Reduced-intensity conditioning allogeneic transplantation after salvage treatment with DT-PACE in myeloma patients relapsing early after autologous transplant.

OBJECTIVE: In this retrospective single-centre study, we have looked into the transplant outcomes(overall survival OS, progression-free survival PFS, GvHD) and the role of chimerism, DLI and pretransplant characteristics in patients who had a suboptimal response (<12 months) to an autologous stem cell transplant for myeloma and underwent an alemtuzumab T-cell depleted reduced-intensity allograft(RIC). METHODS: Twenty-four patients were salvaged with two cycles of DT-PACE and received a RIC transplant with fludarabine, melphalan and alemtuzumab. All the patients received PBSC grafts, eight patients had a sibling donor, and 16 had a graft from a fully matched unrelated donor. The median follow-up was 65.3 months (6-132 months). RESULTS: The median overall survival was 55.4 months. DLI administration was associated with a trend towards better overall survival (P=.05). Disease status at allo-HCT, PR or VGPR, ISS score and CMV serostatus was not significant predictors of OS and PFS. Full donor whole blood chimerism (≥98%) at 3 months post-transplant was associated with PFS (P=.04) but did not have a significant impact on OS(P=.45). CONCLUSION: Reduced-intensity alemtuzumab-conditioned allograft for myeloma after DT-PACE salvage chemotherapy is an efficient and low toxicity treatment for those who had a suboptimal response postautologous stem cell transplant for myeloma.

Psychometric Properties and Construct Validity of the Knowledge Information Profile-Coumadin.

Background: Oral anticoagulation therapy using Coumadin (warfarin) requires significant patient involvement. Limited validated instruments exist to test patient knowledge of Coumadin, and low health literacy may impede patient self-management. Objective: This article reports the psychometric testing of the Knowledge Information Profile-Coumadin (KIP-C20) to determine (a) minimum number of items and dimensions, (b) reliability, and (c) construct validity. Methods: Participants (N = 192) were recruited from outpatient pharmacist-directed anticoagulation clinics associated with an urban teaching hospital in the Midwest United States. Instruments were the Animal Naming test (AN), Rapid Estimate of Adult Literacy in Medicine (REALM), and KIP-C20. Multidimensional item response theory modeling and exploratory factor analyses were used to determine the best fitting model. Results: The final instrument, renamed KIP-C14, with 3 factors and 14 items, had a good fit to data (M2 = 96.49, P < .0001; root mean square error of approximation = .04), and all factor loadings were .3 or larger. Internal consistency reliability was .65; test-retest correlation was .67. The KIP-C14 correlated positively, as expected, with years of Coumadin treatment. Subscales were differentially correlated with sociodemographic variables. Conclusions: The KIP-C14 had nearly identical, slightly higher reliability than the KIP-C20. Still, reliability was lower than expected, indicating a promising clinical assessment scale in need of further refinement.

Survival of Campylobacter jejuni on beef and pork under vacuum packaged and retail storage conditions: examination of the role of natural meat microflora on C. jejuni survival.

The ability of Campylobacter jejuni ATCC 11168 to survive on beef and pork stored under chilled, vacuum packaged and retail display conditions were examined. In addition, the effect of natural microflora on commercial beef and pork on the survival of C. jejuni under these storage conditions was examined. When sterile cores of beef and pork were inoculated with ∼ 10(5) to 10(6) cfu cm(-2)C. jejuni, and were stored under aerobic or vacuum packaged conditions at -1.5 or 4 °C, its numbers dropped significantly and C. jejuni could not be enumerated by direct plating after 21 d of the 6 wks study. In contrast, survival of C. jejuni on commercial vacuum packaged beef and pork was significantly enhanced, resulting in only 1 log cfu cm(-2) reduction at the end of 6 wks. During 7 d of display in a retail case, numbers of C. jejuni dropped quickly, but could be enumerated by direct plating even after the 7 d. The presence of high numbers of inoculated C. jejuni on beef and pork had no significant effect on the natural microflora numbers compared to uninoculated controls when the meat was stored either in vacuum or in a retail display case. These results show that natural microflora on vacuum packaged meat afford enhanced survival of C. jejuni present on the surfaces of both beef and pork when stored at refrigeration temperatures. Hence, strict hygienic practices or the implementation of decontamination technologies are recommended to ensure safety of meat with respect to this pathogen.

Using the teach-back and Orem's Self-care Deficit Nursing theory to increase childhood immunization communication among low-income mothers.

