Delivering Health: A New Legal System for a New Medical Practice

Ordering and interpreting laboratory tests take familiarity with the concepts of normal limits, specificity, sensitivity, and prevalence. The relative importance of these test properties for clinical decisions is presented.     

Tried, True, and New: Public Health Nursing in a County Substance Abuse Treatment System

Abstract The Milwaukee Target Cities (MTC) project was the only site within 19 federally funded Target Cities programs to feature a public health nursing model as its sole means of providing comprehensive health-related services to indigent substance abuse clients. We first describe MTC's implementation process, focusing on the public health nursing component, and then present a program evaluation section with selected findings from the ongoing qualitative evaluation. Initially, misunderstandings about the nurses' community-based, family-centered strategy of assuring access to health care through cross-system service linkage dogged the nurses' efforts to explain their roles and mission to federal funders, project management, coworkers. and treatment providers. In the end, after federal funding ended, public health nursing left an enduring legacy of partnerships in the county substance abuse treatment system: education about public health nursing, networking, referral processes, and resources to meet the complex health-related needs of indigent substance abusers. Despite the project's many changes, the nurses (a) became specialists in substance abuse, gaining expertise and recognition in a new community, particularly with isolated subpopulations; (b) assured substance abuse clients and their families access to health-related resources through core public health nursing skills; and (c) educated project staff, administrators, providers, and clients about public health nursing.     

Prospective, Randomized, Single-Blind, Sham Treatment-Controlled Study of the Safety and Efficacy of an Electromagnetic Field Device for the Treatment of Chronic Low Back Pain: A Pilot Study

Objectives: To evaluate the efficacy and safety of therapeutic electromagnetic fields (TEMF) on chronic low back pain. Secondary objectives included the investigation of the effects of TEMF on psychometric measures. Setting: Pain Research center in an Urban Academic Rehabilitation Facility. Design: Prospective, randomized, single‐blind, placebo (sham) treatment‐controlled design in which participants were evaluated over a 6‐week period. A total of 40 subjects were randomly assigned: 20 subjects to 15 milliTESLA (mT) treatment using a prototype electromagnetic field device and 20 to sham treatment. Interventions: After a 2‐week baseline period, eligible individuals were randomized to one of the treatment groups (sham or 15 mT) for six 30‐minute treatments over 2 weeks, then a 2‐week follow‐up period. Outcome Measures: The primary outcome measure was the self‐report of pain severity using a 100 mm visual analog scale collected using a twice daily McGill Pain Questionnaire—Short Form. Several secondary measures were assessed. Results: Both groups (15 mT and sham) improved over time (P < 0.05). Although groups were similar during the treatment period, treated subjects (TEMF of 15 mT) improved significantly over sham treatment during the 2‐week follow‐up period (20.5% reduction in pain; F_1,34 = 10.62, P = 0.003). There were no reported serious adverse events. Conclusions: This study demonstrates that TEMF may be an effective and safe modality for the treatment of chronic low back pain disorders. More studies are needed to test this hypothesis.     

A New Model for Catalyzing Translational Science: The Early Stage Investigator Mentored Research Scholar Program in HIV Vaccines

Engagement of early stage investigators (ESIs) in the search for a safe and effective vaccine is critical to the success of this highly challenging endeavor. In the wake of disappointing results from a large‐scale efficacy trial, the HIV Vaccine Trials Network (HVTN) and Center for HIV/AIDS Vaccine Immunology (CHAVI) developed a novel mentored research program focused on the translation of findings from nonhuman primate studies to human trials of experimental vaccines. From 2008 to 2011, 14 ESI Scholars were selected from 42 complete applications. Post program surveys and tracked outcomes suggest that the combination of flexible funding, transdisciplinary mentorship, and structured training and networking promoted the scientific contributions and career development of promising ESIs. Embedding a multicomponent research program within collaborative clinical trial networks and research consortia is a promising strategy to attract and retain early career investigators and catalyze important translational science.     

