Fatigue in the General Korean Population: Application and Normative Data of the Brief Fatigue Inventory

The purpose of this study was to provide normative data for the Brief Fatigue Inventory (BFI) in the general Korean population so that the results for the general population could be compared with those for patients. We constructed a questionnaire that included the BFI and items on demographic characteristics and conducted a population-based, cross-sectional survey in 1,000 individuals. We used multivariate logistic analysis to investigate factors associated with “usual” and “worst” fatigue. The internal consistency was very high (Cronbach's alpha = 0.96) and construct validity was confirmed by factor analysis. All patients had a mean ± SD BFI score of 4.33 ± 2.48 for “worst” fatigue and of 4.07 ± 2.27 for “usual” fatigue, and the global BFI score was 3.44 ± 2.05. The prevalence of each moderate-to-severe fatigue type was similar in severity of fatigue, with 55.2% in “usual” fatigue, and 57.3% in “worst” fatigue. Among the types of fatigue, the prevalence of severe fatigue was lowest for “usual” fatigue (16.5%). In multivariate analyses, the group aged 40–59 years had greater levels of “usual” and “worst” fatigue compared with the group aged 20–29 years. Poor general health and the presence of comorbidities were also associated with increased “usual” and “worst” fatigue. Regular physical activity was associated with reduced levels of “worst” fatigue. The normal values of BFI with proper psychometric properties may help us to better understand the correlates of fatigue in the general population and patients. Our findings indicate that comorbidities should be considered when comparing fatigue data from the general population with data from patients.     

Current plasmapheresis practice in the United States

Summary The principal differences of the USA plasmapheresis collection system from most other countries are: it is conducted by the pharmaceutical industry rather than government, it uses remunerated donors, and it draws a larger volume of plasma than is permitted elsewhere. The implications of these features are reviewed in terms of the effects on donors and the effects on the plasma supply. Protein metabolism is reviewed, and the effects of plasmapheresis on overall nitrogen balance are presented.     

Reliability of the Physical Performance Test in People with Dementia

ABSTRACT

Purpose. Approximately 30% of older adults have dementia. Disease progression has been found to be the largest predictor of function, and dementia has been found to influence fall risk. In order to identify individuals with dementia who may benefit from interventions to increase function and decrease fall risk, assessment tools for these domains that are validated in this population are necessary. The 7-item Physical Performance Test (PPT) is a valid measure of balance and function in older adults; however, its reliability has not been established in those with dementia. The purpose of this study was to establish intra-tester, inter-tester, and test–retest reliability of the 7-item PPT in people with dementia. Methods. Thirty-three subjects with a diagnosis of dementia and a Mini-Mental State Examination (MMSE) score between 10 and 24 were tested with the PPT on two separate days with performance on the second day videotaped. One tester scored the videotaped performance on two separate occasions and intra-tester reliability was determined using an intraclass correlating coefficient (ICC) (3,1). Two testers independently scored the videotaped performances and inter-tester reliability was determined using an ICC (2,1). Scores from the first and second testing days were compared and test–retest reliability was determined using an ICC (3,1). Results. All subjects completed both testing sessions and reliability was established for intra-tester, inter-tester, and test–retest with ICCs of 0.99, 0.96, and 0.90, respectively. Conclusion. The 7-item PPT is reliable for use in people with mild to moderate dementia as defined by MMSE scores between 10 and 24.     

Use of CLIA-waived point-of-care tests for infectious diseases in community pharmacies in the United States

Review of point-of-care (POC) testing in community pharmacies, availability and specifications of CLIA-waived infectious disease POC tests, and provide recommendations for future community pharmacy POC models in an effort to improve patient outcomes while reducing antibiotic resistance. PubMed and Medscape were searched for the following keywords: infectious disease, community pharmacy, rapid diagnostic tests, rapid assay, and POC tests. All studies utilizing POC tests in community pharmacies for infectious disease were included. Studies, articles, recommendations, and posters were reviewed and information categorized into general implementation of POC testing in community pharmacies, CLIA-waived tests available, Influenza, Group A Streptococcus pharyngitis, Helicobacter pylori, HIV and Hepatitis C. POC testing provides a unique opportunity for community pharmacists to implement collaborative disease management programmes for infectious diseases and reduce over-prescribing of antibiotics and improve patient outcomes through early detection, treatment and/or referral to a specialist.     

Hospitalizations of Older Patients with Human Immunodeficiency Virus in the United States

Background

Older adults represent a growing percentage of the United States (US) population living with human immunodeficiency virus (HIV). The Emergency Department plays an integral role in the identification and initial evaluation and treatment of patients with HIV.

