Effects of fenfluramine on autistic individuals residing in a state developmental center

The effects of fenfluramine on 21 maladaptive behaviors in 20 autistic individuals were examined over a 9-month period utilizing a double-blind, crossover, placebo-controlled design. Raters carried out time-sampled observations in the school and residence. In addition, videotaped data were collected in controlled settings and assessed by the raters at the conclusion of the study. Some individuals displayed negative side effects such as tension, agitation, insomnia, and sweating during the 16-week period they received fenfluramine. The results demonstrated that fenfluramine caused no significant reductions in maladaptive behaviors. The lack of any significant positive results from this medication and the side effects observed strongly indicate the need for caution in the use of fenfluramine with autistic persons.This research was supported by funding from the California Department of Developmental Services, Gary Macomber, Director; Bamford Frankland, Deputy Director; Don Bowling, Chief of Clinical Program Services. The support of Frank Turley, Executive Director, and David Freehauf, Clinical Director of CSH/DC, was appreciated. The authors gratefully acknowledge the assistance of the following individuals: Gary Bazzell, Cathy Davis, Steve Haferkamp, Tracee Parker, Kathryn Peckham, Debra Spiegle, Roger Light, Henry Soper, and Donna Gaier. We are also indebted to the staff of units 64, 66, and 67 for their participation in the study. The A. H. Robins Company supplied the pondimin (fenfluramine) and placebo tablets, which were dispensed by Charles Davis, Pharm. D. We thank Drs. Edward Ritvo, B. J. Freeman, and Aurthur Yuwiler for their assistance.     

Work performance by persons with multiple sclerosis: conditions that impede or enable the performance of work

This study queried 508 persons diagnosed with multiple sclerosis (MS) regarding what conditions made performing their work or tasks ‘difficult’ and ‘easier’. The subjects represented four groups: employed outside the home, homemakers, unemployed, and retired. Their written responses were content analysed. Conditions reported to impede the performance of work and tasks were related to three categories: physical restrictions, person-environment interaction, and MS-related symptoms. Conditions reported to enhance the performance of work and tasks were related to five categories: assistive devices, human support, personal attributes, health promotion behaviors, and person-environment adjustment. Study findings provide useful information for families, health service providers and employers of persons with MS in assisting them enhance their ability to perform work or tasks.     

Untersuchungen über die Reduktion des Oxyhämoglobins, „Sauerstoffzehrung“, am lebenden Gewebe und ihre Abhängigkeit vom jeweiligen Zustand des Organismus

Zusammenfassung Bei 200 Arbeitern wurde die Zeit, die nach Abschnürung der Finger zur Reduktion des O₂Hb zu Hb benötigt wird (R.Z.) durch Spektroskopie des Blutes am Finger festgestellt. Dabei zeigte sich sowohl ohne wie mit vorausgeschickter Atempause, nach letzterer noch ausgesprochener, ein deutlicher Unterschied; am stärksten war die R.Z. bei schwerer Hitzearbeit verkürzt, während die Arbeiter mit Gifteinwirkung (CS₂, Cyan) dieselben Werte wie ausgeruhte Schwerarbeiter vor der Arbeit hatten, und zwar die Durchschnitts- und die extremen Werte bei den einzelnen Gruppen. Bei CO-Wirkung scheinen die Verhältnisse ähnlich zu liegen. Es wird in Analogie zu der akuten Cyanwirkung als Ursache der Verlängerung der R.Z. bei Giftwirkung eine Schädigung der Zellatmung angenommen. Im übrigen steigt das O₂-Bedürfnis mit der Arbeit und die Parallele der normalen Altersreaktion zur vorzeitigen Abnutzungsreaktion liegt nahe.     

