Improvement of Statin Utilization in Veterans With Diabetes Through Pharmacy Interventions

Quality Improvement Success Stories are published by the American Diabetes Association in collaboration with the American College of Physicians and the National Diabetes Education Program. This series is intended to highlight best practices and strategies from programs and clinics that have successfully improved the quality of care for people with diabetes or related conditions. Each article in the series is reviewed and follows a standard format developed by the editors of Clinical Diabetes. The following article describes an effort aimed at increasing the use of statins among veterans with diabetes at a Veterans Affairs medical center in New Mexico.     

Psychiatric Medication Refill Practices of Juvenile Detainees

To examine the psychiatric medication fill rates of adolescents after release from juvenile detention. The team reviewed 177 charts. A fill was defined as a psychiatric medication charge to Medicaid 30- or 90-days after release. Differences in demographic characteristics were compared among individuals with fills at 30- or 90-days and those with no medication fills. Forty-five percent of patients were on at least one psychiatric medication. Among detainees on a psychiatric medication, 62 % had a fill by 30 days after release, and 78 % by 90 days. At least 50 % of the adolescents on a psychiatric medication were on an atypical antipsychotic. There was no significant relationship between medication fill and race, age, or sex. Despite the known associations between mental health diagnosis and treatment-seeking with age, sex, and race, it appears that psychiatric medication fill patterns after release from detention are not associated with these factors.     

The Actin‐Binding Protein Cofilin and Its Interaction With Cortactin Are Required for Podosome Patterning in Osteoclasts and Bone Resorption In Vivo and In Vitro

The adhesion of osteoclasts (OCs) to bone and bone resorption require the assembly of specific F‐actin adhesion structures, the podosomes, and their dense packing into a sealing zone. The OC‐specific formation of the sealing zone requires the interaction of microtubule (MT) + ends with podosomes. Here, we deleted cofilin, a cortactin (CTTN)‐ and actin‐binding protein highly expressed in OCs, to determine if it acts downstream of the MT‐CTTN axis to regulate actin polymerization in podosomes. Conditional deletion of cofilin in OCs in mice, driven by the cathepsin K promoter (Ctsk‐Cre), impaired bone resorption in vivo, increasing bone density. In vitro, OCs were not able to organize podosomes into peripheral belts. The MT network was disorganized, MT stability was decreased, and cell migration impaired. Active cofilin stabilizes MTs and allows podosome belt formation, whereas MT disruption deactivates cofilin via phosphorylation. Cofilin interacts with CTTN in podosomes and phosphorylation of either protein disrupts this interaction, which is critical for belt stabilization and for the maintenance of MT dynamic instability. Accordingly, active cofilin was required to rescue the OC cytoskeletal phenotype in vitro. These findings suggest that the patterning of podosomes into a sealing zone involves the dynamic interaction between cofilin, CTTN, and the MTs + ends. This interaction is critical for the functional organization of OCs and for bone resorption. © 2016 American Society for Bone and Mineral Research.     

Conventional versus CO2 laser-assisted treatment of peri-implant defects with the concomitant use of pure-phase beta-tricalcium phosphate: a 5-year clinical report

PURPOSE: Recently, histologic studies in the beagle dog model demonstrated that CO2 laser-assisted implant decontamination can result in reosseointegration. Consequently, the purpose of this study was to assess the efficacy of CO2 laser-assisted therapy as compared with conventional therapy, with the concomitant use of beta-tricalcium phosphate, in humans. MATERIALS AND METHODS: The study included 32 patients with 73 ailing implants. In the laser group, 22 implants were treated with soft tissue resection following laser decontamination; whereas in 17 implants, bone augmentation was performed. In the control group, soft tissue resection after conventional decontamination was performed in 19 implants, augmentation in 15 implants. Results were evaluated 4 months after surgery and in May 2004. RESULTS: Four months after therapy, there were no significant differences in distance from implant shoulder to the first bone contact (ie, DIB values) between implants undergoing laser decontamination and soft tissue resection and implants treated with conventional decontamination followed by soft tissue resection. At the end of the study, there was a statistically significant difference between these 2 groups. Four months after therapy, DIB values after laser decontamination and augmentation were significantly more favorable than after conventional decontamination and augmentation. This difference was no longer detectable at the end of the study. CONCLUSION: Based on the results of this study, it may be concluded that the treatment of peri-implantitis may be accelerated by using a CO2 laser concomitant with soft tissue resection. However, with respect to long-term results in augmented defects, there seems to be no difference between laser and conventional decontamination.     

