Medication Profiles at Hospital Discharge Predict Poor Outcomes After Acute Ischemic Stroke

Objectives: To examine the relationship between medications prescribed during the first 6-months post-stroke and functional outcome. Materials and Methods: A retrospective analysis of ischemic stroke survivors enrolled in an observational stroke recovery study from June-2017 to July-2019 was performed. Survivors with favorable outcomes (modified rankin scale (mRS) score 0-2) were compared to those with unfavorable outcomes (mRS ≥3) 6-months after stroke on the following: discharge medication classes prescribed, achievement of recommended targets for blood pressure control, glycemic control, and LDL ≤70 mg/dL, medication changes, medication interactions, and medication list discrepancies. Results: Unfavorable 6-month outcomes occurred in 36/78 (46.2%) of survivors. Survivors with unfavorable outcomes were more likely to be prescribed a central nervous system-acting agent (97.2% vs 71.4%; P = .0022) and/or an anti-hyperglycemic agent (25.0% vs 9.5%; P = .009) at discharge. After adjustment of baseline covariates, total number of medications prescribed was associated with unfavorable 6-month outcomes (OR 1.13, 95% CI 1.0-1.28). Secondary stroke prevention measures were not achieved in a high proportion of survivors. Medication changes during 6-month follow up were common and survivors with unfavorable outcomes were more likely to have clinically significant drug-drug interactions. Discussion: At 6-months, survivors with unfavorable outcomes were found to be prescribed more medications, particularly central nervous system-acting and anti-hyperglycemic agents. There were also more drug-drug interactions in the medications prescribed compared to those with favorable outcomes. Together, these data suggest the need for enhanced screening of high-risk stroke survivors focused on close monitoring of polypharmacy, drug-drug interactions, and adverse events with pharmacotherapy.

Safety and health hazard observations in Hmong farming operations

Agricultural workers have a high risk of occupational injuries, illnesses, and fatalities. However, there are very few standardized tools available to assess safety and health in agricultural operations. Additionally, there are a number of groups of agricultural workers, including Hmong refugees and immigrants, for which virtually no information on safety and health conditions is available. This study developed an observation-based methodology for systematically evaluating occupational health and safety hazards in agriculture, and pilot-tested this on several small-scale Hmong farming operations. Each observation assessed of range of safety and health hazards (e.g., musculoskeletal hazards, dust and pollen, noise, and mechanical hazards), as well as on factors such as type of work area, presence of personal protective equipment, and weather conditions. Thirty-six observations were collected on nine farms. The most common hazards observed were bending at the back and lifting <50 pounds. Use of sharp tools without adequate guarding mechanisms, awkward postures, repetitive hand motions, and lifting >50 pounds were also common. The farming activities observed involved almost no power equipment, and no pesticide or chemical handling was observed. The use of personal protective equipment was uncommon. The results of this assessment agreed well with a parallel study of perceived safety and health hazards among Hmong agricultural workers. This study suggests that small-scale Hmong farming operations involve a variety of hazards, and that occupational health interventions may be warranted in this community. The study also demonstrates the utility of standardized assessment tools and mixed-method approaches to hazard evaluation.

The synergy of health promotion practice/research/education

Many nurses are concerned about the lack of connection among nursing practice, research and education. However, the assumption that nursing practice, research, and education represent separate domains or activities that need to be linked, may well contravene the relational synergy they share. This paper describes a project that sought to illustrate, and further explore, the synergistic, iterative relationship of health promoting practice/research/education. The project revealed how this synergy lives out within the daily practice of frontline practitioners and how the researched knowledge practitioners bring forth through their practice can transform care.

[Measurements of the tensile force in the halo-pelvic apparatus and in the halo-Milwaukee brace (author' transl)]

A measuring device for static and dynamic recordings of the tensile force in the halo-pelvic apparatus and in the halo-Milwaukee brace was developed. The results present a survey of the tensil forces being effective during the preoperative traction in dependence on the extension distance and the duration of the treatment. The considerable variations of the tensile force, especially the high peak values, which were recorded during the normal day-to-day routine of the patients in the ward room, lead to the conclusion, that halo-gravity or halo-femoral traction is to be preferred to traction by the halo-pelvic apparatus or by the halo-Milwaukee-brace.

[Dynamic halo-gravity traction in scoliosis (author's transl)]

First results obtained in halo-gravity traction employing a new developed traction assembly are reported.

[Ito's syndrome (incontinentia pigmenti achromians)]

Ito's syndrome is a distinct entity characterized by bilateral systematized linear depigmentations denominated by Ito as "incontinentia pigmentiachromians". The syndrome includes a variety of anomalies predominantly affecting the central nervous system, the eyes, and the muscular-skeletal-system. The patient described in this paper was a 26 year old man suffering from a sever scoliosis. This anomaly had not been mentioned in previous case reports.

THE STRUCTURE OF THE PARS INTERARTICULARIS OF THE LOWER LUMBAR VERTEBRAE AND ITS RELATION TO THE ETIOLOGY OF SPONDYLOLYSIS

1. An anatomical study of the bony structure of the pars interarticularis of the fourth and fifth lumbar vertebrae has been made in specimens from seven cadavers aged seventeen to sixty-seven.

2. Layers of cortical bone have been described antero-laterally and postero-medially which are thickest in the narrowest region of the pars.

3. In one specimen from a seventeen-year-old male, a healing fracture was found in the antero-lateral layer of cortical bone in the right neural arch of the fourth lumbar vertebra.

4. The stresses to which the pars is subject consist primarily of shear forces applied to the articular processes. The significance of these stresses to the etiology of spondylolysis is discussed.