Cleansing the colon in gallium-67 scintigraphy: a prospective comparison of regimens

Colonic accumulation of gallium-67 frequently complicates the interpretation of gallium-67 scintigrams. Although various modes of cleansing the colon prior to scintigraphy have been suggested, there is controversy over their efficacy and none have been tested prospectively. Three hundred nine patients undergoing gallium-67 scintigraphy were randomly assigned to one of four cleansing regimens: (1) a high fiber diet (78 patients); (2) castor oil (76); (3) milk of magnesia and cascara (76); and (4) not preparation (79). Patient compliance rates for the four regimens were 17%, 32%, 36%, and 46%, respectively. After noncompliant patients were excluded, gallium-67 scintigrams were graded for colonic activity on a scale of 0-3 by three independent, experienced observers. Gallium-67 activity in the colon was significantly less after administration of castor oil than after no preparation (p = 0.047). A high fiber diet also resulted in a substantial reduction of colonic activity when compared with no preparation; the difference, however, was not statistically significant (p = 0.083). Regimen 3 did not produce significantly better results than regimen 4 (p = 0.42). A major impediment to the success of any cleansing regimen seems to be poor compliance of patients.     

Interpretation of medication pictograms by adults in the UK

BACKGROUND: Patients' ability to understand information about medication is crucial for safety and effectiveness. Rates of illiteracy worldwide indicate that written information alone cannot meet many patients' needs. Medication pictograms are an alternative, but may be culturally sensitive. Previous testing has used large pictograms, which are impractical for conventional drug information formats. OBJECTIVE: To compare 2 sets of pictograms for instructions or warnings (from the US and South Africa) for understandability by adults in the UK and examine the effects of pictogram size and repeat presentation on understandability among older adults. METHODS: In the first part of the study, 160 adults (aged 17-83 y) reviewed and interpreted 10 pictograms. In the second, 67 older adults (aged 65-96 y) were randomly assigned to review 10 small or large pictograms. After giving their interpretation, they were informed of the correct meaning. One week later, they were shown the same pictograms and gave their interpretation. RESULTS: The pictograms for the 10 different instructions and warnings showed great variation in interpretation rates (7.5-90%), with few significant differences between the US and South African versions. Only 3 were understood by > or = 85% of the population. Pictograms performed significantly better if they were larger and at the second presentation. CONCLUSIONS: Pictograms have the potential to help patients understand information on drug therapy. This study shows that some existing pictograms are not easily interpreted and that testing is needed before their implementation. A reduction in their size to allow incorporation into conventional written formats may cause additional problems for patients.     

A traditional method of Cinnamomum carolinense preparation eliminates safrole from a therapeutic Pohnpean tea

Cinnamomum carolinense, locally known as madeu, is a tree endemic to the volcanic mountains of the Island of Pohnpei in the Eastern Carolines of the South Pacific. The bark is harvested from trees and brewed to make a medicinal tea and hot beverage that is regularly consumed. Many species of Cinnamomum contain the known hepatocarcinogen safrole, sparking concern regarding habitual consumption of this beverage. HPLC-PDA analysis confirmed the presence of the carcinogen in alcoholic extracts of Cinnamomum carolinense bark shavings (0.435%, w/w), but safrole was not detected in the tea. The limit of detection and limit of quantitation of safrole were determined to be 1.25 and 3.75 microg/mL, respectively. The traditional preparation method, which boils the bark shavings, degrades the safrole.     

Expressing medicine side effects: assessing the effectiveness of absolute risk, relative risk, and number needed to harm, and the provision of baseline risk information

OBJECTIVE: To assess the effectiveness of absolute risk, relative risk, and number needed to harm formats for medicine side effects, with and without the provision of baseline risk information. METHODS: A two factor, risk increase format (relative, absolute and NNH)xbaseline (present/absent) between participants design was used. A sample of 268 women was given a scenario about increase in side effect risk with third generation oral contraceptives, and were required to answer written questions to assess their understanding, satisfaction, and likelihood of continuing to take the drug. RESULTS: Provision of baseline information significantly improved risk estimates and increased satisfaction, although the estimates were still considerably higher than the actual risk. No differences between presentation formats were observed when baseline information was presented. Without baseline information, absolute risk led to the most accurate performance. CONCLUSION: The findings support the importance of informing people about baseline level of risk when describing risk increases. In contrast, they offer no support for using number needed to harm. PRACTICE IMPLICATIONS: Health professionals should provide baseline risk information when presenting information about risk increases or decreases. More research is needed before numbers needed to harm (or treat) should be given to members of the general populations.     

Clinical medication review by a pharmacist of elderly people living in care homes--randomised controlled trial

