Wednesday, 23 August 2017

Caregiving Needs Double as End of Life Nears


Dependence on parental figures duplicates as individuals close passing, and half of those guardians - regularly unpaid relatives - report having no time for themselves, another investigation demonstrates. The examination utilized a broadly illustrative specimen of around 2,400 more established grown-ups in the United States. The investigation creators found that parental figures gave almost double the quantity of hours of assistance every week to passing on people than to those not toward the finish of life. "We were absolutely mindful when managing end-of-life mind that families are generally included, yet we couldn't evaluate that before this [research]," said examine creator Dr. Katherine Ornstein. She's a partner educator of geriatrics and palliative prescription at the Icahn School of Medicine at Mount Sinai in New York City. 

More than 34 million Americans gave unpaid care to a grown-up matured 50 or more seasoned in the previous a year, as per 2015 figures from the National Alliance for Caregiving and AARP. Most guardians are female. Ornstein and her group drew from two broadly illustrative overviews in which parental figures in the United States revealed their encounters nurturing biting the dust grown-ups over age 65. The specialists stood out this information from that of different parental figures giving progressing care. More seasoned grown-ups were delegated being toward the finish of life on the off chance that they kicked the bucket inside a year of the overviews' fruition. 

The examination found that withering grown-ups had a normal of 2.5 guardians helping them. Those close to the finish of life got 61 hours of assistance for every week contrasted with 35 hours of assistance for each week for more established grown-ups who weren't toward the finish of life. More than 33% of the finish of-life guardians detailed physical trouble identified with their obligations. Simply finished half revealed having no time for themselves. These figures were 21 percent and 40 percent, individually, for different guardians. About nine of every 10 guardians are unpaid, as indicated by the examination. For end-of-life parental figures who were companions, almost 66% announced accepting no assistance from family or companions. "What we see now is, all things considered, there are 2.5 individuals helping somebody toward the finish of life. You can suppose they don't have that, it's significantly more troublesome," Ornstein said. "At the point when life partners are filling in as guardians, the greater part are detailing doing only it and have the [most challenging] results." 

Barbara Coombs Lee is leader of Compassion and Choices, a Washington, D.C.- based backing association for patients' rights and end-of-life issues. She called attention to that the parental figures reviewed in the new investigation didn't really know early that the individual they were administering to was toward the finish of life.

Tuesday, 22 August 2017

End-of-life Decision-Making in Neonatology: The Role of Nurses and Parents


Scientific and technical advances applied to the field of neonatology have led to the development of improved intensive care treatments for newborns at risk of increasingly complicated health problems, such as congenital malformations, hypoxic-ischemic events and, in particular, extreme prematurity. Therefore, the resuscitation of preterm infants of under 24 weeks gestation age (GA) is no longer considered exceptional in developed countries. The increase in our ability to intervene has equaled improved survival rates for these children, however the incidence of serious sequelae has not significantly decreased. In 2012, the Spanish Society of Neonatology (SENeo) published its recommendations on decision-making at the end of life in neonatology, establishing categories of patients susceptible to limitation of therapeutic effort (LTE). These categories in-clude: 1. Children born at the limit of viability (gestational age <24 weeks GA). 2. Congenital anomalies incompatible with life. 3. Children with diseases that do not respond to intensive care and who will, therefore, most likely die in a short term. 4. Children who may survive with permanent dependence on invasive life support. This categorization contrasts with the survival and sequelae data of preterm babies available at that time. In the Epicure 2 trial, conducted in England on a cohort of 952 preterm babies less than 26 weeks GA in 2006, an increase in survival in all age groups was observed, compared with the cohort of the first phase this study, collected in 1995. Thus, survival is exceptional below 23 weeks GA and survivors suffer from the most serious side effects. Between 23 and 24 weeks GA, 10% of those admitted to intensive care survived with moderate or severe disability at 6 years of age. In the 1995 cohort, survival preterm babies between 24 and 25 weeks GA receiving intensive care represented 34%, and half of the survivors had moderate or severe disabilities. In the cohort of 2006, the survival of this group increased by 12%, with no evidence of changes in morbidity. Over 25 weeks GA there has been a significant increase in survival, from 54% to 67%, among the groups studied between 1995 and 2006. The figures for survival and morbidity among different age groups does not allow for the detection of qualitative differences, and thus, gestational age becomes a criterion for establishing one of the assumptions of LTE.

