bluuebunny/crossref_metadata_2025 huggingface dataset:
Nonthrombocytopenic Purpura Associated Sequentially with Nifedipine and Diltiazem
Authors: Kuo Margaret , Winiarski Nancy , Garella Serafino
Published: January 2017

OBJECTIVE:

To report the case of a patient who developed nonthrombocytopenic purpura sequentially following the administration of nifedipine and diltiazem.

DATA SOURCES:

Case reports, MEDLINE review of pertinent literature, and review of relevant studies.

DATA EXTRACTION:

Data were extracted from direct patient observation and review of laboratory studies and published reports.

DATA SYNTHESIS:

Nonthrombocytopenic purpura secondary to cutaneous vasculitis is a known, although rare, adverse effect of nifedipine. It has not been reported in association with diltiazem. We report the case of a 75-year-old woman in whom a purpuric rash demonstrated by biopsy to be attributable to cutaneous vasculitis developed in the course of nifedipine therapy. The rash disappeared after discontinuation of the drug; however, it recurred when diltiazem therapy was initiated.

CONCLUSIONS:

Nonthrombocytopenic purpura may be associated with diltiazem as well as with nifedipine. When this adverse effect occurs following administration of a calcium-channel blocker, caution is advised in using other agents of the same class.
Home Total Parenteral Nutrition in a “No-Bowel” Patient in Spain
Authors: Ibáñez Emilio , Ruiz M. Carmen , Corell Ricardo , Guasch Javier , Ferrándiz Amparo , Ferriols Rafael , García Juan
Published: January 2017

OBJECTIVE:

To report a case of a patient with no functional bowel who was receiving home total parenteral nutrition in a country that has had few professional experiences in this area of therapy.

CASE SUMMARY:

A woman with a history of scattered colonic polyposis developed a mesenteric tumor that caused intestinal obstruction. Tumor withdrawal required the excision of 1.5 m of jejunum—ileum. Postoperative complications required further surgical intervention and subtotal intestinal resection. Duodenocolic anastomosis was not possible and a high output and permanent fistula remained.

DISCUSSION:

The complications of home parenteral nutrition addressed in the literature are reviewed. The problems encountered in our patient have been resolved.

CONCLUSIONS:

After three years of postoperative survival, we believe the quality of life of our patient has increased and the parenteral nutrition team members are much better prepared to manage patients with similar problems.
Didanosine-Associated Eosinophilia with Acute Thrombocytopenia
Authors: Lor Edward , Liu Yong Qing
Published: January 2017

OBJECTIVE:

To report a case of didanosine (ddI)-induced acute thrombocytopenia and to discuss the incidence of this occurrence.

CASE SUMMARY:

A 42-year-old man was admitted to the hospital on November 21, 1991, with acute thrombocytopenia. The patient had an AIDS index diagnosis of Kaposi's sarcoma (KS) in 1988 and had been taking zidovudine (ZDV) for three years without any adverse effects. On July 26, 1991, he complained of increasing fatigue and weight loss. At that time, the therapy was changed from ZDV to ddI. Over the next four months the drug therapy was altered from ddI to ZDV and ZDV to ddI because of increasing fatigue and gastrointestinal symptomatology; all of the other chronic medications were maintained at the same dosages and frequency. All laboratory work remained stable and no new active processes were found during this period. The patient developed acute thrombocytopenia upon his last change to ddI and all of the chronic drug therapy was stopped. His platelet count returned to his baseline value three weeks after the discontinuation of ddI and reinstitution of his chronic medications.

DISCUSSION:

A review of the literature showed two documented cases of thrombocytopenia with ddI on a dosage escalation study.

CONCLUSIONS:

Close patient monitoring is essential while administering ddI.
Impact of Vancomycin Therapeutic Drug Monitoring on Patient Care
Authors: Welty Timothy E. , Copa Alan K.
Published: January 2017

OBJECTIVE:

To document differences in the outcome of vancomycin therapy in patients managed through a therapeutic drug monitoring (TDM) service and patients managed empirically, without the participation of a TDM service.

DESIGN:

Prospective, cohort study.

SETTING:

An 1100-bed, tertiary-care, teaching hospital.

PATIENTS:

Those who received vancomycin for more than four days, were at least 18 years old, had an estimated creatinine clearance of more than 0.33 mL/s (20 mL/min), were not neutropenic at the start of vancomycin therapy, and were not treated in a critical care unit were enrolled in the study. A total of 116 patients (61 TDM; 55 non-TDM) were monitored prospectively from June 1990 through March 1991.

INTERVENTIONS:

Patients in the TDM group had vancomycin drug therapy monitored daily by a pharmacist and vancomycin dosages adjusted following a pharmacokinetic analysis of vancomycin serum concentrations. For patients in the non-TDM group, the pharmacist only completed a data collection form. The patients and physicians were unaware of the monitoring.

MAIN OUTCOME MEASURES:

Duration of therapy, total vancomycin dosage, infection site, concomitant antibiotics, body temperature, and white blood cell counts were compared between the two groups. Length of stay data were also compared. Nephrotoxicity was evaluated by comparing serum creatinine concentration and estimated creatinine clearance.

