Brachial approach to emergency cardiac catheterization during thrombolytic therapy for acute Myocardial Infarction

The use of the brachial approach to acute coronary intervention has not been previously studied. In the course of the Thrombolysis and Angioplasty in Myocardial Infarction (TAMI) trials, we used the transbrachial approach to cardiac catheterization with or without angioplasty in 202 of 704(28.6%) patients. The baseline characteristics of age, sex, risk factors, medical history, time from symptom onset to therapy, and left ventricular function were similar for the 2 different approaches. Time from therapy to coronary angiography was not delayed by the brachial approach compared with the femoral approach: 97.1±26 min vs. 99.9±133.8 min, respectively. Chemical patency was established in 78 vs. 73% of patients and technical success with acute PTCA with the brachial approach was 89% vs. 78% with the femoral approach. Clinical outcomes were quite similar with respect to death(6 vs. 6%), reocclusion (10 vs. 14%), and emergency coronary bypass surgery (5 vs. 6%). Baseline hematocrit was 43.9±4.4 and 43.5±4.8, respectively with a nadir of 32.9±5.6 vs. 33.0±5.4. The need for vascular repair occurred in 1% vs. 3% of patients and retroperitoneal hemorrhage was documented in 1% vs. 1% of patients. This study indicates that in thehands of experienced operators the transbrachial approach to acute coronary intervention in theacute phase of treatment with thrombolytic therapy can be used with equal risks and efficacy asthe femoral approach.     

Clients Served and Services Provided by Academic Nurse-Managed Centers

Currently, no national database for academic nurse-managed centers (ANMCs) exists. These primary care services remain somewhat invisible in the policy and reimbursement areas of the American primary care system and, consequently, are undersupported. The purpose of this article is to describe client and service data from a national study of ANMCs. A cross-sectional survey design was used to collect data from ANMC directors. Usable data were received from 64 centers. ANMCs in the sample were relatively small in terms of patients and volume. Client and service profiles demonstrated variation, which seemed to be reflective of needs relative to populations and communities served. Nearly half of the ANMCs responding served clients of all ages, with services representing the breadth of primary care (i.e., health maintenance and management of minor acute and common chronic illnesses). Evidence of community-focused care was also noted. The reported use of standardized nursing language was low. Standardized medical taxonomies were more commonly used, with International Classification of Diseases, Ninth Revision being the most common. ANMCs provide a small but substantial amount of primary care services in communities served. Findings indicated a need for ANMCs to improve the documentation of their contributions through the use of standardized taxonomies to provide aggregated reporting for policy and research purposes.     

Clinical identification of cognitive impairment in ICU survivors: insights for intensivists

Background A growing body of research has demonstrated the presence of ongoing cognitive impairment in large numbers of ICU survivors.Objective This review offers a practical framework for practicing intensivists and those following patients after their ICU stay for the identification of cognitive impairment in ICU survivors.Conclusions Early detection of cognitive impairment in critically ill patients is an important and achievable goal, but overt cognitive impairment remains unrecognized in most cases. However, it can be identified by objective (test scores) or subjective evidence (clinical judgment, patient observation, family interaction).     

Experienced and inexperienced mothers' maternal competence during infancy

In an exploratory study 136 experienced (multiparous) mothers and 166 inexperienced (primiparous) mothers were studied to determine differences in their self-reported maternal role competence, and variables predicting their competence at postpartal hospitalization, 1, 4, and 8 months following birth. The two groups did not differ in their maternal role competence over the 8 months. Inexperienced mothers' competence was higher at 4 and 8 months than at early postpartum and 1 month, indicating a developmental process in maternal role achievement, but no change was observed in experienced mothers' maternal competence. From 45% to 56% of the variance in experienced mothers' maternal competence was explained over the four test periods, and from 43% to 50% among inexperienced mothers. Self-esteem was a consistent, major predictor of maternal competence for both groups. Maternal fetal attachment, readiness for pregnancy, and pregnancy risk variables were explanatory of experienced mothers' maternal competence only. Sense of control was explanatory only of inexperienced mothers' competence at 1, 4, and 8 months. ©1995 John Wiley & Sons, Inc.     

Low‐density lipoprotein receptor‐related protein 1 is a novel modulator of radial glia stem cell proliferation,survival, and differentiation

The LDL family of receptors and its member low‐density lipoprotein receptor‐related protein 1 (LRP1) have classically been associated with a modulation of lipoprotein metabolism. Current studies, however, indicate diverse functions for this receptor in various aspects of cellular activities, including cell proliferation, migration, differentiation, and survival. LRP1 is essential for normal neuronal function in the adult CNS, whereas the role of LRP1 in development remained unclear. Previously, we have observed an upregulation of LewisX (LeX) glycosylated LRP1 in the stem cells of the developing cortex and demonstrated its importance for oligodendrocyte differentiation. In the current study, we show that LeX‐glycosylated LRP1 is also expressed in the stem cell compartment of the developing spinal cord and has broader functions in the developing CNS. We have investigated the basic properties of LRP1 conditional knockout on the neural stem/progenitor cells (NSPCs) from the cortex and the spinal cord, created by means of Cre‐loxp‐mediated recombination in vitro. The functional status of LRP1‐deficient cells has been studied using proliferation, differentiation, and apoptosis assays. LRP1 deficient NSPCs from both CNS regions demonstrated altered differentiation profiles. Their differentiation capacity toward oligodendrocyte progenitor cells (OPCs), mature oligodendrocytes and neurons was reduced. In contrast, astrocyte differentiation was promoted. Moreover, LRP1 deletion had a negative effect on NSPCs proliferation and survival. Our observations suggest that LRP1 facilitates NSPCs differentiation via interaction with apolipoprotein E (ApoE). Upon ApoE4 stimulation wild type NSPCs generated more oligodendrocytes, but LRP1 knockout cells showed no response. The effect of ApoE seems to be independent of cholesterol uptake, but is rather mediated by downstream MAPK and Akt activation. GLIA 2016 GLIA 2016;64:1363–1380     

Treatment patterns in inpatient depression care

This study aimed to identify latent patterns of treatment combinations in inpatient depression care. A secondary analysis of routinely collected data on inpatient depression treatment from 2133 patients was conducted. Exploratory latent class modeling was used to identify distinct classes of treatment combinations based on antidepressant medication, psychotherapeutic interventions, and additional treatments. The classes were compared with regard to patient characteristics and treatment outcomes. Eight different classes of inpatient treatment combinations could be identified: 22.8% of the patients were treated with a combination labelled “standard modern antidepressants”, 14.6% with “standard tricyclic antidepressants”, 12.2% with “high intensity innovative strategies”, 12.1% with “standard selective‐reuptake‐inhibitors”, and 11.6% with “low intensity”, 9.6% with “somatic”, 8.8% with “high intensity traditional”, and 8.3% with “high intensity psychosocial” care, respectively. Patients treated with different patterns of interventions differed statistically significantly regarding demographic and clinical characteristics. Responder rates ranged from 68.4% to 86.6% across treatment classes. The presented attempt of empirical modeling of a complex multifactorial intervention by means of latent class analysis proved to be a promising way of capturing the complexity of routine inpatient depression treatment. The identified classes of treatment combinations may provide relevant information for a re‐evaluation and improvement of inpatient depression treatment strategies. Copyright © 2015 John Wiley & Sons, Ltd.