Factors influencing uptake of influenza vaccination among hospital-based health care workers

BACKGROUND: Vaccination of health care workers against influenza has been shown to lower mortality among elderly patients, but uptake of voluntary vaccination among health care workers remains low. AIMS: Factors influencing uptake of vaccination were examined among a cross-section of health care workers based in an NHS Trust. METHODS: A structured, self-administered questionnaire was mailed to a random sample of health care workers based in the acute services sector of a UK National Health Service Trust, 6 months following a voluntary immunization programme implemented as part of the Scottish Executive Health Department winter planning arrangements for 2000-2001. The programme was promoted using posters in clinical areas and a single leaflet given to all staff through a paycheck advice note. RESULTS: Five hundred and fifty-one health care workers (53%) responded to the questionnaire and influenza vaccination was accepted by 150 (28%). The occupational health poster strongly influenced the decision to accept vaccination [odds ratio (OR) = 11.01; 95% confidence interval (CI) = 2.13-56.80; P < 0.0001]. Other significant influences included female sex (OR = 9.11; 95% CI = 1.26-65.72) and perceived risk of contracting flu without the vaccine (OR = 7.70; 95% CI = 1.44-41.05). Misconceptions regarding the purpose of the vaccination campaign were common and concern regarding possible side-effects was a deterring factor for vaccination uptake. CONCLUSION: Our study showed that visual material displayed throughout the workplace strongly influenced the acceptance of influenza vaccination. Future campaigns should also emphasize the positive benefits to patients of health care worker immunization, with readily accessible information regarding side-effects available from all sources.     

Improved drug dissolution and product characterization using a crescent-shaped spindle

Drug release characteristics of two amoxicillin capsule products, 250 and 500 mg strength each, have been described using USP Paddle and crescent-shaped spindles. Using the same spindles, dissolution experiments were conducted with USP disintegrating (prednisone) and non-disintegrating (salicylic acid) calibrator tablets. Dissolution tests were conducted at 50 and 25 rev min(-1) using USP Paddle and crescent-shaped spindles, respectively. In all cases, even with the higher 50 rev min(-1), lower percent drug release results were observed with the Paddle spindle than with the crescent-shaped spindle, which was operated at 25 rev min(-1). The observed lower dissolution for amoxicillin capsule products (< 36 vs > 87% at 30 min) and USP prednisone calibrator tablets (45.5 vs 99.8% at 30 min) with Paddle spindles appeared to occur because of the accumulation of the disintegrated material (cone formation) at the bottom, thus restricting product-medium interaction. Crescent-shaped spindles did not allow any accumulation of the product and provided improved interaction by mixing and stirring, and thus appeared to provide true drug dissolution characteristics of the products. On the other hand, in the case of non-disintegrating USP salicylic acid tablets (18.5 vs 24.4% at 30 min), lower results with Paddle spindles appeared to be because of stagnation of the tablets, which provided poor product-medium interaction for the surface touching the vessel surface. In this case, the crescent-shaped spindles moved the tablets at the base of the vessel, providing improved and efficient product-medium interaction, thus appearing to reflect truer dissolution characteristics of the tablets. The results highlight the possible artifacts of the USP Paddle spindle, which could lead to inaccurate characterization of drug release properties of test products. As reported previously, the artifacts of high variability in results and lack of relevance to product properties appeared to be related to poor mixing and variable hydrodynamics within a dissolution vessel. Results from this study provide further evidence that these artifacts might be addressed adequately using the crescent-shaped spindle, thus resulting in improved drug release as well as better product characterization.     

Presentation of extramedullary acute myelogenous leukemia as bilateral testicular masses: response to non-myeloablative allogeneic transplantation

We present an unusual case of extramedullary acute myelogenous leukemia (AML) presenting as bilateral testicular masses. The patient subsequently developed diffuse skin lesions and bone marrow involvement. Although he had only a partial response to intensive chemotherapy, the patient obtained a complete remission after non-myeloablative allogeneic transplantation.     

