Focus groups: their role in developing calcium-related education materials

Because attitudes concerning a topic can diminish the effectiveness of educational materials, previously identified attitudes concerning calcium intake were explored through focus group interviews during the developmental stages of calcium education materials. Although four focus groups of six to seven participants were planned, each of the four groups consisted of two to six women. All focus groups followed the same format, lasting for 60–90 min; questions progressed from the general to more specific. The focus groups revealed several attitudinal barriers toward dietary behavioural change, including lack of prior interest in the topic and lack of time. Attitudes about dairy calcium included the belief that dairy foods were high in fat and should be avoided, and the belief that dairy foods would cause stomach upsets. Also, neither younger nor older women felt that osteoporosis was a problem their age group needed to address. Readability scales were not necessarily predictive of preference. This study shows that focus group interviews make a valuable contribution to planning and evaluating nutrition education materials.     

Doctor – How do I use my EpiPen?

Parents and children who have been prescribed an Epipen are often unable to demonstrate its correct administration. One contributory factor may be that doctors are unfamiliar with the EpiPen and are unable to demonstrate the correct administration of the pen to the family. The aim of this study was to determine the rate of correct EpiPen demonstration by junior and Senior Medical Staff at a major tertiary paediatric Hospital. Junior and Senior medical staff were scored on their ability to correctly use the EpiPen trainer. A 6 step scoring system was used. One-hundred doctors were recruited (Residents n = 31, Senior Residents n = 39, Fellow/Consultants n = 30). Junior and Senior Medical staff had similar scores for EpiPen demonstration, the number that needed to read the EpiPen instructions prior to use and the frequancy of accidental self-injection into the thumb. Only two doctors (2%) demonstrated all 6 administration steps correctly. The most frequent errors made were not holding the pen in place for >5 seconds (57%), failure to apply pressure to activate (21%), and self-injection into the thumb (16%). Ninety five doctors needed to read the instructions, and of these, only 39 (41%) then proceeded to correctly demonstrate the remaining 5 steps. Forty-five doctors had previously dispensed an EpiPen, but only three demonstrated its use to parents/children with a trainer. The majority of doctors do not know how to use an Epipen and are unable to provide appropriate education to parents/children. In 37% of cases, the demonstration would not have delivered adrenaline to a patient.     

Modification of odor investigation and discrimination in female opossums (Monodelphis domestica) following the ablation of the accessory olfactory bulbs

To determine whether the vomeronasal system of the Brazilian short-tailed opossum (Monodelphis domestica) is important to the response to conspecific chemical signals, the authors tested female opossums with conspecific odors, before and after ablation of their accessory olfactory bulbs (AOBs). Anesthesia and sham treatments did not modify females' discrimination of conspecific odors when tested against water, between male and female odors, or between different odors from the same male donors. Odor investigation was partially diminished following partial ablation of the AOB, and complete ablation of the AOBs further impaired the ability of females to discriminate between certain odors. These findings provide the first evidence for the importance of the vomeronasal system in the detection of chemosignals of known origin in opossums.     

加味四君子汤联合FOLFOX4 化疗方案治疗脾虚湿盛型晚期结直肠癌临床研究

目的：观察加味四君子汤联合FOLFOX4化疗方案治疗脾虚湿盛型晚期结直肠癌患者的临床疗效。 方法：选取60例脾虚湿盛型晚期结直肠癌患者作为研究对象,采用随机数字表法分为对照组和观察组各 30 例。2组均应用FOLFOX4化疗方案治疗,观察组加予加味四君子汤治疗。2组均治疗3个月。治疗前和治疗 3个月后,评定中医证候评分,检测肿瘤标志物［癌胚抗原（CEA）、糖类抗原（CA199）］、评价健康状态 karnofsky功能状态评分表（KPS） 评分]。比较2组临床疗效。统计治疗期间2组患者不良反应的发生情况。结 果：治疗3个月后,观察组总有效率83.33%,高于对照组（56.67%）,差异有统计学意义（P＜0.05）。2组食后 腹胀、食少纳呆、倦怠乏力、大便稀溏评分和中医证候总分均较治疗前降低（P＜0.05）。观察组食后腹胀、食 少纳呆、倦怠乏力、大便稀溏评分和中医证候总分均低于对照组（P＜0.05）。2组CEA、CA199值均较治疗前 下降（P＜0.05）,观察组CEA、CA199值均低于对照组（P＜0.05）。2组KPS评分均高于治疗前（P＜0.05）。 观察组KPS评分高于对照组（P＜0.05）。观察组不良反应发生率40.00%,低于对照组（73.33%）,差异有统计 学意义（P＜0.05）。结论：采用加味四君子汤联合FOLFOX4方案治疗脾虚湿盛型晚期结直肠癌患者临床疗效 明显,不但能有效缓解临床症状,抑制病情进展,同时还能改善患者的健康水平,提升治疗的安全性。     

Catching the GIST: Massive Gastrointestinal Stromal Tumor Presenting as Acute Dyspnea

We present a case of a 55-year-old woman presenting with worsening shortness of breath and constipation over the course of three days. Initial computed tomography scan showed a large, complex abdominal mass with a vascular pedicle and possible pedunculated origin along the inferior aspect of the greater curvature of the stomach. The mass was further evaluated on magnetic resonance imaging showing an active hemorrhage. The patient became hemodynamically unstable and general surgery was consulted for evaluation. Mass resection was performed, and biopsy revealed KIT/CD117+ and DOG1/ANO1+ gastrointestinal stromal tumor staged as T4. Although definitive diagnosis of a gastrointestinal stromal tumor requires biopsy, prompt clinical and radiological recognition is critical for patients to receive definitive treatment of mass resection.     

Pharmacokinetics of mycophenolate mofetil in stable pediatric liver transplant recipients receiving mycophenolate mofetil and cyclosporine.

There are few pharmacokinetic data for mycophenolate mofetil (MMF) when used in combination with cyclosporine (CsA) in pediatric liver transplant recipients. The aim of this study was to assess the pharmacokinetics of MMF in stable pediatric liver transplant patients and estimate the dose of MMF required to provide a mycophenolic acid (MPA) exposure similar to that observed in adult liver transplant recipients receiving the recommended dose of MMF (target area under the plasma concentration-time curve from 0 to 12 hours [AUC(0-12)] for MPA of 29 mug.hour/mL in the immediate posttransplantation period and 58 microg x hour/mL after 6 months). A 12-hour pharmacokinetic profile was collected for 8 pediatric patients (mean age 20.9 months) on stable doses of MMF and CsA who had received a liver transplant > or = 6 months prior to entry and who had started on MMF within 2 weeks of transplantation. Mean MMF dosage was 285 mg/m(2) (range, 200-424 mg/m(2)). Of 8 patients, 7 had a MPA AUC(0-12) (range, 11.0-37.2 microg x hour/mL) well below the target. One patient had an AUC(0-12) > or = 58 microg x hour/mL but was considered an outlier and was excluded from analyses. Mean MPA AUC(0-12) and maximum plasma concentration values were 22.7 +/- 10.5 microg x hour/mL and 7.23 +/- 3.27 microg/mL, respectively; values normalized to 600 mg/m(2) (the approved pediatric dose in renal transplantation) were 47.0 +/- 21.8 microg x hour/mL and 14.5 +/- 4.21 microg/mL. In conclusion, assuming that MPA exhibits linear pharmacokinetics, when used in combination with CsA, a MMF dose of 740 mg/m(2) twice daily would be recommended in pediatric liver transplant recipients to achieve MPA exposures similar to those observed in adult liver transplant recipients. This finding should be confirmed by a prospective trial.