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Survey concerning internal medicine physicians and prolonged QT interval:Knowledge and treatment practices

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World Journal of Cardiology 2021年第3期13卷 42-45页

作者： Elizabeth Wendl Nelson Telles Geoff C Wall Department of Medical Education Internal Medicine Residency ProgramIowa Methodist Medical CenterDes MoinesIA 50311United States Department of Cardiology Internal Medicine Residency ProgramIowa Methodist Medical CenterDes MoinesIA 50311United States Department of Pharmacy Practice Drake University College of Pharmacy and Health SciencesDes MoinesIA 50311United States Internal medicine Residency Program Iowa Methodist Medical CenterDes MoinesIA 50311United States

Prolongation of the QT interval is associated with adverse cardiac events specifically Torsades de pointes(TdP).There are multiple mediations that have a known,possible,or conditional risk for prolonged QT interval,but general practitioners’knowledge of these medications is *** conducted a survey to assess internal medicine(IM)providers’knowledge of risk factors and medications associated with prolonged QT as well as provider experience and comfort when treating patients with prolonged QT.A 17-question,anonymous survey was constructed in 2019 and distributed to IM providers and residents at a tertiary care *** included demographic information,6 Likert-scale questions gauging provider experience with prolonged QT,and 10 multiple choice clinical vignettes to assess clinical *** was analyzed *** was assessed via clinical vignettes and compared by level of ***-one responses were received out of a total of 87 possible respondents(47.1%response rate).About 70%of respondents see patients with acquired prolonged QT once monthly or more.95%rarely see congenital prolonged *** presented with QTc drug issues,73%of providers seldom or sometimes consulted pharmacy,but about half used online *** average correct score on the clinical vignettes was 5.59/10,with the highest scores seen in attending physicians in their first five years of practice(6.96/10).Our survey suggests that IM providers commonly encounter QT prolonging *** efforts to improve knowledge of drug and patient risk factors for TdP may be needed.

关键词： QTc Torsades de pointes Pharmacotherapy Survey Long QT syndrome Drug interactions

Considerations in Dealing with Ethical Conflict Encountered in Healthcare Reform: Perceptions of Nurse Leaders

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Open Journal of Nursing 2014年第10期4卷 695-704页

作者： Robert Cooper Garry Frank Cherry Shogren college of Business and Public Administration Drake University Des Moines USA Professional Development Unity Point Health—Des Moines Des Moines USA

With the nursing profession continuing to face an array of ethical issues, the article reports the findings of a survey of members of the American Organization of Nurse Executives conducted in 2012 to determine the extent to which nurse leaders at different organization levels perceive various factors in their personal, professional and organizational environments to be helpful in resolving ethical dilemmas. After their personal values, nurse leaders perceive factors related to their organization to be more helpful than those related to their profession, including, among others, the American Nurses Association Code of Ethics. The two highest rated business-related factors deal with the absence of pressure to compromise one’s own ethical standards which suggests that one way healthcare organizations can assist nurses and their leaders is by neither explicitly nor implicitly pressuring them to go against their own ethical values. Other key factors related to the organization include formal organizational factors such as the existence of an ethics committee or a person to whom unethical activity can be reported as well as more informal factors related to organizational climate such as the actions and responsiveness of one’s immediate boss, the ability to go beyond one’s boss if necessary, the organizational culture, management philosophy, and management’s communication of appropriate ethical behavior. Comparison of the findings of the 2012 survey with those of a similar study conducted in 2000 indicated the four factors perceived as most helpful in both studies were identical with the same rank order and the top-10 factors were identical with some differences in ranking. Further analysis indicated the relative degree of helpfulness of the 17 help factors common to both studies was perceived by responding nurse leaders as quite similar overall. The authors also discuss the implications for the profession and the healthcare industry today and in the future.

