Provision of Contraceptive Services to Women with Diabetes Mellitus

BACKGROUND  

Women with diabetes mellitus who delay pregnancy until glycemic control is achieved experience lower rates of adverse pregnancy outcomes.     

Developing a culture of nursing research through clinical-academic partnership

Evidence based practice is essential to advanced practice nursing, enabling the delivery of quality care and improved patient outcomes. As the name suggests, it requires healthcare decisions to be based on the best available and current evidence. Advanced practice nurses need astute critical analysis skills to appraise the evolving literature, and require research skills to lead on scientific inquiry and develop the profession. Yet, advanced practice nurses may not recognize themselves as research leaders. Participation in a journal club can promote evidence-based practice, improve clinician's critical thinking skills, and expose members to different research methodologies, however, nurses continue to face barriers to participation in these clubs. Establishing a clinical-academic partnership appears to be both mutually beneficial for clinicians and academics and is a significant enabler in the sustainability and functioning of the club through sharing expertise and experience. A supportive workplace culture is favourable to research utilization and knowledge translation. This paper outlines the role, practicalities, challenges, and benefits of setting up a hybrid urology journal and research club for advanced practice nurses in a clinical-academic partnership.     

Clinical significance of autoantibodies in a large cohort of patients with chronic graft‐versus‐host disease defined by NIH criteria

There is an unmet need for identifying new clinical biomarkers in chronic Graft‐versus‐Host‐disease (cGVHD) suitable for diagnosis and disease monitoring. Circulating autoantibodies represent an ongoing immune response and suggest a pathogenic role for B cells in cGVHD. Autoantibodies could be useful markers of cGVHD disease activity, severity, or organ specificity; however, their clinical utility is not established. The focus of this study was to determine the incidence and associations of a broad array of clinical autoantibodies with cGVHD manifestations in a large patient cohort characterized by NIH criteria. A panel of 21 circulating antibodies commonly used in clinical medicine was tested in 280 cGVHD patients (70% severe) enrolled in a cross‐sectional prospective natural history study. Median cGVHD duration was two years. Patients with circulating autoantibodies (62%) had significantly higher levels of IgM (P < 0.0001), IgG (P < 0.0001), and IgA (P = 0.001), elevated uric acid (P = 0.008) and total protein (P = 0.0004), and higher numbers of CD3+ (P = 0.002), CD4+ (P = 0.001), CD8+ (P = 0.023) T cells, and CD19+ B cells (P < 0.0001). Multiple antibodies were detected in 35% of patients. Prior rituximab therapy (n = 66) was associated with reduced presence of autoantibodies (48 vs. 66% P = 0.01). Only oral cGVHD was significantly associated with presence of autoantibodies in this study (P = 0.028). No significant associations were found between cGVHD activity and severity, and presence of autoantibodies. Circulating autoantibodies are common in patients with advanced cGVHD. Their presence is associated with better quantitative immunologic reconstitution but does not have utility as a clinical biomarker of cGVHD. Am. J. Hematol. 90:114–119, 2015. © 2014 Wiley Periodicals, Inc.     

Women and War

Most of today's 1.7 million women veterans obtain all or most of their medical care outside the VA health care system, where their veteran status is rarely recognized or acknowledged. Several aspects of women's military service have been associated with adverse psychologic and physical outcomes, and failure to assess women's veteran status, their deployment status, and military trauma history could delay identifying or treating such conditions. Yet few clinicians know of women's military history—or of military service's impact on women's subsequent health and well being. Because an individual's military service may be best understood within the historical context in which it occurred, we provide a focused historical overview of women's military contributions and their steady integration into the Armed Forces since the War for Independence. We then describe some of the medical and psychiatric conditions associated with military service.     

INHIBITION OF α-TOCOPHEROL AND CALCIUM CALMODULIN-STIMULATED PHOSPHODIESTERASE ACTIVITY IN VITRO BY ANTHRACYCLINES

1. The inhibition of alpha-tocopherol and calmodulin-stimulated phosphodiesterase activities was investigated in vitro. 2. Anthracyclines--doxorubicin, daunorubicin and aclacinomycin--inhibited calcium calmodulin-stimulated cyclic 3',5'-AMP (cAMP) nucleotide phosphodiesterase (EC. 3.1.4-17) activity (IC50 = 33.00 +/- 3.50-36.50 +/- 2.75 mumol/l). The stimulation of this enzyme by alpha-tocopherol was also inhibited by doxorubicin (IC50 = 18.50 +/- 4.00 mumol/l). 3. The anthracycline-induced inhibition of the calcium calmodulin and alpha-tocopherol-stimulated phosphodiesterase activity was competitive with calmodulin and alpha-tocopherol respectively. Increasing the concentration of the substrate, cAMP or calcium ions did not attenuate the drug-induced inhibition. The basal activity of the enzyme was not inhibited by concentration of doxorubicin up to 50 mumol/l. 4. In vivo, single dose drug distribution studies of the fluorescence of doxorubicin indicate that in the heart after a cardiotoxic dose (20 mg/kg), myocardial concentrations were achieved which could cause 70-80% inhibition of this phosphodiesterase enzyme. 5. Inhibition of calmodulin function by anthracyclines via direct interaction with calmodulin may contribute significantly to the effects of anthracyclines, such as disturbance in calcium homeostasis as well as acute and chronic deleterious effects on the myocardium. The action of alpha-tocopherol to bind or complex anthracycline may in part contribute to its protection against anthracycline-induced membrane damage and cardiotoxicity.