"Let's talk about it": Black youths' perceptions on the development of a school-based social media campaign.

The increase in social media mental health (MH) campaigns provides an opportunity to improve awareness and attitudes toward MH. However, racial disparities remain in these social media campaigns. Black youth who participated in MH social media campaigns reported lower levels of improvement in stigma and help-seeking than their White peers. We employed a youth participatory action research (YPAR) process to expand on a previous community-wide MH social media campaign (A. Thompson et al., 2021), focusing on a Central Midwest community. We studied Black adolescents' perceptions of MH stigma and help-seeking to determine essential features of a culturally responsive MH social media campaign for Black youth. With a lead youth-research collaborator, the research team designed the following two-staged study. The first stage consisted of four semistructured focus group interviews (FGIs) (N = 20), analyzed by using a rapid analysis strategy to obtain results for the development of the campaign. In the second stage, using YPAR's iterative and action-based process, five youth researchers collaborated with the research team on the campaign's design. Following the two stages, the researcher's thematic analysis resulted in three themes: (a) broadening horizons for campaign designers and MH professionals; (b) considering mistrust of schools and school personnel; and (c) diverse experiences, sustainability, and accessibility in a campaign. Findings indicated that while culturally responsive social media campaigns to promote MH can be designed, mistrust of adults in schools is likely to hinder the impact of such campaigns. Implications for school psychology practice and research are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The effects of surgery on plasma/serum vitamin C concentrations: a systematic review and meta-analysis.

Vitamin C (ascorbic acid) is a water-soluble vitamin with an array of biological functions. A number of proposed factors contribute to the vitamin's plasma bioavailability and ability to exert optimal functionality. The aim of this review was to systematically assess plasma vitamin C levels post-surgery compared with pre-surgery/the magnitude and time frame of potential changes in concentration. We searched the PUBMED, SCOPUS, SciSearch and the Cochrane Library databases between 1970 and April 2020 for relevant research papers. Prospective studies, control groups and true placebo groups derived from controlled trials that reported means and standard deviations of plasma vitamin C concentrations pre- and postoperatively were included into the meta-analysis. Data were grouped into short-term (≤7 d) and long-term (>7 d) postoperative follow-up. Twenty-three of thirty-one studies involving 642 patients included in the systematic review were suitable for meta-analysis. Pooled data from the meta-analysis revealed a mean depletion of plasma vitamin C concentration of -17·99 µmol/l (39 % depletion) (CI -22·81, -13·17) (trial arms = 25, n 565, P < 0·001) during the first postoperative week and -18·80 µmol/l (21 % depletion) (CI -25·04, -12·56) (trial arms = 6, n 166, P < 0·001) 2-3 months postoperatively. Subgroup analyses revealed that these depletions occurred following different types of surgery; however, high heterogeneity was observed amongst trials assessing concentration change during the first postoperative week. Overall, our results warrant larger, long-term investigations of changes in postoperative plasma vitamin C concentrations and their potential effects on clinical symptomology.

Cuidados de enfermagem ao paciente com câncer colorretal em uso de bolsa de colostomia: revisão de literatura / Nursing care for colorectal cancer patients using a colostomy bag: a literature review / Atención de enfermería para pacientes con cáncer colorrectal con una bolsa de colostomía: una revisión de la literatura

