Clinical assessment of extrapyramidal signs in nursing home patients given antipsychotic medication

BACKGROUND: We sought to quantify the relationship between antipsychotic drug use and clinical evidence of extrapyramidal dysfunction in a large population of elderly nursing home patients. METHODS: Subjects were 251 residents (mean age, 84.1 years; range, 65 to 105 years) who were taking psychoactive drugs in 12 long-term care facilities. Patient characteristics and all medication use (both scheduled and as needed) were measured during a 1-month observation period. We then performed neuropsychological and functional testing on residents who received any psychoactive medications during the study month. The presence of rigidity, bradykinesia, or masklike facies was assessed in each patient by a research assistant who was unaware of diagnoses and medication use. RESULTS: The parkinsonian signs studied were found in 127 (50.6%) of these residents. Using logistic regression modeling to adjust for potential confounding, we found this outcome to be increased more than threefold in patients who took low-potency neuroleptics (odds ratio [OR], 3.49 for > or = 50 mg/d of chlorpromazine-type drugs; 95% confidence interval [CI], 1.28 to 9.57) and more than sixfold for use of 1 mg/d or more of haloperidol (OR, 6.42; 95% CI, 2.16 to 19.04). Age, gender, and use of nonneuroleptic psychoactive drugs were not associated with an increase in parkinsonian signs. CONCLUSIONS: Clinical evidence of extrapyramidal dysfunction is three to six times more common in institutionalized elderly patients given antipsychotic medication than in comparable patients not using such drugs. Its risk is substantially increased even in patients given low-potency chlorpromazine-type drugs, as well as those taking haloperidol. The effect is not explained by age or mental status and is not seen with other psychoactive medications. The expected frequency of parkinsonian symptoms can help to inform the balancing of risks vs therapeutic effect when the use of all drugs in this class is considered.     

Multiple canonic RLC ladder synthesis of biquadratic immittance functions with double poles and complex zeros

Sufficient conditions for the precise location of the complex zeros of a subclass of biquadratic immittance functions are derived, such that at least one canonic RLC ladder realisation exists. The synthesis is performed on immittance functions having normalised real double poles. However, an indication is provided on how to extend the proposed procedure to encompass biquadratic functions with complex poles or real single poles.     

Effect of temperature and water on microphase separation of PCL–PEO–PCL triblock copolymers

Microphase separation of poly(ε-caprolactone-ethylene oxide-ε-caprolactone) (PCL–PEO–PCL), with block number-average molecular weights of 9,100–30,400–9,100 g/mol, was studied. Cylindrical morphology was observed in a solvent-cast sample. When the as-cast sample was heated above the melting points of both PEO and PCL blocks, a change in morphology was observed by Small Angle X-ray Scattering (SAXS). When this sample was cooled to room temperature in the ambient atmosphere, another morphology (lamellae) was observed with SAXS and Atomic Force Microscopy (AFM). This asymmetric change in morphology suggests a role of kinetics (microphase separation and crystallization) in determining the observed microstructures. Addition of water at room temperature also affected microphase separation of the block copolymer due to hydrophilicity of PEO. As the polymer concentration decreases from 100 to 60%, the morphology changes from cylinders to lamellae. Differential Scanning Calorimetry (DSC) data show that water addition decreases PEO crystallinity but PCL crystallinity remains.     

Follow-up of TIPS: evaluation of signs of dysfunction with Doppler ultrasonography

The anemia of malignancy is common and is related to several etiologic factors, a major one being relative erythropoietin (Epo) deficiency. Blood transfusions, the traditional therapy, provides a quick solution but is associated with complications. This was the rationale for recombinant human Epo (rHuEpo) in the treatment of anemia of cancer. Over the past few years, about 20 publications have reported the results of rHuEpo in the treatment of cancer-associated anemia in more than 850 patients with a variety of malignancies. In general, more than half of the patients responded with a significant increase in their hemoglobin level, a decrease in blood transfusion requirements, and an improved performance status and quality of life. About 4 weeks are required till the onset of effect. The hormone is well tolerated with minimal adverse effects and subcutaneous injections appear to be the preferred method of administration. Additional studies will hopefully answer several questions including optimal dosage and duration of treatment, Epo resistance, and the possibility of predicting the response.     

