The Fagerstrom test for nicotine dependence and its relationship to NRT use and readiness‐to‐quit

Scores on the Fagerstrom Test for Nicotine Dependence are used as a basis for recommending nicotine replacement therapy (NRT) as an aid to smoking cessation on a number of commercial websites. This study investigated (a) whether dependence on nicotine per se was necessary to score highly on the FTND and (b) whether successful quitters using NRT, with matched scores on the FTND, would report greater difficulty in stopping than successful quitters not using NRT. The paper reports a study with two inter‐related parts. In the first part, 24 smokers and 24 never‐smokers completed the FTND. The never‐smokers were asked to respond as if they were smokers. No significant differences were found between groups either at the total or individual‐item level, suggesting that results can derive from motivated or strategic responding. In part 2, 28 ex‐smokers were matched for age, gender, and FTND scores. Half had used NRT (nicotine patches) and half had not. NRT users reported that smoking was subjectively harder to give up (p<0.05). There was a general attribution across both NRT and non‐NRT groups to internal psychological factors being important for cessation. It is suggested that both high‐dependent scores on the FTND and NRT use are consequences of common motivation and a general ‘readiness to quit’.     

Accuracy of N‐terminal‐pro‐atrial natriuretic peptide in patients admitted to emergency department

Objective. B‐type natriuretic peptide (BNP) and N‐terminal‐pro‐BNP (Nt‐proBNP) are commonly used for the triage of patients in the emergency department (ED) with dyspnoea and/or chest pain. The aim of our study was to determine the accuracy of N‐terminal‐pro‐ANP (Nt‐proANP) in such patients. Material and methods. Nt‐proANP was measured by home‐made radioimmunoassay in 137 ED patients admitted with cardiovascular and/or pulmonary disorders. BNP and Nt‐pro‐BNP were determined with automated assays. Final diagnosis was confirmed at discharge or after follow‐up. Results. Nt‐proANP levels were significantly influenced by the diagnostic subgroups (ANOVA: p<0.001) and were [geometric mean (range)]: 19727?ng/L (5260–45200) in congestive heart failure (CHF, n = 31), 6575?ng/L (1350–36000) in coronary artery disease (CAD, n = 19), 5324?ng/L (1710–13150) in pulmonary embolism (PE, n = 20), 5035?ng/L (1510–16600) in pulmonary diseases (PD, n = 24) and 3001?ng/L (750–11860) in patients without cardiopulmonary diseases (n = 43). Pairwise comparisons demonstrated that CHF patients had Nt‐pro‐ANP values higher than all other groups (p<0.05) and that patients without cardiopulmonary diseases had the lowest values (p<0.05). For diagnosis of CHF, the area under the ROC curve of Nt‐proANP was 0.94 (95?% CI: 0.89–0.98) and was equivalent to Nt‐proBNP (0.91; p = 0.284) and BNP (0.93; p = 0.572). Conclusions. The diagnostic accuracy of Nt‐proANP was equivalent to BNP and Nt‐proBNP in the present cohort of patients admitted to ED with dyspnoea and/or chest pain.     

Non‐pharmacological means to prevent fractures among older adults

Bone fractures affecting elderly people are a true public health burden, because they represent one of the most important causes of long‐standing pain, functional impairment, disability, and death among this population. Compromised bone strength (osteoporosis) and falling, alone, or more frequently in combination, are the two independent and immediate risk factors of elderly people's fractures through which all the other, more distant risk factors, such as aging, inactivity, poor nutrition, smoking, use of alcohol, diseases, medications, functional impairments, and disabilities, operate. Of these two, falling, not osteoporosis, is the strongest single risk factor for a fracture. The most usual occurrence resulting in a fracture of an older adult is a ‘simple’ fall from standing height or less. Although in general terms this type of trauma is mild or moderate only (compared with, for example, motor vehicle collisions), to the specific injury site these traumas are high‐impact injuries often creating forces clearly exceeding the breaking strength of the bone. Therefore, fractures affecting elderly people should be called ‘fall‐induced high‐impact injuries’ instead of the commonly used, partly misleading terms of osteoporotic fractures or minimal‐trauma fractures. Prevention of elderly people's fractures consists of prevention of osteoporosis and of falling, and prevention of fractures using injury‐site protection. Concerning osteoporosis, maximizing peak bone mass and preventing bone loss by regular exercise, calcium, and vitamin D, and, treatment of established osteoporosis with bone‐specific drugs, have a strong scientific basis. In fall prevention, regular strength and balance training, reducing psychotropic medication, and diet supplementation with vitamin D and calcium have been shown to be effective. The multifaceted risk factor‐assessing and modifying interventions have also been successful in preventing falls among the older adults by simultaneously affecting many of the risk factors of falling. Finally, concerning injury‐site protection, padded strong‐shield hip protectors whose effectiveness is scientifically proven seem to be a promising option in preventing hip fractures.     

