What can epidemiology tell us about systemic lupus erythematosus?

Systemic lupus erythematosus (SLE) is an often-severe autoimmune rheumatic disease most commonly diagnosed in women in their childbearing years. It is thought to develop when genetically predisposed individuals are exposed to one or more environmental triggers. This review outlines the epidemiologic evidence for several putative risk factors including cigarette smoke, hormonal and reproductive factors, environmental silica and infectious exposures, as well as many yet to be identified. We also review the evidence for factors associated with increased disease activity and adverse outcomes in SLE. We review the literature on the epidemiology of SLE, its distribution, potential risk factors for its onset and for adverse outcomes. The information considered in this review was gathered through extensive review of the literature. Online Pubmed literature searches, previous reviews of the epidemiology of SLE and original studies were employed. Epidemiologic studies have helped to identify some of these potential risk factors, including exogenous hormone use, cigarette smoking, infections such as Epstein-Barr virus (EBV) and crystalline silica exposure, but many more have yet to be studied. These exposures may interact with multiple genetic factors in determining susceptibility to SLE. While epidemiologic research has contributed an enormous amount to our understanding of the disease and its pathogenesis, there are many more avenues of epidemiologic research that deserve to be pursued.     

Interventions for low back pain: What does the evidence tell us?

Although interventional therapy for chronic spinal pain continues to be popular among patients and providers, the scientific evidence supporting these techniques has lagged behind their presence in the market. This article collates both classic and more recent experimental results involved in the interventional assessment and treatment of chronic spinal pain, and presents key findings for physicians. Although much of the body of evidence is either unsupportive or inconclusive, there are some definitive findings involving each technique that can help shape rational practice. As interventional pain medicine seeks to become a more validated specialty, introspection and advancing science will be key to this development.     

What does the literature tell us about death,dying and palliative care for people with intellectual disabilities?

Abstract

The development and understanding of palliative care as a medical speciality has influenced the way in which end-of-life care is provided and has become routine and medicalised. The majority of the literature reviewed for this paper described the way in which palliative care service delivery is carried out for people with intellectual disabilities. Much of the research reviewed came to similar conclusions about end-of-life care with the major issues being that of education and communication, and involvement of the individual and their family in decisions made either by them or on their behalf. There was no literature identified that related to the personal experiences of people with intellectual disability who were dying however there was some that related to family experiences and to individual experience of loss and the grieving process.     

What does teaching declaratives tell us about the criteria by which we can judge the developmental importance of treatment outcomes?

This article uses examples of treatment research on declaratives to illustrate criteria for determining whether a taught behavior is a “skill”, not just a context-bound behavior and whether the taught skill has associations with other theoretically linked skills as one type of validation evidence. The article uses data from three treatment studies to illustrate the issues and proposed criteria. The article concludes with a call to consumers and producers of treatment research to use the criteria to judge the developmental importance of treatment outcomes.     

What do Cochrane reviews tell us about anti-thrombotic therapy in heart failure with sinus rhythm?

Although major advances have been made in the treatment of manycardiovascular disorders,¹ many patients with advanced cardiovasculardisease remain symptomatic and are far from cured. For mostof the history of medicine, treatments have been designed torelieve symptoms and suffering, and to render the patient morefully functional. In the modern era, the concepts of diseaseand cure have taken on new meaning, and the idea of curativetherapy has become widespread. Even more recent is the conceptof preventive therapy, whose sole aim is to prolong life orprevent some future catastrophe in people who are presentlywell. These are not people complaining of something: they arepeople we seek out to recommend therapies that themselves maycause disability or unpleasant symptoms, in the hope of reducing     

What about antibiotic resistance in Neisseria lactamica?

The in vitro activity of penicillin, ampicillin, cefotaxime, ceftriaxone, rifampicin and ciprofloxacin against 286 Neisseria lactamica isolates was determined by agar dilution and the category of susceptibility was analysed in accordance with the criteria used for Neisseria meningitidis. All isolates were considered to have intermediate susceptibility to penicillin. A total of 1.7% of the isolates were resistant to ampicillin but all were susceptible to cefotaxime and ceftriaxone. Rifampicin MICs ranged between 0.12 and 2 mg/L. Six isolates (2.1%) showed decreased susceptibility to ciprofloxacin.     

Workplace violence directed at nursing and medical students - What can students tell us about it?