Supranormal renal function in unilateral hydronephrotic kidney can be avoided

INTRODUCTION: There are reports and controversy in the literature of supranormal (defined as >55%) differential renal function (DRF) in the hydronephrotic kidney in children with unilateral hydronephrosis. It is not confirmed whether supranormal DRF is an artifact or a true finding. In patients in whom the relative renal function deteriorates, relief of obstruction becomes surgically necessary and if this artifact can be removed. Supranormal function in an obstructed kidney is confusing and there is no consensus on how to manage these patients. There is no agreement if this is a true entity or an artifact. We wanted to address this issue by reporting our experience. METHODS: We reviewed all the consecutive cases from August 2000 to October 2001 who were studied in our center with the diagnosis of unilateral renal obstruction for confirmation or evaluation of DRF. All patients had MAG-3 studies that were interpreted by experienced nuclear medicine physicians. The DRF were measured within the first to second minute of the MAG-3 injection. Regions of interest were drawn by the imaging software and the images were corrected for background counts by drawing regions of interest 2 pixels away from the edge of the renal cortex. RESULTS: Fifty-seven patients were confirmed to be obstructed unilaterally; 41 (72%) patients had obstructive lesions in the left kidney and 16 (28%) in the right kidney. There was no case of supranormal DRF in the obstructed kidneys in our study. CONCLUSION: The supranormal renal function, as noted in some reports in the literature, was not seen in any patients at our institution. We believe that this entity is an artifact and can be avoided by using MAG-3 and projecting regions of interest by computer software; we plan to start analyzing multiple algorithms in phantoms with different ROI selection for background analysis.     

Unusual late sequel of ruptured distal tendon of biceps brachii mimicking a soft-tissue tumor

Objective We report a rare case of chronic, neglected rupture of the distal biceps brachii which presented with gradually increasing swelling over the left lower arm. Fine-needle aspiration cytology was reported as indicative of a soft-tissue neoplasm. Computed tomography and magnetic resonance imaging were unable to rule out a neoplastic mass. Final histopathology after surgical excision revealed a reparative process.Conclusion Such a presentation of ruptured biceps brachii wherein the clinicoradiological features are misleading and suggestive of a soft-tissue tumor is quite unusual.     

Simple technique of securing intraoral skin grafts

Small defects following intraoral resection are often resurfaced by skin grafts. Skin grafting has the advantage of ease of harvest with minimal additional operating time and post-operative hospital stay, an acceptable functional cosmetic result, and the ability to survive post-operative radiation 1. In addition to adequate vascularity of the recipient area, the most important aspect for graft survival is immobilization and adherence of the graft to the defect. However, in the oral cavity due to the uneven wound bed and constant mobility of the cheek, the graft is not completely immobilized. In addition, the salivary secretions tend to accumulate beneath the graft, separating the graft from the bed. Graft-failure can be prevented by immobilizing the graft and closing up any potential dead space that might lead to separation 2. A variety of methods have been described for immobilization and bolstering the graft to the wound. Many types of stents have been used varying from the simple cotton balls, resin molds, and foam pads, to complex stents like metal, plastic, and dental liner 34. The traditional tie over bolster technique described by Schramm and Myers involves fixation of the skin graft to the raw area, followed by placement of non-absorbable silk sutures from the adjacent mucosa, which are then tied over the bolster 1. However, the placement of this tie over sutures requires adjacent normal mucosa for anchorage, which may not be sufficient especially in the gingivo-buccal sulcus. Although external fixation of the stents to the cheek has been described, this results in ugly scarring of the cheek 2. We describe a simple technique of fixation of the skin graft in the oral cavity, which avoids the placement of additional tie over sutures and in our opinion results in better anchorage.     

Differential effects of alcohol upon gluconeogenesis from lactate in young and old hepatocytes

The purpose of this study was to determine the effect of age upon hepatic gluconeogenesis (HGN) from lactate in the presence of various concentrations of alcohol from young (3 months) and old (24 months) male rats. After a 24-hour fast, livers were perfused with collagenase and the hepatocytes were isolated. Aliquots of the cell suspension were placed in Krebs-Henseleit buffer and incubated with lactate, [U-(14)C]lactate, and nine different concentrations of ethanol (EtOH) for 30 min. Dose-effect curves were generated for the determination of maximal and half-maximal alcohol-induced inhibition on gluconeogenesis. There were no significant differences in basal HGN (lactate only and no EtOH) between young and old hepatocytes, 86.9+/-6.3 nmol/mg protein/30 min. The addition of ethanol significantly reduced HGN from lactate in both groups. At the highest ethanol concentration (15 mM), the glucose production was inhibited more from old, 46.1+/-1.2 nmol/mg protein/30 min, compared to young hepatocytes, 56.0+/-1.6 nmol/mg protein/30 min. The greater age-related reduction in HGN was confirmed by the minimal glycogenolysis, and the concomitant decline in [U-(14)C]glucose production, lactate uptake, and [U-(14)C]lactate uptake. The results suggest that alcohol elicits a greater inhibition upon HGN from lactate in old compared to young liver cells.