Pilot Randomized Trial of a Family Management Efficacy Intervention for Caregivers of African American Adolescents with Disruptive Behaviors

Background

Caregivers of adolescents diagnosed with Oppositional Defiant Disorder and/or Conduct Disorder (ODD/CD) experience unique challenges when interacting with child service systems involved in their adolescents’ care. Absent from the literature are interventions to improve these interactions, which in the long term may improve adolescent behavioral health outcomes.

Objective

To examine feasibility/acceptability of Family Management Efficacy (FAME) intervention content, structure, delivery, and appropriateness of selected measures for caregivers of African American adolescents with ODD/CD. Secondary aim was to explore changes in FAME caregivers’ interaction self-efficacy, stress, quality of life, and family functioning scores relative to caregivers receiving treatment as usual (TAU).

Method

A pilot two-group randomized trial was conducted with caregivers of African American adolescents (ages 12–18 years) diagnosed with ODD/CD receiving FAME (n?=?11) or TAU (n?=?9). Feasibility outcomes of enrollment/attrition, measurement completion, session attendance, and homework completion were assessed using tracking logs and field notes, and acceptability through caregiver satisfaction scores and interviews. Preliminary outcomes were assessed at baseline, post- and 2-months post intervention.

Results

FAME was highly acceptable and met a priori thresholds for feasibility in enrollment (56%), attrition (35%), caregiver attendance (55%), and homework completion (50%), with lower than anticipated kin attendance (42%) and measurement completion (55%). Preliminary outcomes suggest FAME may benefit caregivers in areas of family communication, cohesion, and quality of life, but lacked observed benefit for self-efficacy and problem solving indicating need for refinement.

Conclusion

Results inform changes to FAME content, measurement, and delivery schedule in preparation for a fully powered randomized controlled trial.

     

Cellular inflammatory response to porcine collagen membranes

OBJECTIVES: The purpose of this study was to assess local inflammatory changes associated with the implantation of three different porcine collagen membranes having potential use in periodontal regeneration. METHODS: Materials were implanted subcutaneously into prepared sites along the dorsal skin surface of 60 female Wistar rats. Saline and turpentine were used as negative and positive controls, respectively. Animals were killed and biopsies obtained after 3 d, and at 1, 2, 4, 6, and 8 weeks after membrane implantation. A panel of six monoclonal antibodies was used to identify circulating monocytes (ED1), resident tissue macrophages (ED2), lymphoid macrophages (ED3), Ia-antigen expression (OX6), T-lymphocytes (OX19), and B-lymphocytes (OX33). Cells identified by each antibody were subjected to quantitative immunocytochemistry to compare any differences present among groups. Sera obtained 8 weeks after grafting were used in immunoblotting assays to detect the presence of systemic antiporcine antibodies. RESULTS: We found that the mononuclear cell subsets associated with implantation of porcine collagen membranes were similar to those obtained with saline administration. On the other hand, the use of turpentine resulted in an inflammatory infiltrate characterized by significantly higher numbers of all six monoclonal cell subsets at all time periods evaluated, compared to either saline or any of the membranes (P < 0.001). CONCLUSIONS: The collagen membranes do not appear to be associated with a significant local inflammatory response, nor a systemic immune response, and thus appear to be well tolerated, rendering them useful in periodontal regeneration.     

An ergonomic approach to reducing back/shoulder stress in hospital nursing personnel: a five year follow up

The purpose of the study was to determine the impact of an ergonomic program on perceived stress ratings, injury rates and patient care. After implementation of the ergonomic program, the perceived stress ratings by nursing staff were lower than those ratings at the control hospital and the patients felt more comfortable and secure during patient handling tasks than the patients at the control hospital. Eighteen months after ergonomic interventions, the back and shoulder injuries were reduced, and the lost workdays and restricted/transitional days were decreased. Five years after the implementation, the back and shoulder injuries continued to decrease as well as the lost workdays and restricted days. At the control hospital, the back and shoulder injury rates, the lost workdays, and the restricted days remained stable throughout the study period.     

