Hospital food: a survey of patients' perceptions

BACKGROUND & AIMS: Most hospitalised patients are dependent on hospital food for their nutritional requirements. We surveyed hospitalised patients to obtain their opinions of hospital food in order to improve menu planning and food delivery. METHODS: Three hundred and seventeen questionnaires were distributed to patients on an oral diet in two Swiss hospitals. Questions assessed eating habits, appetite, satisfaction with menus, food preferences and presentation, understanding of choices available and preferred choices. RESULTS: Three hundred and nine (97.5%) questionnaires were completed and analysed. Two hundred and sixty-five (86%) respondents were satisfied or very satisfied with hospital food. Two hundred and forty-one (78%) were satisfied with the way in which the food was served. There was a negative correlation (P=0.005) between duration of hospital stay and satisfaction with the food provided: 121 (39%) respondents stated that their appetite was the same as at home, and 50% stated that it had decreased during their time in the hospital. Eighty-seven (28%) patients said they ate all the food served, 148 (48%) ate most of it, and 68 (22%) ate only a small proportion. Patients felt that the temperature, appearance and aroma of the food were particularly important. CONCLUSION: Based on the findings of this survey we have made recommendations for improvements in hospital food and its presentation.     

Evaluation of sprint exercise testing protocols in wheelchair athletes

STUDY DESIGN: Comparison of five different exercise testing protocols with different speeds on a treadmill with seven wheelchair athletes. OBJECTIVE: To determine which speed and duration in an exercise protocol is best to test wheelchair athletes performing sprint races on a track. SETTING: Swiss Paraplegic Centre, Nottwil, Switzerland. METHODS: Three elite and four junior wheelchair athletes (18.7+/-6.8 years, 52.1+/-9.7 kg and 165.3+/-19.3 cm) performed five different exercise testing protocols at different speeds on a treadmill until exhaustion. Maximal effort treadmill (0.7% incline) testing protocols were performed using three timeframes. The first was focussing on short duration tests (S1 and S2) where incremental increases in velocity (0.42 and 0.1 m.s(-1)) were required from a stationary start. The second were medium duration tests (M1 and M2) where the athlete started at their 200 m and 800 m personal best time (mean velocities) and then had the velocity increased 1 km.h(-1) by every 10 and 60 s respectively. The long duration test (L) started at 14 km.h(-1) and velocity was increased by 2 km.h(-1) every 120 s. Maximal heart rate, maximal concentration of lactate, maximal speed, and maximal duration of the test were measured. RESULTS: The highest concentration of lactate and the highest heart rates were measured in the longest tests. CONCLUSION: During maximal effort testing wheelchair athletes are able to produce higher lactate concentrations when tested for longer duration. Post test lactate assessments provide little information in short duration testing protocols. Sequential lactate assessments post-test may provide additional information on the rate of recovery for middle distance wheelchair athletes and warrants further investigation.     

Brain capillaries and cholinergic neurons persist in organotypic brain slices in the absence of blood flow

Angiogenesis plays an important role during development of the brain and under pathological conditions. The aim of the present study was to observe interaction of brain capillaries and cholinergic neurons in organotypic brain slices. Immunohistochemistry was used to visualize brain capillary-like structures (RECA-1 antigen) and cholinergic neurons (choline acetyltransferase). Under normal culture conditions, a very low number of brain capillaries was found in 2- and 4-week-old cortex brain slices. Treatment of slices with acidic medium (pH 6) or hyperthermia (42 degrees C) markedly enhanced the number of brain capillaries. Incubation with 10 ng/mL vascular endothelial growth factor only enhanced angiogenesis in more developed slices. Cholinergic neurons survived in slices of the basal nucleus of Meynert; however, hyperthermia but not acidosis markedly decreased their number. In coslices of the basal nucleus of Meynert and cortex (pretreated with acidic medium), a high number of RECA-1-positive capillaries and cholinergic neurons persisted and displayed strong nerve fibre growth of cholinergic fibres into the cortex. In conclusion, we have demonstrated that RECA-1-positive capillaries and cholinergic neurons can be studied in slice cultures in the absence of blood perfusion, and that this model could provide a system to study mechanisms involved in vascular dementia.     

Prevention of bone loss and fracture after lung transplantation: a pilot study

BACKGROUND: Osteoporotic fracture is a significant source of morbidity after lung transplantation. Therapies to prevent posttransplant fracture are largely untested among lung transplant recipients. METHODS: In this prospective uncontrolled study, lung transplant referrals were assessed for bone health with metabolic, radiographic, and bone mineral density measurements. Transplant recipients were treated with an antiresorptive regimen that included a bisphosphonate starting before or after transplantation. One year after transplantation, the fracture rate and bone density of patients in each group were reassessed and compared to historical controls. Between January 1996 and August 1999, 45/50 (90%) lung transplant referrals underwent bone health assessment. Transplant candidates received calcium, vitamin D, and hormone replacement therapy as indicated for hypogonadism. After July 1998, bisphosphonate therapy was added for candidates with osteopenia or osteoporosis (T score <1). After transplantation, all patients received 90 mg of pamidronate i.v. every 12 weeks, regardless of pretransplant bone density. Radiologic evaluation was performed for clinical suspicion of fracture. Bone density was remeasured 1 year after transplantation. RESULTS: Most transplant referrals suffered from osteopenia or osteoporosis, and 29% of transplant referrals had prevalent vertebral compression fractures. Hypogonadism was untreated in 50% of men and 20% of women, and 15% of patients had hypovitaminosis D. Of the 21 patients assessed 1 year after transplantation, new fractures occurred in 4% of these patients. Lateral lumbar spine and hip bone density remained stable or improved in 65% and 86% of patients, respectively. Most of those who lost bone density had started bisphosphonate therapy after transplantation. CONCLUSIONS: Antiresorptive therapy with a bisphosphonate decreases the fracture rate and preserves bone mass 1 year after lung transplantation. In end-stage lung disease patients with osteopenia or osteoporosis, bisphosphonate therapy should be initiated before transplant surgery is contemplated.     

