Hemodialysis vascular access: percutaneous interventions by nephrologists

Traditionally hemodialysis vascular access-related procedures have been almost exclusively performed by surgeons and interventional radiologists. In recent years, nephrologists have taken the initiative of performing these procedures themselves. Because of their unique clinical perspective on dialysis access and better understanding of the intricacies of renal replacement therapy, nephrologists are ideally suited for this activity. This approach has minimized delays, decreased hospitalizations, and decreased the use of temporary catheters, thereby improving medical care, decreasing costs, and increasing patient convenience. Vascular access-related procedures commonly performed by nephrologists include percutaneous balloon angioplasty, thrombectomy, and tunneled hemodialysis catheter-related procedures. In addition, using vein obliteration and percutaneous balloon angioplasty techniques, nephrologists have recently documented successful salvage of arteriovenous fistulas that had failed to mature, whereas traditionally these fistulas have frequently been abandoned. While the performance of these procedures by nephrologists offers many advantages, appropriate training in order to develop the necessary procedural skills is critical. Recent data have emphasized that a nephrologist can be successfully trained to become a competent interventionalist. In addition to documenting excellent outcome data, multiple reports have demonstrated the safety and success of interventional nephrology. This review focuses on hemodialysis access-related procedures performed by nephrologists and calls for a proactive approach in optimizing this aspect of patient care.     

Health Behaviors of Older Chinese Adults Living in New York City

The dramatic increase in the number of older immigrants living in the U.S. presents new challenges to policy makers concerned with promoting healthy aging. To date, however, strikingly little is known regarding the health and health trajectories of older immigrants. This paper examines the prevalence and predictors of important health behaviors associated with chronic disease prevention, including current smoking status, physical activity, alcohol use, and body mass index (BMI). We analyzed data from the 2003 New York City Chinese Health Survey (NYC CHS), the largest probability-based sample of Chinese immigrants residing in two distinct communities. In-person interviews were conducted with 517 representative men and women aged 55-75. Logistic regression modeling was used to test the influence of demographic, socioeconomic status, acculturation, and health characteristics on selected health behaviors. Results revealed that having more education and better physical health status were associated with greater participation in physical activity. Gender-specific analyses indicated that the effect of selected predictors varied between the sexes. For example, among older Chinese women, acculturation was negatively associated with alcohol use. This study provides some of the first evidence on health behaviors of one of the fastest growing older immigrant groups in the U.S. Study results add to the emerging literature on the complex nature of immigrant health trajectories, and demonstrate that contrary to prior research, living a greater proportion of time in the U.S. can be associated with selected positive health behaviors. Further longitudinal studies are needed to help inform policy initiatives to encourage healthy aging among diverse older immigrant groups.     

Heart-rate response to alpha<Subscript>2</Subscript>-adrenergic receptor antagonism by antipsychotics

Purpose

To explore the relationship between antipsychotic-associated antagonism of alpha₂-adrenergic receptors and resting heart rate in individuals with schizophrenia.

Methods

Thirty-one inpatients treated with antipsychotics were included in this exploratory analysis. Antipsychotic doses were converted to haloperidol equivalents for alpha₂-adrenergic receptor antagonism. Resting heart rate was measured with the patient in the seated upright posture.

Results

After controlling for confounding variables, the relationship between alpha₂-adrenergic receptor antagonism and resting heart rate demonstrated a positive linear effect (P = 0.002) as well as a nonlinear effect that accounted for an additional 14% of the variability in resting heart rate (P = 0.005).

Conclusion

The observed inverted-U relationship between alpha₂-adrenergic receptor antagonism and resting heart rate can possibly be attributed to an altered response of beta₁-adrenergic receptors to increased norepinephrine release. Further investigations are required to confirm this exploratory finding, taking into account additional variables that include other receptors which either directly or indirectly influence heart rate.

ClinicalTrials.gov Identifier

NCT01392885.

     

The cancer Support Person's Unmet Needs Survey

BACKGROUND:

A rigorous psychometric methodology was used to develop a measure of unmet needs for cancer survivors' principal support persons. Principal support person was defined as “someone you can count on and who helps you with your needs.”

