EVALUATION OF A PHARMACIST-MANAGED ANTICOAGULATION CLINIC

Medical records were retrospectively analyzed to evaluate the success of a pharmacist-managed Anticoagulation Surveillance Clinic (ASC). The 78 patients in group I were followed by the ASC. The 17 patients in Group II were followed by other Veterans Administration Medical Center clinics.
Demographic characteristics, warfarin indication and potentially complicating conditions were comparable between the groups. Group I patients had shorter intervals between visits to the clinic than Group II patients. Although not statistically different compared to Group II, Group I patients had better prothrombin time control. Group I patients also had fewer complications per treatment year (6.9% vs 9.0%) and received fewer potentially interacting drugs.
The ASC was at least as successful as the other clinics in managing patients on warfarin, and results compared very favorably to those reported in the literature for other anticoagulation clinics.     

Demographic and sleep characteristics in cognitively impaired nursing home residents with and without severe sleep/wake pattern inefficiency

This study determined the differences in demographic and sleep characteristics in cognitively impaired nursing home residents with and without severe sleep/wake pattern inefficiency. Identification of characteristics associated with severe sleep/wake pattern inefficiency will allow health care providers to make the best cost effective use of finite resources because they can target interventions towards those most likely to need them. This article reports the baseline characteristics of the total sample, compares the demographic and sleep characteristics of the subgroups with and without severe sleep/wake pattern inefficiency, and reviews related literature.     

Lumbar disc replacement surgery—successes and obstacles to widespread adoption

Purpose of review

Lumbar disc replacement has been a surgical alternative to fusion surgery for the treatment of lumbar degenerative disc disease (DDD) for many years. Despite enthusiasm after the approval of the first devices, implantation rates have remained low, especially in the USA. The goal of this review is to provide a general overview of lumbar disc replacement in order to comprehend the successes and obstacles to widespread adoption.

Recent findings

Although a large amount of evidence-based data including satisfactory long-term results is available, implantation rates in the USA have not increased in the last decade. Possible explanations for this include strict indications for use, challenging surgical techniques, lack of device selection, fear of late complications or revision surgeries, and reimbursement issues.

Summary

Recent publications can address some of the past concerns, but there still remain obstacles to widespread adoption. Upcoming data on long-term outcome, implant durability and possible very late complications will determine the future of lumbar disc replacement surgery.

     

以多浆膜腔积液为突出表现的原发性系统性淀粉样变性一例并文献复习

目的 提高对原发性系统性淀粉样变性患者多样化临床表现的认识.方法 对1例以多浆膜腔积液为突出表现的原发性系统性淀粉样变性患者的诊疗经过进行分析总结,并复习相关文献.结果 该患者经尿免疫固定电泳、心肌灌注磁共振成像(MRI)等检查,先后行舌体、牙龈、腹壁脂肪、骨髓、心肌、肾脏活组织检查及刚果红染色,最终明确诊断为原发性系统性淀粉样变性.予VCD方案化疗后,病情好转.结论 原发性系统性淀粉样变性临床少见,表现常缺乏特异性,需提高认识,应尽早行受累脏器活组织检查,以获得早期诊断,提高治疗效果.     

Enabling and empowering certified nursing assistants for quality dementia care

Currently, 1.2 million full-time equivalent employees (FTEs) care for more than 1.5 million residents in nursing homes where 75% of residents have dementia. By the year 2010, the number of residents in these institutions may double. Registered nurses (RNs) make up less than 7% of a home's total FTEs. In contrast, certified nursing assistants (CNAs) account for more than 40% of total FTEs. Thus, CNAs serve as the primary caregivers in nursing homes. Typically, CNAs have a high school education or less, and receive little more than minimum wage. Their extensive contact with residents has a tremendous impact on quality of life, but significant barriers limit their caregiving effectiveness. These barriers include poor pay, minimal long-term benefits, and insufficient training, recognition and support for their physically and emotionally labor-intensive care. This paper addresses the issues of training CNAs for dementia care by suggesting an organizational framework within which to view dementia training; providing an overview of barriers to empowering CNAs to provide quality care to dementia residents; reviewing research that has addressed a specific barrier; making recommendations for future research; and suggesting research approaches to address these recommendations.     