Objetivo: analisar a importância da enfermagem no manejo da bolsa de colostomia em pacientes com câncer colorretal, buscando identificar o papel da enfermagem no processo de viver da pessoa ostomizada com câncer. Método: trata-se de uma revisão da literatura realizada nas bases de dados SCIELO, LILACS e BDEnf, realizada entre abril e maio de 2022 com os descritores bolsa de colostomia, câncer colorretal, enfermagem. Os artigos selecionados para análise e interpretação tinham como os seguintes critérios de inclusão: textos completos sem restrição de delineamento ou cronograma do estudo; escrito em português, disponibilizado em bases de dados gratuitamente e que contemplam o objetivo da pesquisa. Já os critérios de exclusão foram: artigos de revisão bibliográfica, com publicações anteriores a 2016 e aqueles que não contribuía para enriquecer a discussão do tema proposto. Assim, foram selecionados 10 artigos, que serviram de base para a discussão. Resultado: após a análise dos artigos foram encontrados os seguintes temas para discussão: câncer colorretal e a estomização, assistência de enfermagem à pacientes com colostomia e as percepções de pacientes estomizados com câncer colorretal. Conclusão: a sistematização da assistência de enfermagem ao estomizado e sua família é essencial para sua reabilitação, para sua autonomia e o pleno exercício de dignidade diante do enfretamento de uma doença tão estigmatizada que é o câncer colorretal.

Objective: to analyze the importance of nursing in the management of the colostomy bag in patients with colorectal cancer, seeking to identify the role of nursing in the life process of the ostomized person with cancer. Method: this is a literature review carried out in the SCIELO, LILACS and BDEnf databases, carried out between April and May 2022 with the descriptors colostomy bag, colorectal cancer, nursing. The articles selected for analysis and interpretation had the following inclusion criteria: full texts without restriction of study design or schedule; written in Portuguese, made available in databases free of charge and covering the purpose of the research. The exclusion criteria were: literature review articles, with publications prior to 2016 and those that did not contribute to enrich the discussion of the proposed topic. Thus, 10 articles were selected, which served as the basis for the discussion. Results: after analyzing the articles, the following topics were found for discussion: colorectal cancer and ostomy, nursing care for colostomy patients and the perceptions of ostomized patients with colorectal cancer. Conclusion: the systematization of nursing care for people with stomas and their families is essential for their rehabilitation, for their autonomy and for the full exercise of dignity in the face of facing such a stigmatized disease that is colorectal cancer

Objetivo: analizar la importancia de la enfermería en el manejo de la bolsa de colostomía en pacientes con cáncer colorrectal, buscando identificar el papel de la enfermería en el proceso de vida de la persona ostomizada con cáncer. Método: se trata de una revisión bibliográfica realizada en las bases de datos SCIELO, LILACS y BDEnf, realizada entre abril y mayo de 2022 con los descriptores bolsa de colostomía, cáncer colorrectal, enfermería. Los artículos seleccionados para análisis e interpretación tuvieron los siguientes criterios de inclusión: textos completos sin restricción de diseño de estudio o cronograma; escrito en portugués, disponible en bases de datos de forma gratuita y que cubre el objetivo de la investigación. Los criterios de exclusión fueron: artículos de revisión bibliográfica, con publicaciones anteriores a 2016 y aquellos que no contribuyeron a enriquecer la discusión del tema propuesto. Así, fueron seleccionados 10 artículos, que sirvieron de base para la discusión. Resultados: después del análisis de los artículos, se encontraron los siguientes temas de discusión: el cáncer colorrectal y la ostomía, la atención de enfermería a los pacientes con colostomía y las percepciones de los pacientes ostomizados con cáncer colorrectal. Conclusión: la sistematización de los cuidados de enfermería a las personas con estomas y sus familias es fundamental para su rehabilitación, para su autonomía y para el pleno ejercicio de la dignidad frente al enfrentamiento de una enfermedad tan estigmatizada como es el cáncer colorrectal

Clinical outcomes of patients discharged from the Rapid Access Chest Pain Clinic with non-anginal chest pain: A retrospective cohort study.