BackgroundWorkplace violence (WPV) directed at healthcare teams is a widespread growing phenomenon that affects students as well. The negative consequences of WPV may impede patient care and future retention rates.PurposeTo explore (a) the incidence and type of WPV experienced by nursing and medical students during their clinical rotations; (b) the associations between the emotional consequences of WPV events for students and their perceived professional performance; (c) students’ preparedness and current training on WPV.MethodOne hundred and fifty-one Israeli nursing and medical students completed an online questionnaire that included closed and open-ended questions. Quantitative data and qualitative data were analyzed separately, before their integration.ResultsMore than half the students reported having experienced verbal violence during their clinical rotations. Experiencing WPV caused some students (14.6%) to consider leaving the profession and about one third (27.8%) reported that it had affected patients’ care. The vast majority of students did not report experiencing incidents of physical violence.ConclusionsThere is an essential need to promote and implement multidisciplinary programs aimed at eliminating WPV, beginning at the students’ level. Students need preparation and practical tools for coping with WPV. At the same time, health organizations must act to examine how cases of WPV against students are handled.     

What can coronial cases tell us about the quality of emergency healthcare for prisoners in Australia?

Objective

This research aimed to examine the legal and regulatory obligations of authorities and healthcare professionals in the provision of prison emergency health services and to identify problems in the provision of emergency care to prisoners by using case examples from coronial findings.

Methods

Review of legal and regulatory obligations and a search of coronial cases for deaths related to the provision of emergency healthcare in prisons in the past 10 years in Victoria, New South Wales and Queensland.

Results

The case review identified several themes – issues with prison authority policies and procedures that delay access to timely healthcare or compromise the quality of care, operational and logistical factors, clinical issues and stigmatic issues including prison staff attitudes to prisoners requesting urgent healthcare assistance.

Conclusion

Coronial findings and royal commissions have repeatedly identified deficiencies in the emergency healthcare provided to prisoners in Australia. These deficiencies are operational, clinical and stigmatic and not limited to a single prison or jurisdiction. Applying a health quality of care framework focussed on prevention and chronic health management, appropriate assessment and escalation when urgent medical assistance is requested, and a structured audit framework could avoid future preventable deaths in prisons.     

Is there another nursing shortage? What the data tell us

New York State has a very large nursing population. We examined several sources of wage, employment, and other data and determined the presence of a moderate nursing shortage in New York State.     

Exploring patients' rights: what does the NHS Constitution tell us?

On 8 March 2012, the NHS published the latest version of its Constitution. In this article, the author explores the background of the debate regarding patients' rights and entitlements in the NHS. The author also discusses the provisions of the NHS Constitution, noting that it is largely a statement of existing principles, rather than a bold statement of rights. The paper suggests that, in some instances, its discussion of rights may suggest that patients have broader rights than may in fact be the case. The Constitution is currently under review, and the author recommends that the way forward for a society where the provision of care is likely to be more complex would be the introduction of a Patients' Rights Act.     

Methylxanthine use in anaphylaxis: what does the evidence tell us?

OBJECTIVE: To review the literature examining the use of methylxanthines in the treatment of anaphylaxis. DATA SOURCES: A MEDLINE search (January 1966-December 1998) was performed using the terms aminophylline, theophylline, and anaphylaxis. STUDY SELECTION AND DATA EXTRACTION: Articles discussing methylxanthine use in anaphylaxis were independently examined by each author. Additional information was obtained through the references of these articles. Articles not written in English were excluded. DATA SYNTHESIS: No human studies were identified. Limited published data were found in animal models of anaphylaxis. CONCLUSIONS: Safer agents with proven efficacy exist for the treatment of bronchoconstriction in anaphylaxis. Until data are available in humans, methylxanthines should not be recommended in the treatment of anaphylactic reactions.     

Medial prefrontal cortex activity correlates with time-on-task: what does this tell us about theories of cognitive control?

A paper by Grinband et al. (this issue) argues that dorsal medial prefrontal cortex (mPFC) activity reflects time-on-task rather than conflict or error likelihood. In this commentary, Brown suggests that the findings are consistent with a new model in which mPFC learns to predict the nature and timing of action outcomes. The new model predicts that time-on-task effects coexist with distinct error likelihood effects, a result which is consistent with other recent findings from fMRI and monkey neurophysiology.     

Four decades of group hypnosis scales: what does item-response theory tell us about what we've been measuring?

To overcome problems with previous psychometric approaches to hypnosis scales, the authors applied full-information factor analysis, based on multidimensional item-response theory (IRT), to a 39-year sample of 11,517 records of the Harvard Group Scale of Hypnotic Susceptibility, Form A (HGSHS:A). They also performed a comparable analysis on the standardization sample of the Waterloo-Stanford Group C Scale (WSGC). The HGSHS:A emerges as two-factored, whereas the WSGC more closely approaches unidimensionality. The HGSHS:A factor structure and means show very little change over 4 decades. However, IRT-based item analysis on the HGSHS:A indicates that problems such as "pseudoguessing" on 2 items limit the quality of the item set. The authors propose alternative substantive interpretations of the traits that may underlie the two-factor structure.