A recent study published by the SEN1500 group on behalf of the Spanish Society of Neonatology (SENeo) has revealed the incidence of serious sequelae in the population of preterm infants in Spain over recent years. According to the results of this population-based study, the survival rate without major morbidity, which includes major brain damage (MBD), bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC) and early or late onset sepsis, is 2.6% at 24 weeks GA, 5.1% at 25 weeks GA and 9.6% in babies born at 26 weeks GA. If we consider only the MBD, BPD and/or ROP, the survival without sequelae is 9.5%, 19% and 29.9% for 24, 25 and 26 weeks GA, respectively. These results show that the chances of healthy survival below 25 weeks of gestation is very low [4]. Thus we find discrepancies between the available evidence and the recommendations on the limit of viability concept.

End-of-life decision-making in the newborn population who are within the limits of viability is highly complex, with medical, ethical, social and cultural implications that impact the balance between survival and quality of life. The changing parental role in neonatal units over the final years presents a challenge to professionals who seek to include them in ethical and end-of-life decisions. Moreover, the role of the different professionals involved in patient care remains unclear, especially the role of the nurse, who is the professional who spends the most time with both the child and family. In this sense, the SENeo has issued a statement regarding the role of parents: “Parents are generally the best ‘lawyers’ of their children and in most cases wish to actively participate in end-oflife decisions, however they need information that is accurate, comprehensive, honest and understandable”. Concerning the role of the nurse, this institution states: “the importance of the participation of the nurse who is responsible for the patient in the process of deliberation and decision-making is vital, as nurses contribute towards a better understanding of the parents’ values of parents as well as the circumstances and the social and family and social context”. Because of this incoherence in the definition of the limits of viability and the indefiniteness of the different roles of the stake holders, we sought to explore the perceptions of the nursing staff in the neonatal intensive care unit (NICU) of the University Hospital La Paz in Madrid, Spain, on the process of end-oflife decision-making, focusing on aspects related to both the role of nurse and the role of parents.

Monday, 21 August 2017

Zika May Not Last in Semen as Long as Thought


Zika infection won't not stay in the semen of some contaminated men insofar as beforehand thought, a little report recommends. The scientists said Zika may just be available in semen for about a month. Past research had proposed that Zika infection can be found in semen for whatever length of time that 188 days after the beginning of indications. The new investigation included 12 men in French Guiana who had Zika infection. Four of the men never had any noticeable Zika in their semen. One discharged Zika infection in his semen for no less than three days. What's more, seven had Zika-bound semen for no less than a month, the analysts announced. The greatest length of perceptible Zika in semen in the examination was 45 days. "These information propose that not all men who are symptomatically tainted with Zika infection will have Zika infection RNA noticeable in semen," Dr. Franck de Laval, of the Military Center for Epidemiology and Public Health in Marseille, France, and associates composed. The outcomes additionally demonstrated that Zika replicates in the balls or semen-creating organs, since the measure of Zika in semen was essentially not the same as the Zika stack found in the men's blood. "More information are expected to better illuminate general wellbeing proposals," the examination creators recommended. Zika infection is regularly transmitted by means of mosquito nibble. Be that as it may, the infection likewise can be sexually transmitted, as indicated by the U.S. Communities for Disease Control and Prevention. 

The CDC prescribes that men conceivably presented to Zika utilize condoms or avoid sex for no less than a half year, to keep a Zika-contaminated pregnancy bringing about neurological birth absconds. It's impossible the CDC proposals will change in light of these discoveries, an irresistible infection master said. Dr. Daniel Caplivski is chief of the Travel Medicine Program and partner educator for the division of irresistible maladies at the Icahn School of Medicine at Mount Sinai in New York City. "Shockingly, the central suggestions of general wellbeing specialists with respect to deferring pregnancy after Zika infection disease or introduction are probably not going to change, given the level of instability that remaining parts from different examinations in which the hereditary material of the infection was perceptible for longer timeframes," Caplivski said. Furthermore, notwithstanding these discoveries, individuals should in any case take after the CDC's Zika rules for safe sex, wellbeing specialists said. As indicated by Dr. Amesh Adalja, a senior connect with the Johns Hopkins Center for Health Security, in Baltimore, "Since it is vague which men will have longer diligence, it is essential for Zika-tainted/presented men to rehearse safe sexual practices for a half year present disease on stay away from transmission of the infection." 

