Preference of patient information leaflets over standard drug monographs by patients prescribed hydrochlorothiazide, nifedipine and enalapril.

Standard drug monographs (SDMs) have been described as deficient in providing information in a manner simplified enough for patient reading. The aim of this study was to design patient information leaflets for hydrochlorothiazide, nifedipine and enalapril with content indicated by patients as relevant and to evaluate them against the SDM. Patient information leaflet (PIL) for each drug was designed to contain information on name, use of drug, how it works, how it is to be taken, common side effects, storage, missed dose action, things to avoid and when to contact the physician. Appropriateness was assessed by 10 practising pharmacists. For each drug, 40 patients were recruited, of which 20 were given SDM and 20 PIL. The knowledge of each participant was examined before and after exposure to SDM or PIL, as well as opinion on ease of reading and attractiveness using Pearson s Chi-square analysis. The results showed that both SDM and PIL improved knowledge of common side effects when compared with responses before exposure (chi2 = 24.26 for SDM and 27.64 for PIL, p < 0.001) with no difference between the groups. Respondents receiving PILs were better able to recall "things to avoid" after exposure to PIL (chi2 =10.85, p < 0.001). After exposure to SDM or PIL, the respondents who received PIL were more aware of when to contact the physician, compared to the SDM group (chi2 = 8.41, p < 0.01). When compared with SDM, respondents receiving PIL were more likely to indicate that PIL was easy to read (chi2 = 20.00, p < 0.001), attractive (chi2 = 12.45, p < 0.001) and they were more likely to recommend distribution of their reading material to other patients (chi2 = 22.11, p < 0.001). We conclude that there is benefit in designing information leaflets that simplify language and medication information contained in SDMs, including better understanding of precautions to take while on medication and when to consult physicians.

Preference of patient information leaflets over standard drug monographs by patients prescribed hydrochlorothiazide, nifedipine and enalapril / Preferencia por los prospectos de información al paciente en lugar de las monografías estándar sobre medicamentos, por parte de los pacientes a quienes se les ha prescrito hidroclorotiazida, nifedipina y analapril

Standard drug monographs (SDMs) have been described as deficient in providing information in a manner simplified enough for patient reading. The aim of this study was to design patient information leaflets for hydrochlorothiazide, nifedipine and enalapril with content indicated by patients as relevant and to evaluate them against the SDM. Patient information leaflet (PIL) for each drug was designed to contain information on name, use of drug, how it works, how it is to be taken, common side effects, storage, missed dose action, things to avoid and when to contact the physician. Appropriateness was assessed by 10 practising pharmacists. For each drug, 40 patients were recruited, of which 20 were given SDM and 20 PIL. The knowledge of each participant was examined before and after exposure to SDM or PIL, as well as opinion on ease of reading and attractiveness using Pearson's Chi-square analysis. The results showed that both SDM and PIL improved knowledge of common side effects when compared with responses before exposure (χ² = 24.26for SDM and 27.64 for PIL, p < 0.001) with no difference between the groups. Respondents receiving PILs were better able to recall "things to avoid" after exposure to PIL (χ² =10.85, p < 0.001). After exposure to SDM or PIL, the respondents who received PIL were more aware of when to contact the physician, compared to the SDM group (χ² = 8.41, p < 0.01). When compared with SDM, respondents receiving PIL were more likely to indicate that PIL was easy to read (χ² = 20.00, p < 0.001), attractive (χ² = 12.45, p < 0.001) and they were more likely to recommend distribution of their reading material to other patients (χ² = 22.11, p < 0.001). We conclude that there is benefit in designing information leaflets that simplify language and medication information contained in SDMs, including better understanding of precautions to take while on medication and when to consult physicians.