RESULTS:

TDM of vancomycin appeared to reduce the incidence of vancomycin-related renal insufficiency (TDM 7 percent; non-TDM 24 percent). Patients managed through the TDM service received an average of 5 g less of vancomycin than did the patients in the non-TDM group. The duration of vancomycin therapy was an average of 2 days less for patients in the TDM group. Mean length of stay was 38.0 days for the TDM group and 44.5 days for the non-TDM group. Other measures of efficacy, infection site, and concomitant antibiotics were the same for both groups.

CONCLUSIONS:

TDM of vancomycin was associated with fewer cases of vancomycin-related renal insufficiency. Vancomycin efficacy was not compromised by TDM. Provision of TDM for vancomycin therapy aided in patient management.
Delayed Neutropenia with Ticlopidine
Authors: Farver Debra K. , Hansen Lori A.
Published: January 2017

OBJECTIVE:

To report a case of ticlopidine-induced neutropenia occurring 18 days after discontinuation of the drug.

CASE SUMMARY:

A 68-year-old woman was placed on ticlopidine after a transient ischemic attack. Ten days later the drug was discontinued because the patient developed a rash. Eighteen days later she developed pneumonia and neutropenia, which were believed to be induced by ticlopidine.

DISCUSSION:

Drug-induced neutropenia is serious and at times life-threatening. Ticlopidine-induced neutropenia has been described in patients receiving the medication. We report neutropenia occurring 18 days after discontinuation of ticlopidine.

CONCLUSIONS:

Indications for prescribing ticlopidine must be closely followed. Complete blood cell count monitoring is imperative while the patient is receiving the medication. This case suggests that the duration of monitoring after the discontinuation of ticlopidine may need to be longer than the 14 days recommended by the manufacturer.
Hyperphagia and Weight Loss during Fluoxetine Treatment
Authors: Fichtner Christopher G. , Braun Bennett G.
Published: January 2017

OBJECTIVE:

To report the unusual coincidence of weight loss with increased appetite and food intake in a patient treated for depression on two separate occasions with fluoxetine.

CASE SUMMARY:

A 27-year-old woman experienced a modest weight loss during treatment for depression with fluoxetine. The weight loss was associated with a reported increase in daily caloric intake and consumption of a greater proportion of dietary fat than usual for the patient. The same patient was treated again with fluoxetine more than a year later and again experienced weight loss associated with an increase in appetite, caloric intake, and dietary fat consumption.

DISCUSSION:

Fluoxetine is a selective serotonin reuptake inhibitor that often is associated with a modest weight loss when used for the treatment of depression, although it also has been reported to have the opposite effects of weight gain and hyperphagia in some patients. The effects on weight usually are assumed to be the result of primary effects on appetite, but the discrepancy between the appetite and weight changes in this case challenges the applicability of that assumption in all cases.

CONCLUSIONS:

The effects of fluoxetine on appetite and weight may be mediated by partially distinct mechanisms and might conceivably involve a direct metabolic effect in some patients.
Knowledge of and Attitudes About Adverse Drug Reaction Reporting Among Rhode Island Pharmacists
Authors: Generali Joyce A , Danish Michele A , Rosenbaum Sara E
Published: January 2017

Objective:

To survey pharmacists' knowledge of the adverse drug reaction (ADR) reporting process, as well as the nature and seriousness of ADRs observed by pharmacists, and to determine how pharmacists perceive their role in monitoring and reporting suspected reactions.

Design:

A survey was mailed to 793 Rhode Island pharmacists with a 40% (318) response rate.

Results:

Two hundred and thirty-five surveys were reviewed for final analysis. Pharmacists in retail settings were more likely than hospital pharmacists to be aware of ADRs relating to therapeutic inequivalence and over-the-counter products, and more likely to ask the patient about ADRs (40% vs 16%). Hospital pharmacists were more likely to receive ADR information from physicians (40% vs 15%). Almost all pharmacists (97%) believed that action should be taken when a serious ADR is suspected. Younger pharmacists (<45 y) were more willing to contact the physician and refer the patient to medical attention.

Conclusions:

Our results show that fewer than half of the respondents (41%) claimed to have observed a serious ADR (potentially life-threatening or requiring hospitalization), although almost all (97%) believed that pharmacists should take some action when a serious ADR is suspected. The influence of the practice setting, the number of years in practice, and the number of hours worked per week influenced the reporting practices and attitudes.
Multiorgan Failure Associated with Lomusttne Overdose
Authors: Trent Kelley C , Myers Lesley , Moreb Jan
Published: January 2017

Objective:

To report a lomustine overdose in a patient with anaplastic astrocytoma.

Case Summary:

A 28-year-old woman with anaplastic astrocytoma was treated with partial resection and radiation therapy followed by a lomustine-containing regimen. The patient took lomustine 1400 mg po over a week, her regular dose being 200 mg on day 1 of the regimen. Pancytopenia developed within a week after the last dose of lomustine and the patient was admitted to the bone marrow transplant unit for supportive care. About 3 weeks later, the patient gradually developed a multiorgan dysfunction, including liver, brain, and lungs without evidence of infection or tumor progression, and died on day 45 of hospitalization.

Discussion:

This is the third reported case of lomustine overdose that resulted from supplying the patient with more tablets than needed for 1 dose. Although late hematopoietic recovery may be possible after such a high dose of lomustine, other organ toxicities might be detrimental.

