Individual and Combined Associations of Cognitive and Mobility Limitations on Mortality Risk in Older Adults

Objective

To evaluate the potential independent and combined associations of cognitive and mobility limitations on risk of all-cause mortality in a representative sample of the US older adult population who, at baseline, were free of cardiovascular and cerebrovascular disease.

Functional independence measure prediction: an initial evaluation of residents' skills

The purpose of this preliminary study was to assess the ability of first-year PM&R residents to accurately predict functional outcome in an acute rehabilitation setting. Although statistically significant, the accuracy and precision of the residents' predictive skills were rather modest. A future focus on innovative methods to evaluate and develop these clinical skills appears warranted.     

Reviews of units of care: Combining practice,research and quality assurance

Fitzgerald M, Hill A, Mann R, Turrell S. International Journal of Nursing Practice 1998; 4: 134–141 Reviews of units of care: Combining practice, research and quality assurance That nurses should base their practice on the best available knowledge is generally accepted by the profession. However, the operationalisation of this ideal is difficult for hard pressed clinicians. We believe that responsibility for assimilating current knowledge in a practical format belongs to all nurses working in an organisation. This paper describes a project where clinicians, administrators and academics have collaborated to rewrite standards of practice in a format that includes up to date evidence and practical measures for appraising outcomes. This work is a practical example of quality assurance activities serving to create opportunities for collaboration between nurses who have chosen to practice, teach, manage and/or research nursing.     

Herpesvirus saimiri-based vector biodistribution using noninvasive optical imaging

Herpesvirus saimiri (HVS) is capable of infecting a range of human cell types with high efficiency and the viral genome persists as high copy number, circular, nonintegrated episomes which segregate to progeny upon cell division. This allows the HVS-based vector to stably transduce a dividing cell population and provide sustained transgene expression for an extended period of time both in vitro and in vivo. Here we assess the dissemination of HVS-based vectors in vivo following intravenous and intraperitoneal administration. Bioluminescence imaging of an HVS-based vector expressing luciferase demonstrates that the virus can infect and establish a persistent latent infection in a variety of mouse tissues. Moreover, the long-term in vivo maintenance of the HVS genome as a nonintegrated circular episome provided sustained expression of luciferase over a 10-week period. A particularly high level of transgene expression in the liver and the ability of HVS to infect and persist in hepatic stellate cells suggest that HVS-based vectors may have potential for the treatment of inherited and acquired liver diseases.     

Hepatoma induced by thorium dioxide.

A 74-year-old man complained of anorexia and weight loss. Twenty-six years earlier he had received an injection of Thorotrast. A needle biopsy of the liver showed thorium dioxide granules and periportal fibrosis. On laparotomy, a hepatoma of the left lobe of the liver was discovered. Hepatic malignancy should be suspected in any patient with abnormal results of liver function tests, particularly an elevated level of alkaline phosphatase, who previously has had an injection of Thorotrast.     

Characterization of the renal effects and renal elimination of sulotroban in the dog.

The renal effects and renal handling of the nonprostanoid thromboxane receptor antagonist, sulotroban (4-[2-(phenylsulfonylamino)ethyl]phenoxyacetic acid), were characterized in dogs. Sulotroban was infused i.v. at 0.06, 0.2, 0.6 and 1.0 mg kg-1 min-1 (plus prime) for 180 min. Arterial blood pressure was reduced significantly during infusion of the 1.0 mg kg-1 min-1 dosage only. Diuresis, characterized by increases in both fractional and absolute urinary excretion of sodium, potassium, chloride and calcium, and decreases in urine osmolality occurred at each of the sulotroban dosages tested. The renal clearance of sulotroban exceeded the glomerular filtration rate, suggesting renal secretion of sulotroban. The transport maximum for sulotroban secretion was approximately 160 micrograms kg-1 min-1. Renal cortical slices from naive dogs accumulated [14C]sulotroban against a concentration gradient. Sulotroban accumulation was blocked by metabolic inhibitors (dinitrophenol and sodium azide) and inhibitors of organic anion transport (probenecid and p-aminohippurate), but not by inhibitors of organic cation transport (cyanine and tetraethylammonium), suggesting that tubular secretion of sulotroban is mediated by an organic anion transport system. It was concluded that: 1) decreases in blood pressure occurred only after high dosages and were associated with high plasma sulotroban concentrations; 2) diuresis occurred at all dosages and may represent a separate pharmacological action unrelated to thromboxane receptor antagonism; and 3) renal excretion of sulotroban in the dog occurs by both filtration and tubular secretion with secretion occurring via an organic acid transporter.     

Use of the Ottawa ankle rules by nurse practitioners.

OBJECTIVE: To determine the ability of nurse practitioners to use the Ottawa ankle rules by comparing their requests for radiography with those of senior house officers (SHOs). METHOD: 1365 patients were assessed by a nurse trained in the use of the Ottawa ankle rules. Where indicated the nurse sent the patient for radiography. 700 patients in the same period were seen by SHOs who had not received training in these rules. After three months the SHOs were similarly trained in the use of the rules and a further 700 patients were seen. RESULTS: Nurse practitioners assessed 1365 patients; 72.6% had radiography. 1398 patients were seen only by an SHO. Before their use of the Ottawa ankle rules SHOs requested radiography in 91.0% (p = 0.001); using the rules this fell to 74.2% (p = 0.001). CONCLUSION: Nurse practitioners trained to use the Ottawa ankle rules are as effective as SHOs in the implementation of the rules. Moreover the sensitivity and specificity of the Ottawa ankle rules was similar to that seen in other studies.