Intravenous unfractionated heparin dosing in obese patients using anti-Xa levels

There is limited guidance on intravenous dosing of unfractionated heparin in obese patients. The purpose of this study was to determine the efficacy and safety of a standard unfractionated heparin (UFH) protocol in obese patients based on total body weight (TBW) or adjusted body weight (ABW) to reach two consecutive therapeutic anti-Xa levels. This was a retrospective observational cohort study conducted in a large academic medical center. Adults received a standard UFH protocol between January 1, 2013 to December 31, 2015. Inclusion criteria included age ≥ 18 years of age, weight ≥ 100 kg with a BMI ≥ 30 kg/m², and received intravenous UFH. Patients were excluded if they received an alternative UFH protocol, received?<?24 h of the standard UFH protocol, or had inadequate compliance to protocol. Out of the 131 patients included, 109 patients reached two consecutive therapeutic UFH levels within 96 h. The average time to two consecutive therapeutic UFH levels was 29.4 h and 27.6 h in patients dosed by TBW and ABW, respectively (95% CI ??4.63 to 8.11; P?=?0.93). Safety outcomes included major bleeding, overt bleeding, or death events between patients dosed by TBW compared to ABW, (p?=?0.61, p?=?1.0, p?=?1.0, respectively). Dosing intravenous UFH based on TBW or ABW resulted in similar times to therapeutic anti-Xa levels and safety outcomes. The data provided suggests using either TBW or ABW in obese patients is as effective and safe to use.

     

The efficacy and safety of Grafix® for the treatment of chronic diabetic foot ulcers: results of a multi‐centre,controlled, randomised,blinded, clinical trial

In a randomised, controlled study, we compared the efficacy of Grafix^®, a human viable wound matrix (hVWM) (N = 50), to standard wound care (n = 47) to heal diabetic foot ulcers (DFUs). The primary endpoint was the proportion of patients with complete wound closure by 12 weeks. Secondary endpoints included the time to wound closure, adverse events and wound closure in the crossover phase. The proportion of patients who achieved complete wound closure was significantly higher in patients who received Grafix (62%) compared with controls (21%, P = 0·0001). The median time to healing was 42 days in Grafix patients compared with 69·5 days in controls (P = 0·019). There were fewer Grafix patients with adverse events (44% versus 66%, P = 0·031) and fewer Grafix patients with wound‐related infections (18% versus 36·2%, P = 0·044). Among the study subjects that healed, ulcers remained closed in 82·1% of patients (23 of 28 patients) in the Grafix group versus 70% (7 of 10 patients) in the control group (P = 0·419). Treatment with Grafix significantly improved DFU healing compared with standard wound therapy. Importantly, Grafix also reduced DFU‐related complications. The results of this well‐controlled study showed that Grafix is a safe and more effective therapy for treating DFUs than standard wound therapy.     

Trends in Childhood Influenza Vaccination Coverage—U.S., 2004–2012

Objective

We compared estimates of childhood influenza vaccination coverage by health status, age, and racial/ethnic group across eight consecutive influenza seasons (2004 through 2012) based on two survey systems to assess trends in childhood influenza vaccination coverage in the U.S.

Methods

We used National Health Interview Survey (NHIS) and National Immunization Survey-Flu (NIS-Flu) data to estimate receipt of at least one dose of influenza vaccination among children aged 6 months to 17 years based on parental report. We computed estimates using Kaplan-Meier survival analysis methods.

Results

Based on the NHIS, overall influenza vaccination coverage with at least one dose of influenza vaccine among children increased from 16.2% during the 2004–2005 influenza season to 47.1% during the 2011–2012 influenza season. Children with health conditions that put them at high risk for complications from influenza had higher influenza vaccination coverage than children without these health conditions for all the seasons studied. In seven of the eight seasons studied, there were no significant differences in influenza vaccination coverage between non-Hispanic black and non-Hispanic white children. Influenza vaccination coverage estimates for children were slightly higher based on NIS-Flu data compared with NHIS data for the 2010–2011 and 2011–2012 influenza seasons (4.1 and 4.4 percentage points higher, respectively); both NIS-Flu and NHIS estimates had similar patterns of decreasing vaccination coverage with increasing age.

Conclusions

Although influenza vaccination coverage among children continued to increase, by the 2011–2012 influenza season, only slightly less than half of U.S. children were vaccinated against influenza. Much improvement is needed to ensure all children aged ≥6 months are vaccinated annually against influenza.Recommendations to vaccinate children against influenza began in 1960, when people with certain health conditions that put them at increased risk of severe illness from influenza were recommended to receive annual influenza vaccination, implicitly including children with high-risk conditions.¹ The recommendations for influenza vaccination of children remained unchanged until 2002, when providers were encouraged to vaccinate all children aged 6–23 months, regardless of medical conditions,² and in 2004, when all children aged 6–23 months were explicitly recommended for vaccination.³ In 2006, the influenza recommendations were expanded to include annual vaccination for all children aged 6–59 months.⁴ Recommendations were further expanded in 2008 to include annual vaccination of all children aged 6 months to 18 years.⁵Since the 2010–2011 influenza season, annual influenza vaccination has been recommended for all people aged 6 months and older.⁶ Children aged 6 months to 8 years should receive two doses of influenza vaccine, spaced four weeks apart, during their first season of vaccination and then one dose per season in subsequent seasons.⁷ During inter-pandemic seasons through 2011–2012, trivalent influenza vaccine was available, providing protection against two influenza A subtypes and one type B strain. During the 2009–2010 influenza season, two influenza vaccines were recommended: the trivalent seasonal influenza vaccination and the pandemic influenza A(H1N1)pdm09 (pH1N1) monovalent vaccination.⁸The National Health Interview Survey (NHIS) and the National Immunization Survey-Flu (NIS-Flu) have been the primary surveys used to measure influenza vaccination coverage among children. NHIS, an in-person household survey, began collecting parental report of influenza vaccination in 2005.⁹ NHIS has been considered the most representative source for estimates of influenza vaccination coverage among children aged 6 months to 17 years and has served as the Healthy People data source for influenza vaccination estimates.¹⁰ NHIS, however, has not routinely allowed for state-level estimates and is not timely enough to enable the reporting of influenza estimates before the beginning of the next influenza season. NIS-Flu is an ongoing telephone survey of households with children aged 6 months to 17 years. National and state-level estimates of influenza vaccination coverage for children based on parental-reported vaccination status from NIS-Flu have been reported by fall of the subsequent influenza vaccination season.^11,12The aims of this study were to (1) examine estimates of childhood influenza vaccination coverage over time by age, race/ethnicity, and high-risk status; and (2) compare estimates from NHIS and NIS-Flu, the two main survey systems currently used to measure influenza vaccination coverage among children in the U.S.     

