Prospective study of supplemental vitamin K therapy in patients on oral anticoagulants with unstable international normalized ratios.

Background: It is not known whether patients on oral vitamin K antagonists who have unstable INRs achieve more stable INRs with daily vitamin K supplementation. We sought to determine whether vitamin K supplementation may decrease INR variability in patients with a history of unstable INRs, how soon the INR decreases after vitamin K therapy is initiated, the time to reach a therapeutic INR after vitamin K initiation, and how much of an increase in oral anticoagulant dose is needed to maintain the INR in the desired range.

Methods: This is a prospective open label crossover study of patients on warfarin with a history of fluctuating INRs.

Consensus report on impulsive aggression as a symptom across diagnostic categories in child psychiatry: implications for medication studies.

Objective: To determine whether impulsive aggression (IA) is a meaningful clinical construct and to ascertain whether it is sufficiently similar across diagnostic categories, such that parallel studies across disorders might constitute appropriate evidence for pursuing indications. If so, how should IA be assessed, pharmacological studies designed, and ethical issues addressed?

Method: Experts from key stakeholder communities, including academic clinicians, researchers, practicing clinicians, U.S.

Death at a discount: how the tobacco industry thwarted tobacco control policies in US military commissaries.

Background: The US military is perhaps the only retailer consistently losing money on tobacco. Military stores (commissaries and exchanges) have long sold discount-priced cigarettes, while the Department of Defense (DoD) pays directly for tobacco-related healthcare costs of many current and former customers. Tobacco use also impairs short-term troop readiness.

Use of patient flow analysis to improve patient visit efficiency by decreasing wait time in a primary care-based disease management programs for anticoagulation and chronic pain: a quality improvement study.

Background: Patients with chronic conditions require frequent care visits. Problems can arise during several parts of the patient visit that decrease efficiency, making it difficult to effectively care for high volumes of patients. The purpose of the study is to test a method to improve patient visit efficiency.

How the health belief model helps the tobacco industry: individuals, choice, and "information".

Objective: To analyse trial and deposition testimony of tobacco industry executives to determine how they use the concepts of "information" and "choice" and consider how these concepts are related to theoretical models of health behaviour change.

Methods: We coded and analysed transcripts of trial and deposition testimony of 14 high-level executives representing six companies plus the Tobacco Institute. We conducted an interpretive analysis of industry executives' characterisation of the industry's role as information provider and the agency of tobacco consumers in making "choices".

Pictures worth a thousand words: noncommercial tobacco content in the lesbian, gay, and bisexual press.

Smoking prevalence in the lesbian, gay, and bisexual (LGB) community is higher than in the mainstream population. The reason is undetermined; however, normalization of tobacco use in the media has been shown to affect smoking rates. To explore whether this might be a factor in the LGB community, we examined noncommercial imagery and text relating to tobacco and smoking in LGB magazines and newspapers.

'We will speak as the smoker': the tobacco industry's smokers' rights groups.

Introduction: The tobacco industry usually keeps its commercial and political communications separate. However, the images of the smoker developed by the two types of communication may contradict one another. This study assesses industry attempts to organize 'smokers' rights groups,' (SRGs) and the image of the smoker that underlay these efforts.

Making big tobacco give in: you lose, they win.

Objectives: To better understand how the tobacco industry responds to tobacco control activists, we explored Philip Morris's response to demands that consumers in developing countries be informed about smoking risks, and analyzed the implications of negotiating with a tobacco company.

Methods: We reviewed internal tobacco industry documents and related materials, constructed a case history of how Philip Morris responded to a shareholder campaign to require health warnings on cigarettes sold worldwide, and analyzed interactions between (1) socially responsible investment activists, (2) Philip Morris management, (3) institutional investors, and (4) industry competitors.

Results: After resisting for 11 years, Philip Morris unilaterally reversed direction, and proposed its own labeling initiative.

"It's like Tuskegee in reverse": a case study of ethical tensions in institutional review board review of community-based participatory research.

Community-based participatory research (CBPR) addresses the social justice dimensions of health disparities by engaging marginalized communities, building capacity for action, and encouraging more egalitarian relationships between researchers and communities. CBPR may challenge institutionalized academic practices and the understandings that inform institutional review board deliberations and, indirectly, prioritize particular kinds of research. We present our attempt to study, as part of a CBPR partnership, cigarette sales practices in an inner-city community.

Impersistence of depression in youth: Implications for drug study design.

Food and Drug Administration data show that most anti-depressant studies in youth do not show drug effect. The few positive studies used rigorous diagnostic screening procedures, suggesting major depressive disorder (MDD) may not be a persistent condition in a subgroup of youth. To investigate persistence of MDD, we serially assessed a cohort of inpatients admitted to the hospital with a clinical diagnosis of MDD.

Melanin and nicotine: A review of the literature.

The role of melanin in nicotine uptake and metabolism has received little attention. Because nicotine has been shown to accumulate in tissues containing melanin, exploring links between melanin and nicotine may provide additional clues to understanding smoking behavior and disease effects. To examine the scientific literature on the relationship between melanin and nicotine, we conducted a PubMed search.

Effect of refined soy oil or whole soybeans on intake, methane output, and performance of young bulls.

