Palatability of Crushed Over-the-Counter Medications

ContextDysphagia is a common concern, especially in the last several days of life. Medications are often crushed for ease of administration for individuals with swallowing difficulty.ObjectivesTo assess palatability of commonly used crushed over-the-counter (OTC) medications. A secondary objective is to evaluate pharmacist knowledge and opinions of crushing medications.MethodsPharmacist participants sampled crushed OTC medications and completed presampling and postsampling surveys about crushing medications. Participants were excluded for current smoking or tobacco use, pregnancy, allergy to any study medication or applesauce, or potential drug-drug interaction with study medications. Eight OTC medications were crushed and mixed in applesauce: naproxen, fexofenadine, phenazopyridine, multivitamin, loperamide, famotidine, sennosides, and sennosides-docusate. Participants were blinded to medication samples and control (plain applesauce). Samples were rated from one (least palatable) to five (most palatable). Investigators recorded participants' comments, behaviors, and facial expressions during sampling.ResultsNineteen volunteers completed the study. Most participants rated three samples as not palatable (score of two or less): fexofenadine, 16 (84%); loperamide, 13 (68%); and sennosides-docusate, 16 (84%). All participants rated famotidine and sennosides palatable. The percentage of participants who would consider palatability in recommendations for crushing medications increased from 47% prestudy to 79% poststudy.ConclusionPalatability should be considered when recommending crushed medications. Survey responses indicate that pharmacists' opinions of crushed medications changed after this palatability experiment. Clinicians should evaluate the appropriateness of all medications when dysphagia is a concern and deprescribe medications when appropriate to reduce burden for patients and caregivers.     

Epidemiology of dietary supplement use in Serbia: Report from Novi Sad

ObjectivesThe primary objectives were to assess the prevalence of dietary supplement (DS) use and to identify specific demographic and lifestyle characteristics of DS users from Novi Sad, Serbia as well as the most commonly used DS and reasons for their use.DesignObservational, cross-sectional study.Setting and interventionsData on demographics, lifestyle and dietary supplement use of 435 adults from Novi Sad, Serbia were collected using an online questionnaire.ResultsIn total, 435 subjects completed the questionnaire (62.3% women). Prevalence of dietary supplement use in the sample was 42.8%. More women used DS than men (p = 0.002). Higher use of DS was reported among individuals 65+, while the young used DS less (p = 0.001), but the highest proportions of DS users was from the 45–54 age group. DS were used more among those with lower education levels (p < 0.001) and no income (p = 0.009). The highest percentages of DS users reported daily intakes of fruits and moderate physical activity, were non-smokers and social drinkers. Main reason for DS use was maintaining general health. The most commonly used DS were minerals and/or vitamins (68.8%).ConclusionsWe report a high prevalence of dietary supplement use in Novi Sad. DS use was associated with being a female, being older and having minimal/average income, the latter being opposite of the usual findings. Our results warrant a more detailed examination of the association between income, DS use and healthcare availability in developing countries such as Serbia.     

Measuring Faculty Reflection on Medical Grand Rounds at Mayo Clinic: Associations With Teaching Experience,Clinical Exposure,and Presenter Effectiveness

ObjectivesTo develop and validate a new instrument for measuring participant reflection on continuing medical education (CME) and determine associations between the reflection instrument scores and CME presenter, participant, and presentation characteristics.Participants and MethodsThis was a prospective validation study of presenters and faculty at the weekly medical grand rounds at Mayo Clinic in Rochester, Minnesota, from January 1, 2011, through June 30, 2011. Eight items (5-point Likert scales) were developed on the basis of 4 reflection levels: habitual action, understanding, reflection, and critical reflection. Factor analysis was performed to account for clustered data. Interrater and internal consistency reliabilities were calculated. Associations between reflection scores and characteristics of presenters, participants, and presentations were determined.ResultsParticipants completed a total of 1134 reflection forms. Factor analysis revealed a 2-dimensional model (eigenvalue; Cronbach α): minimal reflection (1.19; 0.77) and high reflection (2.51; 0.81). Item mean (SD) scores ranged from 2.97 (1.17) to 4.01 (0.83) on a 5-point scale. Interrater reliability (intraclass correlation coefficient) for individual items ranged from 0.58 (95% CI, 0.31-0.78) to 0.88 (95% CI, 0.80-0.94). Reflection scores were associated with presenters' speaking effectiveness (P<.001) and prior CME teaching experience (P=.02), participants' prior clinical experiences (P<.001), and presentations that were case based (P<.001) and used the audience response system (P<.001).ConclusionWe report the first validated measure of reflection on CME at medical grand rounds. Reflection scores were associated with presenters' effectiveness and prior teaching experience, participants' clinical exposures, and presentations that were interactive and clinically relevant. Future research should determine whether reflection on CME leads to better patient outcomes.     