关键词： Ethical Culture Ethics Committee Nursing Ethics Patient Satisfaction Quality of Care

The Impact of Health Care Reform Initiatives on Ethical Conflict and Opportunities for Nurses to Improve Quality of Care While Enhancing Their Work Environments

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Open Journal of Nursing 2014年第9期4卷 644-655页

作者： Robert Cooper Garry Frank Cherry Shogren college of Business and Public Administration Drake University Des Moines USA Professional Development Unity Point Health-Des Moines Des Moines USA

Background: After more than a decade of the nursing profession contending that healthcare reform based almost exclusively on cost cutting was creating an array of serious ethical issues for nurses, healthcare organizations and other providers are now facing increasing demands primarily from payers to demonstrate improvement in both quality of care and patient experience along with continued cost reduction. Research Question: Have efforts by healthcare organizations to comply with these recently imposed requirements influenced the ethical environment faced by nurses and nurse leaders and if so, how? Materials and Methods: Data for assessing the current ethical environment was gathered with a close-ended survey mailed in October 2012 to a random sample of 3000 members of the American Organization of Nurse Executives. Results and Discussion: Statistical analysis of the data and comparison with the findings of a similar study conducted in 2000 indicated that along with five highly rated issues in the earlier study attributed largely to economic constraints imposed by healthcare organizations, the top-10 key ethical issues today included five issues primarily attributable to interprofessional conflict. Conclusion: Given the success of many ongoing efforts aimed at weakening these key sources of ethical conflict that have blocked many proposals to improve the quality of care, opportunities should arise for the nursing profession to more fully achieve its goals of improving the quality of care, safety and patient satisfaction and enhancing nurses’ work environments essential to that effort.

关键词： Cost Control End-of-Life Care Ethical Consults Futile Treatment Healthcare Reform Nursing Ethics Patient Satisfaction Quality of Care

Progressive <I>β</i>Cell Failure in Type 2 Diabetes Mellitus: Microvascular Pancreatic Isletopathy?

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Journal of Diabetes Mellitus 2015年第1期5卷 21-27页

作者： Udaya M. Kabadi Mary U. Kabadi Sommany Weber Aaron Bubolz Edward Finnerty university of Iowa Carver college of medicine Iowa City Iowa USA VA Medical Center Phoenix Arizona USA des moines university Des Moines Iowa USA

Background: UKPDS suggested relentless deterioration of β cell function as a part of natural course of type 2 diabetes mellitus. However, the course was apparently not universal since many patients maintained glycemic goal (HbA1c β cell failure occurred around the same time as the time of onset of microvascular complications. Finally, the exact mechanism of progressive β cell failure remains to be defined. It is plausible that β cell failure may be due to fibrosis of pancreatic islets secondary to microangiopathy since no organ or tissue is exempt from this complication. Objective: To assess epidemiologic correlation between presence of b cell failure and microvascular complications by determining the prevalence of β cell failure in subjects with type 2 diabetes with increasing number of known microvascular complications. Methods: 650 Subjects with ages 40-75 years and duration of DM 4-23 years were divided into 4 groups according to number of microvascular complications, e.g. retinopathy, nephropathy, and neuropathy. β cell failure (β -?ve ) is defined as HbA1c > 7.0% with any therapy or HbA1c β cell function is deemed “preserved” (β + ve) with HbA1c b cell failure progressively rose with increasing number of microvascular complications from 0 to 2 with no further significant rise with 3 complications whereas subjects with preserved β cell function declined with increasing number of microvascular complications (p β cell failure (p β cell failure/β cell preserved with increasing number of microvascular complications as well as the greater duration of Diabetes. However, a significantly (p β cell failure persisted for rising number of microvascular complications even after eliminating the influence of age and duration of diabetes. Conclusion: β cell failure may be a manifestation of microvascular pancreatic isletopathy similar to other microvascular complications.