Conclusions:

Physicians and pharmacists should avoid supplying more tablets than needed for 1 lomustine dose. High doses of lomustine may cause irreversible multiorgan toxicities.
Use of Antidiabetic and Antihypertensive Drugs in Hospital and Outpatient Settings in Hong Kong
Authors: Lau Grace SN , Chan Juliana CN , Chu Pauline LM , Tse Dylan CK , Critchley Julian AJH
Published: January 2017

OBJECTIVE:

To investigate the usage patterns of antidiabetic and antihypertensive drugs and to identify any discordance between recommended management guidelines and clinical practice in two study locations.

DESIGN:

Prescription survey.

SETTING:

A government-operated general outpatient clinic (GOPC) and a medical/geriatric specialist clinic (SC) affiliated with a regional hospital in the same district.

PATIENTS:

Patients presenting with a prescription during the study period at the respective pharmacy were classified as having diabetes if at least one antidiabetic agent was prescribed and as having hypertension if a cardiovascular drug was prescribed in a hypotensive dosage.

MAIN OUTCOME MEASURE:

The pattern of use of antidiabetic and antihypertensive drugs.

RESULTS:

One thousand one hundred forty-four consecutive prescriptions were collected in the GOPC, and 1523 in the SC. Of these, 9.4% (n = 107) of patients were classified as having diabetes in the GOPC and 20.4% (n = 310) in the SC (ρ > 0.001). Most patients with diabetes were taking oral hypoglycemic agents (98.1% in GOPC vs. 84.5% in SC). Glibenclamide was the sulfonylurea used most often as monotherapy in both settings (50.5% in GOPC vs. 40.6% in SC). The combined use of a sulfonylurea with metformin was common in both settings (22.4% in GOPC vs. 28.4% in SC). Metformin monotherapy (1.9% in GOPC vs. 2.6% in
Evaluation of a Pharmaceutical Care Model on Diabetes Management
Authors: Jaber Linda A , Halapy Henry , Fernet Mireille , Tummalapalli Suresh , Diwakaran Hariharan
Published: January 2017

OBJECTIVE:

To assess the effectiveness of a pharmaceutical care model on the management of non-insulin-dependent diabetes mellitus (NIDDM) in urban African-American patients.

DESIGN:

Eligible patients were randomized to either a pharmacist intervention or control group and followed over a 4-month period. Patients in the intervention group received diabetes education, medication counseling, instructions on dietary regulation, exercise, and home blood glucose monitoring, and evaluation and adjustment of their hypoglycemic regimen. Patients in the control group continued to receive standard medical care provided by their physicians.

SETTING:

A university-affiliated internal medicine outpatient clinic.

PARTICIPANTS:

The study population consisted of urban African-American patients with NIDDM currently attending the clinic.

MAIN OUTCOME MEASURES:

Primary outcome measures included fasting plasma glucose and glycated hemoglobin concentrations. Secondary outcome endpoints included blood pressure, serum creatinine, creatinine clearance, microalbumin to creatinine ratio, total cholesterol, triglycerides, high-density lipoprotein, and low-density lipoprotein concentrations. Quality-of-life assessments were performed in both groups at baseline and at the end of the study.

RESULTS:

Thirty-nine patients (17 intervention, 22 control) completed the study. The intervention group consisted of 12 women and 5 men with a mean ± SD age of 59 ± 12 years, total body weight (TBW) of 93 ± 22 kg, body mass index (BMI) of 34 ± 7 kg/m2, and duration of NIDDM 6.8 ± 6.5 years. The control group consisted of 15 women and 7 men with a mean age of 65 ± 12 years, TBW of 88 ± 19 kg, BMI of 33 ± 7 kg/m2, and a duration of NIDDM of 6.2 ± 4.8 y. Significant improvement in glycated hemoglobin (p = 0.003) and fasting plasma glucose (p = 0.015) was achieved in the intervention group. No change in glycemia was observed in the control subjects. Statistically significant differences in the final glycated hemoglobin (p = 0.003) and fasting plasma glucose (p = 0.022) concentrations were noted between groups. No significant changes in blood pressure control, lipid profile, renal function parameters, weight, or quality-of-life measures were noted within or between groups.

CONCLUSIONS:

Our data demonstrate the effectiveness of pharmaceutical care in the reduction of hyperglycemia associated with NIDDM in a group of urban African-American patients.
Suspected Neuroleptic Malignant Syndrome in a Patient Receiving Clozapine
Authors: Ganelin Luba , Lichtenberg Pesach S , Marcus Esther-Lee , Munter R Gabriel
Published: January 2017

OBJECTIVE:

To report a case of suspected neuroleptic malignant syndrome (NMS) associated with clozapine therapy.

CASE SUMMARY:

A 42-year-old schizophrenic man treated with clozapine developed a temperature of 39.5 °C, diaphoresis, tachycardia, rigidity, and leukocytosis. His serum creatine kinase concentration was 25 000 U/L. A diagnosis of NMS was made. He was treated with bromocriptine and supportive therapy, and recovered within a week.

DISCUSSION:

Despite earlier expectations that clozapine, with a pharmacologic profile differing from that of other antipsychotic medications, might not cause NMS, NMS remains the most likely diagnosis in this case.