Las monografías de medicamentos estandarizadas se han considerado deficientes a la hora de proporcionar información de manera suficientemente simple para que el paciente pueda entenderlas. El objetivo de este estudio fue disenar prospectos con información sobre la hidroclorotiazida, la nifedipina y el analapril con contenidos indicados como relevantes por los pacientes, y evaluarlos en comparación con las monografías estandarizadas de medicamentos (MEM). El prospecto de información para el paciente (PIP) fue disenado de modo que apareciera información sobre el nombre del medicamento, su uso, modo de operar, manera de tomarse, efectos secundarios comunes, almacenamiento, qué hacer en caso de perder una dosis, cosas que deben evitarse, y cuando debe contactarse el médico. Se evaluó la adecuación por parte de 10 farmacéuticos practicantes. Para cada medicamento, se reclutaron 40 pacientes, a 20 de los cuales se les dio monografías (MEM), en tanto que a 20 se les ofreció prospectos (PIP). El conocimiento de cada participante se examinó antes y después de la exposición a MEM o PIP, así como la opinión en cuanto a facilidad de lectura y grado de atracción, usando el análisis del Chi-cuadrado de Pearson. Los resultados mostraron que tanto MEM como PIP mejoraron el conocimiento sobre los efectos secundarios comunes, cuando se hacía una comparación con las respuestas antes de la exposición (χ² = 24.26para MEMy 27.64para PIP, p < 0.001) sin diferencia entre los grupos. Los encuestados que recibieron prospectos pudieron recordar mejor las "cosas a evitar" luego de la exposición a PIP (χ² =10.85, p < 0.001). Después de la exposición a MEM o PIP, los encuestados con PIP tenían mayor conciencia en cuanto a cuando contactar a un médico, en comparación con el grupo MEM (χ² = 8.41, p < 0.01). Cuando se les comparó con el grupo MEM, los encuestados que recibieron PIP mostraron por una parte mayor probabilidad de indicar que PIP era más fácil de leer (χ² = 20.00, p < 0.001) y atractivo (χ² = 12.45, p < 0.001), y por otra, una mayor tendencia a recomendar la distribución de su material de lectura a otros pacientes (χ² = 22.11, p < 0.001). Se llegó a la conclusión de que es beneficioso disenar prospectos que simplifiquen el lenguajey la información médica contenida en las monografias estándar del medicamento, incluyendo una mejor comprensión de las precauciones a tomar mientras se está bajo medicación, y sobre cuándo consultar al médico.

Advances in plasma skin regeneration.

Plasma skin regeneration (PSR) is a novel method of resurfacing that uses plasma energy to create a thermal effect on the skin. PSR is different from lasers, light sources, and ablative lasers in that it is not chromophore dependent and does not vaporize tissue, but leaves a layer of intact, desiccated epidermis that acts as a natural biologic dressing and promotes wound healing and rapid recovery. Histological studies performed on plasma resurfacing patients have confirmed continued collagen production, reduction of elastosis, and progressive skin rejuvenation beyond 1 year after treatment. PSR has received US Food and Drug Administration 510 (k) clearance for treatment of rhytides of the body, superficial skin lesions, actinic keratoses, viral papillomata, and seborrheic keratoses. PSR also has beneficial effects in the treatment of other conditions including dyschromias, photoaging, skin laxity, and acne scars. The safety profile of PSR is excellent, and there have been no reports of demarcation lines in perioral, periorbital, or jawline areas, as can sometimes be observed following CO2 resurfacing. PSR is effective in improving facial and periorbital rhytides and can be used on nonfacial sites, including the hands, neck, and chest. Numerous treatment protocols with variable energy settings allow for individualized treatments and provide the operator with fine control over the degree of injury and length of subsequent recovery time.

Early improvement in rhytides and skin laxity following treatment with a combination fractional laser emitting two wavelengths sequentially.

BACKGROUND: Carbon dioxide laser resurfacing remains the gold standard for the treatment of photoaged skin. Today, however, fewer patients will tolerate the postoperative downtime associated with the use of this device. Fractional photothermolysis was designed to overcome the disadvantages associated with ablative resurfacing. Prototype fractional lasers (Fraxel, Reliant Technologies Inc.) have required the use of blue tracking dye to give evenly spaced microtreatment zones, and treatments are associated with moderate levels of discomfort because of microtreatment zone depths reaching nearly 1000 microm. Newer technologies have evolved that do not require tracking dye, and are less painful than older prototypes because microtreatment zones are more superficial (100 to 300 microm) than that of the Fraxel laser. Newer devices offer advances in treating facial rhytides and skin laxity through the use of 2 laser wavelengths (1320 nm/1440 nm) emitted sequentially through a specialized diffractive lens array that produces high-intensity microtreatment zones surrounded by deeper low level heating. OBSERVATIONS: One to 3 treatments with this combination fractional laser device were performed on 16 Caucasian females with static periocular rhytides or skin laxity affecting the nasolabial crease. There was a 3-week period between treatments. Improvement was noted in both areas after a small number of treatments. CONCLUSION: The technology behind fractional lasers is rapidly evolving, and new devices offer significant advances over older prototypes.

