Parental perception of a picture-based chronic asthma care management tool in an urban pediatric emergency department

BACKGROUND

National asthma guidelines recommend use of an asthma action plan (AAP) as part of chronic asthma care. Unfortunately, AAPs have not been tailored for use in acute care settings, where many patients at risk for poor chronic asthma care are seen, including those who are non-English-speaking or have low literacy levels. We previously developed a picture-based medication plan (PBMP), a unique type of AAP for use in an ambulatory setting and designed to increase patient use and understanding. However, little is known about how parents seeking emergency department (ED) asthma care would perceive the PBMP.

OBJECTIVE

To assess parental attitudes toward an asthma PBMP in the largest pediatric ED in Los Angeles County.

METHODS

We surveyed a consecutive sample of English- or Spanish-speaking parents of children 2-17 years seeking ED asthma care. Parents used a 5-point Likert scale for various statements regarding their perceptions of the PBMP. Responses were analyzed by sociodemographics, asthma control, and health literacy using Chi-squared and t-tests.

RESULTS

90 parents provided feedback on the PBMP. The majority of parents endorsed the PBMP. Endorsement was 20%-30% higher among Spanish-speaking parents and those who did not complete high-school compared to English-speaking parents and parents with a high school education or higher (p < 0.05 for both comparisons).

CONCLUSION

Spanish-speaking parents and parents with less than a high-school education overwhelmingly endorsed the PBMP. It may be useful to consider incorporating the PBMP as part of patient-centered chronic asthma care strategies for populations seen in ED settings.

The Transition from the Hospital to an Inpatient Rehabilitation Setting for Neurologic Patients

Transitions of care from acute hospitalization to postacute rehabilitation settings evolved as a function of cost-saving changes to the Medicare Prospective Payment System. Restricted criteria for inpatient rehabilitation facility admission limited access for patients with severe physical and cognitive deficits. Once used as a resource-intense supplement to hospital care, skilled nursing facilities have metamorphosed into rehabilitation settings with limited nursing staff, lower intensity of therapies, and decreased community discharge rates. A collaborative approach to care transitions, using acute and postacute health care providers, provides the opportunity to improve this process. Early physiatry consultation is a strategy for patients with neurologic disease.

Prenatal drug use in Minneapolis-St Paul, Minn. A 4-year trend

OBJECTIVES

To determine the rates of maternal ingestion of cocaine, marijuana, and opiates in women from Minneapolis-St Paul, Minn, in 1993 and compare them with rates observed in 1989; and to compare outcomes of newborns born to those women with and without evidence of prenatal drug ingestion.

STUDY DESIGN

The meconium from newborns of a representative cluster-based sample of women from Minneapolis-St Paul was analyzed for metabolites of cocaine, marijuana, and opiates. The newborns were consecutive births in four urban and suburban hospitals. Maternal demographic information and newborn outcome data were collected and matched to the meconium samples. The race, age, and socioeconomic status of the mothers whose newborns were screened were the same as the demographic characteristics of all women delivering babies in Minneapolis-St Paul in 1990 and 1991.

SETTING

Metropolitan hospitals of Minneapolis-St Paul.

MAIN RESULTS

Of the 1333 samples, 27 (2.0%) were cocaine positive, 35 (2.6%) were tetrahydrocannabinol positive, and 16 (1.2%) were opiate positive. There were 168 women (22.6%) reporting that they smoked. Detection of tetrahydrocannabinol and cocaine was more common in newborns of women of color, those receiving medical assistance, and those over age 23 years. Newborns with meconium samples positive for cocaine or tetrahydrocannabinol had slightly lower average birth weights but were no more likely to be premature or to require neonatal intensive care unit admission than newborns with no drugs detected in their meconium. Newborns of mothers who smoked throughout pregnancy had lower average birth weights and higher rates of prematurity and neonatal intensive care unit admissions. Standardized rates of cocaine detection in the four hospitals decreased from 4.0% in 1989 to 2.0% in 1993.

CONCLUSIONS

Rates of perinatal cocaine detection have declined in the Twin Cities of Minneapolis-St Paul over the past 4 years. In this population, self-reported smoking was associated with more serious adverse outcomes of the newborns than was the detection of cocaine, marijuana, or opiates.

In vivo studies on the carcinogenic potential of an orthodontic bonding resin

Data from another laboratory have indicated that the individual components of an orthodontic bonding resin might contain a carcinogen. Since that report, the formulation of the product was changed. The purpose of this study was to determine whether the new product is safe. Three groups of rats were used for the experiment. One group served as a control, while the other groups ingested the sealant resin or sealant catalyst. The materials were suspended in an alcohol-aqueous mixture and the solutions were given to the animals as their only source of fluid. The exposure was for 1 year. After this period of time, all the rats were given tap water and observed until day 600. The animals were autopsied at time of death or at the end of the experiment. During the treatment, there were significant differences (p less than 0.01) in water intake among the three groups. The average intake per day for the animals in the control group, the resin group, and the catalyst group was 50.2 cc, 37.8 cc, and 42.2 cc, respectively. Several animals died during the experiment, but there was no significant differences in the life expectancy of the animals in the three groups. The autopsies uncovered one malignant neoplasm, an undifferentiated sarcoma, in a rat from the control group and four benign tumors in rats from the three groups. All of these results indicate that the new formulation of the orthodontic bonding resin is not carcinogenic when ingested at a dose level of 50 ppm.

