Career trends in health information management: a look toward 2006, Part I

The transformation taking place in health information management is causing a shift in the role of HIM professionals. This article examines the influence this shift has had on current trends in the workforce and what it means to HIM professionals.     

Bladder pheochromocytoma encountered on sonography

Pheochromocytomas of the bladder are rare neoplasms, constituting <0.06% of all vesical tumours. Common presenting features of this tumour include episodes of sweating, hypertension, haematuria and postmicturition syncope. We describe a case of bladder pheochromocytoma in a 66‐year‐old man whose only symptom of macroscopic haematuria was initially assessed with ultrasonography. Clinical presentation highlights the need for a high index of suspicion during sonographic evaluation of bladder neoplasms because such tumours might present without symptoms of adrenergic excess.     

Use of the humanized anti-epidermal growth factor receptor monoclonal antibody h-R3 in combination with radiotherapy in the treatment of locally advanced head and neck cancer patients.

PURPOSE: To evaluate safety and preliminary efficacy of the humanized anti-epidermal growth factor receptor monoclonal antibody h-R3 in combination with radiotherapy (RT) in unresectable head and neck cancer patients. Secondary end points were the measurement of h-R3 serum levels and the assessment of the potential mechanisms of antitumor effect on patient biopsies. Anti-idiotypic response to h-R3 was assessed. To predict pharmacologic effect, a mathematical model for antibodies recognizing antigens expressed in tumors and normal tissues was built. PATIENTS AND METHODS: Twenty-four patients with advanced carcinomas of the head and neck received six once-weekly infusions of h-R3 at four dose levels in combination with RT. Pretreatment tumor biopsies were obtained to evaluate epidermal growth factor receptor expression as an enrollment criterion. Second biopsies were taken to evaluate the proliferative activity and angiogenesis in comparison with the pretreatment samples. Patient serum samples were collected to measure h-R3 levels and anti-idiotypic response. RESULTS: The combination of h-R3 and RT was well tolerated. Antibody-related adverse events consisted in infusion reactions. No skin or allergic toxicity appeared. Overall survival significantly increased after the use of the higher antibody doses. Immunohistochemistry studies of tumor specimens before and after treatment revealed that antitumor response correlated with antiproliferative and antiangiogenic effect. One patient developed antibodies to h-R3. The mathematical model predicted that the maximum difference between the area under the curve in tumors and normal tissues is reached when the antibody has intermediate affinity. CONCLUSION: h-R3 is a well-tolerated drug that may enhance radiocurability of unresectable head and neck neoplasms.     

Hydrogen peroxide inhibits gap junctional intercellular communication in glutathione sufficient but not glutathione deficient cells

Cell to cell communication via gap junctions is essential in the maintenance of the homeostatic balance of multicellular organisms. Aberrant intercellular gap junctional communication (GJIC) has been implicated in tumor promotion, neuropathy and teratogenesis. Oxidative stress has also been implicated in similar pathologies such as cancer. We report a potential link between oxidative stress and GJIC. Hydrogen peroxide, a known tumor promoter, inhibited GJIC in WB-F344 rat liver epithelial cells with an I50 value of 200 microM. Inhibition of GJIC by H2O2 was reversible as indicated by the complete recovery of GJIC with the removal of H2O2 via a change of fresh media. Free radical scavengers, such as t-butyl alcohol, propylgallate, and Trolox, did not prevent the inhibition of GJIC by H2O2, which indicated that the effects of H2O2 on GJIC was probably not a consequence of aqueous free radical damage. The depletion of intracellular GSH reversed the inhibitory effect of H2O2 on GJIC. The treatment of glutathione- sufficient cells with H2O2 resulted in the hyperphosphorylation of connexin43, which is the basic subunit of the hexameric gap junction protein, as determined by Western blot analysis. TPA, a well-known tumor promoter, also inhibits GJIC via hyperphosphorylation of GJIC, which is a result of protein kinase-C activation. However, H2O2 also induced hyperphosphorylation in GSH-deficient cells that had normal rates of GJIC. Therefore, the mechanism of GJIC inhibition must be different from the TPA-pathway and involves GSH.      

