A tool to aid nurses' decision making in relation to dressing selection

A multidisciplinary formulary group was established to create a standardized approach to wound management throughout Carmarthenshire. It was felt that a tool to aid nurse's decision making in dressing selection might enhance the process of formulary implementation. This article outlines the development of the tool. An action-research approach was chosen to investigate the idea. The project followed a series of cycles consisting of planning, action, data collection and reflection. The first cycle confirmed the need for such a tool. A reference card was produced. As a result of data collected in the second cycle, the card was reproduced with suggested improvements. The improved tool was then evaluated in the third cycle. Minor adjustments and incorporation of the completed Carmarthenshire formulary took place during the fourth cycle. The Carmarthenshire formulary is now in use and accompanied by the reference card.     

Postmenopausal estrogen and progestogen therapy and the risk of uterine leiomyomas

OBJECTIVE: Leiomyomas are common benign neoplasms. Although hormone therapy is the most common and effective treatment for menopausal symptoms, little is known about its effect on leiomyomas. We examined the risk of a first diagnosis of leiomyomas in peri- and postmenopausal women associated with prior use of estrogen and progestogen therapy (EPT). DESIGN: A case-control study was conducted among enrollees from a nonprofit health plan. Cases had a first diagnosis of leiomyomas confirmed by surgery or ultrasound. Controls were women of the same age range without a diagnosis of leiomyomas selected at random from membership and outpatient files. Participants were interviewed regarding prior use of exogenous hormones, medical history, and reproductive history. This analysis was restricted to cases (n = 256) and controls (n = 276) who were peri- or postmenopausal and more than 40 years of age. Adjusted odds ratios (OR) and 95% CIs were estimated using logistic regression models. RESULTS: EPT use for more than 5 years was associated with a 1.7-fold increased risk of leiomyomas (95% CI, 0.9-3.3). Associations with EPT use were only present among women with a body mass index less than 24 kg/m; OR (ever-use), 2.3 (95% CI, 1.2-4.3); and OR (>or= 5 years use), 4.0 (95% CI, 1.6-10.3). CONCLUSION: Among peri- and postmenopausal women, prior EPT use was associated with an increased risk of a subsequent leiomyomas. This association seemed limited to the subset of women with low body mass index. Exogenous sources of estrogen and progestin in the setting of low adiposity may contribute to the development of leiomyomas.     

An integrative approach to the neurophysiological substrates of social withdrawal and aggression

An integrative model of the neurophysiology of aggression and social withdrawal is proposed. A detailed overview of the limbic-hypothalamic-pituitary-adrenal (LHPA) axis is presented first, because we consider it to be a critical system that interacts with a variety of physiological processes to modulate affect-related behaviors. This detailed analysis of the LHPA axis is then used to clarify the research literature that links aggression and social withdrawal to LHPA functioning. We then review the role of amygdala and prefrontal cortex functioning in modulating aggression and social withdrawal. Particular attention is paid to how the amygdala and the prefrontal cortex interact with the LHPA system and the environment to produce specific behavioral tendencies throughout development. A brief overview of the implied methodological and theoretical model is provided. We explain how a detailed understanding of specific physiological processes is essential in order to develop appropriate research protocols. In addition, we suggest that future research should focus on the mapping of distinct integrative biosocial profiles that are related to specific behaviors during different developmental stages.     

Relationship of physical fitness vs body mass index with coronary artery disease and cardiovascular events in women

Context  Individual contributions of obesity and physical fitness (physical activity and functional capacity) to risk of coronary heart disease in women remain unclear. Objective  To investigate the relationships of measures of obesity (body mass index [BMI], waist circumference, waist-hip ratio, and waist-height ratio) and physical fitness (self-reported Duke Activity Status Index [DASI] and Postmenopausal Estrogen-Progestin Intervention questionnaire [PEPI-Q] scores) with coronary artery disease (CAD) risk factors, angiographic CAD, and adverse cardiovascular (CV) events in women evaluated for suspected myocardial ischemia. Design, Setting, and Participants  The National Heart, Lung, and Blood Institute–sponsored Women's Ischemia Syndrome Evaluation (WISE) is a multicenter prospective cohort study. From 1996-2000, 936 women were enrolled at 4 US academic medical centers at the time of clinically indicated coronary angiography and then assessed (mean follow-up, 3.9 [SD, 1.8] years) for adverse outcomes. Main Outcome Measures  Prevalence of obstructive CAD (any angiographic stenosis 50%) and incidence of adverse CV events (all-cause death or hospitalization for nonfatal myocardial infarction, stroke, congestive heart failure, unstable angina, or other vascular events) during follow-up. Results  Of 906 women (mean age, 58 [SD, 12] years) with complete data, 19% were of nonwhite race, 76% were overweight (BMI 25), 70% had low functional capacity (DASI scores <25, equivalent to 7 metabolic equivalents [METs]), and 39% had obstructive CAD. During follow-up, 337 (38%) women had a first adverse event, 118 (13%) had a major adverse event, and 68 (8%) died. Overweight women were more likely than normal weight women to have CAD risk factors, but neither BMI nor abdominal obesity measures were significantly associated with obstructive CAD or adverse CV events after adjusting for other risk factors (P = .05 to .88). Conversely, women with lower DASI scores were significantly more likely to have CAD risk factors and obstructive CAD (44% vs 26%, P<.001) at baseline, and each 1-MET increase in DASI score was independently associated with an 8% (hazard ratio, 0.92; 95% confidence interval, 0.85-0.99; P = .02) decrease in risk of major adverse CV events during follow-up. Conclusions  Among women undergoing coronary angiography for suspected ischemia, higher self-reported physical fitness scores were independently associated with fewer CAD risk factors, less angiographic CAD, and lower risk for adverse CV events. Measures of obesity were not independently associated with these outcomes.      

