Pseudomonas Folliculitis Associated With Use of Hot Tubs and Spas

In brief: Pseudomonas folliculitis is an increasingly common infection contracted in hot tubs, spas, and swimming pools. Diagnosis requires a thorough knowledge of the symptoms. Patients usually develop a pruritic skin eruption that involves areas abundant with apocrine glands such as the axillae, breasts, and pubic area. Symptoms include itching, pain, and redness of the eyes and ears. The physician should obtain a detailed history that focuses on the patient's recent use of hot tubs, spas, or swimming pools. Treatment is not usually necessary because the infection is most often self-limited and benign. The best preventive measures include chlorination, pH monitoring, and proper maintenance of the whirlpool.     

Influence of age and caloric restriction on liver glycolytic enzyme activities and metabolite concentrations in mice

The influence of caloric restriction (CR) from 2 months of age on the activities of liver glycolytic enzymes and metabolite levels was studied in young and old mice. Livers were sampled 48 h after the last scheduled feeding time. Old mice on CR showed significant decreases in the activities of all the enzymes studied, except for aldolase, triosephosphate isomerase and phosphoglycerate mutase, which were unchanged. The metabolites glucose, glucose-6-phosphate, fructose-6-phosphate, pyruvate and lactate were lower while fructose-1,6-bisphosphate, glyceraldehyde-3-phosphate, dihydroxyacetone phosphate, 3-phosphoglycerate and phosphoenolpyruvate were increased in old CR. Young mice on CR also showed reduced enzyme activities, except for aldolase, triosephosphate isomerase and enolase which were unchanged when compared with young controls. The metabolites glucose, glucose-6-phosphate, fructose-6-phosphate and pyruvate were decreased when compared with young controls, while phosphoenolpyruvate was increased. Ketone bodies increased (65%) in old, but not young, CR mice while fructose-2,6-bisphosphate decreased in both young (22%) and old CR (28%) mice. The results indicate that decreased hepatic glucose levels in CR mice are associated with decreased enzyme activities but not a uniform decrease in metabolite levels. Increased ketone body levels indicate increased utilization of non-carbohydrate fuels while decreased fructose-2,6-bisphosphate level suggests its importance in the control of glycolysis in CR.     

Decision-making capacity to execute a health care proxy: development and testing of guidelines

OBJECTIVE: To evaluate the reliability and validity of guidelines to determine the capacity of nursing home residents to execute a health care proxy (HCP). DESIGN: A cross-sectional study. SETTING: A 750-bed not-for-profit nursing home located in New York City. PARTICIPANTS: A random sample of 200 nursing home residents: average age, 87; 99% white; 83% female; average length of stay, 3.05 years; mean Mini-Mental State Exam (MMSE) score, 15.9. MEASUREMENTS: Demographic characteristics (Minimum Data Set (MDS)); function and cognitive status (Institutional Comprehensive Assessment and Referral Evaluation (INCARE)); Reisberg Dementia Staging; MMSE; Minimum Data Set-Cognitive Performance Scale (MDS-COGS)); an investigator-developed measure of a nursing home resident's capacity to execute a health care proxy (Health Care Proxy (HCP) Guidelines.) RESULTS: The internal consistency of the decision-making scales in the HCP Guidelines, paraphrased recall and recognition, reached acceptable levels, alphas of .85 and .73, respectively. Interrater reliability estimates were .92 and .94, respectively, for the recall and recognition scales; test-retest reliability estimates were .83 and .90. The discriminant validity of these scales is promising. For example, the MMSE correlation was .51 with the Recall scale and .57 with the Recognition scale. Of residents with severe cognitive impairment (MMSE < 10), 71% completed 50% or more of the scaled items in the HCP guidelines and 95% consistently named a proxy. CONCLUSIONS: Seventy-three percent of testable residents, approximately three-quarters of whom were cognitively impaired, evidenced sufficient capacity to execute an HCP. Of residents with severe cognitive impairment, the HCP guidelines are potentially useful in identifying those with the capacity to execute a HCP. The guidelines are more predictive than the MMSE in identifying residents able to execute a HCP.     

Evaluating clinical teaching in the medicine clerkship:

A clinical teaching assessment form was used to evaluate the teaching by faculty and residents in the required third-year medicine clerkship over a two-year period. Data from 1,627 forms were analyzed for differences between groups of teachers at different experience levels and for comparison of teaching programs at different training sites. The level of involvement of instructor with student correlated with ratings by the students. Among groups of instructors, chief medical residents received the highest overall ratings. Faculty were rated higher than first-, second-, and third-year residents when degree of involvement of instructor with student was high. Ratings among faculty of different academic ranks were not significantly different. Analysis of data from different clinical settings showed that the teaching efforts by clinical faculty members in the ambulatory setting received the highest ratings from students. Although increased involvement of instructors with students or other factors may have led to the higher ratings in the ambulatory setting, the results are encouraging for the use of ambulatory teaching sites for the basic medicine clerkship. Received from the Department of Medicine (Division of General Internal Medicine) and the Division of Research in Medical Education, University of Washington School of Medicine, and the Educational Assessment Center, University of Washington, Seattle, Washington.     