Evaluation of Patient Access to Spanish-Language–Concordant Care on a Postpartum Unit

ObjectiveTo evaluate patient access to Spanish-language–concordant care on a postpartum unit and to identify facilitators and barriers to the use of interpretation services.DesignMixed-methods research study, comprising a cross-sectional chart review from September to December 2019 and semistructured interviews from June to December 2020.Setting/Local ProblemA tertiary academic medical center in the southeastern United States where individuals with limited English proficiency are at risk for poor health outcomes when they are unable to communicate with clinicians in their preferred language.ParticipantsWe conducted a chart review of 50 randomly selected birthing parent–newborn couplets and interviews with 14 inpatient health care team members.MeasurementsThe chart review examined patient characteristics, health care team composition including Spanish language proficiency, length of stay, number of interpreter requests, and time between clinician interpreter requests and interpreter arrival on the unit. Interviews evaluated facilitators and barriers to interpreter use.ResultsAccess to a clinician certified in medical Spanish or an interpreter was offered to 12 of 50 (24%) couplets upon admission to the unit and to 7 of 50 (14%) of couplets for daily maternal and newborn medical rounds. Clinicians reported long and unpredictable wait times to access interpreters, which led them to rely on hand gestures, broken Spanish, and smartphone apps to “get by” when communicating with patients without certified interpretation services. Participants described low usage of interpreters for “noncritical” encounters.ConclusionInterpreters and other forms of Spanish-language–concordant care were underused on the postpartum unit. This deviation from national standards may put families at risk for harm. Recommendations from this study include advancing a culture of respectful care, improving the interpreter request workflow, addressing safe staffing, facilitating direct patient access to interpreters, and providing ongoing evaluation and support.     

A Data‐Rich Recruitment Core to Support Translational Clinical Research

Background

Underenrollment of clinical studies wastes resources and delays assessment of research discoveries. We describe the organization and impact of a centralized recruitment core delivering comprehensive recruitment support to investigators.

Methods

The Rockefeller University Center for Clinical and Translational Science supports a centralized recruitment core, call center, Research Volunteer Repository, data infrastructure, and staff who provide expert recruitment services to investigators. During protocol development, consultations aim to optimize enrollment feasibility, develop recruitment strategy, budget, and advertising. Services during study conduct include advertising placement, repository queries, call management, prescreening, referral, and visit scheduling. Utilization and recruitment outcomes are tracked using dedicated software.

Results

For protocols receiving recruitment services during 2009–2013: median time from initiation of recruitment to the first enrolled participant was 10 days; of 4,047 first‐time callers to the call center, 92% (n = 3,722) enrolled in the Research Volunteer Repository, with 99% retention; 23% of Repository enrollees subsequently enrolled in ≥1 research studies, with 89% retention. Of volunteers referred by repository queries, 49% (280/537) enrolled into the study, with 92% retained.

Conclusions

Provision of robust recruitment infrastructure including expertise, a volunteer repository, data capture and real‐time analysis accelerates protocol accrual. Application of recruitment science improves the quality of clinical investigation.     