Reductions in thigh and infraumbilical circumference following treatment with a novel device combining ultrasound, suction, and massage.

Liposuction is the gold standard of body contouring procedures. Many patients, however, will not tolerate the invasiveness and subsequent recovery time associated with this procedure, despite the likelihood of superior results. Consequently, patients opt for minimally invasive forms of body contouring that require several treatments, have fewer associated side effects, and afford more modest improvements. The MedSculpt device is one such modality that combines computerized massage, vacuum suction, and ultrasound with a continuous sinusoidal pulse delivered at a frequency of 3 Hz. The efficacy of this device was assessed in the reduction of thigh and abdominal circumferences. Five patients were included in this pilot study. A total of 12 treatments were performed on a semiweekly basis to 2 abdomens and 3 pairs of thighs. Photographs and circumferential measurements of each area were obtained prior to, and at the conclusion of, the treatment course. The treatments were well tolerated and without side effects. The mean reduction in thigh circumference was 2.25 cm or 4%, with a 5 cm reduction in 1 subject. Although limited improvement was seen in supraumbilical circumference, the mean reduction in infraumbilical circumference was 6.5 cm or 7.3%, with a 10 cm reduction in 1 subject. Mild improvement in skin tone, texture, and the appearance of cellulite was observed in all study participants. The results observed after 12 treatments were similar to or better than those seen with other minimally invasive, body contouring devices.

Nutrient and heavy metal uptake and storage in constructed wetland systems in Arizona.

The Constructed Ecosystems Research Facility (CERF) was conceived in the early 1980s as a test facility to explore the potential for using plants to treat wastewater in the arid west of the USA. One of the major issues that has been identified in the use of constructed wetland technology is plant nutrient uptake and tissue storage of nutrients as well as heavy metals. Our approach to understanding plant uptake and storage has been to look at both controlled conditions in constructed systems and background concentrations in natural systems. Plant tissues have been collected and analyzed from natural systems and from controlled systems receiving either wastewater or municipal water. Plants studied included the herbaceous species Anemopsis californica (Yerba mansa), Scirpus spp. (bulrush) and Typha domingensis (cattail), and tree species Fraxinus velutina (ash), Populus fremontii (cottonwood) and Salix spp. (willow). Data indicate that uptake varies not only among plant species, but also among chemical species, depending upon water quality within the wetlands. Leaf tissues of Fraxinus, Salix and Populus, contained the lowest amounts of nutrients and heavy metals studied (Na, P, K, Cu, Pb and Zn), while the root tissues of the herbaceous plants generally had the highest concentrations.

Characterization of the Calu-3 cell line as a tool to screen pulmonary drug delivery.

The objective of this research was to examine the human sub-bronchial gland cell line, Calu-3, and assess its potential as a metabolic and transport model to study drug delivery to the respiratory epithelium. The present studies were conducted using Calu-3 cells grown in Transwells(R) or in multiwell cluster plates. TEER values for Calu-3 monolayers were determined using the World Precision Instrument Voltohmmeter and STX-2 electrode. The results confirmed that Calu-3 cells form tight monolayers and give appreciable TEER values in culture when grown under air-interface conditions. Permeability data for small lipophilic molecules across Calu-3 monolayers suggested that the cell line is a suitable model to examine the transport of low molecular weight substances and xenobiotics. Calu-3 cells were also found to efflux FITC-transferrin (MW 80000) in a polarized manner. The metabolic capacity of Calu-3 cells was also examined. The P4501A1 and P4502B isozymes were determined to be functional, but not inducible, with fluorescent resorufin assays. The data indicated that the Calu-3 cell line may be useful for studying the contributions of bronchial epithelial cells to mechanisms of drug delivery at the respiratory epithelium.

Oncogene expression cloning by retroviral transduction of adenovirus E1A-immortalized rat kidney RK3E cells: transformation of a host with epithelial features by c-MYC and the zinc finger protein GKLF.