Role of the nurse in patient education and follow-up of people receiving oral chemotherapy treatment: an International survey

PURPOSE: The aim of this study was to explore the nursing role in education and follow-up of patients who were taking oral chemotherapy (CT) and to identify the worldwide gap in patient education about oral CT. MATERIALS AND METHODS: Multinational Association of Supportive Care in Cancer members were invited to participate in a survey on oral CT. Nurse coordinators collected data via a 16-item questionnaire. Respondents totaled 1115 oncology nurses from 15 countries. RESULTS: Findings showed that about half of subjects work in outpatient/ambulatory clinics and had given at least two or more oral CT drugs. Although 52% had some type of guidelines/protocols, 47% reported not having received any education about oral CT drugs. While 64% report being involved in patient education, 58% of subjects indicated lack of patient education materials that are specific for oral CT agents. Only 27% stated that they gave all necessary information such as when and how to take the drugs, drug safety and storage, side effects, and symptom management. Reasons for not being involved in oral CT education and follow-up included beliefs that the physician plans the oral CT and gives patients necessary instructions (34%), that nurses only see patients who receive intravenous chemotherapy (16%), that nurses have lack of knowledge about oral agents (15%), and belief that physicians are responsible for patient follow-up. The nurses suggested better education and follow-up of patients to include the written patient education materials (33%) and professional education for nurses (30%). CONCLUSIONS: Findings revealed the need for professional education for nurses to ensure comprehensive, consistent patient education and development of written materials for patients receiving oral CT treatment.     

Ligamentäre Verletzungen und Bandinstabilitäten der Fingergelenke

Joint capsule and ligamentous lesions are common injuries of the upper extremities. Athletes are particularly inclined to suffer from these injuries. Clinical and radiological examinations are the cornerstone of an adequate treatment. Ultrasound-based diagnostics as a non-invasive and dynamic investigation method are gaining increasing relevance based on the development of high resolution probes. A correct interpretation of the findings is only feasible with a comprehensive knowledge of the anatomy. The most important goal is stability as a prerequisite for early active and passive motion with unrestricted range of motion.     

Postprandial versus preprandial dosing of biphasic insulin aspart in elderly type 2 diabetes patients

Preprandial dosing (within 5 min before meal) and postprandial dosing (15-20 min after meal onset) of NovoLog Mix 70/30 (BIAsp 30, a biphasic formulation of insulin aspart, 30% soluble and 70% protamine-crystallized) were compared in elderly (> or =65 years) type 2 diabetes patients in this open-label, 12-week, crossover study. Ninety-three patients were treated with b.i.d. preprandial injections of BIAsp 30 during a 2-week run-in period and subsequently randomized to a 4-week treatment with either pre- or postprandial b.i.d. BIAsp 30, followed by crossover to the other regimen for 4 weeks. Mean plasma glucose values during a 4-h mealtest at the end of each treatment were similar for pre- and postprandial BIAsp 30 (153 +/- 58 mg/dl and 161 +/- 59 mg/dl, respectively, difference not significant). However, the mean blood glucose increment from self-measured blood glucose values was slightly but significantly greater after postprandial injection than after preprandial injection (treatment difference: 16.3mg/dl; 95% CI: [0.5, 29.3]). Fifty-six percent of patients reported a hypoglycemic episode; postprandial injection did not increase the incidence of hypoglycemia as compared to preprandial injection (113 episodes versus 125 episodes, respectively). For some elderly type 2 diabetes patients, postprandial injection of BIAsp 30 may be an acceptable alternative to standard preprandial injection.     

Prevalence of antibodies against alpha-fodrin in Sjögren's syndrome: comparison of 2 sets of classification criteria

OBJECTIVE: To compare the prevalence of antibodies against alpha-fodrin in Sj?gren's syndrome (SS) classified according to San Diego and European Community Study Group (ESG) criteria. METHODS: The prevalence and mean concentrations of IgA and IgG autoantibodies against alpha-fodrin were determined and compared in patients with SS classified either according to San Diego criteria or to criteria of the ESG by ELISA. RESULTS: IgA antibodies against alpha-fodrin were detected in 88% and IgG antibodies against alpha-fodrin in 64% and either of these antibodies in 93% of 85 patients classified according to San Diego criteria. Antibodies against Ro were present in 38% of these sera. IgA antibodies against alpha-fodrin were detected in 61%, IgG antibodies against alpha-fodrin in 51%, and any of these antibodies in 73% of 51 patients classified according to the ESG criteria. The mean concentrations of both IgA and IgG antibodies against alpha-fodrin that seem to correlate with disease activity were higher in patients classified according to the San Diego criteria. CONCLUSION: Antibodies against alpha-fodrin are detectable in almost all sera obtained from patients with SS classified according to the San Diego criteria and are significantly more prevalent than antibodies against Ro. The lower prevalence of the autoantibodies in patients classified according to the ESG criteria reflects the lower specificity of these criteria for SS.