Using educational games to promote the seeking of a pharmacist and to teach key medication use messages: Results from an inner city health party

BackgroundLow health literacy affects 80–90 million Americans with low-income, minority populations being more vulnerable to this condition. One method of addressing limited literacy that may be particularly well accepted within vulnerable populations is the use of educational board games in order to emphasize seeking health information from reliable sources such as pharmacists.ObjectiveThe research objective was to determine if the use of educational board games could impact community pharmacy patron intentions to seek pharmacist advice in an urban, minority, economically-disadvantaged population.MethodsFour medication-related educational games were played at an urban community pharmacy under the leadership of pharmacy students in the setting of a health party. Game messages, design, and evaluation processes were uniquely guided by community members' input. A verbally administered questionnaire measured game impact via knowledge and perception questions with responses compared between a non-randomly allocated intervention group and a control group.ResultsNinety-nine adults were included in the intervention (or game) group and 94 adults were in the control group. Game participants were significantly more likely than the control group to indicate they would seek pharmacist medication advice in the future.ConclusionEducational board games played in the setting of a health party can be a fun and effective way to convey selected health messages within an urban, minority, economically disadvantaged population. Community input into game development and layering multiple strategies for overcoming health literacy barriers were essential components of this initiative.     

Diagnosis and treatment of the invasive extension of bacteria (cellulitis) from chronic wounds utilising point‐of‐care fluorescence imaging

Early diagnosis of wound‐related cellulitis is challenging as many classical signs and symptoms of infection (erythema, pain, tenderness, or fever) may be absent. In addition, other conditions (ie, chronic stasis dermatitis) may present with similar clinical findings. Point‐of‐care fluorescence imaging detects elevated bacterial burden in and around wounds with high sensitivity. This prospective observational study examined the impact of incorporating fluorescence imaging into standard care for diagnosis and management of wound‐related cellulitis. Two hundred thirty‐six patients visiting an outpatient wound care centre between January 2020 and April 2021 were included in this study. Patients underwent routine fluorescence scans for bacteria (range: 1‐48 scans/patient). Wound‐related cellulitis was diagnosed in 6.4% (15/236) of patients. In these patients, fluorescence scans showed an irregular pattern of red (bacterial) fluorescence extending beyond the wound bed and periwound that could not be removed through cleansing or debridement, indicating the invasive extension of bacteria (wound‐related cellulitis). Point‐of‐care identification facilitated rapid initiation of treatments (source control and antibiotics, when warranted) that resolved the fluorescence. No patients had worsening of cellulitis requiring intravenous antibiotics and/or hospitalisation. These findings demonstrate the utility of point‐of‐care fluorescence imaging for efficient detection and proactive, targeted management of wound‐related cellulitis.     

The past,present, and future of sleep measurement in mild cognitive impairment and early dementia—towards a core outcome set: a scoping review

Study ObjectivesSleep abnormalities emerge early in dementia and may accelerate cognitive decline. Their accurate characterization may facilitate earlier clinical identification of dementia and allow for assessment of sleep intervention efficacy. This scoping review determines how sleep is currently measured and reported in Mild Cognitive Impairment (MCI) and early dementia, as a basis for future core outcome alignment.MethodsThis review follows the PRISMA Guidelines for Scoping Reviews. CINAHL, Embase, Medline, Psychinfo, and British Nursing Index databases were searched from inception—March 12, 2021. Included studies had participants diagnosed with MCI and early dementia and reported on sleep as a key objective/ outcome measure.ResultsNineteen thousand five hundred and ninety-six titles were returned following duplicate removal with 188 studies [N] included in final analysis. Sleep data was reported on 17 139 unique, diagnostically diverse participants (n). “Unspecified MCI” was the most common diagnosis amongst patients with MCI (n = 5003, 60.6%). Despite technological advances, sleep was measured most commonly by validated questionnaires (n = 12 586, N = 131). Fewer participants underwent polysomnography (PSG) (n = 3492, N = 88) and actigraphy (n = 3359, N = 38) with little adoption of non-PSG electroencephalograms (EEG) (n = 74, N = 3). Sleep outcome parameters were reported heterogeneously. 62/165 (37.6%) were described only once in the literature (33/60 (60%) in interventional studies). There was underrepresentation of circadian (n = 725, N = 25) and micro-architectural (n = 360, N = 12) sleep parameters.ConclusionsAlongside under-researched areas, there is a need for more detailed diagnostic characterization. Due to outcome heterogeneity, we advocate for international consensus on core sleep outcome parameters to support causal inference and comparison of therapeutic sleep interventions.     

