Making a difference in making miracles: common roadblocks to miracle question effectiveness.

This article describes a clinical investigation of student-therapists' use of the miracle question (MQ). Data used for this project came from transcribed role-play videotapes by six student-therapists. Transcripts were coded, and findings highlight challenges that prevent beginning therapists from effectively using the MQ. The primary themes that emerged were problems related to introducing, framing, and following up on the MQ. Practical recommendations are offered for improving therapist training in effective use of the MQ.

The evolution of a statewide network: the Bay Area Simulation Collaborative.

The Bay Area Simulation Collaborative (BASC), established in 2007, is a group of more than 100 schools of nursing and hospitals, totaling more than 600 faculty and hospital educators, from both service and academia in the ten counties that comprise the San Francisco Bay Area. The California Institute for Nursing & Health Care leads the BASC, which was funded through a grant from the Gordon and Betty Moore Foundation. This 3-year project was designed to train and educate nursing faculty and hospital educators in the concepts of simulation. It was also designed to develop clinical simulation scenarios for use within the BASC. Finally, the project implemented a research and evaluation agenda to demonstrate that simulation makes a positive difference in the critical thinking skills of nursing students. This article will describe the evolution, purpose, and goals of the BASC and how the initial investment has been leveraged to create addition regional collaboratives in the state and ultimately, the California Simulation Alliance.

Performance of the COBAS® AmpliPrep/COBAS TaqMan® automated system for hepatitis C virus (HCV) quantification in a multi-center comparison.

BACKGROUND: Quantitative HCV RNA testing is considered standard of care for monitoring during treatment of patients infected with HCV. The COBAS(®) AmpliPrep/COBAS(®) TaqMan(®) HCV Test fully automates specimen processing and reaction assembly for HCV viral load testing using reverse transcription and real-time PCR amplification. OBJECTIVES: The performance of the COBAS(®) AmpliPrep/COBAS(®) TaqMan(®) HCV Test was evaluated in a multi-center study. STUDY DESIGN: Typical plasma based specimens were tested for accuracy, analytic range of measurement, reproducibility and genotype specific quantitation. RESULTS: Linear regression analysis of the quantitative results demonstrated a linear range of detection from 50 to 5 million (1.7-6.7 log(10))IU/mL and a coefficient of determination (R(2)) of 0.9948. The precision of the assay was highly reproducible within and between runs and among laboratories with coefficients of variance (CV) ranging from 6.7% to 40.0% across the seven laboratories. A representative sample for each of the six major HCV genotypes demonstrated reproducible quantitation between the seven laboratories. CONCLUSIONS: The COBAS(®) AmpliPrep/COBAS(®) TaqMan(®) HCV Test is a reliable and sensitive assay for HCV RNA quantitation.

Patients with epilepsy's perception on community pharmacist's current and potential role in their care.

A cross-sectional study was conducted surveying patients with epilepsy about the current and potential role community pharmacists play/could play in their care. Seventy-five patients (mean age=38.9 years, 66% female) were enrolled, either from the outpatient epilepsy clinic or from the local Epilepsy Foundation database. Patients were asked a series of questions about six aspects of their health care, as well as which of these aspects would be important to discuss with their pharmacist and what type of relationship they currently have/desire with their pharmacist. Results indicated that patients most commonly use their pharmacist for two aspects of their health care: drug interaction information (65%) and adverse effect information (56%). Fewer patients use their pharmacist for the four other aspects of their care: seizure frequency (13%), antiepileptic drug adherence (27%), medication profile (39%), and impact of their disease on their lifestyle (27%). Many patients want their pharmacist to be more involved in their health care, especially regarding drug interactions (76%), discussing adverse effects (74%), and maintaining a complete medication profile (61%). Patients also desired that their pharmacist communicate with their epileptologist about drug interactions (69%) and adverse effects (64%). Although many patients reported having a good relationship with their community pharmacist, a large concern was lack of privacy for holding conversations and lack of desire to pay for such pharmacy services if available. Overall, these results indicate that the majority of patients with epilepsy do not use their pharmacists to their full potential, yet certainly desire to do so, especially regarding drug interactions and adverse effects. Both pharmacists and patients should strive to form better partnerships that would allow them to take advantage of existing opportunities to enhance patient outcomes.