Consent requirements for research with human tissue: Swiss ethics committee members disagree

Background

In Switzerland, research with identifiable human tissue samples, and/or its accompanying data, must be approved by a research ethics committee (REC) before it can be allowed to take place. However, as the demand for such tissue has rapidly increased in recent years, and biobanks have been created to meet these needs, committees have had to deal with a growing number of such demands. Detailed instructions for evaluating every kind of tissue request are scarce. Committees charged with evaluating research protocols therefore sometimes face uncertainty in their decision-making.

Methods

We examine how a pool of Swiss REC members deal with a number of cases involving human tissue, in order to determine the standards they adhere to, and their understanding and implementation of existing laws and guidelines.

Results

There is considerable divergence in the approaches and decisions of Swiss REC members regarding human tissue sample requests, particularly concerning the issue of informed consent. Despite recent trends towards less strict consent requirements for biosample research, many of our respondents continue to employ demanding standards for researchers. The question of informed consent, and the circumstances in which it is required, continues to result in differences of opinion.

Conclusions

While room for local and cultural interpretation is essential to the workings of an REC, misunderstanding of existing guidelines, or an absence of regulation in sensitive areas, will only lead to suboptimal functioning of the REC itself. Our data suggests that there is uncertainty and disagreement on the question of consent for human tissue sample, which existing laws and guidelines may not fully clarify. Methods to address these uncertainties should be implemented in order to ensure efficient and harmonious review of research protocols.

     

A functional MRI study of visual oddball: evidence for frontoparietal dysfunction in subjects at risk for alcoholism

Attending to rare stimuli interspersed among repetitive frequent stimuli produces a positive scalp potential at 300 to 600 ms after the target stimulus onset; this potential is known as the P300 wave. Although there is clear evidence of low visual P300 in subjects at high risk (HR) for developing alcoholism, the functional neuroanatomical correlates have not been studied. Functional and high-resolution anatomical magnetic resonance images were collected during the performance of a visual oddball task, from six control (low risk-LR) subjects with high P300s and eight HR subjects with low P300s. All the HR subjects were offspring of male alcoholics. The data were analyzed using a randomization-based statistical method that accounts for multiple comparisons, requires no assumptions about the noise structure of the data, and does not require spatial or temporal smoothing. Target counts showed that all subjects performed the task comparably. Analysis of the functional magnetic resonance imaging (fMRI) data revealed two areas with significantly lower activation in the HR group when compared to the LR group: the bilateral inferior parietal lobule (BA 40), and the bilateral inferior frontal gyrus (BA 44). Inferior parietal lobule showed significantly lower activation in the HR group in contrast to the LR group, and inferior frontal gyrus was not activated in the HR group but was only activated in the LR group. This finding indicates that a dysfunctional frontoparietal circuit may underlie the low P300 responses seen in HR subjects. This perhaps implies a deficiency in the rehearsal component of the working memory system.     

Evolution of Ebola Virus Disease from Exotic Infection to Global Health Priority,Liberia, Mid-2014

Over the span of a few weeks during July and August 2014, events in West Africa changed perceptions of Ebola virus disease (EVD) from an exotic tropical disease to a priority for global health security. We describe observations during that time of a field team from the Centers for Disease Control and Prevention and personnel of the Liberian Ministry of Health and Social Welfare. We outline the early epidemiology of EVD within Liberia, including the practical limitations on surveillance and the effect on the country’s health care system, such as infections among health care workers. During this time, priorities included strengthening EVD surveillance; establishing safe settings for EVD patient care (and considering alternative isolation and care models when Ebola Treatment Units were overwhelmed); improving infection control practices; establishing an incident management system; and working with Liberian airport authorities to implement EVD screening of departing passengers.     

Developing the use of poetry within healthcare culture

While the visual arts are often given consideration as an important feature of healthcare environments, the literary arts remain an underdeveloped resource. This article describes recent nurse-initiated developments in Aberdeen which attempt to integrate poetry into the culture of hospitals so that patients, visitors and staff can be involved. In particular, the 'Poem Post' project is described. This project makes a selection of short poems available on postcards in wall-mounted racks within local hospitals, and incorporates a facility for feedback of comments and new poems. Feedback has been generally very positive and over 100 new poems have been submitted to the project. Issues arising from evaluation of the project are discussed, and lessons learnt from the experience are reviewed in order to encourage nurses to consider the possibilities that poetry can offer in the workplace.