Objective

We sought to estimate the number of hospitalizations of older adults (age ≥ 50 years) with HIV in the United States from 2000 to 2006 and compare features of this population to younger adults with HIV. Clinical and demographic characteristics of the younger cohort (19–49 years) and two older cohorts (ages 50–64 and ≥65 years) were examined and compared.

Methods

Data from the Nationwide Inpatient Sample was used to compare the three groups of HIV-positive patients. Comparisons between the most common discharge diagnoses and primary procedures were also made.

Results

Older adults with HIV constitute almost one quarter of the hospitalizations of adults with HIV. Older adults with HIV were more likely to be male, have a significantly higher average hospital charge, and have a longer length of stay than younger adults with HIV. Pneumonia and fluid and electrolyte disorders were common diagnoses among all three age cohorts.

Conclusions

Older HIV patients were more likely to die during hospitalization compared with younger adults with HIV and older adults without HIV. Admissions for older HIV patients almost doubled during the study period and future studies should examine whether this is due to aging of the current HIV population or new infections.     

Assessing and Setting Goals for the Attending and Communicative Behavior of Three Preschoolers with Autism in Inclusive Kindergarten Settings

Research findings of Helios II, a task plan for children with disabilities (1993–96) involving the nations of the European Economic Community, indicate that relevant and individualized inclusion plans, designed and used by well-trained specialists, is a key factor to successful inclusive education. The premise of this study was to set individualized goals that address the communicative difficulties of three preschoolers with autism in inclusive kindergarten settings. The findings of this study indicate that preschoolers with autism, compared with their typical peers in kindergarten, had low attending behavior; did not respond to their peer's comments, questions, and invitations; and did not initiate interactions with peers. Normative data were collected and analyzed in the domains of difficulty stated above, and inclusion goals for children with autism were set accordingly. Setting such goals was considered to be an important prerequisite for a systematic intervention addressing the needs of preschoolers with autism in inclusion settings.     

Impact of Migraine in the United States: Data from the National Health Interview Survey

SYNOPSIS
Data from the 1989 National Health Interview Survey concerning migraine occurrence and impairment were analyzed to assess the impact of migraine on the US population. About four of every one hundred persons in the United States were found to have migraine, accounting for nearly 10 million individuals. Migraine was most prevalent in those aged 25 to 44 years and was about 2.5 times more frequent in females than males. Migraine was most common in whites (85%) and those with low household income. In women, migraine prevalence increased with the level of education. About 10% of migrainous children missed at least one day of school over a two-week period due to migraine; nearly 1% missed four days. Migraineurs were bedridden for about three million days per month and had an estimated 74.2 million days per year of restricted activity due to migraine. The potential cost of lost productivity was estimated at $1.4 billion per year for the estimated 6,196,378 migraineurs who worked outside the home. It is difficult to derive similar estimates for costs of lost productivity in housewives; however, housewives experienced an estimated 38 million days per year of restricted activity. Eighty-five percent of females and 77% of males reported a physician visit at some point for their migraine. Migraine is a relatively common disease whose social and financial impact has been poorly understood.     

静态平衡仪在国内临床康复中的应用进展

静态平衡仪在国内应用已有10余年。由于其可以定量、客观地反映患者的平衡功能，同时还可以有针对性地进行平衡功能训练，因此在国内已得到广泛应用。笔者对平衡仪的应用情况进行综述。     

Myelodysplastic syndromes in the United States: an update for clinicians

Abstract

Myelodysplastic syndromes (MDS) are heterogeneous malignant bone marrow disorders diagnosed most often in elderly white persons. MDS have significant clinical consequences, including cytopenias leading to infection, bleeding, and death; and approximately one-third of cases progress to acute myeloid leukemia (AML). Only one potentially curative therapy exists—allogeneic hematopoietic stem cell transplant (HSCT)—but this therapy is not widely used due to associated morbidity and mortality in elderly patients. Recent research suggests MDS occurs more frequently than previously thought and may be responsible for a substantial proportion of unexplained anemias in elderly persons. Incidence of MDS is expected to increase with increases in life expectancy. Therefore, we offer this comprehensive narrative update of MDS to inform the medical community treating the population at risk for MDS, with a focus on MDS epidemiology and clinical management in the United States. This review includes a brief historical background of MDS, provides an overview of the population burden of disease, discusses the molecular pathology of MDS, describes the clinical features and management of MDS, and discusses future directions in MDS research. Our objective is to inform general medicine practitioners and call attention to the need for translational research in MDS.     

