Gabapentin for the treatment of ethanol withdrawal

Benzodiazepines (BZDs) are the drug of choice for the suppression of alcohol withdrawal symptoms. Gabapentin, a drug approved for use as adjunctive therapy in the treatment of partial seizures, has none of the BZD‐type difficulties (drug interactions, abuse potential). We retrospectively report on the use of gabapentin for ethanol withdrawal in 49 patients. Thirty‐one patients were treated in the outpatient program and 18 in the general inpatient psychiatric unit. Positive outcomes as evidenced by completion of gabapentin therapy were achieved in 25 out of 31 outpatients and 17 out of 18 inpatients. Statistical significance was reached regarding the positive relationship between prior ethanol use and inpatient “as needed”; benzodiazepine use. Both sets of data suggest that gabapentin works well for the mild to moderate alcohol withdrawal patient.     

Doing Foucault: inquiring into nursing knowledge with Foucauldian discourse analysis

Foucauldian discourse analysis (FDA) is a methodology that is well suited to inquiring into nursing knowledge and its organization. It is a critical analytic approach derived from Foucault's histories of science, madness, medicine, incarceration and sexuality, all of which serve to exteriorize or make visible the ‘positive unconscious of knowledge’ penetrating bodies and minds. Foucauldian discourse analysis (FDA) holds the potential to reveal who we are today as nurses and as a profession of nursing by facilitating our ability to identify and trace the effects of the discourses that determine the conditions of possibility for nursing practice that are continuously shaping and (re)shaping the knowledge of nursing and the profession of nursing as we know it. In making visible the chain of knowledge that orders the spaces nurses occupy, no less than their subjectivities, FDA is a powerful methodology for inquiring into nursing knowledge based on its provocation of deep critical reflection on the normalizing power of discourse.     

Decreased Bone Turnover Markers in Children on Long‐Term Parenteral Nutrition (PN) for Intestinal Failure (IF)

Background: Metabolic bone disease (MBD) is a well‐recognized but poorly understood complication of long‐term parenteral nutrition (PN). Bone histomorphometry in adults has provided useful information but does not provide quantitative measures of bone resorption and is to invasive for children. Measurement of bone turnover markers provides an alternative less invasive approach. We therefore aimed to measure bone turnover markers in children on long‐term PN for intestinal failure (IF), and to compare them to age‐ and gender‐matched controls. Methods: Serum concentrations of osteocalcin (OC), bone‐specific alkaline phosphatase (BSAP), and c‐telopeptide (CTx) were measured in IF patients treated at a multidisciplinary intestinal rehabilitation and home PN program at the Hospital for Sick Children, Toronto, Canada. Age‐ and gender‐matched control participants were recruited for comparison. Results: A total of 13 IF patients and 20 control participants were recruited. IF patients had lower serum OC and CTx concentrations when compared with controls: 42.43 ± 11.54 vs 68.39 ± 20.95 µg/L (P < .01) and 7.454 ± 2.17 vs 9.246 ± 1.92 (P < .05; mean ± SD) µg/L for OC and CTx, respectively. In a subgroup of 9 IF patients for whom BMD was available, OC and CTx concentration were negatively correlated to BMD (g/cm²) and BMD z score. Conclusion: Bone turnover markers may be useful indicators for identifying children on long‐term PN at risk of MBD. Further studies are needed to validate the current results and determine the factors that influence the occurrence and evolution of MBD in children on PN.     

Use of a Loading Dose of Vitamin D for Treatment of Vitamin D Deficiency in Patients With Intestinal Failure

Vitamin D deficiency is common in patients with intestinal failure and short bowel syndrome who have been weaned of parenteral nutrition. Dietary supplementation with vitamin D is necessary to correct this deficiency. In certain cases, routine supplementation strategy may be ineffective. We report 3 cases of vitamin D deficiency in patients with intestinal failure who showed improvement in serum 25‐hydroxyvitamin D levels after supplementation with a loading dose of 20,000–40,000 IU vitamin D provided weekly.     

Evaluation of Videophone Communication for Families of Hospitalized Children

This study evaluated videophones as a means of support among families who had limited access to their hospitalized children due to geographic separation. These videophones facilitated video-mediated communication between the hospital and the family home. Qualitative interviews explored the outcomes and processes related to videophone use for a subsample of 14 participants. Content analysis identified six themes: being in hospital far from home is “draining,” vicarious growth and the recalibration of priorities, “it's like you're right there,” source of happiness in a hard place, ease of videophone use, and limitations of the videophone. Participants reported that family separation during pediatric hospitalization was very difficult, and use of the videophones mitigated these effects through decreasing feelings of isolation and anxiety, and increasing feelings of connection between family members.     

Can oral vitamin D prevent the cardiovascular diseases among migrants in Australia? Provider perspective using Markov modelling

The study was designed to model the effectiveness and cost effectiveness of oral Vitamin D supplementation as a primary prevention strategy for cardiovascular disease among a migrant population in Australia. It was carried out in the Community Health Service, Kensington, Melbourne. Best‐case scenario analysis using a Markov model was employed to look at the health care providers’ perspective. Adult migrants who were vitamin D deficient and free from cardiovascular disease visiting the medical centre at least once during the period from 1 January 2010 to 31 December 2012 were included in the study. The blood pressure‐lowering effect of vitamin D was taken from a published meta‐analysis and applied in the Framingham 10 year cardiovascular risk algorithm (with and without oral vitamin D supplements) to generate the probabilities of cardiovascular events. A Markov decision model was used to estimate the provider costs associated with the events and treatments. Uncertainties were derived by Monte Carlo simulation. Vitamin D oral supplementation (1000 IU/day) for 10 years could potentially prevent 31 (interquartile range (IQR) 26 to 37) non‐fatal and 11 (IQR 10 to 15) fatal cardiovascular events in a migrant population of 10 000 assuming 100% compliance. The provider perspective incremental cost effectiveness per year of life saved was AU$3,992 (IQR 583 to 8558). This study suggests subsidised supplementation of oral vitamin D may be a cost effective intervention to reduce non‐fatal and fatal cardiovascular outcomes in high‐risk migrant populations.