CONCLUSIONS:

NMS may be a possible complication of clozapine therapy.
Possible Paroxetine-Induced Bruxism
Authors: Romanelli Frank , Adler David A , Bungay Kathleen M
Published: January 2017

OBJECTIVE:

To report the case of a patient with possible paroxetineinduced bruxism that was effectively treated with buspirone.

CASE SUMMARY:

A 20-year-old woman with no active medical conditions besides acne and no history of dental problems was seen in an outpatient psychiatry clinic for the evaluation of ongoing depression. The patient was prescribed paroxetine 10 mg every morning. After 5 days of therapy the patient reported no adverse effects, and the paroxetine dosage was increased to 20 mg every morning. Due to increased somnolence, the dosing schedule was subsequently changed to 20 mg hs. Two months later during a dental visit for a tooth extraction, the dentist noted that the patient's teeth appeared damaged in what he believed to be a pattern consistent with the grinding and clenching of teeth. Prior to this time, dental examinations had not revealed any tooth damage. The patient was thought to have paroxetine-induced bruxism and, based on earlier case reports, was treated with buspirone 5 mg hs. On day 4 of buspirone therapy the patient reported a significant reduction in the extent of gritting, tooth pain, and jaw tenderness.

DISCUSSION:

The selective serotonin reuptake inhibitors (SSRIs) fluoxetine and sertraline have been associated with bruxism in previous reports. This case suggests paroxetine-induced bruxism. The exact mechanism of SSRI-induced bruxism remains unclear. Many theories have been proposed, including sleep disturbance, serotonergic-mediated inhibition of dopamine manifesting as akathisia, and SSRI-induced anxiety. According to published reports, SSRI-induced bruxism may respond to therapy with buspirone. Consistent with these reports, this patient responded favorably to buspirone therapy.

CONCLUSIONS:

Clinicians should be aware that the potential for paroxetine-induced bruxism exists and that buspirone may be an appropriate therapeutic intervention.
Insulin Lispro: Its Role in the Treatment of Diabetes Mellitus
Authors: Campbell R Keith , Campbell Lance K , White John R
Published: January 2017

OBJECTIVE:

To introduce a rapid-acting human insulin analog, insulin lispro; to review its pharmacology, therapeutics, pharmacokinetics, dosing guidelines, adverse effects, and drug interactions; and to summarize the clinical trials of its efficacy and safety alone and in comparison with regular human insulin in the treatment of diabetes mellitus.

DATA SOURCES:

A MEDLINE database search was completed to identify all relevant articles, including reviews; Eli Lilly and Co.; published articles and abstracts; and review chapters from medical textbooks.

STUDY SELECTION:

Due to the relatively few citations listed in MEDLINE (12 as of December 1995), most of the studies reported were found from abstracts summarizing the clinical action, adverse effects, or pharmacokinetics of insulin lispro in healthy volunteers or patients with diabetes mellitus. A few of the studies used patients with diabetes mellitus in multicenter, randomized, crossover trials of insulin lispro.

DATA EXTRACTION:

All clinical trials that were available prior to submission of this manuscript for publication, including unpublished reports, were reviewed.

DATA SYNTHESIS:

The human insulin analog, insulin lispro, which is biosynthetically made by inverting the amino acid sequence of human insulin at B-28 and B-29, is more effective than regular human insulin in improving postprandial glucose control. Subcutaneous injections of insulin lispro result in decreased blood glucose peaks following meals and a potential decreased risk of hypoglycemic episodes, including nighttime hypoglycemia in patients with type 1 diabetes. Insulin lispro in comparison with regular human insulin provides equal or slightly better blood glucose control. When compared with subcutaneous injections of regular human insulin, the peak serum insulin concentration of insulin lispro is three times higher, time to peak is 4.2 times faster, the absorption rate constant is double, and the duration of action is half as long. Insulin lispro is similar to regular human insulin with reference to dose, toxicity, adverse effects, drug interactions, and imrnunogenicity. When insulin lispro is mixed with human NPH (isophane) or Lente insulins, insulin lispro should be drawn into the syringe first, mixed with the long-acting insulin, and injected immediately after mixing. Patients using insulin lispro perceive an improvement in their well-being and quality of life due to flexible injection times and less frequent hypoglycemic reactions. Insulin lispro is believed to be suitable for patients using insulin infusion pumps.

CONCLUSIONS:

Insulin lispro is equipotent to human insulin and has a much more rapid onset and shorter duration of action than human insulin does, which may reduce the risk of hypoglycemia. In addition, insulin lispro improves the dosing convenience for patients with diabetes and provides a more natural control of blood glucose concentrations. Insulin lispro is a useful new agent in the treatment of diabetes mellitus.
Customizing practices based on the frequency of problems in new product development process
Authors: Echeveste Márcia Elisa S , Rozenfeld Henrique , Fettermann Diego de Castro
Published: January 2017

