Improving management of needle distress during the journey to dialysis through psychological education and training-the INJECT study feasibility pilot protocol.

BACKGROUND: Needle-related distress is a common yet poorly recognised and managed problem among haemodialysis (HD) patients. The aim of this pilot study is to test the feasibility and acceptability of the INJECT Intervention-an innovative psychology-based intervention to empower patients to self-manage needle distress with the support of dialysis nurses. METHODS: This investigator-initiated, single-arm, non-randomised feasibility study will take place in a large dialysis service in Adelaide, Australia. Participants will include patients aged ≥ 18 years, commencing or already receiving maintenance HD, recruited through dialysis physicians and nursing staff as individuals believed to be at risk of needle distress. They will be screened for inclusion using the Dialysis Fear of Injection Questionnaire (DFIQ) and enrolled into the study if the score is ≥ 2. The multi-pronged intervention encompasses (i) psychologist review, (ii) patient self-management program and (iii) nursing education program. The primary aim is to evaluate feasibility and acceptability of the intervention from patient and dialysis nurse perspectives, including recruitment, retention, engagement with the intervention and completion. Secondary exploratory outcomes will assess suitability of various tools for measuring needle distress, evaluate acceptability of the nursing education program and measure cannulation-related trauma and vascular access outcomes. CONCLUSION: The results will inform the protocol for larger trials addressing needle distress in HD patients. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12621000229875, approved 4 April 2021, https://www.anzctr.org.au/ .

Synthesis of CaCO3 nano- and micro-particles by dry ice carbonation.

Here we report a new low temperature dry ice carbonation approach for the synthesis of carbonate-based nano- and micro-particulate materials, which enables the preparation of monodispersed calcium carbonate nanoparticles and microspheres with very high purity phases.

A novel coculture model for benign prostatic hyperplasia expressing both isoforms of 5 alpha-reductase.

We have developed a coculture system for primary fibroblast and epithelial cells derived from benign prostatic hyperplasia (BPH) that retained many of the characteristics of the intact human prostate. In contrast to separately cultured prostate fibroblast and epithelial cells, cocultures of fibroblasts and epithelial cells maintained messenger ribonucleic acid expression and functional activity for both isoenzymes of 5 alpha-reductase (type I and type II) as well as maintained expression of androgen receptors and prostate-specific antigen. Furthermore, levels of prostate-specific antigen secreted by cocultured epithelial cells were increased by treatment with androgens, mimicking the situation in the human gland. This contrasted with conventionally cultured fibroblasts or epithelial cells, which failed to express 50 alpha-reductase type II and rapidly lost expression of androgen receptors and androgen sensitivity upon being placed into culture. Electron microscopy demonstrated intracellular structures indicative of the differentiated state of the cocultured cell types, including round nuclei, tonofibrils, and microvilli in epithelial cells and elongated nuclei; large amounts of Golgi and cilia; along with immature collagen fibers in fibroblasts. The present study demonstrates that the coculture model reflects more closely the in vivo system for human BPH and is thus a far more suitable model for investigating the molecular and cellular events that underlie BPH than current in vitro systems.

A comparison of videotaped and live patient interview examinations and written examination in psychiatry.

The authors scored the examination performance of 28 psychiatrists who were tested after conducting an interview with a real patient and after seeing a videotaped interview with an actor playing the role of either a psychotic or a neurotic patient. The also scored the performance of 15 of the same examinees who completed a written examination. Eighty-five percent of the examinees reported that the videotaped interview examination was a useful learning experience, and 81% said that it was a useful testing experience. The examiners' feelings varied regarding the use of the standardized videotaped format for certification and recertification of psychiatrists.

Further improvement of quality of life by cetirizine in perennial allergic rhinitis as a function of treatment duration.

The SF-36 Health Status Questionnaire is a generic quality of life questionnaire based on 36 questions selected to represent nine health concepts. Perennial allergic rhinitis is a disease which causes variable restrictions on the physical, psychological and social aspects of patients' lives. According to the SF-36 questionnaire assessment, quality of life is impaired in these patients. Cetirizine, a potent, reliable histamine H1-receptor antagonist, has already been found to induce significant improvement in the quality of life of patients with chronic rhinitis, as assessed by the same SF-36 questionnaire after 1 and 6 weeks of treatment. This paper further investigates the extent to which cetirizine continues to improve quality of life after a long-term treatment (6 weeks) compared to a shorter treatment (1 week). The analyses show that, despite the significant improvement found after 1 week of treatment with cetirizine compared to placebo, a further 5-week course of therapy not only maintains this improvement but continues to enhance quality of life significantly above and beyond this.

The effect of cetirizine on symptoms and signs of nasal polyposis.

Forty-five patients with residual or recurrent nasal polyposis after ethmoidectomy were treated with either cetirizine at twice the daily recommended (20 mg) dose or placebo for three months. The number and size of polyps remained unchanged during the study period. Cetirizine was found to reduce nasal sneezing and rhinorrhoea effectively. The drug also had a beneficial effect on nasal obstruction in the latter part of the study. The side effects of 20 mg (double the recommended daily adult dose) of cetirizine were few and comparable to placebo.

Four therapeutic approaches to the same patient. A study of the Truax variables.

Interviewing behavior of psychiatrists representing the Gestalt, Psychoanalytic, Kleinian and Jungian schools of psychotherapy are rated using the Truax-Carkhuff measures of accurate empathy, nonpossessive warmth and genuineness. Although similarities of behavior were found, there were significant behavioral differences that coincide with the theoretical models.

Hilton Head Hospital trustee discusses hospital finance. Interview by Karen Gardner.

Hilton Head Hospital, a 64-bed acute care hospital in Hilton Head Island, SC, was built in 1975. During its early years, the hospital struggled to meet its payroll. For the last few years, the hospital's operating margin has been so healthy that this small, general hospital is now able to contribute substantially to maintaining its sophisticated services and equipment. As vice-chairman of the hospital's board of trustees, vice-chairman of the hospital's parent corporation, and chairman of the hospital's foundation, Frederick S. Donnelly, Jr., is well aware of the governing boards' decisions that have contributed to Hilton Head Hospital's financial turnaround. He recently talked with Trustee managing editor Karen Gardner about the hospital's finances.

Atypical mycobacterial infection in patients with cystic fibrosis: update on clinical microbiology methods.

While patients with cystic fibrosis (CF) have had dramatic improvement in their survival rates, this has been accompanied by the emergence of more virulent pathogens such as Pseudomonas aeruginosa and Burkholderia cepacia complex organisms. In addition, there has been emergence of organisms of increasing clinical significance such as the nontuberculous mycobacterial (NTM). Although TB infection in patients with CF is extremely uncommon, there is growing concern with regard to atypical Mycobacterium spp, in particular Mycobacterium abscessus. Many methods of decontamination of sputum, which have been adapted from TB methodologies, are ineffective; as shown by the overgrowth of P. aeruginosa, it is essential that decontamination methods are optimized to overcome this. Establishing optimal methods of isolation and determining accurate levels of prevalence is of importance as, although NTM may be isolated relatively infrequently in CF populations, their clinical status in pulmonary disease is now beginning to emerge.