Mycotic aneurysm of the aorta: MRI and MRA features

Mycotic aneurysms of the abdominal aorta are potentially fatal but uncommon. We report the MRI and MRA features of an abdominal aortic mycotic aneurysm in a patient who presented with nonspecific low back pain. By delineating the saccular nature of the aneurysm and identifying the coexistence of vertebral enhancement, MRI was crucial for the final diagnosis. A potential pitfall of contrast-enhanced MRA is also demonstrated.     

Substance P augments the rate of vasodilation induced by calcitonin gene-related peptide in porcine ophthalmic artery in vitro.

Peptides may function as neurotransmitters liberated antidromically by sensory nerve fibres, provoking vascular responses having potential importance in some neurological disorders. Dose-response relaxation curves induced by substance P (SP) and calcitonin gene related peptide (CGRP) have been studied in porcine ophthalmic arteries in vitro. Both peptides induced vasodilation when tested separately (CGRP much greater than SP). Because of the putative interactions between such peptides in this vascular territory, a computerised system was also used for analysing over time the response to a single addition of either 10(-8) M CGRP, 10(-8) M SP or a combination of 10(-8) M SP + 10(-8) M CGRP. SP did not augment the maximum relaxation induced by CGRP alone, but increased significantly the rate of relaxation during the initial phase of the response. The effect induced by the SP+CGRP combination was stronger than the sum of the individual SP and CGRP-induced relaxations during the first 4 min of the response, which suggests a SP-CGRP synergism in this artery.     

Medication compliance in elderly people: influencing variables and interventions

This paper describes a study in which 70 elderly patients were assessed for risk factors in their medication regimen They were separated into three study groups, including two levels of teaching intervention focused on the home medication administration system, and a control group The intervention utilizing a follow-up telephone call demonstrated a significant change in risk-related behaviours such as verbalization of the regimen, congruence between instructions and usage of medications, and taking of medicines not currently prescribed or over-the-counter     

Clinical trial of a prevention and treatment protocol for skin breakdown in two nursing homes.

OBJECTIVE: Our objective was to assess the effectiveness of skin care protocols, including a body wash and skin protectant, on skin breakdown in 2 nursing homes. DESIGN: This was a quasi-experimental pretest/posttest design study.Setting and subjects Adult residents (n = 136) of 2 skilled nursing homes consented to participate in this study. Seventy percent were women; the sample average age of 82 years. INSTRUMENTS: A researcher-designed data recording form documented resident demographics, incidence and type of skin breakdown or pressure ulcer, presence of urinary or fecal incontinence, and assessment of the effectiveness of body wash and skin protectant. METHODS: Baseline data on prevalence of pressure ulcers and skin protocol were collected weekly for a 3-month period followed by a week-long educational program by the researchers about skin care and the body wash and skin protectant. During the 3-month trial with the body wash and skin protectant incorporated into routine care, research assistants recorded resident data weekly and researchers again assessed prevalence and incidence of pressure ulcers and skin breakdown weekly. RESULTS: Incorporation of a body wash and skin protectant into a skin care prevention and early intervention protocol in 2 nursing homes documented a decrease in skin breakdowns from 68 pre-intervention to 40 postintervention; the decrease in agency B was statistically significant. There was a statistically significant decrease in stage I and II pressure ulcer incidence overall (pre-intervention = 19.9%, postintervention = 8.1%). Nurses evaluated the body wash and skin protectant as effective for 98% of the time used. CONCLUSION: Implementation of a protocol for skin care along with staff education, including the prophylactic use of a body wash and skin protectant, reduced the incidence of skin breakdown, including pressure ulcers and perineal dermatitis, in 2 long-term care facilities.     

Diagnosis and evaluation of adults with attention-deficit/hyperactivity disorder.

Although some areas of adult ADHD knowledge remain unclear, there isa strong sense of how to proceed with diagnosis using current DSM-IV criteria as a guide. Thorough clinical interview, aided by the use of rating scales for current symptoms and collateral information about childhood from parents or siblings, forms the backbone of the assessment. The poor psychosocial outcomes of patients with ADHD. often a consequence of unrecognized,untreated disorder manifestation, also can serve as a diagnostic indicator. Diagnostic and symptom assessment scales also can be a significant helpin diagnosing and establishing the symptoms of ADHD in adults. It is important to remember that according to DSM-IV, the cardinal criteria for making the diagnosis are the presence of sufficient current symptoms and impairment in two realms (home, school/work, and social interactions). Accordingly, adult ADHD remains a clinical diagnosis, and the clinician-administered interview remains the cornerstone of diagnostic evaluation.     

Cluster headache: phospholipid metabolism in polymorphonuclear cells

Our group has previously reported significant changes in the incorporation of precursors into glycerophospholipids, particularly phosphatidylserine, in polymorphonuclear cells obtained from the peripheral blood of cluster headache patients, when compared with controls. The potential of these results led to further work using both the previous methodology and a modified isolation technique to obtain polymorphonuclear cells in as pure a state as possible. Neither the new results obtained using the original technique, nor the results with high purity polymorphonuclear cells from controls and cluster headache patients, confirm the marked changes in precursor uptake into glycerophospholipids originally reported.     

Proteasome inhibitor model of Parkinson's disease in mice is confounded by neurotoxicity of the ethanol vehicle.