Infectious enteritis after intestinal transplantation: incidence, timing, and outcome.

BACKGROUND: The study reviews the incidence, timing, and outcome of infectious enteritis (IE) after intestinal transplantation (ITx). METHODS: A retrospective review of all patients who underwent ITx at a single institution between 1991 and 2003 was undertaken using database and medical records. Standard statistical analyses were performed. RESULTS: Of 33 ITx recipients, 13 (39%) developed 20 culture- or biopsy-proven episodes of IE. Recipient demographics included the following: 10 males, median age 34 (10-585) months, 11 liver + intestine grafts, and two isolated intestine grafts. Infections were diagnosed a median of 76 days (32-1,800 days) after ITx. There were 14 viral (one cytomegalovirus, eight rotavirus, four adenovirus, one Epstein-Barr virus), three bacterial (Clostridium difficile), and three protozoal (one Giardia lamblia, two Cryptosporidium) infections. The bacterial infections tended to present earlier than the viral infections, and the most frequent presenting symptom was diarrhea. Complete resolution was achieved in 17 (94%) incidences with the appropriate antimicrobial or conservative therapy. It was interesting that there were seven rejection episodes documented by biopsy at the approximate time of diagnosis of IE. There were two graft losses: one because of adenoviral enteritis and one because of rejection after rotavirus enteritis. Three-year patient survival is 74% with no deaths directly attributable to IE. CONCLUSIONS: IE can occur in 39% of recipients after ITx. Viral agents are the cause in two thirds of the cases. With supportive care and appropriate treatment, resolution is possible in the majority of cases. Differentiating rejection and infection on histopathology can be difficult and relies on cultures and immunostaining.

Recurrent papular urticaria after varicella immunization in a fifteen-month-old girl.

Varicella-like rash after immunization with the live attenuated varicella vaccine is relatively common. Such vaccine-associated rashes generally consist of fewer lesions than occur in chickenpox. We describe a 15-month-old girl who experienced the onset of recurring papular urticaria after varicella immunization. The rash was varicella-like and thought by us to be caused by vaccine virus.

Primary herpetic peritonitis causing intestinal perforation: case report and review of the literature.

Peritonitis of viral etiology is rarely reported in the literature; a prior report described a patient undergoing continuous ambulatory peritoneal dialysis who had the disease. We report a case of primary herpetic peritonitis (the agent of which was typed by polymerase chain reaction as herpes simplex virus biotype 1), which caused intestinal perforation, and we review the current literature and provide possible pathophysiologic mechanisms.

Ocular vaccinia following exposure to a smallpox vaccinee.

PURPOSE: To describe the presentation and management of the first identified case of ocular vaccinia infection associated with the current smallpox vaccination program. DESIGN: Case report. METHODS: Vaccinia virus was isolated by cell culture of a conjunctival swab. Direct staining with fluorescein isothiocyanate-labeled vaccinia antibody and polymerase chain reaction testing confirmed the diagnosis. RESULTS: In February 2003, a 26-year-old woman developed right preseptal cellulitis and blepharoconjunctivitis following contact with a vaccinated member of the military. The preseptal cellulitis resolved with antibacterial therapy, and the conjunctival infection was treated successfully with a 14-day course of topical trifluridine and a single dose of intravenous vaccinia immune globulin. CONCLUSIONS: To facilitate rapid diagnosis and appropriate treatment, clinicians must maintain a high index of suspicion for ocular smallpox vaccine-associated adverse reactions in vaccine recipients and their close contacts.