Changes in Overall Participation Profile of Youth with Physical Disabilities Following the PREP Intervention

The Pathways and Resources for Engagement and Participation (PREP), an environmental-based intervention, is effective in improving the participation of youth with disabilities in specific targeted activities; however, its potential impact on overall participation beyond these activities is unknown. This study examined the differences in participation levels and environmental barriers and supports following the 12-week PREP intervention. Existing data on participation patterns and environmental barriers and supports, measured by the Participation and Environment Measure for Children and Youth, pre-and post-PREP intervention, were statistically analyzed across 20 youth aged 12 to 18 (mean = 14.4, standard deviation (SD) = 1.82) with physical disabilities in three settings: home, school and community. Effect sizes were calculated using Cohen’s d. Following PREP, youth participated significantly less often at home (d = 2.21; 95% Confidence Interval (CI) [1.79, 2.96]), more often (d = 0.57; 95% CI [−0.79, −0.14]) and in more diverse activities (d = 0.51; 95% CI [−1.99, −0.51]) in the community. At school, significantly greater participation was observed in special school roles (t = −2.46. p = 0.024). Involvement and desire for change remained relatively stable across all settings. A substantial increase in community environmental supports was observed (d = 0.67), with significantly more parents reporting availability of, and access to information as a support (χ² = 4.28, p = 0.038). Findings lend further support to the effectiveness of environmental-based interventions, involving real-life experiences.

Development of a Documentation Rubric and Assessment of Pharmacists' Competency for Documentation in the Patient Health Record

Background

Documentation of information in the health record by pharmacists is vital to patient care. Failure to document, or failure to document appropriately, may have negative effects on patients.

Objectives

The primary objective was to determine pharmacists' competency in 18 elements of chart note documentation at 2 tertiary care centres and 1 rehabilitation centre. The secondary objectives were to quantify the number of episodes of documentation by pharmacists, to characterize the clinical activities associated with this documentation, and to determine whether there were differences in level of competency according to years of hospital experience, additional clinical training, and note type.

Methods

This study used prospective audit methodology. Notes documented during a 6-week study period (February to April 2015) were assessed using a rubric specifically created to evaluate 18 of the essential elements of documentation, as defined by the Canadian Society of Hospital Pharmacists. Four of the elements of chart note documentation were assessed on a yes/no basis, and Bloom's taxonomy was used to define the level of competency for the other 14 elements. Values were assigned to each level and were then used to calculate mean scores.

Results

A total of 115 pharmacist notes, created by 29 of the 35 pharmacists included in the study, were assessed. The mean competency score per pharmacist was 2.2 (standard deviation [SD] 0.3; maximum score 3). Elements of documentation with the highest level of competency were diplomatic tone, conciseness, and clarity; elements with the lowest level of competency were medication list, note title, monitoring, and drug-related problem statements. The most frequent note types concerned drug-related problems (50 [43%]), pharmacokinetics (25 [22%]), and patient education (19 [17%]). Levels of competency were highest for notes related to patient education (mean 2.4, SD 0.2) and lowest for notes concerning drug-related problems (mean 2.1, SD 0.3) and notes providing clarification (mean 2.1, SD 0.3). The level of competency was not significantly affected by additional clinical training or years of hospital experience.

Conclusions

Pharmacists in this study documented concisely, clearly, and in a diplomatic tone; however, there was room for improvement in the frequency and elements of chart note documentation in the patient health record.

Assessment of Preceptor Development Strategies across Canadian Pharmacy Residency Programs

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A novel preparative regimen for autologous transplant in non-Hodgkin's lymphoma: long-term experience with etoposide and thiotepa