Mindfulness-integrated reproductive health package for adolescents with parental HIV infection: a group-randomized controlled trial

We assessed the effect of a mindfulness-integrated reproductive health (Mind-RH) intervention on knowledge on RH among adolescents with parental HIV and determined their associated factors. A group-randomized controlled trial was conducted among adolescents aged 10–16 years with HIV-infected parent(s) using Mind-RH intervention package. Four selected townships were randomized into two study townships and two control townships. Knowledge on RH and evaluation of mindfulness practice by mindfulness-based self-efficacy scale-revised were assessed at baseline, 3 months and 6 months. Multivariate multilevel regression was used to identify influencing factors of RH knowledge. A total of 160 adolescents (80 per group) were included. A significant improvement of mindfulness scores at 3 months was found overall and sustained at 6 months (p < 0.01). Univariate analysis showed significantly higher knowledge scores in the intervention group than in the control group at 3 and 6 months (p < 0.001). After adjusting for family type, age and HIV status of the adolescents, RH knowledge scores increased at 3 and 6 months in both groups, but at a higher rate at 3 months for adolescents in the intervention group. Early adolescents, HIV negative adolescents and those from extended families had lower knowledge scores (p < 0.01). The Mind-RH package significantly improved knowledge and mindfulness of adolescents with parental HIV. Longer follow-up is required to evaluate the long-term impact of this intervention.     

Ambulatory blood pressure monitoring in patients with hyperthyroidism before and after control of thyroid function

BACKGROUND AND OBJECTIVE: Thyroid hormones have pronounced effects on the cardiovascular system. Thyrotoxicosis affects blood pressure (BP), modifying both diastolic (DBP) and systolic (SBP) pressures. There are no studies examining BP with ambulatory blood pressure monitoring (ABPM) in hyperthyroidism before and after control of thyroid function. Our aims were (1) to analyse ABPM in a group of normotensive hyperthyroid patients before and after normalizing circulating thyroid hormones and (2) to compare these results with those obtained in a group of euthyroid subjects. PATIENTS AND MEASUREMENTS: We studied 20 normotensive hyperthyroid subjects [18 women; age (mean +/- SEM) 49.0 +/- 3.0 years] and 15 healthy subjects. Patients were evaluated by ABPM over 24 h, at diagnosis and after therapy (n = 18). RESULTS: The average 24-h, daytime and night-time SBP was significantly greater in hyperthyroid patients than in controls with no significant differences in DBP. Circadian BP rhythm, estimated by the difference between mean values of SBP, DBP and mean BP during daytime and night-time, was unchanged. The average 24-h and daytime SBP significantly decreased after normalizing thyroid function in the 18 hyperthyroid evaluated patients. Daytime SBP and DBP were higher than night-time values both before and after control of thyroid function. However, no differences in circadian BP rhythm were observed. CONCLUSIONS: Normotensive hyperthyroid patients exhibit higher ambulatory SBP throughout 24 h than normotensive euthyroid subjects. Control of hyperthyroidism decreases ambulatory SBP values. Mean nocturnal fall in BP is comparable in normotensive hyperthyroid patients and control subjects.     

Chronic inflammatory intestinal disease in Catalonia (Barcelona and Gerona)]

We show the results of a retrospective study carried out during ten years (1978-1987), in Catalonia in the provinces of Barcelona and Gerona. The aim of the study was to evaluate the incidence and prevalence of inflammatory chronic bowel disease in our country, its clinical aspects, management and long term survival. An epidemiological inquiry was sent to all the hospitals and gastroenterologists of Catalonia. Nine hundred and seventy six answers were received from 20 Hospitals and four specialists. All of them were revised by the Research Committee, and 761 were validated for their inclusion in the study. The prevalence of the disease was similar both in Barcelona (19 per 100,000) and Gerona (18 per 100,000). The incidence of ulcerative colitis increased during the study, from 0.4 in 1978 to 0.8 in 1987, with a peak of maximum incidence (1.0 per 100,000) in 1985. In the same way, an increase in the incidence of Crohn's disease from 0.2 to 0.7 per 100,000, was observed. The mean incidence per year was 0.6 and 0.4 respectively, similar to the incidence observed in other Spanish regions during the same period of time. Finally we show the most important clinical and therapeutic aspects as well as the survival data.