Usefulness outcome in evaluating the utility of nuclear scans of the bone, brain, and liver in bronchogenic carcinoma patients

In this study we employed the concept of the outcome audit to assess the "benefit" (in contrast to the number of positive readings) derived from 81 bone, 45 brain, and 47 liver scans, performed on 59 bronchogenic carcinoma patients. Benefit was rigorously defined and based on any outcome instrumental in the subsequent management of the patient. Clinically indicated scans were frequently found to be of benefit, while those without indications were not (88.0% vs. 12.5%). Negative scans were as useful as positive scans if clinically indicated (14.0% vs. 9.6%). Histology did not influence the likelihood of benefit. We conclude that scans obtained to evaluate a clinical abnormality are likely to be useful whether positive or negative while scans ordered without specific clinical indications are unlikely to be of management benefit.     

Hemodynamic and metabolic correlates of dipyridamole-induced myocardial thallium-201 perfusion abnormalities in multivessel coronary artery disease

The mechanisms responsible for the development of reversible thallium-201 (Tl-201) defects with dipyridamole stress in patients with coronary artery disease (CAD) is not well understood. Previous experimental animal studies have demonstrated coronary steal characterized by an absolute decrease in subendocardial flow distal to a stenosis in response to dipyridamole infusion. Accordingly, the purpose of this study was to determine if reversible Tl-201 defects in response to dipyridamole infusion are reflective of myocardial ischemia or secondary to regional differences in flow reserve. Dipyridamole (0.56 mg/kg) Tl-201 imaging was performed in 23 patients in whom serial electrocardiographic, hemodynamic, aortic and coronary sinus lactate, and coronary sinus adenosine measurements were obtained. All patients with CAD had Tl-201 redistribution (3.8 ± 2.0 defects/patient), and all patients without CAD had normal scans. Mean aortic pressure was similar in both groups and did not change in response to dipyridamole (non-CAD 103 ± 11 vs CAD 99 ± 15 mm Hg, P = NS). Pulmonary capillary wedge pressure was similar at baseline (non-CAD 11 ± 4 vs CAD 13 ± 5 mm Hg, P = NS) and did not change in response to the drug (non-CAD 14 ± 3 vs CAD 15 ± 7 mm Hg, P = NS). Lactate extraction fraction was similar at baseline (non-CAD 0.22 ± 0.09 vs CAD 0.17 ± 0.14, P = NS) and decreased similarly in both groups (non-CAD 0.08 ± 0.06 vs CAD 0.05 ± 0.12, P = NS). Coronary sinus adenosine concentration was significantly higher at baseline in patients with CAD (non-CAD 16 ± 4 vs CAD 35 ± 13 ng/ml, P = 0.034), presumably to maintain resting coronary blood flow, and increased significantly with a comparable percent increase in both groups after dipyridamole (non-CAD 35 ± 10 vs CAD 69 ± 35 ng/ml, P = 0.0001). In this group of patients with multivessel CAD, dipyridamole-induced Tl-201 perfusion abnormalities were not associated with significant myocardial ischemia by hemodynamic and metabolic criteria and appeared to be more indicative of abnormal flow reserve.     

Two novel and selective nonimidazole histamine H3 receptor antagonists A-304121 and A-317920: I. In vitro pharmacological effects

