Chromium as adjunctive treatment for type 2 diabetes

OBJECTIVE: To review the chemistry, pharmacology, efficacy, and safety of trivalent chromium in the treatment of type 2 diabetes and hyperlipidemia. DATA SOURCES: The English literature was searched from 1966 through May 2002 using MEDLINE, International Pharmaceutical Abstracts, and EMBASE. The key words included chromium, glucose, lipids, and diabetes. Pertinent references from review articles and studies were used as additional sources. DATA SYNTHESIS: Trivalent chromium is an essential nutrient and has a key role in lipid and glucose metabolism. Supplementation with chromium does not appear to reduce glucose levels in euglycemia. It may, however, have some efficacy in reducing glucose levels in hyperglycemia. The effects of chromium on lipid levels are variable. Chromium in doses <1000 microg/d appears to be safe for short-term administration. Kidney function and dermatologic changes need to be monitored. CONCLUSIONS: Chromium appears to be a safe supplement and may have a role as adjunctive therapy for treatment of type 2 diabetes. Additional large-scale, long-term, randomized, double-blind studies examining the effect of various doses and forms of chromium are needed.     

Ethics and human rights issues experienced by nurses in leadership roles

The aims of this study were to identify (1) the ethics and human rights issues experienced by nurses in leadership roles (NLs); (2) how frequently these issue occurred in the NLs'practices; and (3) how disturbed the NLs were by the issues. Dillman's Total Design Method (1978) for mailed surveys guided the study design. Data analysis was performed on 470 questionnaires from New England RNs in nursing leadership roles. The most frequently experienced ethics and human rights issues during the previous 12 months were (1) protecting patient right and human dignity; (2) respecting or not respecting informed consent to treatment; (3) use or nonuse of physical or chemical restraints; (4) providing care with possible risks to the RN's health; (5) following or not following advance directives; and (6) staffing patterns that limit patient access to nursing care. The most disturbing ethics and human rights issues experienced by the NLs were staffing patterns that limited patient access to nursing care, prolonging the dying process with inappropriate measures, working with unethical, incompetent, or impaired colleagues, implementing managed care policies that threaten quality of care, not considering quality of the patient's life, and caring for patients and families who are uninformed or misinformed about treatment, prognosis, or medical alternatives. Nearly 39% of the NLs reported experiencing ethics and human rights issues one to four times a week or more, and more than 90% handled their most recent ethics issue by discussing it with nursing peers. Study findings have implications for ethics education and resource support for nurses in leadership roles, and for further research on how NLs handle ethics and human rights issues in the workplace.     

Allied health representation: a call for action

The Coalition of Allied Health Leadership (CAHL) 2000 Representation Team sought 1) to secure Federal advisory appointments for allied health professionals and 2) to connect allied health representatives with Federal advisory committees, councils, boards, and other deliberative bodies. Among the deliberative bodies providing recommendations on a broad range of issues to the President of the United States and the Executive Branch, there are over 1,000 advisory committees, councils, and boards, with more than 20,000 members. Recommendations made by the deliberative bodies include those related to health care. The literature and Web sites reveal allied health professionals have little or no representation on the bodies that represent allied health professionals and their constituents. These findings provide insights into Federal-level deliberative bodies to which allied health professionals have access or on which they warrant representation. This article reports background information, including the CAHL 2000 Representation Team objectives; an overview of federal advisory committees; recommendations for gaining access to deliberative bodies and active participation in fulfillment of Healthy People 2010 goals; and continued commitment to such representation by the CAHL and allied health professionals.     

A case report of acute pelvic thrombophlebitis missed by magnetic resonance imaging of the pelvic veins

A 29-year-old woman presented post-natally with pulmonary hypertension. Peripheral venous thrombosis was not detected by duplex ultrasound or conventional MRI. Despite anticoagulation, the patient arrested. Autopsy revealed right iliac vein thrombosis. The ability of conventional MRI to detect acute pelvic thrombophlebitis depends on obtaining appropriate views.     

Portable cushioned operating table siderails: an adjunct to pediatric surgery

BACKGROUND: In an effort to prevent falls of pediatric surgical patients from the operating table, a set of portable cushioned operating table siderails was developed. METHODS: A set of portable cushioned operating table siderails was used in the operating room over a 5-year period in more than 2,550 cases. RESULTS: The portable cushioned siderails provided an effective, easily placed barrier to falling. No falls were recorded. CONCLUSIONS: Portable cushioned siderails provide an effective barrier to prevent pediatric surgical patients from falling from the operating table.     