Ladies' wellbeing pro Dr. Jill Rabin said the little size of the investigation warrants a bigger development. "The uplifting news is it might last a shorter period in men than recorded beforehand, yet we need a bigger example measure and take after individuals for a more drawn out timeframe," Rabin said. "Since we don't have enough information and we don't have enough individuals, we can't generally say what is the day and age should have been free of disease," she included. Zika causes neurological birth surrenders, most regularly microcephaly, a condition in which an infant's cerebrum and skull are immature, Rabin said. She's co-head of the division of mobile care with Women's Health Programs-PCAP Services at Northwell Health in New Hyde Park, N.Y. There's likewise worry that Zika-uncovered infants apparently conceived sound will create learning incapacities or issues with hearing or sight further down the road, Rabin noted. "Ladies of conceptive age would prefer not to have an infant conceived with Zika," she said. "You need to take after the most dire outcome imaginable, and the most dire outcome imaginable is it could last up to a half year. Why might you take a risk with your infant?"

Friday, 18 August 2017

The Cardiovascular Protective Effects of Erythropoietin Stimulating Agents

Erythropoietin (EPO) is a member of the class I family of cytokines with a strong ability to stimulate erythropoiesis. The endogenous EPO is mainly synthesized and secreted by the kidney, and the recombinant EPO is utilized in patients suffering from different kinds of anemia. EPO influences erythropoiesis by binding to its specific receptor which is expressed on the surface of immature erythroblasts. However, several studies have demonstrated that EPO and EPO receptors are not only expressed in erythroblasts but also in a number of cell types including those within the cardiovascular and nervous system, suggesting that the effects of EPO extend beyond regulation of erythropoiesis. There are different kinds of EPO, namely, epoetin alfa, epoetin beta, and epoetin gamma, which are analogues of recombinant human EPO (rhEPO) derived from a cloned human erythropoietin gene. All of them have the same 165 amino acid sequence with a molecular weight of 30,400 daltons and have the same pharmacological actions as native EPO. The normal serum concentrations of EPO for individuals with normal hematocrit range from 4-27 mU/mL. However, in certain conditions of anemia and hypoxia, EPO levels can be increased 100-1000 times the normal serum EPO concentration. Moreover, the subcutaneous administration of a single 600 U/ kg dose of epoetin alfa to healthy volunteers produced a peak serum concentration of over 1000 mU/mL after 24 hours.

A second generation drug, namely, darbepoetin has a threefold longer circulating half-life than rhEPO. It was shown that darbepoetin alfa is 3.6-fold more potent than rhEPO in increasing the hematocrit when each is administered thrice weekly, but when the administration frequency is reduced to once weekly, darbepoetin alfa is approximately 13-fold higher in vivo potency than rhEPO. A third-generation EPO-related molecule called continuous EPO receptor activator (CERA) has been manufac tured. The elimination half-life of CERA in humans is considerably increased to about 130 hours maintaining a stable control of hemoglobin levels with a monthly interval dose. The tissue protective effects of EPO, beyond the hematopoietic system, is mediated by activation of homodimeric EPO receptor, but is also believed to be mediated by its actions on the heterotrimeric complex consisting of EPO receptor and the β-common receptor. Nitric oxide (NO) is a potent vasodilator formed in endothelial cells, and plays a key role in control of the cardiovascular system. It was shown that EPO can exert non-erythropoietic effects in vascular endothelium and is increasingly regarded as a potent tissue protective cytokine. Several studies demonstrated that EPO decreases tissue damage by inhibition of apoptosis and reduction of inflammatory cytokines. In-vitro treatment with low dose of rhEPO increased endothelial nitric oxide synthase (eNOS) protein expression in cultured endothelial cells. On the other hand, incubation of human coronary artery endothelial cells with high dose of rhEPO for 24 hours inhibited eNOS expression and NO production suggesting that high dose of EPO may have detrimental effects on endothelial function. EPO has a vast variety of cardiovascular effects. It exerts its effects on cardiac as well as the vascular tissues since EPO receptors are expressed in cardiomyocytes, vascular endothelial cells and smooth muscle cells. The clinical dosage required to observe EPO-induced tissue protection is much higher than that required for hematopoietic effects. There is robust experimental evidence of beneficial effects with the use of EPO in the cardiovascular system. However, all the plausible mechanisms should be tested in clinical situations to properly evaluate clinical outcomes. There are some adverse events data described in clinical trials in patients with heart failure, kidney disease, myocardial infarction, and stroke. The adverse side effects associated with EPO therapy were due to its pleiotropic effects mainly in the cardiovascular system including hypertension, thrombosis and augmented tumor angiogenesis. Single-center studies have shown that EPO therapy of anemia in patients with heart failure was associated with improvement in exercise capacity, improved cardiac and renal function and reduced use of diuretics. Other trials evaluated the safety and efficacy of darbepoetin alfa at a dosage of 0.75μg/kg once every 2 weeks in symptomatic heart failure patients. It was demonstrated that the incidence of adverse events in these trials was similar between placeboand darbepoetin alfa-treated patients. However, the significant increase in hemoglobin shown with darbepoetin alfa therapy correlated well with improved health-related quality of life. 