Circulatory responses to hypoglycaemia in diabetic and non‐diabetic children

The purpose of this study was to investigate the circulatory responses to hypoglycaemia in diabetic and non‐diabetic children and to determine whether these changes were associated with hormone levels or clinical variables. Plasma glucose levels in 18 diabetic and 15 control children were gradually lowered to 2.5 (0.3)?mmol/L (mean (SD)) and 2.9 (0.2)?mmol/L, respectively. Blood pressure and heart rate were recorded at 10‐min intervals, and blood samples were taken for hormone analysis. Systolic pressure increased from 110.1 (10.0) to 115.0 (11.2)?mmHg (p=0.008) in the diabetic children and from 116.9 (12.0) to 121.6 (12.7)?mmHg (p=0.049) in the controls. Diastolic pressure decreased from 61.9 (6.7) to 55.5 (7.6)?mmHg (p<0.001) in the diabetic children and from 66.5 (6.3) to 55.1 (5.1)?mmHg (p<0.001) in the controls. The increase in pulse pressure during hypoglycaemia was significantly smaller in the diabetic children (10.6 (5.5) vs. 15.7 (7.7)?mmHg, p=0.04). The final systolic and pulse pressure correlated with the final adrenaline level in the controls (r=0.66, p=0.008 and r=0.70, p=0.003, respectively). In the non‐diabetic as well as the diabetic group, the increase in pulse pressure correlated with the increase in adrenaline (r=0.66, p=0.008 and r=0.50, p=0.03, respectively). It is concluded that systolic pressure increases and diastolic pressure decreases during hypoglycaemia in children. The smaller increase in pulse pressure observed in the diabetic children is probably related to a significantly smaller increase in adrenaline in this group.     

Point‐of‐care testing has a limited effect on time to clinical decision in primary health care

Objective: To investigate the clinical logistics of laboratory routines at primary health care centres (PHCs). Design and methods: Prospective registration was carried out for each PHC using questionnaires during 2‐week intervals between the end of November 2001 and mid‐January 2002. The study included 9 PHCs in the county of Östergötland and 4 in the county of Jönköping, Sweden, with different numbers of blood tests analysed using point‐of‐care testing (POCT). Data for B‐glucose, HbA1c, C‐reactive protein (CRP), erythrocyte sedimentation rate (ESR), thyroid‐stimulating hormone (TSH), T4, cholesterol, HDL‐cholesterol, LDL‐cholesterol and triglycerides were collected. Main outcome measures were median time from sampling to available test result (TATa) and median time from sampling to clinical decision (TATd), and the proportion of patients informed of the outcome of the blood test in question during the sampling occasion. Results: A total of 3542 samples were collected. The median TATa showed that B‐glucose, ESR and CRP were immediately analysed at all 13 PHCs. For the other tests, TATa varied from immediately to about two days. The median TATd varied from immediately to about a week. When POCT was used, 30% of the patients were informed about the outcome of the test during the sampling occasion. Conclusion: POCT has a limited effect on the clinical logistics in PHCs.     

Evaluating and Giving Feedback to Mentors: New Evidence‐Based Approaches

A comprehensive mentoring program includes a variety of components. One of the most important is the ongoing assessment of and feedback to mentors. Scholars need strong active mentors who have the expertise, disposition, motivation, skills, and the ability to accept feedback and to adjust their mentoring style. Assessing the effectiveness of a given mentor is no easy task. Variability in learning needs and academic goals among scholars makes it difficult to develop a single evaluation instrument or a standardized procedure for evaluating mentors. Scholars, mentors, and program leaders are often reluctant to conduct formal evaluations, as there are no commonly accepted measures. The process of giving feedback is often difficult and there is limited empirical data on efficacy. This article presents a new and innovative six‐component approach to mentor evaluation that includes the assessment of mentee training and empowerment, peer learning and mentor training, scholar advocacy, mentee–mentor expectations, mentor self‐reflection, and mentee evaluation of their mentor. Clin Trans Sci 2012; Volume 5: 71–77     

Autologous c‐Kit+ Mesenchymal Stem Cell Injections Provide Superior Therapeutic Benefit as Compared to c‐Kit+ Cardiac‐Derived Stem Cells in a Feline Model of Isoproterenol‐Induced Cardiomyopathy

Background

Cardiac‐ (CSC) and mesenchymal‐derived (MSC) CD117+ isolated stem cells improve cardiac function after injury. However, no study has compared the therapeutic benefit of these cells when used autologously.

Methods

MSCs and CSCs were isolated on day 0. Cardiomyopathy was induced (day 28) by infusion of L‐isoproterenol (1,100 ug/kg/hour) from Alzet minipumps for 10 days. Bromodeoxyuridine (BrdU) was infused via minipumps (50 mg/mL) to identify proliferative cells during the injury phase. Following injury (day 38), autologous CSC (n = 7) and MSC (n = 4) were delivered by intracoronary injection. These animals were compared to those receiving sham injections by echocardiography, invasive hemodynamics, and immunohistochemistry.

