CSII and MDII for intensive diabetes management: impact perceptions of older adult patients and their significant others.

PURPOSE: To investigate impacts of multiple daily insulin injections (MDII) and continuous subcutaneous insulin infusion (CSII) on disease management and patient lifestyle by patients and significant others (SOs). HYPOTHESES: Older patients (>50 years) and their SOs will perceive differences in satisfaction between CSII and MDII impact on diabetes management and lifestyle. METHODS: Patient and paired SO completed parallel instruments framed by sociotechnical systems theory and the life patterns model. Alpha = .901-.940. RESULTS: Whites reported greater satisfaction with CSII and non-Whites with MDII. Both reported increased independence. CSII scored significantly higher than MDII. Age did not reduce positive impacts. CSII enhanced independence of SOs but 38.6% of SOs did not know how to suspend CSII for hypoglycemia; 47.3% of patients believed SOs would not know. CONCLUSIONS: Neither age nor diabetes type contraindicate using CSII in older patients. CSII is perceived more impactful on disease management and lifestyle. Education of SOs needs emphasis.

Rapid HIV testing in a southeastern emergency department serving a semiurban-semirural adolescent and adult population.

OBJECTIVE: We determine the feasibility and yield of universal opt-out HIV screening among adolescents and adults in a southeastern emergency department (ED) serving a semiurban-semirural population. METHODS: Individuals aged 13 to 64 years who visited the ED during specified hours received the OraQuick rapid HIV test (administered by trained counselors) if they did not opt out. Western blot was used to confirm reactive results. Patients were excluded if they had a history of HIV, had been tested within the past year, were physically or mentally incapacitated, did not understand their right to opt out, or did not speak English or Spanish. Basic demographic information was analyzed by using standard descriptive statistics. Measures of diagnostic test performance were calculated for all valid tests. RESULTS: From March 2008 through August 2009, 91% (n=8,493) of eligible patients accepted testing, and results were valid. Of 41 reactive results, 35 were confirmed HIV positive, 2 were indeterminate by Western blot, and 4 were false positive. Blacks accounted for the largest percentage (0.65%) of newly detected infections, and the percentage among black men (1%) was more than twice the percentage among black women (0.42%). Rapid-test specificity was estimated at 99.95% (95% confidence interval 99.88% to 99.98%). Nearly 75% of patients confirmed as HIV positive kept their first HIV clinic appointment. CONCLUSION: High rates of acceptance of testing in an ED and linkage to HIV care for adolescents and adults with newly detected infection can be achieved by using opt-out testing and trained HIV counselors.

Distribution of herpes simplex virus type 1 and varicella zoster virus in ganglia of the human head and neck.

The distribution of the neurotropic alphaherpesviruses-herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) and varicella zoster virus (VZV)-was determined in autonomic and sensory ganglia of the head and neck obtained from formalin-fixed human cadavers. HSV-1 and VZV DNA were found in 18 of 58 and 16 of 58 trigeminal, 23 of 58 and 11 of 58 pterygopalatine, 25 of 60 and 14 of 60 ciliary, 25 of 48 and 11 of 48 geniculate, 15 of 50 and 8 of 50 otic, 14 of 47 and 4 of 47 submandibular, 18 of 58 and 10 of 58 superior cervical, and 12 of 36 and 1 of 36 nodose ganglia, respectively. HSV-2 was not detected at any site. Viral DNA positivity and location were independently distributed among autonomic and sensory ganglia of the human head and neck.

Encircling reperfusion pattern on the stress-minus-delay bull's-eye map improves sensitivity of myocardial perfusion scans.

BACKGROUND: Myocardial perfusion imaging is subject to considerable noise due to re-registration and attenuation artifact. METHODS: On a retrospective review, we identified 51 studies that showed encircling reperfusion pattern on a stress-minus-delay bull's-eye map with concurrent cardiac catheterization within 4 months. Encircling reperfusion was defined as a band of reversibility > or =2.5 standard deviations above that of the gender-matched and age-matched normal studies. This had to surround the delay defect for at least two-thirds of its circumference on the stress-minus-delay bull's-eye map. Three expert readers, blinded to cardiac catheterization results, individually interpreted myocardial perfusion imaging without and with a stress-minus-delay bull's-eye map. A certainty index of 1-100 (100 being the highest certainty for the presence of perfusion defects) was recorded for image interpretation. RESULTS: The intra-class correlation coefficient between readers indicated a strong agreement. Using encircling reperfusion pattern on a stress-minus-delay bull's-eye map, the mean increase in certainty index scores was 8.0+/-7.30 (P<0.0001). This increase in certainty index scores was associated with a significant increase in sensitivity from 67 to 83% (P=0.01) without any significant decrease in specificity (P=0.16). CONCLUSIONS: The pattern of encircling reperfusion on the stress-minus-delay bull's-eye map can improve the interpreter's confidence and sensitivity without significantly compromising specificity for identifying true myocardial perfusion defects.

Assessment of Insulin Administration Methods: Perceptions by Patients and Significant Others Instrument Development.

BACKGROUND AND PURPOSE: To develop, test, and establish the validity and reliability of 4 instruments to evaluate perceptions of paired patients and patient-identified significant others to assess the impact of continuous subcutaneous insulin infusion (CSII) and multiple daily insulin injections (MDII) on diabetes management and lifestyle. METHODS: Sociotechnical systems theory and the life patterns model framed the study. Four parallel survey instruments (patient CSII and MDII and significant other CSII and MDII) were developed to elicit demographic information and perceptions concerning CSII and MDII. RESULTS: Validity and reliability were established. CONCLUSIONS: The instruments developed for this study could be adapted or used as templates in management approach impact studies of other chronic diseases. The study should be replicated with a different geographic sample.

