The use of life review to enhance quality of life of people living with AIDS: a feasibility study

People living with AIDS (PLWA) are confronted with uncertainty and their own mortality at an earlier than expected age. Life review, an intervention that has the potential to increase life satisfaction in the elderly experiencing transition points in their lives, may have a similar effect when used with PLWA. Therefore, the purpose of this feasibility study was to explore the use of life review in a sample of 20 PLWA through a randomized controlled trial of its effectiveness in decreasing depressive symptoms and in increasing self esteem, quality of life, and purpose in life. Compared to the control group, the treatment group had an improved overall quality of life and self-esteem over 12 months, less depressive symptoms over 12 months, and a greater purpose in life at 3 months. The effects that were seen were mainly small to medium effects. The findings from this feasibility study suggest the potential value of life review to enhance quality of life, purpose in life, and self-esteem, and to decrease depressive symptoms in PLWA. Further research is needed with a larger sample and with other groups such as PLWA experiencing virologic failure.

Low molecular weight heparin and the risk of haemorrhage following percutaneous biopsy, despite a normal standard clotting screen

There has been an increase of the use of low molecular weight heparin in the treatment of thrombotic events. This case report describes a complication of a pelvic mass biopsy performed whilst the patient was being treated with low molecular weight heparin (LMWH). Despite an uncomplicated biopsy procedure and confirmation of normal clotting screen, INR (International normalised ratio), APTR (Activated partial thromboplastin ratio) and platelet levels, the biopsy was complicated by severe haemorrhage.

Utilization and practical aspects of tele-ophthalmology between South Africa and the UK

A tele-ophthalmology service was established between a regional hospital in South Africa and a specialist eye hospital in the UK. The aim of the service was to provide secondary specialist advice in the diagnosis and treatment of difficult ophthalmology cases in South Africa. Over 12 months, the South African medical officers saw 16,458 ophthalmology patients and would have liked a second opinion in 5.7% of these cases. Case discussions conducted by videoconferencing at 384 kbit/s were carried out in 0.5% of cases. No significant connection problems were experienced during the 12-month study period. On 4% of occasions, the case discussions were conducted at a bandwidth of 256 kbit/s, but this did not affect the quality of the still images. The South African medical officers valued the educational benefits gained from the case discussions with the UK specialists.

Ultrasound and fluoroscopic-guided angioplasty over the aortic bifurcation in a patient with previous severe reaction to contrast medium

PURPOSE

To describe a case of ultrasound and fluoroscopic-guided angioplasty necessitated by a patient history of allergic reaction to contrast medium.

CASE REPORT

A 60-year-old man with intermittent right leg claudication had a focal >70% stenosis in the right external iliac artery that was amenable to balloon dilation; however, the patient reported a severe reaction to radiographic contrast medium 10 years previously. Angioplasty was begun with transaortic access to the iliac artery lesion under fluoroscopic guidance only. On-table duplex imaging confirmed the lesion site and reference diameters for balloon selection. The balloon was filled with contrast medium to provide rapid positioning under fluoroscopy. An on-table postangioplasty duplex scan showed improvement in the lumen contour and confirmed a reduction in the peak systolic velocity. At the 1-year follow-up, the patient reports no symptoms referable to the treated segment.

CONCLUSIONS

The combination of ultrasound and fluoroscopy facilitated quick and efficient balloon dilation of an isolated iliac lesion without the use of any contrast medium.

Pre-operative electrocardiograph examination

The leading cause of death following surgery is a cardiac event, and an electrocardiogram is the most common pre-operative test to investigate coronary artery disease. Fifty adults, who required an electrocardiogram, undergoing general surgical procedures, were recruited into this pilot study, which investigated the examination rate of electrocardiographs by doctors pre-operatively. Each tracing was folded in one corner and a paperclip prevented full pre-operative viewing without its removal. Results suggest that 30% of ECGs were not opened and the records of 58% patients overall had no mention of the ECG having been performed. Further analysis showed no correlation with the examination rate of the electrocardiograph with patient age or fitness. If this reflects normal clinical practice, it is sub-optimal use of resources and warrants further audit.