BACKGROUND: The Rapid Access Chest Pain Clinic (RACPC) has become an important means of assessing patients who present with ischaemic or ischaemia-like symptoms of recent onset. Observations have shown that up to 70% are discharged with a diagnosis of non-anginal chest pain (NACP) and accordingly "reassured". This study aims to describe the actual clinical outcomes of this cohort of patients discharged from the RACPC. METHODS: We undertook a single centre retrospective cohort study at a tertiary cardiac hospital. The outcomes of unselected patients diagnosed with NACP and discharged from the RACPC between April 2010 and March 2013 at University Hospitals of Leicester (UHL) were recorded. Re-referrals to cardiology outpatient clinic and emergency hospital admissions for cardiovascular disease within 6 months, and the mortality rate at 12 months, were determined. RESULTS: 7066 patients were seen in the UHL RACPC during the 36-month period. 3253 (46.0%) were diagnosed with NACP and discharged. 7 (0.2%) were diagnosed with coronary artery disease (CAD) and 8 (0.25%) cases of acute coronary syndrome (ACS) identified during the review period. 11 (0.3%) patients died within 12 months of discharge from RACPC. No deaths were attributable to CAD. CONCLUSIONS: Comprehensive assessment using risk-stratification criteria in a nurse practitioner-led RACPC can accurately identify patients who are at low-risk for subsequent CAD. Despite contemporary National Institute for Health and Care Excellence (NICE) guidelines that shift focus away from a clinical judgement based approach, this strategy appears to robustly predict favourable outcomes in patients diagnosed with NACP.

The influence of motor function on processing speed in preterm and term-born children.

This study investigates the relationship between motor function and processing speed in preterm children. Processing speed was compared in 145 adolescents, born 25-41 weeks gestational age, utilizing tasks including differing motor demands. The influence of motor cortex excitability and functional motor skills on task performance was assessed. For tasks with motoric demands, differences in performance between preterm and term-born children were mediated by the relationship between gestational age, corticomotor excitability, and motor function. There were no differences in non-motor processing speed task performance between preterm and term-born children. Measures of processing speed may be confounded by a timed motor component.

The challenges of orphan drugs and orphan diseases: real and imagined.

The Orphan Drug Act of 1983 in the United States and similar legislation in Europe in 1999 provided incentives for companies to develop and sell medicines for diseases with a small market. In this Commentary, we outline the European position on the regulation of orphan drugs and explain where it differs from the regulation in the United States.

How European regulators view foreign data in the approval process.

The regulation of medicines should be based on sound scientific principles, and where these are uncertain the regulator may have difficulties. Nowhere is this illustrated more clearly than in the debate over how clinical data obtained in one part of the world can be used for regulatory purposes elsewhere.

Fulminant liver failure: an indicator of silent myocardial rupture.

A 56 year old man presented with an atypical chest infection. Remote inferoposterior myocardial infarction was noted on electrocardiography and transthoracic echocardiography. Hepatic failure developed with sudden gross elevation of liver aminotransferases and coagulopathy. No primary hepatic cause could be identified. Subsequent right heart failure led to transoesophageal echocardiography that revealed a large inoperable ventricular septal defect. Histopathological data showed ischaemic hepatitis and reinfarction of the inferoposterior myocardial wall. Acute cardiac events may be silent and precipitate misleading severe hepatic dysfunction.

Brain function and personality in normal males: a SPECT study using statistical parametric mapping.

Understanding the differences between individuals' personality types at a functional brain level is now possible due to recent developments in both functional brain imaging and personality models. The psychobiological model for temperament and character offers one approach to exploring personality. This study uses SPECT imaging to investigate brain function in relationship to the personality traits in the Temperament and Character Index. A general linear model approach was implemented at a voxel-by-voxel level, using quartile groupings for the personality predictors. t contrasts were used to investigate significant clusters of activation or deactivation. The results show a number of significant relationships between personality traits and regional cerebral blood flow, which show distinct nonlinear trends. All seven of the Cloninger personality traits were significantly related to regional cerebral blood flow. The results suggest that differences in brain function in some regions may reflect differences in personality traits.

Cost implications of routine tirofiban use in the management of acute coronary syndromes.

