A comparison of intensive care unit physician staffing costs at the 3 Mayo Clinic sites.

Objectives: To determine the provider cost of administering intensive care unit (ICU) services, comparing 3 different staffing models for ICU coverage, and to compare the costs of using house staff vs nonphysician providers (NPPs).

Methods: Data were collected on total staff composition and number of beds In ICUs from January 1, 2004, through December 31, 2004, at the 3 Mayo Clinic sites: Rochester, Minn; Jacksonville, Fla; and Scottsdale, Ariz. Institutional or national average staff salaries were used to determine total staffing costs per ICU bed per year at each site.

Brief review: Nondepolarizing neuromuscular blocking drugs and critical illness myopathy.

Purpose: Critically-ill patients who receive nondepolarizing neuromuscular blocking drugs (NMBDs) may be at risk of developing profound muscle weakness that may last for months after the NMBD is discontinued, especially when large cumulative doses of NMBDs and corticosteroids are co-administered to septic, mechanically ventilated patients. This review focuses on the etiology and clinical features of critical illness myopathy (CIM), summarizes specific risk factors for its development, and discusses strategies that might be used to attenuate or even prevent the development of this potentially devastating syndrome.

Clinical Features: The etiology of CIM is unknown.

Correlates of health literacy in patients with chronic heart failure.

Purpose: Many older adults have inadequate health-related literacy, which is associated with poor health outcomes. Thus, it is important to identify determinants of health literacy. We investigated relationships between health literacy and general cognitive and sensory abilities, as well as education, health, and demographic variables, in a community sample of middle-aged and older adults.

Evidence against breast self examination is not conclusive: what policymakers and health professionals need to know.

Breast cancer is a serious health concern and a disease that is not well understood. Early detection remains the best way to prevent debilitation and death. Traditionally, mammography, clinical breast examination (CBE), and breast self examination (BSE) have been accepted as legitimate breast screening modalities.

Evaluation of the efficacy provided by a Recombinant Canarypox-Vectored Equine West Nile Virus vaccine against an experimental West Nile Virus intrathecal challenge in horses.

Efficacy of the Recombitek Equine West Nile Virus (WNV) vaccine was evaluated against a WNV intrathecal challenge model that results in WNV-induced clinical disease. Ten vaccinated (twice at days 0 and 35) and 10 control horses were challenged 2 weeks after administration of the second vaccine with a virulent WNV by intrathecal administration. After the challenge, eight of 10 controls developed clinical signs of encephalomyelitis whereas one vaccinate exhibited muscle fasciculation only once.

The Fes/Fer non-receptor tyrosine kinase cooperates with Src42A to regulate dorsal closure in Drosophila.

Fes/Fer non-receptor tyrosine kinases regulate cell adhesion and cytoskeletal reorganisation through the modification of adherens junctions. Unregulated Fes/Fer kinase activity has been shown to lead to tumours in vivo. Here, we show that Drosophila Fer localises to adherens junctions in the dorsal epidermis and regulates a major morphological event, dorsal closure.

Recent development of therapeutics for chronic HCV infection.

The global prevalence of hepatitis C virus (HCV) infection and serious health consequences associated with chronic state of the disease have become a significant health problem worldwide. Currently, there is no vaccine to prevent the disease and no specific antiviral drug directed against HCV infection. The current standard of care, interferon-based therapies, both alone or in combination with ribavirin, has demonstrated limited success and is associated with undesirable side effects.

Role of CYP pharmacogenetics and drug-drug interactions in the efficacy and safety of atypical and other antipsychotic agents.

Cytochrome P450 (CYP) drug oxidases play a pivotal role in the elimination of antipsychotic agents, and therefore influence the toxicity and efficacy of these drugs. Factors that affect CYP function and expression have a major impact on treatment outcomes with antipsychotic agents. In particular, aspects of CYP pharmacogenetics, and the processes of CYP induction and inhibition all influence in-vivo rates of drug elimination.

Health psychology and social action.

This article reviews the main epistemological approaches within health psychology. It considers the approach based on critical realism and various strategies for linking health psychology with social action. It argues that critical health psychology has a distinct contribution to make in promoting public health as part of the broader movement for social justice and health.

Association of refill adherence and health care use among adults with hypertension in an urban health care system.

Study Objectives: To determine the rates of undersupply, appropriate supply, and oversupply of antihypertensive drugs, as measured by refill adherence, among patients with complicated and uncomplicated hypertension (i.e., patients who have and have not, respectively, experienced hypertension-related target organ damage), and to examine the association of refill adherence with hospitalization and health care costs among these patients.

A novel methionine aminopeptidase-2 inhibitor, PPI-2458, inhibits non-Hodgkin's lymphoma cell proliferation in vitro and in vivo.

Purpose: Fumagillin and related compounds have potent antiproliferative activity through inhibition of methionine aminopeptidase-2 (MetAP-2). It has recently been reported that MetAP-2 is highly expressed in germinal center B cells and germinal center-derived non-Hodgkin's lymphomas (NHL), suggesting an important role for MetAP-2 in proliferating B cells. Therefore, we determined the importance of MetAP-2 in normal and transformed germinal center B cells by evaluating the effects of MetAP-2 inhibition on the form and function of germinal centers and germinal center-derived NHL cells.

Factors associated with drug adherence and blood pressure control in patients with hypertension.