Improving the oral hygiene of institutionalized mentally retarded clients

PURPOSE

The quality of oral health care of persons with mental retardation has been reported in the literature to be less than that of their normal peers. The purpose of this study, set in a Midwest institution for persons with developmental retardation, was to determine if a change in policy followed by staff training and monitored by an interested third party would improve the oral hygiene of clients living on wards.

METHODS

Methods used to train staff in proper toothbrushing were developed. Three living units were randomly selected for study: control, training plus accountability (experimental group I), and training without accountability (experimental group II). The direct care staff of both experimental groups were trained in proper toothbrushing techniques. Staff of the control group received no training. A dental hygienist visited the living unit periodically to evaluate and provide feedback on the plaque index scores taken by the caregivers in both experimental groups.

RESULTS

The plaque indexes of group I showed significant improvement over the control group and group II.

CONCLUSION

The results of this pilot study support the other findings of higher plaque indexes for residents with mental retardation and that modifying toothbrushing policies and staff training are not as critical to the improvement of the clients' oral hygiene as is the presence of an involved, interested third party.

Changing risk behaviours for non-communicable disease in New Zealand working men--is workplace intervention effective?

AIMS

To evaluate the effectiveness of a health promotion programme targeting dietary behaviours and physical activity among male hourly-paid workers and to explore demographic and attitudinal influences on dietary patterns at baseline.

METHODS

A controlled field trial compared workers at one intervention and one control worksite. The intervention comprised nutrition displays in the cafeteria and monthly 30-minute workshops for six months. Key outcome measures at six and twelve-months were self-reported dietary and lifestyle behaviours, nutrition knowledge, body mass index (BMI), waist circumference and blood pressure.

RESULTS

132 men at the intervention site and 121 men at the control site participated in the study and a high retention rate (94% at 6-months and 89% at 12-months) was achieved. At baseline, 40% of the total sample (253) were obese, 30% had elevated blood pressure, 59% indicated an excessive fat intake and 92% did not meet the recommended vegetable and fruit intake. The intervention reduced fat intake, increased vegetable intake and physical activity, improved nutrition knowledge and reduced systolic blood pressure when compared to the control site. There was no difference in change in mean BMI or waist circumference. Reduction in BMI was associated with reduction in fat intake.

DISCUSSION

Low intensity workplace intervention can significantly improve reported health behaviours and nutrition knowledge although the impact on more objective measures of risk was variable. A longer duration or more intensive intervention may be required to achieve further reduction in risk factors.

Telemedicine techniques can be used to facilitate the conduct of multicentre trials

A multicentre randomized controlled trial was established in Pretoria, Bloemfontein and Edendale in South Africa, and coordinated from London. The purpose of the trial was to determine the efficacy of low-dose beta irradiation of glaucoma. Five communication modalities (telephone, fax, e-mail, videoconferencing and face-to-face meetings) were examined in terms of their benefits in a multicentre trial. The eight stages of the multicentre trial examined were: set-up and training, recruitment, standardization, patient management, data transmission, update and data dissemination, clinical follow-up and monitoring, and publication. On four-point Likert scales for rating the usefulness of the communication modalities at each of the eight stages of the trial (from 0 = not useful to 3 = very useful; maximum score 24) the telephone was given a total score of 10, fax 9, e-mail 13, videoconferencing 15 and face-to-face meetings 9. Telemedicine techniques offer considerable benefits in the coordination of multicentre trials by improving data collection, maintaining the efficacy and monitoring of trials, while potentially offering reduced costs in terms of travel and time. The realtime scrutiny of patient records helps to ensure data uniformity and completeness of data collection. Videoconferencing was most useful when considered as one of several communication tools that can be used to improve the effectiveness of a service or process.

An artificial neural network for the electrocardiographic diagnosis of left ventricular hypertrophy

OBJECTIVE

A neural network was constructed to predict the presence of left ventricular hypertrophy (LVH) using both clinical information and the electrocardiogram (ECG).

DESIGN AND SETTING

In this retrospective study of 317 adult male patients, clinical parameters were age and history/physical examination: normal, heart failure, LV outflow obstruction, mitral regurgitation or aortic regurgitation. Multiple ECG parameters were used. A back-propagation neural network was constructed. The network was trained on 217 patients. A test set of 100 patients was then evaluated. The network was used to predict both LV mass and LVH by the criterion of LV mass index > 132 g/m2.

