Impact of staged InterStim® implantation on the postoperative activities of daily living and pain

Objectives

To evaluate the short-term effects of staged InterStim® implantation on activities of daily living (ADL) and pain.

Methods

This prospective study assessed women undergoing staged InterStim® implantation. The Older Americans Resources and Services Program Multidimensional Functional Assessment Questionnaire asked participants about their ability to complete activities without help or what help they needed following stage I lead placement and stage II neurostimulator implantation. Narcotic use and a visual analog scale (VAS) for pain were recorded daily.

Results

Thirty-eight women underwent stage I with 33 (86.8 %) progressing to stage II. On stage I postoperative day (POD) 2, more women required help shopping compared with baseline (40 vs 17 %, p?<?0.004). The median pain score increased on Stage I POD1 (P?<?0.001) and the use of narcotics increased on POD1 and 2 compared with baseline (50 % vs 14 %, p?=?0.001). The same trends were seen following stage II.

Conclusions

Staged InterStim® implantation has minimal impact on ADL, pain or narcotic requirements.     

The use of adjuvant endocrine breast cancer therapy in the oldest old

In order to report specifically on the use of adjuvant endocrine therapy (ET) in the oldest old breast cancer (BC) patients, we compared treatment patterns including drug compliance and persistence in a cohort of patients who were ≥80 years at diagnosis (n = 79) with those of “younger elderly” patients who were 60–79 years old (n = 358). The geriatric cohort more commonly declined the recommended ET (non-compliance: 13.0% vs. 4.5%, p = 0.011). Of the patients who initiated ET, only a minority of the older patients completed the planned therapy duration of five years (39.6% vs. 71.3%, p < 0.001). However, when applying strict criteria for non-persistence, this was found in comparable frequency (17.0% vs. 12.0%, p = 0.370). In older patients, medication was more often discontinued by the physician due to serious medical reasons independent of BC (17.0% vs. 4.7%, p = 0.003). Older women were treated by a general practitioner more often and not by an oncologist (54.4% vs. 23.9%, p < 0.001). Studies on compliance/persistence on cancer therapy in the oldest old demand a detailed follow-up of the patients and the consideration of principles of geriatric medicine. Efforts should be made to make sure that all physicians, but above all general practitioners, who are predominantly involved in the treatment of elderly BC patients, are provided with current knowledge and skills, as to ensure optimal patient management.     

A Pilot Randomized Controlled Trial of a Daily Living Skills Intervention for Adolescents with Autism

Journal of Autism and Developmental Disorders - Adolescents with autism spectrum disorder (ASD) without an intellectual disability have daily living skills (DLS) impairments. An initial feasibility...     

Contingency Management Versus Psychotherapy for Prenatal Smoking Cessation: A Meta-Analysis of Randomized Controlled Trials

Objectives

Prenatal smoking is the leading preventable cause of poor obstetric outcomes, yet treatment options are limited. Past reviews of prenatal smoking cessation have often grouped all counseling into a single category, which ignores the fact that psychotherapy is distinct from brief counseling. The objective of this study was to compare the effect sizes of two intensive interventions for prenatal smoking cessation: contingency management (i.e., financial incentives for abstinence) and psychotherapy.

Pressure ulcer prevalence in people with spinal cord injury: age-period-duration effects

OBJECTIVE: To examine age-period-duration patterns of the prevalence of pressure ulcers in community-residing people with spinal cord injury (SCI). DESIGN: Multicenter cohort study. SETTING: Nine Model Spinal Cord Injury Systems throughout the United States. PARTICIPANTS: People with SCI (N=3361) injured between 1986 and 1995 and followed up thereafter on a yearly basis through 2002. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Physician-confirmed pressure ulcers of stage II or greater at the follow-up visits. RESULTS: The multivariable generalized estimating equations model showed a significant trend toward increasing pressure ulcer prevalence in the recent years (1994-2002 vs 1984-1993: odds ratio=1.4; 95% confidence interval, 1.2-1.6) not explained by aging, years since injury, or demographic and clinical factors. The risk of pressure ulcers appeared to be steady during the first 10 years and increased 15 years postinjury. Pressure ulcers were more common among the elderly, men, African Americans, singles, subjects with education less than high school, unemployed, subjects with complete injury, and subjects with history of pressure ulcers, rehospitalization, nursing home stay, and other medical conditions. Injury cause and level had no significant effect. CONCLUSIONS: These results highlight the need for research into factors that contribute to the increasing pressure ulcer prevalence.     