The study of new product development best practices aimed at helping new product development process managers improve the process has been the subject of many publications in recent years. These practices have been analyzed, categorized, and disseminated based on numerous research methods, such as benchmarking, success factors analysis, surveys of practices used by successful companies, practitioner panels, and practice frameworks. However, the adoption of such practices depends on many factors, such as product characteristics, market, cultural aspects, and the ecosystem of the country or region where a company operates. This research proposes an alternative to identify and recommend new product development process practices with a greater potential to solve the most common difficulties encountered in new product development process. This approach can be used to complement the previously mentioned ones. The inspiration for this work came from the observation of business process improvement methodologies such as Lean Thinking and Six Sigma, in which the first step is to identify and analyze problems prior to defining actions to eliminate them. To achieve this goal, a survey involving 346 companies operating in Brazil was conducted to identify common new product development process practices and problems. Multivariate contingency tables with Chi-square significance tests and odds ratio were applied to analyze the data. The hypothesis tested was that the absence of a new product development process practice heightens the risk of the new product development process problem. This suggests that the successful application of a practice eliminates or prevents the corresponding problem. The result of this research is an alternative way to propose practices that can potentially eliminate specific new product development process problems.
A Comparison of Calibrated and Non-Calibrated 5.07 Nylon Monofilaments
Authors: Smith Kevin D. , Emerzian Garo J. , Petrov Oleg
Published: January 2017

The study compares the mechanical performance of two types of nylon monofilaments used in testing for the presence of protective sensation in diabetics with peripheral neuropathy. Comparisons of the application force between a group of calibrated and a group of non-cali-brated 5.07 nylon monofilaments were conducted to determine the properties of each type of filament. The analysis demonstrated that there was no significant difference in the application force generated between calibrated and non-calibrated nylon monofilaments.
Measuring Parenting Throughout Adolescence: Measurement Invariance Across Informants, Mean Level, and Differential Continuity
Authors: Van Heel Martijn , Bijttebier Patricia , Claes Stephan , Colpin Hilde , Goossens Luc , Van Den Noortgate Wim , Verschueren Karine , Van Leeuwen Karla
Published: January 2017

This study examined the structural validity of the parenting concept throughout adolescence. First, we examined whether an established five-dimension parenting model including support, proactive control, punitive control, harsh punitive control, and psychological control, showed longitudinal invariance across time (i.e., early, middle, and late adolescence) and measurement invariance across informants (i.e., mothers, fathers, and adolescents). Second, patterns of continuity and discontinuity in these dimensions were examined from the perspective of the different informants. In a four-wave accelerated longitudinal study with 1,111 adolescents and their parents, a multigroup structural equation modelling showed partial scalar invariance across adolescence and across informants. Subsequent growth modelling indicated that parenting was relatively stable over time and that similar patterns were present for mother, father, and adolescent ratings of parenting. Future research on associations between parenting and adolescent development can build on the findings of this study, given that comparing perspectives on parenting by different informants and over time seems to be valid.
Relationship of Health Literacy of Heart Failure Patients and Their Family Members on Heart Failure Knowledge and Self-Care
Authors: Wu Jia-Rong , Reilly Carolyn M. , Holland James , Higgins Melinda , Clark Patricia C. , Dunbar Sandra B.
Published: January 2017

We explored the relationships among patients’ and family members’ (FMs) health literacy, heart failure (HF) knowledge, and self-care behaviors using baseline data from HF patients and their FMs ( N = 113 pairs) in a trial of a self-care intervention. Measures included Rapid Estimate of Adult Literacy in Medicine, Atlanta HF Knowledge Test, a heart failure Medication Adherence Scale, and sodium intake (24-hr urine and 3-day food record). Patients with low health literacy (LHL) were more likely to have lower HF knowledge ( p < .001) and trended to poorer medication adherence ( p = .077) and higher sodium intake ( p = .072). When FMs had LHL, FMs were more likely to have lower HF knowledge ( p = .001) and patients trended toward higher sodium intake ( p = .067). When both patients and FMs had LHL, lowest HF knowledge and poorest medication adherence were observed ( p < .027). The health literacy of both patient and FM needs to be considered when designing interventions to foster self-care.
A Case Study of Point-of-Service Medical Use in a Managed Care Plan
Authors: Wong Herbert S. , Smithen Lindsay
Published: January 2017

This study examines the extent of point-of-service use in a managed care plan using 1990 and 1991 proprietary claims data (excluding pharmacy claims) from a large, well-established individual practice association with a point-of-service option. Results show that approximately 12 percent of all claims were made by out-of-network providers, representing about 9 percent of the dollar value of all claims. This is about $131 per enrollee per year. While younger enrollees (i.e., 6-24 years of age) use fewer medical resources than do older enrollees, they tend to receive a greater share of their medical services from out-of-network providers. There is little difference between point-of-service use by males and females. Mental illness is the most common diagnosis for out-of-network claims, accounting for about 25 percent of the dollar value of out-of-network claims. Ninety-six percent of the out-of-network claims for this diagnosis category were made by providers with a specialty in psychiatry.
Coloring Hope Theory: An Auto-Ethnographic Sketch of Pain, Silent Killers, and Dream Hope for Social Justice
Authors: Sellner Wilson F.
Published: January 2017