Evaluating the effectiveness of advocacy training for breast cancer advocates in Australia

There is growing trend in health care for patients and consumers to have an active voice in all decisions related to their care. The purpose of the current study was to assess the effectiveness of an advocacy training programme for breast cancer consumers in Australia. The participants included 51 women who attended a 3-day advocacy training programme in three different states across Australia. Participants completed a pre- and post-questionnaire at 6 months follow-up to assess their involvement in breast cancer advocacy activities and organizations. Findings revealed a significant increase in participants' involvement in serving as a member of a board or committee, working on clinical trials recruitment issues, working on patient resources, and involvement in breast cancer advocacy groups after completing the training programme. However, no change was found in other key advocacy areas, such as, lobbying for change or reviewing research protocols. Implications for future advocacy training programmes and research were discussed.     

Phase II trial of oral estramustine, oral etoposide, and intravenous paclitaxel in hormone-refractory prostate cancer.

PURPOSE: To evaluate the combination of intravenous (IV) paclitaxel, oral estramustine, and oral etoposide in patients with advanced hormone-refractory prostate cancer. PATIENTS AND METHODS: Forty patients with carcinoma of the prostate that was progressing despite hormonal therapy and who had undergone antiandrogen withdrawal (if previously treated with an antiandrogen) were enrolled onto this phase II trial. Patients were treated with oral estramustine 280 mg tid and oral etoposide 100 mg/d for 7 days, with paclitaxel 135 mg/m(2) IV over 1 hour on day 2 of each 21-day treatment cycle. Patients received a maximum of six cycles of therapy. RESULTS: Thirty-seven patients were assessable for response. Twenty-two had measurable disease at baseline; response was not assessable in six of these patients. Overall response was 45% (10 of 22 patients; 95% confidence interval [CI], 24% to 68%), and response was 63% (10 of 16) in assessable patients. Twenty-six patients had a > or = 50% decrease from their baseline prostate-specific antigen levels during therapy, for a response rate of 65% (95% CI, 48% to 79%) by this criterion. Median duration of response was 3.2 months, with an estimated median survival of 12.8 months. Major toxicities of therapy were leukopenia (eight patients had > or = grade 4 leukopenia) and anemia. Hematologic toxicity seemed to be associated with liver metastases. Serial measurements in 24 patients using the Functional Assessment of Cancer Therapy-Prostate (FACT-P) showed no significant change in quality of life (QOL) as a result of therapy. CONCLUSION: The combination of IV paclitaxel, oral estramustine, and oral etoposide is active in patients with advanced prostate cancer. The regimen is tolerable and does not have a significant impact on QOL as measured by the FACT-P in a limited sample of patients.     

Expression and subcellular localization of cyclin D1 protein in epithelial ovarian tumour cells

The expression of cyclin D1 protein in tumour sections from 81 patients with epithelial ovarian cancer was analysed using immunohistochemistry. The tumours that overexpressed cyclin D1 in more than 10% of neoplastic cells were considered positive. Thus overexpression of cyclin D1 was observed in 72/81 (89%) of the cases examined. Protein was detected in both the nucleus and the cytoplasm in 24/81 (30%) and localized exclusively in the cytoplasm in 48/81 (59%) of the tumours. Cyclin D1 was overexpressed in both borderline and invasive tumours. There was no association between protein overexpression and tumour stage and differentiation. Furthermore, no correlation between cyclin D1 expression and clinical outcome was observed. However, in tumours overexpressing cyclin D1 (n = 72), the proportion displaying exclusively cytoplasmic localization of protein was higher in those with serous compared with non-serous histology (P = 0.004, odds ratio 4.8, 95% confidence interval 1.4-19.1). Western analysis using a monoclonal antibody to cyclin D1 identified a 36 kDa protein in homogenates from seven tumours displaying cytoplasmic only and one tumour demonstrating both nuclear and cytoplasmic immunostaining. Using restriction fragment length polymorphism polymerase chain reaction and PCR-multiplex analysis, amplification of the cyclin D1 gene (CCND1 was detected in 1/29 of the tumours demonstrating overexpression of cyclin D1 protein. We conclude that deregulation of CCND1 expression leading to both cytoplasmic and nuclear protein localization is a frequent event in ovarian cancer and occurs mainly in the absence of gene amplification.