The purpose of this study was to evaluate the efficacy and toxicity of the preparative regimen of thiotepa and etoposide in patients undergoing autologous transplantation for relapsed non-Hodgkin's lymphoma. The study involved 65 consecutive patients who underwent autologous transplantation using the thiotepa/etoposide regimen for relapsed intermediate-grade NHL at the University of Wisconsin Hospital and Clinics (UWHC) between 1987 and 2001. The regimen consisted of thiotepa 300 mg/m(2)/day and etoposide 700 mg/m(2)/day on days -6, -5, and -4. The median age at the time of transplant was 49 years. A total of 50 patients (76%) had diffuse large-cell lymphoma. A total of 50 (77%) patients had chemosensitive disease, and 15 (23%) were chemoresistant. With a median follow-up of 34 months (range, 3-163), 28 patients (43%) remain in CR and 33 (51%) have developed recurrent or progressive disease. The overall survival and event-free survival at 3 years are 40% (95% CI 26-53%) and 32% (95% CI 20-45%), respectively. There was one death attributed to regimen-related toxicity (RRT). Reversible gastrointestinal toxicity was the major RRT, and there was minimal pulmonary and cardiac toxicity. We conclude that the combination of thiotepa and etoposide is an effective preparative regimen with acceptable RRT.

Human metallothionein gene expression determined by quantitative reverse transcription-polymerase chain reaction as a biomarker of cadmium exposure

Expression of the metallothionein (MT) gene in frozen human lymphocytes has been developed as a new molecular biomarker of heavy metal exposure. Workers at a Polish battery factory with high exposure to cadmium were monitored for airborne exposure and blood cadmium levels. A novel quantitative reverse transcription-PCR (RT-PCR) technique, making use of a homologous internal standard, was used to assess the level of MT-specific mRNA in frozen stored aliquots of blood samples taken from exposed and control workers. Results from this assay showed a statistically significant 2.5-fold increase in MT mRNA in exposed compared to control workers. The RT-PCR results also showed significant correlation with airborne cadmium, as registered on personal monitors and with blood cadmium levels. The results suggest that gene induction measured by quantitative RT-PCR is a promising approach for application as a biomarker of biologically effective dose in small samples of frozen tissues or cells.

Effects of the workplace on fertility and related reproductive outcomes

This report reviews the recent literature on the adverse effects of occupational factors on fertility and related reproductive outcomes. Few studies fulfill the criteria of good study design because of small sample size, insensitive measures of effect, selection, recall, and observation bias, weak if any control of confounding factors, bad definition of exposure, inability to analyze a dose-response relationship, and inadequate statistical analysis. The high prevalence of unsuccessful reproductive outcomes in the general population makes the design of human fertility studies difficult. Although a number of publications indicate that certain occupational factors and settings adversely affect both male and female fertility, it is virtually impossible to estimate the proportion of infertility due to occupational factors in the general population. The collected data suggest that the exposure to the following substances or occupational settings may affect a function of male genital system, leading to sperm abnormalities, hyperestrogenism, impotence, infertility, and/or increased spontaneous abortion rate in wives of exposed workers: alkylmercury, antimonide, anesthetic gases, boron, carbon disulfide, chlorodecone, chloroprene, some carbamates (carbaryl), diaminostilbene, 1,2-dibromo-3-chloropropane, ethylene glycol ethers, ethylene dibromide, inorganic lead, manganese, methyl chloride, organic solvents, synthetic estrogens and progestins, tetraethyllead, combined exposure to styrene and acetone, welding operations, and heat. The majority of reviewed papers on female fertility concerns the alterations of menstrual cycle and pregnancy complications rather than occupational exposure-induced female infertility. The literature supports the hypothesis that, in general, working women have a tendency of higher risk of unsuccessful reproductive outcomes, although the existing data are not sufficient.

Different haematopoietic growth factors have different capacity in overcoming the in vitro interferon gamma-induced suppression of bone marrow progenitor cells

Interferon gamma (IFN gamma) inhibits haematopoiesis in vitro and an in vivo role in bone marrow suppression has been implied from clinical studies. We investigated the capacity of three recombinant (r), human (h), haematopoietic growth factors to overcome the in vitro IFN gamma inhibition of bone marrow progenitor cells in a methylcellulose culture system. Granulocyte macrophage-colony stimulating factor (GM-CSF) partially reversed IFN gamma-induced suppression of granulocyte-macrophage colony formation, by increasing colony forming units-granulocyte macrophage (CFU-GM) in a proportion ranging from 54-101%. Interleukin-3 (IL-3) and granulocyte-colony stimulating factor (G-CSF) were much less effective. For erythropoiesis, IL-3 was much more effective and partially reversed IFN gamma-mediated inhibition by increasing burst forming units-erythroid (BFU-E) in a proportion ranging from 52-138%. GM-CSF and G-CSF had no significant effect on IFN gamma-induced suppression of BFU-E. In conclusion, haematopoietic growth factors have different capacity to overcome IFN gamma-induced suppression of marrow progenitor cells in vitro. The findings may have therapeutic implications, as combinations of growth factors may be more effective in treating bone marrow failure syndromes.