The CB-12L: A New Device for Transtelephonic Transmission of a 12-Lead Electrocardiogram

The value of transtelephonic transmission of ECG information is well established, and technological advances have continuously provided improved state-of-the-art equipment. Shahal Medical Services provides professional care to subscribers who call the medical center and describe their symptoms, whereupon therapeutic measures are decided upon. A new 12-lead patient controlled device for telephonically transmitting an ECG (CB-12L) has become available; the aim of this study was to evaluate its accuracy and practicability. Forty tracings (20 standard ECG tracings obtained under medical supervision in the physician's office and 20 by the patient in his home using the new CB-12L ECG device and transmitted by telephone to the center) from 20 subjects with various electrocardiographic pathologies were reviewed by 19 experienced physicians who were asked to interpret the results and identify the recording device. In 82% of the possibilities, the interpretation of the tracings was identical for both those recorded by the standard ECG recorder and the CB-12L ECG. An equal number of physicians could not identify the means by which device the tracings were taken. Proper placement of the electrodes did not prove to be a problem for the patient. Thus, the CB-12L ECG was found to be an easily operable and reliable tool which may be of value for early and prompt diagnosis of threatening cardiac situations in the prehospital setting.     

A Retrospective Review of the Effect of a Simple Foot Immobilization Device for the Treatment of Prostate Cancer

BackgroundThe goal of radical radiation therapy is to eradicate tumor cells by delivering maximum dose to the target volume. This requires accurate daily positioning of the patient to minimize the chances of a geographical miss of the target and minimize dose to surrounding normal tissue. Numerous studies have been conducted to find the best immobilization device to improve reproducibility and setup of patient positioning for men with prostate cancer with inconclusive results.ObjectiveThe aim of this study was to evaluate retrospectively, the consistency and reproducibility of prostate patient positioning using a simple foot immobilization device compared with patients treated without any immobilization device.MethodsA retrospective chart analysis was completed on 40 patients with histopathologically confirmed adenocarcinoma of the prostate between April 2007 and May 2007. Twenty charts were randomly selected for men treated without any immobilization device and 20 charts were randomly selected for men treated with the foot strap immobilization. Incidence and frequency of isocenter shifts were the primary end points of this study. Direction and magnitude of shifts were secondary end points.ResultsThe frequency of isocenter shifts were greater in the patients treated without immobilization (35%) than with patients treated with foot strap immobilization (10%). Required shifts were in either the superoinferior direction or in the right/left direction. No shifts were required in the anteroposterior direction. Magnitude of shifts greater than and equal to 1.0 cm in magnitude was seen only in those treated without immobilization.ConclusionThe foot strap is a simple and inexpensive method of improving daily setup reliability and reducing the need for isocenter shifts.     

The Effect of the Powerball Gyroscope as a Treatment Device for Nonspecific Wrist Pain

ObjectiveThe aim of this study was to determine the effect of using the Powerball gyroscope as a treatment device on pain and change in endurance in nonspecific wrist pain.MethodsThis study was a within-participants pre- and postintervention study consisting of 40 participants between ages 18 and 35 with an equal male-to-female ratio. The participants used the Powerball gyroscope for 5 minutes per treatment session. Treatment comprised 12 sessions carried out 3 × per week over a 4-week period. Participants completed objective and subjective data before the first, seventh, and 12th sessions. Objective data were recorded using the Jamar dynamometer to measure grip strength. Subjective data were gathered using the Patient-Rated Wrist Evaluation Questionnaire. Participants then used the Powerball gyroscope in the hand with the affected wrist. The Wilcoxon signed rank test and 1-way repeated-measures analysis of variance were used to analyze the changes.ResultsA significant decrease in pain was noted throughout the study, but the most significant changes occurred between the seventh and 12th treatment sessions (P < .01). A significant increase in grip strength was also noted throughout the study, with the greater increase in grip strength occurring during the first 7 treatments (P < .02).ConclusionThe Powerball gyroscope showed a change in outcome regarding nonspecific wrist pain and grip strength.     