The following poems are about the hardships faced by people with mental disorders and how society does not understand or accept them. The first poem describes the difficulties in relationships because partners do not always understand their difficulties expressing things or their quirks that might drive the person away. The second poem describes how some mental health patients are better able to cope with their disability than others to be more productive in society. The last poem explains how people with disorders are treated the same as a drug addicts in a recession and how it holds you back from achieving what you know you are capable of.
Exploring an Emotional Intelligence Model With Psychiatric Mental Health Nurses
Authors: Sims Traci T.
Published: January 2017

BACKGROUND: A lack of emotional skills may affect a nurse’s personal well-being and have negative effects on patient outcomes. OBJECTIVE: To compare psychiatric-mental health nurses’ (PMHN) scores on the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) to a normed population and compare the emotional intelligence (EI) scores of PMHNs using two tools, MSCEIT and Self-Rated Emotional Intelligence Scale (SREIS). DESIGN: Comparative descriptive and correlational study. RESULTS: PMHNs in the study had a higher mean EI compared with that of 5,000 participants in the normed MSCEIT sample. Significant weak correlations were seen between the perceiving and understanding emotion branches of the MSCEIT and SREIS. CONCLUSION: The current study added data about a sample of PMHN’s EI levels in the United States, which may encourage dialog about EI among PMHNs. Future research is needed to examine the relationship between self-report EI tools (e.g., SREIS) and performance tools (e.g., MSCEIT) to determine if they are measuring the same construct.
Phonological Working Memory Deficits in ADHD Revisited: The Role of Lower Level Information-Processing Deficits in Impaired Working Memory Performance
Authors: Raiker Joseph S. , Friedman Lauren M. , Orban Sarah A. , Kofler Michael J. , Sarver Dustin E. , Rapport Mark D.
Published: January 2017

Objective: The current study dissociates lower level information-processing abilities (visual registration/encoding, visual-to-phonological conversion, and response output) and examines their contribution to ADHD-related phonological working memory (PHWM) deficits. Method: Twenty children with ADHD and 15 typically developing (TD) children completed tasks assessing PHWM, visual registration/encoding, visual-to-phonological conversion, and response output. Results: Relative to TD children, children with ADHD exhibited deficient visual registration/encoding ( d = 0.60), visual-to-phonological conversion ( d = 0.56), and PHWM ( d = 0.72) but faster response output ( d = −0.66). Bias-corrected, bootstrapped mediation analyses revealed that visual registration/encoding, but not visual-to-phonological conversion, partially mediated ADHD-related PHWM impairments. In contrast, faster response output in children with ADHD served as a suppressor variable, such that greater PHWM deficits were observed in children with ADHD after controlling for their faster response output ( d = 0.72 vs. 0.85). Conclusion: Results implicate both lower level (visual registration/encoding) and higher order (PHWM) impairments in ADHD. Implications for designing educationally relevant cognitive interventions are discussed.
How Can Legal Education Speak to the Discovery-enriched Curriculum?
Authors: Pascoe Daniel
Published: January 2017

City University of Hong Kong’s (CityU) Discovery-enriched Curriculum (DEC) is a pedagogical approach involving discovery, innovation and creativity. With its focus on invention and experimentation, this approach lends itself naturally to the artistic and science-based disciplines; yet with an open mind, it can also be implemented within the undergraduate curriculum in law.

This article discusses the DEC and its theoretical basis within the educational literature on discovery-based learning and the undergraduate research movement, before moving on to suggest the ways and means by which the undergraduate law curriculum at CityU could be changed in order to implement DEC and equally as importantly the ways in which established law-teaching practices already fit within the DEC framework. To fully implement DEC within CityU’s Bachelor of Laws curriculum, some changes to long-standing teaching practices and the list of core courses will be necessary, but perhaps fewer changes than a sceptic might first believe. Overall, DEC has the potential to become a model for other law schools to follow in adopting inductive learning methods, if these are implemented in accordance with the results of existing pedagogical research.
Performance audit as a contributor to change and improvement in public administration
Authors: Reichborn-Kjennerud Kristin , Vabo Signy Irene
Published: January 2017

The last 30 years of the New Public Management ‘regime’ in many western countries have resulted in increased use of audit and other control mechanisms. These mechanisms are supposed to contribute both to accountability and improvement. In this article, theories of evaluation and organizational learning are used to understand how the dynamics of control affect change processes. We analyse responses to performance audit reports carried out by the country’s Supreme Audit Institution – an important control institution in Norway, as in most other countries. The findings are primarily based on survey data from 353 Norwegian civil servants. The auditees reported that they were mostly positive towards the reports and used them to make improvements in their control systems; however, civil servants also perceived the reports to be unbalanced. The results indicate that the performance audits’ contributions to improvements are less clear than they appear to be at first glance, and that personal and political factors may affect civil servants’ responses.
The Demographics of Claudication and the Aging of the American Population
Authors: Kannel William B
Published: January 2017

Most peripheral artery disease is of ischemic atherosclerotic etiology and manifested as intermittent claudication (IC). Death and disability from atherosclerotic cardiovascular disease (CVD) is a growing problem because of the rapidly increasing elderly segment of the population. By the year 2015 the elderly will constitute 14.8% of Americans. Of the total 255 million, 13.8 million are over age 75 years and 9 million are women. On reaching age 65 years, the average remaining lifetime is 17.4 years. In the USA this 11% of the population accounts for 29% of the health costs and 70% of all deaths are attributable to cardiovascular disease.