关键词： Type 2 Diabetes Beta Cell Failure Pancreatic Isletopathy

Marked Improvement in Glycemic Control with Exenatide on Addition to Metformin, Sulfonylurea and Insulin Glargine in Type 2 Diabetes Mellitus, a Real World Experience

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Journal of Diabetes Mellitus 2018年第4期8卷 152-159页

作者： Salina Esmail Sonal Banzal Udaya M. Kabadi university of Iowa Iowa City IA USA MGM college of medicine Indore India Broadlawns Medical Center Des Moines IA USA

Background: The major effect of Exenatide is attributed to lowering of post-prandial glycemia, whereas insulin glargine mainly improves fasting glycemia [FPG]. Objective: Therefore, we assessed effect of Exenatide administration at 6 months and for at 1 year on glycemic control, lipids, body weight [BW], daily insulin dose and hypoglycemic events. Methods: Records of 164 subjects, 126 men and 38 women administered Exenatide between January 2011 and December 2013 are included in this report. Exenatide was initiated at 5 mcg subcutaneously twice daily [BID] in obese subjects, BMI > 30 kg/m2, with C-peptide > 1 ng/d, and HbA1c 7.5% - 9.5%, while receiving daily metformin 2000 mg, Sulfonylurea Glimepiride 8 mg and insulin Glargine [GLAR]. Exclusion criteria were creatinine > 1.5 mg/dL and liver enzymes > 2.5 times upper limit of normal. Indices of glycemic control include fasting plasma glucose levels and HbA1c. Lipids include serum concentrations of total, LDL and HDL cholesterol. Other endpoints are body weight, daily insulin dose and number of hypoglycemic events per patient during 4 weeks prior to initiation of Exenatide, at 6 months and 1 year of therapy. Results: In 37 subjects, Exenatide was discontinued within 1 - 3 weeks;29 due to onset of nausea and vomiting. Seven of these also complained of abdominal pain and in these, serum amylase and lipase were elevated indicating presence of acute pancreatitis. One subject discontinued because of chest pain. Fasting plasma Glucose remained unchanged following Exenatide administration. However, HbA1c declined significantly denoting improvement in overall glycemic control without significant changes in body weight, daily insulin dose and hypoglycemic events. Lipid panel improved as well. Conclusion: Exenatide may be an appropriate adjuvant option in obese subjects with Type 2 diabetes mellitus with lack of desirable glycemic control while receiving therapy with Metformin, Glimepiride, and insulin Glargine. Moreover, impro

关键词： Type 2 Diabetes Mellitus Glycemic Control Insulin Glargine Metformin Sulfonylurea Exenatide

Irritable bowel syndrome: A concise review of current treatment concepts

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World Journal of Gastroenterology 2014年第27期20卷 8796-8806页

作者： Geoffrey C Wall Ginelle A Bryant Michelle M Bottenberg Erik D Maki rew R Miesner Department of Pharmacy Practice Drake University College of Pharmacy Des Moines IA 50311 United States

Irritable bowel syndrome(IBS) is one of the most common gastrointestinal disorders causing patients to seek medical treatment. It is relatively resource intensive and the source of significant morbidity. Recent insights into the pathophysiology and treatment of IBS has given clinicians more options than ever to contend with this disorder. The purpose of our paper is to review older, "classic" treatments for IBS as well as newer agents and "alternative" therapies. We discuss the evidence base of these drugs and provide context to help develop appropriate treatment plans for IBS patients.

关键词： Irritable bowel syndrome Probiotics Rifaximin Lubi

Gap Junctional Intercellular Communication Increases Cytotoxicity and Reduces Resistance to Hydroxyurea

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Journal of Cancer Therapy 2014年第13期5卷 1190-1202页

作者： Randall J. Ruch Paul D. Boucher Brian G. Gentry Donna S. Shewach Department of Biochemistry and Cancer Biology University of Toledo Toledo USA Department of Pharmacology University of Michigan Ann Arbor USA Drake university college of Pharmacy and Health Sciences Des Moines USA