The function of several known oncogenes is restricted to specific host cells in vitro, suggesting that new genes may be identified by using alternate hosts. RK3E cells exhibit characteristics of epithelia and are susceptible to transformation by the G protein RAS and the zinc finger protein GLI. Expression cloning identified the major transforming activities in squamous cell carcinoma cell lines as c-MYC and the zinc finger protein gut-enriched Kruppel-like factor (GKLF)/epithelial zinc finger. In oral squamous epithelium, GKLF expression was detected in the upper, differentiating cell layers. In dysplastic epithelium, expression was prominently increased and was detected diffusely throughout the entire epithelium, indicating that GKLF is misexpressed in the basal compartment early during tumor progression. The results demonstrate transformation of epithelioid cells to be a sensitive and specific assay for oncogenes activated during tumorigenesis in vivo, and identify GKLF as an oncogene that may function as a regulator of proliferation or differentiation in epithelia.

Light induces accumulation of isocitrate lyase mRNA in a carotenoid-deficient mutant of Chlamydomonas reinhardtii.

A cDNA with sequence similarity to isocitrate lyase (ICL) genes was isolated from the unicellular eukaryotic green alga Chlamydomonas reinhardtii as a light-induced mRNA in the carotenoid biosynthetic mutant strain FN68. The 416 amino acid open reading frame shows significant sequence similarity to isocitrate lyases of bacteria (70%), molds (48%), yeasts (45%), and plants (47%). Expression of the Chlamydomonas ICL gene was tested in the mutant strain FN68, which when grown in the dark fails to accumulate carotenoids and is deficient in chlorophyll, and in CC400G, a strain that accumulates wild-type levels of carotenoids and chlorophyll. In vegetative CC400G cells, ICL mRNA accumulated to a high level in the dark and declined to a barely detectable level within 30 min of exposure to light. This response was more sensitive to white (tungsten filament) or red light than green or blue light, excluding cryptochrome and rhodopsin as the photoreceptor. These results are consistent with excitation by chlorophyll and/or a phytochrome-related photoreceptor. In vegetative FN68 cells, ICL mRNA abundance was very low in the dark, but increased dramatically in response to light. At intensities above threshold, excitation by far-red or red light-induced ICL mRNA accumulation to the highest levels. The threshold of the response was lowest for far-red and blue light. These results are consistent with excitation of a photochromic far-red-responsive pigment.

Initial effects of the grounding of the tanker Braer on health in Shetland. The Shetland Health Study Group.

OBJECTIVE: To determine if the oil spillage from the tanker Braer had any immediate health effects on the exposed resident population. DESIGN: Cohort study with a comparison against controls, exposure status being assigned on the basis of geographical location. SETTING: Rural Shetland. SUBJECTS: All those resident on or after 5 January 1993 (day 0) within 4.5 km of the site of tanker's grounding. Controls matched for sex and age were drawn from a general practice list 95 km distant. OUTCOME MEASURES: Demographic details; smoking and alcohol consumption; perception of health and reported presence or absence of specific symptoms; peak expiratory flow; results of haematology, liver and renal function tests, and blood and urine toxicology. RESULTS: Of subjects contacted, 420 (66%) exposed people and 92 (68%) controls were studied; 56 non-attenders were surveyed. Principal health effects arose on days 1 and 2 and were headache, throat irritation, and itchy eyes. No significant differences between those exposed and controls were found for any of the biological markers. Toxicological studies did not show any exposures that are known to affect human health. CONCLUSIONS: The study confirmed the anecdotal reports of certain acute symptoms. No evidence of pulmonary, haematological, renal, or hepatic damage was detected at the population level. Toxicological samples from exposed people did not find levels known to affect human health. Further studies are required to ascertain whether there have been any long term effects on the population.

Microwave radiometry in biomedicine: a reappraisal.

Nearly 20 years ago the first papers appeared on biomedical applications of microwave radiometry, and many other papers have since appeared. Yet, despite its unique capabilities, microwave radiometry has so far received only limited acceptance by the medical community, and little commercial success. The chief reasons, we suggest, are the shallow depth of sensing and the difficulty of extracting imaging information from radiometry signals emitted by electrically heterogeneous media. A secondary factor has been the difficulty of validating many proposed clinical applications for the method--in particular, cancer detection. We suggest that microwave radiometry is a viable method of thermal sensing, but its successful applications are likely to be quite different than those that were originally conceived for the technique.

Perfused phantom models of microwave irradiated tissue.

