Use of communication plans by certified nursing assistants: little things mean a lot

Background: Many residents in long-term care facilities in the United States have communication disorders that impede interactions with staff, particularly certified nursing assistants (CNAs) who provide direct care and are in a position to communicate with residents the most. Researchers in Canada have successfully used individualized communication plans to facilitate staff–resident communication in long-term care settings, but the viability of using communication plans to facilitate staff–resident communication in long-term care facilities in the United States has not been investigated.

Aims: This study sought to determine the usefulness of communication plans by CNAs working in long-term care settings when providing personal care to residents with communication disorders and to explore the role support from the speech-language pathologist (SLP) might play in this process.

Method & Procedures: The study used a grounded theory qualitative research design. Participants included 10 CNAs working in two long-term care facilities. Each CNA chose two residents with a communication disorder whom they felt might benefit from a communication plan. Communication plans were collaboratively developed by the SLP and the CNA for the selected residents. CNAs used the plans to facilitate communication during daily care of their residents for two weeks. Five CNAs from one facility received support from the SLP; five CNAs from a second facility did not. Following 2 weeks of communication plan use, all CNAs were interviewed. Interviews were transcribed verbatim and data were analyzed using open, axial, and selective coding per grounded theory methodology.

Outcomes & Results: Findings indicated that communication plans were useful in facilitating CNA–resident communication. CNA’s negative views of certain aspects of their jobs were altered positively through use of communication plans. They gradually became more familiar with residents which made work less effortful and enriched relationships with residents. Findings also indicated that support for CNAs from a SLP may provide an incentive to use information in the communication plan to more effectively communicate with the resident while providing daily personal care and potentially improving the quality of that care.

Conclusions: Communication plans are useful to CNAs in facilitating communication with residents in long-term care facilities and a minimal amount of support from the SLP enhances this process.     

Clinical and Genetic Predictors of Priapism in Sickle Cell Disease: Results from the Recipient Epidemiology and Donor Evaluation Study III Brazil Cohort Study

IntroductionPriapism is the persistent and painful erection of the penis and is a common sickle cell disease (SCD) complication.AimThe goal of this study was to characterize clinical and genetic factors associated with priapism within a large multi-center SCD cohort in Brazil.MethodsCases with priapism were compared to SCD type-matched controls within defined age strata to identify clinical outcomes associated with priapism. Whole blood single nucleotide polymorphism genotyping was performed using a customized array, and a genome-wide association study (GWAS) was conducted to identify single nucleotide polymorphisms associated with priapism.Main Outcome MeasureOf the 1,314 male patients in the cohort, 188 experienced priapism (14.3%).ResultsPriapism was more common among older patients (P = .006) and more severe SCD genotypes such as homozygous SS (P < .0001). In the genotype- and age-matched analyses, associations with priapism were found for pulmonary hypertension (P = .05) and avascular necrosis (P = .01). The GWAS suggested replication of a previously reported candidate gene association of priapism for the gene transforming growth factor beta receptor 3 (TGFBR3) (P = 2 × 10^?4).Clinical ImplicationsOlder patients with more severe genotypes are at higher risk of priapism, and there is a lack of consensus on standard treatment strategies for priapism in SCD.Strengths & LimitationsThis study characterizes SCD patients with any history of priapism from a large multi-center cohort. Replication of the GWAS in an independent cohort is required to validate the results.ConclusionThese findings extend the understanding of risk factors associated with priapism in SCD and identify genetic markers to be investigated in future studies to further elucidate priapism pathophysiology.Ozahata M, Page GP, Guo Y, et al. Clinical and Genetic Predictors of Priapism in Sickle Cell Disease: Results from the Recipient Epidemiology and Donor Evaluation Study III Brazil Cohort Study. J Sex Med 2019;16:1988–1999.     