Background: Gap junctions enable small molecules to diffuse between adjacent cells and have been associated with greater cytotoxicity of radiation and anti-cancer drugs. We investigated?whether this gap junctional intercellular communication (GJIC) affected the cytotoxicity of the classic?ribonucleotide reductase (RR) inhibitor and anti-cancer agent, hydroxyurea (HU). Materials and Methods: We used GJIC-proficient and deficient, connexin 43-expressing WB rat liver epithelial cell lines. We compared HU toxicity by crystal violet assay, effects of the drug on deoxynucleotide pools by HPLC, and ability of GJIC to increase toxicity of HU-resistant cells through a bystander effect in co-culture experiments. Results: GJIC-proficient cells were three- to five-fold more sensitive (IC50?0.1 mM) to HU than GJIC-deficient derivatives (IC50?0.3 - 0.5 mM). This sensitivity depended upon GJIC because treatment of GJIC-proficient cells with the GJIC blocker oleamide decreased HU toxicity by approximately 60% - 80% and restoration of GJIC in GJIC-deficient cells by stable transduction of connexin 32-encoding?Gjb1?increased HU toxicity (IC500.1 mM). The effects were not due to connexin expression?per se?or its localization since all cell lines expressed comparable quantities of connexin 43 that was localized to the plasma membrane. Also HU sensitivity was not related to differential effects on nucleotide metabolism in the cells. Thymidine triphosphate levels increased and deoxyadenosine triphosphate levels decreased similarly (15% - 20%) in GJIC-proficient and deficient cells over 24 h of HU treatment. More importantly, when HU-resistant cells were co-cultured with sensitive cells, the resistant cells were killed only when GJIC?was present. Conclusion: The data suggest that GJIC enhances cytotoxicity and decreases resistance?to HU. These results may be important clinically if GJIC can be enhanced in drug-resistant cells.

关键词： Bystander Effect Drug Resistance Gap Junctions Hydroxyurea Ribonucleotide Reductase

Reassessment of historical sections from the Paleogene marine margin of the Congo Basin reveals an almost complete absence of Danian deposits

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Geoscience Frontiers 2019年第3期10卷 1039-1063页

作者： Floréal Solé Corentin Noiret Delphine desmares Sylvain Adnet Louis Taverne Thierry De Putter Florias Mees Johan Yans Thomas Steeman Stephen Louwye Annelise Folie Nancy J.Stevens Gregg F.Gunnell Daniel Baudet Nicole Kitambala Yaya Thierry Smith Royal Belgian Institute of Natural Sciences (RBINS) Operational Directorate Earth and History of Life university of Namur (UNamur) Department of Geology Rue de Bruxelles 61 Sorbonne Université UPMC Paris 06 UMR 7207 (CR2P) UMR 5554-Institut des Sciences de l'Evolution Université Montpellier Place E.Bataillon Royal Museum for Central Africa (RMCA) Geodynamics and Mineral Resources Leuvensesteenweg 13 Ghent university (UGent) Department of Geology Royal Belgian Institute of Natural Sciences (RBINS) Heritage Scientific Survey Ohio university Department of Biomedical Sciences Heritage College of Osteopathic Medicine Duke university Lemur Center Division of Fossil Primates (DFP) Centre de Recherches Géologiques et Minières (CRGM) 44 av.de la Démocratie Kinshasa Gombe