African-American women have a higher risk for developing peripartum cardiomyopathy.

OBJECTIVES: The purpose of this study was to assess whether African-American women are at increased risk of having peripartum cardiomyopathy. BACKGROUND: Peripartum cardiomyopathy is a heart disease of unknown cause that affects young women, often with devastating consequences. The frequency of peripartum cardiomyopathy varies markedly between African and non-African regions. METHODS: A case-control study was performed at a regional center that provides medical care to a racially heterogeneous population. For each case, 3 healthy control patients were randomly selected who delivered babies within the same month. RESULTS: African-American women had a 15.7-fold higher relative risk of peripartum cardiomyopathy than non-African Americans (odds ratio [OR]: 15.7, 95% confidence interval [CI]: 3.5 to 70.6). Other significant univariate risk factors were hypertension (OR: 10.8, 95% CI: 2.6 to 44.4), being unmarried (OR: 4.2, 95% CI: 1.4 to 12.3), and having had >2 previous pregnancies (OR: 2.9, 95% CI: 1.1 to 7.4). African-American ethnicity remained a significant risk factor for peripartum cardiomyopathy when other risk factors were considered in multivariable (OR: 31.5, 95% CI: 3.6 to 277.6) and stratified analyses (OR: 12.9 to 29.1, p < 0.001). Although the frequency of peripartum cardiomyopathy (185 of 100,000 deliveries) at this center was higher than in previous U.S. reports, it was comparable to the frequency in countries with more women of African descent (100 to 980 of 100,000). Analysis of other U.S. studies confirmed that the frequency of peripartum cardiomyopathy was significantly higher among African-American women. CONCLUSIONS: African-American women have significantly higher odds of having peripartum cardiomyopathy that could not be explained by several other factors. Further research will be necessary to determine the potential environmental and/or genetic factors associated with African descent that confer this risk.

Acceptance of rapid HIV screening in a southeastern emergency department.

OBJECTIVES: The objective was to assess the acceptance of an emergency department (ED) human immunodeficiency virus (HIV) screening program based on the Centers for Disease Control and Prevention (CDC) recommendations for routine HIV screening in health care settings. METHODS: Rapid HIV screening was offered on an opt-out basis to patients aged 13 to 64 years presenting to the ED by trained HIV counselors. Patients were excluded if they had a history of HIV, were physically or mentally incapacitated, did not understand their right to opt-out, or did not speak English or Spanish. Statistical analyses, including logistic regression, were performed to assess the associations between the demographics of patients offered testing and their test acceptance or refusal. RESULTS: From March 2008 to January 2009, a total of 5,080 (91%) of the 5,585 patients offered the HIV test accepted, and 506 (9%) refused. White and married patients were less likely to accept testing than those who were African American and unmarried (p < 0.001). Adult patients were almost twice as likely to accept testing as pediatric patients (odds ratio [OR] = 1.95; 95% confidence interval [CI] = 1.50 to 2.53). As age increased among pediatric patients, testing refusal decreased (OR = 0.71; 95% CI = 0.59 to 0.85), and as age increased among adult patients, testing refusal increased (OR = 1.17; 95% CI = 1.12 to 1.22). Two percent of persons accepting the test were considered high risk. Males were more likely to report high-risk behavior than females (OR = 1.83; 95% CI = 1.23 to 2.72). CONCLUSIONS: The opt-out approach results in high acceptance of routine HIV screening. Widespread adoption of the CDC's recommendations, although feasible, will require significant increases in resources.

Human papillomavirus vaccine acceptability among parents of 10- to 15-year-old adolescents.

OBJECTIVE: To determine human papillomavirus (HPV) vaccine acceptance among parents of 10- to 15-year-old adolescents. MATERIALS AND METHODS: Five hundred seventy-five parents or guardians completed a 30-question survey regarding their knowledge of HPV and acceptance of an HPV vaccine. Afterward, subjects read an HPV educational fact sheet and completed a 26-question survey. Results were compared using the chi test, analysis of variance, and McNemar's test. RESULTS: More than 60% of subjects had a general understanding of HPV. Parents opposed to the HPV vaccine were more likely to believe it would promote earlier initiation of coitus compared with parents supportive or undecided about vaccination (24%, 9%, and 6%, respectively; p = .003). Of the subjects initially opposed to or undecided about the HPV vaccine, 37% and 65%, respectively, supported HPV vaccination after an educational intervention. CONCLUSIONS: A brief educational intervention significantly improved parent's acceptance of the HPV vaccine. The negative impact of an HPV vaccine perceived as condoning early initiation of sexual intercourse seems to be minimal.

Personal digital assistants used to document compliance of bacterial vaginosis treatment.

OBJECTIVE: The objective of this study was to estimate patient compliance with oral and vaginal metronidazole treatment of bacterial vaginosis using personal digital assistants (PDAs) and paper diaries. GOAL: The goal of this study was to assess a novel compliance documentation approach. STUDY: After each dose of intravaginal or oral metronidazole, 71 subjects recorded the time on a paper diary and answered questions on a PDA. All PDA entries were unknowingly time-date-stamped. Subjects returned for 2- and 6-week posttreatment examinations. Compliance was calculated using a repeated-measures multivariate analysis of variance (ANOVA). RESULTS: Mean patient compliance rates within the oral metronidazole group were greater with the paper diary compared with the PDA (68.3% and 50.0%, respectively, P = 0.001). The observed rate of compliance agreement for PDA versus paper diary was 69.0% (kappa = 0.4). The majority of noncompliant subjects reported they were compliant with the PDA and paper diary. CONCLUSIONS: PDAs could more accurately document true compliance rates and could be reasonable instruments to assess compliance in intravaginal antimicrobial drug or contraceptive trials.