RESULTS

LV mass was predicted with an accuracy of 79%. In predicting LVH, the network showed 82% correct diagnosis, sensitivity 94%, and specificity 65%. Positive predictive accuracy was 81% and negative predictive accuracy was 89%.

CONCLUSIONS

The neural network integrates clinical and ECG data and its resultant prediction of LVH is superior to that obtained using conventional ECG diagnostic criteria.

Calcification on the chest X-ray: a pictorial review

There are numerous causes of calcification on the chest radiograph. Their striking appearance can lead to anxiety among junior medical staff. This article aims to categorize these appearances, and to give examples of the most common causes seen.

Effect of plasma from premenstrual syndrome and control patients on human platelet and rat brain synaptosome monoamine oxidase B activity

The present study determined the kinetic properties of platelet monoamine oxidase (MAO) in patients with premenstrual syndrome (PMS) and control subjects during the pre- and postmenstrual intervals. In addition, we investigated the effects of plasma obtained during the pre- and postmenstrual intervals from both subject groups on MAO activity in washed human platelets and rat brain synaptosomes. The Vmax of platelet MAO in postmenstrual PMS patients was significantly less than that during the premenstrual phase. Plasma from both subject groups (10-100 microliters) inhibited platelet and synaptosomal MAO in a dose-dependent manner to approximately the same degree at each time interval. The results indicate that although human plasma contains endogenous substances which inhibit MAO activity, alterations in their concentration are probably not responsible for the previously reported transient changes in platelet MAO activity in PMS.

Selective attentional bias to alcohol related stimuli in problem drinkers and non-problem drinkers

AIMS

The issues explored in this study were whether a patient group of problem drinkers selectively attend to alcohol-related stimuli and the time course of any interference from alcohol-related stimuli in comparison with two control groups of non-problem drinkers.

DESIGN

A 3 x 2 x 2 x 5 factorial design was used. Drinking group (low, high and problem) and word order (alcohol-neutral, neutral-alcohol) were between-participant factors, and word type (alcohol, neutral) and presentation block (1-5) were within participant factors.

PARTICIPANTS

Three groups were used, 20 participants from a local community alcohol Service (CAS) and 40 participants (student volunteers) in two control groups. The two control groups were differentiated as scoring high or low on the Alcohol Use Disorders Identification Test (AUDIT).

MEASUREMENTS

A modified computerized Stroop colour naming test was used to measure response latencies. Anxiety was measured using the State-Trait Anxiety Inventory.

FINDINGS

The CAS group showed significantly longer reaction times to respond to the colour of alcohol-related words than to neutral category words. Although the interference was smaller for the high AUDIT group it was significant. No significant interference was found in the low AUDIT group. There was no statistical evidence that the interference habituated in the three groups.

CONCLUSIONS

The present study showed it is possible to use a modified Stroop task as a measure of implicit processing of alcohol stimuli. Despite the fact that all participants were asked to ignore the words, they were unable to do so. Alcohol-related words produced more interference than neutral category words in a group of problem drinkers and a control group of high alcohol drinkers.

The effect of a geriatric education program on emergency nurses

OBJECTIVE

In a previous study, emergency nurses gave a high priority to the educational topics of geriatric depression, physical assessment of the elderly, and mental status testing. Our objective was to measure the impact of a 1-day workshop for emergency nurses that addressed these educational needs.

METHODS

The workshop consisted of case-based didactic sessions addressing (1) physical assessment of the elderly, (2) delirium, depression, and dementia, and (3) a practical approach to mental status testing in the elderly. The educational program was evaluated using 2 methods: (1) before, and 1 month after, the workshop, participants rated their own practice patterns; and (2) during the course of 2 years, changes in the number of referrals for geriatric assessment and home care from a large emergency department in the study area were monitored.