Normative Reference Values and Validity for the 30-Second Chair-Stand Test in Healthy Young Adults

BackgroundClinicians often use physical performance tests (PPT) to measure performance measures in sports since they are easy to administer, portable, and cost-efficient. However, PPT often lack good or known psychometric properties. Perhaps, the 30-second chair-stand test (30CST) would be a good functional test in athletic populations as it has been shown to demonstrate good psychometric properties in older adults.Hypothesis/PurposeThe purpose of this study was to determine normative values for and concurrent, convergent and discriminative validity of 30CST for healthy young adults aged 19-35 years.Study DesignCross-sectionalMethodsEighty-one participants completed this study. All participants performed two trials of 30CST, 5-times sit-to-stand (5xSTS), and lateral step-up test (LSUT). Investigators used the International Physical Activity Questionnaire Leisure Domain (LD-IPAQ) to divide participants into insufficiently or sufficiently active groups based on the weekly metabolic equivalent of task per the Physical Activity Guidelines for Americans.ResultsParticipants (Mean + SD age, 25.1 ± 3.4 years; body height, 1.71 ± 0.09 m; body mass, 72.6 ± 16.1 kg; females 47) performed an average of 33.0±5.4 30CST repetitions. The 30CST performance was negatively associated with 5xSTS (r=-0.79 p=0.01) and positively associated with LSUT performances (r=0.51, p=0.01) when using Pearson correlations. In addition, the sufficiently active group performed significantly greater 30CST repetitions than the insufficiently active group (mean difference = 2.5; p=0.04).ConclusionsIn addition to finding a reference value for 30CST performance in young adults, investigators found that the 30CST displayed concurrent and convergent validity in assessing functional lower extremity (LE) muscle strength and discriminated between those with sufficient and insufficient physical activity levels. Training and rehabilitation professionals could use the 30CST for testing functional LE muscle strength for athletes in pre-season or during rehabilitation. Future investigators should perform studies to determine if 30CST predicts sport performance.Level of EvidenceLevel 2     

Resuscitation training for medical students in the United Kingdom — a comparison with the United States of America

Resuscitation training for medical students and junior doctors in the United Kingdom and United States was compared using questionnaires sent to medical schools in both countries. A marked deficiency in the provision of cardiopulmonary resuscitation training has been demonstrated in the United Kingdom; however, in the United States, the availability of uniform certifiable teaching is now widespread. Suggestions for the improvement of training in the United Kingdom are expected to increase medical student proficiency in cardiopulmonary resuscitation. The need for training in basic and advanced resuscitation prior to graduation from medical school is stressed.     

影响青霉素过敏试验的几个问题

综述了青霉素皮试的时辰、患者皮肤敏感性、注入皮试液的量、浓度对皮试结果的影响，并在复习文献后指出了新生儿应该做皮试。     

The Cost-effectiveness of Eltrombopag for the Treatment of Immune Thrombocytopenia in the United States

PurposeEltrombopag was evaluated as a second-line treatment for adult chronic immune thrombocytopenia (ITP) in the 2006 Phase III RAISE (Eltrombopag for Management of Chronic Immune Thrombocytopenia) randomized, placebo-controlled trial. More than 80% of patients reached satisfactory platelet counts within 2 weeks. However, the economic value of eltrombopag as a second-line treatment for ITP remains to be formally assessed. This study aimed to estimate the cost-effectiveness of treating ITP with a comparable thrombopoietin receptor agonist (eltrombopag vs romiplostim).MethodsA Markov model was implemented over a lifetime time horizon to estimate the benefits and costs of each treatment. The model featured 3 health states based on current guidelines: (1) on treatment; (2) treatment failure/discontinuation; and (3) mortality. In line with therapeutic goals in ITP, model patients could experience 3 events: no bleeding, mild/moderate bleeding, or severe bleeding. Data on eltrombopag use were obtained from an open-label extension of previous Phase II/III trials, including RAISE. Romiplostim data were obtained from Phase III trials and an extension study. Lifetime overall survival was extrapolated by using treatment-specific mortality rates derived from severe bleeding and natural mortality rates. The costs of drugs, routine care, bleeding episodes, adverse events, and mortality were represented in the model.FindingsEltrombopag-treated patients gained 17.58 life years and 14.68 quality-adjusted life years, whereas romiplostim-treated patients gained 17.52 life years and 14.67 quality-adjusted life years. The total lifetime cost of eltrombopag treatment was estimated at $1.58 million versus $2.13 million for romiplostim. Sensitivity analyses supported base case findings. Deterministic sensitivity analysis predicted the greatest sensitivity to the rates of severe bleeding, discontinuation, and natural mortality. Probabilistic sensitivity analysis showed that eltrombopag would be an efficient use of resources at a $50,000 threshold in 52.8% of cases. In all probabilistic iterations, the total cost of eltrombopag treatment was lower than with romiplostim, primarily because of lower drug costs.ImplicationsClinical data were applied in an economic analysis, and eltrombopag exhibited economic dominance compared with romiplostim, driven largely by the reduced costs of primary therapy. This model was limited by a lack of specific patient-level data and robust data on the duration of secondary therapy, as well as by the fact that utilization values are likely conservative estimates for routine care use.     