Chemokine gene expression in rat pancreatic acinar cells is an early event associated with acute pancreatitis

BACKGROUND & AIMS: The molecular mechanisms underlying pancreatitis are largely unknown. The goal of this study was to identify an early genetic event that correlated with pancreatitis. METHODS: Differential display of messenger RNAs (mRNAs) was conducted on normal pancreas vs. those of animals with secretagogue-induced pancreatitis. Northern blots from normal animals and animals with experimental acute pancreatitis were probed with cloned complementary DNAs for chemokines. Pancreatitis was induced with cerulein and by retrograde injection of bile salts. Immunocytochemistry was used to identify the source of chemokine expression. Pyrrolidine dithiocarbamate was tested for effects on chemokine expression and pancreatitis. RESULTS: A differentially amplified band was consistently observed early after cerulein hyperstimulation. This band was identified as a portion of the mob-1 gene, an alpha-chemokine. Northern analysis indicated that mRNAs for mob-1 and another chemokine, mcp-1, were induced after cerulein hyperstimulation in vivo. mob-1 mRNA was also induced by retrograde injection of bile salts and by cerulein in acinar cells in vitro. mob-1 protein was localized to exocrine cells in pancreata of diseased animals. Pyrrolidine dithiocarbamate inhibited both chemokine gene expression and early inflammatory characteristics of pancreatitis. CONCLUSIONS: Chemokines are induced in acinar cells by treatments that induce pancreatitis and may play an important role in the early stages of the disease. (Gastroenterology 1997 Dec;113(6):1966-75)     

Utility of retroflexion in lower gastrointestinal endoscopy

Although recommended, retroflexion to evaluate the rectal vault is not always practiced in endoscopy. A prospective study of 600 consecutive patients undergoing flexible sigmoidoscopy or colonoscopy was done to evaluate whether retroflexion increased the diagnostic yield compared with straight view examination of the distal rectum and whether the findings altered subsequent patient management. In this study, 30 patients were found to have distinct lesions in the anorectum. More than 50% of lesions in the rectal vault were identified only by retroflexion. Adenomatous polyps were seen in nine patients, of which six were identified only by retroflex view. Fifty percent of patients with adenomatous polyps in the rectal vault identified only by retroflexion during screening sigmoidoscopy were found to have right sided adenomas on colonoscopy. The retroflex view produced significant additional information, compared with standard forward view of the rectum, and altered the patient management plan. The procedure was easily performed without complications and was tolerated well by patients. Unless contraindicated, rectal retroflexion should be universally practiced and emphasized in training as more nonphysicians become involved in performing sigmoidoscopy.     

Highly Effective Cystic Fibrosis Clinical Research Teams: Critical Success Factors

BACKGROUND

Bringing new therapies to patients with rare diseases depends in part on optimizing clinical trial conduct through efficient study start-up processes and rapid enrollment. Suboptimal execution of clinical trials in academic medical centers not only results in high cost to institutions and sponsors, but also delays the availability of new therapies. Addressing the factors that contribute to poor outcomes requires novel, systematic approaches tailored to the institution and disease under study.

OBJECTIVE

To use clinical trial performance metrics data analysis to select high-performing cystic fibrosis (CF) clinical research teams and then identify factors contributing to their success.

DESIGN

Mixed-methods research, including semi-structured qualitative interviews of high-performing research teams.

PARTICIPANTS

CF research teams at nine clinical centers from the CF Foundation Therapeutics Development Network.

APPROACH

Survey of site characteristics, direct observation of team meetings and facilities, and semi-structured interviews with clinical research team members and institutional program managers and leaders in clinical research.

KEY RESULTS

Critical success factors noted at all nine high-performing centers were: 1) strong leadership, 2) established and effective communication within the research team and with the clinical care team, and 3) adequate staff. Other frequent characteristics included a mature culture of research, customer service orientation in interactions with study participants, shared efficient processes, continuous process improvement activities, and a businesslike approach to clinical research.

CONCLUSIONS

Clinical research metrics allowed identification of high-performing clinical research teams. Site visits identified several critical factors leading to highly successful teams that may help other clinical research teams improve clinical trial performance.

     

Transoral resection of pharyngeal cancer: Summary of a National Cancer Institute Head and Neck Cancer Steering Committee Clinical Trials Planning Meeting,November 6–7, 2011, Arlington,Virginia

Recent advances now permit resection of many pharyngeal tumors through the open mouth, an approach that can greatly reduce the morbidity of surgical exposure. These transoral techniques are being rapidly adopted by the surgical community and hold considerable promise. On November 6–7, 2011, the National Cancer Institute sponsored a Clinical Trials Planning Meeting to address how to further investigate the use of transoral surgery, both in the good prognosis human papillomavirus (HPV)–initiated oropharyngeal cancers, and in those with HPV‐unrelated disease. The proceedings of this meeting are summarized. © 2012 Wiley Periodicals, Inc. Head Neck, 2012