Recent advances in preclinical in vitro approaches towards quantitative prediction of hepatic clearance and drug-drug interactions involving organic anion transporting polypeptide (OATP) 1B transporters

Hepatic uptake mediated by organic anion transporting polypeptide (OATP) 1B1 and 1B3 can serve as a major elimination pathway for various anionic drugs and as a site of drug-drug interactions (DDIs). This article provides an overview of the in vitro approaches used to predict human hepatic clearance (CL_h) and the risk of DDIs involving OATP1Bs. On the basis of the so-called extended clearance concept, in vitro–in vivo extrapolation methods using human hepatocytes as in vitro systems have been used to predict the CL_h involving OATP1B-mediated hepatic uptake. CL_h can be quantitatively predicted using human donor lots possessing adequate OATP1B activities. The contribution of OATP1Bs to hepatic uptake can be estimated by the relative activity factor, the relative expression factor, or selective inhibitor approaches, which offer generally consistent outcomes. In OATP1B1 inhibition assays, substantial substrate dependency was observed. The time-dependent inhibition of OATP1B1 was also noted and may be a mechanism underlying the in vitro–in vivo differences in the inhibition constant of cyclosporine A. Although it is still challenging to quantitatively predict CL_h and DDIs involving OATP1Bs from only preclinical data, understanding the utility and limitation of the current in vitro methods will pave the way for better prediction.     

Patient-important outcomes to inform shared decision making and goal setting for diabetes treatment

ObjectiveDespite well-established treatment guidelines, diabetes is difficult to manage for many individuals. The importance of using shared decision making to optimize diabetes treatment is recognized, yet what matters most to individuals with diabetes is not well established. Our goal was to identify patients’ goals and priorities for diabetes management.MethodsWe engaged 141 participants through interviews and group concept mapping to identify patient-important outcomes (PIOs) for diabetes care. We generated a master list of PIOs by aggregating interview data coded to “goals” and ideas brainstormed during concept mapping, and then a patient advisory board sorted the PIOs into higher-level domains.ResultsWe identified 41 PIOs sorted into 7 broad domains: optimize daily self-care, optimize long term health, learn about diabetes, achieve measurable goals, manage medications, manage diet and best utilize medical / professional services.ConclusionsMost (4/7) of PIO domains focused on personal and life goals, not medically-oriented goals. Use of these PIOs and domains may facilitate more effective SDM discussions for patients with diabetes.Practice implicationsUse of PIOs from this work can enable the empowerment of patients to voice their priorities during SDM conversations, thus facilitating development of truly individualized diabetes treatment plans.     

eCASH理念结合早期活动在ICU机械通气患者的应用研究

目的探讨eCASH理念结合早期活动在ICU机械通气患者中的应用效果。方法将96例ICU机械通气患者按入院时间分为对照组和观察组各48例,对照组给予常规镇痛镇静及护理,观察组实施基于eCASH理念的舒适化浅镇静管理结合早期活动。结果观察组谵妄发生率和ICU获得性衰弱发生率显著低于对照组,MRC肌力评分显著高于对照组,机械通气时间和ICU住院天数显著短于对照组(P0.05,P0.01)。结论 eCASH理念结合早期活动应用于ICU机械通气患者,可降低患者谵妄和ICU获得性衰弱,缩短机械通气和ICU入住时间,促进患者康复。     

Self‐objectification in the context of breastfeeding: A concept analysis

To increase the overall rate of breastfeeding initiation and duration, factors involved in a mother's decision to breastfeed must be identified. Self‐objectification in the context of breastfeeding was a concept selected for exploring factors associated with negative views of breastfeeding. A concept analysis following the eight‐step Walker & Avant method provides clarity and context to the concept of self‐objectification in the context of breastfeeding. The antecedents of self‐objectification in the context of breastfeeding include living in a culture of sexualization and objectification of women and the internalization of the values of objectification. Attributes of self‐objectification in the context of breastfeeding are a prioritization of physical appearance attributes of the breast over the health benefits of breastfeeding and a preoccupation with physical appearance. Consequences include negative views toward breastfeeding initiation, duration, and public breastfeeding. A concept analysis on self‐objectification in the context of breastfeeding will provide definition and clarity to this phenomenon, lend to theory and measurement, and add literature to the sociocultural factors impacting breastfeeding decisions.     

Defining sensory modulation: A review of the concept and a contemporary definition for application by occupational therapists

Background: Sensory interventions are prevalent amongst adult mental health practitioners and are supported by major stakeholders and policy makers across the world. The term commonly used by occupational therapists applying sensory practices is sensory modulation, however this term has evolved.

Aims: This paper aims to investigate and clarify the definition of ‘sensory modulation’ for application by occupational therapists.

Method: A framework guided this concept analysis on sensory modulation. A summative content analysis approach was employed to code results.

Results: Six conceptual themes for sensory modulation were identified. 81% of authors defined sensory modulation as consisting of more than one of these themes. 18% of authors defined sensory modulation as both a neurophysiological process and means to regulate behaviour.

Conclusion: The concept of sensory modulation has evolved in occupational therapy practice. The authors summarise with the following proposed definition of sensory modulation for contemporary occupational therapy practice: ‘Sensory modulation is considered a twofold process. It originates in the central nervous system as the neurological ability to regulate and process sensory stimuli; this subsequently offers the individual an opportunity to respond behaviourally to the stimulus’.

Significance: A contemporary definition of ‘sensory modulation’ has been identified for occupational therapy practice.     

吸毒人员回归社会后的应对方式与生活质量——自我概念的中介作用

目的 本研究旨在探讨吸毒人员回归社会后的自我概念及应对方式是否会影响其生活质量。方法 在四川省成都市、德阳市、西昌市、宜宾市等地招募201名已回归社会的男性吸毒人员（平均年龄22.65±8.31岁，年龄16~59岁）进行调查。参与者完成田纳西自我概念量表（TSCS）、特质应对方式问卷（TCSQ）和药物成瘾者生命质量测定量表（QOL-DA）。结果 高自我概念组吸毒人员的积极应对得分和生活质量均高于低自我概念组，差异具有统计学意义（P<0.05）；吸毒人员的自我概念在积极应对与生活质量之间的中介效应值为0.224（95%CI:0.063~0.434），中介效应显著，占总效应的26.4%。结论 自我概念介导了回归社会的吸毒人员应对方式与生活质量之间的关系，应在学校和特定社区开展提高自我概念和应对技巧的培训。