Shmoo plotting: the black art of IC testing

Obtaining higher yields from IC fabrication is a never ending goal. Toward that end, shmoo plotting can help bridge the gap between design and test and ultimately show ways to improve a product, process, or manufacturing test program     

Hepatic export of glutathione and uptake of constituent amino acids, glutamate and cysteine, in broilers in vivo

This study was conducted to document the glutathione (GSH) cycle (interorgan circulation of GSH) in broilers in vivo. Two experiments were conducted on 36 anesthetized male broilers (n = 6 per treatment) implanted with cannulae in the carotid artery, hepatic portal, and hepatic veins. Plasma GSH, glutamate, cysteine, cystine, and cysteinylglycine levels in each vessel were monitored following a bolus injection [Experiment (Exp.) 1] or 30 min continuous infusion (Exp. 2) of GSH, or a gamma-glutamyltranspeptidase inhibitor (AT125) into the hepatic portal vein. Controls received saline alone. The GSH and AT125 treatments were used to determine the effect of increasing the prehepatic GSH load and of inhibiting systemic GSH degradation, respectively, on the GSH cycle. Hepatic export of GSH was clearly evident in all three treatment groups in both experiments (Exp.). The GSH and AT125 treatments raised amino acid levels in some or all of the vessels, whereas cysteinylglycine was elevated by AT125 and depressed by the GSH treatment compared to Controls. Hepatic uptake of glutamate, cysteine, and/or cystine was observed in Controls and GSH-treated birds, but not in birds given AT125 (Exp. 2). Neither hepatic export nor uptake of cysteinylglycine was observed in any treatment group. The results clearly demonstrate the ability of the avian liver to export GSH into the general circulation despite alterations that might arise from changes in extra-hepatic ability to utilize GSH or its constituent amino acids.     

A model for improving medication use in home health care patients

OBJECTIVES: (1) To develop a model for the identification and resolution of problems associated with suboptimal medication use in elderly patients receiving home health care; (2) To select the most important identifiable problems and develop structured procedures for their resolution. DESIGN: Expert panel review, problem selection, and development of a problem resolution model and guidelines. SETTING: Home health care. PARTICIPANTS: A panel with expertise in home health nursing, pharmacy, clinical pharmacology, gerontology, pharmacoepidemiology, and health services research. INTERVENTIONS: A list of potential problems associated with the most frequently used classes of drugs was compiled for review by the panel. Problems that were controversial or that could not be identified in the home care setting were excluded. Panel members individually ranked the remainder. Detailed procedures for identification and resolution of the 15 top-ranking problems were developed. MAIN OUTCOME MEASURES: Not applicable. RESULTS: Potential medication problems were defined by both drug use and symptoms or clinical signs associated with specific adverse effects, to ensure that clinically relevant problems would be identified. The model developed for problem assessment and resolution was centered on the drug utilization review (DUR) coordinator and the attending home health nurse. Following guidelines developed by the panel, the DUR coordinator advises the home health nurse about identified problems and how to resolve them. One of these practitioners, usually the nurse, then contacts the attending physician to explain their concerns, offer potential solutions, and request instructions. CONCLUSION: A potentially useful model for the identification and resolution of medication problems in the home health care setting was developed. This model is currently being evaluated in a randomized controlled trial.     

Interferometric measurement of length scales at the National Bureau of Standards

The interferometric comparator for calibrating graduated length scales at the National Bureau of Standards is described. Its origins and early development are traced, and recent modernization and automation are detailed. A measurement assurance program is used to evaluate precision, accuracy and long term performance