Delirium in Intensive Care Units: Perceptions of Physicians and Nurses.

Delirium is an indicator of morbidity and mortality in intensive care unit (ICU) patients. It can lead to negative outcomes and longer hospital stays, thus increasing hospital costs. Despite national recommendations for daily assessment of delirium, it remains underdiagnosed. Many studies point to a lack of knowledge among health care professionals to accurately detect and manage ICU delirium. The aim of our study was to assess the knowledge, attitudes, and practices of Palestinian health care professionals regarding ICU delirium. The results of a cross-section observational study revealed that delirium appears to be often underrecognized or misdiagnosed in ICUs in Palestine. Therefore, it is critical to further educate the medical and nursing teams and to promote the use of validated tools that can aid in the assessment of this condition. In this way, the length of hospital stays and related health care costs can be reduced.

Exogenous Thyroid Hormone Is Associated with Shortened Survival and Upregulation of High-Risk Gene Expression Profiles in Steroid Receptor-Positive Breast Cancers.

PURPOSE: Thyroid disease is a frequent comorbidity in women with breast cancer, and many require thyroid hormone replacement therapy (THRT). We postulated that THRT has a deleterious clinical effect mechanistically through hormonal interactions, nuclear receptor cross-talk, and upregulation of high-risk breast cancer genes. EXPERIMENTAL DESIGN: Observational studies of patients with lymph node-negative (LN-) breast cancer (n = 820 and n = 160) were performed to test interactions between THRT and clinical, histologic, outcome, and treatment variables. Differences between the two cohorts include but are not limited to patient numbers, decades of treatment, duration of follow-up/treatment, tumor sizes, incidence, and type and dose/regimen of antihormonal and/or chemotherapeutic agents. In vivo and vitro models, in silico databases, and molecular methods were used to study interactions and define mechanisms underlying THRT effects. RESULTS: THRT significantly and independently reduced disease-free and breast cancer-specific overall survival of only the steroid receptor (SR)-positive (as compared with SR-negative) node-negative patients in both long-term observational studies. Patients with SR+ LN- breast cancer who received THRT and tamoxifen experienced the shortest survival of all treatment groups. A less potent interaction between THRT and aromatase inhibitors was noted in the second patient cohort. Using in vivo and in vitro models, TH administration enhanced estrogen and TH-associated gene expression and proliferation, nuclear colocalization of estrogen receptor and thyroid hormone receptor, and activation of genes used clinically to predict tumor aggression in SR+ breast cancer, including the IGF-IR, WNT, and TGFß pathways. CONCLUSIONS: We show clinically significant adverse interactions between THRT, estrogenic, and oncogenic signaling in patients with SR+ LN- breast cancer.

Neural mechanisms of response-preparation and inhibition in bilingual and monolingual children: Lateralized Readiness Potentials (LRPs) during a nonverbal Stroop task.

Inhibitory control is a core executive function (EF) skill, thought to involve cognitive 'interference suppression' and motor 'response inhibition' sub-processes. A few studies have shown that early bilingualism shapes interference suppression but not response inhibition skills, however current behavioral measures do not fully allow us to disentangle these subcomponents. Lateralized Readiness Potentials (LRPs) are centroparietal event-related potentials (ERPs) that track motor response-preparations between stimulus-presentation and behavioral responses. We examine LRPs elicited during successful inhibitory control on a nonverbal Stroop task, in 6-8 year-old bilingual (n = 44) and monolingual (n = 48) children from comparable socio-economic backgrounds. Relative to monolinguals, bilinguals showed longer and stronger incorrect-response preparations, and a more mature pattern of correct-response preparation (shorter peak-latencies), underlying correct responses on Stroop-interference trials. Neural markers of response-inhibition were comparable between groups and no behavioral differences were found between-groups on the Stroop task. Results suggest group differences in underlying mechanisms of centroparietal motor-response preparation mechanisms in this age group, contrary to what has been shown using behavioral tasks previously. We discuss neural results in the context of speed-accuracy trade-offs. This is the first study to examine neural markers of motor-responses in bilingual children.

Clinical and socio-demographic parameters contributing to treatment incompliance in Palestinian patients with diabetes.

BACKGROUND: This research study investigates the degree of medication-related satisfaction experienced by Palestinian patients with diabetes. In addition, this study further assesses the association between certain clinical and socio-demographic factors and the degree of satisfaction among the patients. METHODS: This cross-sectional, descriptive study design consisted of 415 randomly selected patients from the Palestine Medical Complex (PMC), the Palestinian Ministry of Health Clinics, and from the Palestinian Diabetes Institute (also known as: Al-Bireh Medical Center). The Diabetes Medication Satisfaction (DiabMedSat) questionnaire measured patients' satisfaction levels regarding their medications. RESULTS: Odds ratios from binomial logistic analysis and the analysis of variance determined statistically significant correlations. The analysis has displayed the presence of significant associations between clinical and socio-demographic factors and treatment satisfaction. Significance was determined at p values < 0.05 and p values < 0.01. CONCLUSION: This research identified statistically significant associations between certain clinical and socio-demographic factors and diabetic patients' satisfaction regarding their treatment. Addressing the concerns and difficulties experienced by the patients may impede treatment incompliance and hinder the development of complications, or at least postpone them.