Guided by Orem's Self-care Deficit Nursing theory, the purpose of the pilot study was to assess the relationship between maternal health literacy and the mother's ability to comprehend and communicate information about childhood immunizations. Communication is the key to positive health results, particularly for patients with low literacy skills, yet few studies have examined patients' ability to converse about health information taught to them by providers. The study was conducted in an urban walk-in immunization clinic. A quantitative-qualitative research design was used. Convenience sampling was applied to obtain 15 mothers with one child (M1) and 15 mothers with more than one child (M>1). The Rapid Estimate of Adult Literacy (REALM) was used to assess literacy level. Vaccine information statements on inactive poliovirus (IPV) and pneumococcal conjugate vaccine (PCV) were instructional materials used in the teach- back procedure. Although the results of the study were mixed, patterns and trends were noted. Mothers with higher literacy levels provided more correct responses for the benefits of the polio vaccine than did those mothers with lower literacy levels (F(2,25)=4.70, p= .02). For both IPV and PCV vaccines, more mothers gave correct answers for risks and benefits, but more mothers gave incorrect answers for safety. There also was some relationship between mother's age and correctness of responses regarding risk of pneumonia vaccination (F(2,24)=3.79, p= .04). The inconsistency of the mothers' responses to communicate critical immunization information about vaccines indicates the need to further assess how best to increase parents' vaccine knowledge and communication skills.

Mothers' knowledge and information needs relating to childhood immunizations.

The purpose of this pilot study was to determine mothers' literacy level and knowledge, information needs, and information-seeking behaviors related to the vaccine(s) their children were receiving. A convenience sample of 15 mothers with one child and 15 mothers with two or more children was recruited at a free, urban, walk-in immunization clinic in Detroit. Participants completed the REALM test and a demographic form. Structured interviews were conducted to assess a mother's knowledge, information needs, and information-seeking behavior relating to the vaccines. The average reading skills were at the 7th- to 8th-grade level. Only four mothers knew the name and purpose of the vaccine their child was receiving. Information needs of the 26 mothers who did not know the name or purpose of the vaccine were categorized as immediate or deferred according to Krikelas's model of information seeking. More mothers with one child had immediate information needs, while more mothers with two or more children had deferred information needs. Primary sources of vaccine information were physicians and nurses. More research needs to be done to determine which nursing interventions work best to satisfy a mother's information needs.

Effects of treatment with lysozyme and nisin on the microflora and sensory properties of commercial pork.

A mixture of lysozyme and nisin at a ratio of 3:1 (w/w) and at a surface concentration of approximately 260 microg/cm2 was effective in controlling the growth of lactic acid bacteria, lactic acid bacteria able to grow in the presence of acetate and Brochothrix thermosphacta on naturally contaminated pork loins that were stored in vacuum packages at 2 degrees C for up to 6 weeks. When loins were removed, cut into chops, and displayed in a retail display case, the efficacy of the antimicrobial mixture decreased with increasing display time. At most sampling times, bacterial numbers were lower in treated samples than in untreated samples. The numbers of Enterobacteriaceae were higher in treated samples than in untreated samples. The growth of Enterobacteriaceae may have been reduced as a result of antimicrobial activity of the lactic acid bacteria because when the growth of lactic acid bacteria was inhibited by the antimicrobial treatment, the Enterobacteriaceae were able to grow to higher numbers. Sensory evaluation of the loins showed no difference between treated and untreated samples, but aerobically displayed chops treated with antimicrobial had more prevalent off-odours and reduced odour acceptability than untreated samples.

Bacterial contamination of recirculating brine used in the commercial production of moisture-enhanced pork.

In a commercial process for the production of moisture-enhanced pork, boneless pork loins were conveyed through a recirculating injection apparatus, and brine (sodium phosphate, sodium chloride, and lemon juice solids) was pumped into the meat through banks of needles inserted automatically into the upper surfaces of cuts. Brine samples were collected at intervals during the production process and analyzed to determine the total plate count and the numbers of lactic acid bacteria, pseudomonads, Brochothrix thermosphacta, and Enterobacteriaceae. Listeria monocytogenes numbers in the brine were determined using a PCR with primers for the hemolysin gene in combination with a most probable numbers determination. Maximum numbers of bacteria (log CFU/ml) recovered from the brine after 2.5 h of recirculation were as follows: total plate count, 4.50; lactic acid bacteria, 2.99; pseudomonads, 3.95; B. thermosphacta, 2.79; and enterics, 3.01. There was an increase in the number of L. monocytogenes in the recirculating brine with time, reaching a maximum of 2.34 log CFU/100 ml after 2.5 h of moisture-enhanced pork production. Thus, recirculating brines can harbor large populations of spoilage bacteria and L. monocytogenes and are an important source of contamination for moisture-enhanced pork.