RESULTS

Of 101 ED nurses who attended the 1-day workshop, 51 completed both preworkshop and postworkshop questionnaires (response rate, 50.5%). the most significant self-reported changes in practice 1 month after the workshop were improved screening for depression and altered mental status in older adults (P <.0001 and P <.01, respectively). Other positive changes were noted for inquiring about unplanned weight loss and assistance received at home. A steady increase in the number of referrals for geriatric assessment and home care was noted from the emergency department being monitored.

DISCUSSION

Targeted geriatric educational programs can make an impact on the practice of emergency nurses when they are part of an overall, coordinated approach to improving assessment and discharge planning for elderly patients in emergency departments. Mechanisms for reinforcing learning several months after educational events may prove critical to the long-term success of such initiatives.

Organosulfur compounds as pre-exposure therapy for threat agents

A series of symmetric (Ar-S-S-Ar) and unsymmetric (Ar-S-S-CH2CH2NH3+Cl-) disulfides have been prepared and evaluated as potential cyanoprotective agents. Target compounds have been prepared by known methods and/or methods developed by us specifically for this program, e.g. reaction of a thiol with 2,2'-dithiobis(benzothiazole) (BT-S-S-BT) followed by reaction with a second thiol. Both 4-methoxyphenyl disulfide and 2-aminoethyl-4-methoxyphenyl disulfide hydrochloride are cyanoprotective against 2-LD50 of injected cyanide. Evaluation of both symmetric and unsymmetric related disulfides indicates that structural requirements for cyanoprotective activity are stringent and strongly suggest that protection is enzyme mediated. In addition to cyanoprotective action, initial results suggest that unsymmetric disulfides may evolve into effective antimustard agents.

Alcohol genetics: will the promise be fulfilled?

Genetic research into alcohol-related problems has a long history, but only with the recent advent of molecular biological techniques does it seem poised to fulfill its promise. While such research might be thought to reinforce views of the inevitability and immutability of drinking problems, there have been bold promises of important developments in our understanding of the aetiology of alcohol misuse, as well as promises of innovations in prevention and treatment. A brief consideration of recent research, and of the possibilities that are now before us, reveals that the promise of increased understanding of the aetiology of alcohol misuse is already being fulfilled. Promises of new preventive and therapeutic interventions, if they also are to be fulfilled, require that a number of practical and ethical issues be addressed. Clinicians, researchers and others in the addictions field need to begin to address the ethical issues that are raised.

Depletion of a microtubule-associated motor protein induces the loss of dendritic identity

Dendrites are short stout tapering processes that are rich in ribosomes and Golgi elements, whereas axons are long thin processes of uniform diameter that are deficient in these organelles. It has been hypothesized that the unique morphological and compositional features of axons and dendrites result from their distinct patterns of microtubule polarity orientation. The microtubules within axons are uniformly oriented with their plus ends distal to the cell body, whereas microtubules within dendrites are nonuniformly oriented. The minus-end-distal microtubules are thought to arise via their specific transport into dendrites by the motor protein known as CHO1/MKLP1. According to this model, CHO1/MKLP1 transports microtubules with their minus ends leading into dendrites by generating forces against the plus-end-distal microtubules, thus creating drag on the plus-end-distal microtubules. Here we show that depletion of CHO1/MKLP1 from cultured neurons causes a rapid redistribution of microtubules within dendrites such that minus-end-distal microtubules are chased back to the cell body while plus-end-distal microtubules are redistributed forward. The dendrite grows significantly longer and thinner, loses its taper, and acquires a progressively more axon-like organelle composition. These results suggest that the forces generated by CHO1/MKLP1 are necessary for maintaining the minus-end-distal microtubules in the dendrite, for antagonizing the anterograde transport of the plus-end-distal microtubules, and for sustaining a pattern of microtubule organization necessary for the maintenance of dendritic morphology and composition. Thus, we would conclude that dendritic identity is dependent on forces generated by CHO1/MKLP1.

The design and synthesis of potent cyclic peptide VCAM-VLA-4 antagonists incorporating an achiral Asp-Pro mimetic

The Asp-Pro sequence of the cyclic peptide Ac-HN-Tyr-Cys*-Asp-Pro-Cys*-OH (1) could be replaced with the achiral dipeptide mimetic 1-(2-aminoethyl)cyclpentylcarboxylic acid with retention of potent inhibition of the VCAM-VLA-4 interaction.