An ecological study of temporal trends in ‘deaths of despair’ in England and Wales

Social Psychiatry and Psychiatric Epidemiology - There is growing interest in the concept of ‘deaths of despair’ (DoD)—defined as deaths from three causes: suicide, drug...     

Factors impacting the expression of membrane-bound proteins in lymphocytes from HIV-positive subjects

BACKGROUND: The cellular transport proteins ABCB1, ABCC1 and ABCG2 have been implicated in the efflux of some antiretroviral drugs, thus decreasing their intracellular concentrations. Decreased drug accumulation in lymphocytes may allow viral replication and the subsequent emergence of viral resistance leading to treatment failure. Expression of HIV co-receptors on the surface of lymphocytes may influence viral tropism and therefore viral pathogenicity and disease progression. Here, we describe the relationship between expression of transport proteins and chemokine receptors in lymphocytes isolated from HIV-infected individuals and also investigate their relationship with demographic, therapeutic and virological factors. METHODS: Peripheral blood mononuclear cells (PBMC) isolated from HIV-positive individuals were co-stained for expression of CD4 and ABCB1, ABCC1, ABCG2, CXCR4 and CCR5. The influence of gender, ethnicity, treatment status, viral load and CD4 count was assessed on expression of each protein as well as correlations between expression of the proteins by univariate and multivariate analyses. RESULTS: Expression of ABCB1 was independently associated with gender (n = 98) and expression of ABCG2 and CXCR4. Gender also correlated with expression of ABCC1 and CXCR4 in univariate analysis with lower expression being detected in females compared with males. CONCLUSIONS: Here we confirm that the previously reported correlation between ABCB1 and CXCR4 observed in PBMC isolated from healthy volunteers is also found in HIV-positive individuals. The influence of gender on the expression of drug efflux proteins could be a determinant of intracellular drug concentrations in vivo.     

Validation of the German version of the ‘Hypogonadism Related Symptom Scale’ (HRS) in andrological patients with infertility,HIV infection and metabolic syndrome

As commonly used self‐reported screening instruments for male hypogonadism demonstrated lack of specificity, a Hypogonadism Related Symptom Scale (HRS) was developed in 2009 as a novel self‐rating screening tool. As the questionnaire has not been validated, the purpose of our study was to perform a validation in patients presenting with different disorders (e.g. infertility, HIV infection or metabolic syndrome) and disease‐related risk to develop hypogonadism. Two hundred and eighteen patients aged 19–71 years (40.1 ± 9.5) who completed the HRS and other common questionnaires [International Index Of Erectile Function (IIEF), National Institutes of Health Chronic Prostatitis Symptom Index (NIH‐CPSI), Hospital Anxiety and Depression Scale (HADS), short form (SF)‐12] were included. In all patients, blood levels of total testosterone, luteinizing hormone, follicle‐stimulating hormone, oestradiol and sex hormone‐binding globulin were determined and free testosterone was calculated. Cronbach's α for the scale was 0.896, split‐half 0.871 for the 1st half and 0.807 for the 2nd half. Spearman–Brown coefficient was 0.767, and Guttman split‐half coefficient was 0.759. Consistent correlations were found between HRS and IIEF5 (ρ = 0.57, P < 0.001), and HADS (ρ = ?0.6, P < 0.001). In addition, HRS was significantly correlated with total testosterone (ρ = 0.135, P < 0.05), free testosterone (ρ = 0.148, P < 0.05) and oestradiol (ρ = ?0.134, P < 0.05). Our validation study confirms the data from the initial development of the HRS questionnaire. Clinicians might have an additional advantage from the HRS when investigating males with suspected hypogonadism.     

Robotic Versus Laparoscopic Colorectal Surgery

Background:

Robotic approaches have become increasingly used for colorectal surgery. The aim of this study is to examine the safety and efficacy of robotic colorectal procedures in an adult population.

Study Design:

A systematic review of articles in both PubMed and Embase comparing laparoscopic and robotic colorectal procedures was performed. Clinical trials and observational studies in an adult population were included. Approaches were evaluated in terms of operative time, length of stay, estimated blood loss, number of lymph nodes harvested, and perioperative complications. Mean net differences and odds ratios were calculated to examine treatment effect of each group.

Results:

Two hundred eighteen articles were identified, and 17 met the inclusion criteria, representing 4,342 patients: 920 robotic and 3,422 in the laparoscopic group. Operative time for the robotic approach was 38.849 minutes longer (95% confidence interval: 17.944 to 59.755). The robotic group had lower estimated blood loss (14.17 mL; 95% confidence interval: –27.63 to –1.60), and patients were 1.78 times more likely to be converted to an open procedure (95% confidence interval: 1.24 to 2.55). There was no difference between groups with respect to number of lymph nodes harvested, length of stay, readmission rate, or perioperative complication rate.

Conclusions:

The robotic approach to colorectal surgery is as safe and efficacious as conventional laparoscopic surgery. However, it is associated with longer operative time and an increased rate of conversion to laparotomy. Further prospective randomized controlled trials are warranted to examine the cost-effectiveness of robotic colorectal surgery before it can be adopted as the new standard of care.     

Peroral Endoscopic Myotomy (POEM): Feasible as Reoperation Following Heller Myotomy

Purpose

The purpose of this study was to demonstrate the feasibility of performing peroral endoscopic myotomy (POEM) in the management of recurrent achalasia after failed myotomy.

Methods

Eight patients presented to our institution between October 2010 and June 2013 with recurrent/persistent symptoms after prior laparoscopic Heller myotomy. Three patients underwent redo laparoscopic Heller myotomy, and five patients consented to redo myotomy with POEM.

Results

Demographics were similar between the groups with exception of age (POEM 69.5 vs. laparoscopic Heller myotomy (LHM) 34.5, p?=?0.003). Preoperative Eckardt scores, motility, and prior interventions were not significantly different. Three patients who underwent POEM and two who underwent laparoscopic Heller myotomy had prior fundoplication. There was one perforation identified after laparoscopic Heller myotomy and one patient with persistent subcutaneous emphysema after POEM. Both POEM and laparoscopic Heller myotomy demonstrated significant improvement in symptoms and Eckardt scores at average follow-up of approximately 5 months (p?<?0.05).

Conclusion

POEM is a feasible option for patients after failed myotomy even in the presence of prior fundoplication. The procedure can be performed safely using a similar technique as for primary myotomy with the exception of creating the myotomy laterally along the right side of the esophagus and lesser curvature avoiding the previous anterior myotomy.     

Assessing Student Pharmacists’ Ability to Identify Drug-Related Problems in Patients Within a Patient-Centered Medical Home

Objective. To quantify, describe, and categorize patient drug-related problems (DRPs) and recommendations identified by fourth-year (P4) student pharmacists during a live medication reconciliation activity within a patient-centered medical home (PCMH).Methods. Fourth-year student pharmacists conducted chart reviews, identified and documented DRPs, obtained live medication histories, and immediately provided findings and recommendations to the attending physicians. Documentation of DRPs and recommendations were analyzed retrospectively.Results. Thirty-eight students completed 99 medication reconciliation sessions from June 2011 to October 2012 during their advanced pharmacy practice experience (APPE). The students obtained 676 patient medication histories and identified or intervened on 1308 DRPs. The most common DRPs reported were incomplete medication list and diagnostic/laboratory testing needed. Physicians accepted 1,018 (approximately 78%) recommendations.Conclusion. Student pharmacists successfully identified and reduced DRPs through a live medication reconciliation process within an academic-based PCMH model. Their medication history-taking skills improved and medication use was optimized.