Associations of Cardiac Structure with Obesity, Blood Pressure, Inflammation, and Insulin Resistance in African-American Adolescents

To determine if obesity, blood pressure (BP), markers of inflammation, and insulin resistance are associated with cardiac structure in African-American adolescents, a cross–sectional study was performed on a cohort oversampled for high BP and obesity. Measurements included the following: anthropometrics, BP, homeostasis model assessment (HOMA) to assess insulin resistance, high-sensitivity C-reactive protein, and plasma adipokines (adiponectin, interleukin-6, plasminogen activator inhibitor-1). Echocardiogram measurements were left-ventricular mass index (LVMI) (g/m^2.7), LV relative wall thickness (LVRWT), left-atrial diameter index [LADI (mm/m)], and LV diastolic time intervals. LADI (r ² = 0.25) was associated with body mass index (BMI) systolic BP (SBP) and female sex. LVMI (r ² = 0.35) variation was associated with BMI SBP, heart rate, age, and male sex. LVRWT (r ² = 0.05) was associated with HOMA. Tissue diastolic intervals were not associated with any risk factor. Inflammatory markers and adipokines were associated with BMI but were not independently associated with any echocardiographic measures. In African-American adolescents, BMI and SBP, but not inflammatory markers or adipokines, are important correlates of LA size and LVM.     

Epidermoid Cyst Arising in the Buccal Mucosa: Case Report and Literature Review

Epidermoid cysts are benign subcutaneous lesions, and the large majority of these cysts affect the floor of the mouth; however, the buccal mucosa is not the usual site of occurrence. To date, only 5 articles have been published with 6 cases of epidermoid cysts arising in the buccal mucosa. Therefore, the aim of this study was to describe the clinical, histopathological and immunohistochemical features of a case of an epidermoid cyst located in the buccal mucosa. To our knowledge, this is the first report of an oral epidermoid cyst describing an intense foreign body gigantocellular inflammatory reaction against epithelial keratin component. Although the usual diagnosis for epidermoid cysts is based on histopathological findings, this case report addresses novel information regarding the immunohistochemical pattern which may be found in these lesions.     

Redefining and Redesigning Hospital Discharge to Enhance Patient Care: A Randomized Controlled Study

BACKGROUND  Patients are routinely ill-prepared for the transition from hospital to home. Inadequate communication between Hospitalists and primary care providers can further compromise post-discharge care. Redesigning the discharge process may improve the continuity and the quality of patient care. OBJECTIVES  To evaluate a low-cost intervention designed to promptly reconnect patients to their “medical home” after hospital discharge. DESIGN  Randomized controlled study. Intervention patients received a “user-friendly” Patient Discharge Form, and upon arrival at home, a telephone outreach from a nurse at their primary care site. PARTICIPANTS  A culturally and linguistically diverse group of patients admitted to a small community teaching hospital. MEASUREMENTS  Four undesirable outcomes were measured after hospital discharge: (1) no outpatient follow-up within 21 days; (2) readmission within 31 days; (3) emergency department visit within 31 days; and (4) failure by the primary care provider to complete an outpatient workup recommended by the hospital doctors. Outcomes of the intervention group were compared to concurrent and historical controls. RESULTS  Only 25.5% of intervention patients had 1 or more undesirable outcomes compared to 55.1% of the concurrent and 55.0% of the historical controls. Notably, only 14.9% of the intervention patients failed to follow-up within 21 days compared to 40.8% of the concurrent and 35.0% of the historical controls. Only 11.5% of recommended outpatient workups in the intervention group were incomplete versus 31.3% in the concurrent and 31.0% in the historical controls. CONCLUSIONS  A low-cost discharge–transfer intervention may improve the rates of outpatient follow-up and of completed workups after hospital discharge.     

Planting the seeds of leadership

The college of New Caledonia (CNC) in Prince George, British Columbia, believes in creating an environment where students can learn leadership skills from the beginning of their professional education. To that end, students, faculty members and administrators of CNC's health sciences and social services division worked together to engage in a campaign called "Expect a Leader." The intention of this campaign was to strengthen interdisciplinary awareness between programs and to introduce leadership qualities to future healthcare professionals. This article demonstrates how this initiative created change within six health science programs and across an entire division. The authors represent a cross-disciplinary team of health professionals: former CNC students, faculty members and the administrator. This team came together to discuss leadership strategies and activities that occurred within the educational setting and in the community during the Expect a Leader campaign. The authors anticipate that the campaign will foster students' involvement in interdisciplinary leadership activities within practice settings. Readers of this article will learn about the positive effects of promoting interdisciplinary leadership campaigns across healthcare disciplines, and will gain an understanding of reasons for nurturing leadership from the beginning of the students' education.     

Using a site visit to a contaminated location as a focus for environmental health education for academic and public health nurses

We describe a conference initiative that is distinguished by the use of a "community case study" to increase the knowledge and skills of nursing faculty and public health nurses in environmental health and to provide networking support to facilitate infusion of environmental health into nursing curricula and public health nursing practice. The Institute of Medicine's (1995) general environmental health competencies for nurses provided the conference framework. Woburn, Massachusetts, a Superfund site, served as the community case study to illustrate a complex environmental health problem. Over an extended period of time, Woburn was contaminated with multiple chemicals that eventually contaminated the drinking water supply; a cluster of childhood leukemia cases was linked subsequently to the Superfund site contaminants. A 6-hr interpreted walking and bus tour of the Superfund site enabled us to visit the premises of responsible parties, the vapor extraction fields, the capped Well H in the wooded wetlands, and to tour the affected neighborhood. This intensive, hands-on approach to learning environmental health content and skills that incorporated multiple learning strategies serves as a model for developing future conferences for public health nurses and nursing faculty.     

The Long-term Effects of Behavioural Residential Special Education on Children with Severely Challenging Behaviours: Changes in Behaviour and Skills

Information was collected through the retrospective analysis of records and interview on the characteristics, abilities, challenging behaviours shown and services received by 55 children who attended a behavioural residential special education facility since 1982. Results indicated that, overall, (1) during the mean 2.5 year stay at the facility the children showed significant gains in self-care and communication skills and significant reductions on all indicators of challenging behaviour; (2) that these gains were maintained over the mean 6.5 year follow-up period; but (3) that few additional gains were made during this period. After controlling for initial level of challenging behaviour, greater reductions in challenging behaviour during attendance at the school were observed for children who: prior to entry were living at home; who did not have epilepsy; or who attended the school at a younger age. After leaving school greater improvements were observed by: boys; children who did not have epilepsy; children who were less able; and children who had been followed up for a longer period of time.