About 9.6% of cardiovascular events are due to peripheral artery disease manifested as IC requiring 777 000 office visits and 63 000 hospitalizations. Also, 17 400 deaths each year are attributed directly to this cause. The biennial incidence of IC in the Framingham Study was 7.1 per 1000 for men and 3.6% for women, increasing with age in both sexes up to age 75 years. At all ages there is a distinct male predominance. In the 35–64-year age range IC incidence is virtually identical to that of cardiac failure and stroke, but only one-third of CHD incidence. Beyond age 65 years IC incidence is only half that of other atherosclerotic cardiovascular conditions. The incidence of carotid bruits and non-palpable pedal pulses is virtually identical in the two sexes; only femoral bruits are male predominant.

At time of diagnosis of IC one in three already have overt evidence of CHD, stroke or congestive heart failure (CHF). In those free of these at outset CHD and strokes occur at two to three times the general population rate and CHF 3.5–4.5 times the rate of persons without IC. Within 10 years of IC onset 43% develop CHD, 21% strokes and 24% cardiac failure. Carotid and femoral bruits are likewise harbingers of other atherosclerotic CVD. As many as 45% of IC victims lose their symptoms for extended periods.

Survival following onset of IC is only two-thirds of that of the general population; after 10 years 60% died. This high mortality is largely attributable to coexistent cardiovascular impairments.

A risk profile comprising the major cardiovascular risk factors predicts occurrence of IC even better than CHD. IC risk increases progressively with burden of the risk factors.

With an aging population of increased size peripheral artery disease is a problem of increasing dimensions. Attention to comorbid conditions is essential if survival is to be improved. Because IC shares many of the same risk factors, measures to prevent CHD, CHF and strokes should also reduce IC risk.
Therapeutic Angiogenesis: A New Frontier for Vascular Therapy
Authors: Isner Jeffrey M
Published: January 2017

Angiogenic cytokines constitute a potentially novel form of therapy for patients with cardiovascular disease. The feasibility of using recombinant formulations of angiogenic growth factors to expedite and/or augment collateral artery development in animal models of myocardial and hindlimb ischemia – ‘therapeutic angiogenesis’ – has now been well established. These studies have suggested that two angiogenic growth factors in particular – basic fibroblast growth factor and vascular endothelial growth factor – are sufficiently potent to merit further investigation. More recently, experiments performed in our laboratory have indicated that, in the case of vascular endothelial growth factor – a secreted protein – similar results may be achieved by percutaneous arterial gene transfer. Further laboratory and clinical studies may yield promising insights into the fundamental basis for native as well as therapeutic angiogenesis, and at the same time more explicitly define the manner in which therapeutic angiogenesis may be successfully incorporated into clinical practice.
Age moderates the relationship between source of social support and mental health in racial minority lesbian, gay, and bisexual youth
Authors: Wise Anna E , Smith Brian C , Armelie Aaron P , Boarts Jessica M , Delahanty Douglas L
Published: January 2017

We examined the relationship between source of social support and mental health (and the moderating impact of age) in 64 low socioeconomic status, racial minority lesbian, gay, and bisexual adolescents/young adults. Social support from family ( β = −.302, p = .03; β = −.364, p = .008), but not friends or significant others, was independently related to posttraumatic stress disorder and depression symptoms, respectively. Family social support was associated with lower posttraumatic stress disorder and depression symptoms in participants aged 16–19 years, while friend social support was associated with lower symptoms for participants aged over 20 years. Friend social support was also associated with lower posttraumatic stress disorder symptoms in participants aged 16–17 years. Interventions should target age-appropriate sources of social support.
Care seeking for children with fever/cough or diarrhoea in Nepal: equity trends over the last 15 years
Authors: Målqvist Mats , Singh Chahana , Kc Ashish
Published: January 2017

Aims: Childhood illnesses such as diarrhoea and pneumonia remain major contributors to child mortality globally and need to be continually targeted in pursuit of universal health coverage. This study analyses time trends in the prevalence of fever/cough and diarrhoea in Nepal and applies an equity lens in order to identify disadvantaged groups. Methods: Data from the Nepal Demographic Health Surveys of 2001, 2006, and 2011, together with data from the most recent Multiple Indicator Cluster Survey of 2014 performed in Nepal, were utilized for analysis. Results: Analyses revealed improvements (lower prevalence) of diarrhoea and fever/cough in children under five in Nepal over the last 15 years, with an equitable distribution of symptoms over socio-economic determinants. There was, however, a marked and maintained inequity in care seeking for these symptoms, with less educated mothers and those from poor households being only approximately half as likely to seek care for their children. Conclusions: Results highlight the persisting need for targeting care-seeking and societal barriers to treatment in order to achieve universal health access.
Trauma in Pregnancy: Assessment and Treatment
Authors: Petrone P. , Asensio J. A.
Published: January 2017

Women between the ages of 10 and 50 year-old have the potential for pregnancy; therefore this condition must be taken into consideration when a woman is examined in the Emergency Room after sustaining a traumatic event. Pregnancy produces significant physiologic and anatomic changes in every system of the female body. The evaluation of the traumatized pregnant patient, the approach, and the interpretation of the diagnostic tests results must be accompanied by the full knowledge of all changes that take place during pregnancy.