The theoretical basis, practical design considerations, and prototype testing of a perfused model suitable for simulation studies of microwave heated tissue are presented. A parallel tube heat exchanger configuration is used to simulate the internal convection effects of blood flow. The global thermal response of the phantom, on a scale of several tube spacings, is shown theoretically to be nearly identical to that predicted by Pennes' bioheat equation, which is known to give a reasonable representation of tissue under many conditions. A parametric study is provided for the relationships between the tube size, spacing and material properties and the simulated perfusion rate. A prototype with a physiologically reasonable perfusion rate was tested using a typical hyperthermia applicator. The measured thermal response of the phantom compares favorably with the numerical solution of the bioheat equation under the same irradiation conditions. This similarity sheds light on the unexpected success of the bioheat equation for modeling the thermal response of real tissue.

Small-scale temperature fluctuations in perfused tissue during local hyperthermia.

We develop analytical expressions (scaling laws) for the local temperature fluctuations near isolated and countercurrent blood vessels during hyperthermia. These scaling laws relate the magnitude of such fluctuations to the size of the heated region and to the thermal equilibration length of the vessels. A new equilibration length is identified for countercurrent vessels. Significant temperature differences are predicted between the vessels and the immediately adjacent tissue when the equilibration length is comparable to or longer than the size of the heated tissue region. Countercurrent vessels are shown to have shorter equilibration lengths and produce smaller temperature fluctuations than isolated vessels of the same size.

The UHF and microwave dielectric properties of normal and tumour tissues: variation in dielectric properties with tissue water content.

Dielectric measurements have been made on various soft tumour and normal tissues between 0.01 and 17 GHz at body temperature. At microwave frequencies above 1-5 GHz, the tissue dielectric properties can be fitted to Debye equations with the same relaxation frequency (25 GHz) as found for pure water at 37 degrees C. The tissue dielectric properties correlate well with their water contents. The conductivity of the tissue at 0.1 GHz (which is close to that of the cytoplasm itself) increases with the volume fraction of water in the tissue, in a manner consistent with that previously observed in proteins suspended in electrolyte solution. The contribution of the tissue water to the tissue dielectric permittivity at frequencies below 1 GHz is fitted by a function of water content different to that describing the conductivity data. Empirical equations that may be used to predict the dielectric properties of other soft tissues within this wide frequency range are suggested.

Interaction of laminae of the cingulate cortex with the anteroventral thalamus during behavioral learning.

Neurons in deep laminae of the rabbit cingulate cortex develop discriminative activity at an early stage of behavioral discrimination learning, whereas neurons in the anteroventral nucleus of thalamus and neurons in the superficial cortical laminae develop such activity in a late stage of behavioral learning. It is hypothesized that early-forming discriminative neuronal activity, relayed to anteroventral neurons via the corticothalamic pathway, contributes to the construction of changes underlying the late-forming neuronal discrimination in the anteroventral nucleus. The resultant late discriminative activity in the anteroventral nucleus is then relayed via the thalamocortical pathway back to the superficial cortical laminae, promoting disengagement of cortex from further task-processing.

The metabolic effects of abdominal irradiation in man with and without dietary therapy with an elemental diet.

The metabolic effects of abdominal radiotherapy were assessed in patients with pelvic neoplasms, and the effects of supplementation of the diet with an 'elemental' diet assessed. Therapeutic irradiation led to significant mean weight losses of 1.4 kg in control patients and 1.0 kg in patients receiving 'elemental' diet supplements. Irradiation was associated with small falls in plasma potassium and calcium concentrations in both groups. In the 'elemental' group there was a small increase in circulating alanine and insulin concentrations and a fall in glycerol and ketone body concentrations, but all variables remained within or close to normal basal reference ranges. Plasma albumin fell slightly but significantly in the 'elemental' diet group from 44 +/- 1 to 42 +/- 1 g/litre during treatment. Is is concluded that modern radiotherapy is no more than a modest catabolic stimulus. Long-term dietary supplementation with 'elemental' diets in ill subjects did not produce adverse effects.

Microwave hearing: evidence for thermoacoustic auditory stimulation by pulsed microwaves.

Acoustic transients can be thermally generated in water by pulsed microwave energy. The peak pressure level of these transients, measured within the audible frequency band as a function of the microwave pulse parameters, is adequate to explain the "clicks" heard by people exposed to microwave radiation.