OBJECTIVE: to measure the impact of pharmacist-conducted clinical medication review with elderly care home residents. DESIGN: randomised controlled trial of clinical medication review by a pharmacist against usual care. SETTING: sixty-five care homes for the elderly in Leeds, UK. Participants: a total of 661 residents aged 65+ years on one or more medicines. Intervention: clinical medication review by a pharmacist with patient and clinical records. Recommendations to general practitioner for approval and implementation. Control patients received usual general practitioner care. MAIN OUTCOME MEASURES: primary: number of changes in medication per participant. Secondary: number and cost of repeat medicines per participant; medication review rate; mortality, falls, hospital admissions, general practitioner consultations, Barthel index, Standardised Mini-Mental State Examination (SMMSE). RESULTS: the pharmacist reviewed 315/331 (95.2%) patients in 6 months. A total of 62/330 (18.8%) control patients were reviewed by their general practitioner. The mean number of drug changes per patient were 3.1 for intervention and 2.4 for control group (P < 0.0001). There were respectively 0.8 and 1.3 falls per patient (P < 0.0001). There was no significant difference for GP consultations per patient (means 2.9 and 2.8 in 6 months, P = 0.5), hospitalisations (means 0.2 and 0.3, P = 0.11), deaths (51/331 and 48/330, P = 0.81), Barthel score (9.8 and 9.3, P = 0.06), SMMSE score (13.9 and 13.8, P = 0.62), number and cost of drugs per patient (6.7 and 6.9, P = 0.5) (pounds sterling 42.24 and pounds sterling 42.94 per 28 days). A total of 75.6% (565/747) of pharmacist recommendations were accepted by the general practitioner; and 76.6% (433/565) of accepted recommendations were implemented. CONCLUSIONS: general practitioners do not review most care home patients' medication. A clinical pharmacist can review them and make recommendations that are usually accepted. This leads to substantial change in patients' medication regimens without change in drug costs. There is a reduction in the number of falls. There is no significant change in consultations, hospitalisation, mortality, SMMSE or Barthel scores.     

The Recovery-Based Interprofessional Distance Education (RIDE) Rotation: Content and Rationale

A faculty team of two psychiatric nurse practitioners, an exercise physiologist, a registered dietician and a pharmacist developed the 8-week Recovery-Based Interprofessional Distance Education (RIDE) rotation for graduate students in the four disciplines. Organizing the RIDE rotation around the recovery model ensured an emphasis upon optimal health and quality of life. RIDE faculty engaged in project planning for several months before the RIDE rotation was offered to students. In this paper, we describe details of the 8-week program. Our next step will be to analyze student feedback and de-identified evaluation data from the first student cohort.     

Effects of sensory stimulation and post-ingestive consequences on satiation

This study investigated the influence of sensory stimulation, with and without post-ingestive consequences, on satiation by varying the form of a preload and the timing of a mixed meal presented after the preload. Twenty-four, normal-weight, non-dieting, college-aged women were randomized to different preload groups: water preload (Water), sip-and-spit energy-dense preload (Taste), or energy-dense preload (Taste/kcal). Volume of fluid consumed prior to the meal was controlled. All participants had sessions in which a meal was provided immediately (0 min) or 30 min after the preload. Results showed equal suppression of intake for participants receiving sensory stimulation from an energy-dense preload (Taste and Taste/kcal groups) in comparison to a water preload (Water group). No effect of time from preload to food consumption was found; the suppression of intake was similar whether the meal immediately followed the preload or was 30 min after the preload. These findings suggest that sensory aspects of food can influence satiation, and in the conditions of this study, had a larger influence on satiation than post-ingestive consequences.     

A comprehensive assessment of exposures to respirable dust and silica in the taconite mining industry

This study assessed the present-day levels (year 2010–2011) of exposure to respirable dust (RD) and respirable silica (RS) in taconite mines and evaluated how the mining process influences exposure concentrations. Personal samples (n = 679) were collected to assess exposure levels of workers to RD and RS at six mines in the Mesabi Iron Range of Minnesota. The RD and RS concentrations were measured using the National Institute for Occupational Safety and Health (NIOSH) 0600 and NIOSH 7500, respectively. Between-mine, between-SEG (similar exposure groups), within-SEG, and within-worker components of variability for RD and RS exposures were estimated using a two- or three-way nested random-effects ANOVA model. The majority of RD concentrations across all mines were below the Mine Safety and Health Administration (MSHA) Permissible Exposure Limit (PEL). The highest concentrations of RD were often observed in either the Pelletizing or Crushing departments, which are inherently dusty operations. With a few exceptions, the concentrations of RS in the crushing and concentrating processes were higher than those in the other mining processes, as well as higher than the American Conference of Governmental Industrial Hygienists (ACGIH) Threshold Limit Value (TLV) for RS. The magnetic separation and flotation processes in the concentrating department reduced the levels of RS significantly, and lowered the percentage of quartz in RD in the pelletizing department. There was little variability among the six mines or between the two mineralogically distinct zones for either RD or RS exposures. The between-SEG variability for RS did not differ substantially across most of the mines and was a major component of exposure variance. The within-SEG (or between-worker) variance component was typically the smallest because in many instances one worker from a SEG within a mine was monitored multiple times. Some of these findings were affected by the degree of censoring in each SEG and mine, characteristics of the taconite rock, seasonal effects during sampling, or the tasks assigned to each job in that mine.     

Sural/radial amplitude ratio in the diagnosis of mild axonal polyneuropathy

As proximal nerves are relatively spared in length-dependent, axonal polyneuropathy, we theorized that a sural/radial amplitude ratio (SRAR) might be a sensitive indicator of mild polyneuropathy. In this study, sural amplitudes and SRARs in patients with signs of mild axonal polyneuropathy were compared to those of normal, age-matched control subjects. Sural and radial sensory responses were measured in a standard fashion in all subjects. Thirty polyneuropathy patients had an average SRAR of 0.29 as compared to 0.71 for the 30 normal subjects. An SRAR of less than 0.40 was a strong predictor of axonal polyneuropathy, with 90% sensitivity and 90% specificity, as compared to an absolute sural amplitude of less than 6.0 μV, which had sensitivity of only 66%. Additionally, unlike the sural amplitude, the ratio did not vary significantly with age. We conclude that the SRAR is a sensitive, specific, age-independent electrodiagnostic test for mild axonal polyneuropathy. © 1997 John Wiley & Sons, Inc. Muscle Nerve 20: 1236–1241, 1997