High Dietary Phosphate Intake Induces Development of Ectopic Calcifications in a Murine Model of Familial Tumoral Calcinosis

Familial tumoral calcinosis is characterized by ectopic calcifications due to persistent hyperphosphatemia. The most common genetic cause of the disease is mutations in GALNT3, encoding a glycosyltransferase involved in a posttranslational modification of fibroblast growth factor 23 (FGF23). The Galnt3 knockout mouse we developed was hyperphosphatemic due to low intact Fgf23 levels, but did not develop any apparent calcifications on a standard rodent diet. We therefore tested the hypothesis that a further challenge with a high phosphate diet could induce ectopic calcifications in Galnt3 knockout mice. Mice were fed either normal (0.6%) or high (1.65%) phosphate diet for 20 weeks beginning from weaning at 3 weeks. The high phosphate diet did not affect serum phosphorus concentration. However, regardless of the dietary phosphate contents, serum phosphorus levels were consistently elevated in Galnt3 knockout mice. The mice on the high phosphate diet had slightly low serum calcium, but significantly high alkaline phosphatase, parathyroid hormone (PTH), and calcium in the kidney. Although none of Galnt3 knockout mice on the normal phosphate diet developed calcifications, calcifications appeared in approximately one‐half of the mice on the high phosphate diet by 12 weeks. Calcified masses were most often found around the neck and on the back and as large as 9.9 mm in length. These data indicate that dietary phosphate load has major impact on the development of ectopic calcifications in tumoral calcinosis. © 2014 American Society for Bone and Mineral Research.     

Varenicline effects on drinking,craving and neural reward processing among non-treatment-seeking alcohol-dependent individuals

Rationale

The α4β2 nicotinic acetylcholine receptor partial agonist varenicline has been reported to reduce drinking among both heavy-drinking smokers and primary alcoholics, and this effect may be related to varenicline-mediated reduction of alcohol craving. Among smokers, varenicline has been reported to modulate cigarette cue-elicited brain activation in several reward-related areas.

Objectives

This pilot study tested varenicline’s effects on drinking, alcohol craving, and alcohol cue-elicited activation of reward-related brain areas among non-treatment-seeking alcohol-dependent individuals.

Methods

Thirty-five such individuals (mean age?=?30, 57 % male, 76 % heavy drinking days in the past month, 15 smokers) were randomized to either varenicline (titrated to 2 mg) or placebo for 14 days, and were administered an alcohol cue reactivity fMRI task on day 14. A priori regions of interest (ROIs) were bilateral and medial orbitofrontal cortex (OFC), right ventral striatum (VS), and medial prefrontal cortex (mPFC).

Results

Despite good medication adherence, varenicline did not reduce heavy drinking days or other drinking parameters. It did, however, increase self-reported control over alcohol-related thoughts and reduced cue-elicited activation bilaterally in the OFC, but not in other brain areas.

Conclusions

These data indicate that varenicline reduces alcohol craving and some of the neural substrates of alcohol cue reactivity. However, varenicline effects on drinking mediated by cue-elicited brain activation and craving might be best observed among treatment-seekers motivated to reduce their alcohol consumption.     

Anxiety and Response to Reading Intervention among First Grade Students

Background

For school-aged children with reading difficulties, an emerging and important area of investigation concerns determining predictors of intervention response. Previous studies have focused exclusively on cognitive and broadly defined behavioral variables. What has been missing, however, are studies examining anxiety, which is among the most commonly experienced difficulty for youth.

Objective

The present study examined anxiety among children classified as typically achieving or showing inadequate/adequate response following an intervention for reading problems.

Methods

Participants were 153 ethnically-diverse children (84 male, 69 female) evaluated in the winter and spring of their first-grade academic year. Children completed several standardized measures of reading achievement involving decoding and fluency along with a multidimensional anxiety rating scale.

Results

Repeated measures ANOVA revealed significant main effects for time and scale and significant interactions for time × scale and group × scale. Logistic regression examined whether anxiety predicted response to intervention (Y/N) at the end of the school-year.

Conclusions

Results showed overall decreases in anxiety over time, with the exception of the harm avoidance area which increased and also interacted with group (children with decoding/fluency difficulties reported less harm avoidance than typically achieving children). The harm avoidance area was most pertinent across analyses highlighting the potential importance of targeting this area; however, none of the anxiety scales predicted response group at the end of the intervention. Ongoing research is needed in this area in order to identify characteristics of inadequate responders to reading intervention programs and/or inform interventions that incorporate these socioemotional factors.