An experiment was conducted to establish the effects of feeding refined soy oil (RSO) or whole soybeans (WSB) containing soy oil on DMI, animal performance, and enteric methane (CH4) emissions in young bulls. Thirty-six Charolais and Limousin cross-bred, young beef bulls (338 +/- 27 kg of BW, 218 +/- 17 d of age at the beginning of the experiment) were blocked by BW, age, and breed before being assigned in a randomized complete block design to 1 of 3 experimental treatments (n = 12). The experimental period lasted for 103 d, with enteric CH4 output recorded for 2 periods of 5 consecutive days on d 37 to 41 and d 79 to 83.

Psychiatry and the military: an update.

The United States has historically been concerned about the successful adjustment of its military members returning from war. These concerns are based on the recognition that war-zone exposures may have considerable negative emotional or behavior consequences. As the global war on terror continues, the United States military medical system will be required to address issues at the interface of psychiatry and the law.

Juvenile maladaptive aggression: a review of prevention, treatment, and service configuration and a proposed research agenda.

Objective: To review prevention programs, psychosocial and psychopharmacologic treatments, and service delivery configurations for children and adolescents with maladaptive aggression. To propose a research agenda for disorders of aggression in child and adolescent psychiatry.

Data Sources: Recent empirical studies were reviewed using searches of MEDLINE and PsycINFO (text terms: aggression, antisocial, violence, conduct, oppositional, psychosocial treatment, psychopharmacology, and prevention), relevant books, review articles, and bibliographies.

Nursing's involvement in tobacco control: historical perspective and vision for the future.

There is little evidence that nursing organizations have played a major leadership role in addressing tobacco control at the political level, and none have addressed collectively, in any sustained way, the role of the tobacco industry, the primary vector of the tobacco disease epidemic. The aims of this article are (a) to explore what accounts for organized nursing's relative quiescence about tobacco industry and (b) to elucidate why a nursing voice would be especially effective in addressing the industry as a vector of the tobacco disease epidemic. Drawing on the internal tobacco industry documents research, and incorporating a critical theoretical perspective on education, research, and practice, it is argued that tobacco cessation cannot be viewed solely as an individual problem but must be understood in a sociopolitical context and promoting a nursing agendum on cessation research and practice requires educating (and energizing) nurses on the sociopolitics of tobacco.

Fiscal versus social responsibility: how Philip Morris shaped the public funds divestment debate.

Calls for institutional investors to divest (sell off) tobacco stocks threaten the industry's share values, publicise its bad behaviour, and label it as a politically unacceptable ally. US tobacco control advocates began urging government investment and pension funds to divest as a matter of responsible social policy in 1990. Following the initiation of Medicaid recovery lawsuits in 1994, advocates highlighted the contradictions between state justice departments suing the industry, and state health departments expanding tobacco control programmes, while state treasurers invested in tobacco companies.

Philip Morris's Project Sunrise: weakening tobacco control by working with it.

Objective: To analyse the implications of Philip Morris USA's (PM's) overtures toward tobacco control and other public health organisations, 1995-2006.

Data Sources: Internal PM documents made available through multi-state US attorneys general lawsuits and other cases, and newspaper sources.

Methods: Documents were retrieved from several industry documents websites and analysed using a case study approach.

Labor characteristics and program costs of a successful diabetes disease management program.

Background: Organizations have invested in disease management programs to improve quality and to reduce costs, but little is known about the labor characteristics and the program costs necessary to implement a program.

Objective: To examine the labor characteristics and the program costs of a successful diabetes disease management program.

Study Design: We performed a labor and cost analysis within a randomized controlled trial of a primary care-based diabetes disease management intervention.

Polymorphisms in the VKORC1 gene are strongly associated with warfarin dosage requirements in patients receiving anticoagulation.

Background: Warfarin is a mainstay of therapy for conditions associated with an increased risk of thromboembolic events. However, the use of this common agent is fraught with complications and little is known regarding inter-individual variation in warfarin response.

Objective: We tested for association between single nucleotide polymorphisms (SNPs) in VKORC1 and CYP2C9 and average weekly warfarin dose required to maintain patients at their desired anticoagulation target.

Predictors of opioid misuse in patients with chronic pain: a prospective cohort study.

Background: Opioid misuse can complicate chronic pain management, and the non-medical use of opioids is a growing public health problem. The incidence and risk factors for opioid misuse in patients with chronic pain, however, have not been well characterized. We conducted a prospective cohort study to determine the one-year incidence and predictors of opioid misuse among patients enrolled in a chronic pain disease management program within an academic internal medicine practice.

A heart failure self-management program for patients of all literacy levels: a randomized, controlled trial [ISRCTN11535170].

Background: Self-management programs for patients with heart failure can reduce hospitalizations and mortality. However, no programs have analyzed their usefulness for patients with low literacy. We compared the efficacy of a heart failure self-management program designed for patients with low literacy versus usual care.

Assessing the policy environment.

This article proposes a basic framework for assessing the policy environment. Environment is a key concept in nursing's much-discussed "metaparadigm," but the policy environment is rarely considered. Too often, bedside nurses do not recognize the policy dimensions of clinical practice issues.