföras. Att försöka inkludera familjen i integreringen av livsstilsförändringarna kan vara ett sätt att öka följsamheten samt bidra till en positiv upplevelse för patienten

Upplevelse av livsstilsförändringar vid Diabetes Mellitus typ 2

Bakgrund: Enligt Socialstyrelsen lever omkring 320 000 människor i dagens Sverige med sjukdomen Diabetes Mellitus typ 2. Enligt Socialstyrelsens nationella riktlinjer för diabetesvård finns det ett starkt vetenskapligt underlag för att livsstilsförändringar som bra kost och fysisk aktivitet kan förebygga och förhindra senkomplikationer i samband med Diabetes Mellitus typ 2 vilket är viktigt för denna patientgrupp att eftersträva. Att kunna bistå med stöd skulle kunna underlätta för patienten att genomföra och bibehålla livsstilsförändringar i samband med sjukdomen Diabetes Mellitus typ 2. Syfte: Att beskriva patientens upplevelse av livsstilsförändringar vid sjukdomen Diabetes Mellitus typ 2 Metod: En litteraturstudie med kvalitativ ansats som baserats på elva vetenskapliga artiklar. Artiklarna har granskats med hjälp av ett modifierat granskningsprotokoll från Willman, Stoltz och Bahtsevani. Resultat: I resultatet framkom att patienterna hade skilda upplevelser av livsstilsförändringarna. Kategorier som uppkom var; upplevelse av praktiska livsstilsförändringar, upplevelse av sociala aspekter samt känslomässiga upplevelser i samband med livsstilsförändringar. Dessa kategorier kunde sedan delas upp i elva underkategorier. Slutsats: I resultatet framkom att patienter med Diabetes Mellitus typ 2 har blandade upplevelser av livsstilsförändringar. För att varje patient ska få motivation att genomföra och bibehålla livsstilsförändringar bör därför informationen till patienten individanpassas. Då resultatet påvisar att familjens stöd eller brist på stöd påverkar patientens upplevelse av livsstilsförändringar bör ytterligare studier med denna inriktning genomföras. Att försöka inkludera familjen i integreringen av livsstilsförändringarna kan vara ett sätt att öka följsamheten samt bidra till en positiv upplevelse för patienten