Utility of a Collaborative At-Sea Sampling Program (CASP) for the California Spiny Lobster Commercial Fishery: Catch Characteristics and Implications for Management

Fisheries management, including the development of fishery management plans (FMPs), requires the best available scientific information. To address this need, we piloted a collaborative at-sea sampling program (CASP) among California commercial lobster fishermen, scientists, and fishery managers to develop scientifically rigorous protocols and collect, analyze, and interpret essential fisheries information (EFI). Significant differences in catch characteristics among three regions (South, North Coast, and Northwest Islands) were documented. Legal CPUE was generally similar among regions, whereas sublegal CPUE was consistently highest in the South, followed by the North Coast and Northwest Islands. Evaluation of size structure revealed that legal lobsters were significantly smaller, just larger than legal size, in the South than in the other two regions, suggesting a higher exploitation rate there. Despite this, the South had significantly more prerecruits than the northern regions, a fact not considered in present fishery models. We also found a female bias in the legal sex ratios in the north regions and in the sublegal sex ratios in all regions that could affect model parameters for trap vulnerability and reproductive capacity. A discrepancy in the average weight of legal lobster for the Northwest Islands was identified which has implications for the spawning potential ratio, a reference point that elicits management action. The regional variations in catch characteristics suggest that the California lobster fishery would benefit from using more sophisticated models that incorporate area-based EFI to better inform the harvest control rules. This finding supports the recommendations of the lobster FMP scientific review panel and the interests of resource managers, with the CASP data illustrating the value of the additional EFI and a mechanism for obtaining it. The demonstrated utility of the CASP for both cross-checking and providing additional data supports its ongoing use to inform management of the lobster fishery and as a model for other fisheries.

Received March 8, 2016; accepted January 9, 2017     

Mycophenolic acid in dermatology a century after its discovery

Mycophenolic acid was first discovered in 1913 and first used clinically in the 1970s as an immunosuppressant to prevent organ transplantation rejection. It was later used in the treatment of psoriasis. However due to its side‐effect profile and fears over its carcinogenic potential it was abandoned. From the late 1990s a prodrug, mycophenolate mofetil (MMF), was developed and more recently, enteric‐coated mycophenolate sodium (EC‐MPS), both of which have gained increasing use in the field of dermatology for a variety of skin conditions. This review discusses the pharmacology, mechanisms of action, side‐effects and current clinical applications in dermatology of MMF and EC‐MPS.     

Punicic Acid Triggers Ferroptotic Cell Death in Carcinoma Cells

Plant-derived conjugated linolenic acids (CLnA) have been widely studied for their preventive and therapeutic properties against diverse diseases such as cancer. In particular, punicic acid (PunA), a conjugated linolenic acid isomer (C18:3 c9t11c13) present at up to 83% in pomegranate seed oil, has been shown to exert anti-cancer effects, although the mechanism behind its cytotoxicity remains unclear. Ferroptosis, a cell death triggered by an overwhelming accumulation of lipid peroxides, has recently arisen as a potential mechanism underlying CLnA cytotoxicity. In the present study, we show that PunA is highly cytotoxic to HCT-116 colorectal and FaDu hypopharyngeal carcinoma cells grown either in monolayers or as three-dimensional spheroids. Moreover, our data indicate that PunA triggers ferroptosis in carcinoma cells. It induces significant lipid peroxidation and its effects are prevented by the addition of ferroptosis inhibitors. A combination with docosahexaenoic acid (DHA), a known polyunsaturated fatty acid with anticancer properties, synergistically increases PunA cytotoxicity. Our findings highlight the potential of using PunA as a ferroptosis-sensitizing phytochemical for the prevention and treatment of cancer.     

Novel bronchodilators for the treatment of chronic obstructive pulmonary disease

Because of the central role of bronchodilators in the treatment of respiratory diseases, there is still considerable interest in finding novel classes of broncholytic drugs. It can be hypothesized that a longer duration of bronchodilation with a once-daily agent might be associated with superior and more consistent efficacy over a range of endpoints than is achieved with a twice-daily agent. Several novel β(2)-adrenoceptor (AR) agonists, antimuscarinic agents, new combination platforms such as dual-acting muscarinic antagonist-β(2)-AR agonist bronchodilators, xanthine drugs and phosphodiesterase inhibitors, and their combination with another bronchodilator class, or an inhaled corticosteroid are currently under development with the aim of achieving once-daily dosing and, therefore, increasing the likelihood of compliance with therapy. This review paper mainly focuses on recent results of preclinical studies that have used human tissue and clinical trials of new bronchodilators in patients with chronic obstructive pulmonary disease.