Changes in Internet Use Over Time Among Individuals with Traumatic Spinal Cord Injury

ObjectiveTo investigate the changes in total internet and mobile internet use over time and determine how demographic characteristics are related to changes in internet and mobile internet use among individuals with spinal cord injury (SCI).DesignCross-sectional analysis of a multicenter cohort study.SettingNational SCI Database.ParticipantsIndividuals with traumatic SCI with follow-up data collected between 2012 and 2018 (N=13,622).InterventionsNot applicable.Main Outcome MeasuresProportion of sample reporting internet use at all or through a mobile device over time and specifically in 2018.ResultsThe proportion of internet users increased from 77.7% in 2012 to 88.1% in 2018. Older participants (P<.001); those with lower annual income (P<.001), less education (P<.001), non-White race or Hispanic ethnicity (P<.001), or motor incomplete tetraplegia (P=.004); and men (P=.035) were less likely to use the internet from 2012-2018. By 2018, there were no longer differences in internet use based on race and ethnicity (P=.290) or sex (P=.066). Mobile internet use increased each year (52.4% to 87.7% of internet users from 2012-2018), with a participant being 13.7 times more likely to use mobile internet in 2018 than 2012. Older age (P<.001), income <$50,000 (P<.001), high school diploma or less (P=.011), or non-Hispanic White race/ethnicity (P=.001) were associated with less mobile internet use over time. By 2018, there were no differences in mobile internet use by education (P=.430), and only participants with incomes >$75,000 per year had greater odds of mobile internet use (P=.016).ConclusionsDisparities associated with internet access are decreasing likely as a result of mobile device use. Increased internet access offers an important opportunity to provide educational and training materials to frequently overlooked groups of individuals with SCI.     

Nano curcumin supplementation reduced the severity of diabetic sensorimotor polyneuropathy in patients with type 2 diabetes mellitus: A randomized double-blind placebo- controlled clinical trial

BackgroundDiabetic Sensorimotor Polyneuropathy (DSPN) is a common complication of diabetes mellitus. Curcumin is the most important ingredient found in turmeric which has a very high potential for eliminating free radicals and inhibiting oxidative stress as an antioxidant agent. The aim of this study was to determine the effect of Nano-curcumin supplementation on the severity of sensorimotor polyneuropathy in patients with Type 2 diabetes mellitus (T2DM).MethodThis parallel, double-blind randomized, placebo-controlled clinical trial was conducted on 80 diabetic patients. Participants were allocated randomly to the intervention (n = 40) and the control group (n = 40). They received 80 mg of nano-curcumin or placebo capsules for 8 weeks. Anthropometric measurements, dietary intake, physical activity, glycemic indices and the severity of DSPN were measured before and after the intervention.ResultSupplementation of nano curcumin was accounted for a significant reduction in Glycated hemoglobin(HbA1c) (p < 0.001) and Fast Blood Sugar(FBS) (p = 0.004), total score of neuropathy (p < 0.001), total reflex score (p = 0.04) and temperature (p = 0.01) compared to placebo group.ConclusionOur findings indicated that curcumin supplementation for 2 months improved and reduced the severity of DSPN in patients with T2DM.     

Peptide hormones and risk for future cardiovascular events among prediabetics: a 20-year follow-up in the OPERA study

Abstract

Background: Prediabetes has proven to have many unfavourable impacts on the cardiovascular system.

Methods: The OPERA (Oulu Project Elucidating Risk of Atherosclerosis) study included 1045 middle-aged subjects followed from the years 1990–1993 to 2014. The focus was on peptide hormones.

Results: Plasma resistin levels were higher among prediabetics (p?=?.001), particularly impaired glucose tolerance (IGT) (p?<?.001), but not impaired fasting glucose (IFG) patients than among normal glucose tolerance (NGT) or diabetes groups. Diabetics showed lower resistin levels than IGT subjects (p?<?.001). IGT or diabetes groups showed lower adiponectin and higher leptin levels compared to the NGT group (p?<?.001). The IFG group had the highest blood pressure and left ventricular mass index, even higher than the diabetic group. Diabetics had the highest, prediabetics (IFG?+?IGT) intermediate and NGT the lowest risk for CVD events during follow-up (p?<?.001). Among prediabetics, high plasma ghrelin was an independent predictor of CVD events (p?<?.05) in the Cox regression analysis although it did not significantly improve either classification or discrimination of the patients.

Conclusions: Among glucose tolerance groups, patients with IGT had the highest resistin, but equally high leptin and low adiponectin levels as diabetics. Among prediabetics, ghrelin seems to predict independently cardiovascular events in the long term.

• KEY MESSAGE

• Among glucose tolerance groups, patients with IGT had the highest resistin, but equally high leptin and low adiponectin levels as diabetics.

• Among prediabetics, ghrelin seems to predict independently cardiovascular events in the long term.