Expression of osteonectin/secreted protein acidic and rich in cysteine and matrix metalloproteinases in ameloblastoma

J Oral Pathol Med (2010) 39 : 242–249 Background: Ameloblastoma is the most common clinically‐significant epithelial odontogenic tumor, and is considered a benign but locally‐aggressive tumor of the craniofacial region. Osteonectin/secreted protein acidic and rich in cysteine (SPARC) is induced in response to a number of biological processes such as tumor growth and metastasis, whereas matrix metalloproteinases (MMPs) degrade the extracellular matrix and participate in various biological processes including tumor invasion and metastasis. We hypothesize that SPARC acts with MMPs for the local invasiveness of ameloblastoma. The aim of this study was to examine the association of SPARC with MMP‐1, MMP‐2, and MMP‐9 in ameloblastoma. Method: Immunohistochemical expression of SPARC, MMP‐1, MMP‐2, and MMP‐9 as well as co‐expression of SPARC and MMP‐9 were examined in a cohort of 23 cases of ameloblastoma. Results: SPARC, MMP‐1, ‐2, and ‐9 were detected in the cytoplasm of the ameloblastic‐like columnar cells and stellate‐reticulum‐like cells as well as in the stromal tissues of fibroblasts and endothelial cells of our cohort of ameloblastoma patients. Furthermore, co‐expression of SPARC and MMP‐9 were found in 23 cases of ameloblastoma. This may be the first study to demonstrate that the expression level of SPARC was statistically correlated with MMP‐9 but not with MMP‐1 or ‐2 in ameloblastoma. Conclusion: Our results suggest a putative association between SPARC and MMPs (especially MMP‐9) in ameloblastoma to regulate tumor invasion.     

DEMOGRAPHIC AND SLEEP CHARACTERISTICS IN COGNITIVELY IMPAIRED NURSING HOME RESIDENTS WITH AND WITHOUT SEVERE SLEEP/WAKE PATTERN INEFFICIENCY

This study determined the differences in demographic and sleep characteristics in cognitively impaired nursing home residents with and without severe sleep/wake pattern inefficiency. Identification of characteristics associated with severe sleep/wake pattern inefficiency will allow health care providers to make the best cost effective use of finite resources because they can target interventions towards those most likely to need them. This article reports the baseline characteristics of the total sample, compares the demographic and sleep characteristics of the subgroups with and without severe sleep/wake pattern inefficiency, and reviews related literature.     

Enhanced osteogenesis and angiogenesis by PCL/chitosan/Sr-doped calcium phosphate electrospun nanocomposite membrane for guided bone regeneration

Abstract

Membranes play pivotal role in guided bone regeneration (GBR) technique for reconstruction alveolar bone. GBR membrane that is able to stimulate both osteogenic and angiogenic differentiation of cells may be more effective in clinic practice. Herein, we fabricated the Sr-doped calcium phosphate/polycaprolactone/chitosan (Sr-CaP/PCL/CS) nanohybrid fibrous membrane by incorporating 20?wt% bioactive Sr-CaP nanoparticles into PCL/CS matrix via one-step electrospinning method, in order to endow the membrane with stimulation of osteogenesis and angiogenesis. The physicochemical properties, mechanical properties, Sr²⁺ release behavior, and the membrane stimulate bone mesenchymal stem cell (BMSCs) differentiation were evaluated in comparison with PCL/CS and CaP/PCL/CS membranes. The SEM images revealed that the nanocomposite membrane mimicked the extracellular matrix structure. The release curve presented a 28-day long continuous release of Sr²⁺ and concentration which was certified in an optimal range for positive biological effects at each timepoint. The in vitro cell culture experiments certified that the Sr-CaP/PCL/CS membrane enjoyed excellent biocompatibility and remarkably promoted rat bone mesenchymal stem cell (BMSCs) adhesion and proliferation. In terms of osteogenic differentiation, BMSCs seeded on the Sr-CaP/PCL/CS membrane showed a higher ALP activity level and a better matrix mineralization. What’s more, the synergism of the Sr²⁺ and CaP from the Sr-CaP/PCL/CS membrane enhanced BMSCs angiogenic differentiation, herein resulting in the largest VEGF secretion amount. Consequently, the Sr-CaP/PCL/CS nanohybrid electrospun membrane has promising applications in GBR.