Medical graphics to improve patient understanding and anxiety in elderly and cognitively impaired patients scheduled for transcatheter aortic valve implantation (TAVI)

BACKGROUND

Anxiety and limited patient comprehension may pose significant barriers when informing elderly patients about complex procedures such as transcatheter aortic valve implantation (TAVI).

OBJECTIVES

We aimed to evaluate the utility of medical graphics to improve the patient informed consent (IC) before TAVI.

METHODS

In this prospective, randomized dual center study, 301 patients were assigned to a patient brochure containing medical graphics (Comic group, n = 153) or sham information (Control group, n = 148) on top of usual IC. Primary outcomes were patient understanding of central IC-related aspects and periprocedural anxiety assessed by the validated Spielberger State Trait Anxiety Inventory (STAI), both analyzed by cognitive status according to the Montreal Cognitive Assessment (MoCA).

RESULTS

Patient understanding was significantly higher in the Comic group [mean number of correct answers 12.8 (SD 1.2) vs. 11.3 (1.8); mean difference 1.5 (95% CI 1.2-1.8); p < 0.001]. This effect was more pronounced in the presence of cognitive dysfunction (MoCA < 26) [12.6 (1.2) in the Comic vs. 10.9 (1.6) in the Control group; mean difference 1.8 (1.4-2.2), p < 0.001]. Mean STAI score declined by 5.7 (95% CI 5.1-6.3; p < 0.001) in the Comic and 0.8 points (0.2-1.4; p = 0.015) in the Control group. Finally, mean STAI score decreased in the Comic group by 4.7 (3.8-5.6) in cognitively impaired patients and by 6.6 (95% CI 5.8 to 7.5) in patients with normal cognitive function (p < 0.001 each).

CONCLUSIONS

Our results prove beneficial effects for using medical graphics to inform elderly patients about TAVI by improving patient understanding and reducing periprocedural anxiety (DRKS00021661; 23/Oct/2020). Medical graphics entailed significant beneficial effects on the primary endpoints, patient understanding and periprocedural anxiety, compared to the usual patient informed consent (IC) procedure. Patient understanding of IC-related aspects was significantly higher in the Comic group, with a more pronounced benefit in patients with cognitive impairment (p for IC method and cognitive status < 0.001, respectively; p for IC method x MoCA category interaction = 0.017). There further was a significant decline of periprocedural anxiety in patients with and without cognitive impairment (p for IC method x measuring time point < 0.001; p for IC method x MoCA category x measuring time point interaction = 0.018).

Fetal subjects and maternal objects: reproductive technology and the new fetal/maternal relation

This essay examines three tendencies nurtured in the practices of reproductive technology - tendencies with profoundly disturbing implications for us as individuals and as social beings. They are: 1) the increasing subjectification of the fetus (that is, the increasing tendency to posit a fetal subject), 2) the increasing objectification of the gestating woman, leading to her representation as interchangeable object rather than unique subject, and 3) the increasing tendency to conceive of the fetus and the mother as social, medical, and legal antagonists. Considering the construction of fetus, mother, and the fetal/maternal relation in earlier (Western) historical periods, a contemporary work of literature, a government report, and the popular press, I argue that as the fetus is increasingly being understood as a subject, the mother is increasingly being reduced to an antagonist, an obstacle to fetal health, and an object. The essay concludes by offering some tentative conclusions about the general process of fetal subjectification in the United States and Europe.

Translocation of gut bacteria in rats with cirrhosis to mesenteric lymph nodes partially explains the pathogenesis of spontaneous bacterial peritonitis

Spontaneous bacterial peritonitis is a common infection of ascitic fluid that develops in cirrhosis. The offending organisms are predominantly of enteric origin. However, the mechanism and route by which bacteria exit from the gut and enter the fluid remain unclear. "Translocation" of bacteria from the gut to extraintestinal sites has been postulated in the pathogenesis of gram-negative sepsis in intensive care unit patients, burn-wound sepsis, and sepsis associated with chemotherapy. Translocation is defined by culture-positivity (with enteric flora) of mesenteric lymph nodes. In this study we assessed the frequency of translocation in a carbon tetrachloride-induced rat model of cirrhosis, ascites, and spontaneous bacterial peritonitis. We determined that translocation was more common in rats with cirrhosis (78.1%) than in normal controls (4.3%) (p < 0.001). Escherichia coli and other gram-negative enteric organisms were cultured. Translocation of enteric bacteria in rats with cirrhosis to extraintestinal sites may be an important early step in the pathogenesis of spontaneous bacterial peritonitis.

Largomycin: preparation, properties, and structure

Largomycin has been purified to homogeneity by chromatography on hydroxylapatite whereby carbohydrate and protease impurities were removed. Largomycin is an acidic protein (pI 4.13, molecular weight 29300) which forms a dimer in phosphate buffer. An N-terminal amino acid sequence analysis from the amino-terminal residue gave, for the first 32 residues, Asp-Ile-Leu-Ile-Ala-Gly-Ala-Thr-Gly-Asn-Val-Gly-Lys-Pro-Leu-Val-Glu-Gly-Leu-Leu - Ala-Ala-Gly-Lys-Pro-Val-Arg-Ala-Leu-Thr-Arg-Asn... The sequence from the carboxyl terminus was -Ala-Ala-Leu-Phe-OH with threonine, valine, and glutamic acid being released upon prolonged digestion. The same amino acid sequences were found for largomycin prepared from either the culture broth or the mycelium of Streptomyces pluricolorescens. The similarities extended to the other physical properties, the antimicrobial activity against Staphylococcus aureus and Sarcina lutea, and the antitumor activity against KB cells. Largomycin inhibits the biosynthesis of DNA and RNA. An iodinated derivative did not bind to KB cells. The antimicrobial activity was lost following ultraviolet irradiation, protection against which was not afforded by p-aminobenzoic acid.