The inter‐rater reliability between nurse‐assessors clinically assessing infection of chronic wounds using the WUWHS criteria

The aim of this study was to determine the inter‐rater reliability between one expert‐nurse and four clinical‐nurses who were asked to clinically assess infection of chronic wounds by using the World Union of Wound Healing Societies (WUWHS) criteria. A quasi‐experimental design was used to collect the data. In comparison to phase 1 in which ‘open questions’ were asked, in phase 2 a pre‐printed form (checklist) was introduced. In both phases, 55 chronic wounds were clinically assessed. For each WUWHS criterion the inter‐rater reliability of signs and symptoms was expressed by Cohens Kappa (κ). A substantial agreement (κ ≥ 0·6) was considered as adequate. In both phases pocketing (p < 0·02), and erythema (p < 0·004) scored statistically significant results. Phase 2 showed higher inter‐rater agreements compared with phase 1 (three substantial agreements (easily bleeding/friable granulation tissue, delayed healing, increasing exudate), an almost perfect‐ and a perfect agreement for malodour and pain, respectively. According to the results it can be concluded that the clinical assessment of infection of chronic wounds may be better supported by a pre‐printed form than making use of an ‘open questions’ form. To provide this with a higher level of evidence, there is need for more well conducted studies.     

English-as-a-second language (ESL) nursing students: strategies for building verbal and written language skills

With the growing number of foreign-born residents in the United States, nurse educators face the challenge of educating students who may have difficulty with the English language. There are an estimated 28.4 million foreign-born residents in the United States, which is the largest number in the history of this country (U.S. Census Bureau, 2001). The U.S. census report (2001) shows that the Hispanic/Latino population has increased by 57.9% since 1990 and now accounts for 12.5% of the total population. Another fast growing group is the Asian population that has increased by 48.3% since 1990 and now accounts for 3.6% of the total population. The Annual Report of the American Association of Colleges of Nursing (AACN, 2001) shows that the minority representation in baccalaureate programs has also increased with the Hispanic/Latino students at 4.8% and the Asian/Pacific Islander/Hawaiian students at 4.7% of the undergraduate nursing student population. Several authors (Abriam-Yago, Yoder, & Kataoka-Yahiro, 1999; Lester, 1998; Davidhizar, Dowd, & Geiger, 1998; Dowell, 1996; Andrews, 1992) have discussed the importance of increasing the number of ethnic minority nurses to insure the quality of healthcare to an increasingly diverse population. As the nursing shortage deepens, recruiting minorities into nursing is essential to meet the increasing demand. This change presents unique challenges and opportunities in nursing education. Colleges and universities will need to develop innovative programs to attract these nontraditional students, and support programs to help them complete the nursing curriculum.     

Clinical and Phenotypic Characterization of Common Variable Immunodeficiency Diagnosed in Younger and Older Adults

Journal of Clinical Immunology - Common variable immunodeficiency (CVID) is the most prevalent symptomatic immunodeficiency in adults. Little is known about the manifestations of CVID presenting in...     

Single-step assays to analyze CYP2D6 gene polymorphisms in Asians: allele frequencies and a novel *14B allele in mainland Chinese

BACKGROUND: Cytochrome P450-dependent monooxygenase 2D6 (CYP2D6) activity can be estimated by investigating the metabolism of model drugs or by genotyping the most common CYP2D6 alleles. For Caucasians, the CYP2D6 allele frequencies are well investigated, and single-step assays are available for genotyping, whereas allele analysis in mainland Chinese is limited. METHODS: Two tetra-primer assays and one allele-specific amplification assay were developed to easily genotype the CYP2D6 alleles *8, *10, and *14 previously detected in Asians. Applying these assays in combination with established single-tube assays, we analyzed 223 DNA samples from Chinese volunteers for the CYP2D6 alleles *3, *4, *5, *6, *8, *10, and *14 and for duplication of CYP2D6. RESULTS: Six different alleles were detected in mainland Chinese. The most frequent mutant allele was the intermediate metabolizer allele, CYP2D6*10, with a prevalence of 51.3%, followed by the poor metabolizer alleles CYP2D6*5 (7.2%) and a novel variant of CYP2D6*14. This novel *14B allele (2.0%) differs from the *14 allele by the absence of the C188T substitution and by the additional G1749C substitution. Furthermore, six duplication alleles of CYP2D6 were detected, including one duplication of the *10 allele (*10X2). CONCLUSIONS: The CYP2D6 allele frequencies in mainland Chinese shows some genetic diversity compared with Chinese from other regions: a novel *14B allele, a slightly higher frequency of the *5 allele, and a slightly lower frequency of the *10 allele than in most other Chinese populations.     

