Narrative review: aspirin resistance and its clinical implications

Aspirin is currently the most cost-effective drug for the secondary prevention of cardiovascular disease, but treatment failures are relatively common. Several factors have been linked to these recurrent vascular events in patients prescribed aspirin, including smoking, drug interactions, nonadherence, comorbid conditions, and aspirin resistance. The term aspirin resistance has been used to describe not only an absence of the expected pharmacologic effects of aspirin on platelets but also poor clinical outcomes, such as recurrent vascular events, in patients treated with aspirin. Aspirin resistance is perhaps more precisely understood as the phenomenon of measurable, persisting platelet activation that occurs in patients prescribed a therapeutic dose of aspirin and may underlie an unknown proportion of aspirin treatment failures. Key challenges for future research are to standardize a definition of aspirin resistance and to compare whether different measures of platelet activation, either alone or in combination, independently predict cardiovascular events. These challenges must be met before researchers conduct studies to assess the clinical utility of testing on patient outcomes and cost-effective prescribing.     

Effect of psychiatry liaison with general practitioners on depression severity in recently hospitalised cardiac patients: a randomised controlled trial

OBJECTIVE: To evaluate the effect on depressive symptoms in cardiac patients of patient-specific advice to general practitioners regarding management of comorbid depression. DESIGN AND SETTING: A randomised controlled trial in four general hospitals in Adelaide, South Australia. PARTICIPANTS: Patients (n = 669) admitted to cardiology units for a range of cardiovascular conditions who were screened and assessed as being depressed according to the Center for Epidemiological Studies Depression Scale (CES-D). INTERVENTION: Inpatient psychiatric review, followed by telephone case conferencing between specialist hospital staff and GPs to provide patient-specific information about the patient's depression and its management, educational material, and ongoing clinical support. MAIN OUTCOME MEASURES: Level of depression severity at 12 months post-hospitalisation. RESULTS: On the basis of intention to treat, intervention patients had lower rates of moderate to severe depression (CES-D > or = 27) after 12 months (25% v 35%, relative risk, 0.72; 95% CI, 0.54-0.96, number needed to treat for benefit, 11). The intervention was most effective in preventing progression from mild depression to moderate to severe depression. The multidisciplinary telephone case conferencing was difficult to implement and, in a post hoc analysis, brief phone advice from a psychiatrist was found to be effective. CONCLUSIONS: Screening hospitalised cardiac patients for depression and providing targeted advice to their GPs reduces depression severity 12 months after hospitalisation.     

Prevalence of multiple chemical sensitivities: a population-based study in the southeastern United States

We examined the prevalence of multiple chemical sensitivities (MCS), a hypersensitivity to common chemical substances. We used a randomly selected sample of 1582 respondents from the Atlanta, Ga, standard metropolitan statistical area. We found that 12.6% of our sample reported the hypersensitivity and that, while the hypersensitivity is more common in women, it is experienced by both men and women of a variety of ages and educational levels. Our prevalence for MCS is similar to that (15.9%) found by the California Department of Health Services in California and suggests that the national prevalence may be similar.     

An intra-individual comparison of the previous conventional hearing aid with the bone-anchored hearing aid: The Nijmegen group questionnaire

By spring 2000, a total of 351 patients were implanted in the Birmingham bone-anchored hearing aid (BAHA) programme. This group consisted of 242 adults and 109 children. The aim of this retrospective questionnaire study was to directly assess patient satisfaction with their current bone-anchored hearing aid in comparison with their previous conventional air and/or bone-conduction hearing aids. The Nijmegen group questionnaire was sent by post to 312 patients who used their BAHA for six months or longer. The questionnaire used was first described by Mylanus et al. (Nijmegen group) in 1998. The total response rate was 72 per cent (227 of 312 patients). The bone-anchored hearing aid was found to be significantly superior to prior conventional hearing aids in all respects.     

A review of a two-phase population study of multiple chemical sensitivities

In this review we summarize the findings of a two-phase study of the prevalence, symptomatology, and etiology of multiple chemical sensitivities (MCS). We also explore possible triggers, the potential linkage between MCS and other disorders, and the lifestyle alterations produced by MCS. The first phase of the study consisted of a random sampling of 1,582 individuals from the Atlanta, Georgia, metropolitan area to determine the reported prevalence of a hypersensitivity to common chemicals. In this phase, 12.6% of the sample reported a hypersensitivity. Further questioning of individuals with a hypersensitivity indicated that 13.5% (1.8% of the entire sample) reported losing their jobs because of their hypersensitivity. The second phase was a follow-up questioning of the respondents who initially reported hypersensitivity. In this phase, we found that individuals with hypersensitivity experience a variety of symptoms and triggers. A significant percentage (27.5%) reported that their hypersensitivity was initiated by an exposure to pesticides, whereas an equal percentage (27.5%) attributed it to solvents. Only 1.4% had a history of prior emotional problems, but 37.7% developed these problems after the physical symptoms emerged. This suggests that MCS has a physiologic and not a psychologic etiology.     

Shiverer*jimpy double mutant mice. I. Biochemical evidence for reciprocal intergenic suppression

Shiverer and jimpy are neurological mutations that cause hypomyelination in the mouse CNS. The 3 major protein components of CNS myelin are: myelin basic protein (MBP), proteolipid (PLP) and 2', 3'-cyclic nucleotide phosphohydrolase (CNP). Previous work has shown that in jimpy animals the CNS contains reduced levels of MBP and CNP while PLP is undetectable. In shiverer animals the major forms of MBP ae undetectable in either the CNS or PNS, but the level of CNP is unaffected by mutation. In this study we have measured MBP, PLP and CNP in both the CNS (cerebral hemispheres) and PNS (sciatic nerve) of mice carrying the jimpy and shiverer mutations, individually and in combination. The results indicate that in the double mutant the levels of all 3 myelin proteins in both the CNS and PNS are intermediate between the levels in jimpy and the levels in shiverer animals. This means that part of the biochemical phenotype of the jimpy mutation (reduced levels of CNP and absence of PLP) is suppressed by the shiverer mutation, and part of the biochemical phenotype of the shiverer mutation (absence of MBP) is suppressed by the jimpy mutation. Possible mechanisms for this reciprocal intergenic suppression are discussed.     

Nurses'' opinions of the introduction of computer-assisted learning for use in patient education

Computers have only recently begun to find a place in the everyday work of health care staff. The use of computer-assisted learning (CAL) in patient education is in its infancy. However, the medium appears to offer several advantages to patients. The successful integration of the medium into clinical practice requires the acceptance and support of staff members. Little research exists to date which examines staff responses to the introduction of CAL into their workplace. This small study (n = 14) aims to explore the reactions of staff to the introduction of an experimental CAL package for use in the education of renal patients on continuous ambulatory peritoneal dialysis (CAPD). The opinions of staff members to CAL are probed and their views ascertained regarding the usefulness of CAL to both staff and patients. Results suggest that, despite their initial reservations about CAL, staff were generally positive about the medium.