Feasibility of identifying out of care HIV-positive patients in a hospital setting and enrolling them in a retention intervention

BACKGROUND

The hospital setting provides an opportunity to re-engage people living with HIV (PLWH) in HIV care. We developed and implemented a protocol to identify PLWH in a hospital setting. The aim of the current study was to report on our strategy to recruit hospitalized HIV patients into an intervention study, and to report on lessons learned for future studies.

METHODS

Our protocol was developed based on experience of our research staff in recruiting HIV patients as well as clinical input from providers and administrators on delivering care in hospitalized settings. We identified hospitalized PLWH between 2010 and 2013 who were potentially eligible for an intervention study. Patients were identified by review of electronic medical records and clinician referral, followed by in-person screening to confirm eligibility. We examined factors related to identifying and enrolling hospitalized patients, and documented lessons learned.

RESULTS

Key strategies included systematic medical record review followed by in-person screening, collaboration with staff, and flexibility in recruitment logistics. We identified 1801 PLWH hospitalized during the 3-year study period. Eighty-four percent (n = 1514) met the met the inclusion criteria based on medical record review. Of these, 48% (n = 733) were ineligible. Among eligible patients, 59% (n = 460) were enrolled. Only 3% (n = 23) of eligible patients declined; 84% (n = 321) were not enrolled because they were discharged before enrollment. Lessons learned included (1) needing to identify patients and deliver the intervention before hospital discharge, (2) limiting the complexity of the intervention, and (3) having research staff available on weekends and after hours.

CONCLUSIONS

Targeted recruitment of hospitalized populations is a feasible and productive approach for finding and engaging PLWH who are newly diagnosed or out of routine care.

Acute respiratory effects on workers exposed to metalworking fluid aerosols in an automotive transmission plant

Exposure to metalworking fluids has been linked to modest cross-shift reductions in FEV1 and occupational asthma. To identify responsible agents, we measured personal exposures to thoracic particulate (TP), viable plus nonviable thoracic bacteria (BAC), and vapor phase nicotine (VPN) (as a surrogate for tobacco particulate) among 83 machinists exposed to soluble oils and 46 dry assemblers working in an automotive transmission machining plant using biocides infrequently. The participants completed interviews and performed pre- and postshift spirometry on Monday and Thursday of the same week in each of three rounds of data collection (June 1992, January 1993, June 1993). Generalized estimating equations were used to combine information across rounds in multiple regression models of cross-shift and cross-week changes in forced expiratory volume, I second (FEV1) and forced vital capacity (FVC). Mean seniority was 19 years among machinists. Mean personal TP levels were 0.41 mg/m3 in machinists and 0.13 mg/m3 in assemblers. Six of the 83 machinists and none of the 46 assemblers experienced a greater than 19% cross-shift decrement in FEV1 or FVC at least once (p = .07). In regression models using either TP or BAC, among subjects with lower baseline (Monday preshift) FEV1/FVC ratios, increasing exposure was significantly associated with increasing cross-shift decrements in FEV1 and FVC in linear models, and with increased likelihood of a 10% or greater cross-shift decrement in FEV1 or FVC in logistic models. Adjustment of TP for VPN did not affect models significantly. We conclude that clinically important cross-shift decrements in pulmonary function are associated with exposure to metalworking fluid aerosols within a high-seniority population.

Partially modified retro-inverso-enkephalinamides: topochemical long-acting analogs in vitro and in vivo

The synthesis of four enkephalinamide analogs is described in which the peptide bond between residues 4 and 5 is reversed with or without simultaneous reversal of the carboxyl-terminal amide bond. These so-called partially modified retro-inverso-isomers are new, potent, topochemical analogs of the enkephalins. Tests, both in vitro and in vivo, have shown that these analogs are considerably longer acting than any previously studied enkephalins. Thus, partial reversal of the peptide bonds of the backbone can result in peptides with enhanced activity compared to a parent compound, provide that the structural complementarity of both the side chains and end groups are conserved.

beta-Endorphin secretion of arginine vasopressin in vivo

The effect of beta-endorphin upon plasma arg8-vasopressin release was studied in vivo in rabbits and in vitro in rat neural lobes. Following intravenous administration of 200 mug/kg synthetic beta-endorphin plasma AVP rose significantly by five minutes after injection and remained elevated for twenty-five minutes compared to controls. In contrast beta-endorphin had no significant effect on AVP release from isolated rat neural lobes in vitro. beta-Endorphin stimulates AVP secretion in vivo, but this is not due to a direct action upon the neural lobe.

Regional dissociation of beta-endorphin and enkephalin contents in rat brain and pituitary

beta-Endorphin and enkephalin in extracts of whole brain, various brain regions, adenohypophysis, and combined pars intermedia and neurohypophysis of the rat were measured by radioimmunoassay. In brain extracts, the immunoreactive substances were further separated according to molecular size by gel filtration. beta-Endorphin was found in the diencephalon but not in the hippocampus, cerebral cortex, cerebellum, and striatum. Enkephalin was found predominantly in the striatum and diencephalon. Attention is called to possible artifactual interference by myelin basic protein in the immunoassays for beta-endorphin in some regions of the brain. In the pituitary, enkephalin was mainly restricted to the pars intermedia-neurohypophysis. Neither adrenalectomy nor hypophysectomy significantly altered levels of beta-endorphin in brain extracts. Adrenalectomy increased the levels of beta-endorphin in adenohypophysis and pars intermedia-neurohypophysis; after adrenalectomy, enkephalin was also increased in the adenohypophysis but less so in the pars intermedia-neurohypophysis. These results show that brain endorphin levels are independent of pituitary endorphin levels; they suggest that beta-endorphin-containing neurons and those containing enkephalin constitute two separate groups of brain cells.

beta-Endorphin and adrenocorticotropin are selected concomitantly by the pituitary gland

The opiate-like peptide beta-endorphin and adrenocorticotropin are concomitantly secreted in increased amounts by the adenohypophysis in response to acute stress or long-term adrenalectomy as well as in vitro in response to purified corticotropin releasing factor and other secretagogues. Conversely, administration of the synthetic glucocorticoid dexamethasone inhibits the secretion of both adrenocorticotropin and beta-endorphin. Thus, both hormones possess common and identical regulatory mechanisms and there may be a functional role for circulating beta-endorphin.