Developing end-of-life interdisciplinary programs in universitywide settings.

Interdisciplinary programs in end of life are widely discussed as valuable, particularly approaches to end-of-life care. Despite this emphasis, interdisciplinary programs have not been easy to implement. In universities, the implementation of interdisciplinary programs encounters administrative obstacles, including credit for the time spent in these group efforts and "ownership" of interdisciplinary courses (IDCs). This article details the process of development and the activities of an end-of-life interdisciplinary program at one urban university with a major medical center. The issues faced in the first year are examined. These included trust, group identity, and communication. The lessons from the first-year activities are presented and efforts of the second year described.

Exiting prostitution: an integrated model.

Exiting street-level prostitution is a complex, convoluted process. Few studies have described this process within any formal conceptual framework. This article reviews two general models and two prostitution-specific models and their applicability to the exiting process. Barriers encountered as women attempt to leave the streets are identified. Based on the four models, the barriers, the prostitution literature, and the authors' experience with prostituted women, a new integrated six-stage model that is comprehensive in scope and sensitive to women's attempts to exit prostitution is offered as a foundation for continued research on the process of women leaving the streets.

Information needs at the end of life: a content analysis of one person's story.

During the last phase of life, a person may need a variety of information to help her or him cope with dying and death. This article describes the nature of information needed during this stage. A content analysis was done of a book of conversations between a husband who was dying and his wife who is a grief counselor to determine his information needs. Four categories of needs were proposed, including physical, emotional, spiritual, and financial. Information needs germane to each category were identified. More research needs to be done by library and information science professionals to determine the information needs of people who are dying, as well as those of their families and the health professionals who care for them.

Health sciences librarians' attitudes toward the Academy of Health Information Professionals.

OBJECTIVES: The purpose of the study was to ascertain health sciences librarians' attitudes toward the Academy of Health Information Professionals (AHIP). SAMPLE: Systematic sampling was used to select 210 names from the list of members of the Midwest Chapter of the Medical Library Association. METHODS: A questionnaire containing open- and closed-ended questions was used to collect the data. RESULTS: A total of 135 usable questionnaires were returned. Of the respondents, 34.8% are members of the academy and most are at the senior or distinguished member levels. The academy gives them a sense of professionalism and helps them to keep current with new trends. The majority of participants (65.2%) are not members of the academy. Among the various reasons proffered are that neither institutions nor employers require it and that there is no obvious benefit to belonging to the academy. CONCLUSIONS: More research needs to be done with a larger sample size to determine the attitudes of health sciences librarians, nationwide, toward the academy.

General health problems of inner-city sex workers: a pilot study.

OBJECTIVE: A pilot study was designed to determine the general health problems of inner city sex workers. SAMPLE: The researchers worked with an agency that provides outreach services to these sex workers. Through this agency, they had access to a purposive sample of sex workers in a large Midwest city. METHODS: Nonparticipant observation was used to gather information about their health problems, the nature of information they may need, and the barriers to obtaining health care and health information. RESULTS: Sex workers (N = 75) ranged in age from nineteen to sixty-one years old. They identified a number of physical or psychological problems, such as rape, depression, and tuberculosis. HIV/AIDS was never mentioned. A major barrier to health care is a lack of information about where to go for treatment or how to obtain health insurance. CONCLUSIONS: More research needs to be done by library and information science professionals to determine the information needs of sex workers and the agencies that provide them with health and social services.

An exploratory study of the health problems, stigmatization, life satisfaction, and literacy skills of urban, street-level sex workers.

An exploratory study of 26 female urban, street-level sex workers was conducted to gather information about their health problems, feelings of stigmatizations, satisfaction with life, and literacy skills. Each woman completed the health questionnaire, Stigmatization Scale, Satisfaction with Life Scale, and the Rapid Estimate of Adult Literacy in Medicine. Twenty-one women had acute or chronic health problems; only eleven sought health care. Literacy scores revealed 7th to 8th grade reading levels. Feelings of stigmatization varied from low to high and all the women were found to be dissatisfied with their lives. Further research needs to address how these factors affect their use of health care and outreach services.