Lasmiditan Is a New Option for Acute Migraine Treatment

Lasmiditan is a new oral medication for treatment of acute migraine. It was approved by the U.S. Food and Drug Administration in October 2019 and is marketed under the brand name Reyvow (Eli Lilly and Company, Indianapolis, IN). It is the first of its kind in a new drug class called ditans. Lasmiditan has been studied as monotherapy for acute migraine treatment and as an abortive therapy for adults taking chronic migraine preventive medication. Lasmiditan may be an option for individuals who have had no relief with triptans or other acute migraine treatment agents or who are unable to use other migraine treatments because of contraindications.     

A New Pharmacologic Treatment for Nausea and Vomiting of Pregnancy

Nausea and vomiting of pregnancy (NVP) affects up to 80 percent of pregnant women. This condition is usually self‐limiting, but the symptoms can be distressing and interfere with work, social activities and sleep. Symptoms can often be managed by diet and lifestyle changes, but these interventions may not be successful for everyone. In April 2013, the U.S. Food and Drug Administration approved doxylamine succinate 10 mg/pyridoxine hydrochloride 10 mg (Diclegis®) as the first medication to specifically treat NVP in more than 30 years. This article reviews the indications, dosage and nursing interventions associated with using doxylamine succinate/pyridoxine to treat NVP.     

The Controlled Application of Cold and Heat by a New Device (Migra-lief Apparatus) in the Treatment of Headache

SYNOPSIS
An apparatus which incorporates a cooling compartment encircling the head, extending down the neck, and a separate warming compartment applied to the vertex, was employed in 28 patients with recurrent headaches (20 with migraine, 7 with tension headaches, and I with cluster headaches) who had had inadequate relief from prophylactic and acute medications. This Migra-lief apparatus reduced severity of headache in 15 of the migraine patients, 6 of the tension headache patients, and in the one cluster headache patient.     

A New Model of Continuing Care for Advanced Cancer Pain Treatment

Since 1979, a one-of-a-kind program in Italy for continuing care has been set up at the Pain Clinic of the National Cancer Institute of Milan. Our report describes the objectives and the organization of this program which integrates in-patient care at the Pain Clinic with a Home Care Program. At the basis of this program lies the firm conviction that a multimodal approach is absolutely indispensable to Total Pain care in advanced cancer patients. We feel that the best environment in which to live the remaining portion of one’s life, provided there is an adequate home care, is in the comfort of one’s own home. Therefore, the family plays a very important role within the Home Care Team. The results obtained in a recent study both for pain control and quality of life in patients assisted by the Home Care Program support the effectiveness of such a program and the importance of pursuing this objective.     

Angiotensin II: A New Vasopressor for the Treatment of Distributive Shock

PurposeAngiotensin II (ATII) is a potent endogenous vasoconstrictor that has recently garnered regulatory approval for the treatment of distributive shock, including septic shock. Traditional vasoactive substances used in the management of distributive shock include norepinephrine, epinephrine, phenylephrine, and vasopressin. However, their use can be associated with deleterious adverse drug effects, such as splanchnic vasoconstriction and associated hypoperfusion. The purpose of this review is to describe ATII, including its pharmacologic mechanisms, pharmacokinetic profile, evidence of efficacy and tolerability, and potential role in contemporary critical care practice.MethodsPeer-reviewed clinical trials and relevant treatment guidelines published from 1966 to September 14, 2019, were identified from Medline/PubMed using the following search terms: angiotensin II OR angiotensin 2 AND shock OR septic shock OR vasodilatory shock. Pertinent review articles were reviewed for additional studies for inclusion and discussion. The final decision on the inclusion of studies in the current review was based on the expert opinion of the authors.FindingsOn the basis of the available evidence, ATII is effective at elevating blood pressure in patients with distributive shock and appears to reduce the dose of concurrent vasopressors to maintain adequate blood pressure. ATII has been investigated for other causes of shock; however, robust evidence of off-label indications is lacking and is much needed. Clinical and cost benefits compared with traditional vasopressors have yet to be established.ImplicationsATII represents a welcome addition to the armamentarium of critical care clinicians. Enthusiasm for the use of ATII should be balanced with the current gaps in our understanding of ATII in patients with shock. Until further evidence provides more clinically meaningful benefits, as well as cost-effectiveness compared with currently available vasopressors, critical care clinicians should reserve ATII for salvage therapy in patients with septic shock.