Results

Fractional shortening improved with CSC (26.9 ± 1.1% vs. 16.1 ± 0.2%, p = 0.01) and MSC (25.1 ± 0.2% vs. 12.1 ± 0.5%, p = 0.01) as compared to shams. MSC were superior to CSC in improving left ventricle end‐diastolic (LVED) volume (37.7 ± 3.1% vs. 19.9 ± 9.4%, p = 0.03) and ejection fraction (27.7 ± 0.1% vs. 19.9 ± 0.4%, p = 0.02). LVED pressure was less in MSC (6.3 ± 1.3 mmHg) as compared to CSC (9.3 ± 0.7 mmHg) and sham (13.3 ± 0.7); p = 0.01. LV BrdU+ myocytes were higher in MSC (0.17 ± 0.03%) than CSC (0.09 ± 0.01%) and sham (0.06 ± 01%); p < 0.001.

Conclusions

Both CD117+ isolated CSC and MSC therapy improve cardiac function and attenuate pathological remodeling. However, MSC appear to confer additional benefit.     

A Nurse‐led Initiative to Improve Obstetricians’ Screening for Postpartum Depression

Although up to 20 percent of women experience postpartum depression, screening is not standard practice. In a metropolitan area where only 1 of 30 obstetricians and two primary care clinics reported routine screening for postpartum depression, a nurse‐led initiative to implement routine screening using the Edinburgh Postnatal Depression Scale was carried out. Twenty‐two obstetricians (76 percent) agreed to consistently implement screening for 3 months. Of the 21 participating obstetricians, 71.4 percent indicated that postpartum depression screening would become their standard care. This article describes implementation strategies and lessons learned.     

Novel approaches to treatment of advanced colorectal cancer with anti‐EGFR monoclonal antibodies

The standard treatment of metastatic colorectal cancer (mCRC) is combination of 5‐ fluorouracil/folinic acid with irinotecan or oxaliplatin‐based chemotherapy. Epidermal growth factor receptor (EGFR) is overexpressed in 70%–80% of colorectal cancers (CRC). EGFR overexpression is known to be involved in carcinogenic processes, such as cell proliferation, apoptosis, angiogenesis and metastasis. Monoclonal antibodies targeting EGFR have shown antitumor activity and improved the efficacy of chemotherapy. Cetuximab is a chimeric immunoglobulin (Ig) G1 anti‐EGFR monoclonal antibody (MoAb). Several clinical studies have shown cetuximab, either as a single agent or in combination with irinotecan, having promising efficacy in patients with metastatic CRC. Cetuximab with 5‐fluorouracil/LV (leucovorin) plus irinotecan or oxaliplatin‐based chemotherapy has shown higher response rate and longer time to progression as first‐line treatment of mCRC. Currently, there are no data showing that addition of cetuximab would prolong overall survival in randomized studies. Panitumumab, a fully human IgG2 monoclonal antibody, has also shown antitumor activity against EGFR‐expressing mCRC with less allergic reaction. Anti‐EGFR MoAbs are well tolerated and have limited overlapping toxicities in combination with other cytotoxic drugs. The most common side effect of anti‐EGFR MoAb is an acneform skin rash, which is a surrogate marker of efficacy of treatment with MoAbs. In this review, we will discuss the use of anti‐EGFR MoAbs in the treatment of mCRC, with focus on cetuximab and panitumumab.     

Personal and behavioral variables related to perceived stress of second‐year medical students

A study of second‐year medical students was conducted to determine if selected personal and behavioral variables are related to the perceived amount of stress. Medical students from seven medical schools (N = 555) responded to a mailed questionnaire that assessed their degree of academic, personal, and professional stress. Factors that significantly related to amount of academic stress were general satisfaction with life, sex of student, physical activity, alcohol use, hours of sleep per night, and total number of recent losses and misfortunes. Factors that significantly related to amount of personal stress were general satisfaction with life, sex of student, drug use, number of sensation‐seeking sports and total number of recent losses and misfortunes. Although measured, professional stress was not considered an important component of a second‐year medical student's educational experience.