Solution structure of amyloid beta-peptide (25-35) in different media

The design of molecules able to interact with the amyloid peptides either as inhibitors of fibril formation or as inhibitors of amyloid membrane pore formation represents one of the most relevant approaches in the development of anti-Alzheimer therapies. Abeta-(25-35), sequence GSNKGAIIGLM, is a highly toxic synthetic derivative of amyloid beta-peptides (Abeta-peptides), which forms fibrillary aggregates. Here, we report the NMR and CD investigation of Abeta-(25-35) in a membrane-mimicking environment and in isotropic mixtures of water and fluoro-alcohols to scan its conformational properties as a function of the medium. The analysis of the 3D structures in the mentioned conditions indicates a propensity of the peptide to behave as a typical transmembrane helix in the lipidic environment. In media characterized by different polarity, it loses the structural regularity at specific points of the sequence as a function of the environment. Furthermore, a comparison with the solution structure of full-length amyloid peptides suggests a role for the 25-27 kink region, which appears to be a general feature of all peptides under the solution conditions explored.     

Recent progress in the therapeutic management of pre-eclampsia

Pre-eclampsia is a pregnancy-specific syndrome of unknown aetiology, observed in 3 - 5% of all pregnancies, associated with pathological vascular lesions in multiple organs, activation of the coagulation system, and maternal multisystemic and fetal complications. Clinically, pre-eclampsia is characterised by the onset of hypertension, proteinuria and oedema, usually beginning in the third trimester. Conventionally, antihypertensive agents are the main pharmacological treatment. Recently, some studies have shown that the treatment of pre-eclampsia with antithrombin concentrate corrects the hypercoagulability and improves the fetal status and the perinatal outcome. No clear evidence supports the use of heparin. A conservative treatment of moderate- to- severe pre-eclampsia, based on the administration of antithrombin concentrate, may allow a significant prolongation of pregnancy and a better neonatal outcome, as well as fewer maternal complications.     

External beam irradiation in the palliation of bone metastases: a practice analysis among Sicilian Departments of Radiation Oncology

BACKGROUND: In the treatment of bone metastases, the choice of radiation fractionation, total radiation dose, delivery technique, and imaging studies before treatment varies among radiation oncologists. Surveys on this issue, using case scenarios, have been published by groups from Europe, North America, and Australia-New Zealand. Our objective was to analyze retrospectively the "real" practice in nine radiotherapy centers located in Sicily. METHOD: A questionnaire including 17 items was distributed to 30 practicing radiation oncologists working in seven departments of four Sicilian cities (Messina, Catania, Ragusa and Palermo) during a meeting of the Sicilian Division of the Associazione Italiana Radioterapia Oncologica (AIRO). Participants were asked to answer the questions using a card for every patient treated with external beam irradiation from 1 January to 31 December, 2000. RESULTS: Six centers returned the questionnaires; 332 cards were valuable for a total of 5644 responses. All six responding departments used linear accelerators for treatment delivery. The most common dose fractionation was 30 Gy in 10 fractions and the most common technique used was opposed parallel local fields. Before the start of irradiation a bone scan was performed in 325 of the 332 (98%) patients treated and CT and/or MRI was performed in 320 (96%); surprisingly, standard roentgenograms were used in only 142 of 332 patients (42.8%). CONCLUSION: The "real" radiation practice for bone metastases in the region of Sicily confirms the results of the previously reported international surveys: there is a clear preference for fractionated treatment and local field therapy. The results of randomized studies, which demonstrated both the efficacy and the feasibility of a single 6-8 Gy fraction in the palliation of bone metastases, have little or no impact on the pattern of practice.