Defects in the ubiquitin-proteasome system have been implicated in Parkinson's Disease (PD). Recently, a rat model of PD was developed using a synthetic proteasome inhibitor (PSI), (Z-lle-Glu(OtBu)-Ala-Leu-al). We attempted to transfer this model to mouse studies, where genetics can be more readily investigated due to the availability of genetically modified mice. We treated C57BL/6 (B6) mice with six intraperitoneal injections of 6 mg/kg PSI in 50 mul of 70% ethanol over a 2-week-period. We found significant decreases in nigrostriatal dopamine in PSI-treated mice compared with saline-treated mice. However, we observed similar decreases in the ethanol-treated vehicle control group. Administration of ethanol alone led to significant long-term alterations in dopamine levels. Ethanol significantly eclipses the effects of PSI in the dopamine system, and therefore is a confounding vehicle for this model.     

Theory and practice of sampling studies: exemplified by the MONICA survey

Résumé Parallèlement à l'enregistrement systématique des cas d'infarctus, le projet MONICA prévoit de mesurer à trois reprises le niveau des facteurs de risque cardio-vasculaires auprès d'un échantillon aléatoire. L'article présente le plan d'échantillonnage de ce premier «examen de santé» MONICA réalisé dans les cantons de Vaud, de Fribourg et du Tessin. Il s'agit d'un plan à deux niveaux, avec tirage stratifié des communes en fonction de leur taille, puis tirage des individus dans les fichiers communaux. Les conditions d'un plan d'échantillonnage efficace dans le cadre plus général de l'inférence statistique sont abordées dans une première partie théorique. Les raisons pratiques (contraintes budgétaires, problèmes de logistique, disponibilité des fichiers administratifs) qui ont motivé le choix de ce plan sont exposées ensuite. Une troisième partie décrit toutes les étapes de sa réalisation, avec les difficultés méthodologiques et concrètes rencontrées. La discussion porte sur une évaluation critique de toute la procédure qui, dans le cadre du projet MONICA, a produit des échantillons dont le degré d'adéquation avec la population est assez élevé.

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Theoretical and practical aspects of sampling: the MONICA-Project.

Summary In parallel with the systematic registration of myocardial infarction, the MONICA-Project attempts to investigate at three different times the prevalence of risk factors for cardiovascular disease in the population. This article presents the sampling plan of the first MONICA survey in the cantons of Vaud, Fribourg and Tessin. The sampling procedure was at two levels: first, a sample of communes stratified according to community size was chosen, and secondly, within these communities, individuals were selected from the population registries. The prerequisites for an efficient sampling plan are discussed on a theoretical level. In addition, the practical constraints (budget, organizational problems, population registry files) are presented. Finally, all steps of the sampling procedure are described including the difficulties encountered. The discussion attempts a critical evaluation of the whole MONICA sampling procedure whose results are largely satisfactory.

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Theorie und Praxis der Stichprobenbildung: das Beispiel des MONICA-Projektes

Zusammenfassung Neben einer systematischen Erfassung der Infarktfälle sieht das MONICA-Projekt eine dreimalige Erfassung der Risikofaktorenprävalenz vermittels einer Zufallsauswahl vor. Der vorliegende Artikel schildert den Stichprobenplan der ersten in den Kantonen Waadt, Freiburg und Tessin durchgeführten Untersuchung. Es handelt sich um einen zweistufigen Stichprobenplan: zuerst wurde eine Ziehung der Gemeinden — stratifiziert nach Gemeindegrösse — vorgenommen, danach wurden die Individuen auf Grund der Einwohnerregister gezogen. Die Grundbedingungen für einen effizienten Stichprobenplan werden in einem ersten theoretischen Abschnitt diskutiert. Im weiteren werden die konkreten Bedingungen der MONICA-Stichprobenziehung dargestellt (Budget-Limiten, organisatorische Probleme, Aufbau der Einwohnerregister). Ein dritter Teil beschreibt sämtliche Schritte der eigentlichen Stichprobenbildung einschliesslich der aufgetretenen Schwierigkeiten. Die Diskussion nimmt eine Gesamtbeurteilung der Stichprobenziehung im MONICA-Projekt vor, deren Ergebnis recht befriedigend ausfällt.

     

Disease Management and the Medical Home Model

For the past decade, US physicians have failed to embrace disease management (DM) approaches offered by private DM companies and health plans. Until recently, physicians have not offered an alternative, systematic approach to caring for patients with chronic illnesses and conditions.The medical home model has become the centerpiece of reforms proposed by associations that represent family medicine physicians (the American Academy of Family Physicians [AAFP]) and general internal medicine physicians (the American College of Physicians [ACP]). In February 2007, the AAFP and the ACP were joined by the American Academy of Pediatrics and the American Osteopathic Association in issuing joint principles for the patient-centered medical home. While the medical home model is promoted primarily as a comprehensive approach to primary care reform, there is one aspect where the medical home and DM overlap: care coordination.Medicare has been exploring alternative mechanisms to manage and reimburse chronic care and care-coordination activities. In 2003, the US Congress passed legislation to require pilot projects for chronic care improvement programs; the program implementing this legislation is Medicare Health Support (MHS). To date, very little information has been available about the progress of MHS projects. The three early announcements about MHS progress have not been encouraging: the expected financial results are not being achieved.In December 2006, Congress passed legislation authorizing the Medicare Medical Home Demonstration (MMHD) project. MHS and MMHD are directed at similar patient populations: high-cost, frail, elderly patients with multiple co-morbid conditions. The medical home concept being advanced by primary care physicians has the potential to be competitive with DM companies. Health plans that have built their own DM programs are more likely to be supportive of the medical home model. Do physicians have the ability to compete at providing care-coordination services? There are strong arguments suggesting ‘no’ and strong arguments suggesting ‘yes’.While the medical home model is focused on primary care reform, its effect could be competitive to DM companies and others. The medical home model could affect the flow of hundreds of billions of dollars — money that over time might flow either to physicians or to private companies.