Validation of a whole blood method for cholinesterase monitoring

Traditional cholinesterase monitoring methods requiring several milliliters of blood are too invasive for prolonged routine monitoring. After several years' experience with a whole blood method requiring only 50 microL of blood for each test, a statistical evaluation of 1 year's monitoring data was undertaken to determine the normal variation of the test procedures. The results showed excellent sensitivity and reproducibility. On the basis of these data and other obvious advantages, this method is recommended as a more acceptable procedure for cholinesterase monitoring in field situations as well as plant settings.

Leaching of unpolymerized materials from orthodontic bonding resin

The unpolymerized material extracted from cured orthodontic bonding resin was analyzed by UV spectrophotometry. Under certain conditions, substantial amounts of the material (approximately 14%) were leached from bracketed teeth. The possible carcinogenicity of these unpolymerized materials is discussed.

A technique for intraradicular dental implants

A technique utilizing nonvital roots for the support of intraradicular dental implants has been developed and tested. Using this technique it may be possible to preserve the roots of teeth that would normally be lost because of periodontal involvement. In this technique, a suitable tooth is treated endodontically. The crown is then removed to the height of the alveolar crest, and the root is drilled and tapped to accept a threaded stainless steel Heli-Coil insert. The root is then covered with a gingival flap. This allows for the regeneration of periodontal tissues around the root while it isolated from the oral environment. Following the period of natural healing, a stainless steel post is threaded into the Heli-Coil root implant. In the present studies (canine roots in a rhesus monkey) the implant posts are fitted with Adaptic crowns. These implants have been in place for more than 6 months with no sign of implant failure.

Effect of pneumatic tourniquet application to the distal extremities of the horse: blood gas, serum electrolyte, osmolality, and hematologic alterations

With 120 minutes of pneumatic tourniquet application to the distal extremity in the horse, the following effects were noted in the tourniqueted limb vein (TLV): (i) local venous acidemia, (ii) increase in serum K+ concentrations, (iii) minimal changes in plasma total solids, Na+, or osmolality, and (iv) apparent reduction in hematocrit values when compared with the same measurements in the control leg. Tourniquet release after 120 minutes produced a prompt return to base line for PCV and PO2 in the TLV; however, pH, PCO2 and K+ values in the TLV required 10 to 15 minutes to reach base line (TLV or control leg vein).

Autopsy study of cerebrovascular disease in Japanese men who lived in Hiroshima, Japan, and Honolulu, Hawaii

Evidence of cerebrovascular disease at autopsy was compared in 2 groups of men: 186 long-time residents of Hiroshima, Japan, and 253 men of Japanese ancestry long resident in Honolulu, Hawaii. They were 45 to 71 years-of-age at death. Atherosclerosis of the circle of Willis and its major branches, sclerosis of the intraparenchymal arteries and the frequency of cerebral hemorrhage and cerebral infarct were compared in the 2 populations. The Honolulu subjects had significantly more atherosclerosis of the circle of Willis, but less intraparenchymal artery sclerosis and less cerebral infarction. Cerebral hemorrhage was equally frequent in the 2 cities. It was concluded that cerebral infarction is more frequent in Japanese men in Hiroshima than Honolulu, and that men of Japanese ancestry in Honolulu are spared an appreciable risk of cerebral infarction through decreased frequency of intraparenchymal arterial sclerosis despite higher levels of atherosclerosis of large intracranial arteries.

Dissociation of the DNA replicase system of bovine lymphocyte nuclei

Exposure of S-phase nuclei or subnuclear preparations from phytohemagglutinin-stimulated bovine lymphocytes to 0.02 M ATP caused an immediate and almost total loss of their ability to replicate DNA in vitro. Other ribonucleoside and deoxyribonucleoside triphosphates caused a similar inhibition of DNA replication. Levels of ATP which inhibit replication cause the release of DNA polymerases alpha and beta and small pieces of DNA from these nuclei. This release occurs both at 4 and 37 degrees C. The data support the conclusion that high levels of ATP or other nucleoside triphosphates inhibit DNA replication in nuclei by dissolution of the DNA replication complex. The limited success in reconstitution of the DNA replicase complexes is discussed.

Chronic meningoencephalomyelitis with spastic spinal paralysis: a case report

A case of chronic meningoencephalomyelitis in a 48-year-old housewife is presented. The onset was characterized by spastic paralysis of the lower extremities. The course was progressive with repeated remissions and exacerbations, and the patient died approximately seven years after the onset of disease. Laboratory tests showed slightly increased cell count in the spinal fluid, accelerated sedimentation rate, positive CRP and RA, and increased ASLO and gamma globulin levels. Neuropathologic examination revealed such changes as perivascular cellular infiltration, glial nodules, poorly demarcated demyelination and recent necrosis in the spinal cord and basal ganglia. Only mild inflammatory findings were noted in the telencephalon and brain stem. The clinico-pathologic findings in this case supported a diagnosis of chronic meningoencephalomyelitis which could not be classified as any known type of encephalomyelitis.

DNA replication in nuclei isolated from bovine lymphocytes

DNA replication was studied in nuclei isolated from phytohemagglutin-stimulated bovine lymphocytes. The mitogen treatment induced more than 60% of these cells to engage in DNA synthesis with a peak of synthetic activity occurring about 48 h after the addition of phytohemagglutinin. Throughout this response the ability of isolated nuclei and nuclear sonicates to synthesize DNA in vitro was proportional to the synthetic ability of the intact cells of origin. The subcellular systems appear to continue synthesis at replicative sites which were active in vivo. The rate of in vitro synthesis by both nuclei and nuclear sonicates was about two-thirds that of intact cells. The one cytoplasmic and two nuclear DNA polymerase activities separated from these cells were found to have properties similar to those of other eucaryotic cells.