METHODS:

Development of the domains and the items followed an extensive literature review, iterative input from support persons, and consultation with health professionals and front‐line staff working with cancer survivors and their supports. Cognitive interviews helped clarify item wording, and the draft questionnaire was reappraised by a group of support persons. The questionnaire was reduced to 90 items and sent to a stratified, random sample of cancer survivors selected from a provincial population‐based cancer registry. They were asked to give the survey to their support person.

RESULTS:

The resulting 78‐item Support Person Unmet Needs Survey has high acceptability, item test‐retest reliability, internal consistency (Chronbach alpha = .990), and face, content, and construct validity. It captures 6 domains of unmet needs and accounts for 73.5% of total variance: Information and Relationship Needs (27 items, 22.1% of variance), Emotional Needs (16 items, 15.2%), Personal Needs (14 items, 14.0%), Work and Finance (8 items, 8.8%), Health Care Access and Continuity (9 items, 8.6%), and Worries About Future (4 items, 4.8%).

CONCLUSIONS:

This instrument will be of use where there is an interest in examining the impact of cancer not only on cancer survivors but also on their identified principal support persons. Cancer 2009. © 2009 American Cancer Society.     

An Exploratory Behavioral Intervention Trial to Improve Rates of Screening for AIDS Clinical Trials Among Racial/Ethnic Minority and Female Persons Living with HIV/AIDS

Individuals from racial/ethnic minority backgrounds and women have not been proportionately represented in AIDS clinical trials (ACTs). There have been few intervention efforts to eliminate this health disparity. This paper reports on a brief behavioral intervention to increase rates of screening for ACTs in these groups. The study was exploratory and used a single-group pre/posttest design. A total of 580 persons living with HIV/AIDS (PLHA) were recruited (39% female; 56% African-American, 32% Latino/Hispanic). The intervention was efficacious: 25% attended screening. We identified the primary junctures where PLHA are lost in the screening process. Both group intervention sessions and an individual contact were associated with screening. Findings provide preliminary support for the intervention’s efficacy and the utility of combining group and individual intervention formats. Interventions of greater duration and intensity, and which address multiple levels of influence (e.g., social, structural), may be needed to increase screening rates further.     

Effects of low intensity pulsed ultrasound with and without increased cortical porosity on structural bone allograft incorporation

Background  

Though used for over a century, structural bone allografts suffer from a high rate of mechanical failure due to limited graft revitalization even after extended periods in vivo. Novel strategies that aim to improve graft incorporation are lacking but necessary to improve the long-term clinical outcome of patients receiving bone allografts. The current study evaluated the effect of low-intensity pulsed ultrasound (LIPUS), a potent exogenous biophysical stimulus used clinically to accelerate the course of fresh fracture healing, and longitudinal allograft perforations (LAP) as non-invasive therapies to improve revitalization of intercalary allografts in a sheep model.     

Disrupted cortical map and absence of cortical barrels in growth-associated protein (GAP)-43 knockout mice

There is strong evidence that growth-associated protein (GAP-43), a protein found only in the nervous system, regulates the response of neurons to axonal guidance signals. However, its role in complex spatial patterning in cerebral cortex has not been explored. We show that mice lacking GAP-43 expression (-/-) fail to establish the ordered whisker representation (barrel array) normally found in layer IV of rodent primary somatosensory cortex. Thalamocortical afferents to -/- cortex form irregular patches in layer IV within a poorly defined cortical field, which varies between hemispheres, rather than the stereotypic, whisker-specific, segregated map seen in normal animals. Furthermore, many thalamocortical afferents project abnormally to widely separated cortical targets. Taken together, our findings indicate a loss of identifiable whisker territories in the GAP-43 -/- mouse cortex. Here, we present a disrupted somatotopic map phenotype in cortex, in clear contrast to the blurring of boundaries within an ordered whisker map in other barrelless mutants. Our results indicate that GAP-43 expression is critical for the normal establishment of ordered topography in barrel cortex.