     

Effects of hydroalcoholic extract of Berberis Integerrima on the anthropometric indices and metabolic profile in active rheumatoid arthritis patients

ObjectivesSince, the main cause of death in Rheumatoid arthritis (RA) patients is the presence of type 2 diabetes, abnormal increase in blood lipids, blood pressure and obesity, the aim of this study was to assess the effects of Barberry on the anthropometric indices and metabolic profile in patients with RA.Designpresent study was a double-blinded, placebo-controlled randomized clinical trial.Setting70 active RA patients were randomly allocated into intervention or placebo groupInterventionParticipants received 6 capsules of 500 mg barberry extract or placebo for 3 months.Main outcome measuresSerum levels of fasting blood sugar (FBS), triglyceride (TG), LDL cholesterol (LDL-C) and HDL cholesterol (HDL-C), systolic and diastolic blood pressure and anthropometric factors were assessed at baseline and at the end of the trial.ResultsThe results of intervention on 62 patients showed that weight, BMI, and conicity index increased in both groups, but this was significant only in the placebo group (p < 0.001). Waist and hip circumference were decreased in the intervention group and increased significantly in the placebo group (p < 0.001). Body fat percent (p = 0.04), LDL-C (p = 0.05) and SBP (p = 0.02) significantly were decreased in the intervention group. The results showed a significant decrease in body fat percent (p = 0.05), hip circumference (p < 0.001), FBS (p = 0.03) and HDL-C (p = 0.03) in the intervention group compared to the placebo. Conclusions: Overall, the results of this study demonstrated that the extract of Berberis Integerrima had beneficial effects on metabolic profile and anthropometric indices in RA patients.     

Effect of Patient Use of Physical Therapy After Referral for Musculoskeletal Conditions on Future Medical Utilization: A Retrospective Cohort Analysis

ObjectiveThe purpose of this study was to evaluate whether physical therapy use influenced subsequent use of musculoskeletal-related surgeries, injections, magnetic resonance imaging (MRI), and other imaging.MethodsWe conducted a retrospective cohort study of patients aged 18 to 64 years who had an ambulatory care visit at the University of Utah system, after implementation of the 10th revision of the International Statistical Classification of Diseases and Related Health Problems with adequate data collection in the system at the time of the data pull, between October 1, 2015, and September 30, 2018. We identified patients (n = 85 186) who received care for a musculoskeletal condition (lower back pain, cervical, knee, shoulder, hip, elbow, ankle, wrist/hand, thoracic, and arthritis diagnoses). Regression analyses were used to evaluate the association between physical therapy use and medical care use while controlling for relevant factors.ResultsIn patients referred to physical therapy (n = 15 870), physical therapy use (n = 3812) was associated with increased MRI use (incidence rate ratio, 1.24; 95% confidence interval, 1.15-1.33; P < .001) and surgery use (incidence rate ratio, 1.11; 95% confidence interval, 1.00-1.23; P < .001). Several other factors were also associated with increased health care use, including being referred by an orthopedic provider, obesity, non–lower back pain diagnoses, and having 1 or more comorbidities.ConclusionOutpatient physical therapy use for musculoskeletal conditions in adult patients younger than 65 years at the University of Utah system, a mountain west United States academic health care system, was associated with increased rates of MRI and surgery. This finding is contrary to prior research suggesting that physical therapy improves outcomes in some diagnosis groups. A referral from an orthopedic provider, non–lower back pain diagnoses, and obesity were also associated with increased medical care utilization.     

Therapeutic evaluation of a microbioartificial liver with recombinant HepG2 cells for rats with hepatic failure

Background: HepG2/(ArgI+OTC)4 (previously constructed) is a recombinant human liver cell line with a strong ability to reduce ammonia in vitro. However, its application value ex vivo has not been investigated.

Objectives: To examine the efficacy of HepG2/(ArgI+OTC)4 cells in a micro-bioartificial liver (micro-BAL) device for application ex vivo.

Methods: A simple micro-BAL device containing a microbioreactor and a small-type peristaltic pump was installed. The rats with hepatic failure were randomly divided into three groups (n = 10) and were treated with different micro-BAL loaded HepG2/(ArgI+OTC)4 cells, HepG2 cells and control (without cells), respectively. Changes in the liver and kidney function of the rats were determined before and after the treatment. The lifespan of the rats were observed and recorded.

Results: Despite the difference in survival time between experimental groups of rat model was not statistically significant, the capacity of HepG2/(ArgI+OTC)4 cells treatment group for tolerance and detoxifying ammonia was increased much more than that of HepG2 cells (p < 0.05), and other biochemical indicators of HepG2/(ArgI+OTC)4 cells treatment group were also better than that of HepG2 cells treatment group (p < 0.05).

Conclusions: HepG2/(ArgI+OTC)4 cells can provide a better biological support for rats with hepatic failure in a short period of time, and they may be used as a convenient and useful choice for further cell material research of BAL.