Epstein-Barr virus in the bone marrow of patients with aplastic anemia

STUDY OBJECTIVE

To determine whether Epstein-Barr virus is present in the bone marrow of patients with aplastic anemia.

DESIGN

Assay of fresh and fixed bone marrow specimens for Epstein-Barr virus using immunofluorescence for nuclear antigen, Southern analysis with an Epstein-Barr virus specific probe, and in-situ hybridization.

SETTING

Governmental medical referral center.

PATIENTS

Five patients were studied prospectively: three who previously had infectious mononucleosis, one with a recent viral pneumonitis, and one who was asymptomatic. Stored DNA samples from other patients with aplastic anemia were also screened.

MEASUREMENTS AND MAIN RESULTS

Epstein-Barr virus DNA and protein were detected in the bone marrow of 5 patients studied prospectively and in 1 of 40 patients studied retrospectively. As estimated by in-situ hybridization, about 3% to 5% of marrow cells were infected with virus in those patients who had not received acyclovir. In contrast, Epstein-Barr virus DNA was not detected in peripheral blood DNA of these patients, nor were Epstein-Barr virus proteins or DNA found in the bone marrow of normal donors, patients with other hematologic diseases, or in 1 patient with acute infectious mononucleosis. Analysis of DNA fragments by hybridization with Epstein-Barr virus probes showed a pattern dissimilar to the type of Epstein-Barr virus usually associated with infectious mononucleosis.

CONCLUSIONS

Aplastic anemia may be associated with Epstein-Barr virus more commonly than suspected by history. Localization of the virus in the bone marrow supports a causative role for Epstein-Barr virus in bone marrow failure.

Reye's syndrome-like illness in a patient receiving amiodarone

A 16-yr-old boy who was receiving amiodarone for ventricular arrhythmias developed a Reye's syndrome-like illness several days after an upper respiratory infection. Liver biopsy revealed microvesicular fat and spotty hepatocellular necrosis, typical of Reye's syndrome. Recovery was complete. This case report suggests that medications other than aspirin may predispose to Reye's syndrome, and that children receiving amiodarone should receive prophylaxis against influenza B and chicken pox.

Hematologic consequences of viral infections

This article summarizes the current medical literature regarding the effects of viral infections upon the hematopoietic system. The article discusses the effect of viral infections upon peripheral blood counts, cellular immune system, and the bone marrow. In addition, a few selected syndromes, including human parvovirus, EBV, and HTLV infections, are discussed.

Effect of alcohol intake on some disturbances induced by chronic exposure to carbon disulphide in rats. I. Behavioural alterations

Female white Wistar rats were exposed to CS2 vapour (0.8 mg CS2/1 air) 11 months and to 10% ethanol as the only drinking liquid for the last 3 months of exposure. Spontaneous exploratory motor activity (SEMA), open-field behaviour, passive avoidance performance and the avoidance acquisition were tested. Ethanol did not change the exploratory motor activity and behaviour of CS2-exposed rats in the open-field and passive avoidance tests but it affected their performance in the conditioned avoidance test. The analysis of data suggests that ethanol may adversely affect memory and learning ability in CS2-exposed rats.

Effect of long-term inhalation exposure to cadmium oxide fumes on cardiac muscle ultrastructure in rats

The ultrastructure of the cardiac muscle of rats exposed 5 h daily, 5 days a week to cadmium oxide (CdO) fumes at a concentration of 0.16 mg Cd/m3 for 3 and 6 months and at a concentration of 1 mg Cd/m3 for 3 and 4 months has been evaluated. The structure of muscle cells, arterioles and capillaries remained unchanged. There were distinct alterations of the intercalated disc structure dependent upon the level and time of exposure. The damage to intercalated discs varied from the enlargement of the fissure between membranes (within unspecialized segments) to disruption of the complex junctions.