Further evidence for a functional role of the glutamate receptor gene GRM3 in schizophrenia

In recent years, evidence has been accumulating indicating a major role of glutamate in the pathogenesis and pathophysiology of schizophrenia. Of particular importance in this regard are the metabotropic glutamate receptors (GRM). Thus, a recently published trial of the amino acid analogue LY2140023, which exerts its effects through the activation of the glutamate receptors GRM3/GRM2, showed an improvement of positive and negative symptoms comparable to treatment with olanzapine. A functional variant of GRM3 has been described which modulates synaptic glutamate levels. We assessed whether this functional variant rs6465084 is related to schizophrenia in a large sample of patients and controls. We found an increased frequency of the A allele (p=0.027) and the AA genotype (p=0.024) in schizophrenia patients. Moreover, in an assessment of schizophrenia endophenotypes, patients of the AA genotype performed poorly in the digit symbol test, a measure of attention (p=0.008). Our results provide further evidence for the potential importance of the glutamate receptor GRM3 in schizophrenia, and indicate that the novel antipsychotic LY2140023 may actually be targeting a pathogenic pathway of schizophrenia.     

From genes to psychoses and back: the role of the 5HT2α-receptor and prepulse inhibition in schizophrenia

Decomposition of schizophrenia into neurobiological vulnerability traits is necessary to understand the complex genetic underpinnings of this phenomenologically defined disorder. This issue is discussed with a focus on prepulse inhibition (PPI) as a neurobiological phenotype and the 5HT2a-receptor as a candidate gene. A series of recent studies illuminates that PPI and 5HT2a-receptors present as vulnerability markers for schizophrenia; a functional sequence variant in the 5HT2a-gene is contributing to this relationship and might consequently contribute to the genetic predisposition to schizophrenia with a very small risk increase.

     

Genotypic and phenotypic evidence of T-cell leukemia in a patient successfully treated by interferon-alpha for typical hairy cell leukemia.

A 53-year-old man was diagnosed to have typical hairy cell leukemia. Immunophenotyping of frozen splenic tissue showed clonality of hairy cells for mu lambda, confirmed by the corresponding immunoglobulin gene rearrangements. The patient was successfully treated with interferon-alpha (IF-alpha). In the fifth year of treatment with IF-alpha the morphology of peripheral blood mononuclear cells (PBMC) and of bone marrow infiltration changed with the appearance of numerous small to intermediate shaped lymphocytes of a T-helper phenotype. Frank leukemia, resistant to IF-alpha treatment and ultimately aggressive chemotherapy, developed. Emergence of this second clonal disease was confirmed by rearrangement studies performed on PBMC; rearrangements of both alleles of the TCR beta were identified, whereas the JH and lambda IVS genes were in germline configuration. The outgrowth of a second, malignant T-cell clone paralleled by the disappearance (down-regulation?) of the initial B-cell clone while under cytokine treatment is consistent with the possibility that IF-alpha favoured the emergence of this second clone.     

Acute airway narrowing in monkeys from challenge with 2.5 ppm formaldehyde generated from formalin

Nine adult male Cynomolgus monkeys (Macaca fascicularis) were exposed for 10 min to 2.55 +/- 0.03 ppm formaldehyde (HCHO; mean +/- standard error of the mean, SEM) generated from formalin with a newly developed HCHO challenge system. The generation system was capable of producing highly stable HCHO vapor concentrations with fluctuations of HCHO concentrations of less than +/- 5%. The experimental design included pre-exposure methacholine challenge to determine if responses to HCHO were associated with pre-existing bronchial hyperreactivity. Significant changes in average pulmonary flow resistance (RL) were observed (compared to control RL values) at 2 (p less than 0.01), 5 (p less than 0.01), and 10 min (p less than 0.005) post-HCHO challenge. Pre-challenge RL values (mean +/- SEM) were 11.3 +/- 1.4 cm H2O.l/s, while at 2, 5, and 10 min after HCHO challenge, values were 16.1 +/- 2.1, 16.9 +/- 2.8 and 20.0 +/- 3.4 cm H2O.l/s, respectively. Methacholine challenge data suggest that reactions to HCHO tend to be greater in monkeys hyperreactive to methacholine, but the relationship does not reach statistical significance in this small series of animals. These data indicate that significant pulmonary function deficits occur immediately after challenge with 2.55 ppm HCHO vapor in monkeys.