A self-report home environment screening tool identified older women at risk of falls

Objective

To evaluate a self-report version of the Home Falls and Accidents Screening Tool (HOME FAST-SR).

Study Design and Setting

The HOME FAST-SR was designed using expert review, pretesting and piloting. Agreement of self-reported home hazard ratings and ratings by health professionals was evaluated using the kappa statistic. The HOME FAST-SR was validated in a cross-sectional survey of 568 older community-living Australian women using endorsement rates for HOME FAST-SR items and the association of scores with self-reported falls.

Results

The 87-item HOME FAST-SR was constructed, and a scoring system was devised to calculate equivalent scores for the health professional version of the HOME FAST (HOME FAST-HP). Endorsement rates demonstrated that no items needed to be removed. Agreement between self-reported and professional ratings was moderate with therapists under-reporting hazards compared with older people. The mean HOME FAST score for the 568 cross-sectional participants was 9.39 (95% confidence interval: 9.1, 9.7) with a range from 2 to 23 out of a possible 25. Fallers had a significantly higher HOME FAST score (P = 0.02).

Conclusion

The HOME FAST-SR is a viable alternative to the HOME FAST-HP, and scores were associated with falls experienced by older women in a cross-sectional study.     

An incidental finding of unroofed coronary sinus during angiography confirmed by 3D echocardiography; A case report

Unroofed coronary sinus (UCS) is an uncommon congenital heart anomaly and the most unusual type of atrial septal defect. This report presents a 71‐year‐old female with palpitation and dyspnea following an emotional stress, who was referred for ablation of typical atrial flutter. Finally diagnosed with a partially unroofed CS causing a bidirectional shunt.     

Vaginal cells of smokers are more resistant to human papillomavirus infection than that of non-smokers

To evaluate effect of HPV and smoking on DNA double-strand breaks in vaginal samples, vaginal specimens collected from participants (n = 76) were classified based on HPV and smoking status, and DNA double-strand breaks measured using comet assay.     

Carcinoid heart disease and the utility of 3D trans-thoracic and trans-esophageal echocardiography: Two clinical cases

Carcinoid tumors are rare neuroendocrine malignancies. We present two cases of metastatic carcinoid tumors, complicated by carcinoid syndrome and by cardiac valve involvement. Carcinoid syndrome is characterized by secretory diarrhea, episodic flushing, and bronchospasm. Cardiac involvement occurs in up to 50% of patients with metastatic carcinoid tumors which commonly causes abnormalities of the right sided valves. Echocardiography is the best available and non invasive technique for diagnosis. Characteristic features of carcinoid heart disease are thickened, shortened, retracted, and fixed or partially fixed valve leaflets. Three-dimensional (3D) echocardiography provided an en face view of pulmonary and tricuspid valve, not obtainable by two-dimensional echocardiography, and improved delineation of the relationship between these structures and cardiac chambers.     

Training in the Implementation of Prolonged Exposure Therapy: Provider Correlates of Treatment Outcome

The authors examined the degree to which provider characteristics, such as profession, treatment orientation, prior experience in treating posttraumatic stress disorder (PTSD), prior experience with prolonged exposure (PE) therapy, and attitudes about PE, were related to the clinical outcomes of veterans receiving care from clinicians participating in the national Department of Veterans Affairs (VA) PE Training Program. Positive patient outcomes were achieved by providers of every profession, theoretical orientation, level of clinical experience treating PTSD, and prior PE training experience. With 1,105 providers and 32 predictors (13 provider variables), power was at least 90% power to detect an effect of β = .15. Profession was the only provider characteristic significantly related to outcomes, but the mean effect (a 2 point difference on the PTSD Checklist) was too small to be clinically meaningful. The results support the intensive training model used in the VA PE training program and demonstrate that clinicians of varying backgrounds can be trained using interactive training workshops followed by case consultation to deliver PE effectively.     

Oral carnitine supplementation for dyslipidemia in chronic hemodialysis patients

Carnitine deficiency is a commonly observed problem in maintenance hemodialysis (MHD) patients, which results in altered metabolism of fatty acids and subsequently development of dyslipidemia. To evaluate the effect of oral L-carnitine (LC) supplementation on lipid profile of adult MHD patients, we studied 30 of them (19 males, 11 females) who received LC supplementation of 250 mg tablets three times a day for eight weeks. They were compared with 30 matched patients as a control group. Serum lipid profiles were compared before and after the intervention between the two groups. There was a significant decrease of the values of the lipid profile in the intervention group before and after carnitine supplementation including the mean values of total cholesterol (190 ± 36.8 vs. 177 ± 31.2 mg/dL), triglyceride (210 ± 64.7 vs. 190 ± 54.1 mg/dL) and LDL-cholesterol (117 ± 30.1 vs. 106 ± 26.3 mg/dL), while the values did not change siginificantly from base line in the control group. However, the difference for HDL-cholesterol in intervention group was not statistically significant. None of the patients dropped out of the study due to drug side effects. Oral LC supplementation (750 mg/day) is able to improve lipid profile in patients on MHD. Further long-term studies with adequate sample size are needed to define the population of patients who would benefit more from carnitine therapy and the optimal dose and the most efficient route for administration of the drug.