ASK1 is a novel molecular target for preventing aminoglycoside-induced hair cell death

Journal of Molecular Medicine - Aminoglycoside antibiotics are lifesaving medicines, crucial for the treatment of chronic or drug resistant infections. However, aminoglycosides are toxic to the...     

MC11C4: a pilot randomized,placebo-controlled,double-blind study of venlafaxine to prevent oxaliplatin-induced neuropathy

Purpose

Previous pilot data suggested that venlafaxine could prevent acute and chronic oxaliplatin-related neuropathy. The purpose of this randomized, placebo-controlled, double-blinded pilot study was to obtain additional data to support conducting a phase III trial to test the use of venlafaxine to prevent oxaliplatin neurotoxicity.

Methods

Fifty patients, scheduled to undergo oxaliplatin-based therapy (FOLFOX) for stages II–III (67 %) or stage IV (33 %) colon cancer, were randomized to receive venlafaxine extended release (37.5 mg) or placebo, twice daily, through their last dose of oxaliplatin and then titrated off. Neurotoxicity was evaluated via several patient- and physician-reported measures, including the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Chemotherapy-Induced Peripheral Neuropathy 20 (EORTC QLQ-CIPN20) instrument.

Results

Baseline patient characteristics were equivalent for the two arms, with a median age of 60 years. There was a trend toward benefit for the venlafaxine arm, when evaluated by the oxaliplatin-specific neuropathy scale and by acute neuropathy measures of throat discomfort and discomfort swallowing cold liquids, the latter only for the first two oxaliplatin doses. These trends were outweighed by a lack of any such trends in all other measurements including the following: (1) the CIPN20 sensory subscale (P?=?0.55, primary endpoint), physician-completed NCI CTCAE assessment, or cumulative administered oxaliplatin doses (median 716 vs 631 mg for placebo and venlafaxine, respectively, P?=?0.34).

Conclusions

The present study neither supports the use of venlafaxine for preventing oxaliplatin-induced neuropathy in clinical practice nor the initiation of a phase III trial to investigate venlafaxine in this setting.

     

Nonstandard Lumbar Region in Predicting Fracture Risk

Femoral neck (FN) bone mineral density (BMD) is the most commonly used skeletal site to estimate fracture risk. The role of lumbar spine (LS) BMD in fracture risk prediction is less clear due to osteophytes that spuriously increase LS BMD, particularly at lower levels. The aim of this study was to compare fracture predictive ability of upper L1–L2 BMD with standard L2–L4 BMD and assess whether the addition of either LS site could improve fracture prediction over FN BMD. This study comprised a prospective cohort of 3016 women and men over 60?yr from the Dubbo Osteoporosis Epidemiology Study followed up for occurrence of minimal trauma fractures from 1989 to 2014. Dual-energy X-ray absorptiometry was used to measure BMD at L1–L2, L2–L4, and FN at baseline. Fracture risks were estimated using Cox proportional hazards models separately for each site. Predictive performances were compared using receiver operating characteristic curve analyses. There were 565 women and 179 men with a minimal trauma fracture during a mean of 11?±?7?yr. L1–L2 BMD T-score was significantly lower than L2–L4 T-score in both genders (p?<?0.0001). L1–L2 and L2–L4 BMD models had a similar fracture predictive ability. LS BMD was better than FN BMD in predicting vertebral fracture risk in women [area under the curve 0.73 (95% confidence interval, 0.68–0.79) vs 0.68 (95% confidence interval, 0.62–0.74), but FN was superior for hip fractures prediction in both women and men. The addition of L1–L2 or L2–L4 to FN BMD in women increased overall and vertebral predictive power compared with FN BMD alone by 1% and 4%, respectively (p?<?0.05). In an elderly population, L1–L2 is as good as but not better than L2–L4 site in predicting fracture risk. The addition of LS BMD to FN BMD provided a modest additional benefit in overall fracture risk. Further studies in individuals with spinal degenerative disease are needed.     

