An Exploratory Behavioral Intervention Trial to Improve Rates of Screening for AIDS Clinical Trials Among Racial/Ethnic Minority and Female Persons Living with HIV/AIDS

Individuals from racial/ethnic minority backgrounds and women have not been proportionately represented in AIDS clinical trials (ACTs). There have been few intervention efforts to eliminate this health disparity. This paper reports on a brief behavioral intervention to increase rates of screening for ACTs in these groups. The study was exploratory and used a single-group pre/posttest design. A total of 580 persons living with HIV/AIDS (PLHA) were recruited (39% female; 56% African-American, 32% Latino/Hispanic). The intervention was efficacious: 25% attended screening. We identified the primary junctures where PLHA are lost in the screening process. Both group intervention sessions and an individual contact were associated with screening. Findings provide preliminary support for the intervention’s efficacy and the utility of combining group and individual intervention formats. Interventions of greater duration and intensity, and which address multiple levels of influence (e.g., social, structural), may be needed to increase screening rates further.     

Injury Prevention for Modern Dancers: A Pilot Study of an Educational Intervention

Modern dancers suffer a high rate of musculoskeletal injuries. Preventing injury prolongs dance careers and eases financial burden on both individual dancers and dance companies alike. A medical student partnered with Garth Fagan Dance to develop a curriculum to teach principles of injury prevention specific to preprofessional and professional modern dancers. Quantitative assessments showed a significant increase in participant injury prevention knowledge after completion of the course (P < 0.0001). Participants’ concern that injury may end their careers showed no significant change after the course (P = 0.35). Injury prevention and dance-related injuries were reported the most often as useful topics while weight management was reported the least often as a useful topic. Qualitative evaluations showed that participants’ found a course on injury prevention valuable and desired a course of longer duration that includes a greater number of topics. These findings show that modern dancers perceive an educational course on injury prevention as valuable and retain information presented in the course in the short-term. Further study is warranted to assess changes in injury rates after the course and to continue to improve curriculum content and implementation.     

Electrocardiographic manifestations: acute inferior wall myocardial infarction

The 12-lead electrocardiogram (EKG) is an important tool in evaluating the patient with acute myocardial infarction (MI). Patients with acute inferior wall myocardial infarction (IWMI) represent a heterogeneous group in terms of morbidity, mortality, Emergency Department (ED) management, and site of occlusion in the culprit coronary artery. The standard 12-lead EKG, right-sided chest leads and posterior chest leads, in conjunction with clinical findings often provide the necessary information for the Emergency Physician (EP) to predict complications, morbidity and mortality. IWMI patients may have associated right ventricular infarction (RVI) or lateral and posterior wall extension. Each of these entities is associated with specific hemodynamic abnormalities and increased mortality. In addition, various atrioventricular (AV) blocks are commonly associated with IWMI. This article presents several cases of IWMI with EKGs and a discussion of EKG interpretation in the setting of IWMI.     

Higher Donor Apheresis Blood Volumes Are Associated with Reduced Relapse Risk and Improved Survival in Reduced-Intensity Allogeneic Transplantations with Unrelated Donors

Allogeneic hematopoietic stem cell transplantation (HSCT) with reduced-intensity conditioning (RIC) offers a curative option for patients with hematologic malignancies who are unable to undergo myeloablative conditioning, but its success is limited by high rates of relapse. Several studies have suggested a role for T cell doses in peripheral blood stem cell grafts in RIC HSCT. Because T cell dose is typically not known until after the collection, and apheresis blood volume is easily modifiable, we hypothesized that higher donor apheresis blood volumes would improve transplantation outcomes through an effect on graft composition. Thus, we analyzed the relationships between apheresis volume, graft composition, and transplantation outcomes in 142 consecutive patients undergoing unrelated donor allogeneic RIC HSCT. We found that apheresis volume ≥15 L was associated with a significantly decreased risk of relapse (adjusted hazard ratio [aHR], .48; 95% confidence interval [CI], .28 to .84]; P?=?.01) and improved relapse-free survival (aHR, .56; 95% CI, .35 to .89; P?=?.02) and overall survival (aHR, .55; 95% CI, .34 to .91; P?=?.02). A high apheresis volume was not associated with increased rates of acute or chronic graft-versus-host disease. These results demonstrate that an apheresis volume of at least 15 L is independently predictive of improved transplantation outcomes after RIC allogeneic HSCT.     

Drug-related emergency department visits in an elderly veteran population

BACKGROUND: Given that adverse drug events result in extensive costs and healthcare resource utilization, the goal is to better understand drug-related emergency department (ED) visits so that programs can be implemented to improve the quality of health care. OBJECTIVE: To (1) determine the incidence of drug-related ED visits at a large, tertiary care, Veterans Affairs hospital; (2) identify causes of these drug-related ED visits; (3) determine patient outcomes, healthcare resource utilization, and costs associated with these visits; and (4) determine the proportion of adverse drug reaction (ADR)-related ED visits that were spontaneously reported to the hospital's ADR reporting program. METHODS: We conducted a retrospective electronic chart review of all patients who visited the ED during the second week of each month in 2003. Causes for drug-related visits were identified. ADRs in this study included side effects, drug allergies, and drug-drug interactions (DDIs) and were assessed using the Naranjo probability scale. RESULTS: A total of 2169 patients were included in the study. Drug-related visits accounted for 12.6% of all ED visits. The main causes of drug-related visits were ADRs and nonadherence, which accounted for 33% and 19% of drug-related visits, respectively. Only 11% of these ADRs were spontaneously reported to the hospital's ADR reporting program. Thirty-five percent of drug-related visits led to hospitalizations, which resulted in an average length of stay of 9.3 days. The institution's total cost of drug-related visits was approximately 1.5 million US dollars over 12 weeks. CONCLUSIONS: Many ED visits are drug related and often result in hospitalization and increased healthcare resource utilization. Only a minimal number of the ADRs resulting in ED visits are spontaneously reported to hospital ADR reporting programs.     

Serotonin (5-hydroxytryptamine) 5-HT(2A) receptor: association with inherent and cocaine-evoked behavioral disinhibition in rats

Alterations in the balance of functional activity within the serotonin [5-hydroxytryptamine (5-HT)] system are hypothesized to underlie impulse control. Cocaine-dependent subjects consistently show greater impulsivity relative to nondrug using control subjects. Preclinical studies suggest that the 5-HT(2A) receptor (5-HT(2A)R) contributes to the regulation of impulsive behavior and also mediates some of the behavioral effects of cocaine. We hypothesized that the selective 5-HT(2A)R antagonist M100907 would reduce inherent levels of impulsivity and attenuate impulsive responding induced by cocaine in two animal models of impulsivity, the differential reinforcement of low rate (DRL) task and the one-choice serial reaction time (1-CSRT) task. M100907 reduced rates of responding in the DRL task and premature responding in the 1-CSRT task. Conversely, cocaine disrupted rates of responding in the DRL task and increased premature responding in the 1-CSRT task. M100907 attenuated cocaine-induced increases in specific markers of behavioral disinhibition in the DRL and 1-CSRT tasks. These results suggest that the 5-HT(2A)R regulates inherent impulsivity, and that blockade of the 5-HT(2A)R alleviates specific aspects of elevated levels of impulsivity induced by cocaine exposure. These data point to the 5-HT(2A)R as an important regulatory substrate in impulse control.