Histamine H3 receptor (H3R) antagonists enhance neurotransmitter release and are being developed for the treatment of a variety of neurological and cognitive disorders. Many potent histamine H3R antagonists contain an imidazole moiety that limits receptor selectivity and the tolerability of this class of compounds. Here we present the in vitro pharmacological data for two novel piperazine amide ligands, A-304121 [4-(3-((2R)-2-aminopropanoyl-1-piperazinyl)propoxy)phenyl)cyclopropylmethanone] and A-317920 [N-((1R)-2-(4-(3-(4-(cyclopropylcarbonyl)phenoxy)propyl)-1-piperazinyl)-1-methyl-2-oxo-ethyl-)-2-furamide], and compare them with the imidazole H3R antagonists ciproxifan, clobenpropit, and thioperamide. Both A-304121 and A-317920 bind potently to recombinant full-length rat H3R(pKi values = 8.6 and 9.2, respectively) but have lower potencies for binding the full-length human H3R (pKi values = 6.1 and 7.0, respectively). A-304121 and A-317920 are potent antagonists at rat H3R in reversing R-alpha-methylhistamine [(R)-alpha-MeHA] inhibition of forskolin-stimulated cAMP formation (pKb values = 8.0 and 9.1) but weak antagonists at human H3Rs in cyclase (pKb values = 6.0 and 6.3) and calcium mobilization (pKb values = 6.0 and 7.3) assays in cells co-expressing Galphaqi5-protein. Both compounds potently antagonize native H3Rs by blocking histamine inhibition of potassium-evoked [3H]histamine release from rat brain cortical synaptosomes (pKb values = 8.6 and 9.3) and (R)-alpha-MeHA reversal of electric field-stimulated guinea pig ileum contractions (pA2 values = 7.1 and 8.3). A-304121 and A-317920 are also more efficacious inverse agonists in reversing basal guanosine 5'-O-(3-[35S]thio)triphosphate ([35S]GTP gamma S) binding at the human H3R (pEC50 values = 5.7 and 7.0) than are the imidazole antagonists. These novel and selective piperazine amides represent useful leads for the development of H3R antagonist therapeutic agents.     

Use of non-technical skills can predict medical student performance in acute care simulated scenarios

Background

Though the importance of physician non-technical (NT) skills for safe patient care is recognized, NT skills of medical students, our future physicians, has received little attention. This study aims to investigate the relationship of medical student NT skills and clinical performance during acute care team simulation (ACTS).

Do Schools Influence Student Risk-taking Behaviors and Emotional Health Symptoms?

PurposeMany schools engage in health promotion, health interventions, and services aimed at improving the health and well-being outcomes for students. The purpose of this study was to examine the effects of schools on student health risk-taking behaviors and depressive symptoms.MethodA nationally representative sample (n = 9,056) of students from 96 secondary schools completed a health and well-being survey using Internet Tablets that included questions on school climate, health risk-taking behaviors, and mental health. Teachers (n = 2,901) and school administrators (n = 91) completed questionnaires on aspects of the school climate which included teacher well-being and burnout, the staff work environment, health and welfare services for students, and school organizational support for student health and well-being. Multilevel models were used to estimate school effects on the health risk-taking behaviors and depression symptoms among students.ResultsSchools where students reported a more positive school climate had fewer students with alcohol use problems, and fewer students engaging in violence and risky motor vehicle behaviors. Schools where teachers reported better health and welfare services for students had fewer students engaging in unsafe sexual health behaviors. Schools where teachers reported higher levels of well-being had fewer students reporting significant levels of depressive symptoms.ConclusionsMore positive school climates and better school health and welfare services are associated with fewer health risk-taking behaviors among students. However, the overall school effects were modest, especially for cigarette use and suicidal behaviors.     

Immigrant status and acculturation influence substance use among New Zealand youth

Objective: To investigate the associations between generational status, acculturation and substance use among immigrant and non‐immigrant secondary school students in New Zealand. Methods: A nationally representative sample of secondary school students in New Zealand was selected using a two‐stage cluster sample design. Of the 8,999 students in the sample, 23.81% were first‐generation immigrants and 20.90% were second‐generation immigrants; the remaining 55.29% students are collectively referred to as ‘non‐immigrant’ peers. Logistic regression models adjusted the associations of interest for age, gender, ethnicity, socioeconomic status and experience of ethnic discrimination. Results: First and second‐generation immigrants showed significantly lower risks of smoking cigarettes compared with their non‐immigrant peers. Similar trends were apparent for consuming alcohol and marijuana weekly. The inclusion of some characteristics suggestive of acculturation in multivariable models did not influence the relationship between generational status and smoking cigarettes, but attenuated the apparent protective effect of being a first‐generation immigrant with regard to alcohol and marijuana use. Conclusions and implications: The study shows the lower likelihood of substance use among newer immigrants in a nationally representative sample of New Zealand youth. Policies and health programs that build on this positive profile and reduce the risk of adverse changes over time require attention.