Perception of social support: a comparative study between men with and without substance-related disorders

The influence of drug abuse on social support has been explored in different studies; however, the social support networks of individuals with substance-related disorders have not been described in comparison with individuals without these diagnoses. Therefore, this study aimed to assess the differences in the perception of men with and without substance-related disorders, specifically with regards to their social support network and the structural characteristics of their personal networks. Data were collected using psychometric scales and analysed through statistical methods that compared the two study groups. One-hundred patients participated in this study; participants were recruited at two public health service centres in an inner city of Brazil. The results showed that individuals with substance-related disorders displayed less satisfaction with their social support network and a lower density in their personal networks compared with the group without substance-related disorders. From these results, it appears that professionals involved in caring for these patients should implement interventions that improve the support networks of this patient population to facilitate both prevention and recovery.     

Productivity loss as a major component of disease-related costs in patients with hypercholesterolemia in Germany

Objective Hypercholesterolemia is a common risk factor for cardiovascular diseases; however, there are only few data available on associated costs. The objective of this study is, therefore, to analyse direct and indirect costs in patients with hypercholesterolemia and to determine predictors of costs. Methods The ORBITAL Study is a randomised controlled trial evaluating the effectiveness of a compliance-enhancing program in patients with statin therapy. Consecutive patients eligible for statin therapy according to the Joint European Guidelines were enrolled nationwide in 1961 primary care practices in Germany. For the present cost-of-illness analysis, patients were asked retrospectively about medical resource use and employment status in the 6 months preceding enrolment. The perspective chosen was societal. Factors associated with costs were determined using linear regression. Results A total of 7,640 patients (56% men, mean age 60 ± 10 years, and 44% women, 64 ± 10 years) were included. Of these patients, 32% were employed, 17% had a history of myocardial infarction, 7% a history of stroke, 58% had hypertension, and 29% diabetes. Total disease-related costs amounted to a mean of 2,498 ± 4,898 Euros per patient over 6 months, comprising direct (44%) and indirect (56%) costs. Disease-related early retirement was responsible for 42% of costs, followed by hospital visits (19%), medication (15%), workdays lost (14%), physician visits (5%), outpatient therapy (2%), and rehabilitation (2%). In multivariable analyses, factors associated with direct costs included coronary interventions, risk stratum, and medical history. Factors associated with indirect costs included disease-related early retirement, other socio-economic and lifestyle factors, coronary interventions, risk stratum, and medical history. Conclusion The considerable economic burden associated with hypercholesterolemia indicates the need to assess long-term cost-effectiveness of health care programs in patients with this disorder. ClinicalTrials.gov Identifier: NCT00379249.     

Activation of PAF receptor by oxidised LDL in human monocytes stimulates chemokine releases but not urokinase-type plasminogen activator expression

BACKGROUND: We investigated whether the increase of urokinase-type plasminogen activator (uPA) monocyte expression and chemokine releases induced by oxidised low density lipoproteins (LDL), which participate to vascular tissue remodeling and to atherosclerotic plaque rupture, involved proinflammatory phospholipid products having platelet-activating factor (PAF)-like activity via the PAF-receptor pathway. METHODS: uPA monocyte expression was stimulated by either copper ions-oxidised or O2*-/HO* free radical-oxidised LDL. The effects of PAF and oxidised LDL on the production of monocyte chemoattractant protein-1 and interleukin-8 were also examined. RESULTS: Synthetic PAF significantly enhanced chemokine releases (P<0.001) without modifying uPA expression. Copper-oxidised LDL, which exhibit a higher content in lysophosphatidylcholines than free radical-oxidised LDL, induced a significantly higher enhancement in uPA expression (P<0.05). By contrast, free radical-oxidised LDL were more efficient than copper-oxidised LDL to increase chemokine releases (P<0.01). Oxidised LDL-enhanced uPA expressions were not altered by the PAF-receptor antagonist SR27417, whereas increases in chemokine releases induced by oxidised LDL and by PAF were abolished. PAF-acetylhydrolase activity was rapidly and largely inhibited in free radical-oxidised LDL when compared to copper-oxidised LDL, suggesting that free radical-oxidised LDL would contain a higher content in PAF-like products than copper-oxidised LDL. CONCLUSION: Our results indicated that PAF-like oxidation products are responsible for the monocyte chemokine releases, but did not contribute to the enhanced monocyte uPA expression by oxidised LDL.