In the same context, although the physician treating a pregnant trauma victim must remember that there are two patients, the treatment priorities are the same as for the non-pregnant trauma patient. The best initial treatment for the fetus is the optimum resuscitation of the mother.

A thorough exam should take place to discover unique conditions that might be present in any pregnant patient such as blunt or penetrating injury to the uterus, placental abruption, amniotic fluid embolism, isoimmunization, and premature rupture of membranes.

The obstetrician should be present at all times and be considered a part of the trauma team in the evaluation and treatment of apregnant trauma patient.
Long-Term Results of Laparoscopic Nissen Fundoplication Due to Gastroesophageal Reflux Disease. A Ten Year Follow-Up in a Low Volume Center
Authors: Kornmo T. S. , Ruud T. E.
Published: January 2017

Background and Aims:

Laparoscopic 360° Nissen fundoplication has been our routine surgical procedure since 1995, in the treatment of gastroesophageal reflux disease (GERD). We have reviewed our results of patients treated with laparoscopic Nissen fundoplication (LNF) during 1995–1998.

Material and Methods:

170 patients have undergone LNF in our hospital since 1995. During the period of 1995–1998, 33 patients were treated. All patients were asked to return a structured follow-up questionnaire, using a Visick grading scale, after an average of 69 months (2003) and 117 months (2007). 29 questionnaires (90%) were answered in 2003, and 31 questionnaires (97%) were answered in 2007. One patient died at home before the first questionnaire in 2003, and is therefore not included. We present our results on LNF after an observation time of 117 months (range 99–144 months).

Results:

Patient satisfaction after LNF is rated as very good or good (Visick 1–2) in 93% in 2003 and 97% in 2007. 97% of the patients would recommend the same treatment to other patients with similar symptoms at ten year follow up. One patient has undergone resurgery during follow up. Daily gas bloat and flatulence is reported in 52% in 2003 and 39% in 2007, and is the most common reason for reduced satisfaction. Five patients report of reflux symptoms, one patient daily and four patients sometimes, where the first patient still uses proton pump inhibitor (PPI) daily and three patients use PPI occasionally.

Conclusions:

Patient satisfaction after LNF treatment for GERD is high at long-term (10 years) follow-up. Bloating and flatulence persistently occurred to a great extent and the need for preoperative information regarding these symptoms is important.
An Evaluation of Mitral Valve Procedures Using the European System for Cardiac Operative Risk Evaluation
Authors: Kaartama T. , Heikkinen L. , Vento A.
Published: January 2017

Background and Aims:

This study was undertaken in order to evaluate the usefulness of the Euroscore in the choice and outcome of mitral valve procedures undertaken at the Helsinki University Central Hospital.

Material and Methods:

Data from 378 patients was collected. Predicted mortalities were calculated for all patients using the European System for Cardiac Operative Risk Evaluation and different mitral valve procedures were compared with 30-day mortality, length of hospital care and rate of post-operative complications.

Results:

The mortality rate in the mitral valve repair (MVP) group decreased gradually from 5.9% (in 1999) to 2.2% (2003). The variation of annual mortality was higher in the mitral valve replacement (MVR) group. The predicted mortality given by EuroSCORE increased over the years in both groups. The mortality in the MVR group was nearly four times higher than in the MVP group. The length of both intensive and overall hospital stay decreased in patients with mvp procedures. Post-operative survival was 89% in the MVP patients and 74% in MVR patients after three years.

Discussion:

The results of mitral valve operations have improved. This is observed as decreased mortality rates and lengths of hospital care in the MVP group, although the predicted mortality rate was increased.
The Gesture of Photographing
Authors: Flusser (Translation and Introduction by Nancy Ann Roth) Vilém
Published: January 2017

Phenomenological in its method, the essay examines the movement of a photographer, camera, object to be photographed, and us, the observers, making no assumptions about the relationships among these components. The movement is seen to exhibit a pattern, which in turn is seen to resemble a philosopher’s thought process as s/he seeks a position in the world. The essay concludes by identifying photographing as what the ancient Greeks called ‘theoria’, a gesture of seeing.
Effective public involvement in the HoST-D Programme for dementia home care support: From proposal and design to methods of data collection (innovative practice)
Authors: Giebel Clarissa , Roe Brenda , Hodgson Anthony , Britt David , Clarkson Paul ,   Members of the HoST-D (Home Support in Dementia) Programme Management Group and Patient Public and Carer Involvement Groups
Published: January 2017

Public involvement is an important element in health and social care research. However, it is little evaluated in research. This paper discusses the utility and impact of public involvement of carers and people with dementia in a five-year programme on effective home support in dementia, from proposal and design to methods of data collection, and provides a useful guide for future research on how to effectively involve the public. The Home SupporT in Dementia (HoST-D) Programme comprises two elements of public involvement, a small reference group and a virtual lay advisory group. Involving carers and people with dementia is based on the six key values of involvement – respect, support, transparency, responsiveness, fairness of opportunity, and accountability. Carers and people with dementia gave opinions on study information, methods of data collection, an economic model, case vignettes, and a memory aid booklet, which were all taken into account. Public involvement has provided benefits to the programme whilst being considerate of the time constraints and geographical locations of members.