The early Paleogene is critical for understanding global biodiversity patterns in modern ecosystems. During this interval, Southern Hemisphere continents were largely characterized by isolation and faunal endemism following the breakup of Gondwana. Africa has been proposed as an important source area for the origin of several marine vertebrate groups but its Paleogene record is poorly sampled, especially from sub-Saharan Africa. To document the early Paleogene marine ecosystems of Central Africa, we revised the stratigraphic context of sedimentary deposits from three fossil-rich vertebrate localities: the Landana section in the Cabinda exclave(Angola), and the Manzadi and Bololo localities in western Democratic Republic of *** provide more refined age constraints for these three localities based on invertebrate and vertebrate faunas, foraminiferal and dinoflagellate cyst assemblages, and carbon isotope records. We find an almost complete absence of Danian-aged rocks in the Landana section, contrary to prevailing interpretations over the last half a century(only the layer 1, at the base of the section, seems to be Danian). Refining the age of these Paleocene layers is crucial for analyzing fish evolution in a global framework, with implications for the early appearance of Scombridae(tunas and mackerels) and Tetraodontiformes(puffer fishes). The combination of vertebrate fossil records from Manzadi and Landana sections suggests important environmental changes around the K/Pg transition characterized by an important modification of the ichthyofauna. A small faunal shift may have occurred during the Selandian. More dramatic is the distinct decrease in overall richness that lasts from the Selandian to the Ypresian. The Lutetian of West Central Africa is characterized by the first appearance of numerous cartilaginous and bony fishes. Our analysis of the ichthyofauna moreover indicates two periods of faunal exchanges: one during the Paleocene, where Central Africa app

关键词： Central Africa Paleogene Stratigraphy Carbon isotope Planktonic foraminifera Vertebrates

颈动脉粥样硬化疾病的处理美国血管外科学会临床实践指南

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国际脑血管病杂志 2008年第12期16卷 881-887页

作者： Robert W. Hobson, Ⅱ William C. Mackey Enrico Ascher M. Hassan Murad Keith D. Calligaro Anthony J. Comerota Victor M. Montori Mark K. Eskandari Douglas W. Massop Ruth L. Bush Brajesh K. Lal Bruce A. Perler 刘德志(译) 徐格林(译) 刘新峰(译) university of medicine and Dentistry of New Jersey Newark New England Medical Center Boston Maimonides Medical Center Brooklyn Mayo Clinic Rochester university of Pennsylvania school of medicine Philadelphia Jobst Vascular Center Toledo Mayo Clinic college of medicine Rochester Northwestern university Feinberg School of medicine Chicago The Iowa Clinic Des Moines university of medicine and Dentistry of New Jersey Newark Texas A & M university Health Science Center College Station Johns Hopkins Hospital Baltimore 南京军区南京总医院神经内科 210002

美国血管外科学会（SVS）任命了一个专家委员会制定颈动脉狭窄处理的循证临床指南。在制定临床实践推荐意见过程中，该委员会使用系统评价对当前最件的证据进行了总结，采用GRADE标准对推荐意见的强度（强烈推荐为GRADEI级，一般推荐为G... 详细信息

美国血管外科学会（SVS）任命了一个专家委员会制定颈动脉狭窄处理的循证临床指南。在制定临床实践推荐意见过程中，该委员会使用系统评价对当前最件的证据进行了总结，采用GRADE标准对推荐意见的强度（强烈推荐为GRADEI级，一般推荐为GRADEⅡ级）和证据的质量（高、中、低和极低）进行了分级。对于轻度颈动脉狭窄患者（有症状患者狭窄程度〈50％和无症状患者狭窄程度〈60％），推荐进行最佳的内科治疗而非血管重建术（I级推荐，高质量证据）。对于有症状中到重度狭窄患者（狭窄程度≥50％），推荐行颈动脉内膜切除术（CEA）＋最佳的内科治疗（I级推荐，高质量证据）。对于围手术期风险高的有症状巾到重度狭窄患者（狭窄程度≥50％），建议采用颈动脉支架置入术作为其替代治疗手段（Ⅱ级推荐，低质量证据）。对于中到重度狭窄的无症状患者（狭窄程度≥60％），只要围手术期风险较低，就推荐行CEA＋内科治疗（I级推荐，高质量证据）。对于中到重度狭窄的尢症状患者（狭窄稗度≥60％），不推荐行颈动脉支架置入术（I级推荐，低质量证据）。颈动脉狭窄≥80％但存在CEA高危解剖学风险的患者可能是一个例外。

关键词：临床实践指南动脉粥样硬化疾病血管外科学会美国颈动脉支架置入术颈动脉狭窄颈动脉内膜切除术