BACKGROUND: Several studies have shown that glycoprotein IIb/IIIa receptor inhibitors confer benefit for patients admitted with acute coronary syndromes. However, these drugs are widely regarded as expensive. We therefore decided to assess the theoretical cost implications of introducing glycoprotein IIb/IIIa receptor inhibitors on our coronary care unit (CCU). METHODS: We audited 304 admissions (188 male, mean age 68 years) with unstable angina or a non-q-wave myocardial infarction to the CCU of a large district general hospital between January and December 1998. The main outcome measure was eligibility for treatment with tirofiban in accordance with the entry and exclusion criteria of the PRISM-PLUS trial. RESULTS: Of the 304 admissions, only 77 (25.3%) would have been eligible for randomisation in the PRISM-PLUS trial. The annual cost of selectively treating this subgroup with tirofiban would be 11,090 pounds sterling (Euro 18,520) per 100 admissions overall. Using tirofiban to treat all admissions with unstable angina and non-q-wave myocardial infarction would treat almost four times as many patients at a cost of 43,833 pounds sterling (Euro 73,201) per 100 admissions, with unproven benefits for the majority. CONCLUSIONS: We have found significant differences between patients treated in 'real life' and those enrolled into a randomised controlled trial, and demonstrated the importance of maintaining a patient registry in such trials. Deciding whether to treat only those patients for whom there is trial-based evidence of benefit, or all patients regardless of their similarity to trial populations, is an important factor which needs to be taken into account in preparing treatment protocols and in planning for drug expenditure.

Automated system for capture and detection of nucleic acids.

A fully automated nucleic acid analysis system is described, which offers positive sample identification, improved sensitivity and reduced user interaction compared to conventional techniques. The system relies on the sequence-specific capture of DNA onto solid-phase particles, confirming product identity without the problems of interpretation and lack of sequence information inherent in gel-based analyses. The system can be used for sequence confirmation, mutation analysis and semiquantitative detection of PCR products.

A comparison of clinical pharmacodynamics of different administration schedules of oral topotecan (Hycamtin)

Prolonged exposure to topotecan in in vitro and in vivo experiments has yielded the highest antitumor efficacy. An oral formulation of topotecan with a bioavailability of 32-44% in humans enables convenient prolonged administration. Pharmacokinetic/pharmacodynamic relationships from four Phase I studies with different schedules of administration of oral topotecan in 99 adult patients with malignant solid tumors refractory to standard forms of chemotherapy were compared. Topotecan was administered as follows: (a) once daily (o.d.) for 5 days every 21 days (29 patients); (b) o.d. for 10 days every 21 days (19 patients); (c) twice daily (b.i.d.) for 10 days every 21 days (20 patients); and (d) b.i.d. for 21 days every 28 days (31 patients). Pharmacokinetic analysis was performed in 55 patients using a validated high-performance liquid chromatographic assay and noncompartmental pharmacokinetic methods. Totals of 109, 48, 64, and 59 courses were given, respectively. Dose-limiting toxicity consisted of granulocytopenia for the o.d. x 5-day dosage, a combination of myelosuppression and diarrhea in both of the 10-day schedules, and only diarrhea in the 21-day schedule. Pharmacokinetics revealed a substantial variation of the area under curve (AUC) of topotecan lactone in all of the dose schedules with a mean intrapatient variation of 25.4 +/- 31.0% (o.d. x 5), 34.5 +/- 25.0% (o.d. x 10), 96.5 +/- 70.1% (b.i.d. x 10), and 59.5 +/- 51.0% (b.i.d. x 21). Significant correlations were observed between myelotoxicity parameters and AUC(t) day 1 and AUC(t) per course of topotecan lactone. In all of the studies, similar sigmoidal relationships could be established between AUC(t) per course and the percentage decrease of WBCs. At maximum-tolerated dose level, no significant difference in AUC(t) per course was found [AUC(t) per course was 107.4 +/- 33.7 ng x h/ml (o.d. x 5), 145.3 +/- 23.8 ng x h/ml (o.d. x 10), 100.0 +/- 41.5 ng x h/ml (b.i.d. x 10), and 164.9 +/- 92.2 ng x h/ml (b.i.d. x 21), respectively.] For oral topotecan, the schedule rather than the AUC(t)-per-course seemed to be related to the type of toxicity. Prolonged oral administration resulted in intestinal side effects as a dose-limiting toxicity, and short-term administration resulted in granulocytopenia. On the basis of this pharmacokinetic study, no schedule preference could be expressed, but based on patient convenience, administration once daily for 5 days could be favored.