The results from pre-clinical studies attribute multiple mechanisms of protection by EPO against myocardial disorders besides anemia treatment. Treatment with EPO may decrease apoptosis of myocytes, induce neovascularization by promoting myocardial angiogenesis increasing collateral vessels, reduce collagen deposition in ischemic myocardium, as well as, improve left ventricular function. However, large clinical trials did not demonstrate those benefits. Similarly, trials in patients with anemia and heart failure did not demonstrate improved clinical outcomes and raise concerns about increased complications [25, 26]. It is highly possible that EPO may have failed in these clinical trials because of the employment of insufficient dose. Preclinical studies have frequently used doses in the range of 1,000 to 5,000 IU/kg, while just a dose of 300 IU/ kg were utilized in many large clinical trials. Although this lower dose is adequate for the EPO receptors in the erythroblasts, the EPO receptors found on multiple cell types responsible for cardiovascular protection are different. However, the explanation may not be that simple. There is a complex interplay between vascular abnormalities and inflammatory mediators. There are several different cell types involved, and, within each individual cell, there are complex interactions among multiple signaling pathways. On the other hand, the use of higher doses of EPO in those large clinical trials might have had developed adverse effects such as thrombosis and hypertension. 

Thursday, 17 August 2017

Evaluating the Meaning of the Information Message and Speech-Mental Activity of a Person


We would like to offer to the attention of the readers a scientific report as a statement of the author’s hypothesis, which is experimentally tested, but requires an additional verification. The report addresses the trends outlined in the course of the scientific research on identification of regular patterns that describe the influence of information on people. The content of this scientific report relates to the field of interdisciplinary scientific research at the junction of the information theory and cognitive psychology. The article describes the criteria for evaluating the meaning of an information message and a speechmental activity of a person. Subject to an appropriate follow-on development, the results obtained can be applied in cognitive psychology, psychiatry and in the domain of artificial intellect.

We continue publishing the findings of the scientific research on the topic of information influence on people. This scientific report addresses the findings of the research, the beginning of which was described in our article. In this research we tried to identify the criteria for evaluating the meaning of an information message and speech-mental activity of a person. While the work has been performed, healthy people have been involved as test subjects. But, it would be useful and interesting to conduct a series of experiments under clinical conditions, because in terms of emotions, a healthy individual and a person suffering from a mental disorder can perceive the meaning of the same information message in dissimilar ways. The sphere of our scientific interest includes the elements of information theory and cognitive psychology. Characterizing cognitive psychology as a new scientific trend in psychology, W. Naisser noted in his book that tracing the movement of the information flow within the “system” (i.e. in the brain) is a toppriority objective in this new field of knowledge. The goal set by one of the founders of cognitive psychology is identical to the goal of our scientific work. 

This implies that the object of our study is cognitive psychology, which we research using the method of information theory. A person conveys or receives information in the process of speech-mental activity. This is a conscious or unconscious intellectual activity of a person, in which information is used in the form of speech. For presentation of information, an alphabet of the relevant natural language is used. One of the derivatives of the speech-mental activity of a person is a textual information message (text), to which a person attaches some meaning. A textual information message with a sense attached to it is the subject of our research. The speech-mental activity plays an important role in the process of interaction between people. One of the reasons why conflicts occur between people could be a misinterpreted information message. In other words, misinterpretation of the sense of the information message. This question is also relevant in psychiatry for evaluation of the speech-mental activity of a person in a disturbed state of mind (delirium).

