Paediatric traumatic brain injury: A review of pertinent issues

Children with traumatic brain injury (TBI), regardless of the severity of the injury, often face challenges when living in home, school and community. Their needs are often overlooked and recognition of the long-term consequences is not always central to the management of the child in the school or community. This article provides references to pertinent literature and suggestions for intervention from the clinical experiences of four individuals with extensive experience of the family stresses, educational, cognitive-communicative and behavioural challenges that occur after TBI in children. It provides information regarding these issues, particularly educational situations, and suggests methods that may be useful for service providers and family members.     

A Qualitative Study of Perceived Responsibility and Self-Blame in Type 2 Diabetes: Reflections of Physicians and Patients

BACKGROUND

Despite new treatment therapies and the emphasis on patient activation, nearly 50?% of diabetes patients have hemoglobin A_1c levels above target. Understanding the impact of unmet treatment goals on the physician-patient relationship is important for maintaining quality care in clinical practice.

OBJECTIVE

To explore physicians?? and type 2 diabetes patients?? views of patients?? difficulty achieving diabetes treatment goals.

DESIGN

Qualitative study using in-depth interviews with a semi-structured interview guide.

PARTICIPANTS

Nineteen endocrinologists and primary care physicians and 34 patients diagnosed with type 2 diabetes at least two years prior.

MAIN MEASURES

In-depth interviews with physicians and patients. A multidisciplinary research team performed content and thematic analyses.

KEY RESULTS

Qualitative analysis revealed two main findings, organized by physician and patient perspectives. Physician Perspective: Physicians?? Perceived Responsibility for Patients?? Difficulty Achieving Treatment Goals: Physicians assumed responsibility for their patients not achieving goals and expressed concern that they may not be doing enough to help their patients achieve treatment goals. Physicians?? Perceptions of Patients?? Reactions: Most speculated that their patients may feel guilt, frustration, or disappointment when not reaching goals. Physicians also felt that many patients did not fully understand the consequences of diabetes. Patient Perspective: Patients?? Self-Blame for Difficulty Achieving Treatment Goals: Patients attributed unmet treatment goals to their inability to carry out self-care recommendations. Most patients blamed themselves for their lack of progress and directed their frustration and disappointment inwardly through self-deprecating comments. Patients?? Perceptions of Physicians?? Reactions: Several patients did not know how their physician felt, while others speculated that their physicians might feel disappointed or frustrated.

CONCLUSIONS

Physicians?? perceived responsibility and patients?? self-blame for difficulty achieving treatment goals may serve as barriers to an effective relationship. Physicians and patients may benefit from a greater understanding of each other??s frustrations and challenges in diabetes management.     

ApoA-I Induction as a Potential Cardioprotective Strategy: Rationale for the SUSTAIN and ASSURE Studies

Background  

Considerable interest has focused on the development of therapies that target the functionality of high-density lipoproteins (HDL). Upregulation of endogenous synthesis of the major protein on HDL particles, apolipoprotein A-I (apoA-I), represents a novel approach to generation of new HDL particles. The Study of Quantitative Serial Trends in Lipids with Apolipoprotein A-I Stimulation (SUSTAIN, NCT01423188) study aims to evaluate the lipid efficacy, safety and tolerability of an apoA-I inducer (RVX-208). The ApoA-I Synthesis Stimulation and Intravascular Ultrasound for Coronary Atheroma Regression Evaluation (ASSURE, NCT01067820) study aims to evaluate the effect of RVX-208 on plaque burden.     

The development and validation of the hypertension evaluation of lifestyle and management knowledge scale

Hypertension knowledge is an integral component of the chronic care model. A valid scale to assess hypertension knowledge and self-management skills is needed. The hypertension evaluation of lifestyle and management (HELM) scale was developed as part of a community-based study designed to improve self-management of hypertension. Participants included 404 veterans with hypertension. Literature review and an expert panel were used to identify required skills. Items were generated and pilot tested in the target population. Validity was assessed through comparisons of performance with education, health numeracy, print numeracy, patient activation and self-efficacy, and hypertension control. The HELM knowledge scale had 14 items across 3 domains: general hypertension knowledge, lifestyle and medication management, and measurement and treatment goals. Scores were positively associated with education (0.28, P<.0001), print health literacy (0.21, P<.001), health numeracy (0.17, P<.001), and patient activation (0.12, P=.015) but no association was found with diastolic or systolic blood pressure. The HELM knowledge scores increased following the educational intervention from baseline (mean, 8.7; standard deviation, 2.2) to 12-month follow-up (mean, 9.2, standard deviation, 2.2; P<.001). We conclude that the HELM provides a valid measure of the knowledge required for patients to take an active role in the chronic disease management of hypertension.     

NBOMe instability in whole blood

Forensic Toxicology - The stability of NBOMes, potent new psychoactive substances, in whole blood was studied over 180&nbsp;days. We present a fully validated liquid chromatography–tandem...     

Neurohormone activation

Neurohormonal activation plays a significant role in left ventricular remodeling and progression of heart failure. Treatment strategies that antagonize the RAS and sympathetic nervous system can attenuate the left ventricular remodeling process. Natriuretic peptides, specifically BNP, are a marker of left ventricular dysfunction. With the progressive increase in the incidence and prevalence of heart failure, treatment approaches must focus on the underlying cause as well as on blocking the neurohormonal activation that leads to the remodeling process.