Five days of oral topotecan (Hycamtin), a phase I and pharmacological study in adult patients with solid tumours.

Topotecan is a specific inhibitor to topoisomerase I. An oral formulation of topotecan is available with a bioavailability of 32-44% in humans. A phase I and pharmacological study of the oral formulation of topotecan administered daily for 5 days every 21 days was performed in adult patients with solid tumours to determine the maximum tolerated dose (MTD). Adult patients with a WHO performance status < or = 2 adequate haematological, hepatic and renal functions, with malignant solid tumours refractory to standard forms were entered into the study. Pharmacokinetics were performed on days 1 and 4 of the first course using a validated high performance liquid chromatographic assay. 29 patients entered the study, all patients were evaluable for toxicity and response. The doses studied in the 29 patients were 1.2, 1.8, 2.3, 2.7 mg/m2/day and a fixed dose of 4 mg/day without surface area adjustment. A total of 109 courses were given. Dose limiting toxicity (DLT) was reached at a dose of 2.7 mg/m2/day and consisted of CTC (NCI-Common Toxicity Criteria) grade IV granulocytopenia. The regimen was well tolerated. Non-haematological toxicities were mild, including fatigue, anorexia, nausea, vomiting and diarrhoea. A significant correlation was observed between the percentage decrease in white blood cells versus the area under the curve (AUC(t)) of topotecan lactone (R = 0.76 P < 0.01) which was modelled by a sigmoidal Emax function. The correlation coefficient between the absolute topotecan dose administered and the AUC(t) was R = 0.52 (P = 0.04). Pharmacokinetics of the fixed dose of 4 mg/day were comparable to the 2.3 mg/m2/day dose. DLT in this phase I study of five daily doses of oral topotecan every 21 days was granulocytopenia. The recommended dose for phase II studies is 2.3 mg/m2/day or alternatively, a fixed dose of 4 mg/day.

A new surgical timetable.

A consultant timetable which fulfils the requirements of the Calman Report on medical education and the New Deal on junior doctors' hours is presented.

Continuous infusion of low-dose topotecan: pharmacokinetics and pharmacodynamics during a phase II study in patients with small cell lung cancer.

Preclinical schedule dependency suggests that prolonged maintenance of low plasma levels of topotecan, a specific inhibitor of the nuclear enzyme topoisomerase I, results in optimal antitumor activity. The pharmacokinetics and pharmacodynamics of topotecan, administered as single agent in second-line therapy as a continuous low-dose infusion for 21 days, were evaluated in nine patients with small cell lung cancer (SCLC). Topotecan was administered i.v. as a 21 day continuous infusion every 28 days via an ambulatory pump. Dosages ranged from 0.4 to 0.6 mg/m2/day. Plasma levels of topotecan, the sum of topotecan, and its hydroxy acid congener and the N-desmethyl metabolite were determined at 1, 7, 14 and 21 days during infusion, using a validated high-performance liquid chromatography method with fluorescence detection. Myelosuppression was the most important toxicity. All patients experienced anemia, being severe (grade 3/4) in 55% of all courses. Other adverse effects were relatively mild and reversible, and included nausea, vomiting, diarrhea and fatigue. Three patients achieved a partial response. Mean steady-state concentrations of topotecan (C(ss)) in the first course were 0.46+/-0.17 and 0.47+/-0.19 ng/ml after doses of 0.4 and 0.5 mg/m2/day, respectively. Steady-state levels of the total of topotecan and hydroxy acid (C(ss,tot)) were 1.28+/-0.25 (range 0.93-1.58) and 1.57+/-0.19 (range 1.43-1.70) ng/ml at doses of 0.4 and 0.5 mg/m2/day, respectively. The percentage of the administered topotecan dose excreted in the urine within 24 h was 40+/-14 and 1.2+/-1.0% for total topotecan and N-desmethyltopotecan, respectively. During the second course, C(ss,tot) was significantly higher (p=0.032, paired t-test), which suggests altered topotecan disposition. A sigmoidal relationship was found between C(ss,tot) and the percent decrease in platelets (r=0.76, p=0.018). We conclude that topotecan administered as a 21 day continuous low-dose infusion has activity as single-agent, second-line therapy in patients with SCLC. There was considerable interpatient and intrapatient variability in systemic exposure to topotecan. Differences in organ function might contribute to this variation. Serum aspartate aminotransferase and albumin levels were predictive of topotecan pharmacokinetics.