Host Factors and Outcomes in Hospitalizations for Pneumocystis Jirovecii Pneumonia in the United States

ObjectiveTo assess host factors in pneumocystis jirovecii pneumonia (PCP)–related hospitalizations and compare outcomes between HIV and non-HIV patients.MethodsUsing the National Inpatient Sample database, we identified 3384 hospitalizations with PCP (International Classification of Diseases, Ninth Revision, Clinical Modification code: 136.3) as the primary discharge diagnosis from 2005 to 2014. We evaluated hospitalizations for the following host factors: HIV, malignancies, organ transplantation, rheumatologic diseases, and vasculitides. We compared the prevalence of individual host factors among PCP hospitalizations over time, and compared intervention rates and outcomes between HIV and non-HIV patients with PCP.ResultsAmong all hospitalizations for PCP, malignancy was the most prevalent host factor (46.0%, n=1559), followed by HIV (17.8%, n=604); 60.7% (n=946) of malignancies were hematologic. The prevalence of HIV among hospitalizations for PCP decreased from 25.1% in 2005 to 9.2% in 2014 (P<.001), whereas the prevalence of non-HIV immunocompromising conditions increased. Compared with HIV patients, PCP patients without HIV had higher rates of bronchoscopy (52.3% vs 26.7%, P<.001) and endotracheal intubation (17.0% vs 7.9%, P<.001), prolonged hospitalizations (11.5 vs 8.7 days, P<.001), higher hospitalization costs (86.8 vs 48.2×10³ USD, P<.001) and increased in-hospital mortality (16.0% vs 5.0%, P<.001). After adjusting for age, sex, and smoking status, there was no difference in mortality between non-HIV and HIV patients with PCP (adjusted odds ratio, 1.4; 95% CI, 0.9 to 2.3).ConclusionThe epidemiology of PCP has shifted with an increase in the prevalence of non-HIV patients who have higher intubation rates and prolonged hospitalizations compared with matched HIV patients.     

Treatment Patterns in Disease-Modifying Therapy for Patients With Multiple Sclerosis in the United States

Background

Patients with multiple sclerosis (MS) whose disease activity is inadequately controlled with a platform therapy (interferon beta or glatiramer acetate [GA]) may switch to another platform therapy or escalate therapy to natalizumab or fingolimod, which were approved in the US in 2006 and 2010, respectively.

Objective

The objective of this study was to describe treatment patterns in patients with multiple sclerosis (MS) in the United States who were followed for 2 years after initiating a disease-modifying therapy (DMT).

Methods

A retrospective observational cohort study was conducted to examine treatment patterns of initial DMT use (on initial therapy for 2 years with and without gaps of ≥60 days, medication switching, and discontinuation) among patients with MS who initiated a platform therapy (interferon-β or glatiramer acetate) or natalizumab between January 1, 2007, and September 30, 2009; the first DMT claim was the index. Eligible patients were identified in the MarketScan Commercial and Medicare Supplemental databases based on continuous enrollment for 6 months before (preindex period) and 24 months after their index date, with a diagnosis of MS and no claim for a previous DMT in the 6-month preindex period. Demographics at index and clinical characteristics during the preindex period were also analyzed.

Results

A total of 6181 MS patients were included, with 5735 (92.8%) starting on platform therapy. Natalizumab initiators were more likely to stay on index therapy (32.3% vs 16.9%, P < 0.001) and have fewer treatment gaps of ≥60 days (44.8% vs 55.3%, P < 0.001) compared with platform initiators. In addition, natalizumab initiators were less likely to switch treatment (13.9% vs 19.1%, P = 0.007) and took longer to switch (400.9 days vs 330.7 days, P < 0.001) compared with platform initiators. Nearly 79% of platform initiators who switched went to another platform therapy. Approximately two thirds of patients who switched to a third DMT (n = 130) switched to another platform therapy. A total of 9% of natalizumab and platform initiators discontinued DMT within the 2 years.

Conclusions

Most MS patients initiating DMT started on platform therapy. Natalizumab initiators tended to stay on index therapy, have fewer treatment gaps, and switch less than platform initiators in the 2 years after treatment initiation. Switching between platform therapies is common despite evidence that MS patients on platform therapy may benefit from switching to natalizumab.     

美国急救方向专科护士的资格认证及启示

本文系统地总结了美国对急救方向专科护士资质的认证内容,其中包括认证机构、认证机构对认证申请者的资格要求、考试形式、考试内容、认证结果及认证结果更新等方面。希望通过参考和借鉴国外先进的认证经验,指导和规范我国急救专科护士的培养及认证工作。