Identification of Candida species in the clinical laboratory: a review of conventional,commercial, and molecular techniques

In healthy individuals, Candida species are considered commensal yeasts of the oral cavity. However, these microorganisms can also act as opportunist pathogens, particularly the so‐called non‐albicans Candida species that are increasingly recognized as important agents of human infection. Several surveys have documented increased rates of C. glabrata, C. tropicalis, C. guilliermondii, C. dubliniensis, C. parapsilosis, and C. krusei in local and systemic fungal infections. Some of these species are resistant to antifungal agents. Consequently, rapid and correct identification of species can play an important role in the management of candidiasis. Conventional methods for identification of Candida species are based on morphological and physiological attributes. However, accurate identification of all isolates from clinical samples is often complex and time‐consuming. Hence, several manual and automated rapid commercial systems for identifying these organisms have been developed, some of which may have significant sensitivity issues. To overcome these limitations, newer molecular typing techniques have been developed that allow accurate and rapid identification of Candida species. This study reviewed the current state of identification methods for yeasts, particularly Candida species.     

Lay images of mental illness: Social knowledge and tolerance of the mentally ill

It is argued that demographic factors alone fail to account for public attitudes toward mental illness. Medical and moral lay images of mental illness provide a knowledge base from which tolerance arises. Path analysis of data obtained from 713 rural Tennessee adults indicated low tolerance among those endorsing either lay image. Demographic background variables exerted no direct effects upon tolerance-these effects were mediated by lay images. Comparison of these data with research on attitudes toward alcoholism brings into question the relevance of attributed responsibility for different types of deviant behavior. Finally, the study raises questions regarding the assumption that greater knowledge and understanding will necessarily yield greater tolerance of deviance.     

Race/ethnicity,acculturation, and psychological distress: Fatalism and religiosity as cultural resources

Data from a community sample of 1,784 Anglo, African-American, and Mexican-American adults were examined to assess: (1) the nature and magnitude of observed racial/ethnic and acculturation level differences in depression, (2) the relative contribution of sociodemographic and psychosocial factors (fatalism and religiosity) to observed differences, and (3) the joint effects of fatalism and religiosity as sociocultural resources with regard to depression in differing racial/ethnic and acculturation level subgroups. Analyses indicate the most dramatic differences in depression among males—African Americans were roughly similar to Anglos and levels of depression were significantly higher among the least acculturated Mexican Americans relative to Anglos, even after statistical controls. Acculturation level differences among Mexican-American females were explained by statistical controls. Lower levels of depression among more highly acculturated than among less acculturated Mexican Americans provide little support for a simplistic stress formulation of acculturation. Rather, the interplay of acculturation, fatalism, and religiosity supports a more complex cultural marginality model, emphasizing the consistency of attitudinal elements and language use as facilitators or inhibitors of assimilation into Anglo culture. Both those who successfully acculturate and those who are most insulated in traditional culture appear least depressed from this perspective.     

GM1 and NGF synergism on choline acetyltransferase and choline uptake in aged brain

In the brain of aged rats high affinity choline uptake (HAChU) of the striatum, hippocampus, and frontal cortex is lower than in young rats, while choline acetyltransferase (ChAT) activity is lower in striatum and frontal cortex. Infusion into the lateral cerebral ventricle with nerve growth factor (NGF) enhances the low values of these cholinergic markers in a dose- and region-dependent manner. GM 1 ganglioside infused into the lateral ventricle, at a dose that is ineffective alone, together with NGF synergistically enhances the effect of NGF on ChAT and HAChU activities in the brain of aged animals. The pharmacology of this GM 1/NGF synergism suggests potentiation of response.