Oral topotecan given once or twice daily for ten days: a phase I pharmacology study in adult patients with solid tumors.

Prolonged exposure to topotecan (TPT) in in vitro experiments and in vivo studies in animals yielded the highest antitumor efficacy. An oral bioavailability of TPT of 32-44% enables convenient prolonged administration. Because of unpredictable diarrhea in the third week of the twice daily (b.i.d.) 21-day schedule of p.o. administered TPT and the finding of optimal down-regulation of topoisomerase I level after 10-14 days in mononuclear peripheral blood cells, a shorter period of administration (10 days) was chosen for Phase I and pharmacological studies of oral administration of TPT. Adult patients with malignant solid tumors that were refractory to standard forms of chemotherapy were entered. Two dose schedules were studied: once daily (o.d.) and b.i.d. administration for 10 days every 3 weeks. TPT o.d. for 10 days was studied at dose levels 1.0, 1.4, and 1.6 mg/m2/day, and dose levels were 0.5, 0.6, 0.7, and 0.8 mg/m2 with the 10-day b.i.d. schedule. Pharmacokinetics were performed on days 1 and 8 of the first course using a validated high-performance liquid chromatographic assay and noncompartmental pharmacokinetic methods. Nineteen patients were entered in the 10-day o.d. schedule, with a total of 48 courses given. Dose-limiting toxicity (DLT) was reached at 1.6 mg/m2/day and consisted of common toxicity criteria (CTC) grade IV thrombocytopenia and CTC grade III diarrhea. The maximum tolerated dose was 1.4 mg/m2/day. In the 10-day b.i.d. administration of TPT, a total of 64 courses were studied in 20 patients. DLT was reached at a dose of 0.8 mg/m2 b.i.d. and consisted of CTC grade IV myelosuppression and CTC grade IV diarrhea. The maximum tolerated dose was 0.7 mg/m2 b.i.d. Nonhematological toxicities with both schedules included mild nausea and vomiting, fatigue, and anorexia. Pharmacokinetics revealed a substantial variation of the area under the plasma concentration-time curve of TPT lactone in both schedules. Significant correlations were observed between the myelotoxicity parameters and the area under the plasma concentration-time curve at day 1 of TPT lactone o.d. and b.i.d. The DLT of 10 daily administrations of oral topotecan every 3 weeks consisted of a combination of myelosuppression and diarrhea for both schedules studied. The recommended doses for Phase II studies are 1.4 mg/m2/day for 10 days for the o.d. administration and 0.7 mg/m2 for the b.i.d. schedule.

Aortic valve tumor causing acute myocardial infarction in a child.

A 10-year-old child presented with biventricular failure after an acute myocardial infarction. On investigation a large tumor arising from the aortic valve was diagnosed. The patient underwent successful aortic valve replacement for complete excision of the tumor mass, which was reported to be a papillary fibroelastoma. This case report highlights the unusual presentation of an aortic valve tumor in a child with myocardial infarction. The surgical dilemmas of the timing of the operation and the nature of the operation are discussed.