Immune regulation by low doses of the DNA methyltransferase inhibitor 5-azacitidine in common human epithelial cancers

Epigenetic therapy is emerging as a potential therapy for solid tumors. To investigate its mechanism of action, we performed integrative expression and methylation analysis of 63 cancer cell lines (breast, colorectal, and ovarian) after treatment with the DNA methyltransferase inhibitor 5-azacitidine (AZA). Gene Set Enrichment Analysis demonstrated significant enrichment for immunomodulatory pathways in all three cancers (14.4-31.3%) including interferon signaling, antigen processing and presentation, and cytokines/chemokines. Strong upregulation of cancer testis antigens was also observed. An AZA IMmune gene set (AIMs) derived from the union of these immunomodulatory pathway genes classified primary tumors from all three types into “high” and “low” AIM gene expression subsets in tumor expression data from both TCGA and GEO. Samples from selected patient biopsies showed upregulation of AIM genes after treatment with epigenetic therapy. These results point to a broad immune stimulatory role for DNA demethylating drugs in multiple cancers.     

Early postpartum hemorrhage after induction of labor

M.M., a 25‐year‐old Hispanic primigravida at 41 weeks and 6 days gestation, presented to the labor and delivery unit for postdates induction of labor, accompanied by the father of the baby. She reported normal fetal movement and denied any loss of fluid or vaginal bleeding. Her prenatal course was uncomplicated. The fetal heart rate was reassuring. Occasional contractions were recorded by the tocometer, but not felt by M.M. A pelvic exam found her cervix to be 1 cm dilated, 80% effaced, soft and posterior, with the vertex at ?2 station with membranes intact. Based on a Bishop score of 7, the decision was made to proceed with induction of labor with intravenous oxytocin per hospital protocol of 1 mU every 15 minutes to a maximum of 5 contractions in 10 minutes lasting no more than 60 to 90 seconds or a maximum dose of 20 mU/min. Three hours after oxytocin was initiated, M.M.'s cervical exam was 2 cm dilated, 80% effaced, with the vertex at ?2 station. The fetal heart rate baseline was 135 beats per minute with moderate variability and no decelerations. Six hours after admission, M.M. requested pain relief. Her cervical exam was 4 cm dilated, 90% effaced, with the vertex at ?1 station. The oxytocin was infusing at 16 mU/min and the fetal heart rate was reassuring. Pain management options were discussed with the client and, after being counseled on the risks and benefits, she opted for epidural anesthesia. Eight hours after admission, M.M.'s uterine contractions became difficult to detect with the external tocometer. At examination, her cervix was found to be 7 cm dilated, 100% effaced, with the vertex at 0 station. The oxytocin was infusing at 20 mU/min. The midwife counseled the client on the need to monitor uterine contractions when receiving oxytocin and the decision was made to rupture M.M's bag of waters and place an intrauterine pressure catheter. M.M.'s membranes were ruptured and it was noted that she had a moderate amount of clear amniotic fluid. The intrauterine pressure catheter was placed without complications and recorded adequate uterine contractions of 230 MvU. Eleven hours after admission, M.M. reported rectal pressure and a desire to push. Her cervix was examined and found to be fully dilated with the vertex at +2 station, and again the fetal heart rate was reassuring. Pushing efforts were commenced. One and a half hours later—12 and half hours after the initiation of induction—M.M. gave birth to a vigorous baby girl weighing 3000 g, with Apgar scores of 9 and 9 at 1 and 5 minutes, respectively. The oxytocin infusion was discontinued immediately after delivery. Twenty‐five minutes later, the placenta was expelled spontaneously and appeared intact. An infusion of 20 units of oxytocin in 1000 cc of lactated ringers was given intravenously at 125 ml/hr. Fundal massage was started immediately after delivery of the placenta, because the uterine fundus was found to be boggy, and vaginal bleeding continued to increase. Bimanual uterine compression was added to control the hypotonic uterine bleeding. The urinary bladder was catheterized, producing 100 ml of urine. Ten units of oxytocin were administered intramuscularly in the thigh, again with poor response. Methylergonovine maleate 0.2 mg was then given intramuscularly. The obstetrician on call was notified of the client's uncontrolled immediate postpartum hemorrhage related to atony. Four minutes after Methergine administration, the fundus was firm and bleeding minimal. Twelve hours after delivery, M.M.'s hemoglobin (Hgb) and hematocrit (Hct) were noted to have decreased 23% from her levels at admission. Her Hgb was 7.8 g/dL, and she had an Hct of 23.9%. Her vital signs remained stable throughout, urine output satisfactory, and the client was able to tolerate walking without assistance.