Study Objectives: To determine characteristics associated with drug adherence and blood pressure control among patients with hypertension, and to assess agreement between self-reported and refill adherences.

Design: Cross-sectional analysis of baseline data from an ongoing randomized controlled trial.

Setting: Primary care center at an urban, county health system in Indianapolis, Indiana.

The Indiana Chronic Disease Management Program.

The Indiana Chronic Disease Management Program (ICDMP) is intended to improve the quality and cost-effectiveness of care for Medicaid members with congestive heart failure (chronic heart failure), diabetes, asthma, and other conditions. The ICDMP is being assembled by Indiana Medicaid primarily from state and local resources and has seven components: (1) identification of eligible participants to create regional registries, (2) risk stratification of eligible participants, (3) nurse care management for high-risk participants, (4) telephonic intervention for all participants, (5) an Internet-based information system, (6) quality improvement collaboratives for primary care practices, and (7) program evaluation. The evaluation involves a randomized controlled trial in two inner-city group practices, as well as a statewide observational design.

Supervision of students may protect academic physicians from cognitive bias: a study of decision making and multiple treatment alternatives in medicine.

Objective: To determine how professional characteristics and practices of physicians alter the selection of medical treatments involving multiple alternatives. Situations involving multiple alternatives can increase the difficulty of making a decision, resulting in more choice deferral than when fewer alternatives are available.

Design, Setting, Participants: A survey and scenario were mailed to a random sample of 314 primary and emergency care physicians affiliated with the Indiana University Medical Center.

Effect of alcohol on cytochrome p450 arachidonic acid metabolism and blood pressure in rats and its modulation by red wine polyphenolics.

Alcohol-induced hypertension is well recognized with clear evidence for a direct pressor effect of chronic alcohol consumption provided by a number of intervention studies in humans. In experimental animals, the effect of alcohol on blood pressure is less consistent; however, in Sprague-Dawley rats, alcohol feeding consistently induces a hypertensive response. The mechanism of alcohol-induced hypertension is not clearly understood.

Altered CYP expression and function in response to dietary factors: potential roles in disease pathogenesis.

Increasing evidence implicates dietary factors in the progression of diseases, including certain cancers, diabetes and obesity. Diet also regulates the expression and function of CYP genes, which impacts on drug elimination and may also significantly affect disease pathogenesis. Upregulation of CYPs 2E1 and 4A occurs after feeding of experimental diets that are high in fats or carbohydrates; these diets also promote hepatic lipid infiltration, which is a component of the metabolic syndrome that characterises obesity.

Nutrition in chronic heart failure with coexisting chronic kidney disease.

Background And Research Objectives: Patients with heart failure (HF) may be predisposed to malnutrition. Little is known about the nutritional status of patients with HF, particularly patients who have coexisting major medical conditions such as chronic kidney disease. The purposes of this study were to (1) describe the nutritional status of 211 patients with chronic HF, (2) examine relationships between nutrition variables and health-related quality of life, and (3) evaluate the nutritional status of the subset of HF patients with coexisting chronic kidney disease.

Medication and dietary compliance beliefs in heart failure.

Patients with heart failure are required to comply with a medication regimen and dietary sodium restrictions. The objectives of this study were to determine the most frequently perceived benefits of and barriers to compliance with medication and dietary sodium restrictions and evaluate the relevancy of these scale items for testing in tailored intervention studies. Data were collected as part of two studies that evaluated the psychometric properties of two questionnaires.

Gastric ulcer development in horses in a simulated show or training environment.

Objective: To determine whether conditions representing activities that are typical in the recreational use of horses, including transport to and from show grounds, stall confinement in unfamiliar surroundings, and light exercise, are associated with increased incidence of gastric ulcers in horses.

Design: Randomized controlled study.

Animals: 20 client-owned horses.

Indiana chronic disease management program risk stratification analysis.

Objective: The objective of this study was to compare the ability of risk stratification models derived from administrative data to classify groups of patients for enrollment in a tailored chronic disease management program.

Subjects: This study included 19,548 Medicaid patients with chronic heart failure or diabetes in the Indiana Medicaid data warehouse during 2001 and 2002.

Measures: To predict costs (total claims paid) in FY 2002, we considered candidate predictor variables available in FY 2001, including patient characteristics, the number and type of prescription medications, laboratory tests, pharmacy charges, and utilization of primary, specialty, inpatient, emergency department, nursing home, and home health care.

Improving medication knowledge among older adults with heart failure: a patient-centered approach to instruction design.

Purpose: We investigated whether patient-centered instructions for chronic heart failure medications increase comprehension and memory for medication information in older adults diagnosed with chronic heart failure.

Design And Methods: Patient-centered instructions for familiar and unfamiliar medications were compared with instructions for the same medications from a chain pharmacy (standard pharmacy instructions). Thirty-two adults (age, M = 63.

Characterization of a c-Jun-responsive module in the 5'-flank of the human CYP2J2 gene that regulates transactivation.

The human cytochrome P450 2J2 (CYP2J2) generates cytoprotective epoxyeicosatrienoic acids from arachidonic acid. Expression of CYP2J2 is decreased in hypoxia, and the resultant decrease in CYP2J2-derived epoxyeicosanoids may contribute to the pathogenesis of cardiac ischaemia. Recent studies have indicated that AP-1 (activator protein-1) regulates CYP2J2 expression in normoxia and hypoxia.