Ammonia toxicity: Comparative protective effect of various arginine and ornithine derivatives,aspartate, benzoate,and carbamyl glutamate

Ornithine and arginine compounds were highly effective in preventing an increase in blood ammonia and in preventing or minimizing encephalopathy after acute subcoma, comainducing, or lethal doses of NH ₄ ⁺ . Similar protection was seen after subacute loading with glycine. Ornithine ketoacid derivatives were no more effective than ornithine alone or ornithine glutamate. Ornithine appeared to be a little more effective than arginine, but the differences were slight. Aspartate and glutamate alone were ineffective. Carbamyl glutamate was much less effective than either ornithine glutamate or arginine glutamate. Orotic acid excretion was markedly increased in the presence of excess NH ₄ ⁺ . This increment was eliminated with ornithine or arginine, although the reduction with arginine was unpredictably erratic. Aspartate increased the orotic acid excretion and the amount of urea formed. Sodium benzoate was borderline in its effect on the blood ammonia and on orotic acid excretion.     

U.K. utility weights for the EORTC QLU‐C10D

The EORTC QLU‐C10D is a new multi‐attribute utility instrument derived from the widely used cancer‐specific quality of life questionnaire, EORTC QLQ‐C30. It contains 10 dimensions (physical functioning, role functioning, social functioning, emotional functioning, pain, fatigue, sleep, appetite, nausea, bowel problems), each with four levels. The aim of this study was to provide U.K. general population utility weights for the QLU‐C10D. A U.K. online panel was quota‐sampled to align the sample to the general population proportions of sex and age (≥18 years). The online valuation survey included a discrete choice experiment (DCE). Each participant was asked to complete 16 choice‐pairs, each comprising two QLU‐C10D health states plus duration. DCE data were analysed using conditional logistic regression to generate utility weights. Data from 2,187 respondents who completed at least one choice set were included in the DCE analysis. The final U.K. QLU‐C10D utility weights comprised decrements for each level of each health dimension. For nine of the 10 dimensions (all except appetite), the expected monotonic pattern was observed across levels: Utility decreased as severity increased. For the final model, consistent monotonicity was achieved by merging inconsistent adjacent levels for appetite. The largest utility decrements were associated with physical functioning and pain. The worst possible health state (the worst level of each dimension) is ?0.083, which is considered slightly worse than being dead. The U.K.‐specific utility weights will enable cost–utility analysis (CUA) for the economic evaluation of new oncology therapies and technologies in the United Kingdom, where CUA is commonly used to inform resource allocation.     

US State-Level Infertility Insurance Mandates and Health Plan Expenditures on Infertility Treatments

Maternal and Child Health Journal - Objectives We aimed to examine the extent to which health plan expenditures for infertility services differed by whether women resided in states with mandates...     

A Population-Based Study of School Readiness Determinants in a Large Urban Public School District

Maternal and Child Health Journal - Objectives We examined biologic and social determinants of school readiness in an urban population and whether childcare altered these associations. Methods A...     

Non-invasive ventilation in COPD. 2: Starting and monitoring NIV

Part 2 of this two-part unit examines the role of non-invasive ventilation (NIV) in treating hypercapnic respiratory failure and discusses the care of patients on NIV.     

Predictors of participant adherence and retention in the African American Study of Kidney Disease and Hypertension.

The African American Study of Kidney Disease and Hypertension (AASK) was conducted over a 7-year period at 21 clinical centers across the United States to investigate whether one of two levels of blood pressure control and/or one of three classes of antihypertensive medications was more effective at slowing the rate of renal disease in African Americans with renal insufficiency presumed secondary to hypertension. Analysis at the end of the study revealed an overall participant retention rate of 90% (still alive and not on dialysis); defined as having had at least one 125I-iothalamate GFR, the primary data collection element, measured in the final year of the study. Adherence, defined as not missing 3 consecutive protocol visits (6 months) during the study, was 77%. Adherence to protocol visits showed that participants assigned to a low blood pressure goal (mean arterial pressure [MAP] of 92 mm/Hg or lower) had a 30% (95% CI, 9%-45%) lower risk of nonadherence as compared to those assigned to the usual goal [MAP of 102-107] (p = 0.006). No statistically significant difference was observed between randomized drug assignments. Higher baseline systolic (p = 0.0001) and diastolic (p = 0.007) blood pressures were associated with a higher risk of nonadherence. Declining to provide an annual income is associated with a higher risk of nonadherence compared to those with incomes of $15,000 or higher (p = 0.04). In discussing the identifying factors that may predict nonadherence and the strategies that assisted in improving adherence and retention, this article offers insights for researchers in achieving high levels of participation in long-term clinical studies.     

Content and Process in Clinical Decision-Making by Nurse Practitioners

Clinical decision-making is the process nurses use to gather information, evaluate it and make a judgment that results in the provision of patient care. This research sought to increase our understanding of clinical decision making by nurse practitioners. The sample consisted of 27 nurse practitioners; 6 OB/CYN nurse practitioners, 11 experienced family nurse practitioners and 10 inexperienced family nurse practitioners. All subjects cared for the same patient who was presented via computer and interactive video. Findings indicated that nurse practitioners use a process of clinical decision-making in which diagnostic hypotheses drive data acquisition. The OB/CYN nurse practitioners were more likely to develop lists of diagnostic hypotheses which reflected the patient's chief complaint, while both experienced and inexperienced family nurse practitioners were more likely to acquire subjective and objective data that did not appear to be hypothesis driven.