Soft tissue pathology around the hip

Snapping hip syndromes have been treated with open surgery for many years. Recently, endoscopic techniques have been developed for treatment of snapping hip syndromes with results that are at least comparable if not better than those reported for open procedures. The greater trochanteric pain syndrome is well known by orthopedic surgeons. However, deep understanding of the pathologic conditions generating pain in the greater trochanteric region and endoscopic access to it has only recently been described. Although evidence regarding endoscopic techniques for the treatment of the greater trochanteric pain syndrome is mainly anecdotal, early published reports are encouraging.     

Wounding words: swearing and verbal aggression in an inpatient setting

PURPOSE: The aim of the research was to investigate swearing and verbal aggression in Australian inpatient settings, including incidence, gender, patient motivation, and nursing interventions. DESIGN AND METHODS: A mixed methods approach utilizing the Overt Aggression Scale and a survey of 107 nurses' perceptions of their experience of swearing was used. FINDINGS: High levels of swearing and verbal aggression were found, with differing patterns for male and female patients. Nurses subjected to swearing experienced high levels of distress, especially females. All nurses appeared to use a limited range of interventions to deal with patient aggression. PRACTICAL IMPLICATIONS: In order to provide optimal care for patients, there is a clear need to improve nurses' ability to predict and prevent aggression.     

Truncation of tau at E391 promotes early pathologic changes in transgenic mice

Proteolytic cleavage of tau at glutamic acid 391 (E391) is linked to the pathogenesis of Alzheimer disease (AD). This C-terminal-truncated tau species exists in neurofibrillary tangles and abnormal neurites in the brains of AD patients and may potentiate tau polymerization. We generated a mouse model that expresses human tau truncated at E391 to begin to elucidate the role of this C-terminal-truncated tau species in the development of tau pathology. Our results show that truncated but otherwise wild-type human tau is sufficient to drive pretangle pathologic changes in tau, including accumulation of insoluble tau, somatodendritic redistribution, formation of pathologic conformations, and dual phosphorylation of tau at sites associated with AD pathology. In addition, these mice exhibit atypical neuritic tau immunoreactivity, including abnormal neuritic processes and dystrophic neurites. These results suggest that changes in tau proteolysis can initiate tauopathy.     

Quality Assurance Parameters and Predictors of Outcome for Ilioinguinal and Inguinal Dissection in a Contemporary Melanoma Patient Population

Background  

Regional lymph node dissection (RLND) is currently the most effective therapy for metastatic melanoma in groin lymph nodes. With thorough surgery, RLND lymph node (LN) retrieval numbers have a predictable distribution. Whether patients have inguinal or ilioinguinal dissection varies between institutions. This study was designed to provide LN retrieval parameters for inguinal and ilioinguinal LN dissections, and secondarily, to analyze known predictors for survival outcomes, including LN ratio, i.e., involved/total number LN removed.     

Autoimmune Neuromuscular Disorders in Childhood

Autoimmune neuromuscular disorders in childhood include Guillain-Barré syndrome and its variants, chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), juvenile myasthenia gravis (JMG), and juvenile dermatomyositis (JDM), along with other disorders rarely seen in childhood. In general, these diseases have not been studied as extensively as they have been in adults. Thus, treatment protocols for these diseases in pediatrics are often based on adult practice, but despite the similarities in disease processes, the most widely used treatments have different effects in children. For example, some of the side effects of chronic steroid use, including linear growth deceleration, bone demineralization, and chronic weight issues, are more consequential in children than in adults. Although steroids remain a cornerstone of therapy in JDM and are useful in many cases of CIDP and JMG, other immunomodulatory therapies with similar efficacy may be used more frequently in some children to avoid these long-term sequelae. Steroids are less expensive than most other therapies, but chronic steroid therapy in childhood may lead to significant and costly medical complications. Another example is plasma exchange. This treatment modality presents challenges in pediatrics, as younger children require central venous access for this therapy. However, in older children and adolescents, plasma exchange is often feasible via peripheral venous access, making this treatment more accessible than might be expected in this age group. Intravenous immunoglobulin also is beneficial in several of these disorders, but its high cost may present barriers to its use in the future. Newer steroid-sparing immunomodulatory agents, such as azathioprine, tacrolimus, mycophenolate mofetil, and rituximab, have not been studied extensively in children. They show promising results from case reports and retrospective cohort studies, but there is a need for comparative studies looking at their relative efficacy, tolerability, and long-term adverse effects (including secondary malignancy) in children.     

Experiences with advance care planning: nurses' perspective

jeong s.y.‐s., higgins i. & mcmillan m. (2011 ) Experiences with advance care planning: nurses’ perspective. International Journal of Older People Nursing  6 , 165–175 doi: 10.1111/j.1748‐3743.2009.00200.x Aims and objectives. The aim of this paper is to report the findings of a case study that explored the phenomenon of advanced care planning and advance care directives in residential care settings in Australia. In particular, this paper focuses on the experiences of Registered Nurses with advanced care planning and advance care directives. Background. Nurses need to know how to engage with residents and families when they invest time and effort on advanced care planning and documentation of advance care directives. Methods. A case‐study design involving participant observation, field note recording, semi structured interviews and document analysis was used. Data were collected over 7 months. Data analysis involved thematic content analysis. Findings. The factors that enhanced and inhibited the experiences of the Registered Nurses with advanced care planning were identified. The enhancing factors include; ‘it is their essence of who they are’, and ‘back‐up from family members and other nursing staff’. The inhibiting factors are ‘lack of time’, ‘a culture of do everything and don’t go there’, and ‘lack of family involvement’. Conclusion. The findings of the current study provided nurses with evidence of the positive nature of experiences of older people, family members, and nurses themselves with advanced care planning in an attempt to better implement and practise advanced care planning.     

The effect of numeracy on the comprehension of information about medicines in users of a patient information website

Objective

To investigate the relationship between numeracy and the accuracy of side effect risk estimation following the presentation of information about a medicine via the Cancer Research UK (CR-UK) patient information website.

Methods

591 website users were presented with information in different formats about the risks of side effects from taking tamoxifen. Participants estimated the risk of each side effect, provided other subjective ratings about the information and completed a numeracy task.

Results

Regardless of presentation format, numeracy was correlated with the accuracy of three side effect risk estimates. People with cancer and tamoxifen users showed stronger correlations for all side effect estimates. In addition, numeracy was positively related to the perceived influence of the information on the decision to take the medicine and was negatively related to ratings of satisfaction with the information.

Conclusion

People with a lower numeracy level make larger errors in interpreting medicines side effect risk information.

Practice implications

Pharmacists, other health professionals and patient information websites should ensure they provide clear explanations of risk, particularly to people with low numeracy, and assess their understanding of those explanations. Future research into risk communication should take account of numeracy level, to investigate the impact of different formats.