Wednesday, 16 August 2017

Could Newborn Heart Stem Cells Jump-Start Old Hearts?


Undifferentiated cells from youthful hearts may inhale new life into maturing ones, look into in rats proposes. In the investigation, an exceptional kind of undeveloped cells was taken from the hearts of infant rats and infused into the hearts of old rats, normal age 22 months. Different rats from a similar age assemble were given saline shots. 

Standard heart work was measured in every one of the rats, utilizing echocardiograms, treadmill stretch tests and blood investigation. The gathering of more seasoned rats experienced an extra round of testing one month subsequent to getting the undifferentiated cells from the hearts of the youthful rats. The old rats who were given foundational microorganisms demonstrated better heart work, a 20 percent expansion in practice limit and, strangely, an enhanced capacity to regrow hair. 

"Our past lab studies and human clinical trials have indicated guarantee in treating heart disappointment utilizing cardiovascular [heart] immature microorganism implantations," said co-essential examiner Dr. Eduardo Marban, executive of the Cedars-Sinai Medical Center Heart Institute in Los Angeles. "Presently we find that these specific undeveloped cells could end up reversing issues related with maturing of the heart," he said in an organization news discharge. 

"The way the cells work to invert maturing is interesting," Marban included. "They emit modest vesicles that are packed with flagging particles, for example, RNA and proteins. The vesicles from youthful cells seem to contain all the required directions to get back to former days."

Monday, 14 August 2017

Prevalence and Contributing Factors of Insomnia among Elderly of Pashupati Old Aged Home (Briddhashram)

Insomnia is one of the major and unsolved problems in older people. The prevalence of insomnia increases steadily with age and is often a persistent problem, particularly in older adults and are often mistaken as a normal part of ageing. Studies investigating insomnia among elderly people living in geriatric homes, especially in Nepal, are rare. The objective of this study was to determine the prevalence and contributing factors of insomnia among elderly people of Social Welfare Centre Briddhashram (Old aged home), Pashupati, Kathmandu. A descriptive cross-sectional study design was conducted among 148 elderly people of 60-94 years of age, following simple random sampling technique. The tools used were semi-structured questionnaire, Athens Insomnia Scale (AIS) and Geriatric Depression Scale (GDS). The data was collected by using semistructured interview schedule and was analyzed by using SPSS version 17.0. This study highlights that around three-fifth (61.5%) of the respondents had insomnia associated with different factors such as age, suffering from increased number of physical symptoms, irregular sleep, etc. Three-fourth (75%) of the respondents complained of pain; followed by weakness of extremities (65.5%). Depression, perceived poor health status as compared to one year ago and use of drugs for long term illness were also found to be contributing factors of insomnia. Insomnia is common among elderly population.

Ageing is a natural phenomenon and an inevitable process. Every living being born, develops, grows old and dies. With the increase in age, people lose their creativity level, problem solving ability and learning skills as well as short-term memory. All the people of the world - be they rich or poor and learned or uneducated - have to pass through this cyclical process in their lives, irrespective of their present state of strength or merit or weakness. Sleep is a vital physiological process with important restorative functions. Sleep disorders and sleeping difficulties are among the most pervasive and poorly addresses problems of aging. Getting enough sleep can have a significant impact on daily function, alertness and overall quality of life. Insomnia or sleeplessness, is a sleep disorder in which there is an inability to fall asleep or to stay asleep as long as desired. This sleep disorder is often practically defined as a positive response to either of two questions: “Do you experience difficulty sleeping?” or “Do you have difficulty falling or staying asleep?”.

With age, several changes occur that can place one at risk for sleep disturbances including increased prevalence of medical condition, increased medications use, age related changes in various circadian rhythms, and environmental and life style changes. Insomnia is generally classified as primary or secondary to some underlying cause. Primary insomnia is usually not associated with a medical or psychiatric condition. Secondary insomnia occurs most frequently in the older adult with medical or psychiatric disorders. The causes of insomnia in the elderly are divided into four groups:  physical diseases or symptoms, such as long-term pain, bladder or prostate problems, joint diseases such as arthritis or bursitis, and gastroesophageal reflux;  environmental/behavioral factors; use of drugs, such as caffeine, alcohol, or prescription medications for chronic diseases; and mental diseases or symptoms, such as anxiety, depression, loss of personal identity, or perceived poor health status