Patient Proactivity: Behaviors,Attitudes, and Its Relationship With Satisfaction With the American Health Care Delivery System

A sample of 1,031 U.S. adult residents provided information regarding actions that fall within the realm of patient proactivity, that is to say efforts that are overtly designed to maintain or regain one's health. An assessment of consumers revealed that they engage in, or at least support, behaviors that would be characterized as proactive. Furthermore, there is a significant relationship between some elements of patient proactivity and the level of satisfaction with the American health care system. The relationships are modest, but they offer managerial insight that will benefit those responsible for both delivering and marketing health care.     

Evidence for preferential adhesion of ovarian epithelial carcinoma cells to type I collagen mediated by the αA2β1 integrin

Epithelial ovarian carcinoma, the leading cause of gynecologic cancer death, is characterized by widespread intra-abdominal metastases mediated primarily by surface shedding of tumor cells and peritoneal implantation. Whereas hematogenous metastasis is known to involve cellular adhesion, extracellular matrix proteolysis and cell migration, the role of these processes in the intraperitoneal dissemination of ovarian cancer remains unclear. To analyze further the role of adhesion and proteolysis in ovarian carcinoma dissemination, we have characterized the adhesive profiles of 4 primary cultures of ovarian carcinoma cells and 5 ovarian carcinoma cell lines. Our data demonstrate preferential adhesion of ovarian carcinoma cells to interstitial type I collagen. Analysis of adhesion molecule expression demonstrated the presence of the α2 and β1 integrin subunits by cell surface ELISA, immunoprecipitation and immunohistochemistry. Furthermore, antibodies directed against the α2 and β subunits inhibited adhesion of ovarian carcinoma cells to type 1 collagen by 56% and 95%, respectively. Plasminogen activator and matrix metalloproteinase production by adherent cells was not altered as a consequence of adhesion to individual extracellular matrix proteins; however, adhesion to an extracellular matrix comprised primarily of interstitial collagen increased plasminogen activator activity in 5 of 5 cell lines. Since the ovarian carcinoma micro-environment is rich in type 1 collagen, our data suggest that preferential adhesion to type 1 collagen followed by secretion of serine and metalloproteinases may represent a biochemical mechanism by which the intraperitoneal dissemination of ovarian carcinoma is mediated. © 1996 Wiley-Liss, Inc.     

The empowerment of women: A key to HIV prevention

We discuss the process underlying the success of an HIV-prevention project for young, inner-city women. The intervention was based on the concepts of empowerment and culturally sensitive skill building. Four critical points relevant to the translation of HIV prevention knowledge into behavioral change among the sample are examined: (1) integrating the important issues of the participants' lives into the HIV prevention program, (2) utilizing a group format to encourage cohesiveness and support, (3) engaging group facilitators to promote mutuality and equality, and (4) promoting ongoing, authentic relationships among the participants and staff members. Points are illustrated with vignettes reconstructed from the group facilitators' experiences with the participants.     

European clinical guidelines for Tourette Syndrome and other tic disorders. Part I: assessment

A working group of the European Society for the Study of Tourette Syndrome (ESSTS) has developed the first European assessment guidelines of Tourette Syndrome (TS). The available literature including national guidelines was thoroughly screened and extensively discussed in the expert group of ESSTS members. Detailed clinical assessment guidelines of tic disorders and their comorbidities in both children and adults are presented. Screening methods that might be helpful and necessary for specialists' differential diagnosis process are suggested in order to further analyse cognitive abilities, emotional functions and motor skills. Besides clinical interviews and physical examination, additional specific tools (questionnaires, checklists and neuropsychological tests) are recommended.     

The dopamine D-2 antagonist, Ro 22-1319, inhibits the persistent behavioral syndrome induced by iminodipropionitrile (IDPN) in mice

Chronic administration of beta,beta'-iminodipropionitrile causes a persistent syndrome of excitement, choreoathetoid movements, and circling (the "ECC-syndrome") which persists indefinitely after termination of the IDPN injections. Ro 22-1319 is a specific D-2 dopamine receptor antagonist which was recently synthesized to fit a hypothetical model of the D-2 receptor. Ro 22-1319 inhibited several aspects of the ECC-syndrome, although some of its components, such as backward pedaling and forepaw treading reminiscent of the serotonin syndrome, were exacerbated. These results suggest that several neurotransmitter systems may be involved in the ECC-syndrome.